Briefing Paper: Risk Management of Swine Flu in USA and UK

This briefing paper provides a comprehensive comparative analysis of swine flu risk management strategies implemented in the United States of America (USA) and the United Kingdom (UK). The paper begins with an introduction to swine flu, detailing its causative agent, transmission, and symptoms. It then explores the risk factors associated with the disease, including hazard and context assessments, and examines the impact of the H1N1 virus. A comparative overview of the swine flu outbreaks in both the USA and UK is presented, highlighting the epidemiological aspects, including the groups at higher risk of infection. The paper further delves into the surveillance methods employed by both countries to monitor the spread of the disease, including community and microbiological surveillance. The report also examines the vaccination strategies, control measures, and communication methods used to manage the outbreak and protect the public. The conclusion summarizes the key differences and similarities in the approaches of the two countries, offering insights into effective public health responses to infectious disease outbreaks. The report also provides a detailed analysis of the risk factors, epidemiology, surveillance, control measures, and communication methods employed by both countries.

Running Head: RISK MANAGEMENT OF SWINE FLU
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Risk Management in Health Protection
Name
Institution

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Briefing paper: comparing the response of two countries in the treatment and prevention of swine
flu.
Introduction
Swine flu is a respiratory disease caused by an influenza which infects the respiratory
tract of pigs. The results of the infection are a barking cough, low or lack of appetite, increased
secretions from the nose and listless behavior. The virus is transmissible to human beings since it
goes through mutation for ease transmission. The virus H1N1 which was at the first noted in
Mexico led to the pandemic outbreak in 2009 where thousands of people were infected with
swine flu (Wang, Chen, Wu, Che, Wang, Chen & Zhou, 2018). The symptoms of the infection in
human beings are similar to those of other influenza infections. Fever, cough, increased nasal
secretions, fatigue and persistent headache are the major symptoms of swine flu. The contagious
Swine flu’s incubation lasts for between one and four days.
At first the flu breakout was among people who are in direct contact with pigs. Later
since the virus underwent mutation, human to human transmission resulted. In 1918 the deadly
influenza infected over 500 million people globally leading to a relative death toll of between 5
million to 100 million people (Kini, Badiger & UdayaKiran, 2017). The 2009 breakout did not
claim as many lives as it did at first. The recent 2015 breakout in India infected over 10,000

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people and caused 774 deaths. Though the pandemic is relatively decreasing, it is still claiming
lives of so many people.
The United States of America (USA) is a developed top economic country with an
estimated gross domestic product of $59,531 per person. The country has a well-established and
developed health system. The nation is also politically stable with a well-established political
structure. The country has the lowest illiteracy levels since its educational system is simplified to
suit the citizen. Consequently, the United Kingdom (UK) is also developed with a stable political
base (Kumar, Jatoth, Priya, Mangila, Thirupathi & Kumar, 2015). The economic stability of the
country is also notable given that the gross domestic product is at $39,720 per person. Illiteracy
is also relatively since the education system is well established at the same time. Both countries
are therefore developed in terms of resources. This article will assess all the risk factors that
contribute to the transmission and hamper the diagnosis, vaccination and treatment of swine flu.
The epidemiology will then be explored in each of the two countries, the procedures which are in
place to monitor the spread of the flu, the ways to control the transmission and treatment. The
methods and modes of communication to the stakeholders will also be explored.
Background
Swine flu is a respiratory complication which affects the respiratory tract of human
beings. It was first transmitted from pigs to humans and later with time, human to human
transmission became possible through inhaling contaminated air droplets which then transfer the
virus from the infected person to an uninfected person. The H1N1 or H3N2 viruses (Singh,
Menon, Sharma & Goswami, 2017) are responsible for the transmission of the viral disease. The

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disease attacks the respiratory system by infecting the cells that align the nose, trachea and the
lungs resulting to fever, chills, coughing, sore throat, runny and at times stuffy nose, red watery
eyes headache, fatigue, vomiting and diarrhea which develop between the first and the fourth day
of the infection. This mode of transmission makes it possible for many people to get infected due
to interactions.
Risk factors
Risk assessment is a step by step process of gathering, assessing and documenting
findings in order to assign a level of risk. The process is normally broken into three main sub
stages after the identification of the risk. An analysis is then done to evaluate the level of
seriousness (Vijayalakshmi, Reddy, Surekha, & Devi, 2018). The concurrent stages to be
undertaken according to the World Health Organization are as follows:
Hazard assessment is the process of identifying a hazard which might be causing a condition and
gathering information in regard to the hazard. This is achieved in the medical sector through
physical, chemical and biological processes.
Assessment of exposure is a process where appropriate knowledge is gained in regard to the
number of persons who may have been exposed to the threat earlier and the number of those who
may be exposed to it in the future.
Context assessment is evaluation of the environment where the potential threat is taking place in
consideration of scientific, social, political, economic and ethical factors (Satyadev, shankar,
Divyanjali, & Prajyna, 2015).

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The wider scope of risk factors can be included in the risk assessment process. As a result
of the merging of the viruses from different origins resulting to a stronger H1N1 virus which has
a relatively variable immunity, the flu’s chances of transmission from one person to another has
increases to about 34% and a death toll of about 7.74% as at the case of India in 2015 (Vasanthi,
& Kanimozhi, alias, 2014). Risk management then relies on risk assessment to identify the
possible actions to be undertaken to reduce or eliminate the risk. The possible actions are then
evaluated in terms of the expectations in public health, social, economic and political outcomes.
The most favorable and acceptable actions are then implemented.
Swine flu outbreak
In USA the pandemic outbreak started in Mexico and the spread was quick such that
within a short span of time, 286 cases were reported across 36 states on 4th May 2009. Severe
outbreak was reported from Texas, New York, Utah, and California. On 5th May, the number had
risen to 403 cases being reported from all the states. An alert was raised by the government since
a second death was reported from Texas. Fear increased among the Americans due to the
condition (Chauhan, Narang, Pundir, Singh, & Pundir, 2013). By the mid of March the following
year, the Disease Control and Prevention centers gave a rough estimate that 59 million people
contracted swine flu. Of this, 265,000 were hospitalized and 12,000 of them died. While in the
United Kingdom, the first two cases of the pandemic were confirmed in Scotland and the patients
had come from Mexico. By mid-May, the number had increased to more than a hundred and
consequently more than 6,000 cases were confirmed by the following month. As of January the
following year, around 400 people were hospitalized and more than 100 of them were in critical
condition with a death toll of 360 people. The total number of people who had contracted swine

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flu totaled to about 715,000 and 214 deaths since the country took a swift step (Attavanich,
McCarl, & Bessler, 2011) to administer vaccination to the groups which were at a higher risk.
Though both USA and UK were able to contain the outbreak of the flu, most of the population
remained mentally tortured especially those who had lost close family members and relatives.
Epidemiology
The first isolated case of swine flu was done by USA researchers in the 1930. The flu
mostly caught by people who had close association with pigs such as the veterinarians and
farmers. In 1918 the pandemic outbreak infected around 500 million people and caused more
than 80 million deaths on average in more than 170 countries. By this time, the virus was weak
since it had not undergone mutation to form the H1N1 virus which is deadly (Holland & Blood,
2013). In 2009, the outbreak of the pandemic infected more than 55 million people in USA alone
and led to a death toll of around 12,000 people. In the United Kingdom more than half a million
people contracted the virus with a death toll of more than 214 people. The H1N1 recently broke
out in India and infected more than 10,000 people and caused 774 deaths as of 2015.
The groups which are at a higher risk of infection are children below the age of 5 years
since their immunity is not fully established, adults aged 65 years and above due to their
weakening immunity with age, Individuals with compromised immunity due to other pandemics
such as AIDS, women who are in their gestation or pregnancy period and persons suffering from

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chronic infections such as asthma, diabetes, coronary heart failure and neuromuscular infections
(Wheaton, Abramowitz, Berman, Fabricant, & Olatunji, 2012). The majority of those who
succumbed to the flu in both USA and UK belonged to one of the above groups which are
considered to be at the highest risk. The weakening of the body systems of these groups due to
various conditions leads to more chances of the virus attacking. In the UK swift actions were
taken to ensure the individuals who are at risk obtain vaccination to improve their immunity so
as to reduce the risk of the pandemic. Consequently in the USA the vaccines were administered
to all people and before those at the greatest risk (Mishra, Sachdeva, Malik, & Kumari, 2018)
were identified, so many of them had already succumbed to the flu.
The risk increases easily as the number of individuals who are contracting other
infections increase on a daily basis. The number of pregnant women and children being born
each day also increases the risk. The aging population also advances the risk especially if they
did not receive vaccines. The risk can be managed by administration of vaccines to the
individuals who are at risk. For instance swine flu vaccination can be administered alongside the
normal immunization of children. In USA the vaccination was done across the board to protect
all the people from the virus since it had the greatest death toll in the 2009 outbreak. More so the
outbreak started in Mexico (Ranjan, Kumari, Das, Gupta, Singh, & Yadav, 2012) and spread to
other parts of the world an aspect that demands the country to take more serious actions to
prevent any future outbreaks. In the United Kingdom the vaccination was first administered to
the population that was at risk an aspect that reduced prevented a higher rise in the death toll.
According to Tae Jin Yun, Chang Min Park, Gu Jin Kwon, Sung Koo Woo, Seung Hoon Park,
Seung Hong Choi, Jin Mo Goo. (2011), this has been a continuing practice in a bid to ensure in

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case of outbreak the disease will have been fully contained and its mortality ability reduced to
zero.
Surveillance
The UK developed methods of surveillance so as to ensure the disease is closely
monitored. Community syndromic surveillance where nurses are available on telephone 24/7 was
used in England and Wales. Any respiratory indicators are reported to the nurses if one is
suspected to have contracted flu (Jameel, 2010). This is further advanced in that the callers are
required to tell the age, any health complication or condition of the person that has contracted the
flu. In Northern Ireland data is collected in the centers since the equivalent methods are not
employed. Comparison of data of the previous day and that of the day at hand are used to find
out the difference in numbers (Koşar, Tufan, Ergün, Yiğit, Koşar, & Demiröz, 2012) so as to
determine whether the pandemic is rising or decreasing. Data from all the regions is then
collected at a central point for analysis so as to give a clear report on the state of the nation in
regard to the outbreak. Microbiological surveillance (Reuter, & Renner, 2011) has also been
initiated following the emergence of a complicated to identify H1N1 virus. In cases where
patients are tested and the virus isn’t identified, the regional laboratories forward the cases to the
complex laboratories for confirmation. The complex or more developed laboratories carry out
the test again to ensure rolling out valid results to the patients. All the results from the HPA
laboratories according to Berhane, Ojkic, Pople, Lung, and Pasick (2016), whether positive or
negative are reported to Clf through a standardized email spreadsheet. Reporting was later done
through a datarmart system for swine flu and other related respiratory infections. National
laboratory reporting system gathers all information from all the laboratories and reports out

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positive results for human samples which test pathogens starting with the hospitalized to those in
the community.
In the USA, various methods are used in the monitoring of the epidemic. The WHO
and NREVSS laboratories inclusive of all public health and clinical laboratories report to the
CDC the number of respiratory tests for influenza conducted (Ahmed, Bath, Sbaffi, & Demartini,
2019) and the type of virus which has been detected. The public health laboratories also report
the subtypes of the influenza found to be present during the tests. At the same time they also
determine the age of the persons where the virus has been found. The outpatient reports of
individuals with influenza-like illness were delivered through ILI network and a 0.6% more than
the base line of 2.2% was reported in the 14th week of the outbreak. At the same time the regions
were experiencing an increase in the number of patients reporting for ILI testing (Prati,
Pietrantoni, & Zani, 2011). Mortality surveillance was also conducted to determine the number
of deaths related to the outbreak. This enhanced the determination of the number of deaths
recorded from the various risk groups. Flu view surveillance where data was collected and
analyzed by CDC from social interactive websites enhanced the comparison of data from
different regions, different age groups and different demographics.
Control measures
The USA Centers for Disease Control came up with helpful ways to reduce the spread of
the flu. Through the internet a series of pages were uploaded giving people guidelines of the
possible ways of reducing spread. Of the recommendations given were; avoiding close contact
(Vijayalakshmi, Reddy, Surekha, & Devi, 2018) with people when either of them is sick, staying

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away from work and public activities when sick, practice sneeze and cough etiquette, regular
hand washing and keeping them away from mouth eyes and nose and practicing proper hygiene.
Minimal contact with pigs was advised since the infection from pigs is highly contagious. In UK
the basic infection control measures were proposed to minimize the risk. Among them are;
avoiding close contact with people when either of them is sick, staying away from work and
public activities when sick, practice sneeze and cough etiquette, regular hand washing and
keeping them away from mouth eyes and nose, practicing proper hygiene, wearing a mask at
work to protect others and ensuring that children are also aware of the same advice. Mitigation
then stated to be possible as the practices were implemented (Satyadev, shankar, Divyanjali, &
Prajyna, 2015). Hospital control was also initiated to ensure protection of those that are involved
in carrying out different duties.
Communication
In USA the mode of communication used was briefing the public on the extent of
damage by the pandemic. At the same time preventive measures were communicated as the
citizens were urged to be vigilant. The various ways to get help were also relied to the citizens
(Armstrong-Hough, 2015). Web pages were also used adequately to advise the people on the
various ways to stay away from the risks of infection. Data presentations through various
awareness forums which were held live on televisions were also used to pass relevant
information to the public. In the United Kingdom government agencies gave directions to the
people on the appropriate ways to stay safe. Vaccination guidelines were also communicated
through briefs by government officials an aspect that minimized the spread of the pandemic
(Wheaton, Abramowitz, Berman, Fabricant, & Olatunji, 2012). The internet was also used to

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pass information about the state of various areas and travel advisories were issued in a bid to
limit the number of people who are exposed to the risk. The Medics also played an important
role in urging the population to stay vigilant and report any suspected cases of the flu.
Recommendations
Since the origin of the flu is traced back to pigs which transmit to humans, a permanent
remedy to the virus should be identified and given to the pigs so as to ensure the virus becomes
distinct. This is because when the virus undergoes mutation it gives rise to a deadly virus with
strong immunity as a result of undergoing mutation. A vaccine to reduce mortality rate among
children below the age of 5 years due to the epidemic should be identified and administered
along the normal immunization. This will help to prevent future deaths and infections. Proper
surveillance should be put in place in all the states and regions so as to issue alerts and travel
advisories early enough so as to reduce the number of those who may come into contact with the
risk. Accurate research should always be done in any case when a new infection is first identified
so as to ensure when it breaks out, appropriate ways to deal with it are in place.
Conclusion
Swine flu originates from pigs where its nature is contagious but not fatal. The virus
undergoes mutation hence can possibly be transmitted to humans and at this level it is not only
contagious but also deadly. The 09/10 outbreak in the USA caused death of more than 10,000
people and infected more than 50 million. In the UK more than half a million people were
infected and more than 200 died. Risk assessment found out that at the highest risk are elderly
people above 65 years and infants below age 5 years. Various methods of surveillance were used

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to help people minimize the risk increase by limiting exposure. Communication too has been
very fatal in dealing with the epidemic.
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