Preparing for Flu Season and Preventing Another Pandemic

This is an unedited transcript. 0:06 Hello, everybody, and welcome Sarah Dash, President and CEO of the Alliance for Health Policy. We’re so pleased that you are here with us today for our session on preparing for flu season and preventing another pandemic. 0:20 For those who are not familiar with the Alliance, welcome, We are a non partisan resource for the health policy community, dedicated to advancing knowledge and understanding of health policy issues. 0:31 The Alliance gratefully acknowledges the Coalition to Stop Flu for supporting today’s webinar. And I am extremely pleased to kick off today’s event in conversation with the current chairman of the Coalition to stop flu former Senate Majority Leader Thomas Daschle, Senator Daschle. 0:51 Hello, thank you for being with us today. 0:54 Great to be with you Congratulations, program. 0:58 Oh, Thank you so much And the timing is good. So, Senator, you know before founding the Volition of course you served in both the House of Representatives and the Senate. And you’re the only Senate Democratic leader to serve twice as both majority and minority leaders say you have a lot of experience making policy for sure. Why have you chosen to focus on the flu? Why now? 1:26 Well, Sarah Health Care has been an area that I care deeply about. I’ve worked on it for decades now, and the more I spoke with stakeholders in recent years, the more I became convinced that influenza policy was really one aspect of healthcare. Improvement was not only necessary, but I think really achievable. 1:44 And as you know, flu has two aspects, both seasonal and pandemic, unfortunately, from a, from a federal government perspective, we really don’t handle either one of them, all that. Well, it’s astonishing to me to think that in an average flu season, we could see as many as 60,000 deaths in the US alone. 2:04 In addition to thousands of hospitalizations millions of illnesses, it’s truly one of the country’s most predictable public health thrifts, and yet I’d argue that the federal government doesn’t treat this threat with the urgency that I think it deserves. 2:18 And then secondly, of course, from a pandemic perspective, that it’s clear that our country really remains dangerously unprepared for an influenza pandemic this week. 2:28 We crossed a tragic milestone, as everyone knows we have now lost more Americans to covert than the estimated 675,000 Americans died in the 1918 Influenza Pandemic. 2:41 It’s difficult to even comprehend than yet. 2:44 I have to wonder how much worse the 1918 Flu Pandemic would have been in today’s hyper mobile society. 2:52 So unfortunately one thing can be certain that is that next the next pandemic is, is is going to happen. It’s not a question of when. 3:04 But it’s, it’s, it’s, it’s, it’s likely to be something we’re going to have to confront perhaps even in our lifetimes. 3:12 Yeah that’s a really frightening thought and yeah, someone found out, sometime this year that I had ancestors who actually died in that 918 flu pandemic that I didn’t know about. It kind of brings it home a little bit more. And, of course, so many people have lost loved ones to the current covert pandemic and to answer the flu. No. I mean, is we’re in the midst of this still very much in the midst of the covert 19 pandemic? 3:38 What do you think for you or some of the key learnings from the federal response as they apply to the influenza and other, you know, infectious disease management, particularly the flu, Sorry. What are the things that I came to realize is that we really have to create more of a of a collaborative effort, which is why we started the coalition to stop flu in the first place. 4:04 We think it’s so important that all the different stakeholders work together to see if we can find a way to coalesce around this challenge or effectively and to take the the key learnings that that there really ought to be a clear organizational effort around. 4:22 And so, I would point three lessons that are pretty broadly applicable to influenza and other infectious diseases. The first is Is this pretty simple? 4:33 There’s no substitute for preparation. 4:35 Our country has long taken a reactive, rather than proactive stance or pandemic preparedness. 4:42 And this means that when a crisis arises, we scrambled it for funding and personnel in place, that’s certainly what we did with Kobo. 4:49 But a pandemic response is not simply a switch. You can turn on and off unita, a strong public health infrastructure. You need this disease surveillance capabilities. You need partnerships with diagnostics, and drug manufacturers, and agile, and responsive federal agency, was clear roles, and responsibilities, and strategic plans that can be taken off the shelf and executed, need all of that. 5:14 And 18 months after cobo, I fear we, we’ve only made incremental progress in any of these, these areas. So, that’s number one. 5:23 Just preparedness, the second and related lesson is perhaps an obvious one as well, but it’s that state and local governments need to be vital partners and infectious disease management. 5:35 Know, we’re currently paying a price for years under funding, state, and local public health departments and laboratories, and I worry about what will happen when the co good response funding runs out. And that will happen. 5:48 It’s exactly what happened after the H 1 N 1 pandemic and contributed to the situation that we find ourselves in today, then, I guess I’d say third. 5:57 Just as the Federal Government and each state and local government, the Federal government needs the private sector as well. 6:05 And therein lies this need for a coalition. 6:09 Too often, during the the covert response, the Federal Government was either too late or too conservative, about engaging the private sector on things like testing and therapeutics. 6:19 So infectious diseases impact us all. 6:22 The private sector is just critical in both preparedness, as well as response. 6:28 Yeah. Thank you so much. And we certainly saw some of that with some of the public private collaborations, the response. So I’m hearing preparedness, state and local governments and then in ensuring that there’s a partnership private sector. 6:43 Yeah. 6:43 And so speaking of preparation I mean what do you think? Are we prepared for a flu pandemic? And what are the top things we need to be considering to really stop it? 6:58 Well, like Sarah, I really hate to too acknowledge what I really believe. And that is, I don’t think we are prepared. 7:05 I, I’d hope that we would take lessons from covert by recognizing that public health is truly a national security issue, and taking steps to make new, sustainable investments in public health and endemic preparedness. 7:20 But unfortunately, it just appears that it’s unlikely that anything is going to happen near the scale that is necessary. 7:27 So what we’re hoping is that our coalition and all the critical stakeholders in the infectious disease ecosystem can really help make the case to Congress and the administration, especially right now, that public health and pandemic preparedness does have a constituency. And we quite literally, can’t afford to let this moment pass a spot. 7:49 Well, thank you so much, Senator Daschle. It’s, it’s an important call to action, it’s certainly a challenging one amidst you know, all of the other areas of focus. But we’re so glad to be here today to be able to bring focus on this important issue, And we have a really phenomenal panel of experts that is going to really lay out the issues for us in great detail, including what to expect for this upcoming flu season. So, Senator, I want to thank you for joining us today and for your leadership on this issue. 8:24 Thanks so much, Sarah, And thanks for your leadership, as well, and look forward to working closely together. 8:29 Absolutely. Thank you. 8:34 And now it’s my pleasure to introduce our first. I gotta go over quick housekeeping item. Sorry, guys. And then I’m going to introduce today’s moderator. So, first, you can join today’s conversation on Twitter, at the hashtag #AllHealthLive. Join our community at All Health Policy, Follow us on Facebook, and LinkedIn, we want you to be active. Participants: Please get your questions ready. You should have a dashboard with a little speech bubble icon that has a question mark, and go ahead and use that to submit your questions at any time throughout the broadcast and we’ll get to as many as possible. And if you have any tech issues, go ahead and submit them there, as well. 9:07 Finally, please please be sure to check out our website, all health policy dot org where you can find background materials, including a resource list and an expert list, as well as a recording of today’s webinar and Slide deck, which will be made available on our website soon. So now it is my pleasure to introduce our moderator, doctor Amesh Adalja. Hello doctor Adalja, so nice to see you. Hi. Thank you. 9:33 Yes. So, so, doctor, doctor, you’re a senior scholar at the Center for Health Security part of the Johns Hopkins University, Bloomberg School of Public Health and Adjunct Assistant Professor, and an affiliate of the Johns Hopkins Center for Global Health, as well as an expert in Emerging Infectious Diseases Infectious Disease Pandemic Preparedness and Biosecurity, and, of course, as Senator, National, made the point of public health really, as a national security issue. We are so fortunate to have you with us today to lead our discussion. So, I will now turn it over to you to introduce our panelists and lead the conversation. Thank you. 10:11 So, thank you for that introduction, Sarah. I wanted to start off with just a few minutes of opening comments, just because I’m an infectious disease doctor that works on pandemic preparedness and Emerging Infectious Disease, treating patients throughout this pandemic. And I thought I would maybe just give you some overarching themes to kind of think about during the rest of this webinar and with our panelists. So, I think that we’re here talking about influenza. And I want to just emphasize the fact that these are distinct infectious diseases, but there’s a lot of synergy between them. They’re both respiratory viruses. They’re both spread efficiently from person to person. 10:44 They both have a lot of disruptive effects. And I do think, while there are differences, For example, coven 19 tends to spare the youngest children from severe illness, which is very different. From Flow where we do get a lot of pediatric mortality. There isn’t a lot that we’ve done during this pandemic that has to be built upon. 11:02 There’s a lot of momentum that we’ve seen with Pandemic Preparedness, with coven mitigation that I think can form a basis for us to be much better with, with seasonal flu. Because we still have tens of thousands of people who die every year with seasonal flu. We have poor vaccine uptake. 11:17 We have healthcare workers who don’t get vaccinated against flu and a lot of the energy around Kovac I think can be harnessed and move towards flu. And it’s going to make us all better. 11:26 It’s going to be so much better for all of us if we have even a more milder flu season and there’s a lot of uncertainty about the flu seasons coming up and I think that’s something that we may talk about in that. 11:35 And the discussion. But it’s really important that we don’t lose this moment because pandemic preparedness, as Senator National has said, has been often handled in a reactive manner. 11:44 We need a proactive approach and I think right now, since everyone’s lives have been touched by this pandemic, we will be able to at least get them their attention to see how important public health is, how important infectious disease preparedness is and how it can impact national security. 12:00 Mean, you can just look and see how covenant in flu interact, and just by looking at what happened to our flu seasons in the last two southern hemispheres and now coming up, one northern hemisphere season and another northern hemisphere coming. And we basically had very little flu. And I think that that shows you that there are ways to put mitigation measures in place and to give people harm reduction principles doesn’t mean that we have to have everybody wearing masks during flu season but we see that that actually works or social distancing are hand-washing. How that can impact flu, So there’s a lot to learn. And I think it’s going to be interesting to see how Flu Preparedness builds upon what coven 19 has done and where the differences differences may be. But the main point is there is a lot of synergy that I think would be important to remember and to use as we start to think about what Sluice flu is gonna look like in the coming years. 12:50 So, with those brief remarks, I want to start to introduce this esteemed panel of experts that are going to help us dive deeper. 12:58 First, I’d like to introduce doctor Anand Parekh, Chief Medical Advisor at the Bipartisan Policy Center, where he provides clinical and public health expertise across the organization. 13:10 Next, I am pleased to introduce doctor LJ Tan, Chief Strategy Officer at the Immunization Action Coalition. 13:17 Prior to joining IAC, doctor Tan as a Director of Infectious Disease, Immunology and Molecular Medicine, and then Director of Medicine and Public Health at the American Medical Association. 13:28 Finally, I’m joined by Ms. Jennifer Miller, treasure of families fighting Flu. 13:34 It’s a Twitter account to follow, I follow it, Jennifer. Joint families fighting Flu in 20 13 after her young daughters, frightening data with flu story you’ll hear more about today. 13:44 Jennifer and her family also establish the Caroline Miller Endowed Fund for Nursing Education, indicating Caroline T ICU Award at the the Children’s Hospital of Philadelphia does support continuing education for nurses. 13:58 We’re going to start today’s discussion hearing from doctor Anne …, who will be providing an overview of the federal government’s flu ecosystem. 14:06 Doctor Parekh, I turn it over to you. 14:09 Thank you, doctor Adalja, and thanks to the Alliance for Health Policy and Sarah and everyone who’s organized this important webinar today. So many important themes that doctor … has already covered. 14:23 I think from my perspective, you know, when it comes to seasonal influenza, we can no longer take this for granted as we’ve heard any over here or tens of thousands of Americans, you know, regular flu season, die from seasonal influenza, hundreds of thousands hospitalizations and I think for pandemic influenza. 14:41 I think it’s a question. It’s not a question of if but when. So both of these topics are absolutely critical, and I think Seasonal influenza preparedness helps us with pandemic influenza preparedness as well as and vice versa. So I think it’s something important to acknowledge at the outset. 14:58 When we think about the federal government, sort of the ecosystem of activities with respect to flu, you know, there are so many critical agencies from the CDC to the FDA, to the NIH, asper and Barbara that are involved. 15:12 I think the easiest way to sort of categorize this is really think about sort of the prevention detection and treatment And when it comes to seasonal influenza. 15:22 Certainly on the prevention side, there are many agencies involved with vaccine related efforts, whether it’s at clinical trials, at the NIH, whether it’s increasing domestic manufacturing capacity, asper, as well as as BARDA. There’s the procurement and the purchase of vaccines that’s done through the CDC, through programs like Vaccines for Children and other programs that purchase vaccines for Vulnerable Americans. 15:50 Obviously, CMS, Medicare and Medicaid are important purchasers to get to tens of millions of Americans and then there’s promotion of the vaccine. That is done by CDC, CMS, and other federal agencies. 16:04 On the detection side, there are numerous agencies that work there. Obviously, CDC has an important role with respect to surveillance that’s global surveillance Tracking the circulating strains. As well as domestic surveillance, and looking at, at the Integrated Influenza Surveillance Network, to help us assess where we are with cases, hospitalizations, and deaths. 16:26 Then, of course, with respect, the detection of testing is absolutely critical. And there are a number of agencies there that have an important role from ask earn and Barbara and the work they do there with Advanced Research and development, as well as an FDA from a regulatory perspective. 16:42 Ensuring tests are safe and efficacious. 16:46 And then finally, from a treatment perspective, again, Esper and BARDA and FDA for antivirals have a tremendously important role. And then looking at the healthcare system at large, ensuring that hospitals are prepared, that they’re surge capacity, beds as well as staffing. Asked her plays a critical role there. So as you can see, all of these agencies really work together. They have important roles, both domestically as well as global. Some agencies, like CDC, of course, provide important support, the state, state, and local health departments, who work on all of these different types of issues. 17:25 So, there are a lot of different functions across the federal government, but I think I want to probably end on what I consider probably three of the most important priorities at the federal level. 17:35 These are priorities right now, but I think these need to be the three priorities for the federal government as you look at the blue ecosystem moving forward. 17:45 And the first is certainly that We need better seasonal influenza vaccines. 17:51 And, and I think as as already been alluded to the current effectiveness, miss rate, you looked at over the last decade, the effectiveness, and this rate of the flu vaccine has ranged from about 20 to 60%. I think, and we can all agree that, that we want to do better there. 18:07 There’s a lot of important research right now at NIH, looking at a universal flu vaccine, and that good at that. But to work with multiple strains, that could be effective for kids as Well as adults, that can provide some long term community. At least a year. I think that’s an important development. 18:24 There are many who are talking about using the m-r.n.a. 18:26 platform that several covered vaccines have use for flu and whether that’s a possibility in the future, So that we can get a more effective flu vaccine, as well as a faster vaccines or better. Flu vaccines, I think, are an important priority. 18:43 The second important priority is just to increase the uptake rate of seasonal influenza vaccine over the last decade. If you look at uptake rates, they’re usually around 40 to 50%. So, certainly an area that we want to do better with respect to promotion. 18:58 Of course, vaccine hesitancy plays a role there and I’m sure that’s a topic that we’re going to be talking about. But that’s an important area for the federal government. 19:06 And then third is just continued pandemic preparedness And there are many agencies in the federal government that have an important role there. Asper has a critical role within Health and Human Services. 19:18 Asper recently released the National Influenza Vaccine Modernization Strategy, which also relates to pandemic preparedness. The current White House has recently released a robust $65 billion Pandemic Preparedness Plan that has many foreign elements. 19:34 The CDC, as you know, is moving forward with a new National Center for Epidemic Forecasting and outbreak analysis. So, there are many important developments there at the federal level. I’ll just end by saying, most recently, the Bipartisan Policy Center. 19:49 one of our task forces released a set of recommendations related to positioning the public health system for the next pandemic, focused on increased inter-governmental co-ordination, showing up our public health data infrastructure and financing our public health infrastructure. But one recommendation, they are related to: add an international border on pandemic preparedness, that would set some metrics to ensure that we’re prepared gage how we’re doing on an annual basis. And then report to Congress. So again, I think I think focusing on pandemic preparedness pandemic flu preparedness is absolutely going to be critical as well. 20:25 So those are a couple of opening remarks on the important federal role, vis-a-vis seasonal as well as endemic influences. 20:36 Thank you for that overview, doctor …. Now, I’m going to turn it over to doctor Tan. 20:42 Thank you. very much. Image. Appreciate that. And now I just want to follow up on what had just said, is that this idea that no annual readiness in terms of influenza vaccination equates to pandemic preparedness? And I think that’s that’s something that I think we need to keep emphasizing as we now shift the conversation to talk a little bit about seasonal influenza. Next slide, please. 21:02 So, just to remind everybody, in, this, has already been mentioned by the Senator. Thank you, so much. Then, or the national, again, for your interest in influenza. We talk about this illness: that’s at the bottom of that right hand pyramid, the number of illnesses that that is that occurs Every year, as a result of influenza A, and this is the burden of influenza over the last 10 years. But, I think on top of that, we want to remind ourselves of the hundreds of thousands of hospitalizations and tens of thousands of deaths that are resulting from flu. And, I think we want to remind ourselves that, while we look for a better flu vaccine, and Absolutely, and, and I agree with you what you want. The flu better flu vaccine, we have a good enough vaccine right now that we need to keep using. 21:38 Because that flu vaccine may, while it may only be 20 to 60% effective at preventing those illnesses, it is incredibly effective at preventing the hospitalizations and deaths in the event you get flu, and you’ve been vaccinated. 21:53 Then, the other thing I want to remind everybody also is this concept that you know adults over 65 account, for a lot of our hospitalizations and a lot of our deaths. So, next slide, please. 22:03 So, what I wanted to talk about quickly with the recursive conversations about vaccine effectiveness is this idea that, with the older adults, the conversation should not just be about preventing illness, it should be about improving quality of life. If you look at this Fealty Index, it talks about how, when you get older, you begin to decline on this index towards the bottom where you are in a walker or in a wheelchair. And the goal of obviously, preventive care to prevent you from going down the slide and thanks to John … for sharing this slide with me. So, if we’re talking about this next slide, please. 22:35 What kinda prevent someone from sliding down that frailty curve? We want to be able to say, hey, we want to talk about keeping your glass half full with exercise and diet and smoking cessation to keep you going up this curve. We need to add influenza vaccination there as well. And, what I often like to say is, you know, If you don’t get your flu vaccine this fall, are you willing to risk of independence this winter? Next slide, please, Tracy. 23:00 So, what are we expecting this upcoming flu season, as you’ve already kind of heard from our wonderful speakers already, A flu will likely be back and the reason for this is, as a mesh pointed out, you know, covert mitigation measures worked, but they’ve been relaxed. As many of you know. And with the relaxation of these covert mitigation measures, we’re going to have the assumption of flu season. And in fact, we have warning signals of the respiratory pathogens such as RSV, that disappeared last season, They’re already coming back now that said, we have no idea how severe this next flu season will be. Although there is some speculation that could be pretty bad because of the lack of the environmental boosting that we would have seen last season. But we didn’t see it because we didn’t, I flew, right. So we didn’t get that engagement with the pathogen or the disease. And so as a result, our immune system may be less ready this upcoming fall but that speculation a little bit. But what I’m not going to speculate is I think influenza and sars Kobi two viruses will likely cause circulate. You’ll likely get co-infection with both. 23:57 And, when you have flew on top of Sarkozy, Sauce Coby, two Delta Variants, at the same time, as already heard, this will likely increase the burden on the health care system. It will result in illnesses, hospitalizations, and deaths. On, next slide, please. So where are we? 24:11 We’re back to this whole idea of hashtag Avoid. The two endemic hatch tactic flew off the table. Again, because we said this last season, we’re gonna say it again this season. These overlapping, high risk conditions, using fluid. Coburn 19 that … talked about, makes it critical that we protect against both flu and cover 19. They are both vaccine preventable diseases. 24:32 And importantly, they are both vaccine preventable deaths. 24:36 because the vaccine is extremely effective at helping you not die from these diseases. 24:41 Are two endemic, affluent Coburn 19 will create search capacity issues for our healthcare systems. But we do know from the previous system that season that if we have a strong, unified national message to seek flu vaccination, we can improve vaccination coverage rates. 24:57 So what does that mean for all of us? Right? 24:59 We need to emphasize that after giving Coburn 19 vaccine, you’re not done yet. 25:03 You need the flu and vice versa. 25:06 If someone comes in for flu, you are not done yet. Have you thought about the Coburn 19 vaccine? 25:11 And in order to accomplish getting everyone vaccinated, we need to have varied and innovative access points so that people can get vaccine in multiple locations. 25:21 And then, for flu, in particular, we need to remember that flu vaccine given into December and January, as stipulated by the CDC, is still beneficial. And so we need to keep vaccinating until every dose of flu vaccine is administered, So we do not want to stop after Thanksgiving. We wanted to keep on going. 25:38 Next slide, please. 25:42 So this is the three prong approach to combat flu. This season, I’m going to wrap up with this. You want to vaccinate to prevent flu illnesses, hospitalizations, and deaths. We know that works with, then, if someone does get flu, We want to treat with the antivirals promptly, especially if that person has a high risk high risk flow condition. And then finally, we want to continue all those the everyday infection control interventions that we’ve been doing, right? The things with staying away from others have six cups, it, covering coughs, wearing, masks, if that’s what your local government it’s recommending. We know that works. 26:14 Next slide, please. 26:18 And so finally, I’m gonna leave this up as I wrap up and just talk about the four myths performance does that I addressed here on this slide, but there are many more that we can talk about into Q and A’s. And so just stuck you can take a look at this, about whether the flu will give me the flu shot. We know that’s not possible because it’s made from in inactive viruses are viruses that are not infectious. I’m healthy. I don’t need the flu shot. Hey, as the vaccine, as the Senator has already told, us, many people die every year from flu and many more, get sick. 26:47 I’ve never had the flu Every year up to 20% of Americans get the flu. So do you want to run Do you want to run that risk again, rolling the dice? And then, of course, as we talked about, the flu vaccine doesn’t work. We know what we talked about with effectiveness. It’s not just about preventing illnesses. It’s about preventing hospitalizations deaths and improving quality of life, especially for those over 65. 27:08 So thank you so very much for the attention, and I will turn this back over to you. 27:14 Thank you, doctor Tan. Now, I’m going to turn it over to Ms. Jennifer Miller. 27:27 Jennifer. I think you’re muted on your, your ear pods. Thanks. 27:36 Yes, I’m sorry, can you hear me now? We can, thanks. 27:40 OK, I have a team. 27:43 Familiar with families citing flu. After my healthy five year old daughter became critically ill from influenza. And if you wouldn’t mind sharing the next slide, I’d appreciate it. 27:56 The following slide. 27:59 And I just wanted to share a little bit about my daughter, Caroline. She was a very active and healthy physically fit. five year old. She swam five times a week and hopes of making it on the same competitive swim team that are older daughter that her older sister Katie was on and she truly had never been sick. The only time she went to your pediatrician was for well visits and routine vaccination. 28:22 However, on a random afternoon in December of 2012, what started off, minor sinus congestion and light cough turned into labored breathing. 28:33 And, in just a matter of hours, she would need to go to our local ER where she was diagnosed with influenza A and double pneumonia. 28:42 After diagnosis, we were told shortly thereafter, that she would need to be transported yet again to another hospital one with a dedicated pediatric unit, And once there caroline’s condition deteriorated rapidly, she was beginning to have difficulty breathing on our own. And there was discussion of incubation. And for better clarification, I remember calling our pediatrician. And just saying, hey, you know, they’re talking about the possibility of intubation. 29:09 And I, you know, I mean, I’m getting quite alarmed and quite scared, and I’m not sure where to go from here. And he said, I know I’ve been on the phone with them for the last hour, and I’m in the parking lot. And the reason I share that with you is because I can remember being so touched that he would come and leave his busy. 29:33 He’s busy practice in New York City and drive in busy New York City traffic to get to us in New Jersey. 29:43 But after I’m having that thought, I’m thinking, OK. Why would he come do this unless we were in a dire emergency, it was at the same time that my husband also trying to have a better understanding of what was going on. 29:57 Because things, we’re moving so rapidly, that he stopped the chief of pediatrics in the hallway, and he said, Sir, can you please explain to us what’s going on here? I don’t, I think there’s a misunderstanding. Our daughter, Caroline, is here for the flu. And the doctor turned to him. And he said, Sir, over 50,000 people die of influenza each year, And he walked away. 30:17 And I just remember feeling like the oxygen had been taken out of the room. Because I had never in my entire life, heard that statistic. 30:28 And I had no idea that doubt the number that would affect young, healthy individuals, let alone someone like my child. Caroline was in need of an oscillating ventilator, a special machine that was only available to larger children’s hospitals in the area. 30:45 And so she was airlifted to children Children’s Hospital of Philadelphia in the middle of the night without her mom or dad. 30:52 But instead, with a team of strangers that promise, they do everything in their power to keep her safe. 30:57 And the list of what Caroline was facing was long and frightening, double pneumonia, sepsis, hypoxia, impending cardio respiratory failure, and she would spend two weeks in the … pediatric ICU, fighting for her life all as a result of flu. 31:14 Caroline had been vaccinated against the flu every single year, except for that particular year. The flu vaccine wasn’t readily available in early fall at her school year, and once the busy first year of kindergarten began, I fully admit, it fell off my radar. And it’s a mistake. that nearly stole my child’s life, Caroline. I’m happy to report, made a full recovery. 31:37 And, without a doubt, her survival is by far, like being on the receiving