pandemic planning: community working together get informed / be prepared
TRANSCRIPT
Pandemic Planning: Community Working Together
GET INFORMED / BE PREPARED
Objectives
Review of Influenza Virus and Illness, H5N1 avian influenza (“bird flu”)Pandemic Influenza Planning assumptions and principles
National (Health and Human Services, or HHS)TennesseeKnox County
Local Pandemic planningIndividual Pandemic planning
Local Pandemic Planning
Six groupsFaith based/CommunityHealthcareBusinessMediaMortuarySchools/daycare
You are here*
Why Plan?Evidence suggests… all communities would be severely impacted when a civilian disaster produces more than 120 casualties. Therefore, >120 casualties considered a major MCI- Mass Casualty Incident.In MCI, without Internal Disaster planning, estimated 40% business will fail.For social cohesion in a crisis to occur, planning and communication need to occur now.
The Pandemic Influenza Cycle
Rapid transmission with worldwide outbreaks; multiple waves of disease over a 2 year period.Occurrence of cases outside the usual season.High attack rate for all age groups, with high mortality rates, esp for young adultsCycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)
Situation Report: Avian InfluenzaWidespread prevalence in migratory birds; broad host range
Continued outbreaks among domestic poultry
Mammalian infection (cats, pigs, etc.) - lethal
Virus is evolving
Sporadic human cases (>190 reports to date)
•Most in young and healthy, Case-fatality 50%
•Rare person-to-person transmission
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Avian Flu not yet Pandemic Flu, but current outbreaks for H5N1 Avian Flu in poultry and birds are the largest that have ever been documented.
H5N1 Influenzaand Pandemic Preparedness
Will H5N1 become the next pandemic?
Impossible to know if or when
If not H5N1, then another will come
The prudent time to plan is now
HHS Objectives: Pandemic Planning and Response
Primary objective:
Minimize sickness and death
Secondary objectives:
Preserve functional society
Minimize economic disruption
There is not complete consensus on the proper order of these objectives
Assumptions about Disease Transmission
No one immune to virus; 30% of population will become ill
Most will become ill 2 days (range 1-10) after exposure to virus
People may be contagious up to 24 hours before they know they are sick
People are most contagious the first 2 days of illness
Sick children are more contagious than adults
On average, each ill person can infect 2 or 3 others (if no precautions are taken)
Medical Burden in Tennessee (pop. 6 million) (HHS Plan Estimates)
Characteristic Moderate (0.2%)
Severe (2%)
Illness (30%) 1.8 million 1.8 million
Outpatient Care
900,000 900,000
Hospitalization 17,300 198,000
ICU Care 2,575 29,700
Mechanical Ventilation
1,300 14,850
Deaths 4,180 (0.2%) 38,060 (2%)*HHS recommends that states plan for severe scenario
Medical Burden in Knox County2005 Knox County Population est. 396,741
Characteristic
Moderate (0.2%)
Severe (2%)
Illness (30%) 119,000
119,000
Outpatient care
59,500
59,500
Hospitalization
1,190
11,900
ICU (15% hosp pts)
180
1,800
Mechanical ventilators (50% ICU pts)
90
900
Deaths 240
2,380
Preparing for a Pandemic in Knoxville
Federal Plan: Local and Self-reliance is keyLocal groups to develop Internal Disaster Plan
SurveillanceCommunicationsInfection ControlOccupational IssuesVaccine/Antiviral access
Public Health responsibility to educate and facilitate PanFlu planningPreparation by families and individuals essential
Influenza Virus: How it spreads
Close contact (<6 feet) with sick person who is coughing or sneezing
Touching a surface contaminated by respiratory secretions and getting the virus into mouth, nose or eyes.
Community Disease Control:Early Stage Isolation and Quarantine
Initial Objective: slow spread of disease Isolation vs. QuarantineLegal measures possible but will rely on voluntary cooperationHousing, health care, psychological, spiritual, food needs must be met for those on isolation/quarantine
Once beyond initial cases, shift strategy to “stay home when you are sick”
Influenza Containment Strategy: Community Response
Basic ActivitiesSurveillance; quarantine of early casesPublic information and educationPromote “respiratory hygiene” and hand washing
Enhanced ActivitiesFocused measures to increase social distanceCommunity-wide measures to increase social distance
Community Disease Control:Community Wide Measures
Reduce Social Contact :Canceling large gatherings, mass transit, schools
Decision based on location of flu activity:Outbreak not local: gatherings >10,000 cancelledOutbreak in local/neighboring county: >100
School closings determined by State Commissioner of Health/Board of Education.
Vaccine or Antivirals??
Flu Vaccine Production minimum 6 month process:
Growing eggs (93 million!)
HHS priority groups1. Military and
Vaccine manufacturers 2. Healthcare workers with
direct patient care 3. Persons at highest risk
for complicationsTwo doses needed for protection
TamifluAnti-viral agent, currently in short supplyCould be used in one area of world to contain first human outbreakResistance describedShould be used within 48 of infectionHHS priority groups: military and hospitalized patientsTamiflu ≠ Preparedness
Guidance for PlanningBecause resources will be limited…
Contingency planning should include:
Planning for absenteeism: ~40%Hygiene products and
education in the workplaceSupply shortagesHome offices for critical personnelSick leave policies compatible with state recommendations
Planning to be away…Plan for childcare in the event schools close
Arrangements made for eldercare, pet care Discuss/develop plan with employer how you might work at home
Guidance for Personal /Family Planning
Personal protection: Hand hygiene and respiratory etiquetteSurgical masks: proven effective for
droplet precautions
Pneumococcal vaccination of those for whom it is recommended
Stockpiling: One to three week essential water, food, supplies, medicines
Surveillance Here at KCHDA traditional influenza responsibility of the Department of Health:
Sentinel health care providersER visitsSchool absenteeism911 calls
CDC is planning additional national surveillance activities: hospitals and states will assist upon request
For those at work:Surveillance– Develop screening for employees with flu-like symptoms
Develop sick leave policy specific for panflu
Determine when ill employee may return to work
Internal and External Communication networks
Detailed communications planning needed:Internal- Ensure employees know panflu policy, communications plan, their specific role, esp in surge capacity/
External- Point of contact with Health Department
Access to Public Health education via media, internet, phone bank
Coordinate with like organizations to develop/coordinate emergency plans
Communicate with other organizations affected by yours
Infection ControlHand Hygiene
Frequent washing60%-95% alcohol-basedsanitizer
Environmental cleaning1:10 bleach solutionEPA registered disinfectant
Gloves & surgical masks. Face shields/goggles for specialized procedures
Workforce Support
Psychological and physical strain on personnel responding in emergency situationPsychological stress for families Plan for your staff to have adequate
SleepFoodAccess to psychological and spiritual support
