tool 2 threat of a severe influenza pandemic

ALL SECTORS

PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC

1

TOOL

2

This tool will help you to:

• Provideathoroughintroductiontoyourstaffandvolunteersaboutthekeyaspectsofaninfluenzapandemicthatshouldinformtheirplanningandresponseefforts

Who will implement this tool:

• Themayorormembersofthemunicipal leadership team,emergency response team,disaster management team,andcommunications support team,amongothers

• Leadstafffromanyofthesectorsofthemunicipality

ThistoolwasdevelopedasaslideshowpreparedusingPowerPoint®presentationsoftwarethatyoucanusetoprovideanorientationtoplanningandresponsestaffandvolunteers(e.g.,emergencyresponsepersonnel,communityhealthresponders)whoarenotfamiliarwithpandemicinfluenzaoritspotentiallywide-rangingeffectsoncommunities.

Thetoolintroducestheviewerto:

1. Thediseaseanditssymptoms,andhowthediseasespreads

2. Themeasuresthatcanbetakentolimitthespreadofthediseaseandreduceitsimpact

3. Backgroundinformationaboutpastpandemics,theirimpactoncommunities,andlessonslearnedfromtheplanningandresponseeffortsthattookplacethen

4. Howapandemicisexpectedtostartinamunicipality

Thistoolconsistsoftwoparts:aPowerPointpresentationwithnotesandaseparateslide-by-slidePresenterGuide.Thenotesprovidedintheslidesandintheguidearetoassistyouinpresentingthematerial.Itisimportanttonote,however,thatasthepresenter,youshouldreviewandmodifytheslidesasneededtoaccuratelyreflectthelocallanguageandthelocalcontext.

PREPAREDNESS RESPONSE

NOTE: A print-out of the PowerPoint slide presentation and the presenter guide immediately follow. For the electronic version of the presentation, please refer to the companion CD-ROM in this toolkit.

TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC

2 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 3TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC

TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC

FACILITATOR GUIDE TABLE OF CONTENTS

Slide1:UnderstandingtheThreatofaSevereInfluenzaPandemic............................3

Slide2:IntroductiontoPandemicPlanningandResponse........................................3

Slide3:WhatisSeasonalInfluenza?..........................................................................3

Slide4:WhataretheSymptomsofSeasonalinfluenza?.............................................4

Slide5:MoreSymptoms...........................................................................................4

Slide6:WhatisPandemicInfluenza?........................................................................4

Slide7:PandemicIllness...........................................................................................4

Slide8:TheDifferencebetweenSeasonalandPandemicInfluenza............................5

Slide9:WhatisAvianInfluenza(BirdFlu)?..............................................................5

Slide10:WhatisSwineInfluenza?.............................................................................6

Slide11:WhatisH1N1?...........................................................................................6

Slide12:HowdoSeasonalandPandemicInfluenzaSpread?......................................6

Slide13:HowdoSeasonalandPandemicInfluenzaSpread?(2)................................6

Slide14:WhatHaveWeLearnedfromPastPandemics?............................................7

Slide15:WhatHaveWeLearnedfromPastPandemics?(2)...................................... 7

Slide16:WhatCanbeDonetoSloworDecreasetheImpact?...................................7

Slide17:HowWillaPandemicStartinMyMunicipality?.........................................8

Slide18:WHOPhases...............................................................................................8

Slide19:WHOPandemicPhasesandCurrentlyCirculatingNovelViruses...............9

Slide20:WhatWillLifebeLikeinaSeverePandemic?..............................................9

Slide21:ShortagesofEssentialGoods......................................................................10

Slide22:SupplyChainDelaysorDisruptions..........................................................10

Slide23:DisruptioninRoutineServices..................................................................11

Slide24:ChangesinPublicTransportationandOtherServices................................11

Slide25:HealthcareSystemsOverwhelmed.............................................................11

Slide26:RestrictionsofPersonalMovement............................................................12

Slide27:HowCanMunicipalitiesbePreparedforaSeverePandemic?....................12

Slide28:TwoCitiesin1918....................................................................................13

Slide29:Sources......................................................................................................13

SLIDE 1: UNDERSTANDING THE THREAT OF A SEVERE INFLUENZA PANDEMIC

WhetherfromamorelethalstrainofH1N1,oracompletelynewvirusthatemerges,thethreatofasevereinfluenzapandemic(globalinfluenzaoutbreak)isreal.Leadershipfrommunicipalauthoritiesandfromrespectedcommunitymembersisneededtoprepareourmunicipalities,reducetheimpactofaninfluenzapandemiconindividualsandfamilies,andreduceorevenpreventseriousdamagetotheeconomy.

Amildpandemicmayresembleasevereoutbreakofseasonal(usual)influenza,butaseverepandemiccouldresultineconomicandsocialcatastrophe.Whileitmaynotbepossibletopreventaseverepandemicfromreachingyourlocalarea,thereismuchthatlocalgovernmentsandtheirleadershipteamscandotopreparetolessentheimpact.

Ifacountryisnotadequatelyprepared,aseverepandemicwillnotonlycausemanyinfluenzacasesanddeaths,itwillalsoimpactthecountry,municipalities,andfamilieseconomically.Thecentralgovernmentalonecannotpreparethenationforaninfluenzapandemic—thischallengerequiresyourhelp.Asaleaderinyourmunicipality,youcanplayapowerfulrolebyprovidinginformationandguidancetoencouragepeopletoprepare—eitherthroughyourpositionofauthorityinthemunicipalityorthroughcontactswithyourcolleagues,friends,neighbors,andothers.Youcanalsosendapowerfulmessagebypreparingforthepandemicyourself.

SLIDE 2: INTRODUCTION TO PANDEMIC PLANNING AND RESPONSE

Thegoalofthispresentationistogiveyouasenseofwhatapandemicis,howweexpectittobegin,whatwillhappentopeopleandtotheeconomy,andhowyoucanprepareforit.Duringthispresentation,wewillanswerthefollowingquestions:

• Whatisseasonalinfluenza?

• Whatisaninfluenzapandemic?

• Whatisavianinfluenza(birdflu)?

• Howdoseasonal,avian,andpandemicinfluenzadifferfromeachother?

• Whatarethesymptomsofinfluenza?

• Howisinfluenzaspreadandhowisittreated?

• Whathavewelearnedfrompastpandemics?

• Whatcanbedonetoslowordecreasetheimpactofapandemic?

• Howwillthepandemicstartinmyarea?

• Whatwilllifebelikeduringthepandemic?

• Howcanmunicipalitiesprepare?

SLIDE 3: WHAT IS SEASONAL INFLUENZA?

Thisslidesummarizesseasonalinfluenza.Nearlyeverycountryintheworldexperiencesseasonalinfluenzaoutbreakseveryyear.Itisacauseofmanycasesofillness,deaths,andincreasedhealthcarecosts.

3

2

1


SLIDE 4: WHAT ARE THE SYMPTOMS OF SEASONAL INFLUENZA?

Althoughthesymptomsofthepandemicinfluenzaaresimilartotypicalseasonalinfluenza,itispossiblethatothersymptomsmayappear.ContinuetochecktheWorldHealthOrganizationWebsite(www.who.org)andnationalauthoritiestoobtainupdatedinformationonsymptoms.

SLIDE 5: MORE SYMPTOMS

Influenzainchildrenisoftenhardertodiagnosebecausethemostcommonsymptomsinchildrenmaydifferfromthoseinadults.

SLIDE 6: WHAT IS PANDEMIC INFLUENZA?

Apandemicisaglobaloutbreakofacontagiousdisease.Apandemicofinfluenzaoccurswhenanewvariety—orstrain—ofinfluenzavirusemergesthatisabletospreaddirectlyfromonehumantoanotherhuman.Becausepeoplehavenotbeenexposedtosuchanewvirus,theywillhavelittleornoimmunity (resistance)toit.Therefore,thediseasecanspreadeasilyamongpeopleandtravelquicklyaroundtheworld.

Inadditiontothe2009emergenceoftheH1N1pandemicvirus,threeinfluenzapandemicsoccurredinthepastcentury:theverysevereSpanishInfluenzapandemicin1918,andtwomilderonesin1957–1958and1968–1969.Thelasttwopandemicswererelativelymild,resultinginaworldwidedistributionofsevereillnessinpeopleofallages,manylostdaysofschoolandwork,andanestimated2.5milliondeaths,mostlyinpeopleovertheageof60.Thefirstofthesepandemics—thatof1918–1919—causedanestimated40milliondeathsinpeopleofallages,withmanydeathsofotherwisehealthyyoungadults.Articlespublishedinscientificandmedicaljournalsatthetimedescribesevereillnessanddeath,withabreakdownofroutinehealthandburialservicesinalmostallmajorcities,closureofpublicgatheringplaces,andisolationorquarantineofthoseinfectedorthoseexposedtoinfectedpeopleinanattempttostopthespreadofinfection.

SLIDE 7: PANDEMIC ILLNESS

[Photos:Scenesfromthe1918pandemic.]

Apandemiccausesmanyillnessesanddeathsfortwomainreasons:(1)theentireworld’spopulationisvulnerablebecausetheyhavenoimmunityagainstthevirus,and(2)itoftencausesamoreseriousversionoftheillnesswithmorecomplications—suchaspneumonia,dehydration,andanacuterespiratorydistresssyndrome—comparedwithatypicalseasonalinfluenza.

Inapandemic,nearlyallpeopleworldwidearesusceptibletothevirus,andaround30%ofthepopulationbecomessick.Thepercentageofthepopulationthatgetstheillnessisnearlytwicethatofatypicalseasonalinfluenzaepidemic.Thenumberofpeoplethatdiefromapandemicisrelatedtotheseverity.Inausualinfluenza,thedeathrateisverylow.In1918,thecasefatalityratio(theratioofpeoplewhodiefromthediseasedividedbythenumberofpeoplewhogetthedisease)wasaround2%.Thismeansthat2ofevery100peoplethatgotthediseasediedfromit.Itiswellacceptedthatpopulationsthathavefewerresourcesandotherriskfactorsexperiencemuchhigherdeathrates.

SLIDE 8: THE DIFFERENCE BETWEEN SEASONAL AND PANDEMIC INFLUENZA

[Photos:Peoplesickwithinfluenza]

Itisveryimportanttorememberthedifferencesbetweenseasonalinfluenza(usualinfluenza),andpandemicinfluenza.Seasonalandpandemicinfluenzaaresimilarinanumberofways,suchasthemodeoftransmissionofthevirus.However,theyalsodifferinimportantways.

First,incontrasttopandemicinfluenza,peoplehavesomeimmunitytoseasonalinfluenzabuiltupfrompreviousexposuretotheviruses.Second,symptomsofpandemicinfluenzamaybemoreseverethanseasonalinfluenza,andmorepeoplearelikelytodiefrompandemicinfluenzathanfromseasonalinfluenza.Third,pandemicinfluenzacouldhappenatanytimeoftheyear,whereasseasonalinfluenzausuallyoccursinthefallandwinterinnon-tropicalareas.Finally,vaccinesforseasonalinfluenzaareavailableeachyearandarebasedonknowncirculatinginfluenzastrains,whereasvaccinesforpandemicinfluenzamaynotbeavailablefor4–6monthsafterapandemicstarts.Thisisbecauseittakes4–6monthstodevelopavaccineoncethenewviralstrainisidentified.

SLIDE 9: WHAT IS AVIAN INFLUENZA (BIRD FLU)?

Manypeopleconfusebirdfluwithapandemic,buttheyareverydifferentdiseases.Avianinfluenza(birdflu)isadiseaseofbirds,nothumans.Itinfectswildbirds(suchasducks,gulls,andshorebirds)anddomesticpoultry(suchaschickens,turkeys,ducks,andgeese).ThestrainknownasH5N1isonlyoneofmanystrainsofbirdfluviruses.(Similarly,seasonalhumaninfluenzahasmanystrains.Thisiswhywehavetodevelopanewvaccineeveryyear.)

Birdfluoutbreaksresultinhigheconomiclossesbecauseitisnecessarytokillbirdstocontainthespread,buttheseoutbreaksarenotusuallyarisktohumanhealth.H5N1isaverydeadlystrainthatisrapidlyspreadinginsomepartsoftheworld.Althoughthevirusdoesnotusuallyinfectpeople,itispossibleforhumanstobecomeinfectedundercertaincircumstances,suchasdirectcontactwithinfectedpoultry.Infact,morethan400humancasesin15countrieshavebeenreportedsince2004.Mostpeoplewhohavebecomesickordiedfromthisvirushavehadextensive,directcontactwithsickpoultry.However,evidencesuggeststhatH5N1ischanging,andexpertsareconcernedthatthevirusmaybecomecapableofdirectlyinfectinghumansandspreadingfrompersontoperson,potentiallyresultinginahumaninfluenzapandemic.ThisiswhytheWHOiswatchingthisvirussoclosely.

Atthistime,H5N1isstillabirdvirus,notahumanvirus.Ifitbecomesahumanvirus,wewillseemorehumancasesclusteredtogether,andultimatelytheappearanceofastraincapableofspreadingbetweenhumans.However,aswesawwiththeemergenceofH1N1,itisalsopossiblethatanentirelynewinfluenzaviruscanappearatanytime,orH1N1couldchangeovertimeintoamoreseverestrain.ScientistsworrythatthecurrentsituationofthepresenceofH5N1(averylethalanimalvirus)andH1N1(amilderhumanvirus)couldresultinanewvirusthatcouldcauseaveryseverepandemic.

8

9

4

5

6

7


SLIDE 10: WHAT IS SWINE INFLUENZA?

SwineinfluenzaisaninfluenzaAvirusthatcausesinfectioninpigs.Likeavianinfluenzainbirds,itcansometimescauseillnessinhumansinclosecontactwithinfectedpigs,buthumanscannottransmitittootherhumans.

SLIDE 11: WHAT IS H1N1?

H1N1isthenewvirusthatemergedin2009inMexicoCityandquicklyspreadacrosstheglobe.

ItwasdeclaredapandemicinJune2009.Theviruswasinitiallyreferredtoas“swine”influenzabecausetheviruswasfoundtocontaingeneticmaterialfromswineinfluenzaAstrains,aswellasavianandhumanstrains.However,whiletheH1N1virusappearstohaveemerged,atleastinpart,fromapigvirus,thisisahumanvirus,andpeoplegetitfrompeople—notfrompigs.

SLIDE 12: HOW DO SEASONAL AND PANDEMIC INFLUENZA SPREAD?

Thepandemicinfluenzavirusisexpectedtobetransmittedinthesamewayasseasonalinfluenza—throughlargerespiratory“droplets”thatcontaintheinfluenzavirus.Thesedropletsarereleasedthroughcoughingandsneezingandcanthencomeincontactwiththenoseormouthofahealthyperson—ortheymaybebreathedinbyahealthyperson.Thedropletsreleasedthroughcoughingandsneezingtendtosettlewithin3feet.Undermostconditions,theyrapidlydryoutandthevirusdies.Therefore,thekeytopreventinginfectionistostayawayfromthesedropletsbytryingtostayatleast1meterawayfromsomeonewhoissickwithinfluenza.

SLIDE 13: HOW DO SEASONAL AND PANDEMIC INFLUENZA SPREAD? (2)

Seasonalandpandemicinfluenzacanalsobespreadwhenhealthypeopletouchthingsthatarecontaminatedwiththevirusandthentouchtheireyes,nose,ormouth.

Therefore,thesameprecautionsusedtocombatseasonalinfluenzaareexpectedtobeeffectivebarrierstoinfectionswiththepandemicvirus:goodhandwashing,coveringofone’scough,andstayingawayfromsickpeople.

Thesevirusescouldbespreadbypeoplewhodonotfeelorlooksick,andtheyspreadmostquicklyincrowdedplaces—especiallyindoors.

However,thepandemicinfluenzavirusisverymuchlikeacommonseasonalinfluenzavirusinthatitisspreadinthesameway,throughrespiratory“droplets”fromcoughsandsneezes.

SLIDE 14: WHAT HAVE WE LEARNED FROM PAST PANDEMICS?

Pandemicshavebroad,complex,andcatastrophicimpacts—includinghealth,societal,andeconomicimpacts.Theytendtorecurin1–3wavesofillnesslastingapproximately6–12weekseachoveraperiodof1–2years.Thenumberofsickanddyingpeoplefarexceedstheavailablehealthcareresources,andshortagesofmanyothercriticalresourcesoccurs.

SLIDE 15: WHAT HAVE WE LEARNED FROM PAST PANDEMICS? (2)

Wehaveeveryreasontobelievethatpreparednessandresponseatthemunicipallevelwillprobablydeterminehowseverelyamunicipalityisimpacted.Themunicipalitiesthatwillbebestabletocopewiththeimpactsofaseverepandemicwillbethosethatarewellprepared;havelocalstockpilesofessentialgoodsorplanstoobtainthem;andthatcanrelyontheirownpopulationsandlocalresourcestohelpcareforthesick,provideessentialservices,andmaintainsocialorder.Aswehaveseenrepeatedlyduringotherdisasters,theabilityofamunicipalitytokeepthepublicwellinformedandcalmisthekeytoaneffectiveresponse.

SLIDE 16: WHAT CAN BE DONE TO SLOW OR DECREASE THE IMPACT OF A SEVERE PANDEMIC?

Municipalitiesareunlikelytohaveaccesstosufficientquantitiesofanti-viralmedications,andavaccineisnotexpectedtobemanufactureduntilafterthefirstwaveofapandemic.However,evidencesuggeststhatsimultaneouslyusinggoodhygienicpracticesand“socialdistancing”strategies,whichareintendedtokeeppeopleawayfromeachother,candramaticallyalterthespreadofthevirusinamunicipality.Interventionssuchasgoodhygieneandsocialdistancingstrategiesarecallednon-pharmaceuticalinterventions(becausetheydonotinvolvemedicines).Theseinterventionscanbeusedto(1)delaythestartofthepandemic,allowingmoretimeforfinalpreparednessactivities;(2)decreasethepeakimpact,minimizingthepeakoverloadofthehealthcaresectoranddecreasingpeakratesofworkforceabsenteeism(lostdaysofwork);and(3)decreasethetotalnumberofpeoplewhobecomesickanddiefromthedisease.

13

12

11

10

16

15

14


SLIDE 17: HOW WILL A PANDEMIC START IN MY MUNICIPALITY?

Mostlikely,thepandemicwillarrivethroughexposedorsickpeopleenteringthecountryfromanotherarea.Becauseofthecharacteristicsoftheillnessandthewayitcanbediagnosed,itwillnotbepossibleorpracticaltoclosebordersortoeffectivelyscreentravelersduringapandemic.Thisisbecauseitispossibleforpeopletospreadthediseasebeforetheyhaveanysymptoms,andtherearenolabtestscurrentlyavailabletodetectasymptomaticcasesinapracticalandcosteffectiveway.Whilegovernmentscouldpreventpeoplewithfevers,cough,orothersymptomsfromenteringanarea,otherswhohavenotyetdevelopedthesymptomswillpassthroughandspreadtheillness.Healthresourcesarebetterusedtodetectandtreatcasesratherthanwastedthroughattemptstopreventthevirusfromenteringanarea.

AswasseenwithH1N1,itmaybeweekstomonthsbeforealocalareaexperiencescasesofanewinfluenzavirus.Thisisaveryvulnerableperiodforthecountry.Aspeoplehearthenewsthatapandemichasstarted,theymaybegintofeargettingsickandmaybereluctanttogoabouttheirusualactivities,eventhoughnocaseshaveyetoccurredinsidethecountry.Thiscould(1)slowdownlocalcommerce;(2)causechildrentomissschool;and(3)leadpeopletobuywhatevergoodsareavailableforstockpiling,depletingtheavailabilityofthesegoodsanddecreasingfamilywealth.Thecountryanditsmunicipalitiesmusthaveaclearplaninplaceforthisperiodtopreventunnecessaryharmtothepeopleandtheeconomy.

SLIDE 18: WHO PHASES

WHOhasdefinedphasesofpandemicalert,asfollows:

Innature,influenzavirusescirculatecontinuouslyamonganimals,especiallybirds.Eventhoughsuchvirusesmighttheoreticallydevelopintopandemicviruses,inPhase 1novirusescirculatingamonganimalshavebeenreportedtocauseinfectionsinhumans.

InPhase 2ananimalinfluenzaviruscirculatingamongdomesticatedorwildanimalsisknowntohavecausedinfectioninhumans,andisthereforeconsideredapotentialpandemicthreat.

InPhase 3,ananimalorhuman-animalinfluenzavirushascausedsporadiccasesorsmallclustersofdiseaseinpeople,buthasnotresultedinhuman-to-humantransmissionsufficienttosustaincommunity-leveloutbreaks.ThisisthecurrentphasefortheH5N1avianinfluenzavirus.

Phase 4ischaracterizedbyverifiedhuman-to-humantransmissionofananimalorhuman-animalinfluenzavirusabletocause“community-leveloutbreaks.”Phase4indicatesasignificantincreaseinriskofapandemicbutdoesnotnecessarilymeanthatapandemicisaforegoneconclusion.

Phase 5ischaracterizedbyhuman-to-humanspreadofthevirusintoatleasttwocountriesinoneWHOregion.Whilemostcountrieswillnotbeaffectedatthisstage,thedeclarationofPhase5isastrongsignalthatapandemicisimminentandthatthetimetofinalizetheorganization,communication,andimplementationoftheplannedmitigationmeasuresisshort.

Phase 6,thepandemicphase,ischaracterizedbycommunity-leveloutbreaksinatleastoneothercountryinadifferentWHOregioninadditiontothecriteriadefinedinPhase 5.Designationofthisphasewillindicatethataglobalpandemicisunderway.ThisisthecurrentphasefortheH1N1virus.

Thepost-peak periodsignifiesthatpandemicactivityappearstobedecreasing;however,itisuncertainifadditionalwaveswilloccurandcountrieswillneedtobepreparedforasecondwave.

Inthepost-pandemic period,influenzadiseaseactivitywillhavereturnedtolevelsnormallyseenforseasonalinfluenza.

SLIDE 19: WHO PANDEMIC PHASES AND CURRENTLY CIRCULATING NOVEL VIRUSES

Theemergenceofanovelvirusthatiscapableofinfectinghumansmarksthesevirusesashavingpandemicpotential.TheH5N1viruscontinuestocausewidespreadanimaloutbreaksandsporadichumancaseswithhighcasefatalityratios.Despitetheongoingconcernthatthisvirusmayonedaydevelopefficienthumantohumantransmissionandresultincasesacrossgeographicareas,tothisdateitremainsatPhase3.

Incontrast,H1N1escalatedtoaPhase6declarationwithintwomonthsofthefirstreportedhumancases.Thisvirusdemonstratedefficienthuman-to-humantransmissionfromtheonset,andquicklyspreadaroundtheworld.

ThesetwovirusesdemonstratetheuseoftheWHOpandemicphasestodescribegeographicspread,notseverity.DespiteremainingatPhase3,theH5N1viruscontinuestohaveamuchhighercasefatalityratiothantheH1N1virus.Thereisgreatconcernthatifthesetwovirusesshouldmixinahumanorananimal,anewvirusthathasthehighdeathrateoftheH5N1virusandthecapabilitytospreadeasilyfrompersontoperson,likeH1N1,couldresult.

SLIDE 20: WHAT WILL LIFE BE LIKE IN A SEVERE PANDEMIC?

Dailylifewillchangedramatically,andmostofthechangeswillbedirectlyrelatedtothelossoftheworkforcethroughillnessandfear.Thehighratesofabsenteeismacrosssectorswillresultinshortagesofessentialgoods,disruptionsinroutineservices,alteredorcancelledpublictransportationandotherservices,andahealthcaresystemthatisunabletomeettheneedsofthelargenumbersofsickanddyingpeople.Inaddition,personalmovementmayberestrictedinanattempttoslowthetransmissionoftheviruswithincommunitiesandtodecreasethenumberofpeoplewhogetsick.

Economiclossesareexpectedtobesevere,andalossofpublicordermayoccur.Recoverymaybedifficultbecauselocalcommercewillhavesuffered,andpeoplemaybeafraidtoresumenormalactivities.

Wewillexploreeachoftheseareasinmoredepthinthenextsetofslides.

17

18

19

20


SLIDE 21: SHORTAGES OF ESSENTIAL GOODS

Anythingthatdependsonresupplywillbevulnerabletodelaysorinterruption.Thesesupplychainshortageswilllikelyresultincriticalshortagesoffood,fuel,medicalsupplies,sparepartsforinfrastructuremaintenance,andotheressentialgoods.Concernaboutbecomingsickmaycausepeopletostopgoingtoworkorthemarketortostopsendingtheirchildrentoschool.Commercewillsloworwillbesuspendedasbusinessesandmarketsclosebecauseoflossoftheworkforce,lossofcustomers,orbyordertocontaintheillness.Thiswillresultinalossoffamilyincomeandlivelihoodsformany.

Fearandpanicmayleadtoexcessconsumptionandpersonalhoarding,furtherdepletingthewealthofindividualsandfamiliesandreducingtheavailabilityofgoodsforothers.Hostilityandviolencemayeruptoveraccesstoscarcegoodsandservices,andthemostvulnerablepeople(forexample,thosewhoarepoor,illiterate,chronicallyill,ordisabled)maybethemostseriouslyaffected.

Municipalitieswillneedtohaveaplantomaintainsocialorderandtoensurethatresidentsremaincalm.Thisisbestdonethroughacombinationofeffectiveleadership,theuseoftrustedspokespeople,effectivepubliceducationandcommunicationaboutrisk,theuseoflawenforcementofficialsasneeded,andlocallyavailablegoodsandstockpilestosustainthecommunity.

Availablegoodswilllikelybeconsumedearlyinthepandemic.OnceWHOdeclaresapandemic,itwillbedifficulttobringgoodsintothecountrytoincreaselocalstockpiles.Therefore,municipalitieswillonlyhavewhattheyhaveonhandattheonsetofthepandemic,plusanygoodstheycancontinuetoproduce,orthataidorganizationsareabletogettothem.Itslikely,therefore,thatmostareaswillexperiencesevereshortagesofessentialitems,suchasfood,potablewater,medicines,andfuel.

SLIDE 22: SUPPLY CHAIN DELAYS OR DISRUPTIONS

[Photos:Supplychain]

Mostareasoftheworldaredependentonaninternationalsupplychain,aswellasnationalandlocaltruckingandotherdistributionanddeliverysystems.Aspeoplebegintogetsick,andothersstayhomefromworkbecauseoffearorotherresponsibilities,allsectorswillexperiencehighratesofworkerabsences.Deliveriesofgoodstotheareawillbedisruptedastruckdrivers,loadingdockpersonnel,andallotherpeopleneededtomovegoodsfromoneplacetoanotherarenotavailabletowork.

Availablegoodswillprobablybeconsumedearlyinthepandemic.Duringaseverepandemic,itwillbedifficulttobringgoodsintothecountrytoincreaselocalstockpiles.Therefore,municipalitieswillonlyhavewhattheyhadonhandattheonsetofthepandemic,aswellasanygoodstheycancontinuetoproduceorthataidorganizationsareabletobringtothem.Therefore,mostareaswillprobablyexperiencesevereshortagesofessentialitems,suchasfood,potablewater,medicines,andfuel.

SLIDE 23: DISRUPTION IN ROUTINE SERVICES

Schools,governmentoffices,andthepostofficemaybeclosed.Utilities,communicationservices,andinformationnetworksmaybedisrupted,resultinginalossofservice.Banksmaycloseormayexperienceahighrateofcashwithdrawals,andautomatedtellermachinesmaynotbeserviced.

SLIDE 24: CHANGES IN PUBLIC TRANSPORTATION AND OTHER MUNICIPAL AND PRIVATE SERVICES

Publicandprivatetransportationmaybeslowedorstopped.Fuelmayneedtoberationed.Municipalworkers,suchasgarbagecollectors,utilityrepairpeople,waterandsewermaintenanceworkers,andotherswhoprovideothercriticalinfrastructureneedswillalsobecomeill.Municipalitieswillprobablyexperienceadecreaseinservicesintheseareas.

SLIDE 25: HEALTHCARE SYSTEMS OVERWHELMED

[Photo:Ascenefromthe1918pandemic.]

Healthcaresystemswillcertainlybeoverwhelmedinaseverepandemicandcriticalshortagesofdoctors,nurses,andcommunityhealthworkerswilloccur.Infact,justwhentheneedforhealthcareisthegreatest,atthepeakofthepandemic’simpact,thehighestabsenteeismratesareexpected.Inaddition,non-pandemichealthissueswillcontinueandmayevenincreasebecauseofanoveralldecreaseinaccesstohealthcare.Difficultdecisionswillneedtobemadetoallocatethescarcemedicalresources,andboththepublicandthehealthcareproviderswillneedmentalhealthsupport.

Manycasesoftheinfluenzawillbemild,andwillnotrequireanyspecializedcareorattention.Mostofthesickerpatientswillneedtocareforthemselvesorwillneedfamilymembersorcommunityvolunteerstoassistintheircare.Themunicipalitysimplywillnothaveenoughdoctors,nurses,orhealthcareworkerstoprovidecaretoalloftheinfluenzapatientsaswellasthosewithnon-pandemichealthissues.Itisveryimportantformunicipalitiestoknowwhothemostvulnerablepeopleare(forexample,medicallyvulnerablechildren,elderlypeople,pregnantwomen,andthosewithcompromisedimmunesystems)andtohaveincorporatedthemintotheresponseplan.Thebestwaytodecreasetheoverallimpactofthepandemicistohelpthemunicipalitybecomeasself-sustainingaspossible—thiswillincludeensuringthatinfluenzapatientscareforthemselvesasmuchaspossible.

21

22

23

24

25


SLIDE 26: RESTRICTIONS OF PERSONAL MOVEMENT

Communitycontainmentmeasuresmaybeneededtolimitthespreadofaseverepandemicinthemunicipality.Personalmovementmayberestrictedbecauseoftraveladvisoriesandotherlimitsonmovement.Publicgatheringsandeventsmayalsobecancelledorprohibited.Schoolsmaybeclosed,andpeoplemaybeaskedtolimittheirinteractionswithothers,suchasatmarkets.

Peoplewhoaresickmayberequiredtostayathomeorawayfromothersuntiltheyrecover(referredtoasisolation),andpeoplewhomayhavebeenexposedtoasickpersonmayalsobeaskedtostayawayfromothersforafewdaystodetermineiftheyareill(referredtoasquarantine).Isolationandquarantinearetwoimportantpublichealthmeasuresthatwillprobablybeneeded.Yourhelpmaybeneededtoeducatepeopleaboutthesemeasures,andtoenforcetheirimplementation.

Althoughtheseeffortswillbeimportanttothesurvivalofthecommunityinaseverepandemic,theymayleadtofurtherimpactsonthecommerceandsocialwell-beingofresidents.Municipalitiesmustalsoworktopreventhumanrightsviolationsthatcouldresultfromthemisuseordiscriminatoryuseofthesemeasures.

SLIDE 27: HOW CAN MUNICIPALITIES BE PREPARED FOR A SEVERE PANDEMIC?

Themostimportantthingtodoistostartplanningforyourmunicipalitynow.

Understandthelikelyimpactonyourmunicipalityanddevelopplansforthepeakimpactandforimpactsineachsector.

• Planforpubliceducationandeffectivecommunicationofrisk.

• Planwaystoensurethatthenecessaryfunctionsandservicesofgovernment,businesses,andorganizationscancontinue.

• Planforpreparednessandresponserelatedtohealth,foodavailabilityandaccesstofood,andincomeandlivelihoodissues.

Toplanforthepandemic,youcanbuildongeneraldisasterplanning.Besureto:

• Includenongovernmentalorganizationsandotherpartnersintheplanningprocesstodevelopcontingencyplansforessentialgoods.

• Includebankingandothercommercerepresentativestodevelopeconomicmitigationandrecoveryplans.

• Identifyresponseleadersandpublicspokespeople.

• Developpoliciesonschool,market,andbusinessclosingandre-openingandwaystoreassurethepublicwhenitissafetoresumeactivities.

• Maximizestockpilingbeforethepandemic(NOW!).

SLIDE 28: TWO CITIES IN 1918

ThisgraphisbasedondatafromtwocitiesintheU.S.duringthe1918pandemic.Philadelphiaexperiencedmanydeaths,whereasSt.Louisexperiencedrelativelyfew.Thedifferencebetweenthesetwocurvesisduetotheactionstaken(andnottaken)bythemunicipalgovernmentsinthesetwocities.Bothcitieswerehitbythepandemic,andtheywereunderthesamenationalgovernment.However,theyhadverydifferentexperiences.

St.Louisinstitutedsocialdistancingpoliciesassoonastherewerecasesinthearea.Philadelphiadelayedtheirusefor1–2weeksaftercasesbegan.ItisbelievedthattherapidimplementationofthesocialdistancinginterventionswastheprimaryfactorresponsibleforthelowermortalityrateexperiencedbySt.Louis.

Whatwillthegraphlooklikeforyourmunicipalitywhenwestudytheimpactsafterthenextseverepandemicisover?WhatcanyoudonowtobesurethatyourmunicipalitycanprotectitselfthewaythatSt.Louisdid?

SLIDE 29: SOURCES

• CDC(CentersforDiseaseControlandPrevention).Pandemicinfluenzaplanningchecklists.www.pandemicflu.gov,http://pandemicflu.gov/plan/states/statelocalchecklist.html

• CDC.Riskcommunication.http://www.pandemicflu.gov

• CDC.2007.Interim pre-pandemic planning guidance: Community strategy for pandemic influenza mitigation in the United States.Atlanta,GA:CDC.http://pandemicflu.gov/plan/community/community_mitigation.pdf

• WHO(WorldHealthOrganization).2004.WHO influenza pandemic preparedness checklist.Geneva:WHO.http://www.wpro.who.int/NR/rdonlyres/25885074-7A3B-442A-834E-E96484D14D69/0/WHOInfluenzaPandemicPreparednessChecklist.pdf

• WHO.2009.Pandemic Influenza Preparedness and Response.http://www.who.int/csr/disease/influenza/PIPGuidance09.pdf

• WHO.2008.Pandemic influenza preparedness and mitigation in refugee and displaced populations.2nded.WHO/HSE/EPR/DCE/2008.3.Geneva:WHO.http://www.who.int/diseasecontrol_emergencies/guideline/en/index.html

• WHO.2009.WHO guidelines for pandemic preparedness and response in the non-health sectors.Geneva:WHO.http://www.un-pic.org/pic/web/documents/english/WHO%20WOS%20Pandemic%20Readiness%202009-05-05.pdf

26

27

28

29

14 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO

tool 2 threat of a severe influenza pandemic

Documents