Pandemic Influenza Renee Frauendienst, RN, PHN, BSN Division Director Public Health Division Stearns County Human Services

Pandemic Influenza Preparing for Pandemic Influenza: Business will not be as Usual

Recent Pandemics 1918/1919 Spanish Influenza 1918/1919 Spanish Influenza –40/50 million deaths worldwide 1957 Asian Flu 1957 Asian Flu –2 million deaths worldwide 1968 Hong Kong Flu 1968 Hong Kong Flu –1 million deaths worldwide

1918 Spanish Flu Devastating Devastating –“Hospitals filled up and soon became overwhelmed as doctors and nurses got sick. Children lost their parents, and people hid in their homes to avoid a new and mysterious virus. So many people died that there was no time to make coffins; many victims had to be buried in mass graves.” –“Shops, offices and factories shut down without enough staff to keep them going, and schools, hotels and theatres were closed by order of the government.”

Pandemic Flu Planning –“strong evidence that the 1918 flu virus [was] derived wholly from an ancestor that originally infected birds” Andreas von Bubnoff (Nature) –Two subsequent influenza pandemics – one in 1957 and one in 1968 – have also been linked to avian flu viruses.

Avian Influenza (“Bird Flu”) Viral infection of birds Viral infection of birds Believed to be spread by co-mingling of wild and domestic birds Believed to be spread by co-mingling of wild and domestic birds Controlled by culling infected and exposed birds (Over 200 million birds destroyed to date) Controlled by culling infected and exposed birds (Over 200 million birds destroyed to date)

Bird to Human Transmission Predominantly via contact with feces from infected birds Predominantly via contact with feces from infected birds Handling infected poultry Handling infected poultry Disposing of dead infected poultry Disposing of dead infected poultry No sustained human to human transmission to date No sustained human to human transmission to date

Avian Influenza - H5N1 Why do we care? 238 documented cases, 139 deaths as of August 14, 2006 (58%) 238 documented cases, 139 deaths as of August 14, 2006 (58%) Mutating little by little Mutating little by little Has potential to mutate into a human strain Has potential to mutate into a human strain

Conditions of a Pandemic Widely spread without early detection Widely spread without early detection Novel virus highly infectious to humans, with no immunity Novel virus highly infectious to humans, with no immunity Virus strain is easily transmissible human to human Virus strain is easily transmissible human to human Virus causes serious illness Virus causes serious illness There is no adequate supply of vaccine immediately available There is no adequate supply of vaccine immediately available Supply of antiviral medication is limited Supply of antiviral medication is limited

Could the H5N1 virus cause the next pandemic? Possibly… Possibly… So far the virus cannot pass easily from human to human. But… But… Eventually, there will be another pandemic, we just can’t be sure it will be caused by this H5N1 virus

World Health Organization Influenza Pandemic Phases Interpandemic Period Novel subtypes in animals but not humans Phase 1 Circulating subtypes in animals posing threat to humans Phase 2 Pandemic Alert Period Novel subtypes in humans, but no human-to-human transmission Phase 3 Limited human-to-human transmission Phase 4 Localized clusters of human cases Phase 5 Pandemic Period Increased and sustained transmission in the general population on a large scale Phase 6

Projected Pandemic Impact Based on 2004 U.S. Population Estimate of 294 Million (0.05% of World Population) MODERATE PANDEMIC SEVERE PANDEMIC Illness (30% of population) 90 million Outpatient Care (50% of ill) 45 million Hospitalizations (1% to 11% of ill) 865,0009,900,000 ICU Care (15% of hospitalized) 128,7501,485,000 Ventilators (50% of ICU) 64,875742,500 Deaths (0.2% to 2% of ill) 209,0001,903,000

Projected Pandemic Impact Based on 2004 Minnesota Population Estimate of 5.1 Million (1.75% of U.S. Population) MODERATE PANDEMIC SEVERE PANDEMIC Illness (30% of population) 1,544,000 Outpatient Care (50% of ill) 772,000 Hospitalizations (1% to 11% of ill) 15,000172,000 ICU Care (15% of hospitalized) 2,25025,700 Ventilators (50% of ICU) 1,12012,900 Deaths (0.2% to 2% of ill) 3,60032,900

Assumptions Not a matter of if but when Not a matter of if but when All countries will be impacted All countries will be impacted Medical supplies and care may be inadequate Medical supplies and care may be inadequate Impacts will last for weeks to months

Two to three waves of illness Pandemics can disproportionately affect younger people creating workforce issue Potential for high levels of: - Sickness and death - Disruption of critical services - Economic loss Assumptions

Goals of Pandemic Planning and Response Maintain community infrastructure Maintain community infrastructure Minimize social disruption Minimize social disruption Reduce morbidity/mortality Reduce morbidity/mortality Provide effective public education (before, during and after) Provide effective public education (before, during and after)

Public Health Messages Off site care facilities Off site care facilities Home care activities Home care activities Social distancing Social distancing “Snow Days” “Snow Days” Active Surveillance Active Surveillance Isolation and Quarantine Isolation and Quarantine Vaccines and antivirals Vaccines and antivirals

Planning Priorities Family/Individual Planning Family/Individual Planning Business Continuity Planning Business Continuity Planning Community Planning Community Planning

Family Emergency Preparedness Awareness Food and water Food and water Change of clothes for each person Change of clothes for each person Sleeping bags or blankets Sleeping bags or blankets First aid kit First aid kit Battery powered radio and flashlight with extra batteries Battery powered radio and flashlight with extra batteries Social distancing or “ snow day ” preparations Social distancing or “ snow day ” preparations

Business Continuity Planning Prioritize critical functions Identify functions that could be suspended for up to two months Identify positions needed to carry out critical functions Build depth through cross training Plan for alternative work schedules Explore telecommuting capabilities – large scale Key Elements of Preparedness – From a Business Perspective

Regional and Local Planning Considerations Integrate non-health entities in planning and response Integrate non-health entities in planning and response Establish community stockpiles (e.g. of vaccine and antivirals) & distribution systems Establish community stockpiles (e.g. of vaccine and antivirals) & distribution systems Identify spokespersons Identify spokespersons Provide effective public education Provide effective public education Surveillance systems Surveillance systems

Priority Activities for 2006 Review the federal and state plans Review the federal and state plans Plans from other states Plans from other states Update local plans Update local plans Assure response is community based, and flexibleAssure response is community based, and flexible

Planning Priorities Community meetings Community meetings Education and training staff Education and training staff Creating messages ahead of time regarding response Creating messages ahead of time regarding response Stockpiles of anti-virals and vaccines Stockpiles of anti-virals and vaccines How to get them distributed-local vs. regionalHow to get them distributed-local vs. regional Who will get them- essential personnelWho will get them- essential personnel Where to distributeWhere to distribute

Planning Priorities Coordinated information to public and other partners Coordinated information to public and other partners HAN-health alert networkHAN-health alert network Special and vulnerable populations Special and vulnerable populations Vaccinations/prophylaxisVaccinations/prophylaxis MessagingMessaging Community resources Community resources Community surveillance-early, during, expanded sites Community surveillance-early, during, expanded sites Mass fatalities Mass fatalities

Planning Priorities Working with healthcare regarding: Working with healthcare regarding: –Continuity of services –Supply contingency plans –Surge capacity –Isolation/Quarantine of compliant/non- compliant –Protection for workers Mortuary Services Mortuary Services

Are We Ready? More today than yesterday More today than yesterday More tomorrow than today More tomorrow than today