Jeffrey A. Blystone Bureau of Community Health Systems Pennsylvania Department of Health 1 Pandemic Influenza Planning in Pennsylvania

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Facts About Flu Pandemic –Global disease outbreak. –Unknown timing or severity (many experts agree that a significant threat exists). –WHO has developed a global influenza preparedness plan. Pandemic Influenza Planning in Pennsylvania

Interpandemic PeriodPhase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Pandemic Alert PeriodPhase 3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact. Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Phase 5: Larger cluster(s), but human-to-human spread still localized; virus increasingly better adapted to humans, but not yet fully transmissible. Pandemic Period and Next Wave(s) Phase 6: Increased and sustained transmission in general population. Post-Pandemic PeriodReturn to interpandemic period and evaluation/assessment.

Seasonal Influenza Globally: 250,000 to 500,000 deaths each year In the United States each year: –36,000 deaths –>200,000 hospitalizations –$37.5 billion in economic costs from influenza and pneumonia Pandemic Influenza An ever-present threat Pandemic Influenza Planning in Pennsylvania

Influenza pandemics are inevitable: naturally recur at cyclical intervals. Influenza Pandemics can cause: –High levels of sickness and death –Drastic disruption of critical services –Severe economic losses –Impacts for weeks to months. –A disproportionate effect in younger, working-age people. Pandemic Influenza Planning in Pennsylvania

Pandemics Do Happen! H1 H3 H2 H7 * H5 * H9 * 1918 Spanish Influenza H1N Asian Influenza H2N Hong Kong Influenza H3N * Avian Flu Pandemic Influenza Planning in Pennsylvania

Influenza pandemic is most likely when the Influenza Type A virus makes a dramatic change (i.e., antigenic shift). –This shift results in a new or novel virus to which the general population has no immunity. The appearance of a novel virus is the first step toward a pandemic. Pandemic Influenza Planning in Pennsylvania

Situation Report: Avian Influenza Widespread and spreading prevalence in migratory birds; broad host range. Continued outbreaks among domestic poultry. Mammalian infection (cats, pigs, etc.) lethal. Virus is evolving. Sporadic human cases (281 reports as of March 20, 2007). Most in young and healthy Case-fatality >50% (169 deaths as of March 20, 2007) Rare person-to-person transmission Sustained and rapid person-to-person transmission.

Estimated morbidity and mortality during an influenza pandemic (within weeks) United StatesPennsylvania Require Outpatient Care 50 million1.6 million Hospitalizations 2 million37,800 Deaths500,000 9,100 Pandemic Influenza Planning in Pennsylvania

Pandemic Impact –High absenteeism. –Disruption of transportation, commerce, utilities, public safety and communications. –Psychological impacts will be extreme. –Social distancing efforts may dramatically change hours of operation or close businesses temporarily. –Economic losses – small businesses at greatest risk. Pandemic Influenza Planning in Pennsylvania

Pandemic Impact: Health Care System –Extreme staffing shortages. –Shortage of beds, facility space. –Shortage of key supplies (ventilators, drugs). –Hospital morgues, Medical Examiner and mortuary services overwhelmed. –Extreme demands on social and counseling services. –Demand will outpace supply for months. Pandemic Influenza Planning in Pennsylvania

Limited to no assistance from the federal government due to nationwide impact. Assistance from the state government limited due to the statewide impact Governor Rendell directed Pennsylvania to develop a two- prong planning approach –Department of Agriculture to prepare for the increased threat of an H5N1 outbreak in poultry, wild fowl and live stock. –Department of Health to ensure Pennsylvanias citizens are prepared for a potential pandemic. Pandemic Influenza Planning in Pennsylvania

Department of Agriculture Planning Activities –Developed an Avian Influenza Response Plan –Drafted the Poultry Worker Protection Plan: An Interim Guidance for the Implementation of CDC and OSHA Avian Influenza Public Health Recommendations. –Continue to refine preparedness activities relating to: Increasing agricultural surge capacity Increased monitoring of the risk of the disease appearing in Pennsylvania poultry. Pandemic Influenza Planning in Pennsylvania

Department of Health Planning Activities –Influenza pandemic response activities are coordinated within the following workgroups: Human Avian Influenza Prevention Detection Policies and Processes Workforce Planning Isolation and Quarantine Procedures Vaccine and Medication Distribution Incident Coordination Response Public Communications Planning Legal Review Local Government Pandemic Influenza Planning in Pennsylvania

Focus: Surveillance, data exchange, and prevention through early detection, both avian and human Activities: –Epidemiology Work Group –BSL-3 modular unit for Pennsylvania Animal Diagnostic Laboratory System –Development of inter-laboratory communications systems to enhance rapid communications of Health and Agriculture Diagnostic State Laboratories Human Avian Influenza Prevention Detection Policies and Processes

Focus: Telecommuting, succession planning, business partner preparation, business education, workforce communication, absenteeism policies and workers compensation programs and issues Activities: –Pandemic flu flyers currently available –Handwashing posters –Information technology approach to support social distancing Workforce Planning

Focus: Community containment of diseases, isolation and quarantine procedures with and without a disaster declaration. Activities: –Toolkit for schools –Draft Isolation and Quarantine plan (Community Containment Plan) that includes the need for isolation/quarantine facilities. –Establishing protocols and guidance for determination of quarantine order, type of community containment and other related issues. Isolation and Quarantine

Focus: Activating Point of Dispensing (PODS), staffing, and security of PODS and medications. Activities: –POD Notification –POD Site Assessments –POD Security Surveys –Volunteer Recruitment –Development of state antiviral stockpile strategies –Identification of priority groups Vaccine and Medication Distribution

Focus: Incident command structure and communications. State agency roles in Emergency Support Functions. NIMS/ICS/National Response Plan. Concept of Operations and planning assumptions regarding incident command during a pandemic event. Local readiness considerations. Activities: –State agency pandemic checklists by Agency –County level emergency management preparedness checklist –Community Pandemic Planning Toolkit Incident Coordination

Focus: Messages to the general public, development of prevention materials, communication plan development (stakeholder groups and messages), business education (workforce community), tourist impact, special needs populations and non-emergency updates (non-Emergency Operations Center) to the general public. Activities: –Development of communication pieces –Creation of Powerpoint Presentations –Foreign language translation –Briefing Packets –Website development –Radio and TV spots Communications

Focus: The committee addresses any legal issues relating to the Commonwealths authority to act in a pandemic situation. Activities: –Addressing issues surrounding the use of a volunteer workforce –Governors draft proclamation –Drafted a flowchart matrix outlining agency responsibilities –Continue to research general authority of the Commonwealth –Discussed and drafted responses to frequently asked questions –Discuss and research mutual aid issues –Other legal issue Office of General Counsel Preparedness Committee

Focus: Roles and responsibilities at the local level for planning, command and control, critical infrastructure, disease containment and communication. Activities: –Coordinating pandemic planning activities with: PA School Boards Association PA Municipal Authorities County Commissioners Association of PA PA League of Cities and Municipalities PA State Association of Township Commissioners PA Station Association of Township Supervisors PA State Association of Boroughs Local Government

Roles and responsibilities defined by the National Strategy: –The Federal Government will: Work with international organizations to assist with detection. Work to develop a vaccine to protect 20 million U.S. citizens Work to increase vaccine capacity so that enough vaccine can be produced to vaccinate each U.S. citizen within 6 months of recognition of a pandemic. Stockpile antiviral medications for 75 million people through Federal and state stockpiles by Establish policies with states on international and domestic travel restrictions. Establish effective and accurate information to the public. Providing funding to states to assist with pandemic preparedness. Pandemic Influenza Planning in Pennsylvania

Roles and responsibilities defined by the National Strategy (continued): –State governments will have the responsibility to: Establish a strategy for effective distribution of vaccines and antivirals. Establish an effective multi-agency communications program. Review disease containment strategies and enforcement plans. Establish disease detection and reporting capabilities. Assist local governments in response to a pandemic outbreak. Ensure that state agencies have continuity of operations plans. Work with Department of Interior and the USDA on coordinating surveillance of wild life. Pandemic Influenza Planning in Pennsylvania

Roles and responsibilities defined by the National Strategy (continued): –Local governments will have the responsibility to: Assist states with the location of distribution sites for vaccines and antivirals. Establish medical surge capacity at the local level including the coordination of volunteers. Ensure critical infrastructure (sewer, water, etc.) continues to function during a pandemic. Have a uniform command and control system at the local level that includes integrated communications. Pandemic Influenza Planning in Pennsylvania

Everyone has at least one of the following roles: –Employers Continuity of operations Succession planning Communicating to employees Prevention –Education Educate stakeholders regarding pandemic influenza. Educate on what steps they should take to prepare. Pandemic Influenza Planning in Pennsylvania

Everyone has a role (continued). –Service Provider Plan to continue those services Surge capacity for goods and people Increased prevention Protection and detection capability Disease containment measures –First Responders Pandemic Influenza Planning in Pennsylvania

Ongoing Activities –Public education and communication. Clearly communicate to the public: Prepare people with information Encourage action steps to prepare now Provide updates when new information emerges Use trusted messengers Coordinate to ensure consistent messages Address rumors and inaccuracies Pandemic Influenza Planning in Pennsylvania

Ongoing Activities (continued) –Strengthening essential partnerships Hospitals and health care providers. First responders and infrastructure agencies. Elected officials and government partners. Businesses. Schools, community based organizations. –Strengthening capacity to rapidly vaccinate large populations. Pandemic Influenza Planning in Pennsylvania

Upcoming Activities –Develop an antiviral purchase and stockpile strategy. –Conduct regional summits for school districts. –Coordinate multi-agency Pandemic planning efforts to update Pennsylvania Influenza Pandemic Response Plan. –Implement Pandemic Coordinating Council. Pandemic Influenza Planning in Pennsylvania

Personal Preparedness –Get a flu shot each year. –Stay home when you are sick. –Avoid close contact with people who are sick. –Cover your mouth and nose with a tissue when coughing or sneezing. –Wash your hands. –Avoid touching your eyes, nose or mouth. Pandemic Influenza Planning in Pennsylvania

Seasonal Influenza Preparedness Pandemic Influenza Preparedness Preparing for a pandemic now will mean: Create awareness not anxiety. Lives saved during seasonal influenza Create sense of confidence and provide peace of mind. Pandemic Influenza Planning in Pennsylvania

Pandemic Influenza Planning in Pennsylvania