CONNECTICUT PANDEMIC PLANNING Meg Hooper, MPA Connecticut Department of Public Health 9 Oct 2008

Planning & Response Partners DEMHS, DPS DHS Fire, Police, Emergency Managers DOD Military CT National Guard, Civil Support Team HRSACDC DPH, DMHAS EMS, Local Health, Health Care Mental Health DEP, DOAG Etc. Others Regional and local response teams Emergency

State Pandemic Planning December 2005 – Governor’s Task Force created February 2006 – Summit/State Plan published April 2006 – Strategic National Stockpile Drill June 2006 – Airport Pan Flu Q & I Drill November 2006 – State COOP training February 2007 – State COOP exercise April 2007 – State Pan Flu Plan to CDC July 2007 – State Avian TTX July 2007 – State Pan Flu TTX July 2008 – State Pan Flu Operations Plan to CDC April 2009 – Updated State Pan Flu Plan for Swine Flu

 Anti-Viral Distribution  Vaccination Protocols  Community Mitigation  Risk Communication  Surveillance  Laboratory Protocols Public Health’s Pan Flu Plan

Public Health Assets 30 Acute Care Hospitals 52 Full-time Health Departments 75 Community Health Clinics Emergency Medical Services Medical Reserve Corps State and Hospital Laboratories Medical Satellite Communications 100-Bed Mobile Field Hospital DMAT/Mass Casualty Trailers Integrated Education and Training System All-Hazards Emergency Response Plans and Protocols

Swine Flu and Pandemic Influenza Planning Matthew L. Cartter, MD, MPH Connecticut Department of Public Health April 30, 2009

WHO Phase of Pandemic Alert Phase 5 is characterized by human-to- human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

WHO Phase of Pandemic Alert Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

YearStrainNameNumber of confirmed human deaths (USA) Global deaths H1N1“Spanish” Flu650, million H2N2“Asian” Flu70,0001 million H3N2“Hong Kong” Flu34,0001 million Influenza pandemics in last century

Hurricanes and Pandemic Severity

Pandemic Severity Index 1918

8

Category 5 Category 4 Category 3 Category 2 Category 1

Most Likely Estimates of Potential Impact of an Influenza Pandemic with a 30% Illness Rate in CT Category 2 (1968-like) Category 5 (1918-like) Ill, No medical care474,089422,083 Outpatients563,647504,806 Hospitalizations12,451102,348 Deaths2,90223,852 Totals1,053,089

Community-Based Interventions 1. Delay disease transmission and outbreak peak 2. Decompress peak burden on healthcare infrastructure 3. Diminish overall cases and health impacts Daily Cases #1 #2 #3 Days since First Case Pandemic outbreak: No intervention Pandemic outbreak: With intervention 11

Tools in Our Toolbox Pandemic Vaccine likely unavailable during the first wave of a pandemic Antiviral medications Quantities Distribution logistics Efficacy / Resistance Social distancing and infection control measures

Community Strategies by Pandemic Flu Severity (1) Pandemic Severity Index Interventions by Setting12 and 34 and 5 Home Voluntary isolation of ill at home (adults and children); combine with use of antiviral treatment as available and indicated Recommend Voluntary quarantine of household members in homes with ill persons (adults and children); consider combining with antiviral prophylaxis if effective, feasible, and quantities sufficient Generally not recommended ConsiderRecommend School Child social distancing –dismissal of students from schools and school-based activities, and closure of child care programs Generally not recommended Consider: ≤ 4 weeks Recommend: ≤ 12 weeks –reduce out-of-school contacts and community mixing Generally not recommended Consider: ≤ 4 weeks Recommend: ≤ 12 weeks

Community Strategies by Pandemic Flu Severity (2) Pandemic Severity Index Interventions by Setting12 and 34 and 5 Workplace/Community Adult social distancing –decrease number of social contacts (e.g., encourage teleconferences, alternatives to face-to-face meetings) Generally not recommended ConsiderRecommend –increase distance between persons (e.g., reduce density in public transit, workplace) Generally not recommended ConsiderRecommend –modify, postpone, or cancel selected public gatherings to promote social distance (e.g., stadium events, theater performances) Generally not recommended ConsiderRecommend –modify workplace schedules and practices (e.g., telework, staggered shifts) Generally not recommended ConsiderRecommend