1. Pandemic Influenza Briefing

2. Overview Why are we Talking About Pandemic Flu?
Current Avian Influenza Outbreak (Global)
Pandemic Influenza Response Plan
Public Health and Health Care System Preparedness
Community-wide Preparedness

3. Definitions
An epidemic - is an increase in disease above what you what would normally expect
A pandemic - is a worldwide epidemic

4. How Do Influenza Pandemics Arise?
Wild birds are natural reservoirs of flu viruses, including those that infect people
Flu viruses undergo slight changes each year, requiring us to update our vaccines
Periodically, avian flu viruses will undergo major genetic changes (“shift”)

5. How Do Influenza Pandemics Arise?
When avian influenza viruses experience sudden changes in genetic structure
And
Are capable of infecting humans
Can reproduce and spread from person to person….a pandemic occurs

6. Why Are We Talking About Pandemic Flu?

7. Planning Assumptions Illness will spread quickly and globally
Vaccine will be non-existent or very limited for 6 to 8 months – antivirals will be very limited
The health care delivery system will be completely overwhelmed – restructuring and prioritization of services will be necessary
Planning assumptions help us establish priorities and focus our preparedness efforts. Many are based directly on national and international guidance.
Planning assumptions are essential when so many unknowns are involved.
What does it mean to assume that vaccine and antiviral medications will not be available or will be in extremely limited supply?
Not much in the way of medical interventions
Prioritization becomes a key planning issue
Non-medical strategies become critical, thus involving lots of non-medical partners
Treatment at home becomes a key component of our messaging strategy

8. Planning Assumptions Alternate facilities will be needed to:
Conduct triage of ill people
Provide a supportive care environment for patients
Temporarily store bodies
Health care workers and EMS responders may face staff shortages exceeding 30%
Significant disruptions of critical infrastructure, first response systems, and social services may occur
Impacts to health care workers call into question how these staff (including PH staff) will be utilized, the standards of care that are possible, nurse to patient ratios, etc.
The assumption that critical infrastructure first response systems and social services will be overwhelmed immediately brings in all other partners into the pan flu planning circle.
PH planning and health system planning becomes one piece of a much larger project.

9. Planning Assumptions
Social distancing strategies aimed at slowing the spread of disease may be implemented countywide
Local Emergency Management Plans will be activated countywide directing the management of non-medical information and non-medical resources
Mutual aid from outside south Idaho will be limited or unavailable
It is important to understand that just like an earthquake or winter storm, emergency responders and EOCs will be fully activated.
For nearly all other hazards, we contact neighboring counties or the State EOC for mutual aid assistance. Why would we not be able to rely on mutual aid during a pandemic?
Everyone is impacted or potentially impacted so there are very few if any available resources to share.
See handout #1 on planning assumption numbers

10. History of Influenza Pandemics

11. US Deaths in Previous Pandemics
: 500, ,000
: 70,000
: 34,000
Typical annual influenza season: 36,000

12. 1918 Influenza Pandemic Spread around the globe in 4 - 6 months
At least million people died worldwide
Death rate 25 times higher than previous epidemics
Pandemic affected and killed younger, healthy people

13. This slide series illustrates the spread of influenza in the U. S
This slide series illustrates the spread of influenza in the U.S. during the 1918 pandemic. In a matter of weeks, influenza had spread across the entire country.
It is thought that this rapid spread may have been facilitated by seeding of the virus the previous spring.

14. Current Avian Influenza Outbreak
We will review the pandemic flu preparedness structure currently in place within PHSKC, as well as the county wide structure. Talk about PHSKC’s responsibilities.
We will talk about how the local health care system is preparing for a pandemic.
We will discuss major areas of emphasis locally, as well as state and federal preparedness responsibilities, responsibilities.

15. Current Outbreak of Avian Influenza (H5N1) Across Several Continents
204 confirmed human cases, 113 deaths
[Nine Countries, as of April 21, 2006)
No sustained person-to-person
transmission
Avian outbreak is not controlled
No pre-existing immunity in humans

20. We are Here Phases of a Pandemic World Health Organization
Mitigation and Preparedness
Response
Phase I
Phase 2
Phase 3
Phase 4
Phase 5
Phase 6
A classification system developed by the WHO for global pandemic preparedness planning and response activities.
Includes 6 phases of increasing public health risk associated with the emergence and spread of a new influenza virus subtype that may lead to a pandemic:
Interpandemic – Phases 1 & 2
Pandemic Alert – Phases 3, 4 & 5
Pandemic – Phase 6
Interpandemic
Pandemic Alert
Pandemic
We are Here
Declared globally by the World Health Organization
Declared nationally by the Department of Health and Human Services

21. Impact of Pandemic Flu Today

22. Pandemic Impact Characteristic Severe Flu (Like 1918)
Total Population in South Central Idaho
165,000
Illness
25,000
Home care
19,800
Hospitalization
5,000
Deaths
1,400
Estimated numbers of Illness, Hospitalization, and Deaths
Severe Pandemic – South Central Idaho

23. Pandemic Impact Consequences will effect all organizations:
Extreme staffing shortages (30%)
Overwhelming demand for services
(health care, first responders)
Limited supplies (transportation disrupted)
Reduced reliability in communications, power, water, fuel availability, transportation service
Reduced reliability on contractor services
(maintenance and repair)
The very system we’ll need to triage, diagnose and treat our residents will be severely strained in a pandemic outbreak:
25-35% of our health care workforce will be personally affected by the disease and unable to work
We will not have sufficient hospital beds to take the number of patients who should be admitted
Our current supplies of items like ventilators and drugs will be insufficient
The deaths will overwhelm our hospital morgues, the Medical Examiner’s capacity, and mortuary services
Our residents will have a very high need for social and mental health services; and that need will outstrip supply

24. Pandemic Impact Impacts on Law Enforcement:
25% - 35% of officers absent due to illness, death, caring for family members
911 dispatch centers operating with reduced staff, higher call volumes
Large numbers of people unable to purchase food, pay bills – high unemployment and schools closed
Potential for civil unrest over weeks / months
Hospitals may become high security areas
No mutual aid available
The very system we’ll need to triage, diagnose and treat our residents will be severely strained in a pandemic outbreak:
25-35% of our health care workforce will be personally affected by the disease and unable to work
We will not have sufficient hospital beds to take the number of patients who should be admitted
Our current supplies of items like ventilators and drugs will be insufficient
The deaths will overwhelm our hospital morgues, the Medical Examiner’s capacity, and mortuary services
Our residents will have a very high need for social and mental health services; and that need will outstrip supply

25. Pandemic Impact Impacts on Transit / Transportation:
25% - 35% of drivers, maintenance crews, leadership absent due to illness, death, caring for family members
Mechanics unavailable to affect repairs
Fuel deliveries reduced in frequency or erratic
Contractors normally relied upon also impacted
The very system we’ll need to triage, diagnose and treat our residents will be severely strained in a pandemic outbreak:
25-35% of our health care workforce will be personally affected by the disease and unable to work
We will not have sufficient hospital beds to take the number of patients who should be admitted
Our current supplies of items like ventilators and drugs will be insufficient
The deaths will overwhelm our hospital morgues, the Medical Examiner’s capacity, and mortuary services
Our residents will have a very high need for social and mental health services; and that need will outstrip supply

26. Pandemic Impact Impacts on Airports:
25% - 35% of all workers absent due to illness, death, caring for family members :
air traffic controllers
baggage handlers
Access to critical supplies such as fuel, spare parts, other services will be limited
School closures – how many workers have children in school or day care?
No mutual aid available
The very system we’ll need to triage, diagnose and treat our residents will be severely strained in a pandemic outbreak:
25-35% of our health care workforce will be personally affected by the disease and unable to work
We will not have sufficient hospital beds to take the number of patients who should be admitted
Our current supplies of items like ventilators and drugs will be insufficient
The deaths will overwhelm our hospital morgues, the Medical Examiner’s capacity, and mortuary services
Our residents will have a very high need for social and mental health services; and that need will outstrip supply

27. South Central District Health Pandemic Influenza Response Plan
Goals
Responsibilities
Preparedness Structure
We will review the pandemic flu preparedness structure currently in place within PHSKC
We’ll talk about our major objectives and the scope of our responsibilities
We’ll identify current issues being worked to give you an idea of the latest issues and questions under development.

28. Goals of the Plan Public Health Preparedness Limit illness and death
Preserve Continuity of Government / Business
Minimize social disruption
Minimize economic loss
Important to understand:
These goals are in priority order
Actions taken to save lives and preserve continuity of critical functions may not support the other goals.
We need to be aware that there will be disruption of normal systems, normal functioning of society.
Although we want to minimize it, we can not place economic or societal stability above saving lives and preserving essential functions.
There will be trade offs.
What will help us achieve #1 and #2, and can we do it without sacrificing #3 and #4?

29. Public Health Objectives
Public Health Preparedness
Public Health Objectives
Maintain and expand functions critical to pandemic response
Maintain critical day-to-day operations
All Department resources may be needed to address the consequences of a pandemic
Some Department functions may be suspended
Business continuity planning and “response team” development are underway
Critical Pan Flu Response Functions:
Surveillance
Distribution of antivirals and vaccine
Clinical guidance and infection control
Community containment strategies
Pub ed and risk communications
Critical day-to day functions may include:
Payroll
MIS
Personnel
As well as many others

30. Response Phase Direction and Control
South Central District Health will direct the countywide health and medical response with health care system partners
Local Health Officer will issue countywide directives when needed (i.e. school closings, health and medical response)
South Central District Health response actions will emphasize surveillance, social distancing, and communications
All local jurisdictions will activate emergency operations plans as needed
Local Elected Officials will issue directives to ensure continuity of government

31. Antiviral Medications
Response Phase
Antiviral Medications
CDC is stockpiling anitivirals in the SNS
Vaccines and antivirals will be prioritized for predefined target groups
Local Health Officer will direct (via PH Order) how these medications will be used
Work to do:
Still need to define the target groups in KC based on the broad guidance provided in the HHS plan.
Lots of unanswered questions regarding:
the potential availability of vaccine
how it would be accessed
how it would be delivered
who would be involved in administering it
when it might be available

32. Social Distancing / Isolation and Quarantine
Response Phase
Social Distancing / Isolation and Quarantine
Isolation of patients will occur throughout the event
(mainly at home)
Quarantine of close contacts may occur only in the early phases
Decisions regarding closings and reopening will be based on current epidemiological data
Questions
Will isolation be enforced?
Why stop quarantine at later phases?
Flu spreads too fast, prior to symptoms showing. No way to efficiently identify and track huge numbers of contacts
What is CDC DQ going to do at the airport and what will we be asked to do there?

33. Social Distancing / Isolation and Quarantine
Response Phase
Social Distancing / Isolation and Quarantine
Schools, large child care centers and libraries may be closed early by the Local Health Organization
Stadiums, theaters, churches may be closed by the LHO
Schools means all public, private and colleges / universities. Probably libraries and large day care centers at the same time
The key is to notify the parties we will be closing in advance, along with elected leaders and response partners so they can prepare for the associated consequences.
Appendix D-1 and D-2, E and F speak to social distancing and the specific criteria that will be considered in making these decisions
When LHO determines that schools (public and private K-12, colleges and universities), libraries and large day care centers must be closed, they will be closed indefinitely (several weeks).
Many parents of school-aged children will have to stay home as well.
It will be important to understand the impacts of our decisions. These first impacts to our workforce will likely occur before significant levels of illness occur in KC.
All organizations will be asking the following questions:
Do we know how many of our employees will have to stay home to care for children now that schools are closed?
Do we know which functions in our organization will be affected?
Do we have contingency plans in place to address this?
How much notice do we need from PH to implement those plans?

34. Health Care System Preparedness
Health Care Coalition
Key Components
Key Objectives
We will define the health care coalition, its purpose and composition, key components and objectives

35. Preparing for Pandemic Influenza
Health Care System Preparedness
Preparing for Pandemic Influenza
Severe Pandemic = Mass Casualty Event
Extreme stress on healthcare system:
Overwhelmed capacity
Limited resources
Ongoing critical care needs
All sectors impacted
Weeks to months in duration and global in scope
Need a new way for the health care system to organize and maintain an effective response

36. Health Care System Preparedness
Health Care Coalition
Comprised of representatives from a broad base of health care organizations
Coordinating body and information clearinghouse for the medical system during major emergencies
Health care system response will resemble Unified Command
Why build a HCC:
1. The healthcare system is complex with many players.
2. Planning by individual facilities is necessary but not sufficient for robust community emergency response.
3. Community-wide healthcare emergency response structures and plans are not sufficiently comprehensive to respond to major disasters.
4. There is no forum for public officials and healthcare leaders to discuss policy issues.
5. In an emergency, there is no operational mechanism in place to coordinate and manage resources and information across healthcare organizations.
6. The linkages between the overall healthcare system and the emergency incident command structure need to be strengthened.

37. Health Care Coalition Participants
Health Care System Preparedness
Health Care Coalition Participants
Hospitals
Large medical groups
Safety net healthcare organizations
Professional associations
Home health and long term care providers
Key stakeholders, e.g. EMS, Red Cross

38. Health Care Coalition Responsibilities
Health Care System Preparedness
Health Care Coalition Responsibilities
Develop all-hazard preparedness plans
Develop an Executive Advisory Body:
Review plans and agreements
Advise the LHO on health issues during disasters
Develop a Regional Medical Resource Center
Information Management
Resource Management
Communication
Work with Public Health and emergency management officials to develop
all-hazard preparedness plans, initially emphasizing pan flu preparedness
Develop an executive-level advisory body to review preparedness plans and resource sharing agreements
Develop an emergency coordination and communication system for healthcare organizations
Sample Items for the HCC to work on:
Regional Agreements
Review resource-sharing agreements developed by workgroups, including the Hospital Emergency Preparedness Committee
Policy Issues
Defining elective admissions, surgeries and procedures to be suspended
Defining threshold for canceling elective surgeries to expand bed capacity
Identifying essential healthcare workers for prioritization of vaccines and antiviral medications

39. Regional Responsibilities
Emergency Management
Public Works
First Responders
Human Services
General Government
Private Sector
We will review the county wide pandemic flu preparedness structure currently in place.
We will discuss major areas of emphasis locally, as well as state and federal preparedness responsibilities.

40. Pandemic Preparedness Responsibilities of All Partners
Educate and Inform:
Department / Business Leaders
Supervisors
Staff
Families

41. Wash hands regularly and use alcohol hand gel
Pandemic Preparedness Responsibilities of All Partners
Influenza Prevention
Stay home when sick
Cover your cough
Wash hands regularly and use alcohol hand gel
Avoid touching eyes, nose, mouth

42. Pandemic Preparedness Responsibilities of All Partners
Individual Preparedness
Store an extended supply of food and water at home
Store nonprescription drugs and health supplies at home
Plan with family members about the following:
Caring for loved ones who get sick
Caring for children if the schools are closed
Other impacts on your life if you need to stay at home for an extended period of time
Use separate triage area or designated outpatient clinic sites for persons with fevers or respiratory symptoms.
Have separate sites for persons with highest risk of illness
Consider triage officer’s to manage patient flow and referrals
Anticipate equipment shortages – respiratory care, mechanical ventilation

43. Pandemic Preparedness Responsibilities of All Partners
Continuity of Operations Planning
Identify key functions
Cross train staff
Identify telecommuting opportunities
Review HR policies (sick leave, flex shifts)
Identify ways to maintain payroll functions
Make alcohol gel, disinfectant wipes available

44. Pandemic Preparedness Responsibilities of All Partners
Information Management
Develop ways to track absenteeism
Identify thresholds for critical capacities
Develop reporting strategies for tracking region-wide impacts to critical systems
Develop templates for region-wide situation reporting

45. Pandemic Preparedness More Information…
South Central Public Health District
Pandemic Flu Web Site -
On our Pandemic Flu Page:
Fact Sheets on Pandemic Flu
Checklists for Businesses, Health Care, and Government Agencies
Posters and materials for children