1. May 2006Fences or Flowers Pandemic Influenza and Preparedness Dr Michael Hills Associate Director Critical Response Coordination Health Services Functional Area Coordinator South Eastern Sydney and Illawarra AHS

2. May 2006Fences or Flowers Acknowledgement Several slides come from the UK Department of Health’s website http://www.dh.gov.uk/ - Pandemic FluSeveral slides come from the UK Department of Health’s website http://www.dh.gov.uk/ - Pandemic Flu

3. May 2006Fences or Flowers Outline InfluenzaInfluenza HistoricalHistorical ManagementManagement Health PlanningHealth Planning Business ContinuityBusiness Continuity

4. May 2006Fences or Flowers Understanding pandemic Epidemic: serious outbreak in a single community, population or regionEpidemic: serious outbreak in a single community, population or region Pandemic: epidemic spreading around the world affecting hundreds of thousands of people, across many countriesPandemic: epidemic spreading around the world affecting hundreds of thousands of people, across many countries

5. May 2006Fences or Flowers What is a flu pandemic? Flu pandemics are global epidemics of a newly emerged strain of flu (a new influenza A subtype)Flu pandemics are global epidemics of a newly emerged strain of flu (a new influenza A subtype) Three pandemics in the last centuryThree pandemics in the last century Worst killed 20 - 40 million worldwide – more lives lost than during the First World WarWorst killed 20 - 40 million worldwide – more lives lost than during the First World War

6. May 2006Fences or Flowers What causes pandemic flu? Emergence of a new flu virusEmergence of a new flu virus New virus passes easily from person to personNew virus passes easily from person to person Few, if any, people have any immunityFew, if any, people have any immunity This allows it to spread widely, easily and to cause more serious illnessThis allows it to spread widely, easily and to cause more serious illness

7. May 2006Fences or Flowers Who is at risk? Everyone is at riskEveryone is at risk Certain groups may be at greater risk of serious illness than othersCertain groups may be at greater risk of serious illness than others Until the virus starts circulating we will not know for sure who is at most riskUntil the virus starts circulating we will not know for sure who is at most risk

8. May 2006Fences or Flowers Is there a vaccine? Because the virus will be new, there will be no vaccine ready to protect against pandemic fluBecause the virus will be new, there will be no vaccine ready to protect against pandemic flu A specific vaccine cannot be made until the virus has been identifiedA specific vaccine cannot be made until the virus has been identified Cannot be predicted in same way as ‘ordinary’ seasonal fluCannot be predicted in same way as ‘ordinary’ seasonal flu ‘Ordinary’ flu vaccine or past flu jab will not provide protection‘Ordinary’ flu vaccine or past flu jab will not provide protection

9. May 2006Fences or Flowers An acute illness resulting from infection by an influenza virusAn acute illness resulting from infection by an influenza virus Highly infectiousHighly infectious Can spread rapidly from person to personCan spread rapidly from person to person Some strains cause more severe illness than othersSome strains cause more severe illness than others What is influenza?

10. May 2006Fences or Flowers Symptoms Generally of sudden onsetGenerally of sudden onset Fever, headache, aching muscles, severe weaknessFever, headache, aching muscles, severe weakness Respiratory symptoms e.g. cough, sore throat, difficulty breathingRespiratory symptoms e.g. cough, sore throat, difficulty breathing

11. May 2006Fences or Flowers Incubation period of influenza Estimates varyEstimates vary The range described is from 1 to 4 daysThe range described is from 1 to 4 days Most incubation periods are in the range of 2-3 daysMost incubation periods are in the range of 2-3 days

12. May 2006Fences or Flowers How influenza spreads Easily passed from person to person through coughing and sneezingEasily passed from person to person through coughing and sneezing Transmitted throughTransmitted through –breathing in droplets containing the virus, produced when infected person talks, coughs or sneezes –touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face

13. May 2006Fences or Flowers YearStrainName Global deaths 1918-19H1N1 “Spanish” Flu 20-40 million (11,500 Aus) 1957-58H2N2 “Asian” Flu 1 million 1968-69H3N2 “Hong Kong” Flu 1 million Previous pandemics 1580 - 1900 - 28 pandemics

14. May 2006Fences or Flowers Circulating Influenza strains and pandemics in 20 th Century 19201940196019802000 H1N1 H2N2 H3N2 1918: “Spanish Flu”1957: “Asian Flu”1968: “Hong Kong Flu” 20-40 million deaths1 million deaths

15. May 2006Fences or Flowers Lessons from past pandemics Occur unpredictably, not always in winterOccur unpredictably, not always in winter Great variations in mortality, severity of illness and pattern of illness or age most severely affectedGreat variations in mortality, severity of illness and pattern of illness or age most severely affected Rapid surge in number of cases over brief period of time, often measured in weeksRapid surge in number of cases over brief period of time, often measured in weeks Tend to occur in waves - subsequent waves may be more or less severeTend to occur in waves - subsequent waves may be more or less severe Key lesson - unpredictability

16. May 2006Fences or Flowers Framework Australian Health Management Plan for Pandemic Influenza May 2006Australian Health Management Plan for Pandemic Influenza June 2005 May 2006 NSW Interim Pandemic Plan – Nov 2005NSW Interim Pandemic Plan – Nov 2005 Area Interim Plan – March 2006Area Interim Plan – March 2006 Hospitals etc.Hospitals etc. New national and state plans mid-2006New national and state plans mid-2006 COAGCOAG –National Action Plan for a Human Influenza Pandemic StatesStates –Whole of Government planning

17. May 2006Fences or Flowers Australian Health Management Plan for Pandemic Influenza Two core strategies:Two core strategies: –Containment initial priorityinitial priority –Maintenance of Social Functioning as it progressesas it progresses PhasesPhases –Overseas Level 3 –Australia Level 0

18. May 2006Fences or Flowers Challenges Health planningHealth planning Non-health planningNon-health planning Universal impactUniversal impact ScarcityScarcity UnpredictableUnpredictable UnknownUnknown Information will changeInformation will change VolumeVolume

19. May 2006Fences or Flowers Manage Workforce AbsenteeismAbsenteeism VaccinationVaccination Education and trainingEducation and training Protection, prophylaxisProtection, prophylaxis Allocation of dutiesAllocation of duties Re-allocation of staff to ‘flu responseRe-allocation of staff to ‘flu response Return to workReturn to work Child care requirementsChild care requirements

20. May 2006Fences or Flowers Manage Workload Curtailing of non-priority servicesCurtailing of non-priority services Establishment of fever clinics (if designated)Establishment of fever clinics (if designated) Triaging at ED’s and proceduresTriaging at ED’s and procedures Inpatient units (isolation, wards, ICU/HDU)Inpatient units (isolation, wards, ICU/HDU) Shift services to other sitesShift services to other sites Run new servicesRun new services Management of casesManagement of cases

21. May 2006Fences or Flowers Wider linkages Emergency AccommodationEmergency Accommodation Community linksCommunity links –General practice (through Divisions) –Home discharge –Travellers’ management –Roles of community service staff –Support at home and in nursing homes –Public health surveillance and reporting –Communication and coordination across sectors (National, State, Area, Sector, Public, Individuals)

22. May 2006Fences or Flowers Non-Health Sector COAGCOAG –National Action Plan for a Human Influenza Pandemic States and TerritoriesStates and Territories BusinessesBusinesses –Department of Industry, Tourism and Resources (mid-2006): www.industry.gov.au/avianflubusinesscontinuity www.industry.gov.au/avianflubusinesscontinuity

23. May 2006Fences or Flowers Business Continuity Planning “The most important thing businesses and community organisations can do to prepare for a pandemic is have a business continuity plan in place.” AHMPPI May 2006“The most important thing businesses and community organisations can do to prepare for a pandemic is have a business continuity plan in place.” AHMPPI May 2006 Different from other emergencies.Different from other emergencies. –emphasis on continuity in the event of high absenteeism and interruptions to the supply of goods and services –Absenteeism could be as high as 30% to 50%

24. May 2006Fences or Flowers Key issues Identify essential business activities + alternative arrangementsIdentify essential business activities + alternative arrangements Identify what is required for the organisation to continue operating at the minimum acceptable levelIdentify what is required for the organisation to continue operating at the minimum acceptable level Develop mitigation strategies for business disruptions and shortagesDevelop mitigation strategies for business disruptions and shortages Ensure wide awareness of contingenciesEnsure wide awareness of contingencies Minimising illness in workers, drawing on the guidance on infection control in this plan.Minimising illness in workers, drawing on the guidance on infection control in this plan.

25. May 2006Fences or Flowers Where Next? Consider it as one of the sources of risk in organisational planningConsider it as one of the sources of risk in organisational planning Use the opportunity to review critical aspects of servicesUse the opportunity to review critical aspects of services (Re) Learn interdependencies(Re) Learn interdependencies Start readingStart reading Be engagedBe engaged

26. May 2006Fences or Flowers Thank - you www.health.gov.auwww.industry.gov.au/avianflubusinesscontinuitywww.fluready.nethttp://www.dh.gov.uk