1. Planning for Pandemic 2009 H1N1

2. Key Interagency Points COOP / COG COOP / COG CI/KR CI/KR Interact with the Public / Business Community Interact with the Public / Business Community 1 st Responder Support 1 st Responder Support Social Distancing Social Distancing School Closure School Closure Higher Ed Higher Ed Cancelling Public Events Cancelling Public Events Behavioral Health Behavioral Health

3. Ongoing Initiatives Operationalized (for H1N1) State PanFlu Plan, recently reviewed by Feds and updated. Monitor stock levels. Operationalized (for H1N1) State PanFlu Plan, recently reviewed by Feds and updated. Monitor stock levels. Coordinate with partners for deployment of state antiviral stockpile Coordinate with partners for deployment of state antiviral stockpile Provide daily Situation Reports to state leadership. Provide daily Situation Reports to state leadership. Posting H1N1 info on WebEOC Posting H1N1 info on WebEOC Coordinating with DOE and DMHMRSAS Coordinating with DOE and DMHMRSAS DOE working closely w/ PUBLIC Schools DOE working closely w/ PUBLIC Schools DMHMRSAS w/ CSBs DMHMRSAS w/ CSBs

4. Ongoing Initiatives Develop Guidance Documents / Outreach: Develop Guidance Documents / Outreach: DOE/ Higher Ed, Healthcare, Responders, Pharmacies, etc. DOE/ Higher Ed, Healthcare, Responders, Pharmacies, etc. Received SNS material and operationalizing distribution plan. Received SNS material and operationalizing distribution plan. Active Public Communications Campaign Active Public Communications Campaign Updating Website, Press Releases, FAQs, talking points daily+. Updating Website, Press Releases, FAQs, talking points daily+. Daily Thematic Press Teleconferences, Interviews Daily Thematic Press Teleconferences, Interviews Talking Point Virtual Library Talking Point Virtual Library

5. Incident Commander Dr. Mark Levine Deputy Commissioner Planning Chief Bob Mauskapf Situation Unit Leader Steve Harrison Technical Advisors 35 District Health Planning Units District Planners Operations Chief Dr. Diane Helentjaris Education Branch Director Suzi Silverstein Hospital/Medical Community Branch Director Bill Berthrong EMS Unit Leader Jim Nogle Lab Branch Director Dr. Jim Pearson Fatality Mgmt Director Dr. Leah Bush Behavioral Health Branch Director Beth Nelson, DMHMRSAS CHS Branch Director Jeff Lake 35 Local Health Dept. Units District Directors Epi Branch Director Diane Woolard, PhD Logistics/Administration/ Financial Chief Stacey Ferrer HR Becky Bynum Deputy Incident Commander Rob Oldham, MD Liaison Officer Joe Hilbert PIO Phil Giaramita Safety Officer Joanne Wakeham, PhD SWINE FLU ICS DR. KAREN REMLEY, COMMISSIONER

7. DCLS Laboratory Testing Initially performed validated seasonal flu assay for A/H1, A/H3, and influenza B; forwarding “untypeable” (probable swine flu) specimens to CDC Initially performed validated seasonal flu assay for A/H1, A/H3, and influenza B; forwarding “untypeable” (probable swine flu) specimens to CDC Modified test algorithms and performed Swine flu testing on specimens when the patient met the VDH/DCLS case criteria Modified test algorithms and performed Swine flu testing on specimens when the patient met the VDH/DCLS case criteria Implemented electronic system to pre-accession and track swine flu samples; VDH Regional epidemiologists approved sample submission and assigned numbers based on criteria prior to file transfer to DCLS Implemented electronic system to pre-accession and track swine flu samples; VDH Regional epidemiologists approved sample submission and assigned numbers based on criteria prior to file transfer to DCLS Prepositioned specimen collection kits in OCME regional sites and all District HD for redistribution to medical facilities statewide Prepositioned specimen collection kits in OCME regional sites and all District HD for redistribution to medical facilities statewide Expanded courier schedule to 7 day pickup at District HD locations Expanded courier schedule to 7 day pickup at District HD locations

8. DCLS Laboratory Testing Verified the CDC-Emergency Use Approval (EUA) Swine flu assay in 3 days; CDC certified to report confirmed (positive) influenza A/H1 (swine) results Verified the CDC-Emergency Use Approval (EUA) Swine flu assay in 3 days; CDC certified to report confirmed (positive) influenza A/H1 (swine) results Continued to test respiratory viruses and sub-type seasonal influenza A for H1 and H3 to meet obligation as a WHO reference laboratory Continued to test respiratory viruses and sub-type seasonal influenza A for H1 and H3 to meet obligation as a WHO reference laboratory Updated website information, established a laboratory call center, emailed and blast-faxed laboratory safety, specimen collection and shipping information to Sentinel physicians, sentinel laboratories, and District HDs. Updated website information, established a laboratory call center, emailed and blast-faxed laboratory safety, specimen collection and shipping information to Sentinel physicians, sentinel laboratories, and District HDs. Modified LIMS applications; implemented reports and queries; Modified LIMS applications; implemented reports and queries; Enhanced electronic messaging to provide results to VDH and CDC using HL7 reporting standards Enhanced electronic messaging to provide results to VDH and CDC using HL7 reporting standards Diverted and trained additional staff from other parts of DCLS to support accessioning, testing and reporting Diverted and trained additional staff from other parts of DCLS to support accessioning, testing and reporting

9. Pandemic Influenza Planning: Health Risk communications Risk communications Community containment Community containment Antiviral distribution plan Antiviral distribution plan Mass vaccination Mass vaccination Medical surge, healthcare coalitions Medical surge, healthcare coalitions Surveillance and investigation Surveillance and investigation Laboratory services Laboratory services Fatality management Fatality management Altered standards of care due to resource limitations Altered standards of care due to resource limitations

10. Issue: Antivirals Federal stockpile of antivirals growing Federal stockpile of antivirals growing VA has 770 K courses on-hand VA has 770 K courses on-hand Rec’d 280K add’l courses from SNS Rec’d 280K add’l courses from SNS For Treatment only: Distribution Through Pharmacies+++, in accordance with VDH SNS / Medical Countermeasure Distribution plan For Treatment only: Distribution Through Pharmacies+++, in accordance with VDH SNS / Medical Countermeasure Distribution plan Increasing supply and production capacity Increasing supply and production capacity Discussion of increased prophylaxis use Discussion of increased prophylaxis use AV Prescription Abuse; Stockpile implications: AV Prescription Abuse; Stockpile implications: Avg. Day: AB Co. receives orders for 6k courses Avg. Day: AB Co. receives orders for 6k courses 5/3: 600k courses; Allocations established. 5/3: 600k courses; Allocations established.

11. Vaccines No H1N1 Vaccine yet developed; Working. No H1N1 Vaccine yet developed; Working. VDH has a robust and frequently tested Statewide Mass Vaccination Plan an element of VDH Strategic National Stockpile / Medical Countermeasure Distribution Plan VDH has a robust and frequently tested Statewide Mass Vaccination Plan an element of VDH Strategic National Stockpile / Medical Countermeasure Distribution Plan

12. Pandemic Influenza Planning: Non-Health Command and Control Command and Control Public Safety Sustainability Public Safety Sustainability Community containment measures Community containment measures Economic impact Economic impact School closure / Event cancellation School closure / Event cancellation Isolation Isolation Voluntary quarantine Voluntary quarantine Continuity of Operations: Continuity of Operations: Government entities Government entities Critical infrastructure: Courts, economy, trade, business Critical infrastructure: Courts, economy, trade, business Agriculture, water and food chain safety Agriculture, water and food chain safety Human resource issues, policies (public and private) Human resource issues, policies (public and private)

13. Extended Pandemic Influenza Planning Include involvement of: Include involvement of: DOD Installations DOD Installations Courts Courts Schools/Colleges and Universities Schools/Colleges and Universities First responders – fire, EMS/Public safety, Law enforcement First responders – fire, EMS/Public safety, Law enforcement Business community/Private sector Business community/Private sector Media Media Assisted living and other social services programs Assisted living and other social services programs Volunteer, non-profit groups/Faith community Volunteer, non-profit groups/Faith community Coordinated planning of federal, state, local governments and agencies Coordinated planning of federal, state, local governments and agencies

14. Public Information Issues Integrity of media lists Integrity of media lists Importance of setting clear guidelines and sticking to them Importance of setting clear guidelines and sticking to them Control messages by maintaining consistent news flow Control messages by maintaining consistent news flow Value of networking to dispel contradictory or false information Value of networking to dispel contradictory or false information Partnership support on staffing needs Partnership support on staffing needs Timely approval process Timely approval process

15. Lessons Learned Refine human resource, purchasing, and financial management guidelines for statewide application. Refine human resource, purchasing, and financial management guidelines for statewide application. Improve State Agency familiarity on Continuity of Government plans and policies, and develop additional measures where gaps were identified. Improve State Agency familiarity on Continuity of Government plans and policies, and develop additional measures where gaps were identified. Define and determine “essential personnel” in consideration of a protracted event and assure measures are in place to provide for augmentation personnel and cross-training. Define and determine “essential personnel” in consideration of a protracted event and assure measures are in place to provide for augmentation personnel and cross-training.

16. Lessons Learned (cont’d) Identify state, local government and private sector essential infrastructure and services. Identify state, local government and private sector essential infrastructure and services. Consider Enforcement and Inspection waivers if needed due to staff shortages and to assure business continuity. Consider Enforcement and Inspection waivers if needed due to staff shortages and to assure business continuity. Evaluate legality of suspending FOIA laws pertaining to electronic meetings, quorums and public meeting requirements at the state and local levels, and determining if meeting requirements can be suspended, waived or modified so that state boards can meet on the telephone or electronically. Evaluate legality of suspending FOIA laws pertaining to electronic meetings, quorums and public meeting requirements at the state and local levels, and determining if meeting requirements can be suspended, waived or modified so that state boards can meet on the telephone or electronically. Develop social distancing messages/protocols and public countermeasures. Develop social distancing messages/protocols and public countermeasures.

17. Lessons Learned (cont’d) Prioritize supply chain services and resources to ensure essential needs are met. Consider stockpiling of essential supplies where appropriate. Prioritize supply chain services and resources to ensure essential needs are met. Consider stockpiling of essential supplies where appropriate. Resolve misconceptions on responsibilities for fatality management. Resolve misconceptions on responsibilities for fatality management. Work with the media in delivering educational information to the public. Work with the media in delivering educational information to the public. Vigorously pursue improvements to telework policies and capabilities. Vigorously pursue improvements to telework policies and capabilities.

18. PanFlu COOP Discuss expectations with staff early Discuss expectations with staff early Communications will be key Communications will be key Need reliable, credible sources of information Need reliable, credible sources of information Need coordinated communication channels Need coordinated communication channels Rely on both internal/external channels Rely on both internal/external channels May need to consider relief for regulatory requirements May need to consider relief for regulatory requirements Coordinate vertically and horizontally. Coordinate vertically and horizontally. Cross-train Cross-train Succession is a two-way street. Succession is a two-way street.

19. Questions? http://www.cdc.gov/swineflu http://www.vdh.virginia.gov http://www.vdh.virginia.gov/pandemicflu http://www.vdh.virginia.gov/pandemicflu