1. Pandemic Planning: Community Working Together GET INFORMED / BE PREPARED

2. Objectives Review of Influenza Virus and Illness, H5N1 avian influenza (“bird flu”) Pandemic Influenza Planning assumptions and principles National (Health and Human Services, or HHS) Tennessee Knox County Local Pandemic planning Individual Pandemic planning

3. Local Pandemic Planning Six groups Faith based/Community Healthcare Business Media Mortuary Schools/daycare You are here*

4. Why Plan? Evidence suggests… all communities would be severely impacted when a civilian disaster produces more than 120 casualties. Therefore, >120 casualties considered a major MCI- Mass Casualty Incident. In MCI, without Internal Disaster planning, estimated 40% business will fail. For social cohesion in a crisis to occur, planning and communication need to occur now.

5. The Pandemic Influenza Cycle Rapid transmission with worldwide outbreaks; multiple waves of disease over a 2 year period. Occurrence of cases outside the usual season. High attack rate for all age groups, with high mortality rates, esp for young adults Cycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)

6. Situation Report: Avian Influenza Widespread prevalence in migratory birds; broad host range Continued outbreaks among domestic poultry Mammalian infection (cats, pigs, etc.) - lethal Virus is evolving Sporadic human cases (>190 reports to date) Most in young and healthy, Case-fatality 50% Rare person-to-person transmission

7. 7 Avian Flu not yet Pandemic Flu, but current outbreaks for H5N1 Avian Flu in poultry and birds are the largest that have ever been documented. H5N1 Influenza and Pandemic Preparedness

8. Will H5N1 become the next pandemic? Impossible to know if or when If not H5N1, then another will come The prudent time to plan is now

9. HHS Objectives: Pandemic Planning and Response Primary objective: Minimize sickness and death Secondary objectives: Preserve functional society Minimize economic disruption There is not complete consensus on the proper order of these objectives

10. Assumptions about Disease Transmission No one immune to virus; 30% of population will become ill Most will become ill 2 days (range 1-10) after exposure to virus People may be contagious up to 24 hours before they know they are sick People are most contagious the first 2 days of illness Sick children are more contagious than adults On average, each ill person can infect 2 or 3 others (if no precautions are taken)

11. Medical Burden in Tennessee (pop. 6 million) (HHS Plan Estimates) CharacteristicModerate (0.2%) Severe (2%) Illness (30%)1.8 million Outpatient Care900,000 Hospitalization17,300198,000 ICU Care2,57529,700 Mechanical Ventilation 1,30014,850 Deaths4,180 (0.2%)38,060 (2%) *HHS recommends that states plan for severe scenario

12. Medical Burden in Knox County 2005 Knox County Population est. 396,741 CharacteristicModerate (0.2%) Severe (2%) Illness (30%) 119,000 Outpatient care 59,500 Hospitalization 1,190 11,900 ICU (15% hosp pts) 180 1,800 Mechanical ventilators (50% ICU pts) 90 900 Deaths 240 2,380

13. Preparing for a Pandemic in Knoxville Federal Plan: Local and Self-reliance is key Local groups to develop Internal Disaster Plan Surveillance Communications Infection Control Occupational Issues Vaccine/Antiviral access Public Health responsibility to educate and facilitate PanFlu planning Preparation by families and individuals essential

14. Influenza Virus: How it spreads Close contact (<6 feet) with sick person who is coughing or sneezing Touching a surface contaminated by respiratory secretions and getting the virus into mouth, nose or eyes.

15. Community Disease Control: Early Stage Isolation and Quarantine Initial Objective: slow spread of disease Isolation vs. Quarantine Legal measures possible but will rely on voluntary cooperation Housing, health care, psychological, spiritual, food needs must be met for those on isolation/quarantine Once beyond initial cases, shift strategy to “stay home when you are sick”

16. Influenza Containment Strategy: Community Response Basic Activities Surveillance; quarantine of early cases Public information and education Promote “respiratory hygiene” and hand washing Enhanced Activities Focused measures to increase social distance Community-wide measures to increase social distance

17. Community Disease Control: Community Wide Measures Reduce Social Contact : Canceling large gatherings, mass transit, schools Decision based on location of flu activity: Outbreak not local: gatherings >10,000 cancelled Outbreak in local/neighboring county: >100 School closings determined by State Commissioner of Health/Board of Education.

18. Vaccine or Antivirals?? Flu Vaccine Production minimum 6 month process: Growing eggs (93 million!) HHS priority groups 1.Military and Vaccine manufacturers 2.Healthcare workers with direct patient care 3. Persons at highest risk for complications Two doses needed for protection Tamiflu Anti-viral agent, currently in short supply Could be used in one area of world to contain first human outbreak Resistance described Should be used within 48 of infection HHS priority groups: military and hospitalized patients Tamiflu ≠ Preparedness

19. Guidance for Planning Because resources will be limited… Contingency planning should include: Planning for absenteeism: ~40% Hygiene products and education in the workplace Supply shortages Home offices for critical personnel Sick leave policies compatible with state recommendations

20. Planning to be away… Plan for childcare in the event schools close Arrangements made for eldercare, pet care Discuss/develop plan with employer how you might work at home

21. Guidance for Personal /Family Planning Personal protection: Hand hygiene and respiratory etiquette Surgical masks: proven effective for droplet precautions Pneumococcal vaccination of those for whom it is recommended Stockpiling: One to three week essential water, food, supplies, medicines

22. Surveillance Here at KCHD A traditional influenza responsibility of the Department of Health: Sentinel health care providers ER visits School absenteeism 911 calls CDC is planning additional national surveillance activities: hospitals and states will assist upon request

23. For those at work:Surveillance – Develop screening for employees with flu-like symptoms Develop sick leave policy specific for panflu Determine when ill employee may return to work

24. Internal and External Communication networks Detailed communications planning needed: Internal- Ensure employees know panflu policy, communications plan, their specific role, esp in surge capacity/ External- Point of contact with Health Department Access to Public Health education via media, internet, phone bank Coordinate with like organizations to develop/coordinate emergency plans Communicate with other organizations affected by yours

25. Infection Control Hand Hygiene Frequent washing 60%-95% alcohol-based sanitizer Environmental cleaning 1:10 bleach solution EPA registered disinfectant Gloves & surgical masks. Face shields/goggles for specialized procedures

26. Workforce Support Psychological and physical strain on personnel responding in emergency situation Psychological stress for families Plan for your staff to have adequate Sleep Food Access to psychological and spiritual support

27. Resources PandemicFlu.gov CDC.gov/flu/avian www.nyhealth.gov Knoxcounty.org/health Knoxpanflu@knoxcounty.org