1. Los Angeles County Department of Public Health Emergent Disease Annex Briefing

2. Emergent Disease Annex 2 All-Hazards Emergency Plan (Feb. 2013) -Overarching Departmental emergency plan and response framework -Not specific to any hazard Emergency Operations Annex (Feb. 2014) -Preparation, response and recovery from emergent disease threat -Courses of Action (COAs) and Options -Activation and operation emergency management system (ICS) -Not specific to any hazard Emergent Disease Response Playbooks (Fall 2014) -DOC and Field Specific -ICS section specific -Key objectives, policies, COAs and decision points Emergent Disease Annex (Sept. 2014)

3. Situation and Scenario 3 Emergent Disease Could be caused by a number of organisms Unique disease transmission and severity profile No vaccine or treatment Sustained, human-to-human transmission Scenario (p.3) A novel, SARS-like coronavirus has emerged on the global stage. Early epidemiology and clinical reports from the country/region of origin suggest high transmissibility (R o ~3.0), and there is limited information on disease severity (i.e. hospitalizations, mortality) The disease rapidly progresses from emergence in a foreign country to some other major metropolitan areas in the U.S. before reaching Los Angeles County. Local outbreaks first occur at a school and hospital. Additional clusters then quickly emerge within the County. Each cluster is characterized by high severity in certain populations. The outbreak rapidly evolves through widespread transmission of the disease throughout the County.

4. Mission Areas 4 DPH Mission ( p.6) Save and sustain human life, minimize disease transmission, support public health and healthcare infrastructure and support community recovery. Mission Areas Operational planning in nine (9) key focus areas of responsibilities - Epidemiology and Surveillance- Non-Pharmaceutical Interventions - Public Health Lab- Healthcare Support - Public Information and Warning- Fatality Management - Emergency Management- Mass Care - Intel and Information Management Based on PHEP (CDC), HPP (ASPR) and FEMA Capabilities

5. Timeline 5 Timeline (p.12) Key operational response actions Phase 1a: Pre-Incident (Level Green) Phase 1b: Minimal Cases (Level Yellow/Orange) Phase 2a: Initial Response (Level Orange/Red) Phase 2b: Continued Response (Level Black) Phase 3: Recovery (Level Yellow/Orange) No Cases<10 Cases<100 Cases>100 Cases<100 Cases Monitor Situation Investigate Possible Cases Distribute CDC Guidance Investigate Possible Cases Isolate Cases Assess Severity Distribute CDC Guidance Isolate Cases Quarantine Contacts Community NPIs Assess Severity & Transmissibility Distribute CDC Guidance Cohort Cases Community NPIs Distribute CDC Guidance Demobilization Support Community Recovery

6. Objectives and Key Actions Epi & Surveillance [Appendix B1] –Develop critical information and inform DPH/DOC decision making –Cases; Efficacy of interventions/COAs; Forecast potential impacts Public Health Lab [B2] –Facilitate rapid detection and confirmation of cases Emergency Public Info & Warning [B3] –Develop, coordinate and disseminate warnings and notifications –Many audiences: Healthcare, First responders, Media, Community –At-risk, vulnerable populations 6

7. Objectives and Key Actions Emergency Management [B4] –Manage, sustain DPH response –Coordinate with local, state and federal response agencies Intelligence and Information Management [B5] –Collect, analyze and depict incident information Non-Pharmaceutical Interventions [B6] –Control spread, limit effect of disease –Centerpiece of Annex –Isolation, Quarantine, Community NPI –Efficacy v. Resources 7

8. Objectives and Key Actions Healthcare Support [B7] –Coordination; Communication; Facilitation –Guidance; PPE; Infection control practices Mass Care [B8] –Support health, medical, mental health and social needs of impacted individuals –Coordination of services with partner agencies Fatality Management [B9] –Support recovery, identification and handling of decedents –Surge in death certificates –Support in family assistance centers 8

9. Mission Area Responsibilities 9 Mission Area Public Health CEO/Emergency Management Sheriff’s Department Fire Department Health Services Mental Health Social Services Coroner Epi and Surveillance P S Public Health Lab P S Public Information and Warning SS P S R Emergency Management S P S S Intelligence and Information Management P SS S RRR Non-Pharmaceutical Interventions P S R SS Healthcare S R S P R Mass Care S R SSS P Fatality Management S R SS R P P = Principal Agency S = Support Agency R = Resource Agency

10. 10 Assess & Prioritize Hazards Determine Goals & Objectives Develop the Annex -Planning Directive -Form Core Planning Team -Define Scenario, Assumptions, Goals and Mission Area Objectives -Form Dept. planning workgroups -Develop and analyze COAs and tasks -Write Annex -Vet with Executives for approval Prepare, Review & Approve Annex -Present plan to: -Key government agencies -Healthcare partners -Community stakeholders -Approval by DPH Executives -Submit approved plan to ECO/OEM for County inclusion & adoption Train, Exercise and Maintain Annex Engage the Community -Develop and conduct trainings -Develop and conduct exercises -Review/revise approved plan (every 3 years) Whole Community: FEMA Process in LACDPH