1. California Department of Aging (CDA) Presentation on Disaster Preparedness and Avian/Pandemic Awareness March 23, 2006 By: Robert Ramsey-Lewis, Policy Manager Prepared For: California Association of Area Agencies on Aging (C4A) Materials From: California Department of Health Services, World Health Organization, US Health and Human Services, and Canadian Network for Emergency Preparedness and Response

2. Introduction “Any community that fails to prepare with the expectation that the federal government will, at the last moment, be able to come to the rescue will be tragically wrong. --Mike Leavitt, US Health and Human Services Secretary

3. When is an Emergency a Disaster? –A disaster occurs when the impact on the community exceeds its normal coping resources –A community’s coping resources are its people, materials, equipment, and services used to meet demand created by an incident Preparedness moves the disaster threshold. –Preparedness measures, e.g., evacuating vulnerable populations, increases the disaster threshold, permitting the community to cope better. Source: Canadian Network for Emergency Preparedness and Response, 2004

4. Area Plan Guidance Appendix XI, Disaster Preparation Planning, is optional for the 2006-2007 planning period. Appendix XI will be required for the 2007- 2008 planning period, in addition to an area plan objective concerning preparedness. Opportunity for input on the 2007-2008 Area Plan Guidance in the Fall, 2006.

6. Avian and Pandemic Influenza Howard Backer, MD, MPH California Department of Health Services Sandra Shewry, Director Mark Horton, State Public Health Officer

8. WHO Lab Confirmed Human CasesCasesDeaths Indonesia 16 (29) 11 (22) Vietnam9342 Thailand2214 Cambodia44 China 7 (15) 3 (10) TurkeyAzerbaijanIraq 4 (12) 72 2 (4) 52 Total 146 (184) 76 (103) As of Mar. 21 2006 Mortality 52%

9. Requirements for a Pandemic Unusual type of influenza virus found in humans Little or no immunity in the population Virus can multiply and cause disease in humans Easily spreads from person to person

10. WHO Pandemic Phases Phase 1InterpandemicNo new subtype Phase 2InterpandemicRisk from novel type Phase 3Alert phaseHuman infection-rare spread to contact Phase 4Alert phaseLimited human to human transmission Phase 5Alert phaseSmall clusters; poorly adapted Phase 6Pandemic period sustained transmission

11. Human influenza transmission

12. YearFluVirusMortality 1918-1919“Spanish” H1N1 20 million 550,000 US 1957-1958“Asian” H2N270,000 US 1968-1969“Hong Kong” H3N234,000 US Glezen WP. Epidemiol Rev. 1996;18:65. CDC. Influenza Prevention and Control. 20th Century Influenza Pandemics Which will the next pandemic resemble?

13. CDC Estimates of Percent of Population Affected by the Next Pandemic* Number Affected in California (Pop. 36,363,502)** 15% to 35% of pop. will become ill with flu 5.5 – 12.9 Million 8% to 19% of pop. will require out-patient visits 2.9 – 6.9 Million 0.2% to 0.5% of pop. will require hospitalization 73 – 170 Thousand 0.07% to 0.16% of pop. will die of flu-related causes 25 – 59 Thousand Pandemic Influenza Estimates for California *Estimates from FluAid 2.0, CDC **California Department of Finance Pop. Projections for 2003

14. Components of CDHS Pandemic Planning Organization of response and authorities Surveillance Lab Capacity Infection control Case Management Vaccine and antiviral Community Outbreak Control--nonmedical Health care planning--surge capacity Communications

15. Planning Assumptions It will not be business as usual All sectors of society and government will be involved Widespread impact limits mutual aid Sustained response required Workforce will be impacted, adding to disruption

16. Major response challenges Health care capacity –Estimates of hospitalizations and deaths vary by factor of 10, based on prior pandemics Pharmaceutical solution overly optimistic Need to maintain critical infrastructure Coordination of volunteers May introduce extreme and unusual measures Public will adopt their own measures Communication

17. Avian H5N1 Vaccine Current influenza vaccine is not protective Federal government –Support R&D, production capacity, and stockpile  Federal HHS plans to buy vaccine for 20 million –Distribute vaccine to states Estimate 6 month to produce enough vaccine CDHS –Distributes to local health departments –Technical assistance for mass vaccination –Sets prioritization policy

18. National Vaccination Priority Recommendations* TierElement 1A Health care involved in direct patient contact and essential support Vaccine and antivirals manufacturing personnel 1B Highest risk group (6 mos to 64 yrs with 2 or more risk conditions) 1C Household contacts of children <6 months and severely immune compromised, and pregnant women 1D Key government leaders and critical public health responders 2 Remainder of high risk group (1 risk condition, healthy 6-23 mo) Other public health responders and infrastructure personnel 3 Other key government health decision makers and mortuary services 4 Healthy 2-64 years not in other groups *Approved by NVAC/ACIP committee on July 19, 2005 # indv 9 m 40 K 26 m 11 m 151 K 60 m 8.5 m 500 K 180 m

19. Single manufacturer Worldwide shortage Use for treatment or prevention Prioritization challenges Virus may develop resistance Federal and state stockpiles Anti-viral Medication

20. Outbreak Containment Measures vary as pandemic develops Steps to reduce individual exposure to virus—(respiratory hygiene, masks) Isolation (confinement) of ill persons Quarantine of exposed persons Pharmaceuticals Community-based containment –Cancellation of events, schools, public meetings, malls, businesses, transportation –Snow days: nearly everyone stays home

24. Surge Capacity Flexibility of health care delivery system to accommodate large number of patients Beds –Emergency regulatory changes, increase in beds in existing facilities, alternative facilities, home care Personnel –ESAR-VIP; Medical Reserve Corps; citizens volunteers; staffing ratios; scope of practice changes Equipment –SNS; HRSA grant

25. HOSPITAL BED CAPACITY CountryRankBeds per 1,000 population Switzerland117.9 Japan216.5 Germany99.1 France148.2 UK424.1 Canada453.9 USA463.6 The Economist. World in Figures, 2005 Ed, p 85

26. January 4, 2006 Flu outbreak in Phoenix metro area Flood of visits to the emergency department and from illnesses on their own staff. Medical Center temporarily closed ED. Half-day waits in overcrowded EDs. Ambulance rides to other hospitals miles away. Postponements of routine elective surgeries and other medical procedures. Ambulance patients diverted to other hospitals. Staff sick calls are up 25 percent from last year.

27. Risk Communications Prepare the public with realistic scenarios and likely containment measures Inform public of actions they can take Train spokespersons at state and local levels Prepare health care and public health for their involvement Develop rapid communication channels with medical care Involve non-health sectors in preparedness activities

28. HHS Department Collaboration Identify roles and responsibilities Coordinate response in CA Partners for social distancing decisions and implementation Continuity of government and operations Communication channels Educating workforce Essential personnel for pharmaceuticals Plans for institutional populations