Transcript Pandemic Preparedness

Isolation and Quarantine
Workgroup
March 17, 2006
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Workgroup Members
PENNSYLVANIA DEPARTMENT OF HEALTH:
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Veronica V Urdaneta, MD, MPH (Chair)
State Epidemiologist and Director
Division of Infectious Disease Epidemiology
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Yvette Kostelac
Attorney 4
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Thomas McGroarty
EMS Program Specialist
Bureau of EMS
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John Bart, DO
Public Health Physician
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Anne Evans
Executive Director, South East District Office
OTHER AGENCIES REPRESENTATIVES:
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Department of Military and Veteran’s Affairs:
Lt. Col. Xavier Stewart (Co-Chair)
Director, Military Support to Civil Authorities
Deputy Director, J2/3
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Pennsylvania State Police
John Lutz
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Department of Aging:
Dan McGuire
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Department of Corrections:
Alan Fogel
Nicholas Scharff MD MPH
Robert Dusel, Sr.
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Department of Education:
Sarah Pearce
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Department of Homeland Security:
Roland “Bud” Mertz
Deputy Director for Homeland Security
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Department of Public Welfare:
Jill Morrow-Gorton
Medical Director, Office of Mental Retardation
Pennsylvania Emergency Management Agency
(PEMA)
Richard D. Flinn Jr.
Deputy Director for Operations
Constitutional Basis of
Quarantine
• Intrastate quarantine power
– Considered a police power-- an
inherent authority to protect
health, welfare, and morals of
citizens
– Reserved to states (10th
Amendment)
• Foreign and interstate
quarantine
– Considered essential in
regulation of foreign and
interstate commerce
– Federal authority (Commerce
clause)
Diseases Subject to
Quarantine (2005)
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Cholera
Diphtheria
Infectious TB
Plague
Smallpox
Yellow fever
Viral hemorrhagic fevers
SARS
Potentially Pandemic Influenza Viruses
Others as determined by the Secretary of Health and
Human Services
Management Strategies: Persons
with Disease
Isolation
• separation and restricted movement of ill
persons with contagious disease
• often in a hospital setting
• primarily individual level, may be applied to
populations
• often voluntary, but may be mandatory
• fundamental, commonly used public health
practice
Management Strategies: Contacts
to Persons with Disease
• Range of strategies designed to meet two
objectives
– Facilitate early recognition of symptoms should
they develop
– Reduce risk of transmission before progression to
disease has been recognized
• Applied at the individual or community level
• Close clinical monitoring key to all contact
management strategies
Management Strategies: Contacts
to Persons with Disease
Clinical monitoring
– Assessment for signs and symptoms in
well person(s) exposed to a contagious
disease
– May be passive or active
– May be done with or without activity
restrictions (quarantine)
Management Strategies: Contacts
to Persons with Disease
Quarantine
– separation and restricted movement of
well persons presumed to have been
exposed to contagion
– often at home, may be designated
residential facility
– may be voluntary or mandatory
Quarantine Dichotomy
• “Quarantine” may have negative connotations
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Black Death, Yellow fever, Pandemic Flu
Detention camps equate disease with crime
Stigmatizes victims (e.g., foreign born)
Historical abuses of power
• Quarantine works
– As good or better than other tools to prevent
spread of contagion
– When combined with other techniques may result
in more rapid control
Modern Quarantine
A collective action for the
common good predicated
on aiding individuals
infected or exposed to
infectious agents while
protecting others from the
dangers of inadvertent
exposure
Principles of Community
Containment (1)
Containment measures may need to be implemented
when:
• A person or group of people has been exposed to a highly
dangerous and contagious disease
• Exposed well persons need to be separated from ill cases
How can YOU partner to assure resources are available
to implement and support interventions at the local
level:
– Provide essential goods and services
– Monitor health status (active vs. passive)
– Provide immediate triage & medical care / isolation
Principles of Community
Containment (2)
Strategies that YOU can use for containment
at the local level:
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“Snow days” or “shelter-in-place”
Suspension or restrictions on group assembly
Cancellation of public events
Closure of mass public transit
Closing of public places
Restriction or scaling back of non-essential travel
Cordon sanitaire
Principles of Community
Containment (3)
Containment measures are more likely to
be applied to small numbers of exposed
persons in focused settings:
– Exposed persons on conveyance
containing ill passenger(s)
– Exposed persons in a theater where an
intentional release has been announced
– Close contact to a person with Influenza
Principles of Community
Containment (4)
Implementation of containment measures
require:
• a clear understanding of public health roles at
local, state, and federal levels
• cooperation between public and private
healthcare sectors
• well-understood legal authorities at each level
Principles of Community
Containment (5)
Implementation of containment measures
requires coordinated planning by many
partners at all levels, especially at the
LOCAL level:
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Public health practitioners
Healthcare providers
Healthcare facilities
Transportation authorities
Emergency response teams
Law enforcement
Principles of Community
Containment (6)
To achieve trust and cooperation, the
public must be:
• Informed of the dangers of “quarantinable”
infectious diseases before an
epidemic/outbreak occurs
• Informed of the justifications for quarantine
when an outbreak is in progress
• Informed of anticipated duration and
endpoints of control measures
Where Are We?
• Training of personnel is
essential in tandem with
educating the public
before an event actually
were to happen.
• Identification and
information, in each
community in PA, on
facilities needed for
community isolation and
quarantine.
What can YOU do?
• Establish incident
command structure at
each level
• Establish relationships
with essential partners
• Plan for monitoring and
assessing appropriate
response
• Develop message
strategies for various
responses and groups
What can YOU do?
• Ensure management
protocols for I&Q are up
to date
• Establish supplies for
non-hospital
management of well and
ill people
• Establish
telecommunications plan
• Plan for ensuring
essential day to day
services
What can YOU do?
• Ensure that necessary
legal authorities and
procedures are in place
• Identify key partners and
personnel for quarantine
• Develop training
programs and drills
• Develop plans for
mobilization and
deployment
What can YOU do?
• Identify community-based
facilities for quarantine of
contacts
• Ensure procedures for
assessment of sites are in
place
• Develop protocols for
evaluation and
management of arriving ill
passengers
Conclusions
• In the modern age, community containment
– Represents a range of interventions
– Will be resource- and labor-intensive
– Is an important tool used in conjunction with other
containment measures
• Effective implementation of modern quarantine
and other containment measures is impossible
without planning and preparedness by every
community in Pennsylvania.
Thank you for your Time!
OPEN
DISCUSSION