Transcript Pandemic Response - Northwest Center for Public Health

Pandemic Response
Briefing to Business &
Community Leader
Scenario time: Oct 24
Group 2
Tammy Hunt
David Broudy
Outline
1. The challenge
Without intervention:
•
800K - 9.6M Hospitalizations
•
•
18-42M outpatient visits
80K - 285K deaths
2. Epidemiology: Breaking the cycle of transmission
3. What is to be done? A strategy for communities
Why Multnomah Co should
support community interventions
•
•
•
•
Medical measures may be delayed
Efficacy of vaccine and antivirals unknown
Infection Control Measures are effective
History of 1918 Pandemic supports aggressively
limiting assemblage
– The longer you wait to intervene, the worse the effects
of the epidemic
• Working together and building our community is
good for business and good public health
Social Distancing and
Infection Control
• Social Distancing (Contact Interventions)
– School closure
– Work closure (telecommuting)
– Cancellation of public gatherings
• Infection Control (Transmission
Interventions)
– Facemasks
– Cough etiquette
– Hand hygiene
Non-pharmaceutical Interventions
• Ill persons should be isolated (home vs hospital)
• Voluntary home quarantine for household contacts
• Social distancing measures
– School closures may have profound impact
– Keep your business going by allowing employees to
work from home
– Cancellation of public events
• Individual infection control measures work
– Hand washing and cough etiquette for all
– Mask use for ill persons, PPE stratified by risk
– Disinfection of environmental surfaces as needed
Community-Based Interventions
1. Delay disease transmission and outbreak peak
2. Decompress peak burden on healthcare infrastructure
3. Diminish overall cases and health impacts
#1
Pandemic outbreak:
No intervention
#2
Daily
Cases
Pandemic outbreak:
With intervention
#3
Days since First Case
Susceptible to Targeted Attack
Susceptible to Targeted Attack
Effect of R 0 on Epidemic Curve
Eubank S, personal communication
A Tale of Many Cities:
What Does History Teach Us?
"...Spanish influenza is now present and probably will
become epidemic in the City of St. Louis. In view of
this proclamation, and under the authority vested in
me by the City Charter of the City of St. Louis, after
such proclamation in order to prevent all unnecessary
public gatherings through the medium by which this
disease is disseminated, I hereby order that all
theaters, moving picture shows, schools, pool and
billiard halls, Sunday schools, cabarets, lodges,
societies, public funerals, open air meetings, dance
halls and conventions to be at once closed and
discontinued until further notice." --Mayor Henry Keil
(October 7, 1918)
Liberty Loan Parade
September 28, 1918
The drastic actions of Mayor Keil were sensible
considering by October 7th, 167,000 cases had
broken out, with 4,910 deaths, across the eastern
United States. Mayor Keil's actions perhaps spared St.
Louis of the worst outbreaks.
For instance for the October 10-November 2 time
frame the following deaths were reported:
New York, 16,705
Boston, 3,694
Philadelphia, 12,162
Chicago, 7,405;
Baltimore, 3,507
St. Louis 784.
1918 Weekly Excess Death Rate by City
0.018
0.016
Excess Death Rate
0.014
0.012
Baltimore
Boston
Minneapolis
Philadelphia
Pittsburgh
St. Louis
0.01
0.008
0.006
0.004
0.002
/2
2
/2
9
/2
2
12
/2
2
/2
2
12
/1
5
22
12
/8
/
22
12
/1
/
/2
2
12
/2
4
/2
2
11
11
/1
7
/2
2
22
/1
0
/3
/
11
/2
2
11
/2
7
/2
2
10
/2
0
/2
2
10
/1
3
10
/6
/
22
22
10
29
/
22
9/
22
/
9/
9/
15
/
22
0
Date
Weekly mortality data provided by Marc Lipsitch (personal communication)
22
22
22
22
/1
3/
10 22
/2
0/
10 22
/2
7/
2
11 2
/3
/
11 22
/1
0/
11 22
/1
7/
11 22
/2
4/
2
12 2
/1
/2
12 2
/8
/
12 22
/1
5/
12 22
/2
2/
12 22
/2
9/
22
10
/6
/
29
/
22
/
15
/
10
9/
9/
9/
Deaths Rates / 100,000 Population
(Annual Basis)
1918 Death Rates: Philadelphia v St. Louis
16000
14000
Philadelphia
St. Louis
12000
10000
8000
6000
4000
2000
0
Date
Weekly mortality data provided by Marc Lipsitch (personal communication)
1918 Age-specific Attack Rates
McLaughlin AJ. Epidemiology and Etiology of Influenza. Boston Medical and Surgical Journal, July 1920.
Why close schools?
• In 1918 the “spanish flu” had an unusually high
attack rate among younger people
• Small children are efficient incubators and
spreaders of infectious diseases
• Preventing the spread of the flu among children
will reduce spread to families
• Reducing serious illness and death among working
age adults will reduce impact on economy
• Flattening the epidemiology curve will allow
distribution of scarce resources over longer
periods.
Who Infects Whom?
To Children
To Teenagers
To Adults
To Seniors
Total From
From Children
21.4
3.0
17.4
1.6
43.4
From Teenagers
2.4
10.4
8.5
0.7
21.9
From Adults
4.6
3.1
22.4
1.8
31.8
From Seniors
0.2
0.1
0.8
1.7
2.8
28.6
16.6
49.0
5.7
Total To
Likely sites of transmission
School
Household
Workplace
Demographics
Children/Teenagers
29%
Adults
59%
Seniors
12%
Glass, RJ, et al. Local mitigation strategies for pandemic influenza. NISAC, SAND Number: 2005-7955J
Model Predictions – 1918 Interventions
Ro = 2.1, 2% case fatality rate
18000
16000
14000
12000
10000
8000
MONTREAL 11.5%
6000
SAN FRANCISCO 8.8%
4000
2000
ST. LOUIS 2.2%
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Model Predictions – 1918 Interventions
Ro = 2.1, 2% case fatality rate
Intervention Delay
Sensitivity
*Scenarios
Attack Rate (%)
Deaths
No intervention
46.8
80,405
Intervention at 12%
27.7
47,511
Intervention at 8%
23.9
41,045
Intervention at 2%
9.7
15,782
Intervention at 1%
5.3
9,107
Intervention at 1% w/ TARP
Case Rx, HH Px
2.9
4,889
*Longini model for Chicago pop 8.8M, NPI intervention TLC w 30% compliance HH-Q
Acknowledgements
• Many of these slides are from a presentation by
Martin Cetron, MD, Div Global Migration and
Immigration, CDC
• Thanks to Subject Matter Expert for Group 2:
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Chris Felstadt
Norm Nedell
Peter Rigby
Karen Pendelton
Matt Bernard
Diane Bonne, Facilitator
• Martin, MD