Transcript Pandemic Flu Slide Set

Pandemic Influenza:
How sick might we be?
October 12, 2006
Wayne D. Williams
Director of Logistics
Logistics Health Incorporated
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Monday, August 28, 2006
It's the first day of instruction on campus. Tracy, a
2nd year pre-med student, is coming down with a
cold but feels well enough to go to all her
classes. She lives in a student co-op where she
works in the kitchen. On Thursdays she
volunteers at the Health Center; this week she
helped care for a Chinese-speaking patient with
an “asthma attack.”
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Tuesday, August 29, 2006
Tracy develops a low-grade fever, a dry cough,
and loose stools. She decides she has the
“stomach flu” and takes over-the-counter
medications to treat her symptoms. She attends
her crowded classes that day and has a
persistent annoying cough. That night after
preparing dinner for the co-op she is too tired to
study and goes directly to bed. She wakes up
with chills, drenched in sweat, and with body
aches. She decides to wait a few more hours
until morning before seeking medical care.
4
Wednesday, August 30, 2006
At 4am, Duty Officer at the Health Department
receives a phone call from the Hospital that a
Chinese-speaking male was admitted with his
wife and brother-in-law, all with atypical
pneumonia and difficulty breathing. The patients
recently visited family in southern China and
returned to the U.S. last week. The family goes
to the Community Health Center for their medical
care because they have no health insurance.
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Wednesday, August 30, 2006
(cont'd)
The Health Department decides to notify
physicians, hospitals, and local health officials
about the cluster of atypical pneumonias
associated with a recent traveler to southern
China. They ask Emergency Departments to
increase their surveillance. By Wednesday
afternoon, the CDC learns that outbreaks of
atypical pneumonia are being reported from
southern China.
Wednesday, August 30, 2006
(cont'd)
Tracy wakes up too sick to go to classes and
goes to the hospital emergency department. She
sits in a waiting room full of patients for about on
hour with a persistent cough and no face mask.
Upon evaluation, her oxygen saturation is 88%
and chest X-Ray shows diffuse pneumonia. She
is admitted to the hospital and placed on oxygen
and antibiotics.
6
Thursday, August 31, 2006
In the morning, based on news reports of
influenza-like outbreaks in southern China, the
Governor’s office is flooded with calls from the
press and concerned citizens wanting to know
the following:
– What is the State doing?
– Is the State prepared?
– Will the State restrict travel to and from China?
– How many isolation rooms are ready?
– How will policy decisions be made and who has
input?
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Friday, September 1, 2006
In the morning WHO confirmed by electron
microscopy and PCR that these outbreaks are
highly likely attributed to a strain of avian
influenza virus. At 3pm, the CDC announces a
Travel Advisory for southern China. It is Labor
Day weekend: people leave work early.
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Saturday, September 2, 2006
Tracy takes a turn for the worse. She develops
acute respiratory failure requiring intubation and
mechanical ventilation. Her doctors get an
infectious disease consultation. Pulmonologists
perform bronchoscopy, bronchial alveolar lavage,
and transbronchial biopsy. All cultures and stains
are nondiagnostic. Her clinical status deteriorates
and she expires at 7:31pm. Her parents, are at
her bedside.
Saturday, September 2, 2006
(cont'd)
At the Hospital ED, the attending physician
notices that 3 students from the same co-op
presented with diarrhea, cough, and low grade
fevers. The students report that several
additional co-ops members are ill. The physician
tells them this is most likely a viral gastroenteritis
and that they should get better within 48 hours.
Over the next 24 hours, 5 nurses do not come to
work; 3 are hospitalized with atypical pneumonia,
2 of them at other hospitals. The ED and hospital
infection control do not have this information.
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Sunday, September 3, 2006
On the 10 O'clock News, the anchor reports a
mysterious outbreak of a flu-like illness at a
student co-op leaving one student dead. They
also report that 5 health care workers from local
Hospitals have now been hospitalized with
pneumonia, 1 of them is in critical condition.
Monday, September 4, 2006
The skeletal public health staff meet and outline
some of the investigative and disease control
issues for an interagency Task Force meeting
later in the day:
– Where and how was Tracy infected?
– How many students has she exposed?
– Are we prepared for an explosion of cases?
– Could this be intentional microbiological release
(bioterrorism)?
– Should we quarantine the university?
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Monday, September 4, 2006
(cont'd)
By late afternoon, all area hospitals are reporting
the evaluation and admission of students with
atypical pneumonia consistent with influenza. All
hospitals are all on diversion because their
hospital beds, ICU beds, and respiratory isolation
rooms are full with infected health care workers.
Students not requiring admission are being told
to return to their homes or residential housing, to
stay in their rooms, and that they will be
contacted by the health department.
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Tuesday, September 4, 2006
Residents awake to morning news reports of
widespread illness, crowded emergency rooms,
and hospitals so short-staffed they are turning
away patients. Over the next several weeks, 40%
of school-age children become ill and 1 of every 5
adults become so ill they are unable to work.
Absenteeism soars as people stay home from work
to care for sick family members, while fear keeps
others at home.
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Are you ready?
National Strategy for Pandemic Influenza
• Preparedness and
Communications
• Surveillance and
Detection
• Response and
Containment
Planning Assumptions: Health Care
• 50% or more of those who become ill will seek medical care
• Number of hospitalizations and deaths will depend on the
virulence of the pandemic virus
Moderate (1957-like)
Severe (1918-like)
Illness
90 million (30%)
90 million (30%)
Outpatient medical care
45 million (50%)
45 million (50%)
Hospitalization
865,000
9, 900,000
ICU care
128,750
1,485,000
Mechanical ventilation
64,875
745,500
Deaths
209,000
1,903,000
Pandemic Preparedness
• Early intervention
– Detect and contain where it emerges, if feasible limit
international spread, decrease illness and death, buy time
• Pharmaceutical countermeasures
– Vaccines
– Antivirals
• Non-pharmaceutical interventions
– Isolation for people with illness
– Quarantine for those exposed
– Social distancing
Countermeasures: Vaccines, Antivirals, and
Medical Supplies
FY2006 Emergency Supplemental
Budget: $3.8 billion
• $350 million for upgrading State and local capacity
• $50 million for laboratory capacity and research
• $246 million for international activities, surveillance,
vaccine registries, research, and clinical trials
• $2,750 million to support other core activities:
– expanding domestic production capacity of
influenza vaccine
– developing and stockpiling pandemic vaccine,
– stockpiling antivirals and other medical supplies
to protect and preserve lives
Pandemic Influenza Preparedness Checklists
• State and Local
• Business
• Faith-based &
Community
Organizations
• Family and Individual
• Physician Offices and
Ambulatory Care
• Emergency Medical
Services
• Travel Industry
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Education (K-12)
Colleges & Universities
Child care
Home Health
Correctional
organizations
• Health insurance
• Social service agencies
• Police
www.pandemicflu.gov
Economic Impact: SARS
• Toronto, 2003
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14 weeks, 375 cases, 44 deaths
9 conventions cancelled
12,000 lost jobs
Cost over $1 billion in 2003
2 years for economic indicators to return
Economic Impact: Pandemic Flu
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Duration likely 12 – 18 months
Foreign trade and travel reduced
Transportation may be limited
High absenteeism
Supply chains disrupted
– Many overseas
– Problem with thin inventories
– Just-in-time delivery
• Critical infrastructure challenges
– Food, water, electricity, sanitation, health care
What your organization can do
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Stay informed
Prepare for the common flu
Adopt social distancing practices
Expand online business and telecommuting
Develop strategies for high customer contact
Determine how to minimize disruptions
Collaborate with local health officials and
hospitals
• Create a business continuity plan
What your organization can do
• Review your plan, and update regularly
• Share the plan; those who need to
understand it do
• Stakeholder scenarios: employees,
customers, consumers, media
• Practice
– Testing and drilling
– Tabletop exercises
Remember…
“[Hurricane] Katrina was the most
anticipated natural disaster in American
history, and still government managed to
fail at every level.”
David Brooks, NY Times, 9/11/05
The only thing harder than
planning for an emergency is
explaining why you didn’t.