Transcript Prior Planning Prevents Pandemic Pandemonium

North Florida Region
Domestic Security Task Force
Pandemic Influenza Workshop
Setting the Pace for Florida's Leadership
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11/292/05 Version 3.3
Pandemic Influenza Workshop
Objectives
• Raise awareness about impact of pandemic flu on the health
care system and the community as a whole.
• Increase understanding of the responsibilities of all community
partners.
• Determine the adequacy of current plans to address the range
of anticipated events.
• Identify gaps in coordination among community partners.
• Promote planning continuity among all community partners.
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Pandemic Influenza Workshop
Format
Education Format:
• Influenza Virus Characteristics
• History
• Surveillance
• Planning
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Pandemic Influenza Workshop
Format
Exercise Format:
• Interactive Tabletop
• 3 Modules
•Prepare, Respond, Recover, Mitigate
• Hot Wash
• Action Plan
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Pandemic Definition
Pandemic: An infectious
disease epidemic that affects
people worldwide or over an
extensive geographical area.
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Influenza Virus Characteristics
Primitive “life” form
Only one function: Replication
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Influenza Virus Infection
Virus slips in
RNA issues orders
Viruses break out
High efficiency
High mutation rate
Confuses body defenses
Stellenbosch University, Tygerberg, South Africa
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Influenza Virus Characteristics
Virus Exchange Program
Wild Birds -- Chickens
Chickens -- Humans
Chickens -- Pigs
Pigs -- Humans
Humans -- Humans
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H5N1 Outbreak in Birds
12/2003 – 03/2006
Countries Affected (confirmed in poultry)
Cambodia
China
Indonesia
Croatia
Slovakia
Kuwait
Japan
Russia
Kazakhstan
Switzerland
Korea (Rep. of)
Thailand
Vietnam
Ukraine
Hungary
Romania
Turkey
Mongolia
Malaysia
Albania
Iraq*
Nigeria
Bulgaria
Greece
Poland
Italy
Iran
India
Egypt
Pakistan*
Austria
Azerbaijan
Germany
France
Serbia &
Montenegro*
Bosnia*
Laos*
Slovenia
Niger
Burkina Faso
* - Only H5 confirmed, neuraminidase not determined
December 2003-March 2006 Source: World Health Organization
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Influenza Virus Transmission
Direct – Viral particles
are contained in
droplets resulting from
an uncovered sneeze or
cough.
Breathing them in can
result in an infection.
During a sneeze, millions of tiny
droplets of water, mucus, and virus
particles are expelled at 200 mph.
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Influenza Virus Transmission
Indirect – Viral particles may survive for
a short time on many surfaces (hands,
door knobs, phones). Touching these
surfaces may transmit infection through
eyes, nose, or mouth.
What precaution do these transmissions suggest?
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History
“No disease the world has ever known even remotely
resembles the great influenza epidemic of 1918. Presumed
to have begun when sick farm animals infected soldiers in
Kansas, spreading and mutating into a lethal strain as troops
carried it to Europe, it exploded across the world with
unequaled ferocity and speed. It killed more people in twenty
weeks than AIDS has killed in twenty years; it killed more
people in a year than the plagues of the Middle Ages killed
in a century. Victims bled from the ears and nose, turned
blue from lack of oxygen, suffered aches that felt like bones
being broken, and died. In the United States, where bodies
were stacked without coffins on trucks, nearly seven times
as many people died of influenza as in the First World War.”
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History -- Images
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History – Some Statistics
Death Toll Worldwide: 40 - 100 Million
Death Toll US: 650,000
Normal Season Flu Death Toll: 36,000
Normal Sean Flu Hospitalizations: 200,000
Most Susceptible Population Age: 15-34
Number of Flu-Orphans in NYC: 21,000
I had a little bird
His name was Enza
I opened up the window
And Influenza
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History -- Pandemic Spread
• Exceptionally Virulent Strain
• New and Rapid Population Mixing (Training
Camps)
• WWI Overseas Deployments
• Initial Lack of Communications (Sedition Act)
• Quarantine – None early on
• Weak Public Health Infrastructure
Liberty Bond Rally
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History – Other Pandemics
1957 Asian Flu -- US Deaths 69,800
1968 Hong Kong Flu – US Deaths 33,800
Pandemic Flu Scares:
1976 Swine Flu
1977 Russian Flu
1997 -1999 Avian Flu
SARS Precautions
Non-Flu Scare: SARS Multi-Country Outbreak
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Inter-Pandemic Period – Phases 1 and 2
Inter-Pandemic Period – Phases 1 and 2
•No new influenza virus
•Develop plans and exercise them
•Educate the public (throughout all phases)
•Vaccinate public
•Surveillance
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Pandemic Alert Period – Phase 3
The phase we are currently in
Pandemic Alert Period—Phase 3
•Human infection with a new subtype
•No human to human spread
•Monitor the situation via surveillance
systems and communication with Florida
DOH
•Communicate with community partners
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Pandemic Alert Period – Phase 3
The phase we are currently in
• Pandemic Alert Period—Phase 3 Actions
– Stockpile masks, hand-sanitizer, anti-virals
– Nationally—encouraging the development of
vaccine
– Nationally—develop more rapid testing
methods
– State-Increase surge capacity of laboratories
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Human Cases of H5N1
Avian Flu 2003-2006
Country
Total Cases
Deaths
Indonesia
29
22
Cambodia
4
4
Thailand
22
14
Vietnam
93
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China
15
10
Turkey
12
4
Iraq
2
2
Azerbaijan
7
5
Egypt
7 (4 initial confirmation only)
4
Jordan
2 (initial confirmation only)
Total
193
107
As of 04/04/06 Source: World Health Organization (laboratory confirmed cases)
55%
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Pandemic Alert Period – Phase 4
• Pandemic Alert Period—Phase 4
– Limited human to human transmission
• Isolate / treat the sick
• Vaccinate / treat close contacts
• Encourage self-quarantine
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Pandemic Alert Period – Phase 5
• Pandemic Alert Period—Phase 5
– Larger clusters but still localized
– Adjust and maximize resources—questionable use of
points of distribution (drugs are trickling in)
– If available deploy prototype vaccine
• Questionable use of points of distribution
• Decision on who to vaccinate (ethics?)
– Assess staffing issues
– Travel restrictions
– Social distancing
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Pandemic Alert Period – Phase 6
• Pandemic Period-Phase 6
– Increased and sustained transmission
– Alternative treatment sites
– Ventilator decisions
– State resources for aid
– Continue risk management
– Maintain surveillance, including deaths
• Morgue surge capacity
• Funeral supplies may be limited
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Human Surveillance
• Sentinel physicians – how many are in your
county?
• ESSENCE – influenza symptoms, patient load,
etc.
• BIOSENSE – military hospitals
• EpiCom
• Vital Statistics – death rates
• School absenteeism
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Surveillance Partners
• Sentinel Physicians
• Hospitals
• County Health Departments
• Department of Health and Private Labs
• Department of Agriculture and Consumer Services
• Centers for Disease Control and Prevention (CDC)
• World Health Organization (WHO)
Communication! – Communication! – Communication!
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Between Waves
• Between waves
– Ensure staff recovery
– Re-stock supplies/medications
– Lessons learned to improve
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Influenza H5N1 – Avian Flu
Current Situation -- Avian Flu – Phase 3:
• Bird to Human transmission still very rare
•Vaccine in development for birds for H5N1
•Vaccine in development for H5N1 for
humans – this is not the same as a human to
human virus we are planning for
• Human to Human transmission even more rare
•We can’t develop a vaccine until we know
the human to human strain
• Will this be the “Big One”?
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Request to Fund – National Strategy
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Global surveillance
Vaccine technology
Purchase medication
and vaccines
Vaccine for HHS
Stockpile anti-virals
Emergency preparedness
Total
$ 251 million
$ 2.8 billion
$ 800
$ 1.5
$ 1.0
$ 644
$ 7.1
million
billion
billion
million
billion
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DOH – 12/5/05
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Influenza H5N1 – Avian Flu
The thing to Keep in Mind for Now:
NOT
Recommended.
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Surveillance Urgency
The Clock is Ticking….
We just don’t know what
time it is.
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Pandemic Planning
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Planning Assumptions
• We will have an epidemic soon of a strain of influenza to which
none of us is immune.
• We will likely have only a short window between when the
strain is clearly causing disease and when it starts causing
widespread disease where we live.
• Vaccine likely won’t be available for 6 to 9 months after the
epidemic starts.
• Supplies of anti-virals will be far less than needed for totalpopulation coverage or even coverage of high-priority groups.
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Planning Assumptions
Predicted Morbidity Range for Palm Beach County
• 35% Attack Rate
Predicted Mortality Rate for Palm Beach County
•5% of those infected
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Planning Assumptions
Palm Beach Population
1.2 Million
Attack Rate
35%
420,000
Seeking Treatment
75%
315,000
Hospitalization Rate
10%
31,500
Mechanical Ventilation 7.5%
23,625
Fatality Rate
21,000
5%
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Planning Assumptions
• Once the pandemic takes hold, we have to assume that
there will be little to No Help from the national or state level
– not just for days, but for weeks, and perhaps months.
• We have to assume that every county and every community
will be pretty much on its own in an influenza pandemic.
• County Health Department will have ICS Lead.
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Planning Questions
• When a vaccine first becomes available, who should get it?
• How should we use the limited supplies of antiviral
medications? (Tamiflu – 10 doses in five days. Must be taken
within 48 hours.)
• Given lack of vaccines and anti-virals, how do we approach
reducing illness and death?
• What is the right balance among minimizing health burden,
economic damage, and societal damage?
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Planning – More Questions
Can we hold the fort till we can get vaccine?
• The longer we can delay the onset of the epidemic in our
community, the more illness we can prevent.
• This will require vigorously applying measures that have
limited effectiveness and a strong and continuous, risk
communication campaign directed to all of our citizens.
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Planning – Isolation
The placement of sick persons with
specific infectious illness in
separate rooms from those who are
healthy. This is usually voluntary
and may be at their own home or at
a hospital
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Planning – Quarantine
Usually voluntary, but the FDOH Secretary
may declare a public health emergency and
issue a quarantine order to separate and
restrict movement of people who have been
exposed to an infectious agent, and may
therefore become infectious
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Planning – Options for Disease Prevention
• Isolate the sick
Voluntary or legally mandated?
• Quarantine well, exposed persons
Voluntary or legally mandated?
• Limit personal interactions
e.g., close schools and day-care,
stop large public gatherings
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Planning – Behavioral Modification
Social Marketing
• Change social norms about self-quarantine, personal
hygiene, shaking hands, and masks.
• Advise travel restrictions.
• Home management of uncomplicated influenza
-- Recognition of complications
-- Management of complicated patients
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Planning – Social Issues
• Stigmatization of vulnerable groups
• Equity in access to care and in application of isolation and
quarantine
• Civil liberties balanced with effective disease control
• Potential for civil disorder and vigilante actions
• Trust in government and health care system institutions,
especially if initial measures seem to fail
• Long-term stress and behavioral health
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Planning – Economic Issues
• Cost of care and cost of providing preventive measures.
• Impact on essential services and general productivity of
widespread illness – e.g., 10% of workforce out sick continuously
for many weeks.
• Curtailment of business travel, shopping, and entertainment
venues.
• Shipment of goods, including food, fuel, and essential supplies
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Planning – Communications Issues
• Lots and lots of issues and opportunities with risk
communication
• Prompt, accurate, clear
• Acknowledge uncertainties
• Provide frequent updates as new info becomes available
• Manage the level of expectations
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Communications
• For Unusual death in domestic birds call:
•USDA – Veterinary Services for Florida
at
1-866-536-7593
•The Florida Department of Agriculture recommends that you
contact your local agriculture extension at Broward County Fish
and Game – Non-Game Division 561-625-5122 – Sharon Hood
•The Florida Dept of Agriculture / Division of Animal Industry
can be reached at 850-410-0900
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QUESTIONS?
????????????????
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