Transcript PanFlupresentation6 - University of Virginia

Pandemic Influenza – “Is it real, or is
it just another storm on the horizon?
Pandemic Influenza 101
June 2006
James C. Turner, MD
Executive Director,
Department of Student Health
University of Virginia
Slide templates and background information: Roy Crewz, M.P.H., M.S.
Emergency Preparedness and Response Program
Thomas Jefferson Health Department
Pandemic Planning
 Pandemics have occurred throughout human
history and are a way of life.
 430 BC 25% of Athens died of a pandemic
 14th century plague killed an estimated 25
million people, changing the course of
modern history.
 Ten pandemics have occurred in the last 300
years.
 Last three were in 1918 (devastating), 1957
and 1968 (both mild).
Pandemic Influenza 1918
1918, H1N1 “Spanish Flu”
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> 500,000 deaths in the
U.S.
20-50 million deaths
Young/healthy adults
Death was RAPID
Pandemic Planning
 The world is overdue for a pandemic and is under
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prepared.
Potential for pandemic first recognized with
emergence of pathogenic avian strains passed to
humans in 1997.
The avian strain, H5N1, shares genetic
characteristics of the Spanish flu strain from 1918.
H5N1 is highly pathogenic and mutagenic and is
spreading explosively worldwide among wild and
domestic avian flocks. Human cases are limited.
Increases risk of H5N1 mutation or reassortment to a
strain that transmits easily among humans-the only
missing element of the pandemic.
Pandemic Planning
 Pandemic strain virulence will determine the impact
on the population.
 Current models predict U.S. outcomes if similar in
virulence to 1918:
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30% population attack rate; 40% absenteeism at work
and schools for 6-8 day intervals over 12 weeks;
two to three waves over 2-3 years.
1.5 M patients in ICU’s
750,000 on ventilators
1.9 M deaths in the U.S.
Pandemic Planning
 What about Charlottesville/Albemarle County
(est. population 130,000)?
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39,000 residents will be sick;
390-975 deaths (1-2.5%);
Challenge to local health care system
Challenge to infrastructure; business
community and educational enterprises.
Other Possible Effects of Pandemic
 Economic/Business devastated – actual
dollar costs in the billions…......inestimable
 Production & Transportation impaired – one
of the most basic questions is “how will we
eat?”
 Security: for individuals and businesses
 Behavioral health effects
 National psyche – “will the glass be halfempty or half-full?” Post 9/11 PTSD, can the
public handle it?
Planning:
Who Does What?
 Federal government
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nationwide coordination of the pandemic
influenza response; international collaboration.
 State government: Virginia Department of Health
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coordination of pandemic influenza response
within and between jurisdictions.
 Local government
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developing local plans and insuring these plans
meet both state and federal guidelines.
Local Pandemic Influenza Plan
Builds on Emergency Operations Plan:
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Legal authority
Command and control procedures;
Surveillance/epidemiologic investigation;
Infection control;
Medication/vaccine management;
Coordination local/state agencies; security
Communications; education and training
Pandemic detection and response
 International surveillance for pandemic strain
(rapid person to person transmission).
 International alert
 Containment: targeted antivirals, quarantine,
isolation, limited travel, animal culling
Pandemic detection and response
 Once disease spreads worldwide, local efforts
will include:
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Containing community transmission (social
distancing, isolation, quarantine, protective
sequestration, and health education).
Communication
Medical care
Vaccines and anti-viral medications (available
in limited supplies and perhaps not for
months).
Influenza Vaccine
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No vaccine available for 4-6 months
 Control measures important
Limited vaccine supply
 Focus on vaccine priority groups;
“batching”
IF - Adequate vaccine supply
 Expand coverage
Federal government is providing
substantial support to the vaccine
industry to improve flu vaccine production
capabilities.
Priorities may shift as supply increases
Vaccine Issues
 Security
 Administration of the vaccine
 Prioritization for administering vaccine within
groups (HC providers providing direct care)
Antiviral Medications
 Good news
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Prophylaxis and Treatment:
(duration/severity)
 Bad news
Resistance
 Limited Supplies
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Antiviral Issues
 Prophylaxis vs. treatment: who decides the
priorities and who has access to antivirals
 Stockpiling: Public vs. Private
 Role of local pharmacies
Medical Care
 Access to and provision of healthcare=
cornerstone to reduce morbidity/mortality
 Great demand for beds, ICU, ventilators
 Heath care workers who are ill
 Nosocomial (Hospital-setting) outbreaks
 Canceling of regular medical
appointments and admissions.
Medical Care Issues
 Prioritization and triaging of patients (e.g.
canceling elective surgeries)
 Role of home health care and monitoring
 Ambulatory care facilities
 Counseling and psychological support
 Insufficient medical resources
 Support for HCW’s-housing, food,
transportation, extended shifts, quarantine
Community Transmission
 Goal
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Slow the spread – BUY SOME TIME!until antivirals and vaccine available.
 Factors influencing disease transmission
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Short incubation period
Infectious during asymptomatic stage
Clinical illness - nonspecific
High attack rates
Non-pharmaceutical Interventions
 Social Distancing
 School and business closures
 Sending residential students home if possible
 Recommendations about telecommuting
 “Snow days”- a high # of people stay home for 10 to
100 day intervals
 Discouraging/banning large indoor gatherings-concerts
and athletic events.
 Isolation/quarantine early-liberal sick leave policies
 Health education for hygiene.
 Protective sequestration not an option
 Benefits and impact uncertain
Community Transmission
Issues
 Continuing" essential” services (police, fire,
electricity, water, grocery stores)
 Community wide efforts for cough and hand
washing hygiene
 Voluntary compliance for the common good
vs enforcement actions
 Criteria for closing schools, businesses,
and/or canceling public events
Communication/Education Issues
• How will we disseminate timely information:
influenza bulletins to health care providers
 vaccine availability/distribution plans
 patient education
 identifying official spokesperson
 role of health officials and governmental
authorities
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For More Information ………
 “The HHS Pandemic Influenza Plan is a
blueprint for pandemic influenza preparation
and response. For a copy visit:
www.pandemicflu.gov. “School Planning” tab
to college and university checklist.
 For Virginia Pandemic Influenza Information
visit: www.vdh.virginia.gov/pandemicflu/
 College Health www.acha.org will post draft
of guidelines for colleges and universities in
July.
 Other professional organizations….
UVa Planning To Date
Committee on Emerging Diseases at the
Health System has worked on bed space,
ventilators, antivirals, supplies.
2. Ad hoc work group on international studies
has started meeting to discuss international
students and study abroad programs.
3. Mr. Sandridge has appointed a pandemic
preparedness planning committee to conduct
planning for the entire University community.
4. UVa represented on Health Department
pandemic committees and State Summit
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Break
 Restrooms: one in lower lobby. Four up one
floor, scattered down the hall toward north
end of building.
 Refreshments
 Return in 15 minutes.
UVa’s Charge Today
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Develop and incorporate pandemic influenza
planning into existing University plan.
Address University functioning over various
scenarios.
Address medical, mental, and social services for
University community.
Explore alternatives to assure continuity of
instruction and research
Develop a continuity of operations plan for essential
services.
Implement infection control procedures.
Establish a communication plan.
UVa’s Planning Structure
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Emerging Diseases Committee-Co-chaired
by Marge Sidebottom and Dr. Tom Bleck.
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Pandemic Preparedness Planning
Committee-Chaired by Dr. Jim Turner
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Academic affairs-Anda Webb
Student Support Services-Penny Rue
Faculty and staff-Dave Ripley
Communication-Carol Wood
Legal-Beth Hodsdon
Administrative Operations-Susan Harris
Health care/infection control-Marge Sidebottom
UVa’s Planning Structure
Academic affairs-Anda Webb
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Provost’s office
International programs
Public health faculty
Travel clinic faculty and/or nurses
Environmental Health and Safety
Student Health
Charge: Closure/cancellation policies, continuity
of academic enterprise during pandemic.
UVa’s Planning Structure
Student Support Services-Penny Rue
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Housing
Food services
Parking and transportation
Student affairs
Student Health
Charge: Dealing with closure policies, sending
students home, caring for students who can’t
go home or are ill, preparing residential
units.
UVa’s Planning Structure
Faculty and staff-Dave Ripley
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Human resources
Benefits Office
Payroll
Provost’s Office
Charge: Leave policies, emergency contact lists,
departmental depth charting, communicating
with departments and supervisors, payroll,
benefits.
UVa’s Planning Structure
Communication-Carol Wood
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University and community relations
ITC
Charge: Coordinate communication internally
and externally (health department and
emergency operations), centralized
University information site.
UVa’s Planning Structure
Legal-Beth Hodsdon
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General Counsel’s Office
Attorney General’s Office
LWS office
Charge: Define legal authority for mandated
closures, contract review for pandemic
contingencies, coordinate leave policies and
insurance benefits with HR and State
regulations.
UVa’s Planning Structure
Administrative Operations-Susan Harris
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Office of the EVP and CEO
University police
Procurement
Athletics
Facilities
Parking and Transportation
Charge: Identify critical business functions,
resource allocation for planning and
procurement, facility maintenance, campus
safety, transportation
UVa’s Planning Structure
Health care/infection control-Marge Sidebottom
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Emerging Diseases Committee
Employee Health/Work Med/Hospital Epi.
Student Health/General Medicine, CAPS,
LNEC, Administration
Schools of Nursing and Medicine
Public Health Department
Charge: Ambulatory care, mass clinics for
vaccine and antivirals, mental health, care
for ill residential students, infection control
procedures, faculty/staff vaccine policies.
Subcommittee logistics
 Chairs free to appoint co-chairs or vice
chairs.
 Appoint members of subcommittee from
departmental representation on larger
committee and/or others in departments. JCT
can help with membership suggestions.
 Student Health conference space available to
chairs. Arlene Guenther: 924-2670, or
[email protected]
UVa plan format and communication
 Existing policies or procedures should be
identified.
 Standardized policy or plan format?
 Centralized website?
 Email distribution of plans?
Meetings and Timelines
 Monthly meetings of subcommittee chairs
with JCT
 Planning committee meets in early
September 2006 to receive plan reports from
subcommittee chairs and seek feedback.
 Written plan submitted to LWS October 1,
2006.
 Initial training of key stakeholders October.
 UVa participates in regional drill October 31,
2006.