CAPT Lynn Slepski, RN, MSN, CCNS

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Planning and Preparedness in the Face of Pandemic
Influenza

• CAPT Lynn Slepski, RN, MSN, CCNS

Deputy Director Risk Management and
Analysis National Protection and Programs
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Pandemic Preparedness and Response Equal Parts
Healthcare Public Health (HHS)
Critical / Essential Infrastructure (DHS)

• Prepare
• Respond
• Sustain
• Recover

• Protect
• Prepare
• Respond
• Recover

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Latest Reported Avian Outbreaks
As of September 1, 2007
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A Pandemics Rapid Spread Virus May Reach Across
U.S. in Months (if not Weeks)
Once a fully contagious virus emerges, its global
spread is inevitable. Without intervention,
expect global spread in 1 month and U.S. cases in
1-2 months.

• With border closures and travel restrictions,
  countries might delay the virus arrival, but
  countries cannot stop it. Severe travel
  restrictions may delay U.S. cases by 1-4 weeks.
• Border screening is difficult given people may
  transmit infection for up to 48 hours before
  showing symptoms.
• Previous pandemics circled the globe in 6-9
  months even though most international travel was
  by ship. Given the speed and volume of
  international air travel today, the virus will
  likely spread more rapidly, reaching all
  continents in less than 3 months.

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Terms Defined

• Seasonal (or common) flu
• Can be transmitted person to person
• Most people have some immunity
• Vaccine is available
• Avian (or bird) flu
• Disease primarily of birdsnot readily
  transmitted from birds to humans
• No human immunity
• No human vaccine is commercially available
• Pandemic flu
• Novel virus emerges
• Little or no natural immunity
• Can spread easily from person to person causes
  illness
• No vaccine available

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Emergence of Pandemics
H9
1998
1999
H5
2003
1997
2003-2006
H7
1980
1996
2002
H1
2003 2004 2007
H3
H2
H1
1977
1915
1925
1935
1945
1955
1965
1975
1985
1995
2005
1918 Spanish Influenza H1N1
1957 Asian Influenza H2N2
1968 Hong Kong Influenza H3N2
Avian Flu
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Effects of Past Pandemics on the U.S.
All three spread around the world in less than a
year after efficient sustained human-to-human
transmission.
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Business Continuity in a Pandemic AgeContinuity
of Operations Plan-Essential (COP-E) Supporting
Businesses to Refine their ExistingPlans to
Account for a Catastrophic Disaster

• Extending the Business Disaster Planning
  Continuum

Continuity of Operations Plan-Essential (COP-E)
Pandemic Influenza, Massive Bio, Chemical or
Radiological Event, Cat 5 Hurricane, 8/0
Earthquake
Increasing Disaster Severity
Continuity of Operations Plan (COOP)
Basic Contingency Plans
Major Hurricane, Earthquake or Flood, Localized
Terrorist Conventional or Bio-attack
Localized power outage, Plant fire, IT failure
Normal Operations
Increasing Impacts on CI/KR and National Economy
and Social Stability
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Continuity Plans

• Are TRANSLATIONALcan be used across all hazards
• Still require identifying essential functions
• Still require identifying persons required to
  complete those essential functions
• Tailored to the scope/ length of the event

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Pandemic Challenges

• Pandemics are different from other emergencies
  because its likely that almost all locations
  will be affected simultaneously
• Resources cannot be shifted geographically as in
  other emergencies
• Every country will be affected, but countries
  with better plans will be less vulnerable to
  terrorism and other threats during a pandemic

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Criterion Required for a Pandemic

• The Avian H5N1 is widespread and endemic
• There are continuous outbreaks in poultry
• It has resulted in lethal mammalian infections
• Virus is evolving
• Sporadic human cases
• Mostly young and healthy 327/199 (Sep. 1,
  2007)
• Case fatality rate is 61
• Rare instances of person-to-person transmission
• Sustained and rapid person-to-person
  transmission

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When a Pandemic First Appears

• There will not be enough vaccineinitially NONE
• There will not be enough antivirals (now
  re-thinking)
• The health care system will be stretched beyond
  its limits
• Many sectors of society will begin to be
  affected schools, businesses, large public
  gatherings, just-in-time commerce, air travel,
  and so on

Source HHS, William Hall, Director Press Office,
29 July, 2005
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Planning Assumptions

• From time of sustained human to human overseas in
  multiple sites to introduction in the US is 2 4
  weeks
• Spread of pandemic disease across communities
  within the U.S. will be rapid, nearly
  simultaneous and not predictable and will likely
  preclude shifting personnel or resources from
  safe to affected areas
• HHS or local governments may recommend social
  distancing, quarantine, school closures, snow
  days etc.
• HHS anticipates the potential of two to three
  waves of community outbreaks over a year, each
  wave lasting 12-16 weeks nationally, 6-8 weeks
  locally
• One in three workers or more may be unable to
  report to work for 2-4 weeks due to illness at
  some point during the course of a 6-8 week
  community outbreak
• Additionally workers may stay home in order to
  care for ill family members, children not in
  school due to school closures, and/or because
  they or family members are among the worried
  well who may stay home to avoid exposure to the
  pandemic virus (up to 40 out)

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Business Continuity in a Pandemic AgeContinuity
of Operations Plan-Essential (COP-E) Supporting
Businesses to Refine their ExistingPlans to
Account for a Catastrophic Disaster

• PlanningEssential functions Workers Duration
  Dispersion and Support Families Adaptive Use
• PreparednessShare Plan Networks of
  Preparedness 2nd 3rd Order Effects
  Outsourcing People and Stockpiles
• ResponseDisease Containment Strategies
  Cross-sector Interdependencies Cascading
  Effects Risk Communications Cooperation and
  Collaboration
• RecoverMultiple Waves Worker/Family Losses
  Worker Reconstitution and Competition
  Government/ Community Support Inter-Business
  Support International Recovery

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Pandemic Influenza Planning for
Businesses--Example

• Establish policies for
• Employee compensation and sick-leave absences
• Flexible worksite arrangements and flexible work
  hours
• Employees who have ill family members and need to
  stay home
• Employees who become ill at the worksite
• Return to work policies
• Triggers, authorities and procedures for
  activating and terminating the company's response
  plan

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How Do We Break the Cycle of Transmission?
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Potential Tools in Our Toolkit

• Pandemic Vaccine
• Probably not available 1st wave
• Antivirals
• Transmission Interventions
• Infection Control
• Contact Interventions
• Social Distancing

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Transmission Interventions

• Infection Control
• Hand Hygiene
• Facemasks
• Cough Etiquette
• Environmental cleaning
• Sick people stay home (isolation)
• Exposed to people who are sick stay home
  (voluntary quarantine)

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Interim Public Health Guidance for the Use of
Facemasks and Respirators in Non-Occupational
Community Settings during an Influenza Pandemic

• People should consider wearing a facemask during
  an influenza pandemic if they are
• Sick with the flu and might have close contact
  with other people (within about 6 feet)
• Living with someone who has the flu and might
  have close contact with other people
• Well (not sick themselves) but need to be in a
  crowded place

• People should consider wearing a N-95 respirator
  during an influenza pandemic if they are
• Well and will be in close contact (within about 6
  feet) with people who are known or thought to be
  sick with pandemic flu
• Taking care of a sick person at home
  
• (May 3, 2007)