Approaches to Planning

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Approaches to Planning

• Current approaches for pandemic planning address
• Global emergence of pandemic influenza with WHO
  Pandemic Phases
• National emergence of pandemic influenza in the
  U.S. with U.S.G. Stages
• Pandemic Severity as a qualitative information
  element
• However, most community mitigation strategies are
  initiated based on local or regional emergence of
  pandemic influenza, and many public health
  measures will change as the pandemic progresses.
• A more dynamic approach is needed for determining
  when diagnostic and surveillance strategies
  should be changed based on local influenza
  activity.
• What is missing has been When to act.

Healthy Kansans Living in Safe and Sustainable
Environments
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SIX PHASES ESTABLISHED BY THE WORLD HEALTH
ORGANIZATION
Healthy Kansans Living in Safe and Sustainable
Environments
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Intervals, Triggers, Actions

• Different communities will be at different
  intervals during the pandemic
• State or community level planning needs a
  locally-defined trigger
• National curve is a reflection of state/local
  curves

U.S
Example
KS
KC KS
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Mitigate
Contain
Quench/Extinguish
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Triggers When to Act

• Influenza Intervals
• Provide framework for resource planning
• Provide common approach for Federal and State
  planning
• Provide the missing link for WHEN
• to initiate actions

Healthy Kansans Living in Safe and Sustainable
Environments
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Intervals, Triggers, Actions
- High PPV - Focus on clinical
diagnosis and management - Use broad
approaches to surveillance and
interventions
- Goal to detect early - Initiate community
interventions
- Low PPV - Need high sens/spec tests - Rapid
response needed
CDC Interval
Recognition
Decel
Accel
Resolution
Peak
Initiation
Investigation

• Surveillance and interventions differ by interval
• Pandemic Severity Index qualitatively affects
  interventions.
• Actions based upon our ESF 8 Plans, BIA, SOGs,
• Community Containment Tool Boxes

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Intervals, Triggers, Actions
CDC Intervals

• State Level Trigger for community mitigation
  1) Two or more laboratory confirmed pandemic
  cases in a State without identifiable
  epidemiological links, 2) Increasing numbers of
  cases exceed resources to provide case-based
  control measures.
• National Level At least one state in three of
  the ten FEMA/HHS regions have met the
  Acceleration criteria.

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Actions? At What Level?

• WHO Phases identify global progression of
  pandemic (Who)
• US Government Stages provide more framework for
  national actions (What)
• Pandemic Intervals (When)
• Pandemic Severity Index (How)
• - Based upon severity of specific virus (based on
  mortality estimates)
• - Informs Public Health of the level of Community
  
• Mitigation Interventions to recommend

Healthy Kansans Living in Safe and Sustainable
Environments
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May or May not reduce total number of cases
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Liberty Loan Parade Philadelphia
St. Louis initiated quick comprehensive Community
Interventions