Pandemic Response Briefing to Business

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Pandemic Response Briefing to Business
Community LeaderScenario time Oct 24

• Group 2
• Tammy Hunt
• David Broudy

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Outline

• The challenge
• Without intervention
• 800K - 9.6M Hospitalizations
• 18-42M outpatient visits
• 80K - 285K deaths
• Epidemiology Breaking the cycle of transmission
• What is to be done? A strategy for communities

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Why Multnomah Co should support community
interventions

• Medical measures may be delayed
• Efficacy of vaccine and antivirals unknown
• Infection Control Measures are effective
• History of 1918 Pandemic supports aggressively
  limiting assemblage
• The longer you wait to intervene, the worse the
  effects of the epidemic
• Working together and building our community is
  good for business and good public health

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Social Distancing and Infection Control

• Social Distancing (Contact Interventions)
• School closure
• Work closure (telecommuting)
• Cancellation of public gatherings
• Infection Control (Transmission Interventions)
• Facemasks
• Cough etiquette
• Hand hygiene

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Non-pharmaceutical Interventions

• Ill persons should be isolated (home vs
  hospital)
• Voluntary home quarantine for household contacts
• Social distancing measures
• School closures may have profound impact
• Keep your business going by allowing employees to
  work from home
• Cancellation of public events
• Individual infection control measures work
• Hand washing and cough etiquette for all
• Mask use for ill persons, PPE stratified by risk
• Disinfection of environmental surfaces as needed

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Community-Based Interventions
1. Delay disease transmission and outbreak
peak 2. Decompress peak burden on healthcare
infrastructure 3. Diminish overall cases and
health impacts
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(No Transcript)
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Susceptible to Targeted Attack
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Susceptible to Targeted Attack
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Effect of R 0 on Epidemic Curve
Eubank S, personal communication
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A Tale of Many CitiesWhat Does History Teach Us?
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"...Spanish influenza is now present and probably
will become epidemic in the City of St. Louis. In
view of this proclamation, and under the
authority vested in me by the City Charter of the
City of St. Louis, after such proclamation in
order to prevent all unnecessary public
gatherings through the medium by which this
disease is disseminated, I hereby order that all
theaters, moving picture shows, schools, pool and
billiard halls, Sunday schools, cabarets, lodges,
societies, public funerals, open air meetings,
dance halls and conventions to be at once closed
and discontinued until further notice." --Mayor
Henry Keil (October 7, 1918)
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Liberty Loan ParadeSeptember 28, 1918
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The drastic actions of Mayor Keil were sensible
considering by October 7th, 167,000 cases had
broken out, with 4,910 deaths, across the eastern
United States. Mayor Keil's actions perhaps
spared St. Louis of the worst outbreaks. For
instance for the October 10-November 2 time frame
the following deaths were reported New York,
16,705 Boston, 3,694 Philadelphia, 12,162
Chicago, 7,405 Baltimore, 3,507 St. Louis 784.
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Weekly mortality data provided by Marc Lipsitch
(personal communication)
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Weekly mortality data provided by Marc Lipsitch
(personal communication)
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1918 Age-specific Attack Rates
McLaughlin AJ. Epidemiology and Etiology of
Influenza. Boston Medical and Surgical Journal,
July 1920.
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Why close schools?

• In 1918 the spanish flu had an unusually high
  attack rate among younger people
• Small children are efficient incubators and
  spreaders of infectious diseases
• Preventing the spread of the flu among children
  will reduce spread to families
• Reducing serious illness and death among working
  age adults will reduce impact on economy
• Flattening the epidemiology curve will allow
  distribution of scarce resources over longer
  periods.

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Who Infects Whom?
To Children To Teenagers To Adults To Seniors Total From
From Children 21.4 3.0 17.4 1.6 43.4
From Teenagers 2.4 10.4 8.5 0.7 21.9
From Adults 4.6 3.1 22.4 1.8 31.8
From Seniors 0.2 0.1 0.8 1.7 2.8
Total To 28.6 16.6 49.0 5.7
Likely sites of transmission
Children/Teenagers 29 Adults
59 Seniors 12
Demographics
Glass, RJ, et al. Local mitigation strategies for
pandemic influenza. NISAC, SAND Number
2005-7955J
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Model Predictions 1918 Interventions Ro 2.1,
2 case fatality rate
MONTREAL 11.5
SAN FRANCISCO 8.8
ST. LOUIS 2.2
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Model Predictions 1918 Interventions Ro 2.1,
2 case fatality rate
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Intervention DelaySensitivity
Scenarios Attack Rate () Deaths
No intervention 46.8 80,405
Intervention at 12 27.7 47,511
Intervention at 8 23.9 41,045
Intervention at 2 9.7 15,782
Intervention at 1 5.3 9,107
Intervention at 1 w/ TARP Case Rx, HH Px 2.9 4,889
Longini model for Chicago pop 8.8M, NPI
intervention TLC w 30 compliance HH-Q
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Acknowledgements

• Many of these slides are from a presentation by
  Martin Cetron, MD, Div Global Migration and
  Immigration, CDC
• Thanks to Subject Matter Expert for Group 2
• Chris Felstadt
• Norm Nedell
• Peter Rigby
• Karen Pendelton
• Matt Bernard
• Diane Bonne, Facilitator
• Martin, MD
• Director, Division of Global Migration and
  Quarantine
• Centers for Disease Control and \, MD
• Director, Division of Global Migration and
  Quarantine
• Centers for Disease Control and, MD
• Director, Division of Global Migration and
  Quarantine
• Centers for Disease Control and Prevention