Pandemic Influenza and Disaster Preparedness

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Pandemic Influenza and Disaster Preparedness

• Marshal Bickert, MPH
• Central Ohio Trauma System

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Todays Presentation

• Pandemic and Emergency Preparedness
• National and State Preparedness Initiatives
• Personal and Agency Preparedness

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Influenza 101

• Virus Three types A, B and C
• A influenza Viruses- cause human, pig, horse,
  bird and many other animal flu outbreaks
• segments break apart during replication to mix
  and reassort
• potential for constant evolution is built in
• name based on protein structure

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Influenza Virus
9 Different Neuraminidase (N1, N2..)
16 Different Hemagglutinin (H1, H2..)
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H1N1
H3N2
Etc, etc, etc.
H5N1
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Seasonal Flu

• The flu is a contagious respiratory illness
  caused by a virus.
• It can cause mild to severe illness, and at times
  can lead to death.
• Generally affects the United States each year
  from December to March

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Seasonal Flu

• Spread by contact with an infected person
  through
• Sneezing
• Coughing
• Touching items recently contaminated by a person
  with the flu virus

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Seasonal Flu

• Symptoms include
• Fever (usually high) and chills
• Body aches
• Sore throat
• Non-productive cough (dry)
• Runny or stuffy nose
• Headache
• Extremely tired (fatigue)
• Diarrhea

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Seasonal Flu

• Results
• 37.5 Billion in Economic Loss (US)
• gt 200,000 Hospitalizations (US)
• 36,000 Deaths (US)
• 250,000-500,000 Deaths (Worldwide)

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Seasonal Flu

• Prevention and Treatment

Get Vaccinated. Avoid close contact. Stay home
when you are sick. Cover your mouth and
nose. Clean your hands. Avoid touching your
eyes, nose or mouth. Antivirals
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Avian Flu or Bird Flu

• Avian flu or bird flu is a contagious disease
  of animals caused by viruses that normally infect
  only birds and less commonly pigs.

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Avian Influenza

• Infect respiratory and gastrointestinal tracts of
  birds
• Usually do not cause disease in wild waterfowl
• Can cause morbidity and mortality in domestic
  poultry
• Avian influenza A viruses are shed in the
  respiratory tract and in feces
• Can survive at low temperatures and low humidity
  for days to weeks
• Can survive in water
• Can survive on surfaces
• Disinfection of the environment is needed

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Avian Influenza in US

• 1983-1984 H5N2 in circulation for 6mo
• Adjusted for inflation 85M, 490M, 85M
• 2002 Virginia H7N2
• 2006 August, Low pathogenic H5N1

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Current Outbreak of Avian Flu

• Current poultry outbreaks of avian influenza
  began in South East Asia in mid-1997. They are
  the largest and most severe on record.
• Causative agent is the highly pathogenic H5N1
  virus.
• Poultry or wild bird outbreaks have occurred
  throughout the countries of Asia, Europe, the
  Near East, and Africa.

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Avian Influenza - Human Infection

• As of October 11th, there have been 253 human
  cases and 148 deaths reported in ten countries
  Azerbaijan, Cambodia, China, Djibouti, Egypt,
  Indonesia, Iraq, Thailand, Turkey, and Vietnam.
• Main route of infection is direct sustained
  contact with infected poultry or surfaces
  contaminated with their feces.
• There is no evidence that properly cooked poultry
  or eggs can be a source of infection.

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Implications for Human Health

• Infection with the virus results in very serious
  disease especially in young adults.
• Concern that the virus will become highly
  infectious for humans and spread easily from
  person to person. That could mark the start of a
  global outbreak.

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Avian Influenza in Humans

• Typical influenza-like symptoms (e.g., fever,
  cough, sore throat, and muscle aches) to eye
  infections (conjunctivitis), pneumonia, acute
  respiratory distress, viral pneumonia, and other
  severe and life-threatening complications.

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Avian Influenza in Humans

• Treatment
• No approved vaccine for humans
• Treatable with 2 different antivirals
• Avoid prolonged, direct contact with infected
  birds or surfaces contaminated with fluids from
  infected birds

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Seasonal vs. Avian Influenza

• Common in Humans
• Seasonal in US
• H1N1, H3N2

• Uncommon in Humans
• Requires direct contact
• Very Serious Illness
• H5N1, H7N7..

• Any Questions?

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Pandemic Influenza

• Pandemic flu occurs when a new influenza virus
  appears or emerges in the human population and
  causes a global outbreak of the disease,
  resulting in serious illness as it spreads from
  person to person.

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Why do pandemics happen?

• Emergence of a new flu virus
• New virus passes easily from person to person
• Few, if any, people have any immunity
• This allows it to spread widely, easily and to
  cause more serious illness

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Pandemic Influenza

• Experts believe a worldwide outbreak, or
  pandemic, of influenza will happen someday. The
  exact timing is not known, but it is certain our
  everyday lives will drastically change during a
  pandemic.

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Pandemics Happen!
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When, Why and How Will the Next Pandemic Start?

• Its impossible to know for sure!
• Experts are tracking several avian viruses with
  the potential to cause the next pandemic
• H5N1
• H7s
• H9s

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WHO Pandemic Phases
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Current H5N1 Pandemic Phase
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• Report H5N1 mutated rapidly in Indonesian
  cluster
• Jul 12, 2006 (CIDRAP News) Genetic studies show
  that the H5N1 avian influenza virus mutated
  multiple times as it spread through an Indonesia
  family in May, but the significance of the
  changes is uncertain, according to a news report
  today in Nature.

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Seasonal Flu

• 37.5 Billion in Economic Loss (US)
• gt 200,000 Hospitalizations (US)
• 36,000 Deaths (US)
• 250,000-500,000 Deaths (Worldwide)

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What If?
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Central Ohio

• Population 1.9 Million
• 570,000 Sick
• 285,000 Outpatient Visits
• 57,000 Hospitalizations
• 12,700 Deaths
• 4,275 Mechanical Ventilation

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• The 1918 Spanish Influenza epidemic killed, at a
  very, very conservative estimate, 550,000
  Americans in 10 months thats more Americans
  than died in combat in all the wars of the 20th
  century
• Alfred W. Crosby
• Influenza 1918, The American Experience

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• Avian influenza patterns resemble 1918 pandemic,
  WHO study shows
• Jul 3, 2006 (CIDRAP News) The World Health
  Organization (WHO) on Friday published its first
  epidemiologic analysis of all laboratory-confirmed
  cases of H5N1 avian influenza reported to the
  agency between Dec 1, 2003, and Apr 30, 2006.

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What to Expect?

• Large numbers of people will become ill and die.
• There will be significant economic and social
  disruption.
• There will be prolonged disruption of essential
  services including electricity, water, and proper
  sewer functionality.
• Store shelves will remain empty for prolonged
  periods (multiple weeks).
• The healthcare infrastructure WILL BE severely
  strained.

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What does this mean for you?

• Your place of employment may be closed for
  prolonged periods. Due to economic disruptions
  many employers may close permanently.
• Public transportation may not be available.
• Childcare and schools may close for prolonged
  periods.
• You may have to provide basic medical care to
  loved ones.
• All the essential services we take for granted,
  water, police protection, fire/EMS, social
  services, etc. will be severely limited or maybe
  even non-existent.

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What to Expect for Your Practice?

• Exponential growth in demand (direct illness and
  disaster within a disaster)
• Dramatic worker absenteeism (gt40)
• Disruption of supplies and services
• Social distancing requirements
• Disruption of utilities
• Interruption of insurance payments
• Increased security needs

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Seasonal Flu
Pandemic
Avian Influenza
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National Preparedness

• Monitoring disease spread to support rapid
  response
• Developing vaccines and vaccine production
  capacity
• Stockpiling antivirals and other countermeasures
• Coordinating federal, state and local preparation
  
• Enhancing outreach and communications planning

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CDC Planning Assumptions

• Susceptibility to the pandemic influenza virus
  will be universal
• The clinical disease attack rate will be 30 or
  higher during the pandemic
• Illness rates will be highest among school-aged
  children and decline with age
• 20 of working adults will be ill during a
  community outbreak with 40 work absenteeism.

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Preparing for the Pandemic

• State Response
• Distribute 3.5 Million in FY2006 and 8.5
  Million in FY2007 to local public health
• Draft Pandemic Flu Plan developed through a
  120-day planning period
• Follow National Target Capabilities
• Strategic National Stockpile (SNS)
• Ohio Department of Health website
  http//www.odh.ohio.gov

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Preparing for the Pandemic

• Role of the local health
• department
• Declaration of Public Health Emergency
• Coordination of Community Response
• Surveillance and Tracking
• Isolation and Quarantine as Appropriate
• Vaccine and Pharmaceutical Delivery
• Public Information and Communication

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Preparing for the Pandemic

• Local response Whats in place
• Strong Partnerships and Relationships
• Strong Communicable Disease Reporting System
  (CDRS)
• DRAFT Influenza Pandemic Response Plan
• Extensive Inter-Agency Planning
• Early Warning Systems (Abstrac, RODS / OTC)
• Trained Nurses and Public Health Staff
• State of the Art Technology for Registration and
  Tracking

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Preparing for the Pandemic

• Local response Whats in place (contd)
• Planning for Mass Vaccination Clinics
• Authority Regarding Isolation and Quarantine
• Planning With Health Care Facilities for Mass
  Care and Mass Casualties
• Community Unified Command System
• Established Communication Mechanisms
• Emergency Operations Plan and Departmental
  Operations Center Activated in an Emergency

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Mass Clinic Plans for Vaccine or Medication
Distribution

• PODS Point of Distribution
• 20 Clinics in Columbus 10 clinics in Franklin
  County -geographically located
• Wireless access needed for documentation
• Personnel Needs public health / safety / other
  staff / volunteers
• POD hours and duration will be determined by
  nature of the emergency

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Central Ohio Trauma System

• Non- Profit- Receives significant funding from
  CMAF
• Established 1998
• Initially established to reduced trauma morbidity
  and mortality in Central Ohio
• 1999 Hospital Disaster Preparedness
• Established RHEP Committee in 2003

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Regional Hospital Emergency Preparedness
Committee (RHEP)

• 24 HRSA Eligible Hospitals in Central Ohio
• 3 Specialty Hospitals
• Local Public Health
• EMA
• Fire/EMS
• Law Enforcement
• Support Agencies

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Current RHEP Structure
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Strategic Emergency Preparedness

• Hazard Analysis
• Scenario-Based Planning
• Development of Task Lists
• Capability Based Planning
• Risk Management
• Continuous Quality Improvement

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Pandemic Influenza Model
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Staffing Shortages

• Internal Factors
• Workplace Acquired Illness
• Morale
• Efficacy
• Fear- Self
• Facility Security

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Extremely High Census
Increased Workforce Demands
Loss of Workforce

• External Factors
• Community Acquired Illness- Self
• Fear- For Family
• Illness Spouse
• Illness Dependents
• Transportation
• Home/Childcare

• Increased Needed Output
• High Acuity Illness
• Diminishing Resources
• PPE Requirements
• Security Measures

Catastrophic Workforce Shortages
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Level 3 Surge Community Level
Management
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Central Ohio Threats

• Floods
• Terrorism
• Infectious Disease
• Utility Interruptions
• Storms
• Tornadoes
• Dam Inundations
• Rioting
• Hazardous Materials Spills
• Etc, etc, etc,

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• So What do we do now?

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Private Practice Preparedness

• Step 1. Prepare and Protect Your Staff
• Step 2. Stay in Business
• Step 3. Assist in Disaster Response

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Prepare and Protect Your Staff

• No service agency can mount an effective response
  without staff
• How many staff-members/volunteers have the
  following?
• Emergency Supplies Kits including medications
• Family Communications Plans
• Evacuation Kits
• Pet Care Plan

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Personal/ Family Preparedness Ready In 3
Make a Kit Make a Plan Listen
http//www.publichealth.columbus.gov
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Staffing Shortages

• Internal Factors
• Workplace Acquired Illness
• Morale
• Efficacy
• Fear- Self
• Facility Security

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Extremely High Census
Increased Workforce Demands
Loss of Workforce

• External Factors
• Community Acquired Illness- Self
• Fear- For Family
• Illness Spouse
• Illness Dependents
• Transportation
• Home/Childcare

• Increased Needed Output
• High Acuity Illness
• Diminishing Resources
• PPE Requirements
• Security Measures

Catastrophic Workforce Shortages
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Step Two

• Stay in Business!
• Do you have a business continuity of Operations
  Plan?
• Do you know how your office will continue
  operations should it be directly affected by a
  disaster?

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Emergency Preparedness Cycle
Plan
Prepare
Recover
Respond
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Simple Hazard Analysis

• What hazards are you likely to face?
• What is the probability of that hazard occurring?
• Develop a scale to rate hazard 1-5
• What is the impact if that hazard actually
  occurs?
• Develop a scale to rate impact 1-5
• Rank hazards based on risk score (hazard x impact)

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Simple Hazard Analysis
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Basic Contingency Plans

• Hazard Vulnerability Assessment
• Contingency Plans for Small Emergencies
• Fires
• IT Interruptions
• Winter Storms

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Basic Plan Components

• Medical Emergencies
• Fire
• Evacuation
• Shelter-In-Place (Weather/Chemical)
• Code Adam
• Communications
• Facility Specific (x-ray machines, laboratory
  materials)

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Continuity of Operations Plans (COOP)

• Large Scale Disruptions/Emergencies
• Hurricanes
• Earthquakes
• Floods
• Local Terrorist Events

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Continuity of Operations Plans (COOP)

• How long will it take you to re-establish
  operations after a large emergency?
• Do you have back-up files and/or IT solutions?
• Do you have an alternate site if your primary
  (normal) area of operations is no longer
  functional?

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Continuity of Operations Plan- Essential (COP-E)

• Major Catastrophic Events
• Pandemics
• Large Terrorism Events
• Hurricane Katrina

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Continuity of Operations Plan- Essential (COP-E)

• What are the essential services you must continue
  to provide?
• Have you prioritized these essential services?
• What vulnerabilities exist which would preclude
  you from conducting these essential services?
  Have you mitigated these vulnerabilities?

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Step 3 - Emergency Response

• Potential Community Response Actions
• Integrate into community unified command system
• Assist with Medical Surge Capacity
• Provide Resources
• Disseminate Information
• Assist with Public Health Protective Actions
• Special Needs Sheltering
• Surveillance/Detection/Medical Intelligence

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Integrate into Community Unified Command System

• Establishes a clear chain of command
• Enables effective and efficient resource
  allocation
• Facilitates response information sharing and
  dissemination (Altered Standards of Care and
  Triage/Admission Criteria)

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Columbus and Franklin CountyUnified Incident
Command
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Columbus and Franklin CountyUnified Incident
Command
OPERATIONS SECTION
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Assist with Medical Surge Capacity

• Medical Surge Ability of the community to expand
  medical care capability
• Greatest good for the greatest number
• Provide initial triage and stabilization of
  disaster victims
• Receive overflow of victims from hospitals
• Arrange and coordinate transportation

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Level 2 and 3 SurgeCommand and Control
Community Healthcare Coordination
Altered Standards of Care Coordination
Disaster
Hospital 1
Hospital 2
Private Practice
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Provide Resources

• Again, Greatest Good for the Greatest Number
• Make staff and facilities available for medical
  and public health functions
• Close facility and make staff available at other
  locations
• Provide interpreters
• Provide volunteer management technical expertise

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Disseminate Information

• Inward
• Situation Reports (office operational status)
• Resource Needs
• Rumor Control- Report and dispel
• Outward
• Disseminate prevention information
• Inform clients of available resources
• Provide information regarding emergency response
  actions and self treatment options

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Assist with Public Health Protective Actions

• Mass Vaccination Clinics
• Mass Prophylaxis Operations
• Quarantine/Isolation

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Surveillance/Detection/Medical Intelligence

• Surveillance- Early event detection
• Detection- High index of suspicion and report
• Medical Intelligence
• Nature, number, and severity of victims
• Effectiveness of response measures

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Private Practice Preparedness

• Step 1. Prepare and Protect Your Staff
• Step 2. Stay in Business
• Step 3. Assist in Disaster Response

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Finally, Become Preparedness Ambassadors!

• Disseminate preparedness information and promote
  personal, family, and workplace preparedness.
• Determine what services your organization can
  provide during a pandemic.
• Ensure your political leaders are devoting the
  necessary resources for community preparedness.

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Preparedness is no longer optional!

• www.odh.ohio.gov
• www.pandemicflu.gov
• www.ready.gov
• www.cdc.gov/flu/pandemic/

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Summary

• Influenza/Disaster Preparedness
• Federal, State, and Local Preparedness
• Personal, Family, Organizational Preparedness

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The game will go on!

• Marshal Bickert, MPH
• MBickert_at_goodhealthcolumbus.org
• 614-240-7419x4