Pandemic Influenza: Home Health Care Response Planning

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Pandemic InfluenzaHome Health Care Response
Planning

• Bill Tynan, MD, MPH
• Florida Department of Health
• April 18, 2007
• Bill_Tynan_at_doh.state.fl.us

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Overview

• Threat
• National Strategy
• Planning
• Planning Assumptions
• Agency/Business Planning
• Resources

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Threat

• What will a pandemic influenza cause in the
  United States?
• Increased morbidity (sickness) and mortality
  (death)
• Social disruption
• Economic disruption

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Threat

• How soon will a pandemic occur?
• Additional genetic changes must occur in the
  virus before efficient human to human spread
  occurs
• Polymerase genes circulating in humans as early
  as 1900

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Mortality

• United States
• 1918-19 500,000
• 1957-58 70,000
• 1968-69 35,000
• Early 21st Century ? 2,000,000
• Florida 128,000 ?
• 2 Case fatality rate

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Social Disruption

• Will schools, child care centers, churches,
  malls, theaters, restaurants, courts, government
  agencies, other, be closed?
• Will public gatherings be banned?
• If so, for how long?
• What thresholds or criteria determine closing and
  re-opening?

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Economic Disruption

• Florida 38 billion in year one (5.5 of SDP)
• Will college and professional sporting events be
  postponed?
• Will central Florida theme parks be closed?
• Will gasoline service stations close leading to
  fuel shortages?
• Will the poultry industry be destroyed?
• Will personnel shortages lead to water, food, and
  electricity shortages?
• Will rumors lead to panic purchasing?

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National Strategy

• 1. Stop, slow or otherwise limit the spread of a
  pandemic to the United States
• 2. Limit the domestic spread of a pandemic, and
  mitigate disease, suffering and death
• 3. Sustain infrastructure and mitigate impact to
  the economy and the functioning of society

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Outbreak Control Tools

• Infection control
• Isolation
• Quarantine
• Social distancing
• Sheltering in place
• Antivirals
• Vaccines

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Planning Assumptions

• A reasonable supposition on the current situation
• A reasonable presupposition on the future course
  of events
• Either or both assumed to be true in the absence
  of positive proof
• Necessary to enable leadership to complete an
  estimate of the situation and make a decision on
  the course of action

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U.S. Planning Assumptions

• Attack rate 35 of population
• Treatment rate 25 of population
• 75 of cases
• Hospitalization rate 10 of cases
• Case fatality rate 2 (2 - 50)
• Pre/asymptomatic 30 - 50 (?)
• transmission
• Reproduction number 2 people (0 21 people)
• Incubation period 2 days (1 8 days)

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Florida Planning Assumptions

• 1st Wave/2nd Wave Total
• Cases 3.2 million 6.4 million
• Hospitalized (10) 320,000 640,000
• Surge Beds (130) 65,000
• ICU 48,000
• ICU Ventilator 24,000
• Surge Ventilators 5,000
• Dead (2) 64,000 128,000
• Florida population 18.3 million
• Possible antiviral effect 50 - 70 decrease
  in surge beds 20,000 32,500

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Pandemic Influenza Florida Case Estimate 1st
Wave
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Home Health Care

• Florida
• 1,751 licensed Home Health Care Agencies
• 250 Nurse Registries
• 43 Hospices
• 293,987 Home Health Care Clients
• 10 over age 65 (2.9 million Floridians gtage 65)
• Medicare 1.2 billion
• 10 of the US Medicare Home Health Budget is
  spent in Florida
• Private Pay approx. 1.2 billion
• Number of Home Health Care Employees?
• Association of Home Health Industries of Florida
  (AHHIF)

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Long Term Care

• Influenza Planning Checklist
• 1. Structure for Planning and Decision Making
• 2. Development of a Written Pandemic Influenza
  Plan
• 3. Elements of an influenza Pandemic Plan
• a. surveillance and detection
• b. communication plan
• c. education and training prevention and
  control
• d. infection control plan
• e. occupational health plan
• 1) estimated 40 absenteeism at height of
  pandemic wave
• f. vaccine and antiviral plan
• g. surge capacity
• U.S. Health and Human Services pandemicflu.gov

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Agency/Business Planning

• Planning Assumptions
• Reduction of transportation (drivers) by 20
• Just in time inventories
• Fuel shortages due to above
• Law enforcement, fire, EMS creates mutual aid
  difficulties

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Agency/Business Planning

• Planning Assumptions
• Single parent families
• School or child care closures
• Both parents work in health care
• Children sick, parents not working
• Parents sick, children not cared for
• Create alternatives to customers coming into the
  stores for purchases

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Agency/Business Planning

• Planning Assumptions
• COOP planning should be based on critical
  functions and essential services, not buildings
• Rumors creating staff outages
• Death of employees
• Use of virtual or work at home capabilities

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Preparedness

• World Health Organization
• http//www.who.int/csr/disease/avian_influenza/en/
  index.html
• Department of Health and Human Resources
• http//www.pandemicflu.gov/
• Centers for Disease Control and Prevention
• http//www.cdc.gov/flu/avian/index.htm
• Florida Department of Health
• http//www.doh.state.fl.us/
• Local County Health Department

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