Exercise Cold Play II Introduction

Host Name

Core Statement

‘'We don't know enough about this virus to draw any conclusions about its severity,' he said. 'At this stage I think it would be premature to conclude that this is a

mild infection.'

Sir Liam Donaldson Chief Medical Officer, May 2009

Aims & Objectives

To review the spring/summer H1N1v pandemic flu wave and to prepare for a more serious second wave during

this winter flu season.

Seasonal ’flu vs Pandemic ’flu

SEASONAL FLU

Occurs every year during the winter

Affects up to 10% of the population

The very young, the very old and people with certain chronic illness are most at risk

Annual vaccination available

Antiviral drugs available for the at risk

PANDEMIC FLU

Occurs about 3 times each century – at any time of the year

May affect up to 30% of the population

People of every age may be at risk

Vaccine won’t be available initially - in the first wave

Antiviral drugs are likely to be in limited supply

Previous ’flu Pandemics

Pandemic Spanish Flu Asian Flu Hong Kong Flu Swine Flu

Strain: A(H1N1) A(H2H2) A(H3N2) A(H1N1)

Year: 1918-1919 1957-1958 1968-1969 2009 - ?

Origin: Not known China China Mexico

Estimated Deaths

Global 20-40 million 1million 1-4 million ?

UK 250,000 33,000 30,000 ?

Age Group 20-50 yrs under 14 yrs under 5 yrs ? over 65 yrs over 65 yrs

Shortest interval = 11 yearsLongest interval = 40 years

07/68

08/68

09/68

09/68

09/68

09/68

06/69

09/68

01/69

C.W. Potter, Textbook of Influenza, 1998

Geographic Spread: 1968-69

Pandemic Influenza

• Three pandemics during 20th Century (1918, 1957, 1968)

• 20 million deaths worldwide in 1918-19

• Different data sources

• Current and real threat

0

200

400

600

800

1,000

6 13

20

27 3 10

17

24

31 7 14

21

28 5 12

19

26 2 9 16

23

30 7 14

21

28 4 11 18

25 1 8 15

22

july august september october november december january february

Week No. and Month During the Winter of 1957/58

Reco

rded

Death

s in

En

gla

nd

an

d W

ale

s fr

om

Infl

uen

za

0

200

400

600

800

1,000

1,200

1,400

42

48 4 12

20

28

36

44

50 8 16

24

32

40

48 4 12

20

28

36

1967 1968 1969 1970

Week No. and Year

GP

'IL

I' c

on

sult

ati

on

s p

er

week

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

27

29

31

33

35

37

39

41

43

45

47

49

51 2 4 6 8 10

12

14

16

18

1918 1919

Week No. and Year

Death

s in

En

gla

nd

an

d W

ale

s

1957/8: Flu Deaths Eng. and Wales 1968/9: GP consults Eng. and Wales1918/9: Flu Deaths Eng. and Wales

1957 Pandemic 1968 Pandemic1918 Pandemic

This pandemic

1. Global spread is rapid – we must prepare now, or risk being caught by surprise

2. Possible several epidemic waves; first may be ‘milder’ than subsequent ones – sustainability and resilience will be key issues

3. A pandemic virus is new to man, virtually no one has immunity. This means the virus causes more severe disease in more people.

This pandemic – key events to date

24 April 09 - Mexico City under Swine Flu epidemic

26 April 09 -New Zealand college students return from Mexico with Flu-like symptoms

27 April 09 - New York confirms eight cases of Swine Flu

29 April 09 – WHO - Level 5

29 April 09 - Swine Flu reaches Germany

1 May 09 - UK – Pupil at Downend School, South Gloucestershire, confirmed as having

contracted Swine Flu

4 May 09 - UK – Alleyn’s School, London, closes after Swine Flu outbreak

5 May 09 - UK – The post office distribute Swine Flu leaflets to houses in the UK

18 May 09 - First New York city Swine flu victim dies

11 June 09 - WHO – declares Pandemic Level 6

14 June 09 - First death outside America linked to Swine Flu (woman dies in Paisley)

6 July 09 – UK Government moves from ‘containment’ to ‘ treatment’

Exercise Format

Four ‘blocks’ of time

Week 0 – between waves

Week 6 – First cases – 2nd wave

Week 11 - Peak

Week 21 - Recovery

Each block represents a single day in the pandemic cycle

Each block will bring out specific topics

Broadly they are:

• Infection Control• Vaccines• Anti virals• Staffing and resources• Surveillance• Media • Business Continuity

Key Planning Assumptions

The exercise has been developed using the Department of Health’s planning assumption (July 2009) of:

a 30% clinical attack rate and a

case-fatality rate of up to 0.35%

Guidance AvailableDepartment of Health Pandemic Influenza Plan

http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/PandemicFlu/fs/en

Flu key documents and resources for patients and health professionals

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/fs/en

Department of Health Emergency Preparedness

Beyond a Major Incident – planning for potentially large numbers of casualties

http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en

The Health Protection Agency:

http://www.hpa.org.uk/infections/topics_az/influenza/flu.htm

NICE (National Institute for Health and Clinical Excellence)

http://www.nice.org.uk

The WHO Influenza Pandemic Influenza Preparedness and Response Guidance document is available at

http://www.who.int/csr/disease/influenza/PIPGuidance09.pdf

Block One – Reviewing and Preparing for the Winter Flu Season – Questions

• Plans and Planning Process

• Roles & Responsibilities

• Data Gathering, Surveillance & Reporting

• Co-ordination of Media & Public Communications

• Antivirals

Block Two – Initial response to second wave Questions

• Distribution of antiviral treatment and health advice

• Vaccination

• Use of Personal Protective Equipment (PPE) and infection control guidance

• What measures are you planning locally?

• Resilience of the emergency services

• Social distancing measures/Schools/Travel advice

Block Three – Business Continuity at the peak Questions

• Resilience arrangements

• Staff Shortages/Resources

• Business Continuity

• Management of deaths

• Antiviral distribution

Block Four - RecoveryQuestions

• Recovery

• Voluntary services

• Bereavement

• Lessons learned

Exercise Cold Play II