51
Pandemic Influenza The Business Perspective Golub July 2006
Pandemic InfluenzaThe Business Perspective
Golub July 2006
Influenza A Single stranded
RNA Subtyped based on
surface glycoproteins bull 16 hemagglutinins
(HA) bull 9 neuraminidases
(NA) 8 gene segments
Seasonal Flu
Adults can infect others 1 day before symptoms amp up to 7 days after (ave 5)-children infectious gt10 days and young children shed virus 6 d pre onset
Incubation period 1- 4 days ave 2 days Spread by coughing and sneezing (droplets some
airborne) and contact watch debate on PPE (airborne vs droplet )
Up to 50 cases spread by asymptomatic individuals Survives 12 -24 hr hard surface 12 hr porous longer if
cold amp dry 5 minutes on hands Reproductive Number (Ro) ave number others infected
by by 1 infected individual influenza 2-10 Spread a function of asymptomatic shedding speed of
transmission (serial interval) and Ro transmission
Asian H5N1
Mostly a GI disease in birds -birds excrete virus at least 10 days in stool amp secretions days in stool amp secretions
10487081048708 Virus survives well in feces and water -35d in feces 4 C 6d 37 C wks poultry house environ litterfeces 37 C wks poultry house environ litterfeces
Has adapted wild birds to poultry and now back to wild birds from poultry
Broadening adaptation to mammals and high lethality ndashtigers leopards cats ferrets mice pigs humans
Incubation period up to 8 days in humans Mainly back yard poultry fighting cocks (Thailand) hard to
get watch lower PPE requirements HCWs precaution levels Significant likelihood of arrival in N America of current
nonsustainable transmission H5N1 within 1 -2 yrs Significant likelihood non Asian H5N1 (LPAI) will be identified
in N America as screening efforts grow Have an avian influenza plan separate from pandemic plan
Antigenic Drift vs Shift
bull Driftbull Point mutations in viral RNA copying error
bull Continual process bull Causes yearly epidemics bull Requires annual update of vaccine
bull Shift bull Replacement of H or HampN (ie new
subtype) bull Sporadic event bull Can result in a pandemic (not a given)
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Influenza A Single stranded
RNA Subtyped based on
surface glycoproteins bull 16 hemagglutinins
(HA) bull 9 neuraminidases
(NA) 8 gene segments
Seasonal Flu
Adults can infect others 1 day before symptoms amp up to 7 days after (ave 5)-children infectious gt10 days and young children shed virus 6 d pre onset
Incubation period 1- 4 days ave 2 days Spread by coughing and sneezing (droplets some
airborne) and contact watch debate on PPE (airborne vs droplet )
Up to 50 cases spread by asymptomatic individuals Survives 12 -24 hr hard surface 12 hr porous longer if
cold amp dry 5 minutes on hands Reproductive Number (Ro) ave number others infected
by by 1 infected individual influenza 2-10 Spread a function of asymptomatic shedding speed of
transmission (serial interval) and Ro transmission
Asian H5N1
Mostly a GI disease in birds -birds excrete virus at least 10 days in stool amp secretions days in stool amp secretions
10487081048708 Virus survives well in feces and water -35d in feces 4 C 6d 37 C wks poultry house environ litterfeces 37 C wks poultry house environ litterfeces
Has adapted wild birds to poultry and now back to wild birds from poultry
Broadening adaptation to mammals and high lethality ndashtigers leopards cats ferrets mice pigs humans
Incubation period up to 8 days in humans Mainly back yard poultry fighting cocks (Thailand) hard to
get watch lower PPE requirements HCWs precaution levels Significant likelihood of arrival in N America of current
nonsustainable transmission H5N1 within 1 -2 yrs Significant likelihood non Asian H5N1 (LPAI) will be identified
in N America as screening efforts grow Have an avian influenza plan separate from pandemic plan
Antigenic Drift vs Shift
bull Driftbull Point mutations in viral RNA copying error
bull Continual process bull Causes yearly epidemics bull Requires annual update of vaccine
bull Shift bull Replacement of H or HampN (ie new
subtype) bull Sporadic event bull Can result in a pandemic (not a given)
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Seasonal Flu
Adults can infect others 1 day before symptoms amp up to 7 days after (ave 5)-children infectious gt10 days and young children shed virus 6 d pre onset
Incubation period 1- 4 days ave 2 days Spread by coughing and sneezing (droplets some
airborne) and contact watch debate on PPE (airborne vs droplet )
Up to 50 cases spread by asymptomatic individuals Survives 12 -24 hr hard surface 12 hr porous longer if
cold amp dry 5 minutes on hands Reproductive Number (Ro) ave number others infected
by by 1 infected individual influenza 2-10 Spread a function of asymptomatic shedding speed of
transmission (serial interval) and Ro transmission
Asian H5N1
Mostly a GI disease in birds -birds excrete virus at least 10 days in stool amp secretions days in stool amp secretions
10487081048708 Virus survives well in feces and water -35d in feces 4 C 6d 37 C wks poultry house environ litterfeces 37 C wks poultry house environ litterfeces
Has adapted wild birds to poultry and now back to wild birds from poultry
Broadening adaptation to mammals and high lethality ndashtigers leopards cats ferrets mice pigs humans
Incubation period up to 8 days in humans Mainly back yard poultry fighting cocks (Thailand) hard to
get watch lower PPE requirements HCWs precaution levels Significant likelihood of arrival in N America of current
nonsustainable transmission H5N1 within 1 -2 yrs Significant likelihood non Asian H5N1 (LPAI) will be identified
in N America as screening efforts grow Have an avian influenza plan separate from pandemic plan
Antigenic Drift vs Shift
bull Driftbull Point mutations in viral RNA copying error
bull Continual process bull Causes yearly epidemics bull Requires annual update of vaccine
bull Shift bull Replacement of H or HampN (ie new
subtype) bull Sporadic event bull Can result in a pandemic (not a given)
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Asian H5N1
Mostly a GI disease in birds -birds excrete virus at least 10 days in stool amp secretions days in stool amp secretions
10487081048708 Virus survives well in feces and water -35d in feces 4 C 6d 37 C wks poultry house environ litterfeces 37 C wks poultry house environ litterfeces
Has adapted wild birds to poultry and now back to wild birds from poultry
Broadening adaptation to mammals and high lethality ndashtigers leopards cats ferrets mice pigs humans
Incubation period up to 8 days in humans Mainly back yard poultry fighting cocks (Thailand) hard to
get watch lower PPE requirements HCWs precaution levels Significant likelihood of arrival in N America of current
nonsustainable transmission H5N1 within 1 -2 yrs Significant likelihood non Asian H5N1 (LPAI) will be identified
in N America as screening efforts grow Have an avian influenza plan separate from pandemic plan
Antigenic Drift vs Shift
bull Driftbull Point mutations in viral RNA copying error
bull Continual process bull Causes yearly epidemics bull Requires annual update of vaccine
bull Shift bull Replacement of H or HampN (ie new
subtype) bull Sporadic event bull Can result in a pandemic (not a given)
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Antigenic Drift vs Shift
bull Driftbull Point mutations in viral RNA copying error
bull Continual process bull Causes yearly epidemics bull Requires annual update of vaccine
bull Shift bull Replacement of H or HampN (ie new
subtype) bull Sporadic event bull Can result in a pandemic (not a given)
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
When is it a pandemic
An influenza pandemic is a global outbreak of disease that occurs when
bull A new influenza A virus appears or ldquoemergesrdquo in the human population and
bull It causes serious illness in humans and bull It spreads easily from person to person
worldwide
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
What we know about Pandemics Rare (1918-19 1957 1968) bull ldquoSHIFT happensrdquo bull Transmission is highly efficient among
humans incubation is short bull EVERYONE is susceptible bull Virulence is variable bull Resistance to antiviral agents is variable bull Shedding precedes symptoms by frac12 day
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Importance of Good Match
We need to know what strains are most likely to occur each season (Mortality 36000 per year)
bull We absolutely must know what strain is the cause of a new pandemic (Mortality order of magnitude higher)
bull Importance of international viral surveillance
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Current Status
No Asian H5N1 strain in North America now
Human cases require close contact with illdead poultrydroppingscarcasses and is hard to get
No sustained human to human transmission
We have some time to plan Planning efforts are ramping up Intense watching to detect early
transmission clusters and viral change
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
July 2006 The number of new countries reporting human cases increased from 4
to 9 after October 2005 following the geographical extension of outbreaks among avian populations
Half of the cases occurred in people under the age of 20 years 90 of cases occurred in people under the age of 40 years
The overall case-fatality rate was 56 Case fatality was high in all age groups but was highest in persons aged 10 to 39 years
The case-fatality profile by age group differs from that seen in seasonal influenza where mortality is highest in the elderly
The overall case-fatality rate was highest in 2004 (73) followed by 63 to date in 2006 and 43 in 2005
Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years
Cases have occurred all year round However the incidence of human cases peaked in each of the three years in which cases have occurred during the period roughly corresponding to winter and spring in the northern hemisphere If this pattern continues an upsurge in cases could be anticipated starting in late 2006 or early 2007
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Country
2003 2004 2005 2006 Total
cases deaths cases deaths cases deaths cases
deaths
cases
deaths
Azerbaijan 0 0 0 0 0 0 8 5 8 5
Cambodia 0 0 0 0 4 4 2 2 6 6
China 0 0 0 0 8 5 11 7 19 12
Djibouti 0 0 0 0 0 0 1 0 1 0
Egypt 0 0 0 0 0 0 14 6 14 6
Indonesia 0 0 0 0 17 11 35 29 52 40
Iraq 0 0 0 0 0 0 2 2 2 2
Thailand 0 0 17 12 5 2 0 0 22 14
Turkey 0 0 0 0 0 0 12 4 12 4
Viet Nam 3 3 29 20 61 19 0 0 93 42
Total 3 3 46 32 95 41 85 55 229 131
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Howeverhellip
H5N1 established in birds spreading not going away becoming more lethal and broadening adaptation in mammals and birds
50+ human case fatality rate Vaccine and antivirals will not help in early
pandemic Manu transmission unknowns when
becomes transmissible Very short time to identify and ring clusters
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Challenges
Pandemic of some sort will return eventually
Preparations are and immense undertaking Uncertain and incomplete information Balance
Too much-too early-sky is falling attitude risk liberty and economy pandemic fatigue
Too little-to late- miss chances to contain mistrust unrest lives
Truth communicated quickly even if incomplete is most effective
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Planning Parameters
Ro = approx 2 Targets children and young adults 25-35 world infected CFR 1-20 15 absent 8 weeks above background and
absence rates up to 50 at peak 2-3 waves 4-8 weeks each
12-24-36 months to move through Intense efforts to keep out early and to ring
clusters If these donrsquot work social distancing and
measures to reduce illness center stage
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Early Measures
Travel restrictions screening quarantinesIntense information need
Public health measures bull intense surveillance cases source contacts bull isolation amp quarantine of individuals
Antivirals have a role here-treatment and prophylaxis prophylaxis
Demand for masks alcohol gel antivirals Policy issues -telecommuting ill at work
stay home if ill travel
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Planning Stages
ID critical products services functions suppliers contractors employees
Reduced workforce operations ID ways to increase social distancing Purchase contingency supplies masks
tissues alcohol gel surface sanitizers Employee training on hand washinggel
resp etiquette stay at home if ill Establish triggers to activate plan stages Succession plans Exercises and refinement of plans
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Prep work
Influenza team-members (health and safety executives HR Marcom OPS business continuity planning Security)
Leadership rotation succession Communications processes and parties-
employees suppliers customers Solid two way UTD info and liaisons with
medical amp govt public health resources Modify ICS -rolling shifts 4 rolling shifts 4-8-
12 wks Policies -travel telecommuting LOA ill at
work ees quarantined
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Cluster control
Communications Intensify employee training on hand washing Resp
etiquette stay home if ill Ready for intense public health investigations and
orders movement amp travel restrictions as attempt to ring
Deal with medication prioritizationavailability issues Dealing with isolation of ill and quarantine of well
exposed employees employees-worried ill RTW LOAEffects on plants products services suppliers vendors customers-demand updown
Ready for crowd restrictions -school closures and other gatherings including work potential closure
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Later pandemic scenario
If cluster control fails Health care system overwhelmed-not
enough regular beds ICU beds ICU Beds antivirals
Alternative care sites-schools home isolationcare hotels tents gyms
Essential services may break down - delivery transportation utilities
Just in time inventories impacted ndash food raw materials deliveries
Contractors and subcontractors
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Social distancing measures snow days work at home cancellation of gatherings
School closures add to worker absences Absences supply chain and
infrastructure issues cause shift to only essential services and products
Plant closure issues Support for those at home ill Mental health issues
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Pandemic Management
Influenza amp ICS team rotation Communications Reduced workforce essential products amp services scale back
-demand may be up or down Managing ill employees medical evacuations Cluster ringing less useful medication shortages Social distance measures Work area cleaning Adequate supplies of tissues masks cleansers Closures Support for those at home ill recovering helping Support for
those at home Mental health Monitoring ees preparingencouraging return of those
recovered
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Recovery
Survivors in demand at work Mental health issues Decedent affairs issues continue Preparation for additional waves Staging re-openings
capabilitydemand Variable recovery of different sectors
suppliers contractors Many unknowns
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
Pandemic Recovery
Communications Scaling up services and products production down but demand may down or
up Reopening facilities or not Reopening
facilities Recovering workers and families Mental health Possibility of returning waves Succession plans Manage return to new status
