Pandemic InfluenzaPandemic Influenza

Getting the Community ReadyGetting the Community Ready

Goals of Public HealthGoals of Public Health

Protect the community from diseaseProtect the community from disease

EducationEducation

Create a county-wide planCreate a county-wide plan

Coordination (The Players)Coordination (The Players)

EMAEMAUtilitiesUtilitiesIndustryIndustryHospitalsHospitalsDHRDHRARCARCLaw EnforcementLaw EnforcementFire/RescueFire/RescuePort of MobilePort of Mobile

The County PlanThe County Plan

Written as an annex to the County EOP Written as an annex to the County EOP (Emergency Operations Plan)(Emergency Operations Plan)

Since all emergency operations are Since all emergency operations are coordinated through the EMA, it was coordinated through the EMA, it was logical that coordination of resources logical that coordination of resources during a pandemic would also be located during a pandemic would also be located at the EMA.at the EMA.

How we are doing itHow we are doing it

Scheduled meetings at the EMAScheduled meetings at the EMA

Review of all plansReview of all plans

Revise format and enter into EOPRevise format and enter into EOP

Mobile County Health Department Mobile County Health Department PlanPlan

Flu Kits for employeesFlu Kits for employees

Educate the public (news releases)Educate the public (news releases)

Cross TrainingCross Training

MASS vaccination planMASS vaccination plan

POD planPOD plan

Plan for 30 – 40% absenteeismPlan for 30 – 40% absenteeism

Strategically shut down clinicsStrategically shut down clinics

““Any community that fails to prepare, with the Any community that fails to prepare, with the expectation that the federal government or, for expectation that the federal government or, for that matter, the state government will be able to that matter, the state government will be able to step forward and come to their rescue at the step forward and come to their rescue at the final hour, will be tragically wrong, not because final hour, will be tragically wrong, not because the government will lack a will, not because we the government will lack a will, not because we will lack a collective wallet, but because will lack a collective wallet, but because there is there is no way that you can respond to every hometown no way that you can respond to every hometown in America at the same timein America at the same time.” .”

Secretary Michael LeavittSecretary Michael Leavitt

April 20, 2006April 20, 2006

What is a Pandemic?What is a Pandemic?

No one has immunity to virusNo one has immunity to virus

Virus transmits easily person-to-personVirus transmits easily person-to-person

Virus causes large increases in illness and Virus causes large increases in illness and deaths deaths

1918 Pandemic in Alabama1918 Pandemic in Alabama

9/28/19189/28/1918 – 1 – 1stst AL case was in Huntsville AL case was in Huntsville10/05/1918 – > 1100 cases in Huntsville 10/05/1918 – > 1100 cases in Huntsville 10/07/1918 – Governor called for “closing of schools, 10/07/1918 – Governor called for “closing of schools,

churches, theatres and picture shows….”churches, theatres and picture shows….”10/13/1918 – 2367 cases at Camp Sheridan (outside 10/13/1918 – 2367 cases at Camp Sheridan (outside

Montgomery) Montgomery) 10/13/1918 - All physicians, druggists and prescription 10/13/1918 - All physicians, druggists and prescription

clerks in Huntsville, except one, ill with influenzaclerks in Huntsville, except one, ill with influenza10/15/1918 - Huntsville: Business demoralized; 10/15/1918 - Huntsville: Business demoralized; Postal Postal

Service crippled; Alabama Power having Service crippled; Alabama Power having difficulty difficulty finding employees; Business ordered to finding employees; Business ordered to curtail hours of curtail hours of operationoperation

10/22/191810/22/1918 - 12,000 cases reported in - 12,000 cases reported in MontgomeryMontgomery

Forecasted Impact of Pandemic Influenza

MobileMobile AlabamaAlabama

CharacteristicCharacteristic   Severe (1918-like)Severe (1918-like) Moderate Moderate (1958/68-like)(1958/68-like) Severe (1918-like)Severe (1918-like)

IllnessIllness   120,000 (30%)120,000 (30%) 1.8 million (30%)1.8 million (30%) 1.8 million (30%)1.8 million (30%)

Outpatient medical Outpatient medical carecare   60,000 (50%)60,000 (50%) 900,000 (50%)900,000 (50%) 900,000 (50%)900,000 (50%)

HospitalizationHospitalization 14,143 14,143  17,300 17,300 198,000 198,000

ICU careICU care 2,121 2,121  2,575 2,575 29,700 29,700

Mechanical Mechanical ventilationventilation 1,065 1,065 

1,298 1,298 14,910 14,910

DeathsDeaths 2,719 2,719  4,180 4,180 38,060 38,060

Based upon Table 1 of HHS Planning Assumptions

Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios

Special Collections Division, University of Washington LibrariesSpecial Collections Division, University of Washington Libraries

Situational UpdateSituational Update

April 30April 30thth, 2008 – Indonesia – A 3 year old , 2008 – Indonesia – A 3 year old developed symptoms on April 14developed symptoms on April 14thth and and died on April 23died on April 23rdrd..

This is the 133This is the 133rdrd case in Indonesia. 108 have case in Indonesia. 108 have been fatal. (been fatal. (81%81%))

Situational UpdateSituational Update

April 17April 17thth, 2008 – Egypt – Reported three , 2008 – Egypt – Reported three cases in the month of April:cases in the month of April:

1. 19 yo male died on April 41. 19 yo male died on April 4thth. .

2. 30 yo female died on April 112. 30 yo female died on April 11thth..

3. 2 yo male hospitalized on April 143. 2 yo male hospitalized on April 14thth..

Of the 50 cases, 22 have been fatal (Of the 50 cases, 22 have been fatal (44%44%))

Situational UpdateSituational Update

April 3April 3rdrd, 2008 – Pakistan, 2008 – Pakistan

A case reported on October 29A case reported on October 29thth, 2007 has , 2007 has been confirmed AND been confirmed AND TRANSMITTEDTRANSMITTED to 3 to 3 other family members. This was the FIRST other family members. This was the FIRST case reported in Pakistan. Of the 4 case reported in Pakistan. Of the 4 patients who contracted the disease, two patients who contracted the disease, two cases were fatal.cases were fatal.

Image from the School of Photographic Arts and Sciences at the Rochester Institute of Technology http://www.rit.edu/~andpph/photography.html

Don’t Count on Don’t Count on Vaccine or AntiviralsVaccine or Antivirals

Vaccine not available for at least Vaccine not available for at least

6-18 months after the PI strain identified 6-18 months after the PI strain identified and then only for and then only for prioritypriority groupsgroups

In 2008, U.S. will have enough antivirals In 2008, U.S. will have enough antivirals for for 25%25% of the U.S. population in a of the U.S. population in a priority grouppriority group

Protecting Your AgencyProtecting Your Agency

PLAN for the impact on agencyPLAN for the impact on agency

Protect employees and their familiesProtect employees and their families

ALLOCATE/OBTAIN resourcesALLOCATE/OBTAIN resources

Coordinate with external Coordinate with external organizationsorganizations

Plan for Rates of Plan for Rates of Absenteeism up to 40%Absenteeism up to 40%

IllnessIllnessFear of InfectionFear of InfectionCare ProvisionCare ProvisionPlus Public Health MeasuresPlus Public Health Measures– School ClosuresSchool Closures– Quarantining HouseholdsQuarantining Households– ““Snow Days”Snow Days”

HHS Pandemic Planning AssumptionsHHS Pandemic Planning AssumptionsThese assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government to define a severe case These assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government to define a severe case scenario. scenario.

Planning AssumptionsPlanning Assumptions

Attack Rate 30% or higherAttack Rate 30% or higher– 40% School-aged Children40% School-aged Children– 20% Working Adults20% Working Adults

½ of Ill Will Seek Care½ of Ill Will Seek Care

Plan for Most SeverePlan for Most Severe– Extremes of age, pregnancy, chronic Extremes of age, pregnancy, chronic

conditionsconditions

HHS Pandemic Planning AssumptionsHHS Pandemic Planning AssumptionsThese assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government These assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government to define a severe case scenario. to define a severe case scenario.

Planning Assumptions - cont’d.Planning Assumptions - cont’d.

Can spread virus up to 2 days before you feel Can spread virus up to 2 days before you feel sicksickViral Shedding Viral Shedding – 1 Day Before - 5 Days After Onset1 Day Before - 5 Days After Onset– Highest 2 Days of OnsetHighest 2 Days of Onset– Children Shed MoreChildren Shed More

One sick person will make 2 sickOne sick person will make 2 sickOutbreaks 6-8 weeksOutbreaks 6-8 weeksMultiple WavesMultiple Waves

HHS Pandemic Planning AssumptionsHHS Pandemic Planning AssumptionsThese assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government to define a severe case These assumptions, based largely on the 1918 influenza epidemic, are being used throughout the federal government to define a severe case scenario. scenario.

BusinessBusiness ChecklistChecklist

Plan for the impact on businessPlan for the impact on businessIdentify a pandemic coordinator or teamIdentify a pandemic coordinator or teamIdentify mission essential functionsIdentify mission essential functionsCross-trainCross-train

Plan for the impact on employeesPlan for the impact on employeesForecast employee absencesForecast employee absences

Assess the type of face-to-face contactAssess the type of face-to-face contact

Business ChecklistBusiness Checklist

Establish policiesEstablish policiesSick leave and compensationSick leave and compensation

Flex work hours/sitesFlex work hours/sitesPrevention policiesPrevention policies

Allocate resourcesAllocate resourcesProvide sufficient infection control suppliesProvide sufficient infection control supplies

Enhance communicationsEnhance communicationsPrepare for financial lossPrepare for financial loss

Business ChecklistBusiness Checklist

Communicate to and educate Communicate to and educate employeesemployeesDevelop and disseminate programs and Develop and disseminate programs and materialsmaterials

Anticipate employee fear and anxietyAnticipate employee fear and anxiety

Provide info to employees about at-home careProvide info to employees about at-home care

Identify community resources for accurate Identify community resources for accurate pandemic informationpandemic information

PlanPlan

Federal “checklists”—Federal “checklists”—www.pandemicflu.govwww.pandemicflu.gov– BusinessesBusinesses– State and local planningState and local planning– Individuals and familiesIndividuals and families– Community and faith-based organizationsCommunity and faith-based organizations– EducationEducation– Home health careHome health care

www.adph.orgwww.adph.orgwww.cdc.govwww.cdc.govwww.who.intwww.who.int/en/en

Remember!Remember!

We ARE with the government We ARE with the government

AND we are here to help!AND we are here to help!

Cindy Lesinger (ADPH) (334) 206-2018Cindy Lesinger (ADPH) (334) 206-2018

Melissa Tucker (MCHD) (251) 690-8884Melissa Tucker (MCHD) (251) 690-8884

Sandy Evans (MCHD) (251) 544-2196Sandy Evans (MCHD) (251) 544-2196