Transcript Projections: U.S. Pandemic

Chance Favors the
Prepared Community:
Preparing for a Flu
Pandemic
February 14, 2007
Mark J. Levine, MD MPH
BIRD FLU PANDEMIC?
Influenza Virus
 Single-stranded
RNA virus
 Surface
membrane spiked
with 2 types of
protein
– Hemagglutinin (H)
– Neuraminidase (N)
Influenza Virus Composition
Type of
nuclear
material
Neuraminidase
Hemagglutinin
A/Beijing/32/92 (H3N2)
Virus
type
Geographic
origin
Strain
number
Year of
Isolation
Virus subtype
“The pandemic clock is
ticking, we just don’t
know what time it is”
E. Marcuse
Pandemic influenza: definition
Pandemic influenza, or flu, is a
global outbreak of disease that
occurs when a new influenza A
virus appears in humans, causes
serious illness and then spreads
easily from person to person.
“A pandemic is the viral equivalent
of a perfect storm. There are
three essential conditions,
which rarely converge, and
they are impossible to predict.”
Michael Specter, The New Yorker
The three conditions…
1.
A new subtype that has not infected
people in the past
2.
Causes severe illness in people
3.
Sustained transmission from person
to person
 Emergence of pandemic strain = most
significant public health emergency
caused by a naturally occurring
pathogen
Timeline of Emergence of
Influenza A Viruses in Humans
Avian
Influenza
Russian
Influenza
Asian
Influenza
Spanish
Influenza
H1
1918
H9
H5
H7
H5
H1
H3
H2
Hong Kong
Influenza
1957 1968 1977
1997 2003
1998/9
Effects of Typical Flu
Season (U.S.)
5-20% ill
200,000 hospitalizations
36,000 deaths
Impact of Past Influenza
Pandemics/Antigenic Shifts
Pandemic, or
Antigenic
Shift
Excess
Mortality
Populations
Affected
1918-19
(A/H1N1)
500,000
Persons <65
years
1957-58
(A/H2N2)
70,000
Infants, elderly
1968-69
(A/H3N2)
36,000
Infants, elderly
Pandemic Prediction:
U.S.A.
Planning Assumptions:
• 30% attack rate
• 50% or more of those who become ill will seek medical care
• Number of hospitalizations and deaths will depend on the
virulence of the pandemic virus
Moderate (1957like)
Illness
Severe (1918-like)
90 million (30%)
90 million (30%)
Outpatient medical care 45 million (50%)
45 million (50%)
Hospitalization
865,000
9,900,000
ICU care
128,750
1,485,000
Mechanical ventilation
64,875
745,500
Deaths
209,000
1,903,000
Pandemic Prediction:
Central Region
Planning Assumptions:
• 30% attack rate
• 50% or more of those who become ill will seek medical care
• Number of hospitalizations and deaths will depend on the
virulence of the pandemic virus
Moderate (1957like)
Severe (1918-like)
Illness
360,000 (30%)
360,000 (30%)
Outpatient medical care
180,000 (50%)
180,000 (50%)
Hospitalization
3,460
39,600
ICU care
519
5,940
Mechanical ventilation
260
2,970
Deaths
836
7,612
Sudden surge from a immediate
event
Out of hospital
????
Expanded
capacity-
3900
3200
Standard
operations
0 days
10 days
Biological attack or Pandemic ?
Care in the
community
Out of hospital
????
Expanded
capacity-
3900
3200
Slowly growing surge from a rolling event:
0 days
10 days3 months
Standard
operations
1918 Pandemic
25-30 percent
of the world’sPandemic
population fell
The Influenza
ofill 1918-1919
25-30
percent
of in
thethe
world’s
500,000
deaths
US population fell ill
25-30 percent of the world’s population fell ill
500,000 deaths in the US
500,000 deaths in the US
Avian Influenza H5N1
as of February 7, 2007
55 countries with documented
H5N1 avian influenza in bird
populations
11 countries with documented
human cases of H5N1
Nations With Confirmed Cases
H5N1 Avian Influenza (Feb ‘07)
Cumulative Number of Confirmed Human
Cases of Avian Influenza A/(H5N1)
Reported to WHO as of 02/06/07
Country
2003
cases
2004
deaths
cases
2005
deaths
cases
2006
deaths
cases
2007
deaths
Total
cases
deaths
cases
deaths
Azerbaijan
0
0
0
0
0
0
8
5
0
0
8
5
Cambodia
0
0
0
0
4
4
2
2
0
0
6
6
China
1
1
0
0
8
5
13
8
0
0
22
14
Djibouti
0
0
0
0
0
0
1
0
0
0
1
0
Egypt
0
0
0
0
0
0
18
10
2
2
20
12
Indonesia
0
0
0
0
19
12
56
46
6
5
81
63
Iraq
0
0
0
0
0
0
3
2
0
0
3
2
Nigeria
0
0
0
0
0
0
0
0
1
1
1
1
Thailand
0
0
17
12
5
2
3
3
0
0
25
17
Turkey
0
0
0
0
0
0
12
4
0
0
12
4
Viet Nam
3
3
29
20
61
19
0
0
0
0
93
42
Total
4
4
46
32
97
42
116
80
9
8
272
166
Integrated Planning
for a Large Scale
Health Emergency
The
Public
Health
System
Accountants!
Police
EMS
Community
Centers
MCOs
Health
Department
Home Health
Churches Corrections
Parks
Schools
Elected
Hospitals
Officials Nursing Mass Transit
Doctors
Philanthropist
Homes
Environmental
Civic Groups
Health
CHCs
Fire
Tribal Health
Economic
Laboratory
Employers
Drug
Mental
Development
Facilities
Treatment
Health
National
Preparedness
Community
Preparedness
Business and
Organizational
Preparedness
Individual and Family
Preparedness
Pandemic Flu
Preparedness for
Individuals and Families
http://www.pandemicflu.gov
Pandemic Flu
Preparedness for
Businesses
http://www.pandemicflu.gov
In a Pandemic…
Despite all preparedness efforts,
Virginia will not be spared from a
flu pandemic.
 All businesses, hospitals and
government agencies will feel the
effects of a pandemic.
Ten to 25 percent of the
workforce may be ill at any one
time.
 Unlike other disasters, a flu pandemic
will touch every population in every
part of the country. Moving operations
to another location may not be a viable
option.
 A flu pandemic could cost the U. S.
economy billions of dollars in lost
productivity and medical expenses.
During a pandemic, it will not be
business as usual.
The number one thing
you can do to prepare
for a pandemic is to
learn as much as you
can and personally plan
ahead of time
Local Emergency
Planning and Response
Framework
Health Districts in Virginia
Preparing for
Emergencies in the
Face of Uncertainty
Hope?
Hope is not a strategy…
Julie Gerberding, Director,
Centers for Disease Control and Prevention
Chance Favors the
Prepared Mind
Louis Pasteur
Chance Favors the
Prepared Community
Mark Levine
What is a
“Prepared Community?”
Incident Command Structure
Incident Commander
Safety Officer
Public Information Officer
Liaison Officer
Planning
Operations
Logistics
Finance/Admin
Division
Supply Unit
Group
Resource Unit
Unit
Food Unit
Unified Command
Unified Command
(Representatives From Local Jurisdictions)
Operations
Planning
Logistics
Finance/
Administration
Components of Local Response
Communication/Awareness
Surveillance/Investigation
Containment/Control
– Distribution of antivirals/vaccine
Healthcare Surge
Components of Local Response
 Communication/Awareness
Surveillance/Investigation
Containment/Control
– Distribution of antivirals/vaccine
Healthcare Surge
Communication/Awareness
Virginia Department of Health
– http://www.vdh.virginia.gov/pandemic
flu/
Henrico County Health Department
– http://www.co.henrico.va.us/health/
CDC
– Travel: http://www.cdc.gov/travel/
– Avian flu:
http://www.cdc.gov/flu/avian/
Continued…
Education/Information Exchange
– Public Health: Epi-X, CDC
– Medical community: Public Health
Bytes
• www.publichealthbytes.org
– General community: Promote
individual/family preparedness
• www.pandemicflu.gov
• Media spots
• Health Department Web site info
Components of Local Response
Communication/Awareness
Surveillance/Investigation
Containment/Control
– Distribution of antivirals/vaccine
Healthcare Surge
Surveillance and Detection
-current statusSurveillance is a routine function
of the Health Department and is
always ongoing
Influenza surveillance is not
something new and is already very
extensive
Enhanced surveillance
experience/process already in
place
Additional Surveillance
Efforts
Syndromic Surveillance
– Surveillance for symptoms of disease
rather than actual cases
– May detect a disease outbreak
sooner
Ongoing issues
Communication/Awareness
Surveillance/Investigation
Containment/Control
– Infection Control measures
– Distribution of antivirals/vaccine
Healthcare Surge
NPI
Summary of NPI
Isolation and treatment of people
infected with pandemic flu strain
Voluntary home quarantine of
members of households with
pandemic flu strain
Social distancing
– Children: school closure and out of
school social activity suspension
– Adults: Cancellation of public
gatherings; alteration of workplace
environments
CDC
Pandemic
Severity
Index
Meteorology
Meteorology
Geology
SaffirSimpson
Hurricane
Scale
Fujita
Tornado
Scale
Richter
Earthquake
Scale
0 - 73 MPH
0 - 39 MPH
0
Category 1
>74 MPH
F0
40 - 72 MPH
1
No damage
Category 2
>96 MPH
F1
73 - 112 MPH
2
No damage
Category 3
>111 MPH
F2
113 - 157
MPH
3
Little damage
Category 4
>131 MPH
F3
158 - 206
MPH
4
Light damage
Category 5
>155 MPH
F4
207 - 260
MPH
5
Moderate damage
F5
261 - 318
MPH
6
Mod.-Heavy
damage
F6
319 - 379
MPH
7
Heavy Damage
8
Very Heavy
Damage
9
Total destruction
10
Unheard - never
seen
Pandemic Severity Index
2 and 3
4 and 5
Recommend
Recommend
Recommend
Voluntary quarantine
Generally not
recommended
Consider
Recommend
School closure
Generally not
recommended
Consider:
4 weeks
<=
Recommend:
12 weeks
<=
Out of school activity restrictions
Generally not
recommended
Consider:
4 weeks
<=
Recommend:
12 weeks
<=
Decrease number of social contacts
Generally not
recommended
Consider
Recommend
Increase distance between people
Generally not
recommended
Consider
Recommend
Modify/Postpone public gatherings
Generally not
recommended
Consider
Recommend
Modify workplace schedules
Generally not
recommended
Consider
Recommend
Interventions by Setting
1
Home
Voluntary isolation
School
Child Social Distancing
Workplace/Community
Adult Social Distancing
Ongoing issues
Communication/Awareness
Surveillance/Investigation
Containment/Control
– Distribution of antivirals/vaccine
Healthcare Surge
HENRICO MEDICAL
RESERVE CORPS
http://www.vdh.virginia.gov/LHD/henrico/myweb/mrc.asp
Goal of Planning for
Large Scale Health
Emergencies
Enhance our capacity and ability
to better perform our day to day
tasks and build capacity to ramp
up for large scale health issues
Questions to Ask
 How will you maintain your business
operations when 10 to 25 percent of
the workforce falls ill at one time?
 How can you adapt your existing
continuity of operations plans to reflect
this kind of human resources impact?
 How will you cope when the other
businesses and suppliers you rely on
experience the same absentee rates?
Continued…
 How will you adapt to disruptions in the supply
chain for the raw materials you need and how
will you get your product to the consumer if
your distribution network is hit with high
absentee rates?
 How can existing return-to-work and travel
policies be adapted to control the spread of
this virus among employees?
 How will you limit the economic impact of a
flu pandemic on your business?
Chance Favors the
Prepared Mind
Louis Pasteur
Chance Favors the
Prepared Community
Mark Levine