Transcript Document 7142510

Get the Facts, Not the Flu:
Preparing Your Business for the Next
Pandemic
Catherine Slemp, MD, MPH
2006 Human Resources Summit and
Governor’s Safety Conference
November 1, 2006
Objectives / Overview
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Review Influenza Basics
Putting Pandemics into Perspective
Why the Concern Now (Avian Flu-H5N1)
Discuss Pandemic Control Measures
Implications for Business
Pan Flu
All Hazard Preparedness
INFLUENZA – Key Facts
• Incubation period ~1-4 days
• Transmission: Respiratory
droplet (coughing, sneezing);
Contact? Aerosol?
• Seasonal Flu causes
– 200,000 hospitalizations
– 36,000 deaths / yr
• Flu Viruses are constantly changing,
evolving, reassorting
Influenza Pandemic Viruses
Requirements:
– A new influenza A subtype that can infect humans
AND
– Causes serious illness
AND
– Spreads easily from human-to-human
H5N1 meets the first two prerequisites,
but not the last
Next pandemic virus may or may not be due to a
variation of current H5N1 virus
Putting Flu Pandemics in
Perspective
1918: heavy
impact on
young healthy
adults –nation’s
workforce
Impact of 1918
Pandemic on
US Life
Expectancy
Daily Deaths in Ohio - 1918
Brodrick OL. Influenza and pneumonia deaths in Ohio in October and November, 1918.
The Ohio Public Health Journal 1919;10:70-72.
West Virginia in 1918
Court System
COMMUNITY
INFRASTRUCTURE
Flu stops court,
Bluefield
Oct. 8, 1918
Business
Local Government
Newspapers
The Bluefield Telegraph
Oct. 8, 1918
Huntington mayor dies
The New Dominion,
Morgantown, WV
Oct. 24th
Oct. 19, 1918
“Less than half a
dozen families in
Fayetteville have
illness…Dr.
Grose was one
of the first
victims….”
Oct. 10, 1918,
The Fayette Tribune
“The Mt. HopeKilsyth
community is
credited with
over 500 cases
and the death
rate is on the
increase….”
Oct. 31, 1918,
The Fayette Tribune
Why the Concern Now?
“AVIAN” OR “BIRD” FLU:
THE H5N1 VIRUS
Update
As of 10/31/06: 256 cases; 152 deaths; most poultry related
H5N1 in Humans – 2003-2006
• As of October 31, 2006: 256 cases,
152 deaths (~60%)
•
– Ten countries
• Sporadic, with occasional clusters
• Most had touched or handled sick poultry
• A few cases of probable, limited human-to-human
transmission
• All lived in countries with poultry outbreaks
Sample Estimate of Morbidity/Mortality
West Virginia*
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Characteristic Moderate (1957-68-like) Severe (1918-like)
Illness
540,000 (30%)
540,000 (30%)
Outpatient
270,000 (50%)
270,000 (50%)
Hospitalization
5,314
60,813
ICU Care
791
9,123
Ventilators
399
4,558
Deaths
1,284
11,690
* based upon DHHS U.S. estimates applied to WV population numbers. These are
in the absence of potential interventions.
Much we don’t know … about
the next pandemic
• When will it occur?
• Which virus will cause it, H5N1 or another?
• Who will be most at risk (Elderly and infants?
Healthy adults? Children?)
• How severe an illness will it cause?
• Will there be multiple waves?
• Will antiviral medication work?
• How long until we have a vaccine?
• What are the best control measures?
Understanding Disease
Spread
Ro
R0 = 12
Ways to Increase “Social
Distance”
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Implement “Community Shielding” recommendations
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Close or alter high risk transmission environments e.g. schools,
daycare centers if supported by epidemiology
Cancel large public gatherings (concerts, theaters)
Minimize other exposures (markets, churches, public transit)
Encourage ill and exposed persons to stay home (isolation and
quarantine)
Encourage telecommuting; other worksite adaptations
Scaling back or altered transportation services (holiday schedule)
Consider additional community measures
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COOP to minimize economic impact
Distribution of surgical masks, barrier precautions, hand hygiene
Planning Pandemic Control
Measures
Potential Tools in Our Toolbox
• Our best countermeasure – vaccine – will probably be
unavailable during the first wave of a pandemic
• Antiviral treatment may improve outcomes but will have
only modest effects on transmission
• Antiviral prophylaxis may have more substantial effects
on reducing transmission
• Infection control and social distancing should reduce
transmission, but strategy requires clarification
Community interventions
What does history and modeling tell us?
What planning can be done now?
A Tale of Two Cities
16000
Philadelphia
St. Louis
14000
12000
10000
8000
6000
4000
2000
2
10 2
/6
/
10 2 2
/1
3/
10 22
/2
0/
10 22
/2
7/
2
11 2
/3
/
11 2 2
/1
0/
11 22
/1
7/
11 22
/2
4/
2
12 2
/1
/2
12 2
/8
/
12 2 2
/1
5/
12 22
/2
2/
12 22
/2
9/
22
29
/
9/
22
/
9/
15
/
9/
22
0
22
Deaths Rates / 100,000 Population
(Annual Basis)
1918 Death Rates: Philadelphia v St. Louis
Date
Weekly mortality data provided by Marc Lipsitch (personal communication)
Value of combining strategies –
Longini model
70
60
50
40
30
20
10
0
Clinical attack rate
Antiviral stockpile needed
Base case (Ro=1.9)
Generic social distancing
School closure
School closure + generic social distancing
60% Case treatment + 60% household prophylaxis
60% Case treatment + 60% household prophylaxis + 60% social prophylaxis (60% TAP)
60% TAP + School closure + generic social distancing
Residences
Workplace / Classroom Social Density
Offices
Hospitals
7.8 feet
Elementary
Schools
11.7 feet
16.2 feet
3.9 feet
http://buildingsdatabook.eren.doe.gov/docs/7.4.4.xls
Spacing of people: If homes were like
schools
*Based on avg. 2,600 sq. ft. per single family home
Spacing of people: If homes were like
schools
*Based on avg. 2,600 sq. ft. per single family home
Labor Status of Parents in U.S.
Households with no children<18
Households with children>12
Households with children<12 and non-working adult
Working couple with children<12
62.0%
Single working parent with children<12
66 million
18 million
5 million
8 million
9 million
16.6%
4.5%
8.0%
8.9%
Source: U.S. Census Bureau, Population Division, Current Population Survey, 2003 Annual Social and Economic Supplement
http://www.census.gov/population/www/socdemo/hh-fam/cps2003.html
What are limits of this data?
• Observational data from 1918; data
incomplete; cannot link cause and effect
• Modeling impact of different
interventions. Useful, but
• Doesn’t yet incorporate impact of people’s
behavioral responses to interventions
• Doesn’t incorporate secondary consequences
of interventions (e.g., effects of school closure
on education, workforce, etc.)
• Does help shape discussion.
A Targeted and Layered
Approach
A Layered Approach
Individual / Household /
Business
Community
Isolation of ill
Hand hygiene
Treatment of ill
Cough etiquette
Quarantine of exposed
Infection control
Prophylaxis of exposed
Living / working space
School closure
adaptation
Protective sequestration
Isolation of ill & designated
of children
care provider
Social distancing
- Community
- Workplace
Liberal leave policies
International
Containment-at-source
Support efforts to reduce
transmission
Travel advisories
Layered screening of
travelers
Health advisories
Limited points of entry
Epidemiology Drives Approach
(Targeted)
Mild
Moderate
Severe
Case Fatality Rate
≤ 0.1%
0.1 - 0.5%
≥ 0.5%
Isolation
Yes
Yes
Yes
Treatment
Yes
Yes
Yes
Quarantine
No
???
Yes
Prophylaxis
High-risk individuals
High-risk individuals
Yes
School Closure
Reactive
Punctuated ???
Proactive
Protective sequestration High-risk individuals
High-risk individuals
Children
Community social
distancing
High-risk individuals
Encouraged
Encouraged +
selective closures
Workplace protections
Encourage good
hygiene
Social distancing
Aggressive social
distancing
Liberal leave policies
Confirmed influenza
Influenza-like illness
ILI and/or sick family
members
Remember: We have a Tool Kit
of Control Measures to Use
• Community Shielding (many methods)
• Hygiene measures
• Antivirals (treatment; prevention, if
supplies sufficient)
• Vaccine
• Continuity of Operations Planning
Current Thoughts on Control
Measures
• Earlier rather than later implementation of
measures more likely to be effective
• Targeted and layered application of measures
(e.g., combinations are more effective than a
single measure at a time; scale response based
on severity of pandemic)
• Communities must consider practicality and ethics
of implementing any measure.
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Transparency
Public discussion and dialogue
Planning
Coordination across jurisdictions
Tackling This from the Business
Perspective
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Educate Leadership and Staff
COOP, COOP, COOP (Continuity of Operations)
Personnel Policies
Knowing your Workforce
Employee and Family Safety
Employee Communications
Contributions to / Participation in Community
Response
Interesting Correlation
Businesses truly embracing a culture of
preparedness
High performing businesses everyday
What does this take?
(Now and when the time comes)
Leadership
Imagination
Resiliency of Businesses and
Communities
Contributors to Historical
Analysis and Modeling
HSC/NSPI Writing Team
Richard Hatchett, MD
Carter Mecher, MD
Laura McClure, MS
CDR Michael Vineyard
HSC
Rajeev Venkayya, MD
Ken Staley, MD, MPA
NSC
Rita DiCasagrande, MS
CEA
Steven Braun, PhD
CDC
David Bell, MD
Martin Cetron, MD
Rachel Eidex, MD
Lisa Koonin, MN, MPH
Anthony Marfin, MD
Modelers
Joshua Epstein, PhD
Stephen Eubank, PhD
Neil Ferguson, PhD
Robert Glass, PhD
Betz Halloran, PhD
Nathaniel Hupert, MD
Marc Lipsitch, MD
Ira Longini, PhD
NIH
James Anderson, PhD
Irene Eckstrand, PhD
Peter Highnam, PhD
Ellis McKenzie, PhD
RTI
Philip Cooley, PhD
Diane Wagener, PhD
NVPO
Bruce Gellin, MD
Ben Schwartz, MD
Department of Education
Camille Welborn, MS
Department of Labor
Suey Howe, JD
Department of the Treasury
Nada Eissa, PhD
Chris Soares, PhD
John Worth, PhD
Department of Finance Canada
Steven James
Timothy Sargent
University of Michigan
Howard Markel, MD
Get Informed,
Be Prepared!
RESOURCES
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WV Bureau for Public Health:
http://www.wvflu.org
Your Local Health Department or Emergency
Management Agency
USDHHS: http://www.pandemicflu.gov
Seattle-King County Health:
http://www.metrokc.gov/health/pandemicflu/
CDC: www.cdc.gov