British Columbia Pandemic Influenza Preparedness Plan

Guidelines for Planning, Response and Recovery

AUGUST 2005

Hope for the Best Prepare for the Worst

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BC Pandemic Influenza Preparedness Plan BC Pandemic Influenza Preparedness Plan

Why We Should Worry About Influenza

A WORD FROM THE PROVINCIAL HEALTH OFFICER

Influenza pandemics represent global emergencies with catastrophic impact. During a pandemic, worldwide epidemics of influenza due to a new viral subtype occur simultaneously and with high death rates. Pandemics have been documented every ten to forty years dating back to the 1600s, and likely long before that. There were three during the last century alone. The worst was 1918 to 1919 when over 20 million people died worldwide. The last pandemic occurred in 1968. Experts agree we are overdue for another. Progress in medical science has enabled the medical community to identify, characterize and produce vaccines for new influenza sub-types, but the ease and speed with which people now move around the world enables rapid global dispersion of the virus. Between the onset of a pandemic and the production

When a pandemic occurs and it will no time can be lost in responding. This means that we must work now to develop efficient

and dissemination of an effective vaccine lies a period of months during which medical and social resources will be stretched to the limit.

d effective interventions. This revised lanning guide is intended to help all of us

ine

anpanticipate, prepare and respond to the next influenza pandemic and to other new and emerging diseases. Every influenza season should be viewed as an opportunity to refthis planning.

P.R.W. Kendall, MBBS, MSc, FRCPC Provincial Health Officer Ministry of Health Services British Columbia, Canada

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Members of the British Columbia Influenza Advisory Committee

Danuta M. Skowronski (Chair) Physician Epidemiologist BC Centre for Disease Control Aleina Tweed (Co-Chair) Epidemiologist BC Centre for Disease Control Denys J. Carrier Leader, Emergency Preparedness Program Providence Health Care Jeff Cornell Emergency Social Services Ministry of Human Resources Paul Cox Corporate Manager Emergency Planning and Response Provincial Health Services Authority Wayne Dauphinee Executive Director, EP Branch Ministry of Health Services Meena Dawar First Nations and Inuit Health Branch Health Canada Bill Douglas Interim Coordinator Emergency Preparedness and Response Public Health Agency of Canada, BC/Yukon Valery Dubenko Manager, Communicable Disease Prevention Immunization Ministry of Health Services Sally Greenwood Communications Director Provincial Health Services Authority Louise Holmes Infection Control Practitioner BC Professionals in Infection Control Vancouver Coastal Health Authority

Pauline James Nursing Consultant BC HealthGuide Shirley Jones Public Health Nursing Supervisor Interior Health Authority Perry R.W. Kendall Provincial Health Officer Ministry of Health Services Mel Krajden Associate Director, Laboratory Services BC Centre for Disease Control Gail McNabb Supervisor, Virology, Laboratory Services BC Centre for Disease Control Tracey Parnell ER Physician Cranbrook, BC Linda Poirier Communicable Disease Nurse Coordinator Fraser Health Authority Ramona Trump Quality Management Coordinator BC NurseLine Shelagh Weatherill Communicable Disease Coordinator Vancouver Coastal Health Authority Sharon White Senior Risk Management Consultant Health Health Care Protection Program Eric Young Deputy Provincial Health Officer Ministry of Health Services

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Chapters, Annexes and Appendices

Foreword.................................................................................................................................... 1 1. Introduction .......................................................................................................................3 2. About the Plan ...................................................................................................................5 3. Roles and Responsibilities.................................................................................................7 4. Emergency Financial Assistance.......................................................................................8 5. Pre-Pandemic.....................................................................................................................9 6. Pandemic .........................................................................................................................20 7. Post-Pandemic.................................................................................................................28 Glossary of Abbreviations/Acronyms/Definitions................................................................. 31 Influenza Information Resources............................................................................................46 Annex A: Regional Health Authority (HA) Pandemic Influenza Preparedness Plans .........48 Appendix A-1: Canadian Pandemic Phases ......................................................................70 Appendix A-2: Vaccine Priority Groups ............................................................................ 71 Appendix A-3: Health Care Worker Estimates as a Priority Group for Vaccine ..............73 Appendix A-4: Emergency/Essential Service Worker Estimate as a Priority for Vaccine ........74 Appendix A-5: Antiviral Priority Groups ...........................................................................76 Annex B: Estimating Health Impacts....................................................................................77 Appendix B-1: FluSurge.....................................................................................................80 Annex C: Emergency Response Guidelines ........................................................................... 81 Annex D: Planning for Mass Immunization...........................................................................92 Appendix D-1: Mass Clinic Equipment List in-a-Box ..................................................99 Appendix D-2: Immunization Team In-a-Box.............................................................101 Annex E: Healthcare Service Planning principles ................................................................ 102 Appendix E-1: Critical Hospital Operations ................................................................... 106

Appendix E-2: Hospital Bed Capacity ............................................................................ 107 Appendix E-3: Other Health Service Needs ....................................................................112 Appendix E-4: Critical supplies........................................................................................113

Annex F: Municipal/Local Government Planning Considerations ......................................116 Annex G: Provincial Health Agencies Roles and Responsibilities...................................... 133

Appendix G-1: BC Centre for Disease Control (BCCDC).............................................. 133 Appendix G-2: Provincial Health Officer and Ministry of Health Services/Emergency

Management Branch ....................................................................................................... 139 Appendix G-3: Medical Health Officers (MHOs) ......................................................... 142 Appendix G-4: Health Authorities and Public Health Nursing Leaders ...................... 146 Appendix G-5: Laboratories ........................................................................................... 150 Appendix G-6: Pharmacists ............................................................................................ 152

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Appendix G-7: BC Ambulance Service (BCAS) .............................................................. 154 Annex H: Overview of Federal Roles and Responsibilities .................................................. 155 Annex I: Infection Control guidelines for pandemic influenza management.......................161 Annex J: Non-Traditional Sites ............................................................................................. 166

Appendix J-1: Non-Traditional Sites Assessment Team................................................. 177 Appendix J-2: Non-Traditional Site List ......................................................................... 178

Annex K: Communications Planning.................................................................................... 179

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Tables and Figures Table 1: BC Pandemic Influenza Preparedness Plan Revisions..................................................................2 Table 2: Pre-Pandemic Responsibilities: Overview ......................................................................................9 Table 3: Pre-Pandemic Responsibilities: Emergency Response................................................................11 Table 4: Pre-Pandemic Responsibilities: Vaccine........................................................................................13 Table 5: Pre-Pandemic Responsibilities: Antivirals..................