Community Preparedness

for Health Threats

Union of British Columbia MunicipalitiesSeptember 27, 2005

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Pandemic:

Epidemic over a wide geographic area and affecting a large proportion of the population (global)

Outbreak:

A sudden increase /eruption of a specific disease

Epidemic:

Disease affecting many individuals in an area or population at the same time

Outbreak, Epidemic or Pandemic?

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Legal Authority

Under the BC Emergency Program Act and Regulations

Local authorities are required to prepare risk based emergency plans respecting preparation for, response to and recovery from emergencies and disasters, such as West Nile Virus (WNv).

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Legal Authority

Under the BC Health Act and Regulations

A Medical Health Officer (MHO) has the authority to enact community-based control measures that are considered important in controlling the spread of influenza and minimizing its impact. Such measurers may include

Closure of community facilities (e.g. schools, community centres)

Cancellation of large gatherings

 

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Legal Authority

Under the Drinking Water Protection Act

Water suppliers, including local government, must provide potable water.

Legal Authority

Waterborne Illness

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• Approximately 4000 operational water systems in B.C. (everything other than a single family dwelling)

• Very few systems filter• B.C. has one of the highest reported incidences of intestinal

illness in Canada• 29 Waterborne Disease Outbreaks between 1980-2000• Currently there are approximately 400 ‘Boil Water Advisories’

in effect, mostly on small water supply systems serving fewer than 500 people

Context

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Drinking Water Protection Act (2003)

• Requires construction approval• Requires operating permits• Requires disinfection of surface water)• Specifies no detectable E. coli / fecal coliforms• Requires public notification of water quality problems• Requires an emergency response plan• Empowers conditions on an operating permit• Empowers a system assessment• Empowers an assessment response plan and enables

drinking water protection plans• Requires certified operators – Jan 1, 2006

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• Provision of water has always been a local government responsibility

• Expectations and the definitions of due diligence are changing

• Local government is best positioned to make community-based decisions

Local Government Responsibility

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What does this mean to you?

• Places full responsibility on the “owner” of a water supply system to provide safe drinking water at all times

• “Owner” means elected officials as well as staff• Responsibility to set and enforce policy that protects public

health and ensures compliance

West Nile Virus

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Reducing Risk: BC’s Preparations

An integrated pest management (IPM) approach is the cornerstone of the planned BC response, with a graduated response depending on current risk. This includes:

• Extensive surveillance of birds, mosquitoes, humans, and temperatures

• Communication strategy• Developing legal tools• Preventative Mosquito larval control programs• Emergency response preparedness for selective and

localized adult mosquito control in the event of an WNv outbreak.

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Reducing Risk: Legal Tools

• Legislation• Health Act –

• gives Medical Health Officers the authority to issue an order to protect the health of the public

• The council of a municipality is the local board of health and has responsibilities as such

• WNV Regulation – • Clarifies that Medical Health Officers have authority under

the Health Act to issue orders to a local authority

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Preventative Control: Funding • Nuisance control of mosquitoes has been done in many

communities in B.C. for decades.• $5 million has been granted by MoH to the Union of BC

Municipalities to distribute to its members for implementing Integrated Pest Management programs in 2005.

• The program was very successful with local authorities (approx 60%) and First Nations (40%) applying for and receiving $4 million.

• A few local governments have questions about their responsibilities to protect their citizens and did not participate in 2005.

• The protection of the public from WNv through mosquito control programs has to be a cooperative effort.

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Emergency Mosquito Control: Funding for Adult Mosquito Control Programs

• $250K in total was provided to Health Authorities for setting up contingency ground based adult mosquito control programs.

• $200K was set aside by the province for aerial adult mosquito control to assist local authorities and health authorities if needed to control a threatened outbreak of WNv.

• If adult mosquito control was required in any area of the province the government would pay for any incurred expenses directly related to the adult mosquito control product application.

• Any decision would involve the Medical Health Officer, West Nile virus coordinators, BCCDC, Office of the Provincial Health Officer, and local authority officials.

• Adequate public notification would be provided.

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Challenges

• Indemnification – of local authorities, contractors and health authorities – successfully negotiated – government, UBCM and Municipal Insurance Association

• Public education about benefits of IPM program including possible necessity of adult mosquito control to reduce local risk.

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Malathion• broad spectrum insecticide • registered in Canada since 1953• used extensively in agriculture• for aerial and ground ULV for WNv risk reduction• recent extensive Pest Management Regulatory Agency re-

evaluation – malathion will not pose a health concern to general population, but some may experience side-effects if over-exposed

• Public information about benefits and side-effects – as with any medical treatment.

Adult Mosquito Control

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Plan• Identify key staff• Gather information• Connect with municipalities with current programs• Connect with Health Authority – Public Health Dept

What Municipalities Can Do Now

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Prepare• Determine community level of support• Develop policies• Obtain permits • Source reduction and pre-emptive larviciding in higher

risk areas• Adult mosquito control contingency plan with H.A. in

areas of higher risk

What Municipalities Can Do Now

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Prepare• Mosquito breeding site mapping• Plan public campaign in spring 2006

- education- residential clean-up

• Apply for funding for 2006 when announced

What Municipalities Can Do Now

Pandemic Influenza

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• Anticipated but unpredictable

• Starts abruptly without warning

• Rolls through populations with ferocious velocity

• Cannot be stopped, peak rapidly then subside almost as abruptly

• Second and third waves can be more powerful and destructive

Delay between waves lulls into relief and complacency

•   Leaves considerable damage in its wake

Recovery impeded by multiple waves with simultaneous global onset

. . . . a disease tsunami?

What is known and the uncertainties

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• Could be up to 3 million may be infected 715 per 1000

• Up to 1.8 million may be clinically ill 430 per 1000

• 18,500 thousand may require hospitalization 4.4 per 1000

• 6800 may die 1.6 per 1000

Depends on the assumptions of proportions of the population infected and severity of disease

Impact on BC

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• Vaccine and Antiviral Availability – Need assured surge production

• Antiviral effectiveness for H5N1 not fully known• Antiviral use and distribution strategy• Priority target groups - Ethical and legal issues• Response Triggers - Service Restrictions• Societal Impact - Community strategies • Healthcare surge capacity - Non tradition service delivery• Integrated Consequence Management - Essential Services• Public information and education

Management Challenges

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• Establish plans and procedures to support the local HA

• Develop a program, in conjunction with the HA to facilitate an annual vaccination program.

• Establish a list of public buildings and events and review the benefits of closure/cancellation

• Ensure that areas of responsibility that are ESSENTIAL to maintaining government services are backed up

• Review mutual aid agreements to ensure that essential services are backed up so that appropriate designated personnel are available in the event of illness

• Review and confirm availability of community facilities for mass clinics, triage, alternate care, body disposal . . .

Government Planning Considerations

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• Involve all essential service providers in the planning process

• Clarify relationships, responsibilities, and communication lines between organizations at the federal, provincial and local level

• Market the plan to all stakeholders to obtain the necessary support and resources prior to a pandemic

• Work at local level with support from the province

Key Issues

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Why Local Governments Should Act

• Protect Citizens and Employees • Ensure the Delivery of Essential Services• Support Health Authorities• Assist Community Members• Minimize Financial Impacts• Protect Local Economy

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Key Steps for Local Governments

• Business Continuity1. Prioritize critical functions

Life, health and safety (police, fire, emergency medical services, etc)

Identify functions that affect life, health and safety , and communications

Identify functions that are critical to organizations mission2. Identify staff need to execute critical functions3. Identify function that could be suspended4. Build depth/redundancy through cross training5. Plan for alternate work schedules6. Explore/exploit telecommuting capabilities – large scale

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Key Steps for Local Governments

• Ensure local emergency managers coordinate with health authority

• Engage local businesses and major employers

Educate – inform – support• Involve elected leaders and identify action they may be

required to take in response to a pandemic• Foster health system resilience and expanded capacity• Support business continuity planning• Conduct training and exercises

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Local Governments

• Areas of concern:– Employee health– Essential community services / social disruption– Assisting HAs with alternate sites– Possible closure of public gatherings

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Employee Health

• Prior to a Pandemic- Promote annual flu vaccination- Promote workplace hygiene (hand washing, cough

etiquette, stay home when ill)• During Pandemic

- Promote self-isolation when employees ill with flu - Facilitate employee immunization when vaccine becomes

available- Grief counseling (deaths in co-workers and families)

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Essential Services

• A cumulative 25% + staff may be off during pandemic, but likely less than 10% in any one week.

• What essential services must be maintained (public safety, social disruption)

• Minimum staffing needed for essential services • Training of staff to allow cross coverage• Working with businesses to ensure supply chain

continues

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Assist Health Authorities with alternate sites

• Work through emergency planners to ensure up to date lists of potential sites that could be used for:

- Mass immunization clinics (security concerns)- Alternate care sites

facilities with beds or space for portable beds easy for public to access washroom facilities

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Possible Closures

• Possible closure of public gatherings- May slow spread of virus during early pandemic, prior to

vaccine availability- Main concern will be prolonged, high density gatherings

(e.g. schools, public venues, other venues)- May need to cancel events

public disobedience security concerns

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Managing Pandemic Influenza

– A Guide for BC Local Governments –

Draft 5 – For Discussion Only

September 2005

M inistry of Health

Managing Pandemic Influenza

– A Guide for BC Local Governments –

Draft 5 – For Discussion Only

September 2005

M inistry of Health

The Ministry of Health has prepared a

guide for local

governments

The Ministry of Health has prepared a

guide for local

governments

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Potential for Death

Severity

0 2 4 6 8 10 12 14

Exposed

Infectious After 1 Day

Symptoms

Complications

Earliest Return to Work

Infectious

Days

Incubation

Infection Timeline

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05

101520253035404550

Percent

Severity

No or FewSymptomsSelf Care

Outpatient Care

Hospitalization

Death

Severity Among Those Exposed

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Objective

1. Assess Risks

2. Mitigate Risks

3. Preparedness

4. Coordinate Response

5. Lead Recovery

For Local Government

For Community

Pandemic Influenza Management Guide

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Managing Pandemic Influenza

Guide

Annotated Index

Sample Pandemic Response

Plan

Estimating Health Effects

Forms and Templates

Other Detailed

Guidance

Level 1 – Basic Overview

Level 2 – More Details

Level 3 – Detailed Guides

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The EndQuestion/Comments/

Concerns