Pandemic Influenza – “Is it real, or is it just another storm on the horizon?

Pandemic Influenza 101

June 2006

James C. Turner, MDExecutive Director,

Department of Student HealthUniversity of Virginia

Slide templates and background information: Roy Crewz, M.P.H., M.S.Emergency Preparedness and Response Program

Thomas Jefferson Health Department

Pandemic Planning Pandemics have occurred throughout human

history and are a way of life. 430 BC 25% of Athens died of a pandemic 14th century plague killed an estimated 25

million people, changing the course of modern history.

Ten pandemics have occurred in the last 300 years.

Last three were in 1918 (devastating), 1957 and 1968 (both mild).

Pandemic Influenza 1918

1918, H1N1 “Spanish Flu”

> 500,000 deaths in the U.S.

20-50 million deaths Young/healthy adults Death was RAPID

Pandemic Planning The world is overdue for a pandemic and is under

prepared. Potential for pandemic first recognized with

emergence of pathogenic avian strains passed to humans in 1997.

The avian strain, H5N1, shares genetic characteristics of the Spanish flu strain from 1918.

H5N1 is highly pathogenic and mutagenic and is spreading explosively worldwide among wild and domestic avian flocks. Human cases are limited.

Increases risk of H5N1 mutation or reassortment to a strain that transmits easily among humans-the only missing element of the pandemic.

Pandemic Planning Pandemic strain virulence will determine the impact

on the population. Current models predict U.S. outcomes if similar in

virulence to 1918: 30% population attack rate; 40% absenteeism at work

and schools for 6-8 day intervals over 12 weeks; two to three waves over 2-3 years.

1.5 M patients in ICU’s 750,000 on ventilators 1.9 M deaths in the U.S.

Pandemic Planning

What about Charlottesville/Albemarle County (est. population 130,000)?

39,000 residents will be sick; 390-975 deaths (1-2.5%); Challenge to local health care system Challenge to infrastructure; business

community and educational enterprises.

Other Possible Effects of Pandemic Economic/Business devastated – actual

dollar costs in the billions…......inestimable Production & Transportation impaired – one

of the most basic questions is “how will we eat?”

Security: for individuals and businesses Behavioral health effects National psyche – “will the glass be half-

empty or half-full?” Post 9/11 PTSD, can the public handle it?

Planning:Who Does What?

Federal government nationwide coordination of the pandemic

influenza response; international collaboration. State government: Virginia Department of Health

coordination of pandemic influenza response within and between jurisdictions.

Local government developing local plans and insuring these plans

meet both state and federal guidelines.

Local Pandemic Influenza Plan

Builds on Emergency Operations Plan: Legal authority Command and control procedures; Surveillance/epidemiologic investigation; Infection control; Medication/vaccine management; Coordination local/state agencies; security Communications; education and training

Pandemic detection and response

International surveillance for pandemic strain (rapid person to person transmission).

International alert Containment: targeted antivirals, quarantine,

isolation, limited travel, animal culling

Pandemic detection and response

Once disease spreads worldwide, local efforts will include: Containing community transmission (social

distancing, isolation, quarantine, protective sequestration, and health education).

Communication Medical care Vaccines and anti-viral medications (available

in limited supplies and perhaps not for months).

Influenza Vaccine

No vaccine available for 4-6 months Control measures important

Limited vaccine supply Focus on vaccine priority groups; “batching”

IF - Adequate vaccine supply Expand coverage

Federal government is providing substantial support to the vaccine industry to improve flu vaccine production capabilities.

Priorities may shift as supply increases

Vaccine Issues

Security Administration of the vaccine Prioritization for administering vaccine within

groups (HC providers providing direct care)

Antiviral Medications

Good news Prophylaxis and Treatment:

(duration/severity)

Bad news Resistance Limited Supplies

Antiviral Issues

Prophylaxis vs. treatment: who decides the priorities and who has access to antivirals

Stockpiling: Public vs. Private Role of local pharmacies

Medical Care

Access to and provision of healthcare= cornerstone to reduce morbidity/mortality

Great demand for beds, ICU, ventilators Heath care workers who are ill Nosocomial (Hospital-setting) outbreaks Canceling of regular medical

appointments and admissions.

Medical Care Issues

Prioritization and triaging of patients (e.g. canceling elective surgeries)

Role of home health care and monitoring Ambulatory care facilities Counseling and psychological support Insufficient medical resources Support for HCW’s-housing, food,

transportation, extended shifts, quarantine

Community Transmission Goal

Slow the spread – BUY SOME TIME!-until antivirals and vaccine available.

Factors influencing disease transmission Short incubation period Infectious during asymptomatic stage Clinical illness - nonspecific High attack rates

Non-pharmaceutical Interventions

Social Distancing School and business closures Sending residential students home if possible Recommendations about telecommuting “Snow days”- a high # of people stay home for 10 to

100 day intervals Discouraging/banning large indoor gatherings-concerts

and athletic events. Isolation/quarantine early-liberal sick leave policies Health education for hygiene. Protective sequestration not an option Benefits and impact uncertain

Community TransmissionIssues

Continuing" essential” services (police, fire, electricity, water, grocery stores)

Community wide efforts for cough and hand washing hygiene

Voluntary compliance for the common good vs enforcement actions

Criteria for closing schools, businesses, and/or canceling public events

Communication/Education Issues

• How will we disseminate timely information: influenza bulletins to health care providers vaccine availability/distribution plans patient education identifying official spokesperson role of health officials and governmental

authorities

For More Information ……… “The HHS Pandemic Influenza Plan is a

blueprint for pandemic influenza preparation and response. For a copy visit: www.pandemicflu.gov. “School Planning” tab to college and university checklist.

For Virginia Pandemic Influenza Information visit: www.vdh.virginia.gov/pandemicflu/

College Health www.acha.org will post draft of guidelines for colleges and universities in July.

Other professional organizations….

UVa Planning To Date

1. Committee on Emerging Diseases at the Health System has worked on bed space, ventilators, antivirals, supplies.

2. Ad hoc work group on international studies has started meeting to discuss international students and study abroad programs.

3. Mr. Sandridge has appointed a pandemic preparedness planning committee to conduct planning for the entire University community.

4. UVa represented on Health Department pandemic committees and State Summit

Break

Restrooms: one in lower lobby. Four up one floor, scattered down the hall toward north end of building.

Refreshments Return in 15 minutes.

UVa’s Charge Today1. Develop and incorporate pandemic influenza

planning into existing University plan.2. Address University functioning over various

scenarios.3. Address medical, mental, and social services for

University community. 4. Explore alternatives to assure continuity of

instruction and research5. Develop a continuity of operations plan for essential

services.6. Implement infection control procedures.7. Establish a communication plan.

UVa’s Planning Structure

• Emerging Diseases Committee-Co-chaired by Marge Sidebottom and Dr. Tom Bleck.

• Pandemic Preparedness Planning Committee-Chaired by Dr. Jim Turner

• Academic affairs-Anda Webb• Student Support Services-Penny Rue• Faculty and staff-Dave Ripley• Communication-Carol Wood• Legal-Beth Hodsdon• Administrative Operations-Susan Harris• Health care/infection control-Marge Sidebottom

UVa’s Planning Structure

Academic affairs-Anda Webb• Provost’s office• International programs• Public health faculty• Travel clinic faculty and/or nurses• Environmental Health and Safety• Student Health

Charge: Closure/cancellation policies, continuity of academic enterprise during pandemic.

UVa’s Planning Structure

Student Support Services-Penny Rue• Housing• Food services• Parking and transportation• Student affairs• Student Health

Charge: Dealing with closure policies, sending students home, caring for students who can’t go home or are ill, preparing residential units.

UVa’s Planning Structure

Faculty and staff-Dave Ripley• Human resources• Benefits Office• Payroll• Provost’s Office

Charge: Leave policies, emergency contact lists, departmental depth charting, communicating with departments and supervisors, payroll, benefits.

UVa’s Planning Structure

Communication-Carol Wood• University and community relations• ITC

Charge: Coordinate communication internally and externally (health department and emergency operations), centralized University information site.

UVa’s Planning Structure

Legal-Beth Hodsdon• General Counsel’s Office• Attorney General’s Office• LWS office

Charge: Define legal authority for mandated closures, contract review for pandemic contingencies, coordinate leave policies and insurance benefits with HR and State regulations.

UVa’s Planning Structure

Administrative Operations-Susan Harris• Office of the EVP and CEO• University police• Procurement• Athletics• Facilities• Parking and Transportation

Charge: Identify critical business functions, resource allocation for planning and procurement, facility maintenance, campus safety, transportation

UVa’s Planning Structure

Health care/infection control-Marge Sidebottom• Emerging Diseases Committee• Employee Health/Work Med/Hospital Epi.• Student Health/General Medicine, CAPS,

LNEC, Administration• Schools of Nursing and Medicine• Public Health Department

Charge: Ambulatory care, mass clinics for vaccine and antivirals, mental health, care for ill residential students, infection control procedures, faculty/staff vaccine policies.

Subcommittee logistics

Chairs free to appoint co-chairs or vice chairs.

Appoint members of subcommittee from departmental representation on larger committee and/or others in departments. JCT can help with membership suggestions.

Student Health conference space available to chairs. Arlene Guenther: 924-2670, or ag5z@cms.mail.virginia.edu

UVa plan format and communication

Existing policies or procedures should be identified.

Standardized policy or plan format? Centralized website? Email distribution of plans?

Meetings and Timelines Monthly meetings of subcommittee chairs

with JCT Planning committee meets in early

September 2006 to receive plan reports from subcommittee chairs and seek feedback.

Written plan submitted to LWS October 1, 2006.

Initial training of key stakeholders October. UVa participates in regional drill October 31,

2006.