Pandemic Influenza: Role and Responsibility of Local Public Health

Richard M. Tooker, MDChief Medical Officer

Kalamazoo County Health and Community Services

Pandemic Impact: Infrastructure

• Significant disruption of transportation, commerce, utilities, public safety and communications. Affecting almost every person in some way.

• Limited to no assistance from State and Federal governments due to nation-wide impact

Response will be:

» Family by family

» Community by community

» Business by business

Local Impact: Health Status

• 2 month duration per wave

• 245,000 - 612,000 clinically ill

• 36,000 – 60,000 outpatient medical visits

• 1,200 – 10,000 people hospitalized

• 350 – 3,000 dead

• An unmanageable strain on the health care

system

• Up to 200 million people infected

• 40 - 90 million people clinically ill• 20 - 46 million (low range estimate only)

outpatient medical visits

• 360,000 – 9,600,000 people hospitalized

• 104,000 – 2,200,000 deaths

National Impact: Health Status

Public Health Goals in a Pandemic: Protecting the Public’s Health

• Limit death and illness

• Preserve continuity of essential government and business functions

• Minimize social disruption

• Minimize economic losses

Public Health’s Role in a Pandemic

• Disease Tracking and Monitoring

• Control Measure Recommendations

• Environmental health response

• Health System Coordination

• Mass fatality response

• Communications

• Laboratory services

Strategies

• Reduce the frequency with which people come into contact with one another

• Avoid unnecessary interactions

• When people do come into contact with one another, minimize the opportunity for exposure

Public Health Control Measures

Limit person-to-person transmission by:• Isolating the ill in hospitals• Quarantine the exposed• Targeted Layered Containment

Targeted Layered Containment

• Ill patients should stay at home• Home quarantine for household

contacts• Social distancing measures• Antiviral treatment and targeted

prophylaxis• Individual infection control measures• Disinfection of contaminated surfaces

Public Health Control Measures

• School and day care closures may have profound impact

• Cancellation of public events such as sporting events, movies, concerts, church services, museums and conventions

• Issuing county-wide voluntary shelter-at-home orders similar to snow days.

• Closing public transportation• Cancel business and work

activities except for critical infrastructure staffed by minimum personnel (liberal leave vs. closure; telecommuting; etc)

Public Health Control Measures

Public Health Recommendations

• Avoiding exposure when in public places:– Limitation of all close personal

contact, – Frequent hand washing– Use of masks

Vaccine: The Realities

• Vaccine takes 6-8 months to produce following the emergence of a new virus

• Supplies will be limited, if available at all– Establish priority groups for use of limited

vaccine – 2nd dose after 30 days will likely be required– Need to monitor vaccine safety and efficacy

Antiviral Drugs: The Realities

• Antiviral agents– Effective in preventing illness– Can prevent severe complications – May not be effective against pandemic virus

• Supplies will be limited– Establish priority groups for use of available

drug– Treatment over prevention

Pandemic Prevention and You

• You must attempt to keep influenza out of:– Your home– Your workplace

• Limit the person-to-person spread of the virus

Limiting Person-to-Person Spread: What Can You Do?

•Stay home when sick•Respiratory & hand hygiene: Cover your cough Wash hands and/or

use alcohol hand gelAvoid touching eyes, nose, mouth

•Implement “social distancing” measures

•Masks

Plan for Employees and Community

• Encourage annual influenza vaccinations• Improve healthcare • Provide mental health

services• Plan for special needs• Implement guidelines on face-to-face

contact among employees and between employees and customers

• Follow CDC, State, and local public health guidelines