1 1 Pandemic Flu Scenario Workshop June 22, 2005 Albany, New York June 22, 2005 Albany, New York University at Albany School of Public Health University

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Pandemic Flu Scenario Workshop

Pandemic Flu Scenario Workshop

June 22, 2005

Albany, New York

June 22, 2005

Albany, New York

University at Albany

School of Public Health

University at Albany

School of Public Health

Regional Resource Center for Emergency & Disaster

Preparedness

Regional Resource Center for Emergency & Disaster

Preparedness

Center for Public Health Preparedness

Center for Public Health Preparedness

Albany Medical Center

Albany Medical Center

Regional Resource Center

Regional Resource Center

Champlain Valley Physicians HospitalChamplain Valley

Physicians Hospital

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PurposePurpose

• To give you an opportunity to review the serious impact of an influenza pandemic on your community, your organization, and your partner organizations.

• To give you an opportunity to review the serious impact of an influenza pandemic on your community, your organization, and your partner organizations.

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Breakout GroupsBreakout Groups

• Crisis & Risk Communication• Surge Capacity Issues• Inter-agency Issues• Resource Distribution• Operational & Implementation Issues

• Crisis & Risk Communication• Surge Capacity Issues• Inter-agency Issues• Resource Distribution• Operational & Implementation Issues

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ObjectivesObjectives

• Review the impact of an influenza pandemic on your community, organization, partner organizations, and professional activities

• Identify problems and potential solutions that are appropriate to the unique conditions of your agency and community

• Share the identified problems and solutions with your peers

• Review the impact of an influenza pandemic on your community, organization, partner organizations, and professional activities

• Identify problems and potential solutions that are appropriate to the unique conditions of your agency and community

• Share the identified problems and solutions with your peers

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AgendaAgenda• Overview• Scenario:

• Module 1• Module 2• Module 3• Module 4

• Summary discussion with all groups (auditorium)

• Overview• Scenario:

• Module 1• Module 2• Module 3• Module 4

• Summary discussion with all groups (auditorium)

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Module FormatModule Format

Situation UpdatePandemic scenario

advances.

Situation UpdatePandemic scenario

advances.

Table Discussion (5 min.)

Brainstorm initial responses to question

assigned.

Table Discussion (5 min.)

Brainstorm initial responses to question

assigned.

Report Back & Group Discussion (20 min.)

Each table shares initial responses brainstormed.

Report Back & Group Discussion (20 min.)

Each table shares initial responses brainstormed.

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Ground Rules (1)Ground Rules (1)

• You are playing yourself (but you may need to think outside your usual role).

• You are not making official representation of your agency.

• There are no wrong answers (but there are better ones).

• You are playing yourself (but you may need to think outside your usual role).

• You are not making official representation of your agency.

• There are no wrong answers (but there are better ones).

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Ground Rules (2)Ground Rules (2)

• Assume that the information you are given is accurate.

• Where the information provided is insufficient, do your best to explore all possibilities.

• The facilitators are there to help you. You are not limited to just the facilitator in your room.

• Assume that the information you are given is accurate.

• Where the information provided is insufficient, do your best to explore all possibilities.

• The facilitators are there to help you. You are not limited to just the facilitator in your room.

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Questions before we begin?Questions before we begin?

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Begin ExerciseBegin Exercise

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Module 1

It’s There!Module 1

It’s There!

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BackgroundBackground

• The health care and public health community worldwide has been watching and studying the avian influenza A/H5N1 virus that has continued to evolve in southeast Asia.

• The health care and public health community worldwide has been watching and studying the avian influenza A/H5N1 virus that has continued to evolve in southeast Asia.

June 2005June 2005

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BackgroundBackground

• The recent outbreaks that began in December 2004 have resulted in 59 cases and 22 deaths in southeast Asia.

• To date no cases of human-to-human transmission have been confirmed.

• The recent outbreaks that began in December 2004 have resulted in 59 cases and 22 deaths in southeast Asia.

• To date no cases of human-to-human transmission have been confirmed.

Source: WHO. June 16, 2005.Source: WHO. June 16, 2005.

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Pandemic StatusPandemic Status

New Pandemic Phase 3:

“Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.”


“Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.”

Source: WHO. Global influenza preparedness plan. May 2005.Source: WHO. Global influenza preparedness plan. May 2005.

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Suspicious CaseSuspicious Case

• In Hanoi, Vietnam a worrisome case has come to the attention of the Ministry of Health.

• A migrant worker (identified only as Mr. W.) lies critically ill in an area health center with an influenza-like illness.

• In Hanoi, Vietnam a worrisome case has come to the attention of the Ministry of Health.

• A migrant worker (identified only as Mr. W.) lies critically ill in an area health center with an influenza-like illness.

1616

InvestigationInvestigation

• Two days ago Mr. W. fell ill on the job at the Hotel Universal.

• According to the investigation, Mr. W. and several others left their home village to return to work in Hanoi, leaving sooner than planned because 4 residents of his village had died.

• The symptoms of the deceased were similar to what a companion suffered from after returning from a 2-day trip to a regional market town.

• Two days ago Mr. W. fell ill on the job at the Hotel Universal.

• According to the investigation, Mr. W. and several others left their home village to return to work in Hanoi, leaving sooner than planned because 4 residents of his village had died.

• The symptoms of the deceased were similar to what a companion suffered from after returning from a 2-day trip to a regional market town.

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“Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.”


“Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.”


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AlertAlert

• The WHO Global Influenza Surveillance Network reports the following on the situation in Vietnam:• Mr. W. has died, along with 8 other

individuals from his village who recently returned to work in Hanoi hotels and private residences.

• Lab tests on collected samples from the victims have isolated a new strain of avian influenza A/H5N1.

• The WHO Global Influenza Surveillance Network reports the following on the situation in Vietnam:• Mr. W. has died, along with 8 other

individuals from his village who recently returned to work in Hanoi hotels and private residences.

• Lab tests on collected samples from the victims have isolated a new strain of avian influenza A/H5N1.

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AlertAlert

• Investigation concludes that human-to-human transmission did occur in these cases.

• The new strain is highly pathogenic.• The new strain can cause primary viral

pneumonia, unlike pneumonia in most influenza patients caused by secondary bacterial infection.

• Investigation concludes that human-to-human transmission did occur in these cases.

• The new strain is highly pathogenic.• The new strain can cause primary viral

pneumonia, unlike pneumonia in most influenza patients caused by secondary bacterial infection.

2020

OutbreakOutbreak

• Initial investigation in the last 24 hours has revealed 26 other suspected cases in area homes and hospitals.

• Initial investigation in the last 24 hours has revealed 26 other suspected cases in area homes and hospitals.

• Laboratory confirmation of the strain is expected soon.

• Laboratory confirmation of the strain is expected soon.

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“Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).


“Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).


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Situation UpdateSituation Update

• With the cases in Vietnam mounting, the neighboring countries of Laos, Thailand, and Cambodia report confirmed and suspect cases of influenza infection by the new strain.

• With the cases in Vietnam mounting, the neighboring countries of Laos, Thailand, and Cambodia report confirmed and suspect cases of influenza infection by the new strain.

• Some cases were quickly traced back to foreign travel and stays at the Hotel Universal in Hanoi.

• Some cases were quickly traced back to foreign travel and stays at the Hotel Universal in Hanoi.

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Situation UpdateSituation Update

• The ministries of health in China, Indonesia and Canada report confirmed cases of infection by the new strain.

• The ministries of health in China, Indonesia and Canada report confirmed cases of infection by the new strain.

• Everywhere, previously unsuspected cases are being investigated retroactively.

• Some cases are in health care workers who probably delivered care to infected travelers.

• Everywhere, previously unsuspected cases are being investigated retroactively.

• Some cases are in health care workers who probably delivered care to infected travelers.

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“Pandemic phase: increased and sustained transmission in general population.”


“Pandemic phase: increased and sustained transmission in general population.”


2525

Casualty ReportCasualty ReportJuly 2005July 2005

Module 1Module 1

Cases Deaths

Vietnam 62 35

Laos 12 4

Thailand 17 12

Cambodia 4 4

Canada 6 1

China 9 2

Indonesia 8 0

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Coming and Going (1)Coming and Going (1)

International air travel:• 2 million passengers per month

arrive on international carriers at NYC airports

• 1,400 passengers per month arrive directly from Canada at Albany International Airport.

International air travel:• 2 million passengers per month

arrive on international carriers at NYC airports

• 1,400 passengers per month arrive directly from Canada at Albany International Airport.

The New York State Thruway serves 230 million vehicles per year.

The New York State Thruway serves 230 million vehicles per year.

Eric N Gebbie

All of the outbreaks in the world are of concern, but this is why the cases in Canada are of special concern. The new strain is on our doorstep and its arrival here is inevitable.

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Coming and Going (2)Coming and Going (2)

Daily traffic at the New York - Canadian border:• Train passengers: 200• Pedestrians: 1,800• Bus passengers: 4,655 • Car passengers: 58,074

Daily traffic at the New York - Canadian border:• Train passengers: 200• Pedestrians: 1,800• Bus passengers: 4,655 • Car passengers: 58,074

Source: Bureau of Transportation StatisticsSource: Bureau of Transportation Statistics

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Table Discussion PeriodTable Discussion Period

• At your table, address at least one question.

• The facilitator and advisors are available to answer any factual questions they can.

• Report back to the group in approximately 5 minutes.


• The facilitator and advisors are available to answer any factual questions they can.


Module 1Module 1

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Report Back & Group DiscussionReport Back & Group Discussion

• What problems did you identify?• What solutions do you recommend?• What remains unresolved?


Module 1Module 1

3030

Key ConcernsKey Concerns

• What are three key concerns from this module that should be shared with the other groups?

1)

2)

3)


1)

2)

3)

Module 1Module 1

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It’s Here!It’s Here!Module 2Module 2

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Local OutbreakLocal Outbreak

• During the last week, 42 suspect cases of infection with the novel pandemic strain have been detected in New York State.

• Four cases have been confirmed in your county.

• During the last week, 42 suspect cases of infection with the novel pandemic strain have been detected in New York State.

• Four cases have been confirmed in your county.

August 2005August 2005

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SourceSource

• Investigation reveals that most transmissions occurred at a Fresh Air Fund summer camp session.

• The session was attended by 240 campers from around the region.

• Counselors and staff included local residents as well as college students from foreign summer abroad programs.

• Investigation reveals that most transmissions occurred at a Fresh Air Fund summer camp session.

• The session was attended by 240 campers from around the region.

• Counselors and staff included local residents as well as college students from foreign summer abroad programs.

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SurgeSurge

• Local hospitals are seeing a surge of patients in emergency departments.

• Political and health authorities are bombarded with questions about what to do.

• Local hospitals are seeing a surge of patients in emergency departments.

• Political and health authorities are bombarded with questions about what to do.

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Vaccine StatusVaccine Status

• There is no vaccine available.

• There is no vaccine available.

3636

Casualty ReportCasualty ReportAugust 2005August 2005

Module 2Module 2

Total Cases to Date

Total Deaths to Date

Global 2,730 1,150

U.S. 750 231

New York 420 106

Canada 670 150

Eric N Gebbie

Note that these numbers are somewhat arbitrary, intended to show the participants that the flu is here and it is serious, at the start of the first big wave. But there is still time to intervene, as the effects aren’t catastrophic yet, as they are later on. The mortality rate does not reflect the final mortality rate given for this flu pandemic at the end of the scenario, which is much lower than here (12 per 1,000 in the US & Canada, which is double the rate of the 1918-19 pandemic).

3737

Table DiscussionTable Discussion





Module 2Module 2

3838




Module 2Module 2

3939



1)

2)

3)


1)

2)

3)

Module 2Module 2

4040

Breathing RoomBreathing Room

CasesCases

Module 3Module 3

4141

ImpactImpact

• The pandemic has not been stopped and the impact to date has been enormous…

• The pandemic has not been stopped and the impact to date has been enormous…

December 2005December 2005

4242

Casualty ReportCasualty ReportModule 3Module 3


Total Cases to Date


Global 322 million 7.7 million

U.S. 14.8 million 177,600

New York 950,000 11,400

Canada 1.6 million 19,680

Eric N Gebbie

These numbers are a snapshot of the end of the first major wave, after it is clear the infection rate is slowing. The mortality rate is 12 per 1,000 in the US and Canada (double the rate of the 1918-19 pandemic) and 24 per 1,000 for the world (arbitrary). Estimates at this point are about 1/3 the final number given in the conclusion of the scenario. The number of cases is greatly increased since the casualty report at the end of Module 2 --- that report was for the start of the local, massive outbreaks, to get participants to think about what they would do at the start of local outbreaks. For this Module 3 report, for the beginning of the slow down, participants will address what to do at the end of the first wave, but will also have to process what a massive impact the first wave really had.

4343

End of First WaveEnd of First Wave

• However, in the northeastern US and most other parts of the country, the rate of new outbreaks has reduced to a fraction of the rate during the peak 3 months ago.

• However, in the northeastern US and most other parts of the country, the rate of new outbreaks has reduced to a fraction of the rate during the peak 3 months ago.

CasesCases

4444

Vaccine ArrivesVaccine Arrives

• Reaction is mixed• Fear of side effects• Demand greater than supply

• Shortages occur at all levels: International, national, state, local, organization

• Reaction is mixed• Fear of side effects• Demand greater than supply

• Shortages occur at all levels: International, national, state, local, organization

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OverseasOverseas

• Outbreaks continue abroad.• Poor countries on every

continent are experiencing local, savaging outbreaks in remote regions and mega-cities alike.

• Outbreaks continue abroad.• Poor countries on every

continent are experiencing local, savaging outbreaks in remote regions and mega-cities alike.

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PrioritizationPrioritization

• Many advocate prioritizing the military for vaccine, medications, equipment, and medical personnel to maintain national security.

• Many advocate prioritizing the military for vaccine, medications, equipment, and medical personnel to maintain national security.

4747

Psychosocial ImpactPsychosocial Impact

• After months of steady outbreaks, few lives are untouched by illness, death, bereavement, and stress.

• After months of steady outbreaks, few lives are untouched by illness, death, bereavement, and stress.

4848

VigilanceVigilance

• Public health authorities stress the need to maintain infection control practices and surveillance.

• Many believe they can relax a bit now that the pandemic has lessened locally.

• History shows that another wave is likely.

• Public health authorities stress the need to maintain infection control practices and surveillance.

• Many believe they can relax a bit now that the pandemic has lessened locally.

• History shows that another wave is likely.

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Political TensionsPolitical Tensions

• Some countries blame each other for not preventing or stopping the pandemic.

• Poor countries make pleas for financial aid and resources.

• Congressional scrutiny is constant.

• Some countries blame each other for not preventing or stopping the pandemic.

• Poor countries make pleas for financial aid and resources.

• Congressional scrutiny is constant.

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Module 3Module 3

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Module 3Module 3

5252



1)

2)

3)


1)

2)

3)

Module 3Module 3

5353

It’s Back!It’s Back!Module 4Module 4

CasesCases

5454

Second WaveSecond Wave

• Illness and death rates have crept back up.

• Illness and death rates have crept back up.

July 2006July 2006

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On the MoveOn the Move

• Areas that normally serve only as vacation homes for urban dwellers now see unusually high population levels due to urban “Flu Flight”.

• Areas that normally serve only as vacation homes for urban dwellers now see unusually high population levels due to urban “Flu Flight”.

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OvertimeOvertime

• The staff shortage in healthcare facilities is estimated to be an average of 30%, due to both inability and unwillingness to work.

• Available staff see shifts extended and vacation requests denied.

• Overtime pay and costs reach unprecedented levels.

• The staff shortage in healthcare facilities is estimated to be an average of 30%, due to both inability and unwillingness to work.

• Available staff see shifts extended and vacation requests denied.

• Overtime pay and costs reach unprecedented levels.

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Now HiringNow Hiring

• Demand for able and willing healthcare workers exceeds supply locally and internationally.

• Employers that are able to are offering enormous pay for temporary healthcare workers.

• Demand for able and willing healthcare workers exceeds supply locally and internationally.

• Employers that are able to are offering enormous pay for temporary healthcare workers.

Eric N Gebbie

During the SARS outbreak of 2003, Canada offered up to $2,000 per day to physicians that would come.

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Surge CapacitySurge Capacity

• Auxiliary hospitals increase in size and number in temporary facilities and structures.

• Auxiliary hospitals increase in size and number in temporary facilities and structures.

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Vaccination CampaignVaccination Campaign

• Immunization levels in the US range from 1% to 25% in different areas.

• Immunization levels in the US range from 1% to 25% in different areas.

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Casualty ReportCasualty ReportModule 4Module 4

Total Cases to Date



U.S. 29.6 million 355,200

New York 1.9 million 22,800


July 2006July 2006

Eric N Gebbie

These numbers are a snapshot after the second wave just gets started. Estimates are approximately two-thirds the number given in the final report at the conclusion of the scenario.

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Module 4Module 4

6262




Module 4Module 4

6363



1)

2)

3)


1)

2)

3)

Module 4Module 4

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ConclusionConclusion

• The rate of new infections with the pandemic strain has fallen to levels similar to non-pandemic strains, as have survival rates.

• Vaccine production and delivery continue to climb.

• Thorough evaluation of the response to this pandemic continues.

• The rate of new infections with the pandemic strain has fallen to levels similar to non-pandemic strains, as have survival rates.

• Vaccine production and delivery continue to climb.

• Thorough evaluation of the response to this pandemic continues.

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Casualty ReportCasualty Report

Total Cases Total Deaths


U.S. 44 million 532,800

NY 2.9 million 34,200


ConclusionConclusion


Eric N Gebbie

Total cases is based on gross attack rate of 15% for all countries. Mortality rate for US & Canada is 12 per 1 thousand (double the 1918-19 pandemic), and 24 per 1 thousand for the world (arbitrary doubling). This is a conservative estimate!!! [This estimate is much lower than others (such as ones that estimate 100 million dead worldwide), but this estimate is based roughly on good peer-reviewed numbers (such as the Meltzer, Cox, and Fukuda article in Emerging Infectious Diseases, Oct 1999), and it was felt that if the numbers of cases and deaths were so incredibly high the participants might totally disbelieve it and no get engaged in the scenario.]

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End ExerciseEnd Exercise

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Wrap UpWrap Up

• Discussion• Key concerns• Next: Report back to other groups in the

auditorium

• Discussion• Key concerns• Next: Report back to other groups in the

auditorium

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Acknowledgements (1)Acknowledgements (1)• References & Sources:

• WHO Global Influenza Preparedness Plan

• WHO Checklist for Global Influenza Pandemic Preparedness Planning

• FEMA, HHS: Pandemic Tabletop, 1999.• Exercise guidelines adapted from FEMA

• References & Sources:• WHO Global Influenza Preparedness

Plan• WHO Checklist for Global Influenza

Pandemic Preparedness Planning• FEMA, HHS: Pandemic Tabletop, 1999.

• Exercise guidelines adapted from FEMA

Eric N Gebbie

This does not need to be presented in the exercise, but is put here for when the slides are disseminated.

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Acknowledgements (2)Acknowledgements (2)Scenario originally developed for:

Avian Influenza: Preparation and Response Regional Workshop

Rensselaer, NY, June 22, 2005

Presented by:

University at Albany Center for Public Health Preparedness

Albany Medical Center Regional Resource Center for Bioterrorism and Emergency Response

Champlain Valley Physicians Hospital Regional Resource Center

Available at www.UAlbanyCPHP.org

Scenario originally developed for:

Avian Influenza: Preparation and Response Regional Workshop

Rensselaer, NY, June 22, 2005

Presented by:

University at Albany Center for Public Health Preparedness

Albany Medical Center Regional Resource Center for Bioterrorism and Emergency Response

Champlain Valley Physicians Hospital Regional Resource Center

Available at www.UAlbanyCPHP.org

Eric N Gebbie

This does not need to be presented in the exercise, but is put here for when the slides are disseminated.

Documents

1 1 Pandemic Flu Scenario Workshop June 22, 2005 Albany, New York June 22, 2005 Albany, New York University at Albany School of Public Health University