Pandemic Influenza

Renee Frauendienst, RN, PHN, BSNDivision Director

Public Health DivisionStearns County Human Services

Preparing for Pandemic Pandemic InfluenzaInfluenza:

Business will not be as Usual

Recent PandemicsRecent Pandemics

1918/1919 Spanish Influenza 1918/1919 Spanish Influenza – 40/50 million deaths worldwide40/50 million deaths worldwide

1957 Asian Flu1957 Asian Flu– 2 million deaths worldwide2 million deaths worldwide

1968 Hong Kong Flu1968 Hong Kong Flu– 1 million deaths worldwide1 million deaths worldwide

1918 Spanish Flu1918 Spanish Flu

Devastating Devastating – ““Hospitals filled up and soon became Hospitals filled up and soon became

overwhelmed as doctors and nurses got overwhelmed as doctors and nurses got sick. Children lost their parents, and sick. Children lost their parents, and people hid in their homes to avoid a new people hid in their homes to avoid a new and mysterious virus. So many people died and mysterious virus. So many people died that there was no time to make coffins; that there was no time to make coffins; many victims had to be buried in mass many victims had to be buried in mass graves.” graves.”

– ““Shops, offices and factories shut down Shops, offices and factories shut down without enough staff to keep them going, without enough staff to keep them going, and schools, hotels and theatres were and schools, hotels and theatres were closed by order of the government.” closed by order of the government.”

Pandemic Flu PlanningPandemic Flu Planning

– ““strong evidence that the 1918 flu strong evidence that the 1918 flu virus [was] derived wholly from an virus [was] derived wholly from an ancestor that originally infected ancestor that originally infected birds” birds” Andreas von Bubnoff (Andreas von Bubnoff (Nature)Nature)

– Two subsequent influenza Two subsequent influenza

pandemics – one in 1957 and one in pandemics – one in 1957 and one in 1968 – have also been linked to 1968 – have also been linked to avian flu viruses.avian flu viruses.

Avian Influenza (“Bird Avian Influenza (“Bird Flu”)Flu”)

• Viral infection of birdsViral infection of birds• Believed to be spread by co-Believed to be spread by co-

mingling of wild and domestic mingling of wild and domestic birdsbirds

• Controlled by culling infected and Controlled by culling infected and exposed birds (Over 200 million exposed birds (Over 200 million birds destroyed to date)birds destroyed to date)

Bird to Human Bird to Human TransmissionTransmission• Predominantly via contact with Predominantly via contact with

feces from infected birdsfeces from infected birds• Handling infected poultryHandling infected poultry• Disposing of dead infected poultryDisposing of dead infected poultry• No No sustainedsustained human to human human to human

transmission to datetransmission to date

Avian Influenza - H5N1Avian Influenza - H5N1Why do we care?Why do we care?

• 238 documented cases, 139 238 documented cases, 139 deaths as of August 14, 2006 deaths as of August 14, 2006 (58%)(58%)

• Mutating little by littleMutating little by little

• Has potential to mutate into a Has potential to mutate into a human strainhuman strain

Conditions of a Pandemic Conditions of a Pandemic

• Widely spread without early detectionWidely spread without early detection• Novel virus highly infectious to humans, Novel virus highly infectious to humans,

with no immunitywith no immunity• Virus strain is easily transmissible human Virus strain is easily transmissible human

to humanto human• Virus causes serious illnessVirus causes serious illness• There is no adequate supply of vaccine There is no adequate supply of vaccine

immediately availableimmediately available• Supply of antiviral medication is limited Supply of antiviral medication is limited

Could the H5N1 virus Could the H5N1 virus cause the next cause the next pandemic?pandemic?• Possibly…Possibly…

So far the virus cannot pass easily So far the virus cannot pass easily from human to human.from human to human.

• But…But…

Eventually, there will be another Eventually, there will be another pandemic, we just can’t be sure it pandemic, we just can’t be sure it will be caused by this H5N1 viruswill be caused by this H5N1 virus

World Health Organization World Health Organization Influenza Pandemic PhasesInfluenza Pandemic Phases

Interpandemic PeriodInterpandemic Period

Novel subtypes in animals but not Novel subtypes in animals but not humanshumans

Phase 1Phase 1

Circulating subtypes in animals posing Circulating subtypes in animals posing threat to humansthreat to humans

Phase 2Phase 2

Pandemic Alert PeriodPandemic Alert Period

Novel subtypes in humans, but Novel subtypes in humans, but no human-to-human no human-to-human transmissiontransmission

Phase 3Phase 3

Limited human-to-human Limited human-to-human transmissiontransmission

Phase 4Phase 4

Localized clusters of human casesLocalized clusters of human cases Phase 5Phase 5

Pandemic PeriodPandemic Period

Increased and sustained transmission in Increased and sustained transmission in the general population on a large scalethe general population on a large scale

Phase 6Phase 6

Projected Pandemic Impact Based on Projected Pandemic Impact Based on 2004 2004 U.S. PopulationU.S. Population Estimate of 294 Estimate of 294

MillionMillion(0.05% of World Population)(0.05% of World Population)

  MODERATE PANDEMIC

SEVERE PANDEMIC

Illness(30% of population)

90 million 90 million

Outpatient Care (50% of ill)

45 million 45 million

Hospitalizations(1% to 11% of ill)

865,000 9,900,000

ICU Care(15% of hospitalized)

128,750 1,485,000

Ventilators(50% of ICU)

64,875 742,500

Deaths(0.2% to 2% of ill)

209,000 1,903,000

Projected Pandemic Impact Based on Projected Pandemic Impact Based on 2004 2004 MinnesotaMinnesota Population Estimate of Population Estimate of

5.1 Million 5.1 Million (1.75% of U.S. Population) (1.75% of U.S. Population)

  MODERATE PANDEMIC

SEVERE PANDEMIC

Illness(30% of population)

1,544,000 1,544,000

Outpatient Care(50% of ill)

772,000 772,000

Hospitalizations(1% to 11% of ill)

15,000 172,000

ICU Care(15% of hospitalized)

2,250 25,700

Ventilators(50% of ICU)

1,120 12,900

Deaths(0.2% to 2% of ill)

3,600 32,900

Assumptions Assumptions

• Not a matter of if but when Not a matter of if but when • All countries will be All countries will be

impactedimpacted• Medical supplies and care Medical supplies and care

may be inadequatemay be inadequate• Impacts will last for weeks to months

•Two to three waves of illness

• Pandemics can disproportionately affect younger people creating workforce issue

• Potential for high levels of:- Sickness and death- Disruption of critical services- Economic loss

Assumptions

Goals of Pandemic Planning Goals of Pandemic Planning and Responseand Response

• Maintain community infrastructureMaintain community infrastructure

• Minimize social disruptionMinimize social disruption

• Reduce morbidity/mortalityReduce morbidity/mortality

• Provide effective public education (before, Provide effective public education (before, during and after)during and after)

Public Health MessagesPublic Health Messages

Off site care facilitiesOff site care facilities Home care activitiesHome care activities Social distancingSocial distancing ““Snow Days”Snow Days” Active SurveillanceActive Surveillance Isolation and QuarantineIsolation and Quarantine Vaccines and antiviralsVaccines and antivirals

Planning PrioritiesPlanning Priorities

Family/Individual Family/Individual PlanningPlanning

Business Continuity Business Continuity PlanningPlanning

Community PlanningCommunity Planning

Family Emergency Family Emergency Preparedness AwarenessPreparedness Awareness

• Food and waterFood and water• Change of clothes for each personChange of clothes for each person• Sleeping bags or blanketsSleeping bags or blankets• First aid kitFirst aid kit• Battery powered radio and flashlight Battery powered radio and flashlight

with extra batteries with extra batteries • Social distancing or “snow day” Social distancing or “snow day”

preparationspreparations

• Business Continuity Planning

• Prioritize critical functions

• Identify functions that could be suspended for up to two months

• Identify positions needed to carry out critical functions

• Build depth through cross training

• Plan for alternative work schedules

• Explore telecommuting capabilities – large scale

Key Elements of Preparedness – From a Business Perspective

Regional and Local Planning Regional and Local Planning ConsiderationsConsiderations

• Integrate non-health entities in Integrate non-health entities in planning and responseplanning and response

• Establish community stockpiles (e.g. of Establish community stockpiles (e.g. of vaccine and antivirals) & distribution vaccine and antivirals) & distribution systemssystems

• Identify spokespersonsIdentify spokespersons

• Provide effective public educationProvide effective public education

• Surveillance systemsSurveillance systems

Priority Activities for Priority Activities for 20062006

• Review the federal and Review the federal and state plansstate plans

• Plans from other statesPlans from other states• Update local plansUpdate local plans

• Assure response is community based, Assure response is community based, and flexibleand flexible

Planning PrioritiesPlanning Priorities

• Community meetingsCommunity meetings• Education and training staff Education and training staff • Creating messages ahead of time Creating messages ahead of time

regarding responseregarding response• Stockpiles of anti-virals and vaccinesStockpiles of anti-virals and vaccines

• How to get them distributed-local vs. How to get them distributed-local vs. regionalregional

• Who will get them- essential personnelWho will get them- essential personnel• Where to distributeWhere to distribute

Planning PrioritiesPlanning Priorities

• Coordinated information to public and Coordinated information to public and other partners other partners • HAN-health alert networkHAN-health alert network

• Special and vulnerable populationsSpecial and vulnerable populations• Vaccinations/prophylaxisVaccinations/prophylaxis• MessagingMessaging

• Community resources Community resources • Community surveillance-early, during, Community surveillance-early, during,

expanded sitesexpanded sites• Mass fatalitiesMass fatalities

Planning PrioritiesPlanning Priorities

Working with healthcare Working with healthcare regarding:regarding:– Continuity of servicesContinuity of services– Supply contingency plansSupply contingency plans– Surge capacitySurge capacity– Isolation/Quarantine of Isolation/Quarantine of

compliant/non-compliantcompliant/non-compliant– Protection for workersProtection for workers

Mortuary ServicesMortuary Services

Are We Ready?Are We Ready?

• More today than yesterdayMore today than yesterday• More tomorrow than todayMore tomorrow than today