Question What was your county doing at the peak H1N1 threat? –Fall, 2009

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Question

What was your county doing at the peak H1N1 threat?– Fall, 2009.

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A Pandemic Tabletop to Exercise the Transitional Paradigm

Eric Zgodzinski, MPH, RSGreg Moore, MBA, PMP

Toledo-Lucas County Health District –APCToledo, Ohio

Objectives for the TTXObjectives for the TTX

1.1. To introduce the Transitional Medical To introduce the Transitional Medical ModelModel

2.2. To explore its integration into individual To explore its integration into individual county disaster planscounty disaster plans

TTX FormatTTX Format

1.1. Brief narrativeBrief narrative

2.2. Situation Report (SitRep) or updateSituation Report (SitRep) or update

3.3. Discussion of actions by playersDiscussion of actions by players

4.4. Questions and clarificationsQuestions and clarifications

5.5. Final discussionFinal discussion

Activities that will take place Activities that will take place during break-outs:during break-outs:• Apply TMM Phase and commence Apply TMM Phase and commence

activities accordinglyactivities accordingly• Stakeholder communication:Stakeholder communication:

– PublicPublic– Neighboring jurisdictionsNeighboring jurisdictions– Response agenciesResponse agencies

• Coordination with RMRS, ODH, CDCCoordination with RMRS, ODH, CDC

Be prepared to…Be prepared to…

• Develop and implement plans during Develop and implement plans during the break-outsthe break-outs

• Document actions takenDocument actions taken• Appoint a spokespersonAppoint a spokesperson• Present plans to all the attendeesPresent plans to all the attendees• Respond to queries by facilitator and Respond to queries by facilitator and

other attendeesother attendees

In H1N1 Season

• While the nation has been subjected to over 17,000 deaths from H1N1 and 5.7 million people taken ill, experts agree that it could have been worse.

• Locally, in NWO, thousands took ill – 1 in 5 Americans on average

• 99% recovered uneventfully.• Even seasonal flu has been tamed.

– “Thank you, H1N1.”• The Big Question: A Third Wave?

• There have been unconfirmed There have been unconfirmed reports of major domestic poultry reports of major domestic poultry deaths in rural sections of Cuyahoga deaths in rural sections of Cuyahoga CountyCounty

Breakout SessionBreakout Session

• What level are you at currently?What level are you at currently?• How does your jurisdiction react?How does your jurisdiction react?• Change in preparedness & response level?Change in preparedness & response level?• What is/are the hospital(s) doing?What is/are the hospital(s) doing?• What is public health doing?What is public health doing?• What is EMS doing?What is EMS doing?• What are the elected officials doing?What are the elected officials doing?• Mental health?Mental health?• Special needs?Special needs?

Associated PressAssociated Press

• Cuyahoga Co. health officials receive Cuyahoga Co. health officials receive unconfirmed reports of an unusual unconfirmed reports of an unusual number of sudden respiratory illness number of sudden respiratory illness in Parma.in Parma.

• The ill are being taken to Cleveland The ill are being taken to Cleveland hospitals.hospitals.

• Cleveland media raise concerns Cleveland media raise concerns about a third wave of H1N1.about a third wave of H1N1.

http://www.blackweb20.com/wp-content/uploads/2009/07/associated_press_logo.jpg

Death in DetroitDeath in DetroitBreaking News: Detroit, MI:Breaking News: Detroit, MI: ““In a matter of hours, patients In a matter of hours, patients are progressing from a Upper are progressing from a Upper Respiratory Infection (URI) to Respiratory Infection (URI) to an Acute Respiratory Distress an Acute Respiratory Distress Syndrome (ARDS) and quickly Syndrome (ARDS) and quickly succumb. Family members succumb. Family members seem to be falling ill as well. seem to be falling ill as well. Public health officials are Public health officials are concerned about a new H1N1 concerned about a new H1N1 variant that is immune to the variant that is immune to the vaccine.”vaccine.”

CDCCDC

CDC 1000 h press conference: CDC 1000 h press conference: Dr. Frieden states: “We’re investigating Dr. Frieden states: “We’re investigating reports from Detroit and the Cleveland area. reports from Detroit and the Cleveland area. Nothing has been confirmed at this time….Nothing has been confirmed at this time….Yes, we have also heard that some of the Yes, we have also heard that some of the patients had already been immunized with patients had already been immunized with both seasonal and H1N1 vaccines in both seasonal and H1N1 vaccines in November….”November….”

• The Public Information Officer (PIO) from University of Michigan Hospital in Ann Arbor, confirms that three ICU patients transported yesterday from Windsor, Ontario have died. They were all Influenza Type A positive.



• Detroit hospitals are calling in Detroit hospitals are calling in additional personnel to assist with additional personnel to assist with surgesurge

• Record numbers of ED visits for ILI Record numbers of ED visits for ILI affecting mostly the young affecting mostly the young

• Increasing numbers of admissions of Increasing numbers of admissions of pregnant womenpregnant women

• Rumors of “closing the border” will Rumors of “closing the border” will impact healthcare commutersimpact healthcare commuters

5PM Press Conference5PM Press Conference

• Hundreds of suspected/probable Hundreds of suspected/probable cases along the Lake Erie shorecases along the Lake Erie shore

• 50-60 suspected cases hospitalized 50-60 suspected cases hospitalized in Detroit and Cleveland in Detroit and Cleveland – 15% in critical condition and 15% in critical condition and

• 28 reported deaths already28 reported deaths already• Preliminary data: H1N1 Preliminary data: H1N1

– Probably a mutated versionProbably a mutated version



Irish Hills, MichiganIrish Hills, Michigan

• A professional fishing guide who returned A professional fishing guide who returned from fishing in Devil’s Lake two days ago from fishing in Devil’s Lake two days ago was hospitalized today at Defiance was hospitalized today at Defiance Regional Medical Center for an acute ILI. Regional Medical Center for an acute ILI.

• There is no report of illness in her There is no report of illness in her immediate family. immediate family.

• Public health officials in Defiance are Public health officials in Defiance are investigating.investigating.

• Guide’s family traveling back to Lima areaGuide’s family traveling back to Lima area

• Breaking News: Local TV journalists are Breaking News: Local TV journalists are interrupting American Idol to announce that two interrupting American Idol to announce that two flights from Toronto to Columbus International flights from Toronto to Columbus International Airport have been quarantined.Airport have been quarantined.

• Several passengers are believed to have ILI Several passengers are believed to have ILI symptoms.symptoms.

• One passenger required resuscitation prior to One passenger required resuscitation prior to landing and is enroute to a local hospital.landing and is enroute to a local hospital.

What now?

• Local hospitals and medical offices are calling local public health for advice on what to do, what to tell patients, and what to tell media.

• So far, there has been no sudden increase in ILI locally.

• Routine URIs


• How does your jurisdiction react?How does your jurisdiction react?• Change in preparedness & response level?Change in preparedness & response level?• What is/are the hospital(s) doing?What is/are the hospital(s) doing?• What is public health doing?What is public health doing?• What is EMS doing?What is EMS doing?• What are the elected officials doing?What are the elected officials doing?• Mental health?Mental health?• Special needs?Special needs?

Suddenly…Suddenly…

• EDs are seeing a spike in ILIs.EDs are seeing a spike in ILIs.– Waits are twice baselineWaits are twice baseline– Most are + for Influenza A.Most are + for Influenza A.

• Due to M&M seen in Cleveland and Due to M&M seen in Cleveland and Detroit, patients with even minor ILI Detroit, patients with even minor ILI are being admitted more liberally are being admitted more liberally than before.than before.

Medical Offices and Clinics

Many are not seeing respiratory complaints

Patients are being referred to closest ED.

• Hospital pharmacies are reporting Hospital pharmacies are reporting that doctors are prescribing antiviral that doctors are prescribing antiviral medications for themselves and medications for themselves and familiesfamilies

• Kroger's and Wal-Mart are reportedly Kroger's and Wal-Mart are reportedly running out of cough/cold remedies, running out of cough/cold remedies, hand sanitizer, and maskshand sanitizer, and masks

NWONWO

8PM Press Conference8PM Press Conference

– Latest outbreak must be taken seriouslyLatest outbreak must be taken seriously• Emphasize H1N1 precautionsEmphasize H1N1 precautions

– Etiology: Influenza Type A, Etiology: Influenza Type A, H1N1-VariantH1N1-Variant• More severe than H1N1 pandemic of this yearMore severe than H1N1 pandemic of this year

– Numbers:Numbers:• Thousands with latest flu virusThousands with latest flu virus• Scores in critical conditionScores in critical condition• 66 dead in Canada66 dead in Canada• 34 dead in Detroit and environs34 dead in Detroit and environs• 28 dead in Cleveland28 dead in Cleveland

Press ConferencePress Conference

H1N1-VariantH1N1-Variant• Communities to activate fully their Pandemic Flu plansCommunities to activate fully their Pandemic Flu plans

– Aggressive social distancing measuresAggressive social distancing measures• Summary of ILI (probable/proven) cases:Summary of ILI (probable/proven) cases:

– 1,541 hospitalized cases/87 deaths: Ontario1,541 hospitalized cases/87 deaths: Ontario– 356 hospitalized cases/67 deaths: Michigan356 hospitalized cases/67 deaths: Michigan– 311 hospitalized cases/57 deaths: Ohio311 hospitalized cases/57 deaths: Ohio

• SNSSNS– What is available?What is available?– Where is it located?Where is it located?– How is it accessed?How is it accessed?

Current Inventory Status

• Tamiflu• Peramivir• Masks

– Surgical– Respirators

• Gloves• Vaccines



CDC

Breakouts of H1N1-Variant occurring in major metropolitan areas– NY– SF– DC

Locally

• Hospitals are diverting patients– Over-capacity

• Staff shortages• EMS surge protocols• Public demanding vaccine



DiscussionDiscussion

Documents

Question What was your county doing at the peak H1N1 threat? –Fall, 2009