pandemic flu workshop slide pack

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Pandemic Flu - PreparingYour BusinessA one-day workshop held at the Royal Society of Medicine • Thursday 11 September 2008

WELCOME

Pandemic influenza

September 2008

Dr Quentin SandiferDeputy Regional Director of Public Health, NHS South East Coast and HonoraryClinical Senior Lecturer, University of Kent

Dr James SedgwickConsultant in Communicable Disease Control, Kent Health Protection Unit andHonorary Senior Lecturer, University of Kent

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Aims of the workshop

To raise awareness of the threat and consequences of an

influenza pandemic and to highlight the associated major

issues for business

Pandemic influenza

September 2008

Dr James Sedgwick

Consultant in Communicable Disease ControlKent Health Protection Unit

Honorary Senior LecturerUniversity of Kent

Session 1

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Content

1. Science (seasonal, avian & pandemic flu)

2. Impact of pandemic flu

3. Public sector response to pandemic flu

Seasonal flu

What is flu?• Viral respiratory infection• Highly infectious (secondary cases >2)• Incubation period (time from exposure to onset) 1-3 days• Period of infectivity 3-5 days from onset• Lasts 2-7 days (usually self-limiting)• Can be serious – complications (eg, bronchitis,

pneumonia) esp. in those with underlying disease(lung/heart) and elders

• Infection confers immunity to that strain• Causes 3,000 - 4,000 deaths in non-epidemic (normal)

years (mostly in elders)

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Consultation rate for flu-like illness, 1988-2008

Source – HPA http://www.hpa.org.uk/infections/topics_az/influenza

Source: CDC / Dr Erskine; L Palmer; Dr ML Martin

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Flu viruses and antigenic changes

Flu A viruses• infect birds and other animals (eg, pigs, horses) as well as humans• cause ‘ordinary’ seasonal flu epidemics and all pandemics• undergo frequent changes in surface antigens or proteins

- Minor changes - antigenic drift• result in seasonal flu each winter

- Major changes - antigenic shift• mutation or by ‘reassortment’ between viruses• potential pandemic strains (population little immunity)

Flu B viruses• infect humans only• no pandemic potential

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Flu A virus reassortment (possible pandemicstrain)

Migratorywater birds

Domesticpoultry

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Understanding pandemic flu

Epidemic• serious outbreak in a single community, population or

region

Pandemic• worldwide epidemic

Flu pandemics are worldwide epidemics of a newlyemerged strain of flu• which passes easily from person to person

and• to which few, if any, people have immunity

Iowa State gymnasium, converted into hospital, 1918 flu pandemic

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What will a flu pandemic mean for UK?

Pandemics occur unpredictably, not necessarily in winter

Great variations in• mortality,• severity of illness and• pattern of illness or age of most severely affected

Rapid surge in number of cases over brief period of time(weeks)

Tend to occur in waves – subsequent waves may be moreor less severe (“weeks or months later”)

Intense pressure on health (and other) services

Disruption to many aspects of daily life

Avian flu – what is it?

Contagious disease caused by flu A viruses

Can affect all bird species esp migratory wildfowl (eg, ducks)

Particularly devastating among domestic poultry (high bird death rate)

Spreads through droplet inhalation or contact with droppings

• migratory wildfowl• live bird markets

Virus can survive for prolonged periods in the environment

People usually infected through close contact with live infected birds

Transmission from birds to people rare

Transmission from person to person extremely rare

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Cases of avian flu in humans

243 385WorldwideA/H5N12003-2008

0 2UKA/H7N22007

0 1Hong KongA/H9N22007

0 1UKA/H7N32006


1 89NetherlandsA/H7N72003

0 2CanadaA/H7N32003


0 2USAA/H7N22002


0 6ChinaA/H9N21998


Confirmedhuman deaths

Confirmedhuman cases

CountryStrainYear

Data up to 4 July 2008“Outbreaks caused by the H5N1 strain are presently of the greatest concernfor human health.” World Health Organization, 29 January 2004

http://www.who.int/csr/disease/avian_influenza

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Content




History of flu pandemics

1580 to 1900:28 flu pandemics

20th Century pandemics:

1 million30,000‘Hong Kong’ fluH3N21968-69

1 million33,000‘Asian’ fluH2N21957-58

20-40 million250,000‘Spanish’ fluH1N11918-19

Global deaths(estimated)

UK deaths(confirmed)NameStrainYear

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750,00055,50030,000,00015,000,000All Weeks5,250389210,000105,000Week 156,750500270,000135,000Week 14

12,000888480,000240,000Week 1319,5001,443780,000390,000Week 1239,0002,8861,560,000780,000Week 1156,2504,1632,250,0001,125,000Week 1072,7505,3842,910,0001,455,000Week 9

107,2507,9374,290,0002,145,000Week 8159,00011,7666,360,0003,180,000Week 7162,00011,9886,480,0003,240,000Week 679,5005,8833,180,0001,590,000Week 523,2501,721930,000465,000Week 46,000444240,000120,000Week 31,50011160,00030,000Week 2

7505630,00015,000Week 1

Deaths @2.5% of 50%

Deaths @0.37% of 25%

Clinical cases @50%

Clinical cases @25%Period

Health impact(population 60,000,000)

Staff absence from work

Staff will be absent from work for a variety of reasons:1. if ill with flu (absent for about a week)

2. if ill with other medical problems

3. to care for children or other family members who are ill (orbereavement)

4. to care for (well) children because of the closure of schools andchildcare settings

5. if employers have advised them to work from home or they havepractical difficulties getting to work (eg, fuel shortage)

6. due to fear of infection or taking home infection to their household

Large organisations should plan for absence of up to 15-20% at peak

Small businesses should plan for up to 30-35% at peak

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Other issues to consider

Staff absence

Schools’ closures

Fuel (domestic, businesses, public transport)

Food

Vulnerable individuals

Panic

Excess deaths

Economy

Content




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Pandemic preparedness and response

Reduce impact through:• Surveillance (WHO, European, HPA)• Diagnosis• Public health interventions• Antiviral drugs• Vaccines (once they become available)

Alert levels – surveillance

WHO international phase of pandemic alert

UK pandemic alert level

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Health response

Public health / hygiene advice

Self care

Flu Line

Antivirals (‘flu friend’)

Referral to hospital for some (under 1s, complications)

Vaccination

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Public health interventions

Personal interventionsBasic measures to reduce the spread of infection

• Hand washing: washing hands frequently with soap and waterreduces the spread of the virus from the hands to the face, or toothers

• Respiratory hygiene: covering the mouth and nose when coughing orsneezing; using a tissue when possible; disposing of dirty tissuepromptly are carefully – bag and bin

• Avoiding non essential travel: non-attendance at large gatheringssuch as concerts, theatres, cinemas, sports arenas etc

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Public health interventions

Population-wide interventions• Travel restrictions

• Restrictions of mass public gatherings

• Schools’ closures

• Voluntary home isolation of cases• Voluntary quarantine of contacts of known cases

• ?? Screening of people entering UK ports

Likely to be only major medical countermeasure available early in apandemic

Used in the absence of, or as an adjunct to vaccination

UK has stockpile of 14.6 million treatment courses

Some limited use as prophylaxis, if expert advice suggests appropriate

Prioritisation only when becomes scarce

Antiviral drugs –for treatment of cases

Reproduced with permission from Roche Products Ltd. Tamiflu ®

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Vaccine

• No vaccine ready to protect against pandemic flu (new virus)• Specific vaccine cannot be made until the virus has been identified• Cannot be predicted in same way as seasonal flu• Seasonal flu vaccine will not provide protection• Advance work is being done to facilitate production of a pandemic

vaccine once the virus is known• Four to six months to develop, possibly longer• Plus more than 12 months for enough for UK population to be

manufactured• When available, aim to immunise whole population as soon as

possible• Vaccines will be given to some groups before others according to

nationally agreed priorities• H5N1 vaccine may be used for HCWs (3.5 million doses purchased)

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Sources of information

Cabinet Office – www.ukresilience.gov.uk

Health Protection Agency – www.hpa.org.uk

Department of Health – www.dh.gov.uk/pandemicflu

Health and Safety Executive – www.hse.gov.uk/biosafety/diseases/pandemic.htm

WHO – www.who.int/csr/disease/influenza

ECDC – ecdc.europa.eu/Health_topics/Pandemic_Influenza

CDC (USA) – www.cdc.gov/flu/pandemic

Pandemic influenza

September 2008

Dr Quentin Sandifer

Deputy Regional Director of Public HealthNHS South East Coast

Honorary Clinical Senior LecturerUniversity of Kent

Sessions 2 and 3

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SARS in Toronto

• High rates of staff absenteeism• Complete workplace closure• Loss of key staff and knowledge• Reduced delivery to customers• Travel and meeting disruption• Supply chain disruption• Increased demand for some services (eg internet access

and technical support to home workers)• Decreased demand for some products and services

$2bn lost revenue

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SARS in Toronto

251 cases and 43 deaths verified

Building resilience in today’s business

Focus of sessions - Business Impact and Response

Impacts - Economic and Staff

Response - Planning to stay in business

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Business Continuity Management

Planning to ensure that your organisation has a relatively

quick and painless return to “business as usual” in the event

of a major disruption, regardless of the cause.

Why?

• To protect your business by planning to stay in business• To protect your most important assets - your people• To protect the reputation of your business• To protect and enhance your profitability• To ensure compliance and secure recognition for your

business

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Principles of BCM

1. One basic plan

2. Focus on the response to the incident not its cause

3. Response arrangements must be fully integrated into the organisation’sstructure - build-ons not add-ons

4. Activities of different organisational units must be integrated

5. Your plans should be co-ordinated with the plans of others

Pandemic flu planning should be an extension of your business

continuity plans

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Potential impact UK-wide

25-50% of population symptomatic

50,000-750,000 deaths

15-30% absent from work at peak

£1242bn cost to society

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Demand effects across industries

Source: Trust for America's Health

Industry/Government

Cumulative 3 month loss in

demand over course of a year

agriculture, forestry, fishing and hunting 10%

mining 10%

utilities 0%

construction 10%

manufacturing 10%

wholesale trade 10%

retail trade 10%

transportation and warehousing 67%

information 0%

financial services 10%

real estate, rental and leasing 0%

professional and technical services 0%

corporate management 0%

administrative services 0%

educational services 10%

health and social care -15%

arts and entertainment, including sports

and leisure 80%

hotel and food services 80%

other services, except government 5%

government services 0%

Assumed declines in demand by industry during a severe

flu pandemic

Why staff will be absent

• They are ill with flu• They need to care for people who are ill• They need to care for (well) children• They have non-flu medical problems• They have been advised to work from home• They absent themselves for other reasons

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Estimates of absenteeism

Communication is everything!

• Agree the message• Decide how you will communicate the message• Decide how you invite staff• Agree who will speak and make sure they are well briefed

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Possible issues and questions

• Employment• Medical countermeasures• Services and working - duty of care

Pandemic influenza

September 2008

Appendices

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Business continuity management

Key headings• Business processes• Emergency response• Personnel• Premises and facilities• Information systems and internal communications• Public relations and external communications• Insurance• Financial• Legal


Key resources (of the organisation)• Staff• Property and equipment• Services - power, heating, light, water etc• Technology - IT and telecommunications• Paper records and filing system

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Key issues• Risk assessment and business impact assessment• Immediate response and what takes priority• Duration of disruption• Support to staff• Storage and security of data• Alternative sites of working, including home working• Dealing with external agencies


LUNCH

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Pandemic influenza exercise

September 2008

Dr James Sedgwick

Dr Quentin Sandifer

Introduction

• Groups• Timings• Scenarios• Video• Questions• Feedback

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Section one

Questions

1. What plans are in place within your organisation to deal with pandemic flu?a. Who is responsible for pandemic flu (and/or business continuity) planning?b. If no specific plans are in place, what other plans or policies do you have?c. What planning guidance are you aware of in your business sector?

2. Would any existing plans be activated at this point?a. If not now, when?

3. What communications will be issued to staff at this point and how will this be done?

4. What would you advise your staff about international (and other) travel?a. Where could you get advice about this?

Other questions and/or issues to take away

5. What are the critical activities for your organisation?

6. Do your suppliers/subcontractors have robust business continuity plans?

7. What are the Local Resilience Forum’s plans for responding to a pandemic?

Section two

Questions

1. What infection control procedures will be implemented in your workplace?

2. What arrangements have been made with regard to personal protectiveequipment?

3. What changes to working arrangements will be made to reduce the risk oftransmission within the workplace?

Other questions and/or issues to take away

1. What occupational health arrangements are in place for your staff?a. What is the occupational health / sick leave policy during a flu pandemic?

2. How will your staff who are ill get access to antivirals?

3. What communications will be issued to staff at this point and how will this bedone?

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Section three

Questions1. What will your organisation do about staff shortages?

a. Do all areas of your organisation have nominated deputies for keyemployees in case of absence?

b. Where would your organisation look for additional resources?c. What actions could you take to maximise staff resources?d. What steps could be taken to accommodate employees who have

difficulties with childcare or sick family members?e. How does your organisation monitor staff absence?f. What is the legal position regarding staff who refuse to work?

2. How will disruption in utility services (transport, fuel, power, water,etc) effect your organisation?

3. What actions can you take to minimise this disruption?

Other questions and/or issues to take away4. How will staff shortages specifically affect the critical services in your

organisation?

Section four

Questions

1. What are the priority areas for your organisation in termsof a return to normal business?

2. What actions would your organisation need to take to:1. Return to normal business?2. Prepare for a second wave?

3. What arrangements are in place to deal with staff healthand welfare issues following a pandemic?

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Conclusion

• Exercise debrief• Lessons learned/identified

- List three things that you are going to do when you returnto your organisation in order to prepare for a flu pandemic.

• Wrap up Q&A


THANK YOU!

pandemic flu workshop slide pack

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