Pandemic Influenza: Pandemic Influenza: A Primer for A Primer for

Organizational PreparationOrganizational Preparation

Kristine Perkins, MPH

Director, Office of Public Health Emergency Preparedness

Maine Center for Disease Control and Prevention

Public Health plays a major role in Public Health plays a major role in Emergency PreparednessEmergency Preparedness

Protect the health of communities from naturalProtect the health of communities from naturaland manmade disastersand manmade disasters

Serves as the nations first line of defense Serves as the nations first line of defense against numerous threats such as:against numerous threats such as:

Infectious disease Infectious disease Food borne and water borne illnessFood borne and water borne illness Biological, chemical, radiological attackBiological, chemical, radiological attack

OverviewOverview

What is Avian Influenza ?What is Avian Influenza ? Bird FluBird Flu

A viral infection caused by avian (bird) influenza normally a subtype of a type A influenza virus

Occurring naturally among birds (low pathogenic and high pathogenic)

Often carried by wild birds in their intestines

Can cause domestic birds, including chickens to become very ill and die

Occasionally some strains can infect

What is Pandemic Influenza?

Pandemic Influenza is a widespread outbreak of a new influenza virus that humans have no immunity to thus causing a global outbreak of serious illness that spreads easily from person to person.

Currently, there is no pandemic flu.

What if …What if …An Influenza Pandemic Struck MaineAn Influenza Pandemic Struck Maine

State population:State population:   1,274,923 1,274,923

Number of ill persons:Number of ill persons:  382,477 (30% attack rate)  382,477 (30% attack rate)

Number of persons seeking outpatient careNumber of persons seeking outpatient care 167,405  (50% of those ill minus persons who are 167,405  (50% of those ill minus persons who are hospitalized or die)hospitalized or die)

Number of persons hospitalized:Number of persons hospitalized:   38,582 (range: 38,582 (range: 14,549- 48,699) 14,549- 48,699)

Number of deaths:Number of deaths:   9,086 (range:  5,421 -- 14,837) 9,086 (range:  5,421 -- 14,837)  

Community ImpactCommunity Impact

Hospitals working to capacity/ turning away some Hospitals working to capacity/ turning away some illill

Alternate care sites limited—homecare is the normAlternate care sites limited—homecare is the norm Assistance from the federal government limitedAssistance from the federal government limited Antiviral and vaccine supplies depletedAntiviral and vaccine supplies depleted Mortuaries unable to manage increased mortalityMortuaries unable to manage increased mortality Food supplies limited/ trucks, trains not movingFood supplies limited/ trucks, trains not moving Increased security at groceries, pharmaciesIncreased security at groceries, pharmacies Schools, many gov’t offices closedSchools, many gov’t offices closed Others dying from lack of supportOthers dying from lack of support

Lessons from SARSLessons from SARSToronto--2003Toronto--2003

438 probable or suspect cases438 probable or suspect cases 43 deaths43 deaths 23% decline in tourism23% decline in tourism 20-30% decline in retail sales20-30% decline in retail sales $30 million per day cost to Canada’s $30 million per day cost to Canada’s

economyeconomy Decrease in growth from 2.5% to 1%Decrease in growth from 2.5% to 1% Travel advisoryTravel advisory Organizational/governmental disasterOrganizational/governmental disaster

What About My Town? What About My Town? County?County?

In a population of 30,000—In a population of 30,000—

9,000 will become ill9,000 will become ill 900 will require hospitalization900 will require hospitalization 213 will die213 will die

How will I be Affected?How will I be Affected?

In a “Social or Business Circle” of In a “Social or Business Circle” of 100100

30 will acquire the disease30 will acquire the disease 3 will require hospitalization3 will require hospitalization Nearly 1 will dieNearly 1 will die

What’s my Responsibility?What’s my Responsibility?PersonallyPersonally

Stay up with the worldwide epidemicStay up with the worldwide epidemic

Participate in prevention strategiesParticipate in prevention strategies

Practice and teach “personal protective Practice and teach “personal protective behaviors”behaviors” Sneeze and cough properlySneeze and cough properly Stay home when illStay home when ill Monitor friends who are illMonitor friends who are ill Learn about homecare for influenzaLearn about homecare for influenza Stockpile supplies, food and waterStockpile supplies, food and water Fill fuel tanksFill fuel tanks

What’s My Responsibility?What’s My Responsibility?ProfessionallyProfessionally

Participate in planningParticipate in planning Develop a catalog of “critical operations”Develop a catalog of “critical operations” Plan to provide those services with ~40% fewer Plan to provide those services with ~40% fewer

staffstaff Practice and support Personal Protective Practice and support Personal Protective

Behaviors Behaviors at workat work Consider volunteer supportConsider volunteer support Consider engineering controlsConsider engineering controls Reduce direct close client contactReduce direct close client contact Ask for technical assistanceAsk for technical assistance

Sample COOP Outline and Sample COOP Outline and ProcessProcess

Define “Critical Functions”Define “Critical Functions”

Define critical staff and backup (deep)Define critical staff and backup (deep)

Cross train non-critical staff in critical Cross train non-critical staff in critical functionsfunctions

Ensure infrastructure supportEnsure infrastructure support

Develop/test operations management planDevelop/test operations management plan

Develop operations/ public communications Develop operations/ public communications planplan

Are We Sure ???Are We Sure ???

No, but…No, but… The conditions are rightThe conditions are right

Highly pathogenic bug--H5N1 (in birds)Highly pathogenic bug--H5N1 (in birds) High mortality rate in humans (~ 50%)High mortality rate in humans (~ 50%) Extensive coverage worldwide (in birds)Extensive coverage worldwide (in birds) Limited human to human transmissionLimited human to human transmission Influenza mutates constantlyInfluenza mutates constantly Global shipment and migration of birdsGlobal shipment and migration of birds