Pandemic Emergency Toolkit

1. Pandemic Emergency Toolkit Are you ready?

2. Getting Started • All residents have a role in preparing for a public health emergency – like pandemic influenza • The community Tool Kit provides information on how to prepare for public health emergencies.

3. Getting started • Goals of community Tool Kit: • Increase knowledge about pandemic influenza • Provide information on how to prepare for a pandemic • Start discussions how communities can work to prepare for a pandemic

4. Agenda • Influenza overview • Historical recount of pandemic influenza • Future view of a pandemic • Individual, Family, and Community emergency preparedness.

5. What is Influenza? • Influenza is a respiratory infectioncaused by the influenza virus • In Canada, the flu season runs from November to April and up to 25% of Canadians may be infected with influenza • Influenza can kill, particularly people who are older and people with other serious medical conditions

6. The Influenza (Flu) viruses • 3 types : A, B, C (mild) • A or B cause epidemics almost every winter • 10-20% of people affected, 3 500 deaths • Influenza A divided in subtypes : 15 different H subtypes, 9 N subtypes • Vaccines : current A sub-types + B strains • Animal reservoirs : birds, pigs susceptible to swine, bird and human influenza viruses

7. What does Pandemic Mean? • Pandemic: occurring over a wide geographic area and affecting an exceptionally high proportion of the population • By affecting many people, pandemic influenza could well overwhelm health services • In addition, other aspects of society could be affected, simply because of a lack of staff due to illness

8. How the Flu Virus can change • Two different ways : • Antigenic « drift » (A and B) : small changes in the virus that happen continually over time. This is why we can catch the flu more than one time in a lifetime, why vaccine composition is constantly modified • Antigenic « shift » (A only) : abrupt, major change in the Influenza A viruses. Most people have little or no protection against the new virus.

9. What happens in a pandemic? • If this new virus (with an H and/or an N component from the avian virus) is able to infect humans AND spread from person to person, an influenza pandemic can occur. • It is possible for the genes of two influenza viruses to mix and create a new virus. • PANDEMIC = everywhere on earth, limited in time.

10. How does virus get transmitted? • Contact with feces, blood, sputum and tears from infected animals and birds.

11. History of Pandemic Influenza • Previous pandemics in the 20th century occurred in 1918-19 (“Spanish”), 1957-58 and 1968-69 (“Hong-Kong”) • In 1918-1919, an estimated 30-50,000 Canadians died, part of 20-40 million deaths around the world • While most deaths from influenza occur among the elderly, the highest number of deaths in the 1918-19 epidemic occurred among people aged 20-40 • The 1968-1969 pandemic caused less deaths than observed in a “regular” flu season.

12. The estimated impact of a pandemic in Canada • “Normal” flu season affects 10-20% of people • pandemic influenza could affect 30-50% and be more severe • Between 4.5-10.6 million Canadians infected • Between 11,000-58,000 deaths (vs 160,000 in 1918) • Economic impact $10-24 Billion • Heath care system overwhelmed…

13. Pandemic Planning Components 7 Components of the Pandemic Influenza Plan • Surveillance • Public health measures • Use of antivirals • Vaccination • Emergency services • Health services • Communications

14. Planning for Influenza • Planning for pandemic influenza involves federal, provincial, territorial and community officials • Planning is dynamic – the plan is not completed and put on a shelf but must be regularly tested (annually before September) and updated in light of new information or interventions to prevent and treat influenza

15. Pandemic Influenza – How will we know it is coming? • Novel (new) virus likely cause of pandemic • Novel/new virus likely to arise in Asia due to crowded living conditions and people living close to livestock animals (e.g. pigs & chickens) • Surveillance systems detect novel/new viruses • Health Canada supports these activities and receives information from World Health Organization (WHO) and others

16. Pandemic Influenza – How will we know it is coming? • Estimated lead-time for pandemic strain to reach Canada : 3 months (surveillance) • WHO declares pandemic phases 4, 5, 6… Novel/new virus likely to arise in Asia due to crowded living conditions and people living close to livestock animals (e.g. pigs & chickens)

17. WHO Pandemic Phases - 2006

18. The initial reaction :quarantine and isolation • A naturel reaction, but ineffective • High contagiousness • No acquired immunity • High number of infected individuals • Potential for discrimination and harm • Lose sight of effective components of pandemic planning to reduce spread

19. Public Health Measures • Increasing awareness in individuals and communities: personal hygiene, personal protection, avoiding unnecessary personal contacts (educational material) • Infection control measures in health care settings (educational material, supplies) • Infection control measures include immunization, hand hygiene, barrier control (masks, gloves, gowns), patient isolation/accommodation, restriction of visitors, staff, cohorting, environmental cleaning, and education for staff, patients and visitors. • Public Health advisories to reduce congregation : schools, public gatherings… (MOH, Head Nurse, C & C) • Self Care

20. Pandemic Flu Vaccine • Challenge : mass immunization when vaccine becomes available • Likely to proceed by priority groups • Canada self-sufficient and capacity well maintained • Vaccines can be mass-produced, distributed, and administered

21. Use of Antivirals • Treatment : documented effectiveness in reducing complications, hospitalizations, and mortality. • Prophylaxis : may have protectective effect against clinical disease or severe disease, dose not prevent infection and antibody development.

22. Business Continuity • Pandemic influenza could create a general state of emergency • At least 33% absenteeism in workplaces • Business continuity : identifying essential services and contingency measures • Governance continuity : who makes the decisions (at all times) ? • Issues with infrastructures, transportation, food supply, communications, etc.

23. Health Services • Medical supplies may be inadequate • Hospitals and medical clinics may be overwhelmed. • Significant numbers of illness and death may occur. • Significant number of people may not have anyone to take care of.

24. Health Services (2) • Self Care Education • Infection control measures • Think about a place for Flu/Alternate Care Centre

25. Communications • Two key roles in communities (Health Care Workers (HCW) and Chief and Council (C&C) • HCW and C&C will receive information and make decisions and will transmit information to the public and local decision-makers (school principal, other health professionals, Northern store, etc.). • HCW and C&C will report back information to the zone / regional / provincial / national level

26. Participate • Surveillance activity • Early detection / diagnosis period : ILI surveillance in communities ; identification of pandemic strain • Does your community participate in ILI surveillance?

27. Participate(School Curriculum) • Public Education – Crucial to integrate ‘Infection Control’ in school curriculum • Goal – To form habits to control spread of infection. • Teaching and Learning Strategies – must be theory and practice base • Hand hygiene • Coughing precautions • Germ education • Self Care • Environmental Cleanliness – control of spitting, garbage, body hygiene, homes, school, community

28. Prepare • Believe that the preparation for an emergency is necessary • Disasters do happen where you live and work • Disasters do impact you, your family and your community • You can significantly lessen the impact by being prepared • Plan for all hazards • Consider infrastructure disruption (i.e., power outage, water/sewer treatment, communication, etc.)

29. Prepare • Community plans • Community planning – addresses the 7 components of the Pandemic Influenza Plan in each community.

30. The objectives Pandemic plan 1)to reduce the morbidity and mortality by influenza 2) to minimize social disruption

31. Your Community Plan Do you know what is in your community plan?

32. Prepare Personal responsibility: • Create a family communication plan: • Work/school/cell numbers, addresses and e-mail • Meeting place for your family if separated – local/distant • Personal information on all family members • Gather emergency supplies • Talk about emergency planning in your community.

33. Prepare Emergency Supplies Water & food Cash funds Battery /crank radio Maps Spare batteries Communication plan Flash lights Medical histories ID and credentials Infant needs Medications Pet needs First aid kit Copy of legal/financial papers Etc………

34. Practice • Self care measures (self isolation, taking measures to self treat until medical intervention is necessary) • Infection control measures • First aid

35. Are you ready? • In an emergency the best way to ensure the safety your family and your community is to prepare

36. Websites • The Ontario Pandemic Plan (hard to find on the MOHLTC site) • http://www.health.gov.on.ca/english/providers/program/emu/pan_flu/pan_flu_plan.html • World Health Organization for an international perspective • www.who.int • Centers for Disease Control (US, this is science) • http://www.cdc.gov/flu/pandemic/ • FluWatch : influenza surveillance in Canada • http://www.hc-sc.gc.ca/pphb-dgspsp/fluwatch Thanks !