Association of Health Care Journalists Preparing Communities For Pandemics Houston, Texas

1. Planning & Coordinating The Response: Pandemic Influenza Association of Health Care Journalists Preparing Communities For Pandemics Houston, Texas March 18, 2006 Georges C. Benjamin, MD, FACP Executive Director

2. United States of America: 1918 - 1919 “In Boston the stock market closed. In Pennsylvania a statewide order shut down every place of amusement, every saloon. In Kentucky the Board of Health prohibited gatherings of any kind, even funerals …..Deadly influenza, the so-called “Spanish Flu,” was sweeping the country, spreading terror everywhere” David McCullough National Museum of Health & Medicine Armed Forces Institute of Pathology --- 675,000 Americans died; 40 million people died worldwide ---

3. Are We Prepared For Pandemic Flu? • A process not a point in time! • Always ask - Prepared for what? • Use real life events to measure preparedness • First step is to get annual flu right • Under prepared for pandemic influenza Goal: To go from chaos to controlled disorder

4. We Already Have A Bird PandemicThree Likely Initial U.S. Presentations* • First H5N1 solitary positive bird could be in U.S. this year • First outbreak of highly pathogenic avian flu in birds • An outbreak in birds with sick people • Management crisis will be the birds; • and will be immediate health threat • Community preparedness efforts need to focus in five broad areas: • Family preparedness • Avoiding sick or dead birds • Surveillance for sick people • Disease containment • Treatment *Assumes no human to human transmission in world

5. HHS Planning Assumptions • Global susceptibility • Incubation period ~2 days with 1:2 spread • > 30% attack rate • 50% will seek outpatient care • Hospitalizations / mortality depends on virulence • Absenteeism will occur • Will last 6-8 weeks & may come in waves

6. Plan For Three Clinical Scenarios • There are enough effective vaccine & antivirals • Vaccination & antivirals • Some community disease control efforts 2. The amount of vaccine / antivirals are insufficient in efficiency or amount • Vaccination & antivirals • Mild to moderate community disease control efforts • Medical management of clinical complications • Manage societal disruption 3. There is no vaccine or useful antivirals • Maximum community disease control efforts • Medical management of clinical complications • Mange societal disruption

7. Prepare To Respond • Bird surveillance & response • Early disease surveillance – will transform to disease differentiation • Laboratory capacity • Disease control • Mass vaccination • Antiviral distribution • Exposure reduction, social distancing • Health system surge capacity • Patients, workforce, supplies & equipment, space • Risk communication • Mortality management • Routine health management • Coordination: regional, national

8. Prepare For Societal Disruption • Continuity of government • Business continuity • Food, water • Transportation • Public safety • Trash, sanitation • Goods & supplies • Services • Critical infrastructure

9. Social Distancing Strategies • Voluntary home curfew • Suspend group activity • Cancel public events • Close public places • Suspend public travel • Restrict travel • Snow days • Non-essential workers off • Work quarantine • Cordon sanitaire • Isolation • Separation of infected persons • Usually in a hospital setting (Other settings may be difficult) • Quarantine • Restriction of persons presumed exposed • Community or individual level Primary hygiene: Hand washing & coverage of nose & mouth Barriers: Surgical Masks vs. N - 95 Masks

10. Plan To Care For Sequestered Persons • Food & Water • Housing • Hygiene & sanitation • Social support systems • Treatment & prophylaxis for disease • Disease monitoring • Dependent care • Compensation & liability issues

11. Georges C. Benjamin, MD, FACP Executive Director American Public Health Association WWW.APHA.ORG “Public Health: Prevent, Protect, Promote”