H1N1 Flu Virus Preparations and Response in Ontario Region

1. H1N1 Flu VirusPreparations and Response in Ontario Region AIAI Elders Gathering Batchewana First Nation August 5, 2009

2. H1N1 Flu Virus • H1N1 (referred to a swine flu early on) is a new flu virus • First cases detected in April 2009 with rapid spread of the virus • The level 6 pandemic declared by the World Health Organization (WHO) is determined by the geographical spread of the H1N1 virus globally • It is not related to the severity of the illness, which the WHO has indicated as "moderate" • While we are all taking the situation seriously, the province has not declared an emergency

3. How does H1N1 compare to Seasonal Flu? • Seasonal flu affects 10-25% of Canadians each year • While the majority who become sick will recover, the seasonal flu results in an average of 20,000 hospitalizations and 4,000 deaths in Canada annually • H1N1 flu virus has the potential to be at least as serious as seasonal flu • Because this is a new virus, most people will not have immunity to it. There is currently no vaccine. Illness may be more severe and widespread as a result

4. The H1N1 Situation in Ontario • All public health units in the province are reporting some cases • 16 deaths in Ontario as of July 18, 2009

5. The H1N1 Situation in First Nations Communities in Ontario • As of July 31, 2009 • There are 64 confirmed H1N1 cases in 20 different communities in Northwestern Ontario. • Two (2) outbreak communities remain. There are only a few cases of influenza like illness in existing outbreak communities • Early treatment measures have been put in place • Most cases have been mild and recovered at home

6. Response to H1N1 among First Nations Communities in Ontario • For many years, the Pandemic Technical Working Group with First Nations, FNIH, and the province has supported First Nations Pandemic Planning in Ontario • Chapter 20 of the Ontario Pandemic Plan outlines roles and responsibilities of federal and provincial governments with respect to supporting First Nations communities • While the Ontario Pandemic Plan has not been brought into effect for H1N1 by the Province, FNIH, MOHLTC, the Public Health Agency of Canada, and First Nations PTO’s, COO and Independents have been working on a constant basis on the prevention and management of H1N1

7. Response (ctd) • The Emergency Coordination Centre of Health Canada’s Ontario Region, which includes the Public Health Agency of Canada, has been activated to Level 2 for communications, advanced planning, operations and logistics • Ontario provincial scientific experts are providing us with advice on the care and treatment of H1N1 cases on reserve in Ontario • Zone Communicable Disease Nurses communicate with all community health workers about the management of cases and contacts of H1N1 as well as infection prevention and control practices • Nurses collect data on influenza like illness and send it to the Ontario Regional Epidemiologist to track the possible spread of the virus • Zone Directors will contact Chiefs directly if cases are confirmed in their communities

8. Response (ctd) • The FNIH Regional Public Health Unit is broadcasting communiqués on a regular basis to First Nations Chiefs and Health Directors • Information is also posted on the First Nations pandemic website: www.pandemic.knet.ca Some information is available in Cree, Oji-cree and Ojibway • A toll free telephone hotline (1-877-365-3623) is open from 9am-6PM (EST) 7 days / week to answer general questions on H1N1 • Weekly teleconferences are held with First Nations PTO's, Independents and the Chiefs of Ontario • The Regional Director is updating directly the Ontario Regional Chief

9. Response (ctd) • Plans for relief teams of nurses, physicians, pharmacists and clerical support are being set up to ensure we have the surge capacity in each Zone • Transportation measures for relief professionals is also being put into place • Isolated First Nations communities have access to the provincial stockpile of Tamiflu (province shipping to Zones, and FNIH Zones distributing to communities) even before a case is confirmed in the community • For non-isolated First Nations communities, First Nations who meet the criteria can also be prescribed Tamiflu by a physician and paid for through the Non-Insured Health Benefits Program without pre-approval required • Tamiflu is the predominant antiviral prescribed to treat H1N1 within the first 48 hours of the onset of symptoms • FNIH has shipped personal protective equipment for the health staff and supplies such as hand sanitizers to communities

10. Response (ctd) • Zone program managers have approached each community to fill out a pandemic preparedness questionnaire which will inform a detailed picture of what levels of additional supports communities will need to complete and test their plans • A community pandemic planner has been hired to support First Nations over the coming months hosted by the Union of Ontario Indians • Contact is Tony Jocko, 1-877-702-5200, ext. 2313; email: jocton@anishnabek.ca

11. What can you do? • Ask about your community’s pandemic plan • Promote good public health practices • Consider postponing or cancelling large social gatherings in the community if you have cases OR use community events to promote good public health practice and distribution of information materials

12. Signs and symptoms • Symptoms of H1N1 flu in people are similar to those associated with seasonal flu. • Fever • Cough • Sore throat • Runny or stuffy nose • Body aches • Headache • Chills • Fatigue • In addition, vomiting (25%) and diarrhea (25%) have been reported. (Higher rate than for seasonal flu.)

13. How does H1N1 flu virus spread? • This virus is thought to spread the same way seasonal flu spreads • Primarily through respiratory droplets • Coughing • Sneezing • Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands

14. What can you do to protect yourself and your family members from getting sick? • A vaccine is in development • Basic, everyday actions can help prevent the spread of germs that cause respiratory illnesses like influenza • Wash your hands often with soap and warm water, especially after you cough or sneeze. Wash for 15 – 20 seconds. • Bottled water can be made available for families without running water • Hand wipes or gel sanitizers can also be an alternative if hand-washing isn’t accessible

15. If you get sick… • See a health professional • Stay home if you are sick • If you are sick, limit your contact with other people as much as possible • Practice frequent hand-washing and proper respiratory etiquette by coughing or sneezing into your arm or sleeve.

16. Watch for emergency warning signs Most people should be able to recover at home, but watch for emergency warning signs that mean you should seek immediate medical care. • In adults: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms improve but then return with fever and worse cough

17. Emergency warning signs in children If a child gets sick and experiences any of these warning signs, seek emergency medical care. In children: • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or not interacting • Irritable, the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough

18. More Information • For general questions: Hotline 1-877-365-3623 open from 9am-6PM (EST) 7 days / week • Pandemic Website www.pandemic.knet.ca