Pandemic Influenza Planning in Pennsylvania Jeffrey A. Blystone Bureau of Community Health Systems Pennsylvania Department of Health 1
Pandemic Influenza Planning in Pennsylvania • Facts About Flu Pandemic • Global disease outbreak. • Unknown timing or severity (many experts agree that a significant threat exists). • WHO has developed a global influenza preparedness plan.
Pandemic Influenza Planning in Pennsylvania Seasonal Influenza • Globally: 250,000 to 500,000 deaths each year • In the United States each year: • 36,000 deaths • >200,000 hospitalizations • $37.5 billion in economic costs from influenza and pneumonia Pandemic Influenza • An ever-present threat
Pandemic Influenza Planning in Pennsylvania • Influenza pandemics are inevitable: naturally recur at cyclical intervals. • Influenza Pandemics can cause: • High levels of sickness and death • Drastic disruption of critical services • Severe economic losses • Impacts for weeks to months. • A disproportionate effect in younger, working-age people.
Pandemic Influenza Planning in Pennsylvania Pandemics Do Happen! H9* 1998 1999 H5* 2003 1997 2003-2006 H7* 1980 1996 2002 2003 2004 H1 H3 H2 H1 1977 1915 1925 1935 1945 1955 1965 1975 1985 1995 2005 *Avian Flu 1918 Spanish Influenza H1N1 1957 Asian Influenza H2N2 1968 Hong Kong Influenza H3N2
Pandemic Influenza Planning in Pennsylvania • Influenza pandemic is most likely when the Influenza Type A virus makes a dramatic change (i.e., antigenic “shift”). • This shift results in a new or “novel” virus to which the general population has no immunity. • The appearance of a novel virus is the first step toward a pandemic.
Situation Report: Avian Influenza • Widespread and spreading prevalence in migratory birds; broad host range. • Continued outbreaks among domestic poultry. • Mammalian infection (cats, pigs, etc.) lethal. • Virus is evolving. • Sporadic human cases (281 reports as of March 20, 2007). • Most in young and healthy • Case-fatality >50% (169 deaths as of March 20, 2007) • Rare person-to-person transmission Sustained and rapid person-to-person transmission.
United States Pennsylvania Require Outpatient Care 50 million 1.6 million Hospitalizations 2 million 37,800 Deaths 500,000 9,100 Pandemic Influenza Planning in Pennsylvania Estimated morbidity and mortality during an influenza pandemic (within 12-16 weeks)
Pandemic Influenza Planning in Pennsylvania • Pandemic Impact • High absenteeism. • Disruption of transportation, commerce, utilities, public safety and communications. • Psychological impacts will be extreme. • Social distancing efforts may dramatically change hours of operation or close businesses temporarily. • Economic losses – small businesses at greatest risk.
Pandemic Influenza Planning in Pennsylvania • Pandemic Impact: Health Care System • Extreme staffing shortages. • Shortage of beds, facility space. • Shortage of key supplies (ventilators, drugs). • Hospital morgues, Medical Examiner and mortuary services overwhelmed. • Extreme demands on social and counseling services. • Demand will outpace supply for months.
Pandemic Influenza Planning in Pennsylvania • Limited to no assistance from the federal government due to nationwide impact. • Assistance from the state government limited due to the statewide impact • Governor Rendell directed Pennsylvania to develop a two-prong planning approach • Department of Agriculture to prepare for the increased threat of an H5N1 outbreak in poultry, wild fowl and live stock. • Department of Health to ensure Pennsylvania’s citizens are prepared for a potential pandemic.
Pandemic Influenza Planning in Pennsylvania • Department of Agriculture Planning Activities • Developed an Avian Influenza Response Plan • Drafted the “Poultry Worker Protection Plan: An Interim Guidance for the Implementation of CDC and OSHA Avian Influenza Public Health Recommendations.” • Continue to refine preparedness activities relating to: • Increasing agricultural surge capacity • Increased monitoring of the risk of the disease appearing in Pennsylvania poultry.
Pandemic Influenza Planning in Pennsylvania • Department of Health Planning Activities • Influenza pandemic response activities are coordinated within the following workgroups: • Human Avian Influenza Prevention Detection Policies and Processes • Workforce Planning • Isolation and Quarantine Procedures • Vaccine and Medication Distribution • Incident Coordination Response • Public Communications Planning • Legal Review • Local Government
Human Avian Influenza Prevention Detection Policies and Processes • Focus: Surveillance, data exchange, and prevention through early detection, both avian and human • Activities: • Epidemiology Work Group • BSL-3 modular unit for Pennsylvania Animal Diagnostic Laboratory System • Development of inter-laboratory communications systems to enhance rapid communications of Health and Agriculture Diagnostic State Laboratories
Workforce Planning • Focus: Telecommuting, succession planning, business partner preparation, business education, workforce communication, absenteeism policies and worker’s compensation programs and issues • Activities: • Pandemic flu flyers currently available • Handwashing posters • Information technology approach to support social distancing
Isolation and Quarantine • Focus: Community containment of diseases, isolation and quarantine procedures with and without a disaster declaration. • Activities: • Toolkit for schools • Draft Isolation and Quarantine plan (Community Containment Plan) that includes the need for isolation/quarantine facilities. • Establishing protocols and guidance for determination of quarantine order, type of community containment and other related issues.
Vaccine and Medication Distribution • Focus: Activating Point of Dispensing (PODS), staffing, and security of PODS and medications. • Activities: • POD Notification • POD Site Assessments • POD Security Surveys • Volunteer Recruitment • Development of state antiviral stockpile strategies • Identification of priority groups
Incident Coordination • Focus: Incident command structure and communications. State agency roles in Emergency Support Functions. NIMS/ICS/National Response Plan. Concept of Operations and planning assumptions regarding incident command during a pandemic event. Local readiness considerations. • Activities: • State agency pandemic checklists by Agency • County level emergency management preparedness checklist • Community Pandemic Planning Toolkit
Communications • Focus: Messages to the general public, development of prevention materials, communication plan development (stakeholder groups and messages), business education (workforce community), tourist impact, special needs populations and non-emergency updates (non-Emergency Operations Center) to the general public. • Activities: • Development of communication pieces • Creation of Powerpoint Presentations • Foreign language translation • Briefing Packets • Website development • Radio and TV spots
Office of General CounselPreparedness Committee • Focus: The committee addresses any legal issues relating to the Commonwealth’s authority to act in a pandemic situation. • Activities: • Addressing issues surrounding the use of a volunteer workforce • Governor’s draft proclamation • Drafted a flowchart matrix outlining agency responsibilities • Continue to research general authority of the Commonwealth • Discussed and drafted responses to frequently asked questions • Discuss and research mutual aid issues • Other legal issue
Local Government • Focus: Roles and responsibilities at the local level for planning, command and control, critical infrastructure, disease containment and communication. • Activities: • Coordinating pandemic planning activities with: • PA School Boards Association • PA Municipal Authorities • County Commissioners Association of PA • PA League of Cities and Municipalities • PA State Association of Township Commissioners • PA Station Association of Township Supervisors • PA State Association of Boroughs
Pandemic Influenza Planning in Pennsylvania • Roles and responsibilities defined by the National Strategy: • The Federal Government will: • Work with international organizations to assist with detection. • Work to develop a vaccine to protect 20 million U.S. citizens • Work to increase vaccine capacity so that enough vaccine can be produced to vaccinate each U.S. citizen within 6 months of recognition of a pandemic. • Stockpile antiviral medications for 75 million people through Federal and state stockpiles by 2008. • Establish policies with states on international and domestic travel restrictions. • Establish effective and accurate information to the public. • Providing funding to states to assist with pandemic preparedness.
Pandemic Influenza Planning in Pennsylvania • Roles and responsibilities defined by the National Strategy (continued): • State governments will have the responsibility to: • Establish a strategy for effective distribution of vaccines and antivirals. • Establish an effective multi-agency communications program. • Review disease containment strategies and enforcement plans. • Establish disease detection and reporting capabilities. • Assist local governments in response to a pandemic outbreak. • Ensure that state agencies have continuity of operations plans. • Work with Department of Interior and the USDA on coordinating surveillance of wild life.
Pandemic Influenza Planning in Pennsylvania • Roles and responsibilities defined by the National Strategy (continued): • Local governments will have the responsibility to: • Assist states with the location of distribution sites for vaccines and antivirals. • Establish medical surge capacity at the local level including the coordination of volunteers. • Ensure critical infrastructure (sewer, water, etc.) continues to function during a pandemic. • Have a uniform command and control system at the local level that includes integrated communications.
Pandemic Influenza Planning in Pennsylvania • Everyone has at least one of the following roles: • Employers • Continuity of operations • Succession planning • Communicating to employees • Prevention • Education • Educate stakeholders regarding pandemic influenza. • Educate on what steps they should take to prepare.
Pandemic Influenza Planning in Pennsylvania • Everyone has a role (continued). • Service Provider • Plan to continue those services • Surge capacity for goods and people • Increased prevention • Protection and detection capability • Disease containment measures • First Responders
Pandemic Influenza Planning in Pennsylvania • Ongoing Activities • Public education and communication. Clearly communicate to the public: • Prepare people with information • Encourage action steps to prepare now • Provide updates when new information emerges • Use trusted messengers • Coordinate to ensure consistent messages • Address rumors and inaccuracies
Pandemic Influenza Planning in Pennsylvania • Ongoing Activities (continued) • Strengthening essential partnerships • Hospitals and health care providers. • First responders and infrastructure agencies. • Elected officials and government partners. • Businesses. • Schools, community based organizations. • Strengthening capacity to rapidly vaccinate large populations.
Pandemic Influenza Planning in Pennsylvania • Upcoming Activities • Develop an antiviral purchase and stockpile strategy. • Conduct regional summits for school districts. • Coordinate multi-agency Pandemic planning efforts to update Pennsylvania Influenza Pandemic Response Plan. • Implement Pandemic Coordinating Council.
Pandemic Influenza Planning in Pennsylvania • Personal Preparedness • Get a flu shot each year. • Stay home when you are sick. • Avoid close contact with people who are sick. • Cover your mouth and nose with a tissue when coughing or sneezing. • Wash your hands. • Avoid touching your eyes, nose or mouth.
Pandemic Influenza Planning in Pennsylvania Seasonal Influenza Preparedness Pandemic Influenza Preparedness • Preparing for a pandemic now will mean: • Create awareness not anxiety. • Lives saved during seasonal influenza • Create sense of confidence and provide peace • of mind.
Pandemic Influenza Planning in Pennsylvania www.pandemicflu.state.pa.us