The Avian Influenza Threat. What s s the Big Deal?

Transcription

1 The Avian Influenza Threat What s s the Big Deal? Tampa ACP Meeting June 27, 2007

2 Epidemics & Pandemics Definitions Epidemic An infectious disease affecting a disproportionately large number of individuals within a population, community, or region at the same time. Pandemic A highly infectious disease occurring over a wide geographic area and affecting an exceptionally high proportion of the population. 2

3 Pandemic Diseases Tracking: Have Been Many Pandemics Pandemic Diseases (which spread from Animals to humans) AIDS Diphtheria Influenza Plague (Yesinia Pestis) Smallpox Tuberculosis 20 th Century Flu History Spanish flu ( H1N1) Killer! Asian flu ( H2N2) Hong Kong flu ( H3N2) 3

4 Influenza Disease Characteristics Flu Characteristics A highly contagious respiratory disease Goes back to 1500 s Caused by a virus Characteristics of Types Influenza A moderate to severe, all ages Influenza B mild to moderate, mostly children Influenza C mild illness, minor outbreaks 4

5 An Influenza A Primer Influenza A has 2 subtypes (based on surface proteins) H (Hemagglutinin) helps virus attach to cells (16) N (Neuraminidase) helps virus penetrate cells (9) Influenza A is typed by the H and N they possess Bird Flu is H5N1 Influenza constantly mutates Mutations caused by RNA replication 5

6 Course of H5N1 Influenza Infection Days Incubation Contagious Problem Symptomatic Energy Drained 6

7 Flu Mutations Antigenic Drift Subtle shift within subtype Can be associated with pandemics Drifts occur continually Antigenic Shift New subtype of combined human & animal antigens Associated with pandemics because no one has resistance Impossible to predict mutations 7

8 1918 Spanish Influenza 1918 Flu Came in 3 waves over 18 months Worldwide Killed million people Attacked young & healthy (20 30 yrs) Destroyed the lungs 8

9 How Big Is the Threat Today? Inter-pandemic phase New virus in animals, no human cases Low risk of human cases 1 Higher Risk of Human Cases 2 Pandemic Alert New virus causes human cases Pandemic No or very limited human-to-human transmission Evidence of increased human-to-human transmission Evidence of significant human-to-human transmission Efficient and substantial human-to-human transmission May

10 Human Deaths from Bird Flu Human Deaths: Asia Europe Africa 10

11 Confirmed Human Fatalities 24 May 2007 Country Total cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Laos Nigeria Thailand Turkey Viet Nam Total Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. 11

12 What Can We Expect? 12

13 What Can We Expect? 1) No Safe Zones 2) 3 Waves Over 18 Months Blue: <1 per 1,000 persons Green: 50 per 1,000 Red: 100+ per 1,000 persons 13

14 What Protection Can Medicine Offer? Medical Solutions Antibiotics are ineffective on viruses Vaccines take 6+ months to create Vaccines are not always effective (shifts & drifts) Anti-Virals like Tamiflu Effective today on H5N1 In short supply Offer protection while taking Do not build immunity Preventative Measures Hand washing Sneeze etiquette Avoid face touching Isolation of sick Protective masks Social distancing 14

15 What The Authorities Say The virus was moving toward becoming transmissible by humans and that the international community has no time to waste to prevent a pandemic. Chief WHO Many scientists believe its only a matter of time until the next influenza pandemic occurs. The severity of the next pandemic cannot be predicted, but modeling studies suggest that the impact of a pandemic on the United States could be substantial. CDC website President Bush's plan for dealing with a flu pandemic warns that the federal government won't be able to bail out communities reeling from illness and economic upheaval, and calls on businesses and individuals to take steps now to keep vital services running. AP Governor of Florida said, FL could be ground zero for the bird flu in the U.S. 15

16 What Can Business Expect? Flu Predictions Bird flu may go person to person Less than 6 weeks warning 3 waves of flu over 18 months No vaccine immediately available Up to 30% employee absenteeism Customers will be affected Supply chain shortages Healthcare stressed Government will not bail out businesses Advanced planning is advisable Healthcare planning is critical 16

17 Pandemic Flu Disaster Planning Assumptions # Localized World Wide # Last <30 Days 3 Waves Over 18 Months # Can Get Help From Others Must Be Self Sufficient # Key People Are Available 30% Absenteeism & Many Key People Will Die 17

18 Leveraging Pandemic Strategies MIS Solutions Can Facilitate Virtualization of work Workforce communication Social distancing Service alternatives Delivery innovations Control mechanisms Workforce productivity 18

19 In Case of a Pandemic What MIS Can Expect Overnight Explosion of VPN usage Explosion of on-line interactions Explosion of teleconferencing Explosion of Internet traffic MIS Preparatory Action Items Expand communications infrastructure Expand work from home capabilities Key users on notebook computers Build remote workflows Create pandemic communications website Provide pandemic education Ensure employee personal information is up to date 19

20 Pandemic Planning Assumptions Based on History Escalation from Level 4-6 may be rapid Worldwide in less than 6 weeks Up to 30% worker absenteeism 3 waves lasting up to 18 months Many deaths in first 120 days No remedies immediately available Critical supply shortages Civil infrastructure - stressed Healthcare - very stressed Closure of meeting places Expect quarantines Severe economic stresses Key people will die Critical functions carried out by outside firms not guaranteed 20

21 Pandemic Flu Impacts on Health Care Scenario Health Care Reality Expect stress of entire healthcare system No quick solutions Depends on hospital planning A long-term problem CDC Standard Precautions Standard Precautions Hand hygiene Contract Precautions Gloves & gowns for all patient contact Use dedicated equipment (stethoscopes, BP cuffs) Eye Precautions Wear eye covering Airborne Precautions Negative air pressure Fit tested respirators Worker Precautions Healthcare workers get current flu vaccinations Monitor workers for symptoms 21

22 Pandemic Preparations Mitigation During Pandemic Social distancing Onsite work split into 3 shifts Workers clean own areas Eliminate most work travel Provide N95 masks 3 deep in all positions Eliminate face to face meetings Establish conference call bridges Establish net meeting software Pandemic declaration protocol Mandatory leave for ill employees Pandemic training Hand washing education Sneeze etiquette training Restrict personal travel Work with other depts 22

23 The End of the Matter 23

24 Ways To Protect Workers Change Personal Habits Establish Workplace Policies 24

25 How Clinical Workers Stay Healthy Distancing Personal Hygiene Protective Barriers 25

26 Establishing Habits Knowledge Habits Skills Desire 26

27 Getting In Habits 27

28 Clinically Proven Protective Strategies Cough / Sneeze Etiquette Hand Washing Protective Barriers Social Distancing Cleanliness 28

29 How Flu Spreads Flu Transmission Modalities Airborne droplets Physical contact Body Fluids Factors in Airborne Exchange Number of droplets Size of droplets Distance 29

30 Sharing Droplets 30

31 Spreading Droplets 31

32 Sneeze Etiquette #1 Cover mouth and nose with tissue #2 Put used tissues in trash Sneeze into bend of elbow rather than in your hand 32

33 Hand Washing Proper Hand Washing Technique 1) Wet with warm water 2) Soap & scrub for 20 seconds 3) Rinse with warm water 4) Dry with disposable towels 5) Turn off fixtures & open door with disposable towel 6) Discard towels in trash 33

34 Alternative to Hand Washing Alcohol Based Hand Sanitizers 1) When hand washing is impractical 2) Rub in for 20 seconds 34

35 When to Clean Hands Before Touching After Contact With 35

36 Minimizing Contamination Exploit Touch Free Technology Flushers Soap dispensers Hand sanitizer Towel dispenser Faucets Touch Free Policies Open door policy Use door stops Observe fire codes Facilitate Hygiene in Work Environment Hand sanitizer stations Distribute hand sanitizer or wipes 36

37 Protective Barriers 37 Minimize Direct Contact

38 Types of Masks Which Masks Are Effective? N95 Masks Provide 98% Protection 38

39 Wearing Masks - During Pandemic When To Wear Masks When can t maintain social separation In public settings When exposed to sick people When you are sick (to limit spread) 39

40 Wearing Masks Properly Fitting Masks Form tight seal over mouth & nose Snugly adjusted to one s face Safely remove after use When to Discard Masks When get wet When soiled or dirty Before next sick person 40

41 Wearing Gloves When to Wear Gloves Caring for sick person Exposed to contaminated area When to Discard Gloves When torn or worn When contaminated After caring for sick person 41

42 Minimize Face Touching Mouth Nose Eyes Cheeks Don t Touch Your Face It It Can Can Insert the the Virus Into Into Your Body Back-Hand Scratch 42

43 Social Touching During Pandemic Hugging Minimize Minimize Social Social Contact Contact Kissing Kissing Handshaking Nodding 43

44 Travel & Sick During Pandemic Pandemic Travel Policies Avoid crowds Restrict work travel Restrict personal travel Pandemic Sick Policies #3 Telecommuting allows at risk employees to work Never work sick policy #2 Social distancing increases worker flexibility Liberal leave policy for family care #1 Social distancing reduces chance of spreading Quarantine disease 10 days after exposure before return to work 44

45 Social Distancing During Pandemic Office Policies 6 feet of separation between people Avoid crowds Spread in-office workers over 3 shifts Open door policy w/door stops Observe 1 way traffic patterns Minimize elevator use Designate up and down stairwells Limit ALL travel Work from home if possible Do Not report to work sick Require flu shots for everyone Meeting Policies Use teleconferencing Limit face to face meetings Eliminate hand shaking 45

46 Self Quarantine During Pandemic Self Quarantine At Home Quarantine for 10 days after exposure Quarantine Triggers If you show any flu symptoms Any exposure to sick family member Unprotected exposure to sick person Unprotected public travel Plane Train Bus 46

47 Pandemic Cleanliness Strategies Self-Clean Personal Workspace Less chance sharing germs Frequently Clean Keyboard, mouse & keypads Printer, copier, fax Door handles Phone Office touch points Distribute Hand wipes Keyboard wipes Cleaning supplies 47

48 Don t t Share Personal Items Avoid Sharing Pens Tape dispensers Staplers Scissors Phones Calculators Keyboards & Mice Other Personal Items 48

49 Questions 49