Planning for Pandemic Influenza in York County: Considerations for Healthcare and Medical Response

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1 Planning for Pandemic Influenza in York County: Considerations for Healthcare and Medical Response York County Pandemic Influenza Stakeholders Village by the Sea, Wells, Maine 8 August 2006 Steven J Trockman, MPH Director

3 Objectives 1. Describe planning efforts worldwide, in the U.S., and in Maine to prepare for a possible influenza pandemic 2. Understand implications of pandemic influenza in York County and the surge effect on hospitals 3. Discuss strategies and tools for healthcare preparedness and response planning at the organizational and local level 4. Identify essential healthcare roles and responsibilities before and during a flu pandemic 5. Understand the mission and supporting role of the Southern Maine Regional Resource Center in pandemic influenza planning and in preparedness for other public health disasters

Symptoms: Abrupt onset fever, cough, fatigue, body ache August 8, 2006 -- S.

4 Pandemic Flu: what you need to know What is the flu? Virus 15 different H proteins 1 of 9 N proteins Injects into cells and reproduces Results in illness Symptoms: Abrupt onset fever, cough, fatigue, body ache August 8, S. Trockman Transmission electron micrograph of influenza A virus (CDC) Influenza Virus Anatomy (Molecular Expressions, Florida State Univ.). Used with permission by author.

5 Pandemic Flu: what you need to know Seasonal Flu Every year A flu virus infects people around the world Killing ~36,000 people in the U.S. Killing ~250, ,000 people worldwide. Pandemic Flu Occasionally, a new virus appears that does not follow the normal seasonal cycle, or follow many of the same rules. Seasonal Flu Occurs every year Occurs during winter; in the U.S. flu season typically begins in December and ends in March Most people recover within 1-2 weeks without requiring medical treatment The very young, the very old, and chronically ill (very sick) are at highest risk of serious illness Pandemic Flu Occurs infrequently; three times in the past century Occurs at any time of year Some people will not recover even with medical treatment People of every age may be at risk of serious illness, including previously healthy adults

6 Pandemic Flu: what you need to know A pandemic is an outbreak (epidemic) of a disease that covers a wide geographic area and affects large numbers of people. Will H5N1 cause a pandemic? Waves Duration Attack rate

7 Historical Characteristics 3-4 pandemics per century Spread rapidly over the globe. High morbidity and mortality in young healthy persons Tend to recur in waves. 2 nd and 3 rd waves often more severe as virus adapts to its new host. Economies and societies severely impacted.

8 Pandemic Flu: what you need to know

9 Emergency hospital during influenza epidemic, Camp Funston, Kansas, 1918 (Nat l Museum of Health & Medicine) August 8, S. Trockman

10 Avian influenza, China & Southeast Asia, 2005 (National Geographic Society) August 8, S. Trockman

11 Status of Avian Influenza Worldwide

12 Areas reporting confirmed H5N1 in birds since 2003 August 8, S. Trockman Spreading rapidly through wild bird population High mortality rate among birds Feces of infected birds highly infectious for weeks

14 International, National, and Statewide Planning for Pandemic Influenza

15 World Health Organization Tracking H5N1 since 1996 Orchestrating and coordinating the international response to this threat. Surveillance of virus in avian and mammalian populations. Identification and treatment of human cases Vaccine development Developed models to predict impact of pandemic flu. Outlined international and national public health response plans for each level on the pandemic alert scale

16 Confirmed human cases of H5N1 avian flu since 2003 August 8, S. Trockman Bird to human transmission has followed avian epidemic

Worldwide pan flu preparedness efforts WHO / CDC International surveillance systems Early warning Advanced planning Stockpiled medications Vaccine

18 Worldwide pan flu preparedness efforts WHO / CDC International surveillance systems Early warning Advanced planning Stockpiled medications Vaccine capability possible capacity Dependant highly centralized population Unused to disciplined behavior in face of threat Minimal excess capacity in health care system

19 Pandemic Flu: what you need to know What will happen if a flu pandemic occurs in the U.S.? A flu pandemic would spread across the U.S. within weeks and could cause: Disease in large numbers (up to 25% of population) Potential deaths in all age groups Significant pressure and disruption to all aspects of daily life, and to the entire health care system Possible emergency measures (quarantine & isolation) that will affect the entire nation

20 U.S. pan flu preparedness efforts Funding Existing stockpiles Strategic National Stockpile (SNS) Stockpiles under consideration Enhanced vaccine production capacity Travel and border control Vaccination

21 Strategic National Stockpile (SNS) Goal: 20 million courses Zanamivir Oseltamivir Only source in Switzerland Demand far outstrips supply Treatment data from Asia suggests Rimantadine and Amantadine are ineffective.

22 U.S. pan flu preparedness efforts Goals Stop, slow, or limit spread to U.S. Limit domestic spread to mitigate disease National Strategy (3 pillars) 1. Preparedness and communication 2. Surveillance and detection 3. Response and containment For more information... National Pandemic Influenza Plan

24 Maine pan flu preparedness efforts Focus Areas Emergency Management Healthcare Response Community Coordination Structure Operations and Management Surveillance Healthcare and Patient Management Mass Casualty Management Mass Dispensing Community Support Communication Maine Pandemic Influenza Plan & other information

26 Implications for York County

27 Facts & Assumptions Population, York County (2000 Census) 0-19 Years: 55, Years: 118, Years: 27,717 Licensed Hospital Beds Available Non-ICU: 265 ICU: 23 Duration of Pandemic (1 st Wave) 8 weeks Attack Rate 25% Modeling Software FluSurge *Data Set: Census 2000 Summary File 1 (SF 1) 100-Percent Data Geographic Area: York County, Maine

31 Healthcare and Medical Response Planning at the County Level

32 Local Planning Community Coordination County leadership team County pandemic planning work group Areas of Integration Operations and Management Surveillance Healthcare and Patient Management Mass Casualty Management Mass Dispensing Community Support Communication

33 Strategies Strategies Institutional/organizational planning Community coordination and integration Tools Planning Checklists (US DHHS, 2006) HHS Pandemic Influenza Plan (US DHHS, 2006) State of Maine Pandemic Influenza Plan (ME DHHS, MCDC, 2005) Guidelines for Development of Maine County Plans for Preparedness and Response to Pandemic Influenza (MCDC/MEMA, 2006) Your existing Emergency Operations Plans (EOP) Other s institutional plans (as reference)

38 Roles and Responsibilities for Healthcare Facilities

41 Interpandemic and Pandemic Alert Periods Develop planning and decision-making structures for pan flu response Develop/augment written plans that address: Disease surveillance Hospital communications Education and training Triage and clinical evaluation Facility access Occupational health Use and administration of vaccines and antiviral drugs Surge capacity Supply chain and access to critical inventory needs Mortuary issues Participate in pandemic influenza response exercises and drills, and incorporate lessons learned into response plans

42 Pandemic Period If an influenza pandemic begins in another country: Heighten institutional surveillance for influenza and prepare to activate institutional pandemic influenza plans, as necessary.

43 Pandemic Period If an influenza pandemic begins in or enters the United States: Activate institutional pandemic influenza plans, in accordance with triggers Identify and isolate potential infected patients Implement infection control practices Ensure rapid and frequent communication within healthcare facilities and between healthcare facilities and public health/emergency management Implement surge-capacity plans to sustain healthcare delivery

44 Creating Preparedness Planning simultaneous ( in parallel ) Top down (planners) Bottom up (responders) Coordination of plans To meet in the middle To tie paper plans to real resources and capacities

45 How are we addressing health emergency preparedness and response planning in Southern Maine? (i.e. bridging the gap between state and local capacity)

46 Regional Resource Centers A new approach Funding Federal State Scope 4 Counties 11 Hospitals Hundreds of partners

47 Mission: SMRRC The Southern Maine Regional Resource Center protects the health and lives of people in Maine by strengthening the ability of health agencies and partner organizations in Southern Maine to detect, contain and manage public health threats and emergencies.

48 The Emerging Need A mechanism for... Coordination of Plans Communications Resources Staff (trained and available) Space (hospital-based and off-site) Beds Transfers Supplies

50 To accomplish this mission, the SMRRC... Engages partners in every aspect of planning and communication Seeks low-cost, high-yield solutions to complex problems Nurtures new partnerships and collaborations between healthcare, public health, and safety Shares information broadly Provides leadership within the Region and across the State

51 To accomplish this mission, the SMRRC... Funds partners directly and indirectly to purchase necessary equipment and supplies Responds to special needs and requests of its partners Responds to threatened or actual emergency events in the appropriate capacity Participates in drills and exercises Conducts trainings Provides access to clinical expertise Engages in formative and outcome evaluation of activities

52 Partners Hospitals Health Clinics/Agencies Laboratories EMS Providers Nursing/Home Health Municipal Health Departments/Officers Emergency Management Fire Law Enforcement Volunteer Organizations Schools Government

53 Regarding Pandemic Influenza Planning Serve on county pan flu leadership teams as healthcare and medical response representative and advisor Provide leadership, support to healthcare agencies and orgs across region Assist in the integration of institutional, county, regional, and state response plans Provide timely and accurate data to MCDC and other agencies as requested Provide funding to hospitals to support their involvement in county and regional planning, and to aid in the development of institutional plans Coordinate and administer training, education, and exercises

In preparing for battle I have always found

-- S. Trockman You must be the change you

54 In preparing for battle I have always found that plans are useless, but planning is indispensable. - Gen. Dwight D. Eisenhower ( ) 1969) August 8, S. Trockman You must be the change you wish to see in the world. - Mahatma Gandhi ( ) 1948)

55 Steven J Trockman, MPH Director

56 Avian/Pandemic Influenza resources: online Official United States government website on pandemic flu and avian influenza Avian and Pandemic Influenza Management and Response Unit, USAID ms/avian_influenza.html National Vaccine Program Office, HHS Avian Flu Facts, CDC National Institute for Allergy and Infectious Diseases, NIH WHO Avian Flu Home Page World Organization for Animal Health Maine CDC Pandemic Influenza Information Global Health Council

57 KNOW these resources! Northern New England Poison Center /7 hotline service for both general public and healthcare professionals in ME, NH, and VT for poison information and on-site poison management Public Health Emergency Consultation and Disease Reporting Line Possible outbreaks or unusual infectious disease clusters Suspected infectious disease cases requiring immediate public health intervention Clinical syndromes that may be associated with biological, chemical, or radiological weapons exposure U.S. Centers for Disease Control and Prevention

Pandemic Influenza: Considerations for Business Continuity Planning

Pandemic Influenza: Considerations for Business Continuity Planning Maine Telecommunications Users Group (MTUG) VTEC, South Portland, ME 10 October 2006 Steven J. Trockman, MPH Joshua C. Frances, NREMT-I