PANDEMIC FLU PLANNING: ADVICE FOR RESIDENTIAL CARE HOMES

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PANDEMIC FLU PLANNINGADVICE FOR
RESIDENTIALCARE HOMES

• April 2009

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WHAT IS PANDEMIC FLU?

• Influenza viruses are commonly circulating in the
  human and animal environment.
• Different strains can cause illness in humans,
  bird and pigs.
• Seasonal influenza is caused by influenza viruses
  that are adapted to spread in humans (human
  influenza).
• Humans have some natural immunity to the strains
  that are in common circulation.
• An influenza pandemic is defined as a new or
  novel influenza virus that spreads easily between
  humans worldwide

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PREVIOUS PANDEMICS

• 1918-1919 Spanish Flu, 20-40 million deaths,
  peaked in 20-45 age group
• 1957 Asian Flu
• 1968 Hong Kong Flu
• 1957 and 1968 pandemics cost 1-4 million deaths

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PANDEMIC ALERTS

• World Health Organisation (WHO) levels 1 to 6
• At WHO 4, small clusters with limited spread
  Review Business Continuity and response plans
• At WHO 5, large clusters but still limited
  spread, Plans ready for instant implementation
• At WHO 6, Increased and sustained transmission,
  Pandemic declared, UK Alert levels 1-4 applied

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UK ALERT LEVELS

• UK 1 No cases in the UK, heightened alert,
  review and test plans
• UK 2 Virus isolated in UK, implement plans to
  maintain core services
• UK 3 Outbreaks in the UK, national and local
  response measures implemented
• UK 4 Widespread activity across the UK, Monitor
  and respond to pressures on services etc

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LIKELY PANDEMIC PROGRESS

• 2-4 weeks to reach 1,000 cases
• 2-4 weeks to reach UK
• 1-2 weeks to reach all population centres in the
  UK
• May have one or more waves, weeks or months apart.

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TYPICAL PANDEMIC WAVE
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USE OF ANTIVIRALS

• Oseltamivir (Tamiflu) or Zanamivir (Relenza)
• Works by preventing the virus from reproducing
• NOT a cure
• Reduces length of symptoms by about a day, and
  reduces severity
• Enough for 50 of population
• Targeted at those symptomatic for less than 48
  hours, and provided within 12-24 hours
• Planning for distribution centres and flu friends

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IMPACT OF ANTIVIRALS
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PLANNING FOR THE PANDEMIC

• Overview Pandemic Flu A national framework
  for responding to an influenza pandemic November
  2007
• For care homes An operational and strategic
  framework Planning for pandemic influenza in
  adult social care
• Plus other guidance Ethics, Surge Capacity,
  infection control etc.

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KEY ELEMENTS

• Care homes at full capacity, with increased
  temporary admissions
• Care in patients usual home preferable
• Provide a high level of infection prevention and
  control
• Maintain a minimum level of service
• continuity of meal provision
• continuity of essential supplies, maintenance,
  cleaning of linen etc.
• House some workers onsite to enable extended
  shifts and minimise travel from outside?
• Care Homes to pair up and agree staff sharing
  to mitigate shortages?

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FURTHER INFORMATION

• DH Website http//www.dh.gov.uk/en/Publichealth/F
  lu/PandemicFlu/index.htm
• UK Homecare Association http//www.ukhca.co.uk/fl
  u/
• North Yorks PCT http//www.nyypct.nhs.uk/AdviceIn
  formation/InfectionControl/docs/PandemicFlu/D320-
  20Pandemic20influenza20care20homes.pdf
• UK Resilience http//www.ukresilience.info/
• Your Local Authority Duty under Civil
  Contingencies Act 2004

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PLANNING FOR PANDEMIC

• Plan for business as usual - as far as
  practicable
• Build on tried and trusted systems
• Make plans which will meet a range of needs
• Take action NOW where we can
• Work within a national framework, adapted to
  local circumstances
• Base plans on the best available evidence
• Share information, understanding and approaches
• Exercise and review

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PLANNING ASSUMPTIONS

• Attack rate of 50, cumulative over one 15 week
  wave
• 25 of these may develop complications
• Up to 2.5 may die
• Those with complications and all under 3s need GP
  assessment and treatment
• Up to 4 may require hospital admission, with 25
  of these critical

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STAFF IMPACT

• Up to 50 absent at some stage
• Additional absences for other factors
• Small units, 5-15 staff, allow up to 30-35
  absence over a 2-3 week peak period
• Staff may suffer bereavement
• Additional 5-6 absence if schools closed

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IMPACT ON DEVON PCT AREA
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KEY PRINCIPLES

• Joint working and integrated planning
• Flexible planning
• Flexible thinking in bolstering staff capacity
• Building on normal delivery models
• Advising and enabling symptomatic flu patients to
  stay at home
• Rapid access to antiviral medicines
• Reducing routine activity, but continue essential
  care
• Adopting measures to maintain public confidence
  and feel fair

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FINAL THOUGHT

• Let our advance worrying become advance thinking
  and planning.
• Winston Churchill

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• For further information or advice, please contact
• 01392 207783