Pandemic Flu Preparedness

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Pandemic Flu Preparedness

• Presented By
• Kathleen M. Camelo, M.D.
• Director, Center for Student Health
• Psychological Services
• State University of New York at Plattsburgh
• November 15, 2007

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OBJECTIVES

• Become familiar with common flu terms
• Understand why we need to prepare for a pandemic
  flu
• Review pandemic flu planning assumptions
• Review specific departments planning needs

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Definitions of 3 Flu Terms

• Seasonal Flu (common flu)
• Respiratory illness transmitted from person to
  person
• Most people have immunity
• Vaccine is available

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• Avian Bird Flu (H5N1)
• Caused by influenza virus that occurs naturally
  in wild birds
• Is deadly to domestic fowl
• Transmitted from birds to humans
• NO human immunity
• NO vaccine

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• Pandemic Flu
• Human Flu that causes a global, worldwide
  outbreak or pandemic of serious illness
• Little natural immunity in the population easily
  spread person to person
• No vaccine
• Currently there is no pandemic flu

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Why Are We Concerned?

• International experts feel we are overdue for a
  pandemic

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History 3 Pandemics last century

• 1918 Spanish Flu
• Most devastating in recent history
• gt 500,000 fatalities in US
• gt1/2 between ages 18-40
• 20-50 million fatalities worldwide
• 4 waves, most lethal was 2nd

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• 1957 1958 Asian Flu
• First seen in China
• Death rate US 70,000
• 1968 1969 Hong Kong Flu
• Death rate US 34,000
• This virus still circulating
• 1997 Avian Flu Appears
• Hong Kong 18 people affected 6 fatalities
• To date 335 cases 206fatalities

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Avian Flu continued

• Countries where humans have been infected
• Vietnam Turkey
• Thailand Iraq
• Cambodia Egypt
• Indonesia Azerbaijan
• China
• Nigeria
• Djibouti
• Lao Peoples Democratic
  Republic

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Avian Flu (H5N1)

• Spread by migratory birds in saliva, nasal
  secretions, and feces
• Spread from bird to human
• Very limited human to human spread not beyond
  one person
• Continues to mutate

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Avian Flu continued

• Symptoms
• fever, cough, sore throat, achiness
• pneumonia and severe respiratory distress
• high mortality rate 50
• If virus mutates and is easily spread from person
  to person, H5N1 could be our next cause of a
  pandemic flu
• Tamiflu and Relenza 2 antivirals that decrease
  the severity and duration of symptoms and help
  prevent new cases after an exposure

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World Health Org. Alert Phases

• 6 phases
• 1 lowest
• 6 highest
• Currently phase 3 New influenza subtype causing
  death among humans but it is not yet easily
  transmissible

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Pandemic Flu Planning Assumptions

• Based on severity of the 1918 epidemic
• Timeline
• May last gt year 18-24 months
• Multiple waves of infection outbreaks
• Waves last 8-12 weeks
• Historically largest waves occur Fall Winter
• 1st wave may not necessarily be the most fatal
  wave

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Assumptions continued

• Attack rates
• 30 or higher in the overall population (seasonal
  flu 5-10)
• Attack rates highest among children
• 40
• 20 - working adults
• Rates of absenteeism 40 during peaks

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Assumptions continued

• Mortality rates
• 1,903,000 people will die in the U.S.
• Risk groups for severe fatal infection infants,
  elderly, pregnant women, people with chronic
  medical conditions
• In 1918 most deaths occurred in young adults

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Assumptions continued

• Transmission
• Interval between exposure and onset of symptoms
  (incubation period) 2 days
• Can shed virus one day before the onset of
  symptoms
• Transmission is greatest the 1st 2 days of
  illness
• Children shed the greatest amount of virus
• On average one person will transmit the flu to 2
  people

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Vaccination during Pandemic

• Currently for seasonal flu takes 6 months to
  produce vaccine and 350 million chicken eggs
• Pandemic flu vaccine also takes minimum of 6
  months to develop
• No vaccine for 1st wave of flu
• Need another method for vaccine production
  current research for this method is occurring
• Need to establish priority lists for vaccine
  essential personnel health care workers, police
  force, key administrators

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What do we need to be doing to prepare?

• Social distancing is our best defense need
  criteria statewide that dictates when we should
  close
• 1918 pandemic flu spread across the country in
  3-4 weeks
• In 2007 probably would take 3 days to spread
  across the country
• CLOSE CAMPUSES EARLY
• Establish evacuation plans
• Keep schools closed minimum of 12 weeks

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What do we need to be doing to prepare? continued

• Encourage vaccination of staff yearly for
  seasonal
• Encourage staff to make personal emergency
  preparedness with family
• Fit test all appropriate staff with N95
  respirators
• Protect against transmission of small droplets in
  air i.e. from coughing
• Forms a tight seal over nose and mouth

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• Establish depth charting for essential personnel
• Who takes over administrative rolls when
  administrators are ill or die?
• Human resources will be a major problem

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ACHA Preparedness Recommendation Specific to
Health Services

• Engage staff in planning and drills
• Provide regular updates
• Monitor websites CDC, WHO, ACHA
• Compile a supply list and ID a storage area
• Provide administration with a cost estimate
• Consult with HR regarding the recruitment of
  volunteers-consult with legal counsel

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ACHA Recommendations cont

• Develop a communication plan with student health
  and counseling services, residence life, and
  student affairs re reporting calls and
  transports
• Develop telephone triage protocols
• Develop a 24/7 operating clinic schedule
• Develop a transport protocol when 911 is not
  available
• ID an alternate clinic space

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• If unable to provide infirmary care identify
  community resources
• Develop a protocol for monitoring cases on and
  off campus
• Develop a plan for the care of the deceased
• Develop a mass immunization clinic plan

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Counseling Services

• Develop a 24/7 plan for services
• Consider telephone and internet services

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University Police

• Develop procedures for securing buildings
  especially those with stored essential supplies
• Develop procedures restricting access to campus
  after closure
• Develop triage protocol for responding to
  students in distress either due to illness,
  illness of others
• Develop protocol for those requesting transport
  for medical care when all ambulances are
  unavailable

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UP cont

• Equip patrol cars with the following
• Disinfectants
• Surgical masks for possible transports or to give
  to affected people when responding to a call
• Gloves
• Hazard waste bags

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Housing / Res. Life

• ID buildings and rooms for quarantine, isolation,
  and residence
• Develop procedures to evacuate students and
  close buildings
• Develop communication protocols with student
  health for student health surveillance

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Housekeeping

• Develop plans to continue services and
  stockpile cleaning supplies and paper products
• Train staff in proper cleaning procedures and the
  use of personal protective equipment

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Dining Services

• Stockpile nonperishable foodstuffs and drinks
• Include estimations for staff that may need to
  shelter in place i.e. essential personnel
• Develop procedures for food delivery to students
  in isolation or quarantine

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International Student Services / Study Abroad

• Develop a system to monitor student travelers
  returning to campus from affected areas.
• Maintain close communication with health services
• Develop a communication plan with international
  students, study abroad students, and families re.
  travel restrictions and re-entry.
• Develop plan to temporarily cease study abroad
  programs

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International Student Services cont

• Develop a plan with leaders in charge of domestic
  students studying abroad to assist with
  sheltering in place procedures and identifying
  necessary resources

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Human resources

• ID essential personnel
• Update emergency contact info SUNY Alert
• Establish return to work guidelines in accordance
  with case definitions Exposed persons should
  not be working
• Establish work at home guidelines
• Recruit a volunteer pool

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Academic Affairs

• Develop plans for completing coursework via
  alternate modes of teaching i.e. web based course
  completion
• Review policies for student absenteeism and
  effects on academic standing

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Research

• ID buildings which may need to remain open due to
  specific research projects
• Plan for the care of research animals
• Plan for the storage of specimens and basic
  management of experiments

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Business and Finance

• Communicate with departments to assess the
  financial impact a pandemic
• ID emergency funding
• Develop procedures for rapid procurement of
  supplies and services i.e. department credit
  cards
• Plan how to continue payroll with a decreased
  accounting staff

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Admissions / Financial Aid

• Develop plan to recruit new students without
  personal interviews and tours
• Plan for financial aid impact for students taking
  leaves or if the campus suspends classes

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Physical Plant and Maintenance

• Develop plan for fuel, water, and energy
  shortages
• Check for the availability of emergency
  generators
• ID buildings ventilation systems esp. buildings
  slated for quarantine and isolation

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Psychosocial Issues of Response Workers

• Dealing with illness and death among family
  members and colleagues
• Fear of contracting and transmitting disease
• Sense of ineffectiveness
• Constant stress and pressure to keep performing
• Family members may experience stigmatization
  because of responders role in the pandemic

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Previous Issues Exacerbated by

• Dealing with mass casualties and death among
  children
• Lack of information
• Death of immediate supervisors or other leaders
  trained in the response alert
• Economic collapse shortages of food, H20, fuel,
  electricity
• Dealing with people who perceive that their civil
  liberties are restricted

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Lessons Learned 04-05 Tsunami Disaster Response
Effort

• Timely, accurate, and candid information needs to
  be shared to facilitate decision making
• Need to support the physical and emotional health
  of your force
• Need to encourage communication and sharing of
  experiences among staff
• In a disaster, workers may be asked to do out of
  title work. How do we deal with this request?

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Recovery Campus Wide

• Establish criteria for calling an end to a
  pandemic event and reopen for business
• Develop plan to debrief faculty, staff, and
  students
• Evaluate past event and the effectiveness of
  emergency response once in recovery

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References

• www.pandemicflu.gov
• New England Journal of Medicine
• Volume 352, 1839 1842
• May 5, 2005 Number 18
• Preparing for the Pandemic
• American College Health Association
• Guidelines for Pandemic Planning
• July 7, 2006

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Questions and Answers