Community Preparedness for Health Threats

1. Community Preparedness for Health Threats Union of British Columbia Municipalities September 27, 2005

2. Outbreak, Epidemic or Pandemic? Outbreak: A sudden increase /eruption of a specific disease Epidemic: Disease affecting many individuals in an area or population at the same time Pandemic: Epidemic over a wide geographic area and affecting a large proportion of the population (global)

3. Legal Authority Under the BC Emergency Program Act and Regulations Local authorities are required to prepare risk based emergency plans respecting preparation for, response to and recovery from emergencies and disasters, such as West Nile Virus (WNv).

4. Legal Authority Under the BC Health Act and Regulations A Medical Health Officer (MHO) has the authority to enact community-based control measures that are considered important in controlling the spread of influenza and minimizing its impact. Such measurers may include • Closure of community facilities (e.g. schools, community centres) • Cancellation of large gatherings

5. Legal Authority Legal Authority Under the Drinking Water Protection Act Water suppliers, including local government, must provide potable water.

6. Waterborne Illness

7. Context • Approximately 4000 operational water systems in B.C. (everything other than a single family dwelling) • Very few systems filter • B.C. has one of the highest reported incidences of intestinal illness in Canada • 29 Waterborne Disease Outbreaks between 1980-2000 • Currently there are approximately 400 ‘Boil Water Advisories’ in effect, mostly on small water supply systems serving fewer than 500 people

8. Drinking Water Protection Act (2003) • Requires construction approval • Requires operating permits • Requires disinfection of surface water) • Specifies no detectable E. coli / fecal coliforms • Requires public notification of water quality problems • Requires an emergency response plan • Empowers conditions on an operating permit • Empowers a system assessment • Empowers an assessment response plan and enables drinking water protection plans • Requires certified operators – Jan 1, 2006

9. Local Government Responsibility • Provision of water has always been a local government responsibility • Expectations and the definitions of due diligence are changing • Local government is best positioned to make community-based decisions

10. What does this mean to you? • Places full responsibility on the “owner” of a water supply system to provide safe drinking water at all times • “Owner” means elected officials as well as staff • Responsibility to set and enforce policy that protects public health and ensures compliance

11. West Nile Virus

12. Reducing Risk: BC’s Preparations An integrated pest management (IPM) approach is the cornerstone of the planned BC response, with a graduated response depending on current risk. This includes: • Extensive surveillance of birds, mosquitoes, humans, and temperatures • Communication strategy • Developing legal tools • Preventative Mosquito larval control programs • Emergency response preparedness for selective and localized adult mosquito control in the event of an WNv outbreak.

13. Reducing Risk: Legal Tools • Legislation • Health Act – • gives Medical Health Officers the authority to issue an order to protect the health of the public • The council of a municipality is the local board of health and has responsibilities as such • WNV Regulation – • Clarifies that Medical Health Officers have authority under the Health Act to issue orders to a local authority

14. Preventative Control: Funding • Nuisance control of mosquitoes has been done in many communities in B.C. for decades. • $5 million has been granted by MoH to the Union of BC Municipalities to distribute to its members for implementing Integrated Pest Management programs in 2005. • The program was very successful with local authorities (approx 60%) and First Nations (40%) applying for and receiving $4 million. • A few local governments have questions about their responsibilities to protect their citizens and did not participate in 2005. • The protection of the public from WNv through mosquito control programs has to be a cooperative effort.

15. Emergency Mosquito Control: Funding for Adult Mosquito Control Programs • $250K in total was provided to Health Authorities for setting up contingency ground based adult mosquito control programs. • $200K was set aside by the province for aerial adult mosquito control to assist local authorities and health authorities if needed to control a threatened outbreak of WNv. • If adult mosquito control was required in any area of the province the government would pay for any incurred expenses directly related to the adult mosquito control product application. • Any decision would involve the Medical Health Officer, West Nile virus coordinators, BCCDC, Office of the Provincial Health Officer, and local authority officials. • Adequate public notification would be provided.

16. Challenges • Indemnification – of local authorities, contractors and health authorities – successfully negotiated – government, UBCM and Municipal Insurance Association • Public education about benefits of IPM program including possible necessity of adult mosquito control to reduce local risk.

17. Adult Mosquito Control Malathion • broad spectrum insecticide • registered in Canada since 1953 • used extensively in agriculture • for aerial and ground ULV for WNv risk reduction • recent extensive Pest Management Regulatory Agency re-evaluation – malathion will not pose a health concern to general population, but some may experience side-effects if over-exposed • Public information about benefits and side-effects – as with any medical treatment.

18. What Municipalities Can Do Now Plan • Identify key staff • Gather information • Connect with municipalities with current programs • Connect with Health Authority – Public Health Dept

19. What Municipalities Can Do Now Prepare • Determine community level of support • Develop policies • Obtain permits • Source reduction and pre-emptive larviciding in higher risk areas • Adult mosquito control contingency plan with H.A. in areas of higher risk

20. What Municipalities Can Do Now Prepare • Mosquito breeding site mapping • Plan public campaign in spring 2006 • education • residential clean-up • Apply for funding for 2006 when announced

21. Pandemic Influenza

22. What is known and the uncertainties • Anticipated but unpredictable • Starts abruptly without warning • Rolls through populations with ferocious velocity • Cannot be stopped, peak rapidly then subside almost as abruptly • Second and third waves can be more powerful and destructive Delay between waves lulls into relief and complacency • Leaves considerable damage in its wake Recovery impeded by multiple waves with simultaneous global onset . . . . a disease tsunami?

23. Impact on BC • Could be up to 3 million may be infected715 per 1000 • Up to 1.8 million may be clinically ill430 per 1000 • 18,500 thousand may require hospitalization 4.4 per 1000 • 6800 may die1.6 per 1000 Depends on the assumptions of proportions of the population infected and severity of disease

24. Management Challenges • Vaccine and Antiviral Availability – Need assured surge production • Antiviral effectiveness for H5N1 not fully known • Antiviral use and distribution strategy • Priority target groups - Ethical and legal issues • Response Triggers - Service Restrictions • Societal Impact - Community strategies • Healthcare surge capacity - Non tradition service delivery • Integrated Consequence Management - Essential Services • Public information and education

25. Government Planning Considerations • Establish plans and procedures to support the local HA • Develop a program, in conjunction with the HA to facilitate an annual vaccination program. • Establish a list of public buildings and events and review the benefits of closure/cancellation • Ensure that areas of responsibility that are ESSENTIAL to maintaining government services are backed up • Review mutual aid agreements to ensure that essential services are backed up so that appropriate designated personnel are available in the event of illness • Review and confirm availability of community facilities for mass clinics, triage, alternate care, body disposal . . .

26. Key Issues • Involve all essential service providers in the planning process • Clarify relationships, responsibilities, and communication lines between organizations at the federal, provincial and local level • Market the plan to all stakeholders to obtain the necessary support and resources prior to a pandemic • Work at local level with support from the province

27. Why Local Governments Should Act • Protect Citizens and Employees • Ensure the Delivery of Essential Services • Support Health Authorities • Assist Community Members • Minimize Financial Impacts • Protect Local Economy

28. Key Steps for Local Governments • Business Continuity • Prioritize critical functions • Life, health and safety (police, fire, emergency medical services, etc) • Identify functions that affect life, health and safety , and communications • Identify functions that are critical to organizations mission • Identify staff need to execute critical functions • Identify function that could be suspended • Build depth/redundancy through cross training • Plan for alternate work schedules • Explore/exploit telecommuting capabilities – large scale

29. Key Steps for Local Governments • Ensure local emergency managers coordinate with health authority • Engage local businesses and major employers Educate – inform – support • Involve elected leaders and identify action they may be required to take in response to a pandemic • Foster health system resilience and expanded capacity • Support business continuity planning • Conduct training and exercises

30. Local Governments • Areas of concern: • Employee health • Essential community services / social disruption • Assisting HAs with alternate sites • Possible closure of public gatherings

31. Employee Health • Prior to a Pandemic • Promote annual flu vaccination • Promote workplace hygiene (hand washing, cough etiquette, stay home when ill) • During Pandemic • Promote self-isolation when employees ill with flu • Facilitate employee immunization when vaccine becomes available • Grief counseling (deaths in co-workers and families)

32. Essential Services • A cumulative 25% + staff may be off during pandemic, but likely less than 10% in any one week. • What essential services must be maintained (public safety, social disruption) • Minimum staffing needed for essential services • Training of staff to allow cross coverage • Working with businesses to ensure supply chain continues

33. Assist Health Authorities with alternate sites • Work through emergency planners to ensure up to date lists of potential sites that could be used for: • Mass immunization clinics (security concerns) • Alternate care sites • facilities with beds or • space for portable beds • easy for public to access • washroom facilities

34. Possible Closures • Possible closure of public gatherings • May slow spread of virus during early pandemic, prior to vaccine availability • Main concern will be prolonged, high density gatherings (e.g. schools, public venues, other venues) • May need to cancel events • public disobedience • security concerns

35. The Ministry of Health has prepared a guide for local governments

36. Infection Timeline Potential for Death Severity Incubation Exposed Symptoms Complications Infectious 0 2 4 6 8 10 12 14 Days Infectious After 1 Day Earliest Return to Work

37. Severity Among Those Exposed

38. Pandemic Influenza Management Guide

40. The End Question/Comments/Concerns