Exercise Cold Play II Introduction

1. Exercise Cold Play II Introduction Host Name

2. Core Statement • ‘'We don't know enough about this virus to draw any conclusions about its severity,' he said. 'At this stage I think it would be premature to conclude that this is a mild infection.' Sir Liam Donaldson Chief Medical Officer, May 2009

3. Aims & Objectives • To review the spring/summer H1N1v pandemic flu wave and to prepare for a more serious second wave during this winter flu season.

4. SEASONAL FLU Occurs every year during the winter Affects up to 10% of the population The very young, the very old and people with certain chronic illness are most at risk Annual vaccination available Antiviral drugs available for the at risk PANDEMIC FLU Occurs about 3 times each century – at any time of the year May affect up to 30% of the population People of every age may be at risk Vaccine won’t be available initially - in the first wave Antiviral drugs are likely to be in limited supply Seasonal ’flu vs Pandemic ’flu

5. Previous ’flu Pandemics • Pandemic Spanish Flu Asian Flu Hong Kong Flu Swine Flu • Strain: A(H1N1) A(H2H2) A(H3N2) A(H1N1) • Year: 1918-1919 1957-1958 1968-1969 2009 - ? • Origin: Not known China China Mexico • Estimated Deaths • Global 20-40 million 1million 1-4 million ? • UK 250,000 33,000 30,000 ? • Age Group 20-50 yrs under 14 yrs under 5 yrs ? • over 65 yrs over 65 yrs Shortest interval= 11 years Longest interval= 40 years

6. Geographic Spread: 1968-69 09/68 01/69 09/68 09/68 07/68 09/68 08/68 06/69 09/68 C.W. Potter, Textbook of Influenza, 1998

7. 1918 Pandemic 1957 Pandemic 1968 Pandemic 1918/9: Flu Deaths Eng. and Wales 1957/8: Flu Deaths Eng. and Wales 1968/9: GP consults Eng. and Wales Pandemic Influenza • Three pandemics during 20th Century (1918, 1957, 1968) • 20 million deaths worldwide in 1918-19 • Different data sources • Current and real threat

8. This pandemic • Global spread is rapid – we must prepare now, or risk being caught by surprise • 2. Possible several epidemic waves; first may be ‘milder’ than subsequent ones – sustainability and resilience will be key issues • 3. A pandemic virus is new to man, virtually no one has immunity. This means the virus causes more severe disease in more people.

9. This pandemic – key events to date • 24 April 09 - Mexico City under Swine Flu epidemic • 26 April 09 -New Zealand college students return from Mexico with Flu-like symptoms • 27 April 09 - New York confirms eight cases of Swine Flu • 29 April 09 – WHO - Level 5 • 29 April 09 - Swine Flu reaches Germany • 1 May 09 - UK – Pupil at Downend School, South Gloucestershire, confirmed as having • contracted Swine Flu • 4 May 09 - UK – Alleyn’s School, London, closes after Swine Flu outbreak • 5 May 09 - UK – The post office distribute Swine Flu leaflets to houses in the UK • 18 May 09 - First New York city Swine flu victim dies • 11 June 09 - WHO – declares Pandemic Level 6 • 14 June 09 - First death outside America linked to Swine Flu (woman dies in Paisley) • 6 July 09 – UK Government moves from ‘containment’ to ‘ treatment’

11. Exercise Format • Four ‘blocks’ of time • Week 0 – between waves • Week 6 – First cases – 2nd wave • Week 11 - Peak • Week 21 - Recovery • Each block represents a single day in the pandemic cycle • Each block will bring out specific topics • Broadly they are: • Infection Control • Vaccines • Anti virals • Staffing and resources • Surveillance • Media • Business Continuity

12. Key Planning Assumptions • The exercise has been developed using the Department of Health’s planning assumption (July 2009) of: • a 30% clinical attack rate and a • case-fatality rate of up to 0.35%

13. Guidance Available • Department of Health Pandemic Influenza Plan • http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/PandemicFlu/fs/en • Flu key documents and resources for patients and health professionals • http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/fs/en • Department of Health Emergency Preparedness • Beyond a Major Incident – planning for potentially large numbers of casualties • http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en • The Health Protection Agency: • http://www.hpa.org.uk/infections/topics_az/influenza/flu.htmNICE (National Institute for Health and Clinical Excellence) • http://www.nice.org.ukThe WHO Influenza Pandemic Influenza Preparedness and Response Guidance document is available at • http://www.who.int/csr/disease/influenza/PIPGuidance09.pdf

15. Block One – Reviewing and Preparing for the Winter Flu Season – Questions • Plans and Planning Process • Roles & Responsibilities • Data Gathering, Surveillance & Reporting • Co-ordination of Media & Public Communications • Antivirals

16. Block Two – Initial response to second wave Questions • Distribution of antiviral treatment and health advice • Vaccination • Use of Personal Protective Equipment (PPE) and infection control guidance • What measures are you planning locally? • Resilience of the emergency services • Social distancing measures/Schools/Travel advice

17. Block Three – Business Continuity at the peak Questions • Resilience arrangements • Staff Shortages/Resources • Business Continuity • Management of deaths • Antiviral distribution

18. Block Four - RecoveryQuestions • Recovery • Voluntary services • Bereavement • Lessons learned

19. Exercise Cold Play II