Pandemic Influenza – “Is it real, or is it just another storm on the horizon?

1. Pandemic Influenza – “Is it real, or is it just another storm on the horizon? Pandemic Influenza 101 June 2006 James C. Turner, MD Executive Director, Department of Student Health University of Virginia Slide templates and background information: Roy Crewz, M.P.H., M.S. Emergency Preparedness and Response Program Thomas Jefferson Health Department

2. Pandemic Planning • Pandemics have occurred throughout human history and are a way of life. • 430 BC 25% of Athens died of a pandemic • 14th century plague killed an estimated 25 million people, changing the course of modern history. • Ten pandemics have occurred in the last 300 years. • Last three were in 1918 (devastating), 1957 and 1968 (both mild).

3. Pandemic Influenza 1918

4. 1918, H1N1 “Spanish Flu” • > 500,000 deaths in the U.S. • 20-50 million deaths • Young/healthy adults • Death was RAPID

5. Pandemic Planning • The world is overdue for a pandemic and is under prepared. • Potential for pandemic first recognized with emergence of pathogenic avian strains passed to humans in 1997. • The avian strain, H5N1, shares genetic characteristics of the Spanish flu strain from 1918. • H5N1 is highly pathogenic and mutagenic and is spreading explosively worldwide among wild and domestic avian flocks. Human cases are limited. • Increases risk of H5N1 mutation or reassortment to a strain that transmits easily among humans-the only missing element of the pandemic.

6. Pandemic Planning • Pandemic strain virulence will determine the impact on the population. • Current models predict U.S. outcomes if similar in virulence to 1918: • 30% population attack rate; 40% absenteeism at work and schools for 6-8 day intervals over 12 weeks; two to three waves over 2-3 years. • 1.5 M patients in ICU’s • 750,000 on ventilators • 1.9 M deaths in the U.S.

7. Pandemic Planning • What about Charlottesville/Albemarle County (est. population 130,000)? • 39,000 residents will be sick; • 390-975 deaths (1-2.5%); • Challenge to local health care system • Challenge to infrastructure; business community and educational enterprises.

8. Other Possible Effects of Pandemic • Economic/Business devastated – actual dollar costs in the billions…......inestimable • Production & Transportation impaired – one of the most basic questions is “how will we eat?” • Security: for individuals and businesses • Behavioral health effects • National psyche – “will the glass be half-empty or half-full?” Post 9/11 PTSD, can the public handle it?

9. Planning:Who Does What? • Federal government • nationwide coordination of the pandemic influenza response; international collaboration. • State government: Virginia Department of Health • coordination of pandemic influenza response within and between jurisdictions. • Local government • developing local plans and insuring these plans meet both state and federal guidelines.

10. Local Pandemic Influenza Plan Builds on Emergency Operations Plan: • Legal authority • Command and control procedures; • Surveillance/epidemiologic investigation; • Infection control; • Medication/vaccine management; • Coordination local/state agencies; security • Communications; education and training

11. Pandemic detection and response • International surveillance for pandemic strain (rapid person to person transmission). • International alert • Containment: targeted antivirals, quarantine, isolation, limited travel, animal culling

12. Pandemic detection and response • Once disease spreads worldwide, local efforts will include: • Containing community transmission (social distancing, isolation, quarantine, protective sequestration, and health education). • Communication • Medical care • Vaccines and anti-viral medications (available in limited supplies and perhaps not for months).

13. Influenza Vaccine • No vaccine available for 4-6 months • Control measures important • Limited vaccine supply • Focus on vaccine priority groups; “batching” • IF - Adequate vaccine supply • Expand coverage • Federal government is providing substantial support to the vaccine industry to improve flu vaccine production capabilities. Priorities may shift as supply increases

14. Vaccine Issues • Security • Administration of the vaccine • Prioritization for administering vaccine within groups (HC providers providing direct care)

15. Antiviral Medications • Good news • Prophylaxis and Treatment: (duration/severity) • Bad news • Resistance • Limited Supplies

16. Antiviral Issues • Prophylaxis vs. treatment: who decides the priorities and who has access to antivirals • Stockpiling: Public vs. Private • Role of local pharmacies

17. Medical Care • Access to and provision of healthcare= cornerstone to reduce morbidity/mortality • Great demand for beds, ICU, ventilators • Heath care workers who are ill • Nosocomial (Hospital-setting) outbreaks • Canceling of regular medical appointments and admissions.

18. Medical Care Issues • Prioritization and triaging of patients (e.g. canceling elective surgeries) • Role of home health care and monitoring • Ambulatory care facilities • Counseling and psychological support • Insufficient medical resources • Support for HCW’s-housing, food, transportation, extended shifts, quarantine

19. Community Transmission • Goal • Slow the spread – BUY SOME TIME!-until antivirals and vaccine available. • Factors influencing disease transmission • Short incubation period • Infectious during asymptomatic stage • Clinical illness - nonspecific • High attack rates

20. Non-pharmaceutical Interventions • Social Distancing • School and business closures • Sending residential students home if possible • Recommendations about telecommuting • “Snow days”- a high # of people stay home for 10 to 100 day intervals • Discouraging/banning large indoor gatherings-concerts and athletic events. • Isolation/quarantine early-liberal sick leave policies • Health education for hygiene. • Protective sequestration not an option • Benefits and impact uncertain

21. Community TransmissionIssues • Continuing" essential” services (police, fire, electricity, water, grocery stores) • Community wide efforts for cough and hand washing hygiene • Voluntary compliance for the common good vs enforcement actions • Criteria for closing schools, businesses, and/or canceling public events

22. Communication/Education Issues • How will we disseminate timely information: • influenza bulletins to health care providers • vaccine availability/distribution plans • patient education • identifying official spokesperson • role of health officials and governmental authorities

23. For More Information ……… • “The HHS Pandemic Influenza Plan is a blueprint for pandemic influenza preparation and response. For a copy visit: www.pandemicflu.gov. “School Planning” tab to college and university checklist. • For Virginia Pandemic Influenza Information visit: www.vdh.virginia.gov/pandemicflu/ • College Health www.acha.org will post draft of guidelines for colleges and universities in July. • Other professional organizations….

24. UVa Planning To Date • Committee on Emerging Diseases at the Health System has worked on bed space, ventilators, antivirals, supplies. • Ad hoc work group on international studies has started meeting to discuss international students and study abroad programs. • Mr. Sandridge has appointed a pandemic preparedness planning committee to conduct planning for the entire University community. • UVa represented on Health Department pandemic committees and State Summit

25. Break • Restrooms: one in lower lobby. Four up one floor, scattered down the hall toward north end of building. • Refreshments • Return in 15 minutes.

26. UVa’s Charge Today • Develop and incorporate pandemic influenza planning into existing University plan. • Address University functioning over various scenarios. • Address medical, mental, and social services for University community. • Explore alternatives to assure continuity of instruction and research • Develop a continuity of operations plan for essential services. • Implement infection control procedures. • Establish a communication plan.

27. UVa’s Planning Structure • Emerging Diseases Committee-Co-chaired by Marge Sidebottom and Dr. Tom Bleck. • Pandemic Preparedness Planning Committee-Chaired by Dr. Jim Turner • Academic affairs-Anda Webb • Student Support Services-Penny Rue • Faculty and staff-Dave Ripley • Communication-Carol Wood • Legal-Beth Hodsdon • Administrative Operations-Susan Harris • Health care/infection control-Marge Sidebottom

28. UVa’s Planning Structure Academic affairs-Anda Webb • Provost’s office • International programs • Public health faculty • Travel clinic faculty and/or nurses • Environmental Health and Safety • Student Health Charge: Closure/cancellation policies, continuity of academic enterprise during pandemic.

29. UVa’s Planning Structure Student Support Services-Penny Rue • Housing • Food services • Parking and transportation • Student affairs • Student Health Charge: Dealing with closure policies, sending students home, caring for students who can’t go home or are ill, preparing residential units.

30. UVa’s Planning Structure Faculty and staff-Dave Ripley • Human resources • Benefits Office • Payroll • Provost’s Office Charge: Leave policies, emergency contact lists, departmental depth charting, communicating with departments and supervisors, payroll, benefits.

31. UVa’s Planning Structure Communication-Carol Wood • University and community relations • ITC Charge: Coordinate communication internally and externally (health department and emergency operations), centralized University information site.

32. UVa’s Planning Structure Legal-Beth Hodsdon • General Counsel’s Office • Attorney General’s Office • LWS office Charge: Define legal authority for mandated closures, contract review for pandemic contingencies, coordinate leave policies and insurance benefits with HR and State regulations.

33. UVa’s Planning Structure Administrative Operations-Susan Harris • Office of the EVP and CEO • University police • Procurement • Athletics • Facilities • Parking and Transportation Charge: Identify critical business functions, resource allocation for planning and procurement, facility maintenance, campus safety, transportation

34. UVa’s Planning Structure Health care/infection control-Marge Sidebottom • Emerging Diseases Committee • Employee Health/Work Med/Hospital Epi. • Student Health/General Medicine, CAPS, LNEC, Administration • Schools of Nursing and Medicine • Public Health Department Charge: Ambulatory care, mass clinics for vaccine and antivirals, mental health, care for ill residential students, infection control procedures, faculty/staff vaccine policies.

35. Subcommittee logistics • Chairs free to appoint co-chairs or vice chairs. • Appoint members of subcommittee from departmental representation on larger committee and/or others in departments. JCT can help with membership suggestions. • Student Health conference space available to chairs. Arlene Guenther: 924-2670, or ag5z@cms.mail.virginia.edu

36. UVa plan format and communication • Existing policies or procedures should be identified. • Standardized policy or plan format? • Centralized website? • Email distribution of plans?

37. Meetings and Timelines • Monthly meetings of subcommittee chairs with JCT • Planning committee meets in early September 2006 to receive plan reports from subcommittee chairs and seek feedback. • Written plan submitted to LWS October 1, 2006. • Initial training of key stakeholders October. • UVa participates in regional drill October 31, 2006.