Pandemic Influenza - Readiness and Emergency Management for ...

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Pandemic Influenza - Readiness and Emergency Management for ...

Planning forPandemic InfluenzaPegi McEvoy, MN, ARNPSafety and Security DepartmentSeattle Public Schools


A Pandemic Occurs…..When 3 criteria are met:1. Novel subtype where people do not haveimmunities, AND2. Humans are infected and severe illness iscaused, AND3. Virus spreads easilyH5N1 meets criteria 1 and 2


World Health OrganizationPhases of an Influenza PandemicPhaseDefinition1 Inter-pandemic PeriodNo new flu subtypes in humans.Possibly present in animals.Risk to humans is low.2 Inter-pandemic PeriodNo new flu subtypes in humans.A circulating animal flu subtype poses asubstantial risk of human disease.


World Health OrganizationPhases of an Influenza PandemicPhaseDefinition3 Pandemic Alert PeriodHuman infections with a new subtype.No human-to-human spread, or rare instances ofspread to a close contact.4 Pandemic Alert PeriodSmall clusters, limited human-to-human transmission.Spread is highly localized: Virus is not well adapted tohumans.5 Pandemic Alert PeriodLarger clusters, but human-to-human spread stilllocalized: Virus becoming better adapted to humans.6 Pandemic PeriodIncreased and sustained transmission in generalpopulation.


The World Health Organization (WHO)defines six pandemic alert phasesWe are currently at Phase 3


Potential Impact of PandemicFlu in the US and Locally


Who are We?46, 000 students7,000 staff97 different homelanguages93 schoolsFunding issuesLeadership issues


Who are We?Near the Canadianborder6,000 persons per dayarrive from AsiaCity EmergencyManagement OfficeCounty EmergencyManagement OfficeCity/County PublicHealth Department


Integrating NIMS andSchool All-Hazard Plans


All Hazard PlanBasic PlanAppendicesEmergencySupport FunctionsImplementingProceduresMission andresponsibilitiesAuthorities, terms, andacronymsPolicies, planningassumptions, andconcept of operationsDetails


Integrating NIMS andPandemic Plans


Local Impact: Health StatusIn the first 6 weeks of a pandemic:• 1.2 million people are infected• 245,000 - 612,000 are clinically ill• 180,000 - 470,000 outpatient medical visits• 24,436 – 57,216 people are hospitalized• Up to 11,500 people are dead


So What Did that Mean to Us?Schools may be closed for up to 2 monthsfor health and safety reasons, but we mayrun out of staff first (and soap)Essential functions are different in apandemicAcronyms are differentLead agency is different (plans are vague incity emergency plan)Pandemic table tops start off slowLegislature has not dealt with funding issuesfor prolonged emergenciesSchool staff resist planning- “This is not anemergency.”


Goals in a Pandemic: Public HealthProtecting the Public’s HealthLimit death and illnessPreserve continuity of essentialgovernment and business functionsMinimize social disruptionMinimize economic losses


Goals in a Pandemic - SchoolsLimit death, illness,and emotionaltraumaPreserve continuity ofessential businessfunctionsMinimize social andeducationaldisruptionMinimize economiclosses


PhasePhases of an Influenza Pandemicand School Incident ManagementDefinition3 Pandemic Alert PeriodHuman infections with a new subtype.No human-to-human spread, or rareinstances of spread to a close contact.456Pandemic Alert PeriodSmall clusters, limited human-to-humantransmission.Spread is highly localized.Pandemic Alert PeriodLarger clusters, but human-to-humanspread still localized: Virus becomingbetter adapted.Pandemic PeriodIncreased and sustained transmission ingeneral population.


Updating Plans: Pandemic InfluenzaIt is different than other typesof planningGet ready for lots of questionsHave the answers or …talk about where thecommunity is in the process


Pandemic Influenza: Prevention/MitigationWith the Community:Review newest World HealthOrganization (WHO), Centers for DiseaseControl (CDC), PHD recommendations,PHD plan, and local emergency plans


Public Health DepartmentProactive MeasuresSchoolclosures


Public Health DepartmentProactive MeasuresSchoolclosureauthorities


F. A. Q. S #1, 5, 6, 7, & 16How is it spread and how do we protectour staff and students? How sure arewe of the information we are relaying?


Pandemic Influenza: Prevention/MitigationIsolation & Infection Control Procedures• Isolation precaution options:– Standard, contact, droplet, airborne• Respiratory hygiene and cough etiquetteCDC Division of Healthcare Quality Promotion• Precaution recommendations ratings:Category 1A Lots of EmpiricalCategory 1B Suggestive EvidenceCategory II Strong TheoreticalCategory NR No Recommendation;Unresolved Issue


Pandemic Influenza: Prevention/MitigationIsolation PrecautionsAdministrative controls• Education• Adherence to precautionsCategory1BInfection control precautions 1B• Hand washing, gloves, gowns• Environmental controls• Use of masksSocial distancing techniques 1B, II, NR


F. A. Q. #2If a child comes to school ill, when shouldavian flu be suspected?


Pandemic Influenza: PreparednessInfluenza-like Illness (ILI)SurveillanceTemperatures above 100.4º FANDOne or more of the following: cough, sorethroat, or shortness of breathANDHistory of contact with domestic poultry orknown or suspected case of H5N1 in anH5N1 affected county within 10 days ofsymptoms


F. A. Q. #3What is social distancing?


Pandemic Influenza:Prevention/MitigationAuthoritiesSocial distancing– District closures (snow days vs. labor strike)– School closures– Libraries, malls, after school day care centersTransportation– Public– Private/contractors– School ownedIsolation and quarantineUnion contracts


Pandemic Influenza:Prevention/MitigationContinuity of BusinessMaintenance of essentialservicesInformation technologycapacityTelecommuting


F. A. Q. #4How long will it take the avian flu tospread throughout the U.S.?


…a newly emerging influenzavirus can wreak catastrophicdamage worldwide in a matter ofmonths.Anthony S. Fauci, M.D.Director, National Institute of Allergyand Infectious Diseases


F. A. Q. #8What is the local government plan relatedto pandemic events?


Pandemic Influenza:Prevention/MitigationSurveillanceSentinel program –Absences beyond 10% with respiratorysymptoms:– Monitored by IT/safety & security &schools– Student absences– Staff absences


F. A. Q. #9What is the best way to teach studentsabout avian flu?


Pandemic Influenza: Preparedness


Pandemic Influenza: PreparednessEducationStaff


Pandemic Influenza: PreparednessEducationStaffStudents:Posters


Pandemic Influenza: PreparednessEducationStaffStudents:PostersCurricula


Pandemic Influenza: PreparednessEducationStaffStudentsParents/volunteersVendors/agencies


Pandemic Influenza: PreparednessEducationResourcemanagementSimulations and drills:Table topFunctional exercises


F. A. Q. #10How is mortality and morbidity predictedfor the avian flu?


Formula for Estimating Health Impacts(per 1000 persons)HealthriskStudentsStaffOutpatient visitsHospitalizationsDeathsHigh289 - 403 70 - 149Other165 - 230 40 - 85High2.1 - 9.0 0.9 - 5.1Other0.2 - 2.9 0.18 - 2.8High0.13 - 7.65 0.1 - 5.7Other0.014 - .13 0.025 - .09Meltzer, M., Cox, N. and Fukuda, K. 1999. The Economic Impact of Pandemic Influenza in the UnitedStates: Priorities for Intervention. Emerging Infectious Diseases, vol. 5:5.


F. A. Q. #12How does the district predict how manystaff might be affected?


Estimated Health Impactsfor a District of 50,000 students and 7,000 staffDistrict with….Otherstudents5% High-riskstudentsOtherstaff10% High- riskstaffOutpatient visits8,25011,5008,56011,933280 595256.9639.8Hospitalizations1014514.25160.251.3 19.61.7321.21Deaths0.76.51.6525.30.20.60.24.6


Estimated Health Impactsfor a District of 50,000 students and 7,000 staffDistrict with….Otherstudents5% High-riskstudentsOtherstaff10% High- riskstaffOutpatient visits8,25011,5008,56011,933280 595256.9639.8Hospitalizations1014514.25160.251.3 19.61.7321.21Deaths0.76.51.6525.30.20.60.24.6


F. A. Q. #18What are essential services for schoolsand school districts?


Pandemic Influenza: PreparednessResource ManagementHuman resourcesFlex timeTelecommutingReassignment of staff toessential services:• Retraining• Union contractsPersonal protective equipmentVaccination priority list


F. A. Q. #20What can the schools do to help thecommunity during a pandemic?


Pandemic InfluenzaIf schools and day care centersare closed, who will take care ofour responder’s children?• Develop a volunteer roster tohelp support their families

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