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Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic

Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic. Catherine Slemp, MD, MPH 2006 Human Resources Summit and Governor’s Safety Conference November 1, 2006. Objectives / Overview. Review Influenza Basics Putting Pandemics into Perspective

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Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic

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  1. Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic Catherine Slemp, MD, MPH 2006 Human Resources Summit and Governor’s Safety Conference November 1, 2006

  2. Objectives / Overview • Review Influenza Basics • Putting Pandemics into Perspective • Why the Concern Now (Avian Flu-H5N1) • Discuss Pandemic Control Measures • Implications for Business • Pan Flu All Hazard Preparedness

  3. INFLUENZA – Key Facts Incubation period ~1-4 days Transmission: Respiratory droplet (coughing, sneezing); Contact? Aerosol? Seasonal Flu causes 200,000 hospitalizations 36,000 deaths / yr Flu Viruses are constantly changing, evolving, reassorting

  4. Influenza Pandemic Viruses Requirements: • A new influenza A subtype that can infect humans AND • Causes serious illness AND • Spreads easily from human-to-human H5N1 meets the first two prerequisites, but not the last Next pandemic virus may or may not be due to a variation of current H5N1 virus

  5. Putting Flu Pandemics in Perspective

  6. 1918: heavy impact on young healthy adults –nation’s workforce Impact of 1918 Pandemic on US Life Expectancy

  7. Daily Deaths in Ohio - 1918 Brodrick OL. Influenza and pneumonia deaths in Ohio in October and November, 1918. The Ohio Public Health Journal 1919;10:70-72.

  8. West Virginia in 1918

  9. Court System COMMUNITY INFRASTRUCTURE Flu stops court, Bluefield Oct. 8, 1918 Business Local Government Newspapers The Bluefield Telegraph Oct. 8, 1918 Huntington mayor dies Oct. 19, 1918 The New Dominion, Morgantown, WV Oct. 24th

  10. “Less than half a dozen families in Fayetteville have illness…Dr. Grose was one of the first victims….” Oct. 10, 1918, The Fayette Tribune “The Mt. Hope-Kilsyth community is credited with over 500 cases and the death rate is on the increase….” Oct. 31, 1918, The Fayette Tribune

  11. Why the Concern Now?“AVIAN” OR “BIRD” FLU: THE H5N1 VIRUS

  12. Update As of 10/31/06: 256 cases; 152 deaths; most poultry related

  13. H5N1 in Humans – 2003-2006 • As of October 31, 2006: 256 cases, 152 deaths (~60%) • Ten countries • Sporadic, with occasional clusters • Most had touched or handled sick poultry • A few cases of probable, limited human-to-human transmission • All lived in countries with poultry outbreaks

  14. Sample Estimate of Morbidity/MortalityWest Virginia* • CharacteristicModerate (1957-68-like) Severe (1918-like) • Illness 540,000 (30%) 540,000 (30%) • Outpatient 270,000 (50%) 270,000 (50%) • Hospitalization 5,314 60,813 • ICU Care 791 9,123 • Ventilators 399 4,558 • Deaths 1,284 11,690 * based upon DHHS U.S. estimates applied to WV population numbers. These are in the absence of potential interventions.

  15. Much we don’t know … about the next pandemic • When will it occur? • Which virus will cause it, H5N1 or another? • Who will be most at risk (Elderly and infants? Healthy adults? Children?) • How severe an illness will it cause? • Will there be multiple waves? • Will antiviral medication work? • How long until we have a vaccine? • What are the best control measures?

  16. Understanding Disease Spread

  17. Ro = 2 R0 = 1

  18. Ways to Increase “Social Distance” • Implement “Community Shielding” recommendations • Close or alter high risk transmission environments e.g. schools, daycare centers if supported by epidemiology • Cancel large public gatherings (concerts, theaters) • Minimize other exposures (markets, churches, public transit) • Encourage ill and exposed persons to stay home (isolation and quarantine) • Encourage telecommuting; other worksite adaptations • Scaling back or altered transportation services (holiday schedule) • Consider additional community measures • COOP to minimize economic impact • Distribution of surgical masks, barrier precautions, hand hygiene

  19. Planning Pandemic Control Measures

  20. Potential Tools in Our Toolbox • Our best countermeasure – vaccine – will probably be unavailable during the first wave of a pandemic • Antiviral treatment may improve outcomes but will have only modest effects on transmission • Antiviral prophylaxis may have more substantial effects on reducing transmission • Infection control and social distancing should reduce transmission, but strategy requires clarification

  21. Community interventions What does history and modeling tell us? What planning can be done now?

  22. A Tale of Two Cities Weekly mortality data provided by Marc Lipsitch (personal communication)

  23. Value of combining strategies – Longini model

  24. Residences Workplace / Classroom Social Density Offices Hospitals 7.8 feet Elementary Schools 16.2 feet 11.7 feet 3.9 feet http://buildingsdatabook.eren.doe.gov/docs/7.4.4.xls

  25. Spacing of people: If homes were like schools *Based on avg. 2,600 sq. ft. per single family home

  26. Spacing of people: If homes were like schools *Based on avg. 2,600 sq. ft. per single family home

  27. Labor Status of Parents in U.S. 66 million 18 million 5 million 8 million 9 million Source: U.S. Census Bureau, Population Division, Current Population Survey, 2003 Annual Social and Economic Supplement http://www.census.gov/population/www/socdemo/hh-fam/cps2003.html

  28. What are limits of this data? • Observational data from 1918; data incomplete; cannot link cause and effect • Modeling impact of different interventions. Useful, but • Doesn’t yet incorporate impact of people’s behavioral responses to interventions • Doesn’t incorporate secondary consequences of interventions (e.g., effects of school closure on education, workforce, etc.) • Does help shape discussion.

  29. A Targeted and Layered Approach

  30. A Layered Approach Individual / Household / Business Hand hygiene Cough etiquette Infection control Living / working space adaptation Isolation of ill & designated care provider Community Isolation of ill Treatment of ill Quarantine of exposed Prophylaxis of exposed School closure Protective sequestration of children Social distancing - Community - Workplace Liberal leave policies International Containment-at-source Support efforts to reduce transmission Travel advisories Layered screening of travelers Health advisories Limited points of entry

  31. Epidemiology Drives Approach(Targeted) SAMPLE

  32. Remember: We have a Tool Kit of Control Measures to Use • Community Shielding (many methods) • Hygiene measures • Antivirals (treatment; prevention, if supplies sufficient) • Vaccine • Continuity of Operations Planning

  33. Current Thoughts on Control Measures • Earlier rather than later implementation of measures more likely to be effective • Targeted and layered application of measures (e.g., combinations are more effective than a single measure at a time; scale response based on severity of pandemic) • Communities must consider practicality and ethics of implementing any measure. • Transparency • Public discussion and dialogue • Planning • Coordination across jurisdictions

  34. Tackling This from the Business Perspective • Educate Leadership and Staff • COOP, COOP, COOP (Continuity of Operations) • Personnel Policies • Knowing your Workforce • Employee and Family Safety • Employee Communications • Contributions to / Participation in Community Response

  35. Interesting Correlation Businesses truly embracing a culture of preparedness High performing businesses everyday

  36. What does this take? (Now and when the time comes) Leadership Imagination Resiliency of Businesses and Communities

  37. Contributors to Historical Analysis and Modeling HSC/NSPI Writing Team Richard Hatchett, MD Carter Mecher, MD Laura McClure, MS CDR Michael Vineyard Modelers Joshua Epstein, PhD Stephen Eubank, PhD Neil Ferguson, PhD Robert Glass, PhD Betz Halloran, PhD Nathaniel Hupert, MD Marc Lipsitch, MD Ira Longini, PhD NVPO Bruce Gellin, MD Ben Schwartz, MD Department of Education Camille Welborn, MS HSC Rajeev Venkayya, MD Ken Staley, MD, MPA Department of Labor Suey Howe, JD Department of the Treasury Nada Eissa, PhD Chris Soares, PhD John Worth, PhD NSC Rita DiCasagrande, MS NIH James Anderson, PhD Irene Eckstrand, PhD Peter Highnam, PhD Ellis McKenzie, PhD CEA Steven Braun, PhD Department of Finance - Canada Steven James Timothy Sargent CDC David Bell, MD Martin Cetron, MD Rachel Eidex, MD Lisa Koonin, MN, MPH Anthony Marfin, MD RTI Philip Cooley, PhD Diane Wagener, PhD University of Michigan Howard Markel, MD

  38. Get Informed, Be Prepared! RESOURCES • WV Bureau for Public Health: http://www.wvflu.org • Your Local Health Department or Emergency Management Agency • USDHHS: http://www.pandemicflu.gov • Seattle-King County Health: http://www.metrokc.gov/health/pandemicflu/ • CDC: www.cdc.gov

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