Charity at a Distance?

1. Cypress Stake Table-Top Exercise Charity at a Distance? Presented by: Kory Mikesell Stake Emergency Preparedness Chairman 4-19-07

2. Overview • Introduction. • Bird Flu Basics • What is a Pandemic. • What we know. • What we don’t know. • How can we prepare? • How will we react?

3. Why the pandemic isn’t Global Warming Global Warming Pandemic Flu • 1918, 1957, 1968 • H5N1 • Experts all agree • UN upgrading impact • Not a Political issue • May happen anytime! • No “Al Gore” • Hasn’t happened before • Multiple possible sources • Experts disagree • UN lessened impact • Political issue • Impact 50/100 yrs

5. Bird Flu Basics

6. Bird Flu Basics Excerpted from a presentation by: Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

7. Bird flu basics Why are we concerned about A (H5N1)? Ongoing human infection with A (H5N1). 241 cases / 141 deaths in 10 countries (as of 8/23/06). Occurring in countries with poor protective measures. Co-circulating with human influenza viruses which can increase the odds of genetic reassortment. Can lead to a new pandemic strain; human population would have NO existing immunity. Ongoing reservoir in wild birds. Migratory patterns make the spread of A (H5N1) to the US inevitable. Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

8. Traveling slower than originally expected. Associated with illegal bird trade? A problem in Los Angeles?

10. Los Angeles Times (Sunday, October 22, 2006) Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

11. First Case of Avian Influenza in Anaheim Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

12. Bird flu basics Why are we NOT concerned about A (H5N1)? No (very rare) human-to-human transmission. Even when does arrive…… - unlikely to affect our food supply; - human infection from wild birds also unlikely. While there have been human cases, human cases are still very rare/uncommon. avian flu DOES NOT = pandemic flu If not A (H5N1), then another? ……Maybe….. Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

13. Why do we care? Even in non-pandemic years, considerable morbidity and mortality + 36,000 excess deaths/year + 100,000 hospitalizations + especially serious for: very young, elderly, those with chronic health conditions Affects almost everyone Normal season = 10-15% population sick Severe season = more than 20% and more sick In LAC = 1 million sick during a mild season

14. Why do we care? Causes more morbidity and mortality than any other vaccine preventable disease One of the most significant Infectious diseases in human history 1918–1919 Spanish Flu 20-40 million deaths worldwide 75 % of the deaths in WW1

16. What is a Pandemic?

17. Pandemic Flu Basics Pandemic = worldwide illness Requires many aspects: efficient person-to-person spread little to no existing immunity in the population results in increased mortality in the young/healthy These are inevitable: naturally recur in cyclical intervals we are “past due” for the next pandemic its ultimate onset (when?) and severity is unknown Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

18. Isolation: separating ill from well Quarantine: separating exposed well Possible/practical for flu? Flu can be transmitted before development of symptoms… Who has been exposed? Who is ill? Isolation(cohorting the sick)is a critical step for infection control in medical settings(hospitals and nursing homes). Possible on college campuses? Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

19. Influenza Pandemics 20th Century unique situation 1968: “Hong Kong Flu” 1918: “Spanish Flu” 1957: “Asian Flu” A(H1N1) A(H2N2) A(H3N2) 1-4 m deaths 34,000 US deaths 20-40 m deaths 675,000 US deaths 1 % of the US population 1-4 m deaths 70,000 US deaths Sadina Reynaldo, PhD Acute Communicable Disease Control Los Angeles County Dept. of Public Health

20. Mortality rates for Spanish Flu

21. Requirements for Pandemic Dr. Anthony S. Fauci Director National institute of Allergies and Infectious Diseases National Institutes of Health • Virus appears in foul in restricted geographic settings • Virus spreads to foul in broader geographic settings • Virus spreads from foul to mammals • Virus spreads from foul to humans inefficiently • Virus spreads from foul to humans with increasing efficiency • Virus spreads from human to human inefficiently • Virus spreads from human to human efficiently

22. Requirements for Pandemic Dr. Anthony S. Fauci Director National institute of Allergies and Infectious Diseases National Institutes of Health H5N1 “Bird Flu” • Virus appears in foul in restricted geographic settings • Virus spreads to foul in broader geographic settings • Virus spreads from foul to mammals • Virus spreads from foul to humans inefficiently • Virus spreads from foul to humans with increasing efficiency • Virus spreads from human to human inefficiently • Virus spreads from human to human efficiently Not Yet………..

25. As of March 1st 2007277 Infected167 DeadThat’s 60%

26. Why Is It So Prevalent in South East Asia?

28. We Need Experts to Help Guide Our Decisions.We have a bird Problem Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google.

29. Two Very Different “Avian Flu” Expert Communities Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google. The “Chicken Little” The sky is falling… The sky is falling… The “Ostriches” with their head in the sand.Waiting too long….Denying the problem

30. Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google. We need a different type of bird.“A wise old owl” As we try to make decisions under conditions of uncertainty we would like to find some prescient experts to guide our decisions and scenarios, but experts themselves vary from chicken little, to ostriches…… …How can we try to find the Owl’s wisdom?

31. Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google. Pandefense Survey November 2005 a symposium was held in San Mateo CA, with 20 “experts” (epidemiologist, flu-ologists, virologists) and 20 “other experts” (Business Continuity Specialists, Economists, Social Scientists, Risk Evaluators) to reach a “best-guess” consensus estimates to use for scenario planning.

32. Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google. Pandefense Survey- Variables in the Survey - • Estimates of likelihood and severity • Morbidity • Mortality • Consensus of Best and Worst Case scenarios • Vaccines – Human and poultry • Antivirals • Social Distancing • Business Continuity • Risk Communications

33. Dr. Larry Brilliant Epidemiologist, Executive Director of Google.org, the philanthropic arm of Google. Pandefense Survey- Variables in the Survey - 15% 3 yrs / 90% 20 yrs • Estimates of likelihood and severity • Morbidity • Mortality • Consensus of Best and Worst Case scenarios • Vaccines – Human and poultry • Antivirals • Social Distancing • Business Continuity • Risk Communications World = 650m / 2.8b US 25m / 200m World = 6m / 200m US 300k / 5m (next slide) 1/3 pop - 94% Said no 1/3 - 90% Said no Lessen impact by 1/3 (next slide) (next slide)

34. Experts: What are the most important consequences of a “Worst-Case” outbreak other than morbidity & Mortality Commerce Disruption: Transportation Communications Bankruptcy Economic depression Public Safety Disruption: Public Panic Lawlessness Violence Riots Heath Care Disruption: Hospital overloaded Staff Shortages Shortage of Supplies Political Unrest: Loss of trust in Gov. Wars over shortages Rise in Fascism Global Terrorism Food Shortages: Disruption of supplies Famine The needy starving Long Term Effects: Migration Social Fabric disruption Demographic Psychological

35. What does LDS.org say? Go to LDS.org. Type in “Pandemic” You’re Sent to Provident living.org Which Links you to Pandemicflu.gov

36. What does Pandemicflu.gov say? • Social Disruption May Be Widespread • Being Able to Work May Be Difficult or Impossible • Schools May Be Closed for an Extended Period • Transportation Services May Be Disrupted • People Will Need Advice and Help at Work and Home • Be Prepared • Stay Healthy

37. What we don’t know

38. How could this effect our Stake? Approximately 4000 Souls Between 1200 / 2000 ill (Morbidity) Between 36 and 200 deaths (Mortality) Average age of dead would be 35! 5% of this room could be dead

39. Cypress Stake Action Plan Mitigation Preparation Response Recovery

40. Mitigation Questions: Can we stock up on supplies? Masks, gloves, Antivirals Who will pay for supplies? Who will keep the supplies? How will we distribute them?

41. Preparation Questions: How should we prepare? Stake Preparedness Fair? Should we have Ward level training? What should that training entail?

42. Response Questions: Will we cancel Church meetings? (Sacrament, Mutual, Ward Council etc.) What criteria will be used? Government, Internet, Church Head Quarters? Who will make that decision? Stake Presidency, High Council, each Bishop?

43. Response Questions: cont How will we get the word out? Home Teachers? Phone Trees? How will triage the sick and needy? Every ward has members that can’t cope with day- to-day problems. How are we going prioritize the needs of the Stake? How will we protect the lives of our Bishops and Relief Society Presidents? How will we communicate?

44. Recovery Questions: cont With the Pandemic there will be: Loss of life Loss of income Loss of jobs. What will we do?

45. Review

46. Questions?

47. Thank you For your Attention & contributions