Pandemic Flu Preparedness

1. Pandemic Flu Preparedness

2. Threat: Hype or Real? Pandemics • Ten recorded over past 300 years • Range between events 10-49 years, average 24 • No predictable pattern • Three in the past century • 1957-58 – reassortment event • 1967-68 – reassortment event • 1918-20 – mutation event with markers similar to those found in birds

3. Threat: Hype or Real? A pandemic today is likely to: • Spread rapidly and span the globe in weeks • Affect 15-30% of the population of any one country within weeks • Have greater socio-economic impact • Impact supply chains • Not easily contained

4. Threat: Hype or Real? • It is the H1N1 type that causes seasonal influenza worldwide each year and kills tens of thousands of people. Other strains of H1N1 are endemic in pigs (swine flu) and in birds (avian influenza). • The danger here isn’t that pigs, or turkeys will get and transmit the novel H1N1 virus to people – there is already plenty of that virus floating around the human population - it’s that they could enable a reassortment of the virus to occur. • This novel form of H1N1 flu strain has evolved with genes from human, pig, and bird flu viruses combined. The use of the term swine flu or swineflu is therefore something of a misnomer

5. Threat: Hype or Real? • The pandemic virus wending its way around the globe is a reassortment of human, swineand avian flu viruses, and previous pandemics have been launched by similarly derived mutations. • We worry most about pigs because they are uniquely susceptible to human, swine, and bird flu strains – making them a likely `mixing vessel’ for influenza’s. In recent months we’ve seen herds of pigs that have picked up the virus, presumably from infected humans. • The discovery of novel H1N1 influenza in Turkeys this past week in Chile has raised concerns that poultry may become another possible avenue for reassortment of the pandemic virus with other flu strains. • But reassortments can occur in any host;  humans, swine, birds . . . any host capable of being infected by influenza viruses. 

6. Threat: Hype or Real? • The danger here isn’t that pigs, or turkeys will get and transmit the novel H1N1 virus to people – there is already plenty of that virus floating around the human population - it’s that they could enable a reassortment of the virus to occur. • While this is a theoretical concern, no one knows how likely it is to actually happen.  We know it does happen, but a reassortment that results in a biologically `fit’, and easily transmitted virus would seem to be a fairly rare event. • Else we’d be hip deep in new viruses all the time. • Today, from the UN’s Food and Agriculture Organization (FAO), we get this report on concerns over this reassortment possibility .

7. Q & A

8. Preparedness Planning Getting Started!!

9. Preparedness Planning Why plan? • More effective response to any public health emergency • Social responsibility to prepare for a potential catastrophic event • Potential increase in liability for failure to plan • Maintain continuity of essential services

10. Preparedness Planning Nine Planning Steps: 1. Identify who to engage on your campus to get pandemic planning on the table (see committee list below) 2. Establish a Pandemic Preparedness Team (Decision Making Vs Response.) 3. Identify appropriate channels of communication and chain of command 4. Create a contingency plan. Does your school have an emergency response plan/template? Can it be tailored to pandemic planning?

11. Preparedness Planning Nine Planning Steps, continued: • Identify essential functions and personnel (additional cleaning, care for ill students in dorm., etc) • Articulate duties and delegate responsibility to staff and faculty • Provide advisories and regular updates to traveling staff, faculty and students • Educate campus community on pandemic flu and your institution's plan response (posters, memos, email, etc.) • Communicate regularly as the threat heightens

12. Preparedness Planning Identify Planning Committee Members • Executive management (President, Provost, COO, VP. Student Affairs, VP Admin., HCCS) • Student Affairs (Student Health, Child Care, Housing, Mental Health, Dining Svces., etc.) • Public Safety • Environmental Health & Safety • Public Affairs • Government Relations • Facilities Management • International Student Services • Human Resources • Risk Management • Information Technology/Telecommunications • Operations and Finance

13. Preparedness Planning Organize Response Executive Steering Group Pandemic Preparedness Team Dept. Teams Dept. Teams Dept. Teams Dept. Teams

14. Preparedness Planning Contingency Planning Assumptions • Large percentage of students and staff who will become affected, as much as 40%. • Large Numbers Hospitalized • Fatalities

15. Preparedness Planning Contingency Planning Assumptions (cont.) 1. A pandemic flu will result in the rapid spread of infection throughout the world. 2. You will not be able to reply on mutual aid resources, or state or federal assistance to support local response efforts. 3. Antiviral medications will be in short supply. Local supplies will be prioritized for use in hospitals, for health care workers, and other groups based on DOH guidelines. 4. A vaccine will not be available for 4-6 months following the emergency of a novel strain.

16. Preparedness Planning Contingency Planning Assumptions (cont.) 5. The number of ill requiring medical care will overwhelm the local health care system (More patients and fewer workers) 6. The number of fatalities will overwhelm the medical examiners office, hospital morgues, and funeral homes. 7. The demand for home care and social services will increase dramatically and won’t be available 8. There is likely to be a significant disruption of public and privately owned critical infrastructure including transportation, businesses, utilities, public safety, and communications.

17. Preparedness Planning Determine triggers for Moving Plans to Action • Short window for critical decision making • Reducing the number of students on campus may be best strategy • Resources/expectations for care/support • Once closed, when do you reopen? • 8-12 weeks to avoid resurgence of illness • Define closing – no classes? No research? • Lock down of all buildings?

18. Preparedness Planning Challenges to Planning • Requires multi-faceted, multi-departmental effort over time • Deficits in knowledge • No case definition • Gaps in our understanding of viruses • Gaps in our understanding of which strategies are most effective

19. Preparedness Planning Challenges to Planning • Consider the what ifs • We can’t send all students home • We have students who are ill and the local health systems are overwhelmed • We must work with a reduced staff • Allocation of resources • Stockpile goods? How much? • Questions of ethical nature

20. Preparedness Planning Planning in the Present • Based on current knowledge and understanding • Inclusive, collaborative • Plans must be flexible, adaptable, resilient • Plans must be tailored to the particular type of institution • Plans must be tested and rehearsed

21. (Good time for a break, announce the next section focuses on specific groups and we need help identifying responsibilities –preparedness by sector).

22. Preparedness Planning By Sector

23. Preparedness Planning - Student Health Services • Health Service Staff education and preparation • Supplies/equipment/services • Identify vendors/storage • Cost estimate for stockpiling/storage • Clinical Issues • Consult with HR regarding use of volunteers • Plans for setting up an infirmary – staffing, location? • Protocol for monitoring cases in quarantine • Triage and treatment protocols • Care of the deceased – morgue/notification of family • Plans for mass immunization clinics

24. Preparedness Planning - Counseling Services • Anticipate high need • 24/7 counseling for staff, faculty, students • Protocols for providing service via telephone or internet

25. Preparedness Planning - Housing Services • Identify rooms and buildings for quarantine, isolation and residence for students who cannot go home • Develop a procedure for closure and evacuation of residence halls • Procedures for notifying and relocating students • Housekeeping staff trained in personal protection and proper cleaning • Communication protocols between Housing and Residence Life

26. Preparedness Planning - Dining Services • Stockpiling and storing non-perishable food stuffs and fluids • Procedures for delivery to residential areas

27. Preparedness Planning - Campus Security and Environmental Health & Safety • Procedures for securing buildings, protecting stored supplies • Communication with local police, fire, and emergency response • Protocols for transporting sick students • Fit, tested, and trained for use of N95s (flu kits for sick people) • Equip cars with disinfectants, gloves, etc.

28. Preparedness Planning - International Students and Study Abroad • Plans for communicating with students abroad • Guidelines for closure of study abroad programs • Procedures for monitoring student travel • Procedures for communicating to international students about travel restrictions and re-entry • Tuition Refund Policies

29. Preparedness Planning -Physical Plant • Contingency plans in case of fuel, water and energy shortages • Emergency generators??? • Building ventilation systems. Changing filters more frequently? Cleaning Freq.?

30. Preparedness Planning – Human Resources • Identify essential personnel and depth charting • “Call-offs,” vacation, and sick leave guidelines • Return to work guidelines • Work-at-home guidelines • Recruitment of volunteers • Communications for supervisors and campus work force • Benefit Plans

31. Preparedness Planning -Academic Affairs • Policies for student absenteeism due to illness/quarantine • Alternative procedures for completing course work (backup plan for evaluating students, distance learning, blackboard, etc.)

32. Preparedness Planning -Research • Can some research continue? (animal feeding? culling?) • Plan for maintaining security in labs. • Plan for care of lab animals. • Plan for specimen storage and managing experiments in progress.

33. Preparedness Planning - Business and Finance • Procedures for rapid procurement of goods • Continuation of payroll functions • Emergency funding issues • Contracts • Insurance

34. Preparedness PlanningAdmissions/Financial Aid • Plan for reviewing applications and recruiting in absence of face-to-face interviews or campus visits. • Contingency plans for dealing with financial aid, withdrawal from school, other factors related to tuition and registration.

35. Preparedness Planning Recovery Plan • Criteria for calling an end to the crisis and resuming business • Communication plan for advising students, staff, faculty of plan to resume business • Timeline for restorations of operations • Plan to debrief

36. Q&A/Feedback

37. 4 Lines of Defense • Surveillance • Vaccines • Containment measures • Medical treatment

38. Surveillance

39. Vaccines, Treatment • Will not be available at the start of pandemic. • There will not be sufficient amounts to vaccinate everyone (identify most vulnerable groups). • Tamiflu, is an antiviral, not a vaccine • Tamiflu: no country has enough stockpiled to protect all of their citizens • Used to treat essential workers such as healthcare workers and emergency responders.

40. Containment Management Action • Continually monitor employee health • Encourage and make available use of hand sanitizers and gloves • Frequently sanitize hand railings, door knobs etc.

41. Containment Measures Personal care • Seasonal influenza immunizations • Social distancing when feasible • Frequent and vigorous hand washing • Respiratory hygiene/cough etiquette • Refrain from shaking hands • Restrict travel to and in infected areas • Avoid contact with live poultry

42. Medical Treatment/Facts • Early detection with treatment is stressed • Virus can survive in environment 6-35 day • droplet infection • depending on temperature • Incubation period in humans ranges from 2-17 days • 7 day range current WHO standard for observation • Antibiotics not effective in treating pneumonia

43. Communication Internal Communication Plan • Establish a central reporting plan • Determine Communication Mechanisms • Designate a Spokesperson • Have established protocol for printed materials development and dissemination

44. Communication External Communication Plan • Collaborate with credible sources • Collaborate with media relations • Maintain communications with local public health authorities, emergency preparedness groups, hospital systems • Benchmark activities/planning of other like colleges and universities

45. State and Local Health Departments Threat Immunization Lab Services College and University Campuses

46. Communication Messages will need to address: • Symptoms and transmission of influenza • Geographic spread • Current case counts • Designated treatment sites • Vaccine availability • Information about canceled public events and meetings • Quarantine laws and enforcement • Need for volunteers

47. Communication Post- Pandemic Communications • Recovery time varies depending on the intensity of loss. • Within reason, overlook dress codes, personal phone calls, allow time off for family matters. • Be truthful about job security. • Encourage talking • Create situations for positive group events • Be aware of signs that indicate need for professional help.

48. Q & A