Pandemic Influenza: How sick might we be? October 12, 2006

1. Pandemic Influenza: How sick might we be?October 12, 2006 Wayne D. Williams Director of Logistics Logistics Health Incorporated

2. 2 Monday, August 28, 2006 It's the first day of instruction on campus. Tracy, a 2nd year pre-med student, is coming down with a cold but feels well enough to go to all her classes. She lives in a student co-op where she works in the kitchen. On Thursdays she volunteers at the Health Center; this week she helped care for a Chinese-speaking patient with an “asthma attack.”

3. 3 Tuesday, August 29, 2006 Tracy develops a low-grade fever, a dry cough, and loose stools. She decides she has the “stomach flu” and takes over-the-counter medications to treat her symptoms. She attends her crowded classes that day and has a persistent annoying cough. That night after preparing dinner for the co-op she is too tired to study and goes directly to bed. She wakes up with chills, drenched in sweat, and with body aches. She decides to wait a few more hours until morning before seeking medical care.

4. 4 Wednesday, August 30, 2006 At 4am, Duty Officer at the Health Department receives a phone call from the Hospital that a Chinese-speaking male was admitted with his wife and brother-in-law, all with atypical pneumonia and difficulty breathing. The patients recently visited family in southern China and returned to the U.S. last week. The family goes to the Community Health Center for their medical care because they have no health insurance.

5. 5 Wednesday, August 30, 2006 (cont'd) The Health Department decides to notify physicians, hospitals, and local health officials about the cluster of atypical pneumonias associated with a recent traveler to southern China. They ask Emergency Departments to increase their surveillance. By Wednesday afternoon, the CDC learns that outbreaks of atypical pneumonia are being reported from southern China.

6. 6 Wednesday, August 30, 2006 (cont'd) Tracy wakes up too sick to go to classes and goes to the hospital emergency department. She sits in a waiting room full of patients for about on hour with a persistent cough and no face mask. Upon evaluation, her oxygen saturation is 88% and chest X-Ray shows diffuse pneumonia. She is admitted to the hospital and placed on oxygen and antibiotics.

7. 7 Thursday, August 31, 2006 In the morning, based on news reports of influenza-like outbreaks in southern China, the Governor’s office is flooded with calls from the press and concerned citizens wanting to know the following: What is the State doing? Is the State prepared? Will the State restrict travel to and from China? How many isolation rooms are ready? How will policy decisions be made and who has input?

8. 8 Friday, September 1, 2006 In the morning WHO confirmed by electron microscopy and PCR that these outbreaks are highly likely attributed to a strain of avian influenza virus. At 3pm, the CDC announces a Travel Advisory for southern China. It is Labor Day weekend: people leave work early.

9. 9 Saturday, September 2, 2006 Tracy takes a turn for the worse. She develops acute respiratory failure requiring intubation and mechanical ventilation. Her doctors get an infectious disease consultation. Pulmonologists perform bronchoscopy, bronchial alveolar lavage, and transbronchial biopsy. All cultures and stains are nondiagnostic. Her clinical status deteriorates and she expires at 7:31pm. Her parents, are at her bedside.

10. 10 Saturday, September 2, 2006 (cont'd) At the Hospital ED, the attending physician notices that 3 students from the same co-op presented with diarrhea, cough, and low grade fevers. The students report that several additional co-ops members are ill. The physician tells them this is most likely a viral gastroenteritis and that they should get better within 48 hours. Over the next 24 hours, 5 nurses do not come to work; 3 are hospitalized with atypical pneumonia, 2 of them at other hospitals. The ED and hospital infection control do not have this information.

11. 11 Sunday, September 3, 2006 On the 10 O'clock News, the anchor reports a mysterious outbreak of a flu-like illness at a student co-op leaving one student dead. They also report that 5 health care workers from local Hospitals have now been hospitalized with pneumonia, 1 of them is in critical condition.

12. 12 Monday, September 4, 2006 The skeletal public health staff meet and outline some of the investigative and disease control issues for an interagency Task Force meeting later in the day: Where and how was Tracy infected? How many students has she exposed? Are we prepared for an explosion of cases? Could this be intentional microbiological release (bioterrorism)? Should we quarantine the university?

13. 13 Monday, September 4, 2006 (cont'd) By late afternoon, all area hospitals are reporting the evaluation and admission of students with atypical pneumonia consistent with influenza. All hospitals are all on diversion because their hospital beds, ICU beds, and respiratory isolation rooms are full with infected health care workers. Students not requiring admission are being told to return to their homes or residential housing, to stay in their rooms, and that they will be contacted by the health department.

14. Tuesday, September 4, 2006 Residents awake to morning news reports of widespread illness, crowded emergency rooms, and hospitals so short-staffed they are turning away patients. Over the next several weeks, 40% of school-age children become ill and 1 of every 5 adults become so ill they are unable to work. Absenteeism soars as people stay home from work to care for sick family members, while fear keeps others at home.

15. 15 Are you ready?

16. National Strategy for Pandemic Influenza • Preparedness and Communications • Surveillance and Detection • Response and Containment

17. Planning Assumptions: Health Care • 50% or more of those who become ill will seek medical care • Number of hospitalizations and deaths will depend on the virulence of the pandemic virus

18. Pandemic Preparedness • Early intervention • Detect and contain where it emerges, if feasible limit international spread, decrease illness and death, buy time • Pharmaceutical countermeasures • Vaccines • Antivirals • Non-pharmaceutical interventions • Isolation for people with illness • Quarantine for those exposed • Social distancing

19. Countermeasures: Vaccines, Antivirals, andMedical Supplies

20. FY2006 Emergency Supplemental Budget: $3.8 billion • $350 million for upgrading State and local capacity • $50 million for laboratory capacity and research • $246 million for international activities, surveillance, vaccine registries, research, and clinical trials • $2,750 million to support other core activities: • expanding domestic production capacity of influenza vaccine • developing and stockpiling pandemic vaccine, • stockpiling antivirals and other medical supplies to protect and preserve lives

21. State and Local Business Faith-based & Community Organizations Family and Individual Physician Offices and Ambulatory Care Emergency Medical Services Travel Industry Education (K-12) Colleges & Universities Child care Home Health Correctional organizations Health insurance Social service agencies Police Pandemic Influenza Preparedness Checklists www.pandemicflu.gov

22. Economic Impact: SARS • Toronto, 2003 • 14 weeks, 375 cases, 44 deaths • 9 conventions cancelled • 12,000 lost jobs • Cost over $1 billion in 2003 • 2 years for economic indicators to return

23. Economic Impact: Pandemic Flu • Duration likely 12 – 18 months • Foreign trade and travel reduced • Transportation may be limited • High absenteeism • Supply chains disrupted • Many overseas • Problem with thin inventories • Just-in-time delivery • Critical infrastructure challenges • Food, water, electricity, sanitation, health care

24. What your organization can do • Stay informed • Prepare for the common flu • Adopt social distancing practices • Expand online business and telecommuting • Develop strategies for high customer contact • Determine how to minimize disruptions • Collaborate with local health officials and hospitals • Create a business continuity plan

25. What your organization can do • Review your plan, and update regularly • Share the plan; those who need to understand it do • Stakeholder scenarios: employees, customers, consumers, media • Practice • Testing and drilling • Tabletop exercises

26. Remember… “[Hurricane] Katrina was the most anticipated natural disaster in American history, and still government managed to fail at every level.” David Brooks, NY Times, 9/11/05

27. The only thing harder than planning for an emergency is explaining why you didn’t.