NOVEL INFLUENZA A (H1N1) VIRUS RESPONSE

1. NOVEL INFLUENZA A (H1N1)VIRUS RESPONSE Greenwich Department of Health July 22, 2009 Caroline C. Baisley, MPH Director of Health Tom Mahoney, MS Public Information Officer

2. EVENTS HAPPENING PRIOR TO 6TH GRADE STUDENT H1N1 OUTBREAK AT FIELD TRIP CAMP (May 18-22, 2009) • Novel Influenza A (H1N1) virus was detected in April 2009 • Public Health Emergency declared by World Health Organization (WHO) on 4/25/09 Pandemic Alert Level raised to Phase 3 • Conference call from State Public Health Officials to local Health Directors and School Superintendents – 4/29/09 • WHO raised H1N1 Pandemic Alert Level to Phase 5 on 4/29/09 • H1N1 Outbreak Worldwide – 1,882 cases - by WHO on 5/6/09 2

3. EVENTS HAPPENING PRIOR TO 6TH GRADE STUDENT H1N1 OUTBREAK AT FIELD TRIP CAMP (May 18-22, 2009) • CDC Travel Release – recommends against non-essential travel to Mexico – 5/9/09 • H1N1 Outbreak in US – 3352 confirmed cases in 44 states and DC and 3 deaths as of 5/13/09 • H1N1 Outbreak in Mexico – 2,446 confirmed cases and 60 deaths as of 5/18/09 • H1N1 Outbreak in CT – 56 confirmed cases and no deaths as of 5/18/09 3

4. 6TH GRADE MIDDLE SCHOOL OVERNIGHT CAMP CLASS TRIP (May 18-22, 2009) • Camp • Week long program full of environmental experiences • Middle School 6th Grade Class • 146 students in class • 133 students on trip (52 female / 81 male) • 8 teachers • 8 cabins • 3 buses 4

5. 6TH GRADE MIDDLE SCHOOL OVERNIGHT CAMP CLASS TRIP (May 18-22, 2009) • Monday, May 18, 2009 • Students board buses for camp facility • Wednesday, May 20, 2009 – 10:00 AM • Director of Health receives call from Superintendent of Schools – “Medical Emergency” • Approximately 55 students in camp infirmary with multiple symptoms (cough, sore throat, diarrhea, fever, chills, etc.) • Of the 55 students, 19 were very sick with fever, sore throat, etc. and had to go home 5

6. 6TH GRADE MIDDLE SCHOOL OVERNIGHT CAMP CLASS TRIP (May 18-22, 2009) • Investigation Results So Far Of the 133 students on the trip • 72 students became ill • 39 students reported no illness • 22 had an unknown illness status Of the 72 students reporting illness • 45 were tested for Influenza A (H1N1) • 37 were found by PCR to have Novel H1N1 infection (Greenwich Hospital) 6

7. 6TH GRADE MIDDLE SCHOOL OVERNIGHT CAMP CLASS TRIP (May 18-22, 2009) • Investigation Results So Far, Cont’d) The most common symptoms among confirmed ill students were (Greenwich Hospital): • fever - 87% • sore throat – 63% • cough – 84% 7

8. 3 MAIN CATEGORIES IDENTIFIED • LEADERSHIP (Decision Making) • COMMUNICATION • PARTNERSHIPS 8

9. Leadership (Decision Making) • Both Departments assumed leadership in making decisions • Canceling the remainder of the trip was based on: • input from the Director of Health • number of ill students • severity of illnesses • inability to care for ill students • increased risk of additional illness • heightened awareness of Influenza A H1N1 virus 9

10. Leadership Problems Identified A power struggle between Departments: • Education - needed to defend the action of bringing students aback • Health - needed to investigate student illnesses and work with Hospital 10

11. Leadership Action Taken • Health – notified State Department of Public Health and Greenwich Hospital • Education – notified parents and school staff 11

12. Communication • Both Departments were obligated to communicate information • prepare news releases • talk to the media • provide guidance and educational materials - both factual and anecdotal information was available 12

13. Communication Problems Identified Timeliness of getting the message out with one voice. • Health - wanted factual information for release • Education - wanted an immediate response, thus using mostly anecdotal information 13

14. Communication Problems Identified, Cont’d Both Departments struggled to disseminate a common message • Health – offered explanation on virus activity and the need for accurate information • Education - offered explanation on delaying communication with parents 14

15. Communication Actions Taken • Health – • drafted joint press release • met with government agencies, EMS and Hospital • provided guidance for attendance in schools and posted it on Town Website • supported Education as the common voice with input 15

16. Communication Actions Taken, Cont’d • Education – • Notified parents through daily updates on the website • Arranged press conferences with teachers, parents and media • Arranged public meeting with parents with state and local health officials attending 16

17. Partnerships Lessons Learned • Each agency needs to establish its role and respect each other’s jurisdiction • Each agency needs to work on enhancing its partnership and confidence level • Each agency needs to share contact information for key responsible staff 17

18. Partnerships Lessons Learned, Cont’d • Each agency needs to agree on communication process • Each agency needs to work on coordinating responses collectively 18

19. 19

20. 20

21. 21

22. 22

23. 23

24. 24