1 / 68

Case Study: Pandemic Flu Scenario January 11, 2007 Newark, NJ

Case Study: Pandemic Flu Scenario January 11, 2007 Newark, NJ.

katy
Download Presentation

Case Study: Pandemic Flu Scenario January 11, 2007 Newark, NJ

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study: Pandemic Flu Scenario January 11, 2007Newark, NJ This public health case study was developed by the Center for Public Health Preparedness at the State University of New York at Albany. It has been adapted by the New Jersey Preparedness Training Consortium and Rutgers Nursing Center for Bioterrorism and Emerging Infectious Disease Preparedness for use in training health care professionals under HRSA Grant No. T01HP01407 RUTGERS COLLEGE OF NURSING CENTER FOR PROFESSIONAL DEVELOPMENT

  2. New Jersey Preparedness Training Consortium www.nj-ptc.org

  3. Ground Rules • Play yourself, but think outside your usual role • No wrong answers; try to find better ones • Avoid jargon and define acronyms • Assume the information is accurate even though the scenario is hypothetical • Facilitators are here to help you to think through possible answers from multiple perspectives • No one person is expert in all areas but we are here to learn how different groups might interact in an emergency setting

  4. Rutgers Nursing Center for Bioterrorism & Emerging Infectious Diseases Preparedness Facilitators • Mary L. Johansen MA, RN, Project Manager, The Nursing Center for Bioterrorism and Emerging Infectious Disease Preparedness • Miriam Cohen, MS, RN, APN, Director of Disaster Preparedness, New Jersey Primary Care Association • Joy Spellman, MSN, RN, Director, Center for Public Health Preparedness

  5. Objectives • Discuss the impact of an influenza pandemic on your community, organization, partner organizations, and professional activities • Identify problems and potential solutions that are unique to your agency and community • Cite the identified problems and solutions with your peers • State the proceeding and recommendations made by the group in order to recognize the unique perspective of public health in planning efforts. • State how critical thinking may be applied when using simulation.

  6. It’s There!

  7. Background June 2005 • For months the health care and public health community worldwide has been watching and studying the avian influenza A/H5N1 virus that has continued to evolve in southeast Asia.

  8. Background • The recent outbreaks that began in December 2004 have resulted in 59 cases and 22 deaths in southeast Asia. • To date no cases of human-to-human transmission have been confirmed. Source: WHO. June 16, 2005.

  9. What Makes a Pandemic? • Novel virus sub-type must emerge to which the general population has no or little immunity • New virus must be able to replicate in humans and cause serious illness • New virus must be transmissible from human to human giving it the capability of causing community-wide outbreaks Weir E. CMAJ 2005;173:869-70.

  10. Avian Influenza: The Virus library.wur.nl/frontis/avian_influenza/

  11. Mortality Due to Influenza The red line indicates observed deaths. The middle line or epidemic threshold is the upper limit of expected deaths over an average of 5 years. The bottom line is the baseline death rate. Excess morbidity & mortality is the difference between the two top lines. Note ↑in 2002 and 2004. Deaths from flu & pneumonia usually range between 8.5-10.4% http://www.medscape.com/viewarticle/517503_3

  12. Prophylaxis and Treatment of Influenza MMWR Morb Mort Wkly Ret. 2003:52(RR-8):1-36

  13. How Oseltamivir Works Moscona A . NEJM 2005; 353:1363-73

  14. Lab Confirmed Cases of Human Avian Flu as of February 21, 2006 Case-Fatality Ratio (92/170 ~54%) Adapted from http://europa.eu.int/comm/health/ph_threats/com/Influenza/ai_current_en.htm. Accessed 5 March 2006

  15. Suspicious Case • In Hanoi, Vietnam a worrying case has come to the attention of the Ministry of Health. • A migrant worker (identified only as Mr. W.) lies critically ill in an area health center with an influenza-like illness.

  16. Investigation • Two days ago Mr. W. fell ill on the job at the Hotel Universal. • According to the investigation, Mr. W. and several others left their home village to return to work in Hanoi, leaving sooner than planned because 4 residents of his village had died. • The symptoms of the deceased were similar to what a companion suffered from after returning from a 2-day trip to a regional market town.

  17. Alert • The WHO Global Influenza Surveillance Network reports the following on the situation in Vietnam: • Mr. W. has died, along with 8 other individuals from his village who recently returned to work in Hanoi hotels and private residences. • Lab tests on collected samples from the victims have isolated a new strain of avian influenza A/H5N1.

  18. Alert • Investigation concludes that human-to-human transmission did occur in these cases. • The new strain is highly pathogenic. • The new strain can cause primary viral pneumonia, unlike pneumonia in most influenza patients caused by secondary bacterial infection.

  19. Outbreak • Initial investigation in the last 24 hours has revealed 26 other suspected cases in area homes and hospitals. • Laboratory confirmation of the strain is expected soon.

  20. Situation Update • The number of cases in Vietnam has grown to 62 confirmed by laboratory, 125 other under investigation, and 35 deaths. • Neighboring countries of Laos, Thailand, and Cambodia have reported confirmed and suspect cases of influenza infection by the new strain. • Some cases were quickly traced back to foreign travel and stays at the Hotel Universal in Hanoi.

  21. Situation Update • The ministries of health in China, Indonesia and Canada report confirmed cases of infection by the new strain. • Some cases are in health care workers who probably delivered care to infected travelers. • Previously unsuspicious cases in patients are being investigated retroactively.

  22. Casualty Report July 2005

  23. Coming and Going (1) International air travel: • 2 million passengers per month arrive on international carriers at NYC airports • 1,400 passengers per month arrive directly from Canada at Albany International Airport. The New York State Thruway serves 230 million vehicles per year.

  24. Coming and Going (2) Daily traffic at the New York - Canadian border: • Train passengers: 200 • Pedestrians: 1,800 • Bus passengers: 4,655 • Car passengers: 58,074 Source: Bureau of Transportation Statistics

  25. Discussion • What questions from the public are likely? • What should you do to prepare for outbreaks in your local area? • To prepare, what new relationships would you need to form immediately? • What resources can you call on to ease the psychological strain on the emergency response personnel? • Flu response overwhelms routine health department activities; should routine disease surveillance and control cease?

  26. It’s Here!

  27. Local Outbreak August 2005 • During the last week, 42 suspect cases of infection with the novel pandemic strain have been detected in New York State. • Four suspect cases reside in Bergen County, NJ.

  28. Source • Investigation reveals that most transmissions occurred at a Fresh Air Fund summer camp session in Catskills. • The session was attended by 240 campers from around the region. • Counselors and staff included local residents as well as college students from foreign summer abroad programs.

  29. Surge • Local hospitals are seeing a surge of patients in emergency departments. • Political and health authorities are bombarded with questions about what to do.

  30. Vaccine Status • There is no vaccine available.

  31. Casualty Report August 2005

  32. Discussion • Who should be involved in developing messages for the public? • How might you use volunteer organizations to help respond? • What are the pros and cons of implementing Unified Command for the NY-NJ regional response? • What resources will you run out of quickest? • How will you meet the needs of people isolated or quarantined at home?

  33. Breathing Room Cases

  34. Impact December 2005 • The pandemic has not been stopped and the impact to date has been enormous…

  35. Casualty Report December 2005

  36. End of First Wave • In the northeastern US and most other parts of the country, the number of new outbreaks has reduced to a fraction of the rate during the peak 3 months ago. Cases

  37. Vaccine Arrives • Reaction is mixed • Fear of side effects • Demand greater than supply • Shortages occur at all levels: International, national, state, local, organization

  38. Overseas • Outbreaks continue abroad. • Poor countries on every continent are experiencing local, savaging outbreaks in remote regions and mega-cities alike.

  39. Prioritization • Many advocate prioritizing the military for vaccine, medications, equipment, and medical personnel to maintain national security.

  40. Psychosocial Impact • After months of steady outbreaks, few lives are untouched by illness, death, bereavement, and stress.

  41. Vigilance • Public health authorities stress the need to maintain infection control practices and surveillance. • Many believe they can relax a bit now that the pandemic has lessened locally. • History shows that another wave is likely.

  42. Political Tensions • Some countries blame each other for not preventing or stopping the pandemic. • Poor countries make pleas for financial aid and resources. • Congressional scrutiny is constant.

  43. Discussion • How do you address public concerns over flu vaccine? • What problems and solutions are likely to arise with rapid vaccination efforts, given current POD planning and experience? • What private agencies do you need/want to help with mass vaccination? • Only half the expected vaccine arrives at your area: how do you prioritize who receives it? • What are security concerns at PODs?

  44. It’s Back! Cases

  45. Second Wave July 2006 • Illness and death rates have crept back up again.

  46. On the Move • Areas that normally serve only as vacation homes for urban dwellers now see unusually high population levels due to urban “Flu Flight”.

  47. Overtime • The staff shortage in healthcare facilities is estimated to be an average of 40%, due to both inability and unwillingness to work. • Available staff see shifts extended and vacation requests denied. • Overtime pay and costs reach unprecedented levels.

  48. Now Hiring • Demand for able and willing healthcare workers exceeds supply locally and internationally. • Employers that are able to are offering enormous pay for temporary healthcare workers, as during the SARS outbreak of 2003 when Canadian hospitals paid up to $2,000 per day to physicians.

  49. Respiratory Intervention • Assumptions: • Anticipate > 20,000 deaths in NJ • 80% of decedents were intubated prior to death • 1/3 of intubated patients will die • Deaths are calculated as distributed evenly over 10 mos. • All 115 NJ hospitals have equal capacity • Required ventilator capacity for flu only • 4,800 per month • 42 per month per hospital

  50. Surge Capacity • Auxiliary hospitals increase in size and number in temporary facilities and structures.

More Related