Ken August –Office of Public Affairs Terri Stratton -Emergency Preparedness Office

1. California’s Approach to Risk Communication – Diversity, Flexibility and Model Program Development Ken August –Office of Public Affairs Terri Stratton -Emergency Preparedness Office California Department of Health Services

2. Overall CDHS Emergency Preparedness Goal Ensure California is prepared for: • Bioterrorism (Biological/Chemical/Radiological) • Other infectious disease outbreaks • Natural disasters and other public health threats and emergencies • Where possible, take an “all hazards” approach

3. Risk Communication Principles and Approach

4. Initial Maintenance Resolution Evaluation Precrisis • Prepare • Foster alliances • Develop consensus recommendations • Test message • Evaluate plans • Express empathy • Provide simple risk explanations • Establish credibility • Recommend actions • Commit to stakeholders • Further explain risk by population groups • Provide more background • Gain support for response • Empower risk/benefit decisionmaking • Capture feedback for analysis • Educate a primed public for future crises • Examine problems • Gain support for policy and resources • Promote your organization’s role • Capture lessons learned • Develop an event SWOT • Improve plan • Return to precrisis planning Crisis Communication Lifecycle

5. 5 Communication Failures that Kill Operational Success • Mixed messages from multiple experts • Information released late • Paternalistic attitudes • Not countering rumors and myths in real-time • Public power struggles and confusion

6. What Do People Feel Inside When a Disaster Looms or Occurs? Psychological barriers: • Denial • Fear, anxiety, confusion, dread • Hopelessness or helplessness • Seldom panic • Vicarious rehearsal

7. Communicating in a Crisis Is Different • Public must feel empowered – reduce fear and victimization • Mental preparation reduces anxiety • Taking action reduces anxiety • Uncertainty must be addressed

8. Decision Making in a Crisis Is Different • People simplify • Cling to current beliefs • We remember what we see or previously experience (first messages carry more weight) • People limit intake of new information (3-7 bits)

9. Risk Communication Principles for Emergencies • Don’t over reassure - deal with uncertainty • When the news is good, state continued concern before stating reassuring updates • Under promise and over deliver

10. Judging the Message • Speed counts – marker for preparedness • Facts – consistency is vital • Trusted source – can’t fake these. Consider the importance of messenger

11. California’s Risk Communication Preparedness Efforts CDHS in partnership with Federal, State, and Local Government in collaboration with Red Cross, CBOs and Others

12. California Strategic Frameworkfor Risk Communication • Transparency • Echo Strategy • Primary Focus on communicating during an event • Partnerships and Collaborations • Tools and training – CERC Tool Kit • Multi-language focus

13. Key Activities • Emergency Plans • Fact sheets, key messages, press releases • Translation of materials • Website • Drills and exercises • Partner/Stakeholder Involvement • Special populations • Ethnic media roundtables

14. An Introduction to Seasonal, Avian, and Pandemic Influenza California Department of Health Services 2007

15. Pandemic Influenza • What You Should Know • How Should You Prepare • How You Can Help Others

16. Influenza Terms • Avian/Bird Flu in birds– is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans when close contact with infected birds exists. • Avian/Bird Flu in humans – Limited cases of human H5N1 with exposure to sick birds. Poultry is safe to eat when fully cooked. There is no human immunity and no vaccine is available. • Pandemic Flu – is a virulent human flu that causes a global outbreak or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. • Seasonal Flu – is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

17. Definition of Influenza • A contagious disease caused by a virus • Primarily affects the respiratory tract • Can cause severe illness and lead to life-threatening complications • A global infectious disease threat • An annual public health problem

18. More About Seasonal Influenza or the “Flu” • Easily confused with other infections, such as • Colds • Other viral infections • Usually self-limited to about a week of illness • Complications can contribute to serious secondary infections and may lead to hospitalizationand death

19. Fever Fatigue Body aches Headache Dry Cough Runny or stuffy nose Usual Symptoms of Seasonal Flu

20. How Seasonal Influenza is Spread • Primarily through respiratory droplets • Coughing • Sneezing • Touching respiratory droplets on self, another person, or an object, and then touching mouth, nose, eyes without washing hands

21. Seasonal Influenza Protections • Practice good personal hygiene • Stay home if you are sick • Get vaccinated • Influenza viruses change more than other respiratory viruses • Minor changes occur constantly (drift) • Cumulative • Reason why vaccine is updated each year Keep informed about influenza outbreaks: www.cdc.gov/flu

22. Impact of Seasonal Influenza • 250,000 to 500,000 deaths globally/year • 36,000 deaths and more than 200,000 hospitalizations/year in United States • $37.5 billion in economic costs/year in United States related to influenza and pneumonia • Ever-present threat of pandemic influenza

23. Seasonal Influenza vs. Pandemic • Seasonal outbreaks • Caused by subtypes of influenza viruses that already circulate among people • Pandemic outbreaks • Caused by • New subtypes • Subtypes that have never circulated among people (H5N1 fits this criteria) • Subtypes that have not circulated among people for a long time

24. Influenza Viruses • Naturally infect several animal species • Birds and mammals, including people • People usually infected only by human viruses • Wild birds are main reservoir for influenza A viruses • All known “A” subtypes circulate in wild birds • Infect wild and domesticated birds • Ultimate source for viruses (and virus genes) infecting other animal species

25. Avian Influenza Viruses Human Influenza A Viruses H1 – H16 H1 – H3

26. Impact of Potential Pandemic • Illness (estimated 30% attack rate): • Moderate 9 million • Severe 90 million • Hospitalization: • Moderate 865,000 • Severe 9,900,000 • Mechanical ventilation: • Moderate 65,000 • Severe 750,000 • Deaths: • Moderate 209,000 (comparable to 1956-58) • Severe 1,903,000 (comparable to 1918-19)

27. Current Influenza Vaccine Production Timeline: 6-9 months

28. Stages of an Influenza Pandemic • The World Health Organization defines the six stages of a pandemic: • Interpandemic period • Phase 1: No new influenza virus subtypes have been detected in humans. • Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

29. Stages of an Influenza Pandemic (continued) • Pandemic alert period • Phase 3: Human infection(s) but no human-to-human spread, or at most, rare instances of spread to a close contact. • Phase 4: Small cluster(s) with limited human-to-human transmission, but spread is highly localized. • Phase 5: Large cluster(s), but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

30. Stages of an Influenza Pandemic (continued) • Pandemic period • Phase 6: Pandemic: increased and sustained transmission in general population worldwide.

31. Currently… H5N1 infection is widespread among wild birds and domestic poultry Reports of H5N1-infected humans Limited human-to-human spread of virus

32. Preparation and Response • Individuals and Families • Businesses • Communities • Faith-based Organizations • Health Care Providers • Schools • Governments • International Organizations

33. Importance of Seasonal Flu Program to Pandemic Preparedness Everyone has a role: • People learn and practice basic steps to stay healthy. • Manufacturers strengthen resources to produce and deliver influenza vaccines. • Collaborative planning helps ensure readiness in communities, states, nationally and internationally.

34. What is Being Done on Your Behalf to Prepare for an Influenza Pandemic? • U.S. Government, including Health and Human Services (HHS), CDC, the National Institutes of Health, and other federal agencies • World Health Organization (WHO) • Governments and other organizations around the world

35. National Strategy for Pandemic Influenza • Preparedness and Communication • Surveillance and Detection • Response and Containment

36. Public Health’s Role in Preparation and Response Selected examples: • Conducts and supports clinical and virological influenza surveillance. • Coordinates pandemic response activities with state, local and tribal public health agencies. • Coordinates antiviral and other drug delivery from the Strategic National Stockpile.

37. What Individuals and Families Can Do to Prepare for a Pandemic • Store a supply of water, food, medical, health and emergency supplies. • Talk with family members and loved ones about how they would be cared for if they got sick or what will be needed to care for them in your home. • Teach your children to wash hands frequently with soap and water, and model the correct behavior.

38. What Individuals and Families Can Do (continued) • Teach your children to cover coughs and sneezes with tissues or sleeve (not hand), and be sure to model that behavior. • Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick. Complete pandemic influenza checklist for individuals and families:www.pandemicflu.gov/planguide/checklist.html

39. What Businesses Can Do to Prepare for a Pandemic • Plan for the impact on your business • Plan for the impact on your employees and customers • Establish policies to be implemented during a pandemic • Allocate resources to protect your employees and customers during a pandemic Complete pandemic influenza checklist for businesses: www.pandemicflu.gov/plan/businesschecklist.html

40. What Faith-based and Community Organizations Can Do to Prepare for a Pandemic • Plan the impact of a pandemic on your organization and its mission. • Communicate with and educate your staff members and persons in the communities that you serve. • Plan for the impact of a pandemic on your staff, members and the communities you serve.

41. What Faith-based and Community Organizations Can Do (continued) • Communicate to and educate your employees • Coordinate with external organizations and help your community Complete pandemic influenza checklist for faith-based and community organizations: www.pandemicflu.gov/plan/pdf/faithbasedCommunityChecklist.pdf

42. What Health Care Providers Can Do to Prepare for a Pandemic • Health care providers play an essential role in the detection of an initial case of novel or pandemic influenza in a community. Early identification and isolation of cases may help slow the spread of influenza within a community. Clinical guidelines:www.hhs.gov/pandemicflu/plan/sup5.html

43. What Schools Can Do to Prepare • Have an emergency plan in place including basic supplies and call down list. • Model proper hygiene and encourage students and families to do the same. • Participate in local discussions regarding emergency preparedness, response and criteria for school closures. • Consider distance learning techniques and the internet to communicate to families if there was school closure.

44. Questions to anticipate • Is poultry safe to eat? • Should I have my chickens tested and where? • Is it safe for children to play where birds have been? What precautions should I take? • Will H5N1 arrive in CA and when? • When we have positive birds here does that mean we have a pandemic?

45. Discussion Question • Please jot down three actions to take for either personal or school preparedness that you can begin working on this month. • Briefly share these with your those sitting near you.

46. Summary • Another pandemic is probably inevitable. • We are facing an unknown, but increased risk of a pandemic. • H5N1 will likely persist/recur in Asia, Europe, and Africa and may spread to other parts of the world. • H5N1 is a “new” virus to humans and can cause severe disease; person-to-person spread has been very limited.

47. Summary(continued) • No evidence now of sustained H5N1 transmission among people • H5N1 is a leading pandemic candidate, but • must continue to monitor other avian influenza viruses. • must push forward pandemic preparedness actions BEFORE final warning signs are detected.

48. Resources • www.cdc.gov/flu • www.cdc.gov/flu/workplace • www.cdc.gov/flu/school • www.cdc.gov/flu/professionals/index.htm • www.pandemicflu.gov • www.dhs.ca.gov

49. For More Information Terri Stratton (916) 650-6457 tstratto@dhs.ca.gov Ken August (916) 650-6864 kaugust@dhs.ca.gov CA Department of Health Services