Disasters & Emergencies

1. Disasters & Emergencies How Infectious Diseases Cause Emergencies Nancy Blackmore, Coordinator Preparedness, Planning & Equipment Resource, EHS,

2. Outline • Infectious diseases by category • Bioterrorism • New & emerging • Pandemic influenza • Impact & planning considerations

3. Endemic Normal expected level of disease Epidemic An outbreak with unusual high numbers Pandemic A world wide outbreak Bioterrorism 3 categories E.g. anthrax Newly emerging West Nile virus, SARS, etc. Naturally occurring E.g pandemics of influenza Infectious [Communicable] Diseases

5. Definition • Bioterrorism is the use of biological agents to intentionally produce disease or intoxication in susceptible populations to meet the aims of terrorists. • In addition to the potential medical consequences is the likelihood of human panic – a worthwhile goal in itself for the terrorist group.

6. Public Reaction • Cannot see, touch or feel it • People can’t get to a safe place, but sit and wait • Panic! • Increased psychosomatic illnesses • Increased visits to an already overtaxed emergency department • Health workers themselves may be fearful and stressed • Hoarding of medical supplies and resources

7. The Threat • The Good News - low probability • The Bad News - huge impact

9. Organisms & Diseases of “New” Concern to Us: • West Nile Virus • Lyme disease • Hantavirus • Human Granulocytic Ehrlichiosis • Son of SARS???

10. What is Pandemic Influenza? • A new influenza virus arising from a major genetic change [antigenic shift or adaptive mutation] • The population will be very susceptible with little or no immunity • The virus will transmit efficiently from person to person • The virus will be virulent with the capacity to cause serious illness and death

11. Each Pandemic is Different Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 40-50 million deaths 2-4 million deaths 1 million deaths H1N1 H2N2 H3N2 Source: WHO

12. 75% of people will be infected 15 – 38% will be clinically ill 6.8 – 17% will require outpatient care 0.1 – 0.3% will require hospitalization 0.03 – 0.1% will die Based on a “flu aid” formula developed by Meltzer & colleagues, CDC Atlantahttp://www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm 681,005 will be infected 136,201 – 345,042 will be clinically ill 61,744 – 154,361 will require out-patient care 908 – 2724 will require hospitalization 272 – 908 will die Based on population numbers from 2001 census Estimating the Impact for Nova Scotia:

13. Direct impact of influenza: Attack rate [15>35%] Affected age groups [unknown until it begins] Virulence of the strain and rates of adverse outcomes/complications [mild, moderate or severe?] Speed of spread from country to country and within a country [1-3 months to arrive? 2-3 waves? 12-18 months duration?] Effectiveness of the response: Vaccines [not available for 1st wave] antivirals [in stockpile now for treatment] non-pharmaceutical interventions [public health measures] Psychologically induced impacts/public behaviour Pandemics are Unpredictable

14. Potential Challenges: • Must maintain mandatory business [BCM] • Reduce elective or optional services • Cope with simultaneous emergencies [e.g. hurricanes, storms, etc.] • Prepare for economic consequences • Increased demand for health & social services • Increased demand for volunteers • Cope with loss of employees [permanent or temp]

15. Consequences of Absenteeism: • All sectors impacted: e.g. manufacturer, transportation, municipal services, etc. • Possible shortages: e.g. food, fuel, cash in bank machines • Issues for workers: ill themselves; need self-care info; may have elder or child care needs; fear; may be asked to work outside of usual environment, etc.

16. The hardest part of responding to an emergency is explaining why we didn’t prepare” Questions?