Northwest Ohio Regional Pandemic Flu Functional Exercise May 10 & 11, 2006

1. Northwest Ohio RegionalPandemic Flu Functional ExerciseMay 10 & 11, 2006 NOTE TO ALL LOCATIONS: Please connect for Conference Call by 8:25am . . .Call: 1-866-356-2416Enter ID: #873247

2. Medical University of Ohio Center for Creative Instruction Created by:

3. Introduction Local Public Health Commissioner Report The flu season in the USA is in full swing. Fortunately, seasonal influenza has been milder than what most experts had predicted. Across the nation, there have been about 100,000 hospital admissions and only 4,500 deaths attributed to the flu. Cases of seasonal influenza and influenza-like-illness (ILI) typically peak towards the end of January, and the flu season is generally over by the end of March. Normally, influenza in America hits up to 20% of the population, causing >200,000 hospitalizations and 36,000 deaths. Nevertheless, an overburdened hospital system struggles to keep up and manage the increased patient load.

4. Introduction continued Even within the walls of the CDC and DHS there is a sense of optimism that the worst fears concerning a pandemic flu will remain unrealized, at least for another year. The person-to-person threat of H5N1 remains theoretical. As of March 23, there have been 151 cases of H5N1 in humans in China, Cambodia, Indonesia, Vietnam, Thailand, and Turkey, with 82 deaths reported as confirmed cases to the World Health Organization (WHO). We are still WHO’s Pandemic Alert Period, Phase 3 – human infections with a new subtype (of influenza A virus) but no human-human spread, or at most, rare instances of spread to a close contact.

5. Introduction continued There is still no H5N1 vaccine for humans available. Preliminary data from the U.S. National Institute for Allergy and Infectious Disease indicate that an effective vaccine is possible. Discussion at government levels centers around the facts that (i) at present, 90% of the production capacity for influenza vaccines for humans is in N. America and in Europe, (ii) global manufacturing capacity is estimated to be only 300 million doses per year of the present influenza vaccines, and (iii) any switch of production to an H5N1 vaccine would compromise the capacity to produce vaccines for the seasonal influenza. World-wide, seasonal influenza is estimated to cause 250,000 – 5,000 deaths each year.

6. Introduction continued April 2: the number of confirmed cases in humans is now 174, with 94 deaths, with a seventh country, Iraq now reporting fatal cases. The reported human cases have all been associated with close contact with domestic poultry, no cases have been associated with contact with wild birds, despite the increasing numbers of reports of H5N1 in such birds. 27 countries have now reported H5N1 in birds; countries including India, in Europe as far west as France and Germany, in Africa, Egypt, Nigeria, and Niger. April 3, the virus was found in wild ducks in Sweden. Reports in the media in many countries indicate increasing concern in the general public of the risk of contracting H5N1 from eating domestic poultry; the official positions are that correctly cooked poultry presents no risk.

7. Introduction continued The report, from Germany of a dead cat from which H5N1 was isolated has raised in the general public, concerns that domestic, pet cats may be a source of infection to their human owners. So far there have been no outbreaks of H5N1 disease in cats, although cat-to-cat spread is known. No reported human cases associated with pet cats are known. Unconfirmed earlier reports of H5N1 in cats have been around for several years – cases possibly acquired by cats eating raw, infected poultry. Documented fatal H5N1 infections are known in “big cats” – tigers and leopards – in captivity. Reports out of France tell of people abandoning their cats and of some municipalities rounding up and destroying stray cats. In England, a government spokesman said that the report from Germany was “of interest”, but scientists were expressing concern that infected cats could spread the virus to mice and other small animals; one was quoted as saying “That would be a bit of a problem.” (Ref. The Daily Telegraph, London 2/2/2006, 2/3/2006)

8. Introduction continued Mid April: There have been increasing numbers of people seeking medical attention for Influenza-Like-Illness (ILI) in India and countries of the Near and Far East. In many cities unusually large numbers of hospitalizations of seriously ill person with ILI have occurred. Some have been confirmed as having H5N1. A few cases have occurred in health care workers in several of these hospitals, with H5N1 infection confirmed. In view of the apparent human-to-human transmission, but on a limited level, WHO declared the situation to be now in Phase 4.

9. Introduction continued Later in April: There is now increasing numbers of people in Europe seeking medical attention for Influenza-Like-Illness (ILI) although it is beyond the end of the usual season for influenza. Many of these have been confirmed as H5N1 infections. Epidemiological studies have shown many of these patients with no contact with live poultry, and who have carefully followed the recommendations for handling and cooking poultry. Several report that their pet cats appeared ill, but none sought veterinary attention for the animals. H5N1 influenza is being increasingly diagnosed in health care workers. Now in view of the apparent increased human-to-human transmission, WHO considers declaring the situatio to be in Phase 5.

10. 0845 EST TIME: DAY: May 1 The World Health Organization reports: Several EPI teams are being sent to Calcutta, India to investigate the ILI that has taken the city by surprise Several EPI teams are also being sent to Turkey, where Health Ministry are reporting an influx of nearly 2000 hospital admissions for cases of ILI and 150 deaths .

11. 0930 EST DAY: TIME: May 1 CNN has breaking news from Paris. Parisian scientists at The Sorbonne have announced that their studies revel that H5N1 is beginning to exhibit increased pathogenicity. Their studies suggest that the world should be concerned about the beginnings of a pandemic

12. 1300 EST DAY: TIME: May 1 Local hospitals and 911 dispatch centers begin to receive calls regarding signs and symptoms of influenza-like illness (ILI) and “Bird Flu”

13. 1423 EST DAY: TIME: May 2 Law enforcement agencies are reporting random shootings of birds on private property. These individuals tell law enforcement and wild life officials they are trying to protect their livestock from sick birds.

14. 1530 EST DAY: TIME: May 2 Calls about influenza to local Health Departments, Hospitals, Physician Offices, Clinics, and Mental Health are increasing substantially

15. 1545 EST DAY: TIME: May 2 Members of the local Veterinary community are offering assistance with information regarding pet and animal safety.

16. 1600 EST DAY: TIME: May 2 Farmers in the Van Wert area have expressed concerns regarding Stoller Farms, Inc. and the farm coalition in Van Wert is trying to schedule a meeting with the Department of Agriculture and other agencies in Ohio.

17. 0838 EST DAY: TIME: Day 3 TLCHD receives a call from a woman who explains that she and nearly 20 relatives have arrived back in Toledo after a two week trip to Calcutta, India to attend a family wedding. She is wondering if she and her family members have been exposed to the “Bird Flu.” She reports that several family members have had a cough and cold and chills while they were in India She furthers that her brother and his wife, who arrived in Chicago last evening are quite ill. Can she get tested for this?

18. 1000 EST DAY: TIME: May 3 The International Herald Tribune is reporting that over the past several days, hospitals in Madrid and the surrounding areas have been inundated with patients seeking treatment for respiratory complaints. The CNN is reporting that Cinco Dias has interviewed the Spanish Health Minister. She reports that hospitals in Barcelona have seen hundreds with ILI and numerous unexplained deaths have occurred None of the deaths can be traced to birds or animals.

19. 1130 EST DAY: TIME: May 3 The BBC reports that “anonymous sources” from the WHO headquarters in Geneva have disclosed that the sudden onset of ILI in Europe may be a result of novel influenza strain, and that due to the increased pathogenicity, it may be responsible for “person-to-person” transmission. This source could not confirm that the ILI was due to H5N1, but did state that WHO Officials were “having immense challenges” in their attempts to keep up with the rapidly unfolding events. Sky News is reporting as many as 6,000 hospital admissions with 150 unusual deaths in United Kingdom over the past week.

20. 1300 EST DAY: TIME: May 3 Local hospitals, clinics, physician offices, and health departments are receiving large numbers of calls from concerned citizens. All are requesting information about cases of flu in their area.

21. 1345 EST DAY: TIME: May 3 A local hospital is reporting numerous ED visits from individuals concerned that they have “Bird Flu”. They would like to put the public at ease with an ad in the local paper. Would the Health Commissioner like to “proof read” their ad?

22. 0905 EST DAY: TIME: May 4 A concerned parent calls reporting that her son and twenty of his classmates from are currently in London doing a “drama club exchange”. They have been staying in Kensington and commuting to the Covent Garden area for the past several days. They are expected back in two days. When her son called home last evening, he reported that several of the kids and one of the adult chaperones had the flu and had to miss some of the scheduled activities. She wants to know if they have the influenza that they are talking about on TV? She also wants to know what to do if they quarantine London or the Heathrow airport?.

23. 0930 EST DAY: TIME: May 4 A second phone call is received from the Principal of the Local High School asking for advice as to what to tell concerned parents.

24. 1430 EST DAY: TIME: May 4 Chicago and Detroit have made press releases, where the Health Commissioners have declared a public health emergency . They report an influx of hospital admissions for ILI, 5 “atypical deaths”, drastically increased ED waiting times, and EMS calls as the reason. He reports that the local and state health departments, as well as the CDC have been alerted to the situation.

25. Connect with Conference Call Now 1-866-356-2416, Conference ID #873247. After a brief roll call, representatives from the six playing health departments (Defiance, Erie, Lucas, Sandusky, Seneca, and Van Wert) will be asked to present a brief summary of the steps they have taken thus far, and what they will do at this point in time. At the end of this please instruct participants to end conference call.

26. 1000 EST DAY: TIME: May 5 “A number of patients in Miami have been admitted to the hospital with an unusual influenza-like-illness (ILI) All were recent arrivals from London. Several of these individuals are in the ICU, many require ventilators.”

27. 1015 EST DAY: TIME: May 5 A source within WHO issues a statement: “We are currently facing WHOs Global Influenza Preparedness Plan Phase 6 --- the beginning of a pandemic outbreak.”

28. 1300 EST DAY: TIME: May 5 All networks cover press conference. Dr. Julie Gerberding reads the following from a prepared script. “The CDC acknowledges the possibility of a particularly severe form of influenza. American experts are unaware of any confirmed cases domestically. Federal epidemiological investigation teams are being dispatched to assist local public health with data-gathering, surveillance, and laboratory testing. The CDC has been in constant communication and consultation with WHO and other international health agencies. I advise all local and state public health agencies to activate their Pandemic Protocols. There is no need to panic!”(continued)

29. 1300 EST DAY: TIME: May 5 Dr. Gerberding offers the following advice to the general public, “Have faith in your local and state Health Departments! They have been working and planning for this eventuality for a long time. Keep tuned to your local television stations and follow the advise and instructions given to you by your local health department and health care providers!” Dr. Gerberding does not take any questions, she promises to provide at least daily public briefings. She reminds the viewers that the CDC is in constant contact with state and local health departments via the HAN, local and state laboratories via the LRN, and that the general public can go to the cdc.gov website, pandemicflu.gov website or websites for their local or state health departments.

30. 1400 EST DAY: TIME: May 5 Situation Report #1 presented

31. 0900 EST DAY: TIME: May 6 Rumors are spreading within local hospitals that Detroit is seeing many infected patients. Several nurses at The Toledo Hospital have been contacted by staffing agencies to pick up shifts in the Detroit area.

32. 0945 EST DAY: TIME: May 6 CNN is reporting that an unspecified number of health care providers from the Miami-Dade County area have been hospitalized with a severe respiratory illness.

33. 1100 EST DAY: TIME: May 6 Hospital administrators are beginning to hear concerns being raised by nursing staff about the pandemic influenza. Director of Nursing wants to clarify the issues in order to provide information to hospital staff.

34. 1130 EST DAY: TIME: May 6 NWO hospital administrators are beginning to report to their respective public health agencies that they are receiving urgent requests from Detroit hospitals to receive their patients.

35. 1615 EST DAY: TIME: May 6 SKY News in a televised editorial raises concerns that the difficult decisions being made by healthcare personnel during these trying times might ignite a trend of suicides among healthcare personnel and the general public should this current pandemic overwhelm the world.

36. 0900 EST DAY: TIME: May 7 Situation Report #2 presented

37. 1625 EST DAY: TIME: May 7 A press release is requested at 0900 EST tomorrow morning from public health, which will detail the local/regional/and state initiatives for the pandemic flu.

38. End of Facilitated Play Day One – 12:15 p.m. Closing Instructions:1) The RAC Public Information Officer (PIO) will be required to prepare a 10 minute (max) situation report/press release to panflu@meduohio.edu for presentation at 9:00 a.m. on May 11, 2006 via conference call. 2) Health Departments: Please email your Incident Action Plans (mandatory) and Activity Logs (optional) to panflu@meduohio.edu by 4:30 p.m. May 10, 2006 3) Hospitals: Please email your Incident Action Plans and Activity Logs to Kathi Silvestri at ksilvestri@hcno.org by 4:30 p.m. May 10, 2006PLEASE NOTE: Roll call for day Two will begin promptly at 8:30 a.m. on May 11, 2006. Please dial into the conference call at 1-866-356-2416, conference ID #873247 no later than 8:25 a.m. Play will resume promptly at 9:00 a.m. with the delivery of a situation report/press release by the PIO. Injects will follow immediately.

39. Day Two Playing Counties – Defiance, Erie, Lucas, Sandusky, Seneca, and Van WertPlease dial into the conference call at 1-866-356-2416, conference ID #873247 no later than 8:25 a.m. Play will resume promptly at 9:00 a.m. with the delivery of a situation report/press release by the RAC PIO. Injects will follow immediately.

40. 0900 EST DAY: TIME: May 8 NWO hospitals and health care facilities are noticing an increase in admissions and waiting times in Emergency Departments are beginning to creep upwards. The number of respiratory cases being reported through a variety of surveillance monitors has steadily increased throughout the past 24 hours

41. 0915 EST DAY: TIME: May 8 Situation Report presented

42. 0925 EST DAY: TIME: May 8 Local Media are airing stories about hospitals being filled to near capacity and interviewing disgruntled patients waiting in area Emergency Departments for up to 4 hours for treatment. Local pharmacies and grocery stores are experiencing a “run on” cold and flu remedies. Local vendors are reporting that face masks and gloves are a precious commodity and that they cannot fill all of their routine orders. Viewers are told to beware of “scam artists” who are going door-to-door selling medications that will prevent the flu. If these individuals are seen in your neighborhood, contact local law enforcement ASAP!

43. 1000 EST DAY: TIME: May 9 Regional Hospitals are currently at 110% capacity (based on increased admissions minus early discharges and canceling of elective services). Numerous admissions are pending and, in most EDs, these admissions are being quartered in the ED, further crippling ED operations.

44. 1015 EST DAY: TIME: May 9 Hospitals are reporting high numbers of deaths especially of previously health young individuals. They are reporting that morgue capacities have been exceeded. ME’s at the local levels within the region are working with OFDA and many have activated their Mass Fatality Plans.

45. 1018 EST DAY: TIME: May 9 Medical Reserve Corp reports it has 25 health professionals, mostly retired, available for service.

46. 1020 EST DAY: TIME: May 9 Mental health services reporting that hotline is receiving thousands of calls daily. Website is underway at this time.

47. 1025 EST DAY: TIME: May 9 Detroit Receiving Hospital, announced that several high school students from Ohio and Michigan and one teacher from Ethel Rosenberg High School have died from a respiratory illness. The hospital official confirms that these individuals all recently arrived from London, England after having attended a drama exchange program. Several students and three adult chaperones remain hospitalized.

48. 1100 EST DAY: TIME: May 9 School system superintendent is calling to find out about the efficacy of closing schools for the duration of the pandemic

49. 1115 EST DAY: TIME: May 9 GED Program Director is calling to find out if he should cancel Adult GED Courses for the next several weeks?

50. 1230 EST DAY: TIME: May 9 The Medical Director for EMS in your county, calls to report that their EMS is on the verge of collapse due to the high demand on their services. Hospitals in their county are currently spending more time on diversion than ever before. Can they take patients to an alternative care facility?