Pandemic Flu Why should you care Why should you prepare June 29, 2006 Larimer County Pandemic Influenza Retreat a

2. �Hospitals Full Up�� Video

3. �1918 Flu in  Larimer County� Kim Meyer- Lee, Epidemiologist Larimer County Department of Health and Environment

4. Larimer County in 1918 County population about 27,000 Fort Collins population 8,700 Loveland population about 5,000

5. Social Environment in 1918 Most residents involved in agriculture, directly or indirectly World War I was the major news story There was rationing of coal, fuel, food and other items needed for war effort Red Cross was very active in community, supporting war effort

6. Outbreak begins in military training camps Deaths occurring in training camps in East were reported in local newspapers Numerous Larimer County enlistees/ draftees were among the fatalities (4 from Camp Dix in 1 wk.)

7. Spreading to Civilians Larimer County residents were aware of growing, alarming deaths among civilians in Eastern cities First cases in CO in Boulder; army trainees on College campus. (First cases in FC at Ag College)

8. Flu shut down schools Loveland schools closed on Oct. 8 Fort Collins closed schools on Oct. 10 They would not reopen untilDec. 30

9. Flu changed �business as usual� Customers were asked to call orders in advance, come in to pay and pick up merchandise Shop owners had to enforce restrictions of no more than 1 person per 100 square feet in store Masks were required briefly, but not enforced.

10. Flu closed churches All church services were cancelled for weeks Funerals allowed outside only at the cemetery, only immediate family

13. 1918 Flu killed young adults Highest number of deaths were in people in their late teens through mid 30�s

15. By the end of the outbreak Overall, there were 67 deaths in Loveland in a 15 week period. Nationwide, over 650,000 people died in the U.S. 40-50 million people died worldwide Overall in U.S. a 2.5% case-fatality rate In certain areas, case fatality rates were much higher. On Western Samoa, 20% of the population died. In Brevig Mission, in Alaska, 72/80 residents died or 90%In certain areas, case fatality rates were much higher. On Western Samoa, 20% of the population died. In Brevig Mission, in Alaska, 72/80 residents died or 90%

18. Why Should You Care? A severe influenza pandemic in Northern Colorado could close schools and businesses overwhelm our health care system disrupt essential services cause many deaths

20. What are Flu Pandemics and Why Do They Happen? Adrienne LeBailly, MD, MPH Larimer County Dept. of Health and Environment

21. Influenza Pandemics What is a Flu Pandemic? Outbreak in wide geographic area (global) Effects large # of people with serious illness Usually a new flu virus or one which population has not had exposure in a long time May spread rapidly in waves of 6-8 wks.

22. Where do new flu viruses come from? Several diseases have moved from animals to man in recent times-- such as HIV/AIDS, SARS, West Nile Influenza pandemics occur when a bird flu virus, which has not infected people before, changes in ways that lets it infect humans.

23. Influenza Viruses Influenza A viruses arenamed for proteins on viral surface. H (16 known types) N (9 known types) Your body makes antibodies to these two proteins. These antibodies, especially to H, help protect you against future infections.

24. Birds, especially waterfowl and shore birds, are the natural hosts for all influenza viruses, but they can sometimes spread to other species, such as

25. Bird viruses can change to infect people and cause pandemics 3 viruses have caused human influenza pandemics during the 20th century H1N1 (1918) �Spanish Flu� H2N2 (1957) �Asian Flu� H3N2 (1968) �Hong Kong Flu� Three subtypes that usually infect birds have also caused rare infections in humans: H5, H7, and H9

26. Two Ways Bird Viruses Change Gradual mutations in the H that allow bird viruses to attach to the human cell binding site and infect it (1918) A bird virus and a human virus �swap� genetic material when both infect the same cell. (1957 & 1968)

27. Influenza H�s and N�s andsusceptible animals

28. Influenza Virus The flu virus constantly changes As a human flu virus changes a little bit each year, it causes annual flu outbreaks. (H & N remain same type) If an animal flu virus changes so it can infect humans and spread easily between them, it can cause a pandemic. (A new H�or new H and N�appear)

30. Seasonal Flu vs Pandemic Flu Seasonal Occurs every year Respiratory sympt. Occurs during winter (usually Dec-Mar) Most recover in 1-2 weeks without tx Very young, very old, ill most at risk of serious illness Pandemic Occurs 3-4x/century Resp, other sympt. Occurs any time of year Some may not recover, even with tx People of all ages may be at risk

31. Pandemics can range from mild to severe.

32. Infectious Disease Deaths in 20th Century The pandemic of 1918 was a very severe pandemic as you can see by the huge spike in the graph. During the course of the epidemic,47% of all deaths in the US resulted from influenza and its complications. Influenza killed enough people during this time to depress the average life expectancy in the US by more than 10 years. This spike represents about a 2.5% mortality rate among people who became ill, or about 0.6% (less than 1%) of the total population--since not everyone got infected or became ill. The pandemic of 1918 was a very severe pandemic as you can see by the huge spike in the graph. During the course of the epidemic,47% of all deaths in the US resulted from influenza and its complications. Influenza killed enough people during this time to depress the average life expectancy in the US by more than 10 years. This spike represents about a 2.5% mortality rate among people who became ill, or about 0.6% (less than 1%) of the total population--since not everyone got infected or became ill.

33. 1918-1919 influenza pandemic Estimated 20-40% of world ill 40-50 million people died worldwide Over 600,000 deaths in US 2.5% of cases died in U.S. (0.6% of population) High mortality in young adults

34. Why concern about H5N1, the bird flu in Asia? Might mutate or exchange genes with human flu virus & become easily spread between people. Clinical illness it causes resembles severe flu cases from 1918 Causes severe disease in humans with high fatality rate No vaccine available. Takes 6-9 mos. to make a vaccine when new virus found.

35. Cumulative Number of Confirmed Human Cases of Avian Influenza H5N1 Reported as of June 20, 2006 Is it high case-fatality rate, or are we just looking at �the tip of the iceberg�? Though seroprevalence studies have not yet been published, interviews with the scientists doing the research do not suggest that asymptomatic or mild infection is common. Though jury is still out, it�s looking like C-F rate actually is very high. Is it high case-fatality rate, or are we just looking at �the tip of the iceberg�? Though seroprevalence studies have not yet been published, interviews with the scientists doing the research do not suggest that asymptomatic or mild infection is common. Though jury is still out, it�s looking like C-F rate actually is very high.

36. What might happen in a severe pandemic? Bruce Cooper, MD, Health District of Northern Larimer County

37. Impact of a severe pandemic onLarimer County

38. Impact of a severe pandemic onLarimer County

39. If it happens soon�.. There will be little or no vaccine until 6 - 9 months after the outbreak begins There will be very limited supplies of antiviral medicines for treatment (for 1% of populations, perhaps less). All communities hit a about the same time We need a plan for the short-term that assumes no effective shots or Rx

40. What might occur High levels of absenteeism Health system could be overwhelmed Essential services could be at risk (fuel, power, water, food, etc.) �Just-in-time� supply lines could be disrupted High mortality rates could occur Social disruption could occur

41. Who will help us? Little or no state and federal assistance Local government also limited in what it can do to assist citizens Churches, neighbors, friends and families will need to help each other out Vulnerable groups will need extra assistance Advance planning and stockpiling of necessities could help.

42. Are we more or less at risk today compared to 1918?

43. Why at LESS risk in 2006 Antibiotics for bacterial pneumonia complications of influenza Some antiviral medicines IV fluids, oxygen, ventilators Greater ability to do surveillance, confirm diagnosis of flu

44. Why at LESS risk in 2006 Rapid means of communications - internet, TV, radio, email More effective personal protective equipment Fewer people living in each household and more rooms.

45. Why at MORE risk in 2006 A lot more international travel Far more people in Northern Colorado, contact with far more people daily Very little surge capacity in health care today Greater reliance on health professionals Most people in Larimer County in 1918 were farmers. Not only more travellers, but much faster. In 1918 it took 75 days to go around the world; today it takes 24-48 hours. Little surge capacity in 1918 as well, due to many MD�s and nurses participating in WWI, but less reliance on professional health care then. Less use of hospitals in 1918, mostly for those who were too poor and too sick to be cared for at home. MD�s and nurses usually hired to come into the home for more affluent patients Most people in Larimer County in 1918 were farmers. Not only more travellers, but much faster. In 1918 it took 75 days to go around the world; today it takes 24-48 hours. Little surge capacity in 1918 as well, due to many MD�s and nurses participating in WWI, but less reliance on professional health care then. Less use of hospitals in 1918, mostly for those who were too poor and too sick to be cared for at home. MD�s and nurses usually hired to come into the home for more affluent patients

46. Why at MORE risk in 2006 More elderly and immune-compromised people in population Infectious disease deaths uncommon Much less self-sufficient than in 1918�s (households and businesses) Today�s society not used to rationing, sacrifice, compared to war-time 1918. Farmers would have had food and grain stored up to get them through the winter. Most people today would not have such provisions. Look at where most of the non-food items you purchase are made (usually not the U.S.). The produce you buy in food stores in the winter is generally imported. If illnesses, quarantines, or closed borders interrupt the production or delivery of goods, it may be difficult or impossible to get critical supplies (chlorine for water treatment plants, medicines for all kinds of illness (not just flu), key parts to keep telecommunications functioning. Farmers would have had food and grain stored up to get them through the winter. Most people today would not have such provisions. Look at where most of the non-food items you purchase are made (usually not the U.S.). The produce you buy in food stores in the winter is generally imported. If illnesses, quarantines, or closed borders interrupt the production or delivery of goods, it may be difficult or impossible to get critical supplies (chlorine for water treatment plants, medicines for all kinds of illness (not just flu), key parts to keep telecommunications functioning.

47. Why at MORE risk in 2006 Far more manufactured goods and raw materials come from distant areas, especially Asia �Just-in-time� ordering of needed supplies instead of warehousing critical items on site Greater expectations that government will be able to protect us Farmers would have had food and grain stored up to get them through the winter. Most people today would not have such provisions. Look at where most of the non-food items you purchase are made (usually not the U.S.). The produce you buy in food stores in the winter is generally imported. If illnesses, quarantines, or closed borders interrupt the production or delivery of goods, it may be difficult or impossible to get critical supplies (chlorine for water treatment plants, medicines for all kinds of illness (not just flu), key parts to keep telecommunications functioning. Farmers would have had food and grain stored up to get them through the winter. Most people today would not have such provisions. Look at where most of the non-food items you purchase are made (usually not the U.S.). The produce you buy in food stores in the winter is generally imported. If illnesses, quarantines, or closed borders interrupt the production or delivery of goods, it may be difficult or impossible to get critical supplies (chlorine for water treatment plants, medicines for all kinds of illness (not just flu), key parts to keep telecommunications functioning.

48. Overall, are we at more or less risk? Up to individuals, organizations, businesses, communities, states, and nations to decide as they plan for a possible pandemic

49. Pandemic PlanningA Business Point of View

50. What I Plan to Cover

51. Why You Should Care As a Leader, it�s your job Moral Reasons Care about safety and welfare of your people Massive failure of leadership during 1918 influenza pandemic Business Reasons Business continuity Legal concerns

52. Business Leader Objectives Keep people alive Keep business alive

53. Business Planning Assumptions Operational Risks from absenteeism are greatest challenge to businesses and economy Pandemic will stress fiscal stability of economies worldwide due to increased spending on health, public safety, social welfare, and lost revenues If Pandemic is severe, economic impact will be significant After Pandemic, economic activity should rebound though a severe Pandemic will have longer impact Expect 6-8 weeks of HR disruption, possibly longer in severe case Expect 12-18 months of supply chain issues

54. 10 Steps for Your Business Educate yourself about pandemic flu Get organized: appoint �pandemic manager� assemble planning team outline process to develop plan check current plans to see if applicable

55. 10 Steps for Your Business Assess the potential risks: meet with local public health authorities visit county website identify employee risks identify your facilities and suppliers� facilities that could close Protect employee health develop infection counter-measures plan for workplace social distancing

56. 10 Steps for Your Business Prepare employee policies update employee leave policies and communicate importance of staying home if ill develop employment policies for use during pandemic (for instance, tools for working from home) prepare plans to support workers during pandemic

57. 10 Steps for Your Business Plan for business continuity business continuity is preplanning that allows businesses to function during / after emergency situation enables critical services or products to be continually delivered to clients need to identify critical business functions develop pandemic scenarios (high absenteeism, facility closures, surge demand for your products) analyze potential business impacts

58. 10 Steps for Your Business Prepare for supply & service interruptions identify sources stockpile critical supplies arrange alternatives develop access to contingency funds Prepare to fill vacancies cross train staff to accomplish critical functions

59. 10 Steps for Your Business Inform employees write communication plan to inform employees share information about threat of pandemic flu and the company�s pandemic plan advise staff of infection prevention procedures & policies to stop spread of disease have a system to keep employees informed during pandemic

60. 10 Steps for Your Business Prepare written pandemic flu management plan put all of the above information in written plan

61. Written Plan = Insurance How many of you have insurance? How many of you have ever had to make claims on your insurance?

62. General Steps You Can Take �Investing in pandemic preparedness is essentially like investing in an insurance policy�Hope we never have to make a claim.� -- Dr. Margaret Chan, World Health Organization

63. Resources Larimer County http://www.larimer.org/health/cd/pandemic_flu.htm http://larimerfluplan.wikispaces.com Checklists Sample Plans Federal Government, World Health Organization and Larimer County Resources and Information American Red Cross CD-ROM �Guide to Business Continuity Planning� Fort Collins Area Chamber of Commerce www.fortcollinschamber.com www.fcchamber.org/data/pandemicbrochure.pdf www.fcchamber.org/data/pandemicplan.pdf www.fcchamber.org/data/pandemicplan2.pdf (British Columbia) www.fcchamber.org/data/pandemicquestions.pdf.

65. Community Protection thru Preparedness Elements of Basic Preparedness Steve Blois Ft. Collins Office of Emergency Management

66. Historically Preparedness was a personal or family issue The Pioneer ethic included preparations for uncertain times, hard times. Recognizing the need to prepare your family and helping those neighbors whom needed it.

67. After Hurricane Katrina, there were three easily recognized categories of Emergency Preparedness Officials 1) those that made things happen, 2) those who watched things happen, and3) the some who had no idea what happened�

68. Post Katrina National Realities Local response 1st 72 hours State and Federal response determined by regional and national need. Personal and Family basic preparedness activities are essential to weather the storm

69. Fundamental Community Preparedness Family Preparedness Neighborhood Preparedness Community Preparedness

70. Family & Individual Preparedness 1. The foundation of Community preparedness is family and individual preparedness. 2. Preparation for an All Hazards situation, 90% is repetitive in nature, 10% specific 3. Information readily available, ARC, CDEM, CDC, FEMA 4. No lack of information, lack of desire

71. Hierarchy of Family Preparedness Family communications plan Family 72-hour �Go Kit� Family �shelter in place� plan and essentials

72. Family Preparedness Find out what dangers exist Create a disaster plan Complete the checklist Practice your plan

73. Fundamental Community Preparedness Family Preparedness Neighborhood Preparedness Community Preparedness

74. Neighborhood Preparedness In Hurricane-prone states this practice has been around awhile Works on the basis of a neighborhood watch program. If you aren�t available to protect your family or property, who is in a better position to than your neighbor

75. Fundamental Community Preparedness Family Preparedness Neighborhood Preparedness Community Preparedness

76. Community Preparedness All the agencies within the city will respond and participate in the event of a disaster, following the Emergency Operations Plan. Those agencies include: Elected Officials and City Staff Office of Emergency Management Police, Fire, Utilities, Streets, Transportation, IMS and support services.

77. Community Preparedness The emergency officials and first responders of the community are always ready to fulfill their mission to protect lives and property however in a pandemic resources will be stretched

78. Community Preparedness The better prepared all individuals, families and neighborhoods become, the more local first responders and other support servicess can help those special needs populations during a pandemic situation

79. Community Preparedness

80. Community Preparedness Special needs populations; Those groups with little or no �safety net� Impaired, physically, emotionally or developmentally The senior community Non English speaking populations Transient populations

81. Resources Health and Human Services, One Stopwww.pandemicflu.gov/ Colorado Dept. of Health and Environment www.cdphe.state.co.us/dc/Influenza/ Larimer County Health and Environment http://www.co.larimer.co.us/health/

82. Communicating with the Publicabout Pandemic Influenza Adrienne LeBailly, MD, MPH Larimer County Department of Health and Environment

83. Communications Challenges: The Dilemma: Don�t want to frighten the public without good reason.

84. Communications Challenges: Don�t want to leave communities unprepared for a disaster.

85. How can you talk to the public about pandemic flu without frightening anyone?

86. Severe pandemic would cause high loss of life and complex societal challenges Some level of fear is a rational reaction Intense reactions can be directed constructively with patience Why you can�t...

87. The Good News True panic is rare in disasters. Adaptability, cooperation, and resourcefulness are the rule. Trust is created by openness in discussing potential risks now. Sharing uncertainties and dilemmas is important.

88. How You Can Help People Display coping skills and help people move from reactive fear to proactive planning Show people what they can do to prepare Make local planning efforts transparent and involve the public

89. Fear can be a good motivator Motivates protective behaviors Helps prepare a person emotion-ally for what could occur Generally returns to a �new normal� level of concern

90. Are People Panicking Now?  Only 20% of people state they are very concerned about pandemic flu. - 30% not concerned at all or not very concerned - 48% are somewhat concerned. Wall Street Journal - Harris Poll April 25-57, 2006

91. Are People Preparing Now? Only 7% have begun to stockpile food, water, and meds as suggested by HHS.  - 93% have put no supplies aside Wall Street Journal - Harris Poll April 25-57, 2006

92. Public Perceptions of Flu Pandemic What was expected

93. Public Perceptions of Flu Pandemic What was found

94. We must convey to people realistic expectations of what government--at all levels--will be able to do (or not do) in a pandemic,and what people must do for themselves.

95. Don�t Over-reassure Natural tendency of public officials is to want to reduce citizen fears. Complacency is a bigger problem than panic for now. Persuade people to prepare,not because a pandemic is imminent, but because if we wait until it�s imminent, it will be too late.

96. NO Community is Prepared for a Severe Pandemic Govt. role is only a part of pandemic preparation. People can do more to protect themselves, their families, and their businesses than governments can. Must encourage households and businesses to learn about pandemic flu and make an informed decision about their own preparation

97. Will you be criticized if you spend resources on pandemic planning and no pandemic occurs in the next 1- 4 years? YES. Plan and prepare ANYWAY.

98. Flu Pandemics are inevitable Naturally occurring events like earthquakes, floods, hurricanes (3 - 4 per century) Can�t stop a pandemic, but we can lessen the harm by planning and preparing This is the first time humankind has ever had a chance to see one evolve and try to mitigate it.

99. We Can�t Predict When a Pandemic Will Occur (or how bad it will be) Don�t assume it�s tomorrow, and distort your life unbearably. Don�t assume it�s never, and postpone your preparations indefinitely. --Peter Sandman, Risk Communications Expert

100. Try not to say �Bird Flu� when you mean �Pandemic Flu� Avian (or Bird) flu is not the same as Pandemic flu A bird flu virus would have to change to a more human form to spread easily person to person and cause a pandemic.

101. �Bird Flu� �Pandemic Flu� We could have bird flu in birds in Colorado soon--and even rarely in a human who catches it from a bird--but that doesn�t bring us significantly closer to a pandemic. We could also have a pandemic before we have the current bird virus in Colorado birds

102. How Ready Are We?

103. "Every day a pandemic doesn't happen is another day we have to prepare.�

104. References/Acknowledgments Peter Sandman, PhD, and Jody Lanard, MD, risk communication experts, for numerous excellent sources Wall Street Journal/Harris Poll, May 2006 Public Perception of Pandemic Influenza Messages, Alan Janssen, National Immunization Conference, March 2006 Steve Sack, Minneapolis Star Tribune Walt Disney/Dreamworks Chicken Little Hurricane Katrina, for helping us all see what happens when we don�t do adequate planning for the unthinkable

105. Fictional Scenario:A 1918-like outbreak in Larimer County today