Pandemic Flu Preparedness

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Pandemic Flu Preparedness

• Web Conference
• June 28, 2006

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Todays Presenters

• John McLaughlin
• Managing Director, Higher Education Practice,
  Arthur J. Gallagher, Inc.
• Anita L. Barkin, MSN, DrPH
• Director, Student Health Service, Carnegie Mellon
  University
• Chair, Pandemic Planning Task Force, American
  College Health Association
• David Pajak, ARM
• Director of Risk Management, Syracuse University
• Co-Chair, SU Pandemic Flu Preparedness Committee

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Ask Questions!

• Feel free to ask questions anytime during the web
  conference by using the
• text tool

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Evaluation

• At the end of the web conference, you will be
  taken to an on-line evaluation.
• Please fill in it -
• your feedback is important to us!

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National Association of College Auxiliary
Services

• NACAS is a non-profit organization of
  professionals serving nearly 1,000 institutions
  of higher learning throughout North America and
  other nations around the world.
• Our members provide quality campus services such
  as bookstores, food services, student housing,
  security, transportation parking, just to name
  a few.
• Visit www.nacas.org for more information

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Student Affairs Administrators in Higher
Education

• NASPA is the leading voice for student affairs
  administration, policy and practice and affirms
  the commitment of student affairs to educating
  the whole student and integrating student life
  and learning.
• With over 9,400 members at 1,400 campuses, and
  representing 29 countries, NASPA is the largest
  professional association for student affairs
  administrators, faculty and graduate students.
• Visit www.naspa.org to learn more

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Purpose of Todays Web Conference

• To define the reality of the threat
• To discuss planning and how to get started
• To identify challenges to planning
• To describe specific areas that should be
  included in planning
• To review elements of effective communication

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Threat Hype or Real?

• Pandemics
• Ten recorded over past 300 years
• Range between events 10-49 years, average 24
• No predictable pattern
• Three in the past century
• 1957-58 reassortment event
• 1967-68 reassortment event
• 1918-20 mutation event with markers similar to
  those found in birds

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Threat Hype or Real?

• Concerns about H5N1
• Highly pathogenic strain persists in the bird
  population despite culling
• Crossed species infecting 42 other animal
  species, including humans
• Suspected human-to-human transmission

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Threat Hype or Real?

• Similarities to 1918
• High mortality rate
• Appears to have W shaped mortality curve
• Has the same protein tag
• NS1 protein found in H1N1 and H5N1 only ones
  alike out of 169 viruses
• Increased level of tumor necrosis factor alpha
  assoc with tissue destruction
• Cascade leading to cytokine storm ARD

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Threat Hype or Real?

• Modes of Introduction into North America
• Migratory birds flocks
• Spread occurs via intersecting flyways
• Change to human form occurs in North America and
  then spreads rapidly
• International travel
• Change to human form occurs in Asia or Europe
• Virus enters through a North American
  international port of entry
• 1.6 billion annual air passengers worldwide
• 120 million international travelers arrive in
  U.S. each year

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(No Transcript)
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Threat Hype or Real?

• A pandemic today is likely to
• Spread rapidly and span the globe in weeks
• Affect 15-30 of the population of any one
  country within weeks
• Have greater socio-economic impact
• Impact supply chains
• Not easily contained

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Threat Hype or Real?

• Seasonal influenza
• Peaks usually December thru March in North
  America
• 36,000 deaths/200,000 hospitalizations/yr
• Frail, elderly and very young U shaped
  distribution
• Pandemic influenza
• Rapid, global spread among humans
• No seasonal preference
• Comes in waves
• Total duration a year or more
• Millions of deaths

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Threat Hype or Real?

• Impact
• Attack rate - 25-50
• Sickness rate 4-12
• Normal flu is 5-10
• Absenteeism
• 25-35 for 5-8 days over a 3 month period
• Difficult to impossible to travel
• Disruptions and shortages of fuel, food stuffs,
  health care

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Threat Hype or Real?

• Condition One
• Novel virus
• Condition Two
• Crosses species
• Humans, pigs, tigers, cats
• Condition Three
• Efficient, persistent human-to-human transmission
• Reassortment
• Mutation

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Process of Genetic Reassortment
Avian Influenza Virus
Human Influenza Virus
High mortality rate among birds, spreads rapidly
Spreads easily from human-to-human, low mortality
rate
Mutated (Novel) Virus Can easily spread
human-to-human
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Cumulative Number of Confirmed Human Cases of
Avian Influenza A/(H5N1) Reported to WHO 20 June
2006
Total number of cases includes number of
deaths.WHO reports only laboratory-confirmed
cases.
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Threat Hype or Real?
Countries with H5N1 Outbreaks
Image source BBC News, http//news.bbc.co.uk/2/hi
/health/4531500.stm
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Q A
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Preparedness Planning

• Getting Started!!

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Preparedness Planning

• Why plan?
• More effective response to any public health
  emergency
• Social responsibility to prepare for a potential
  catastrophic event
• Potential increase in liability for failure to
  plan
• Maintain continuity of essential services

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Preparedness Planning

• Nine Planning Steps
• 1. Identify who to engage on your campus to get
  pandemic planning on the table
• 2. Establish a Pandemic Preparedness Team
• 3. Identify appropriate channels of
  communication and chain of command
• 4. Create a contingency plan. Does your school
  have an emergency response plan/template? Can it
  be adapted for pandemic planning?
• 5. Identify essential functions and personnel

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Preparedness Planning

• Nine Planning Steps, continued
• 6. Articulate duties and delegate responsibility
  to staff and faculty
• 7. Provide advisories and regular updates to
  traveling staff, faculty and students
• 8. Educate campus community on pandemic flu and
  your institution's plan response
• 9. Communicate regularly as the threat heightens

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Preparedness Planning

• Identify Planning Committee Members
• Executive management (President, Provost,
  Chancellor or designees)
• Student Health
• Public Safety
• Environmental Health Safety
• Public Affairs
• Government Relations
• Facilities Management
• Student Affairs
• International Student Services
• Housing
• Dining
• Auxiliary Services
• Human Resources
• Risk Management
• Telecommunications
• Information Technology
• Operations and Finance

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Preparedness Planning Organize Response
Executive Steering Group
Pandemic Preparedness Team
Dept. Teams
Dept. Teams
Dept. Teams
Dept. Teams
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Preparedness Planning

• Contingency Planning Assumptions
• As much as 40 of the work force will be affected
  during the peak
• Hospitalized
• Low end of range 10 per 100,000
• High end of range 8,000 per 100,000
• Dead
• Low end of range 1 per 100,000
• High end of range 1,000 per 100,000

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Preparedness Planning

• Contingency Planning Assumptions (cont.)
• 1. A pandemic flu will result in the rapid
  spread of infection throughout the world.
• 2. You will not be able to reply on mutual aid
  resources, or state or federal assistance to
  support local response efforts.
• 3. Antiviral medications will be in short
  supply. Local supplies will be prioritized for
  use in hospitals, for health care workers, and
  other groups based on DOH guidelines.
• 4. A vaccine will not be available for 4-6
  months following the emergency of a novel
  strain.

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Preparedness Planning

• Contingency Planning Assumptions (cont.)
• 5. The number of ill requiring medical care
  will overwhelm the local health care system
  (More patients and fewer workers)
• 6. The number of fatalities will overwhelm
  the medical examiners office, hospital morgues,
  and funeral homes.
• 7. The demand for home care and social
  services will increase dramatically and wont be
  available
• 8. There is likely to be a significant
  disruption of public and privately owned
  critical infrastructure including
  transportation, businesses, utilities, public
  safety, and communications.

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Preparedness Planning
Levels of Emergency Response

• Level One
• Pre-event planning to first case of
  human-to-human transmission
• Level Two
• Suspected/confirmed cases of sustained
  human-to-human transmission anywhere in the world
• Level Three
• Suspected/confirmed cases in the United States

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Preparedness Planning

• Determine triggers for Moving Plans to Action
• Short window for critical decision making
• Reducing the number of students on campus may be
  best strategy
• Resources/expectations for care/support
• Once closed, when do you reopen?
• 8-12 weeks to avoid resurgence of illness
• Define closing no classes? No research?
• Lock down of all buildings?

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Preparedness Planning

• Challenges to Planning
• Requires multi-faceted, multi-departmental effort
  over time
• Deficits in knowledge
• No case definition
• Gaps in our understanding of viruses
• Gaps in our understanding of which strategies are
  most effective

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Preparedness Planning

• Challenges to Planning
• Consider the what ifs
• We cant send all students home
• We have students who are ill and the local health
  systems are overwhelmed
• We must work with a reduced staff
• Allocation of resources
• Stockpile goods? How much?
• Questions of ethical nature

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Preparedness Planning

• Planning in the Present
• Based on current knowledge and understanding
• Inclusive, collaborative
• Plans must be flexible, adaptable, resilient
• Plans must be tailored to the particular type of
  institution
• Plans must be tested and rehearsed

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Preparedness Planning - Student Health Services

• Health Service Staff education and preparation
• Supplies/equipment/services
• Identify vendors/storage
• Cost estimate for stockpiling/storage
• Clinical Issues
• Consult with HR regarding use of volunteers
• Plans for setting up an infirmary staffing,
  location?
• Protocol for monitoring cases in quarantine
• Triage and treatment protocols
• Care of the deceased morgue/notification of
  family
• Plans for mass immunization clinics

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Preparedness Planning - Counseling Services

• Anticipate high need
• 24/7 counseling for staff, faculty, students
• Protocols for providing service via telephone or
  internet

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Preparedness Planning - Housing Services

• Identify rooms and buildings for quarantine,
  isolation and residence for students who cannot
  go home
• Develop a procedure for closure and evacuation of
  residence halls
• Procedures for notifying and relocating students
• Housekeeping staff trained in personal protection
  and proper cleaning
• Communication protocols between Housing and
  Residence Life

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Preparedness Planning - Dining Services

• Stockpiling and storing non-perishable food
  stuffs and fluids
• Procedures for delivery to residential areas

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Preparedness Planning - Campus Security and
Environmental Health Safety

• Procedures for securing buildings, protecting
  stored supplies
• Communication with local police, fire, and
  emergency response
• Protocols for transporting sick students
• Fit, tested, and trained for use of N95s
• Equip cars with disinfectants, gloves, etc.

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Preparedness Planning - International Students
and Study Abroad

• Plans for communicating with students abroad
• Guidelines for closure of study abroad programs
• Procedures for monitoring student travel
• Procedures for communicating to international
  students about travel restrictions and re-entry
• Tuition Refund Policies

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Preparedness Planning -Physical Plant

• Contingency plans in case of fuel, water and
  energy shortages
• Emergency generators
• Building ventilation systems

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Preparedness Planning Human Resources

• Identify essential personnel and depth charting
• Call-offs, vacation, and sick leave guidelines
• Return to work guidelines
• Work-at-home guidelines
• Recruitment of volunteers
• Communications for supervisors and campus work
  force
• Benefit Plans

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Preparedness Planning -Academic Affairs

• Policies for student absenteeism due to
  illness/quarantine
• Alternative procedures for completing course
  work

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Preparedness Planning -Research

• Can some research continue?
• Plan for maintaining security in labs.
• Plan for care of lab animals.
• Plan for specimen storage and managing
  experiments in progress.

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Preparedness Planning - Business and Finance

• Procedures for rapid procurement of goods
• Continuation of payroll functions
• Emergency funding issues
• Contracts
• Insurance

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Preparedness PlanningAdmissions/Financial Aid

• Plan for reviewing applications and recruiting in
  absence of face-to-face interviews or campus
  visits.
• Contingency plans for dealing with financial aid,
  withdrawal from school, other factors related to
  tuition and registration.

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Preparedness Planning
Recovery Plan

• Criteria for calling an end to the crisis and
  resuming business
• Communication plan for advising students, staff,
  faculty of plan to resume business
• Timeline for restorations of operations
• Plan to debrief

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Q A
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4 Lines of Defense

• Surveillance
• Vaccines
• Containment measures
• Medical treatment

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Surveillance

• Influenza Monitoring Agencies
• ? WHO ? CDC
• ? PAHO ? HDs
• EU Monitoring Program
• Local Governments
• Culling Infected/Exposed Poultry

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Organizations Enforcing BCPs

• White House Mandated
• Business Pandemic Contingency Planning
• OSHA
• The Agency will target employers who refuse to
  maintain safer workplaces. May 14, 2006,
• Jonathan Snare, Deputy Assistant Secretary of
  Labor
• NFPA 1600
• NIMS

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4 Lines of Defense

• Surveillance
• Vaccines
• Containment measures
• Medical treatment

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Vaccines

• Clinical trials ongoing
• Adjuvant that allows for effective delivery and
  adequate immune response using smaller doses of
  vaccine developed
• New technologies for vaccine development continue
  to be explored
• Will not be available at the start of pandemic
  and there will not be sufficient amounts to
  vaccinate everyone

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Vaccines

• Tamiflu, an antiviral, not a vaccine
• Tamiflu No country has enough stockpiled to
  protect all their citizens
• Used to treat essential workers such as
  healthcare workers and emergency responders.
• Needs to be taken every day for weeks in order to
  prevent influenza infections
• Currently manufactured by one company in
  Switzerland.

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4 Lines of Defense

• Surveillance
• Vaccines
• Containment measures
• Medical treatment

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Containment Measures

• Effective containment measures depend on
• Preparedness Planning
• Three desired outcomes
• To minimize hospitalizations and deaths
• To preserve critical infrastructure
• To minimize social disruption

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Containment Measures

• Management Action
• Secure medication and medical supplies in safe
  location
• Continually monitor employee health
• Encourage and make available use of hand
  sanitizers and gloves
• Frequently sanitize hand railings, door knobs
  etc.

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Containment Measures

• Personal care
• Seasonal influenza immunizations
• Social distancing when feasible
• Frequent and vigorous hand washing
• Respiratory hygiene/cough etiquette
• Refrain from shaking hands
• Restrict travel to and in infected areas
• Avoid contact with live poultry

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4 Lines of Defense

• Surveillance
• Vaccines
• Containment measures
• Medical treatment

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Medical Treatment

• Clinical Features
• Aggressive clinical course with concentration in
  previously healthy children and young adults
• Current features
• Virus can survive in environment 6-35 day
• droplet infection
• depending on temperature
• Incubation period in humans ranges from 2-17 days
  
• 7 day range current WHO standard for observation

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Medical Treatment

• Oseltamivir and Zanavir
• Prior to outbreak in Turkey, most patients
  treated late in disease
• Early detection with treatment is stressed
• Recommendations on optimum dosing and duration of
  treatment continue
• Expensive, production capacity limited
• Antibiotics
• Not effective in treating pneumonia

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Communication

• Internal Communication Plan
• Establish a central reporting plan
• Determine Communication Mechanisms
• Designate a Spokesperson
• Have established protocol for printed materials
  development and dissemination

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Communication

• External Communication Plan
• Collaborate with credible sources
• Collaborate with media relations
• Maintain communications with local public health
  authorities, emergency preparedness groups,
  hospital systems
• Benchmark activities/planning of other like
  colleges and universities

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State and Local Health Departments
Threat Immunization Lab Services
College and University Campuses
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Communication

• Messages will need to address
• Symptoms and transmission of influenza
• Geographic spread
• Current case counts
• Designated treatment sites
• Vaccine availability
• Information about canceled public events and
  meetings
• Quarantine laws and enforcement
• Need for volunteers

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Communication

• Post- Pandemic Communications
• Recovery time varies depending on the intensity
  of loss.
• Within reason, overlook dress codes, personal
  phone calls, allow time off for family matters.
• Be truthful about job security.
• Encourage talking
• Create situations for positive group events
• Be aware of signs that indicate need for
  professional help.

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Communication

• Crisis and Emergency Risk Communication
• By Leaders for Leaders
• The Centers for Disease Control and Prevention
• http//www.cdc.gov/communication/emergency/leaders
  .pdf

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Tabletop Exercises

• An excellent way to test
• Plan functionality
• Individuals knowledge of roles and
  responsibilities
• Intra-departmental communications
• Communication with external partners
• Coordination of resources

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Useful Websites

• Overseas Security Advisory Council
• http//www.osac.gov
• World Health Organization
• http//www.who.int/csr/disease/avian_influenza/en/
  
• Centers for Disease Control and Prevention
• http//www.cdc.gov/flu/avian/index.htm
• Pandemic Flu Center
• http//pandemicflu.gov/

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Q A