Council of State Governments

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Pandemic Influenza A National Perspective

• Council of State Governments
• August 13, 2006
• Georges C. Benjamin, MD, FACP
• Executive Director

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United States of America 1918 - 1919

• In Boston the stock market closed. In
  Pennsylvania a statewide order shut down every
  place of amusement, every saloon. In Kentucky the
  Board of Health prohibited gatherings of any
  kind, even funerals ..Deadly influenza, the
  so-called Spanish Flu, was sweeping the
  country, spreading terror everywhere
• David McCullough

National Museum of Health Medicine Armed Forces
Institute of Pathology
--- 675,000 Americans died 40 million people
died worldwide ---
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Are We Prepared For Pandemic Flu?

• A process not a point in time!
• Always ask - Prepared for what?
• Use real life events to measure preparedness
• First step is to get annual flu right
• Under prepared for pandemic influenza

Goal To go from chaos to controlled disorder
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We Already Have A Bird PandemicThree Likely
Initial U.S. Presentations

• First H5N1 solitary positive bird could be in
  U.S. this year
• First outbreak of highly pathogenic avian flu in
  birds
• An outbreak in birds with sick people
• Management crisis will be the birds and will be
  immediate health threat
• Community efforts need to focus in five areas of
  preparedness
• Family preparedness
• Avoiding sick or dead birds
• Surveillance for sick people
• Disease containment
• Treatment

Assumes no human to human transmission in world
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HHS Planning Assumptions

• Global susceptibility
• Incubation period 2 days with 12 spread
• gt 30 attack rate
• 50 will seek outpatient care
• Hospitalizations / mortality depends on virulence
• Absenteeism will occur
• Will last 6-8 weeks may come in waves

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Plan For Three Clinical Scenarios

• There are enough effective vaccine antivirals
• Vaccination antivirals
• Some community disease control efforts
• 2. The amount of vaccine / antivirals are
  insufficient in efficiency or amount
• Vaccination antivirals
• Mild to moderate community disease control
  efforts
• Medical management of clinical complications
• Manage societal disruption
• 3. There is no vaccine or useful antivirals
• Maximum community disease control efforts
• Medical management of clinical complications
• Mange societal disruption

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Prepare To Respond

• Bird surveillance response
• Early disease surveillance will transform to
  disease differentiation
• Laboratory capacity
• Disease control
• Mass vaccination
• Antiviral distribution
• Exposure reduction, social distancing
• Health system surge capacity
• Patients, workforce, supplies equipment, space
• Risk communication
• Mortality management
• Routine health management
• Coordination regional, national

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Prepare For Societal Disruption

• Continuity of government
• Business continuity
• Food, water
• Transportation
• Public safety
• Trash, sanitation
• Goods supplies
• Services
• Critical infrastructure

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Social Distancing Strategies

• Voluntary home curfew
• Suspend group activity
• Cancel public events
• Close public places
• Suspend public travel
• Restrict travel
• Snow days
• Non-essential workers off
• Work quarantine
• Cordon sanitaire

Isolation Separation of infected persons Usually
in a hospital setting (Other settings may be
difficult) Quarantine Restriction of persons
presumed exposed Community or individual level

• Primary hygiene Hand washing coverage of nose
  mouth
• Barriers Surgical Masks vs. N - 95 Masks

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Plan To Care For Sequestered Persons

• Food Water
• Housing
• Hygiene sanitation
• Social support systems
• Treatment prophylaxis for disease
• Disease monitoring
• Dependent care
• Compensation liability issues

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• Georges C. Benjamin, MD, FACP
• Executive Director
• American Public Health Association
• WWW.APHA.ORG

Public Health Prevent, Protect, Promote