Title: H1N1 Novel Influenza and Communications Issues for Minnesotas Hospitals
1Webinar for Minnesota Hospital Communicators
October 12, 2009
H1N1 Novel Influenza and Communications Issues
for Minnesotas Hospitals
www.mnhospitals.org
2Agenda
- Current State of Affiairs
- Dr. Ruth Lynfield, State Epidemiologist,
Minnesota Department of Health - Overview of MDHs communications role and the
media - Buddy Ferguson, Risk Communications Specialist,
- Minnesota Department of Health
- Overview of Communications Efforts with
Non-English Speaking Populations - Mr. Ferguson
- Coordinating, Monitoring and Managing Internal
Communications - Allison Sandve, Senior Communications/Public
Relations Specialist, HealthEast Care System and
Marla Mayer, Director of Marketing and Community
Relations, Queen of Peace Hospital - Questions and Answers
3Novel H1N1 Influenzain Minnesota
- Ruth Lynfield, M.D.
- Minnesota Department of Health
- ruth.lynfield_at_state.mn.us
4 Seasonal Influenza
- Outbreak every year between November and April in
Northern Hemisphere, generally due to circulating
H1, H3 and B influenza viruses - Vaccine available each year based on circulating
strains - Associated with about 36,000 deaths per year in
US - Most deaths (90) in persons 65 years old and
older - More than 225,000 hospitalizations per year in US
- Half of hospitalizations in persons 65 and older
5Pandemic Influenza
- Novel strain of virus
- Little to no immunity in the general public
- Virus infects all age groups
- The novel virus can spread easily person-person
- Spreads throughout multiple countries and
continents - More than one wave of influenza is likely
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9Novel H1N1
- Transmissibility similar or greater than seasonal
influenza - Severity currently similar to seasonal influenza
although cases generally younger - Increased severity pregnancy asthma, other
chronic respiratory conditions diabetes chronic
cardiovascular, neurological, cognitive, kidney,
liver conditions obesity chronic care - children lt 5 years (especially less than 2)
- adults over 65 years
- Vaccine available beginning in October 2009
10Surveillance Systems in Minnesota
- Hospitalizations for influenza
- MDH conducts laboratory testing for type of
influenza - Outpatient sentinel site surveillance for
influenza-like illness - Surveillance for outbreaks in schools, nursing
homes - Mortality due to influenza
- Unusual clusters
11March
January
February
April
May
June
December
November
July
August
October
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13H1N1 Cases in Minnesota Preliminary Data
- As of October 7 354 hospitalized confirmed
cases - Median age 12.5 years (range 0-91 years)
- 68 of hospitalizations lt25 years
- Median length of stay 3 days
- 15 in ICU
- 36 of hospitalized cases had asthma 64 of
hospitalized had an underlying condition - 7 deaths 3 children (two had no underlying
conditions), 3 adults and one elderly individual
14Schools with Influenza-like Illness, MN,
9/19-10/3/09
15Sentinel Network, Influenza-like Illness, MN
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18Reducing Spread
- Sick people stay home
- Respiratory and Hand Hygiene
- Vaccination
- In healthcare settings
- isolate, cohort suspect cases
- infection control precautions, PPE
- dont let sick family members visit
19Antiviral Drugs for the Treatment and Prevention
of Influenza
- Decreases rate of severe illness
- Can be used to prevent disease in exposed
- Have the greatest efficacy when started when
started within 48 hours - For novel H1N1 use promptly in those at higher
risk for severe disease or for individuals with
significant symptoms - Oseltamivir (Tamiflu) or zanamivir (Relenza)
- Rare cases of novel H1N1 resistant to oseltamivir
20Respiratory Etiquette
Respiratory Etiquette Campaign
21Stay Informed
- www.who.int/en/
- www.flu.gov
- www.cdc.gov
- www.health.state.mn.us
- www.cidrap.umn.edu
22Communicating About Novel H1N1 Influenza
Issues, Challenges Tools Oct. 12, 2009
- Buddy Ferguson
- Risk Communication Specialist buddy.ferguson_at_state
.mn.us - 651-201-4997
23Genesis Reaction
- April-May the sudden storm
- June-August slow simmer
- and a summer of planning
- Since labor day the second wave
24Educational Activities (setting the stage)
- Media Briefing (Aug. 26)
- H1N1 Summit (Sept. 14)
- CIDRAP Summit (employers, business,
government) - (Sept. 22-23)
- Cultural Communities Forum (Sept. 28)
25 The Current Environment
- Media are hungry for fresh angles
- Areas of interest (potential trigger events)
- dramatic increase in schools reporting flu-like
illness - unusual illnesses or deaths
- clustering of illnesses or deaths (outbreaks)
- dramatic increase in illnesses or deaths
26 The Current Environment
- Areas of interest (potential trigger events)
- any possible sign of that virus is causing more
severe disease - dramatic increase in demands on health care
system (activation of flu centers) - the pending H1N1 vaccination campaign
- possible vaccine shortages (delays in vaccine
availability)
27 The Current Environment
- Areas of interest (potential trigger events)
- possible antiviral shortages
- vaccination apathy
- active opposition to vaccination
- possible vaccine adverse events
- (real or perceived)
28Vaccine AvailabilityA Long-Running Drama
- vaccine will arrive in multiple shipments, over
time - target population for vaccine will gradually
widen - scarcity effect may take over
- initial targeting of health care workers has put
providers in spotlight
29Who Takes Center Stage When
- We all have a story to tell
- Feel free to refer calls to local public health
or MDH when appropriate - Use message coordination tools (more about that
in a minute)
30What Were Doing at MDH
- incident command approach
- coordination with partners
- critical role for local health departments
- earned media
31What Were Doing at MDH
- paid media campaign
- TV
- radio
- bus ads (four languages)
- outdoor(?)
32What Were Doing at MDH
33www.mdhflu.com
- print materials (multiple languages)
- cover your cough (19 languages)
- bookmarks
- wallet cards
- refrigerator magnets
- basic message points (18 languages)
- other materials (general)
- other materials (non-English)
34www.mdhflu.com
- current statistics
- hospitalizations for ILI
- of schools reporting ILI
- arrival of vaccine shipments ( of doses) (?)
35A note about what we say and what we dont
- We only provide minimal information about cases
- Gender, age, place of residence
- Number of people hospitalized with novel H1N1
- Schools have been an exception
- Currently provide lists of schools with flu-like
illness but only on request - Currently post updated school and hospitalization
numbers weekly (on Wednesdays)
36More Online Resources
37E-Subscription Resources (GovDelivery)
- news releases
- www.mdhflu.com
- flu statistics
38Message Coordination Tools (on WorkSpace)
- standard talking points
- (updated regularly)
- situation reports
- WorkSpace messaging
39- get designated as a Public Communication
Coordinator (PCC) - by your HAN coordinator
- by your Hospital Preparedness Representative
- get added to a contact group
- (e.g., the Metro Health PIO Group)
40MnTrac
- online discussion format
- originally set up to track hospital/EMS resources
- allows for posting of informational resources
- exploring use as virtual JIC
- (ala Snowball SNS exercise)
41MnTrac
- requires training
- by MDH staff
- by regional healthcare preparedness coordinators
(RHPCs) (?)
42Limited-English Populations
- Community outreach activities at MDH (e.g., the
September forum) - Outreach to limited-English media
- Materials on mdhflu.com
- ECHO Minnesota
43ECHO Minnesota and H1N1
- ECHO a tool for reaching LEP audiences
- The evolution of ECHO from government-led
collaborative to private non-profit - ECHO in the spring a lost opportunity
- ECHO in the fall a fresh start
44The Current ECHO Initiative
- TV show (seven languages)
- Three packages of messages
- TV and radio PSAs (12 languages)
- ECHO Phone messages (12 languages)
- (1-888-883-8831)
45The Current ECHO Initiative
- Three packages of messages
- Two packages in production or complete (personal
protection and vaccination) - One package held in reserve
- (for emerging issues)
- Proposal for additional packages
46The Triage Line
- 24/7 1-800 number
- In development ready soon
- Not an all-purpose hotline
47The Triage Line
- Will provide guidance and assistance for people
who are ill or have been exposed to illness. - Will have language capability
- Not sure how it will be promoted
48Internal Communications
- Allison Sandve
- Senior Communications/PR Specialist
- HealthEast Care System
49Meet your new best friends
- Infection Control/Infectious Disease
- Occupational Health
- Emergency Preparedness
50H1N1 novel strain,not-so-novel challenges
- Communicating plans when resource scarcity enters
the picture - Prioritization Who gets the vaccine first?
- The questions that wont go away Is this safe?
Is this really effective?
51What stays the same
- While we may be facing a new challenge, our
obligation to provide a calm, therapeutic
environment for patients is unchanged. - Our pledge to provide a safe workplace for
employees is unchanged.
52 and how we create messages that sustain
stability during the unknown
- Empathy We understand that this influenza season
may create concern among some employees. - Consistency The decisions were communicating
follow the recommendations of those who
understand the challenges better than anyone
CDC, MDH. - Acknowledgement We may not have all the answers
right now. What we do have is a commitment to
communicate with you.
53Someone already invented the wheel
- Much of the work has already been done for you.
CDC and MDH fact sheets are easily reformatted,
if you wish. If so, make sure you note the source
of the information so that employees become
accustomed to seeing that messages are
consistently being relayed from CDC and MDH to
our hospitals. They arent local or subjective.
54Lessons learned along the way
- Be prepared for things to change the document
you created yesterday may become obsolete
tomorrow. Or sooner. - Front-load your communications with FAQs youve
already created. It sets a calm tone. - Incident Command works. It establishes clear
authority and assignment of duty. Its flexible. - but deputizing is a good idea!
55HealthEasts Infonet
- Our one-stop shop for information
56Just remember
- Today, its this
- Sooner or later, itll be something else.
57H1N1 Novel Influenza
Cluster Outbreak Seneca Foods, Montgomery August
2009
58Timeline
- Thursday, August 6, 2009
- Late afternoon First phone calls re increase in
ILI in migrant workers from Seneca. LPH called
Brad Krier, MDH Epidemiologist. - Friday, August 7, 2009
- Morning flurry of phone calls.
- 130 pm Conference Call with LPH, MDH and health
care partners. - Saturday, August 8, 2009
- 400 pm Notified that all three swabs were
positive for H1N1. Partners notified. - Monday, August 10, 2009
- 1000am Conference call with LPH, MDH, partners
and Seneca. Concern re 189 workers on-site in
sleeping trailers. Action Item Collaborate with
partners to do an on-site flu clinic at Seneca. - 1230 pm Conference call with partners to plan
the clinic. - 300 pm Clinic set-up.
- 400-800 pm Seneca on-site flu clinic.
59Screening Education
Registered Nurses From Le Sueur County Public
Health, Le Sueur Hospital, Queen of Peace
Hospital and Migrant Health Services
Translators From Seneca Foods and Centro
Campesino
60Treatment
ER Physician Queen of Peace Hospital FNP Le
Sueur Clinic
61On-Site Flu Clinic in Action
- 132 people screened
- 55 people received treatment or prophylaxis
- 2 people sent to the hospital
62Press Release
63Follow up News Release
On-Site Flu Clinic at Seneca Foods, Montgomery In
response to the 3 laboratory confirmed cases of
H1N1 in workers at Seneca Foods and the increased
reports of influenza-like illness (ILI) from area
hospitals and clinics, Le Sueur County Public
Health organized an On-Site Flu Clinic at Seneca
on Monday, August 10. The purpose of the
clinic was to assess the level of ILI within the
population living on-site at Seneca in the
housing trailers, with the goal of limiting the
transmission among the workers and within the
greater community. This was accomplished by
screening workers for symptoms of ILI and
underlying health conditions and providing
education to each worker on hand washing,
covering their cough and staying home from work
if sick until 24 hours after fever resolution.
Next, workers were seen by a physician or nurse
practitioner to have a prescription written for
antiviral treatment or prophylaxis if needed and
then were able to fill that prescription by an
on-site pharmacist. Seneca Foods provided
financial assistance to workers needing
medication. 132 people were screened and 55
received treatment or prophylaxis with antiviral
medication. Local partners who so willingly
stepped forward to staff the On-Site Flu Clinic
included Queen of Peace Hospital - ER
physician, Dr. Timothy Miller, RNs Tiana Wells
and Diann Kelly Le Sueur Hospital and Clinic -
Ruth Vortherms, FNP and RN Pam Williams
Pharmacist, Ron Grothe, Le Sueur Corner Drug
Pharmacist, Troy Rabenberg, Herrmann Drug was on
standby backup Migrant Health Services - RN and
two translators Centro Campesino - translator
Minnesota Department of Health Regional
Epidemiologist and Regional Preparedness Nurse
Consultant Le Sueur County Public Health - PHNs
Elisa OMalley, Jessica Stadick, Cindy
Shaughnessy Le Sueur County Deputy Emergency
Manager, Ann Traxler Seneca Foods - six
translators. Cindy Shaughnessy, Director of Le
Sueur County Public Health would like to thank
these people for their dedication to our local
communities and their willingness to share their
time and expertise in less than 5 hours notice!
The assistance and cooperation of Seneca Foods
including providing translators, an on-site
location and financial assistance to their
employees for treatment were key to the success
of the clinic. The Minnesota Department of
Health has defined this as a cluster of H1N1
cases. At the onset, 3 people were swabbed/
tested to confirm that we were dealing with H1N1.
Following that confirmation, the only people
tested are those that are hospitalized with ILI.
People presenting in the area emergency rooms or
clinics with ILI will be presumed to have H1N1.
All persons previously hospitalized with ILI have
been released and are recovering at home. For
more information on the H1N1 flu, go to the
Minnesota Department of Health website at
www.health.state.mn.us and click on H1N1 Novel
Influenza Information.
64Key Learnings
- Relationships are vital know and trust your
partners. Involve all partners and then let them
do what they do best. - Make the connection with Public Health and other
partners outside your systems. - Communication is crucial. We had three
conference calls re the situation and included
every health care partner in the area and also
the business that was affected. - Have one point of contact for release of
information so message is consistent. - Keep the business (organization) in the loop.
They need to have a plan for internal
communication. - Previous exercises and planning gave us the
skills, experience and tools to pull this
together so quickly.