Pandemic Influenza Planning

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Pandemic Influenza Planning

• Stan Sexton MA, MIOSH, CSPA
• Corporate Manager Safety
• Public Transport Authority
• Western Australia

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• The Public Transport Authority (PTA) is
  responsible for the following transport services
• rail, bus and ferry services in the metropolitan
  area (Transperth)
• public transport services in regional centres
• coach and rail passenger services to regional
  areas (Transwa) and
• school buses.
• Transport approximately 320,000 passengers each
  weekday which is expected to increase to 380,000
  per weekday when the southern suburbs railway
  opens.

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Pandemic Influenza

• An influenza pandemic is a disease outbreak that
  occurs worldwide when
• a new strain of influenza virus emerges, to which
  no-one is immune
• the virus causes disease in humans
• the virus is easily spread between humans
• In 1918, a pandemic of the Spanish flu caused
  an estimated 20 million to 40 million deaths
  around the world.
• Subsequent influenza pandemics in 1957 and 1968
  were milder but still caused widespread illness,
  over a million deaths worldwide and significant
  economic and social disruption.
• SARS outbreak 2002/2003. 8,096 known cases of the
  disease, and 774 deaths a mortality rate of 9.6
• Mortality and infection rate determining factors
  in any response

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Why?

• Why do we need to plan for a pandemic?
• To meet Government requirements
• Good business practice
• To meet the needs and expectations of our
  customers and the Western Australian public
• Good employer

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Defining The Problem For A Public Service Employer

• How is pandemic influenza spread? How do we stop
  it spreading? How long does the virus survive?
  How do we disinfect?
• How long does a pandemic last? What will the
  affect be on PTA personnel?
• What services could we provide? Should we stop
  all services? If so when? What is the impact?
  Who decides?
• What PPE do we provide for employees? When do we
  provide it? What other strategies should we
  implement?
• What requirements do we place on passengers?
• How do we communicate this information?

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Finding Solutions

• Research and consultation
• Used information from
• Department of Health
• The Australian Health Management Plan for
  Pandemic Influenza
• Other Government agencies
• Internet

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• How do we disinfect?
• Facilities, buses, trains and ferries
• Continue with existing cleaning arrangements
  using Department of Health recommended cleaners
• Sodium hypochlorite 1 in 50 dilution of 5
  liquid bleach
• Workstations
• Solely occupied workstations should be
  disinfected daily
• Shared workstations and especially telephones,
  must be disinfected before and after each change
  of shift
• When disinfecting workstations, all touched
  surfaces such as controls, telephones and
  computer keyboards must be disinfected using
  alcohol wipes
• Isopropyl alcohol 70 or ethyl alcohol 60 as
  alcohol wipes must be used for workstation
  disinfection

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• How long does a pandemic last?
• Pandemics typically unfold in waves with each
  wave lasting 12 weeks. Past pandemics have
  averaged three waves with each subsequent wave
  tending to be more severe.
• What will the affect be on PTA personnel?
• Absenteeism will depend on the severity of a
  pandemic but may reach 40 during the peak weeks
  of a severe outbreak.
• What services could we provide? Should we stop
  all services? If so when? What is the impact?
  Who decides?
• In the event of an influenza pandemic the PTA
  shall provide public passenger transport services
  in line with available staffing and external
  services and supplies necessary to ensure the
  safe provision of those services, or as directed
  by Government.
• What requirements do we place on passengers?
• From Aus Phase 4, PTA will liaise with Department
  of Health and DPC on requirement for face masks
  on public transport

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• Social distancing

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• What PPE do we provide for employees?
• Face Masks
• Disposable gloves
• Alcohol wipes
• Alcohol hand cleaner
• Facial tissues
• Clip seal bags
• What type of PPE do we provide?
• Face masks - N95/P2 respirator facemasks (AS/NZ
  1716) recommended by the Department of Health
• Nitrile gloves latex allergies
• Facial tissues antiviral tissues

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• Who do we provide PPE to?
• All PTA employees
• How much PPE do we provide?
• Face Masks 3/person per day
• Disposable gloves 2 pairs/person per day
• Alcohol wipes 4/person per day
• Alcohol hand cleaner 1 bottle/person per week
• Facial tissues 1 box/person per week
• Clip seal bags 4/person per day
• When do we provide PPE?
• Alcohol wipes, hand cleaner, tissues Aus Phase
  4
• Face masks, disposable gloves Aus Phase 5
• Shelf life of PPE
• Facemasks - five years
• Alcohol wipes - 12 months
• Alcohol hand cleaner - 30 months
• Anti viral facial tissues - 12 months

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• Capital Costs
• Based on the above costs and usage rates, the up
  front capital cost of providing the above items
  for 1 pandemic wave of 12 weeks duration for 1050
  PTA personnel with an absenteeism rate of 30 is
• Face Masks 132 300 _at_ 3.36ea
  444 528
• Disposable Gloves 88 200 _at_ 4.50ea
  396 900
• Alcohol Wipes 176 400 _at_ 0.085ea 14 994
• Alcohol Hand Cleaner 8 820 _at_ 5.00ea
  44 100
• Facial Tissues 8 820 _at_ 3.00ea
  26 460
• Clip Seal Bags 176 400 _at_ 0.067ea
  18 819
• 
  TOTAL 945 801
• Recurrent Costs
• Based on the above shelf lives, the recurrent
  cost of holding 12 weeks supply of the above
  items is 147 999 per annum.
• Include 24/7 PPE MOU provision

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Evaluation Of Options

• Option 1. No pandemic response.
• Option 1 is not consistent with Government and
  public expectations and requirements and as such
  will not be considered further.
• Option 2. Purchase PPE and disinfectants as
  required.
• Option 2 is based on the expectation that the PTA
  would be able to procure all required stocks of
  PPE when required.
• Given that in the event of a worldwide pandemic
  demand for this kind of PPE will be very high and
  the supply chain including the producer may very
  well be affected, there is a significant
  likelihood that the PTA may not he able to
  procure these items at a high pandemic phase.
• Option 3. Purchase 50 of PPE and disinfectants
  required for 1 pandemic wave and remainder as
  required.
• The up front capital cost of Option 3 is
  approximately 472 900.
• The annual recurrent cost of Option 3 is
  approximately 74 000.
• This option provides the PTA with PPE and
  disinfectants for immediate use that would last
  approximately 6 weeks in which the PTA would be
  required to procure additional supplies.
• As with Option 2, there is the risk that at high
  pandemic phases, global supplies of some products
  may be significantly affected reducing the PTAs
  ability to procure these items within 6 weeks
  with a corresponding impact on its business.
• Option 4. Purchase 100 of PPE and disinfectants
  required for 1 pandemic wave and remainder as
  required.
• The up front capital cost of Option 4 is
  approximately 945 801.
• The annual recurrent cost of Option 4 is
  approximately 147 999.
• This option is the same as Option 3 but provides
  the PTA with PPE and disinfectants for immediate
  use that would last approximately 12 weeks in
  which the PTA would be required to procure
  additional supplies.
• As with Option 2, there is the risk that at high
  pandemic phases, global supplies of some products
  may be significantly affected, however, this
  option gives the PTA 12 weeks to procure
  additional supplies.
• Option 5. Purchase 100 of PPE and disinfectants
  required for 3 pandemic waves.
• The up front capital cost of Option 5 is
  approximately 2 837 403.
• The annual recurrent cost of Option 5 is
  approximately 443 997.
• This option is the lowest risk option as it
  provides the PTA with all required PPE and
  disinfectants for up to 3 waves of pandemic
  influenza, however, it is also the highest cost
  option.

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Conclusion

• The 4 Ps
• Pragmatism
• Proportionality
• Preparedness
• Protocols

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Questions?