Unit 13: Pandemic Scenario Rick Bissell, PhD Tom Kirsch, MD - PowerPoint PPT Presentation


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Unit 13: Pandemic Scenario Rick Bissell, PhD Tom Kirsch, MD


Unit 13: Pandemic Scenario Rick Bissell, PhD Tom Kirsch, MD, MPH * Session 13: Catastrophe Readiness and Response Course * HHS Pandemic Flu Plan - 6 State roles ... – PowerPoint PPT presentation

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Title: Unit 13: Pandemic Scenario Rick Bissell, PhD Tom Kirsch, MD

Unit 13 Pandemic Scenario
  • Rick Bissell, PhD
  • Tom Kirsch, MD, MPH

Learning Objectives
  • By the end of this session (readings, lectures
    and exercises) the student should be able to
  • Describe mechanisms of disease spread and
  • Describe the current estimates of the social,
    economic, transportation, communications and
    health sector impacts of a pandemic, and their
    affects on critical systems (e.g. food,
    utilities, law enforcement, healthcare, etc.).
  • Describe current federal pandemic preparedness
    and response plans.

Learning Objectives - 2
  • Identify potential strategies for dealing with/
    responding to a pandemic.
  • Describe barriers to effective inter-jurisdictiona
    l planning for pandemic response.
  • Discuss the impact of a pandemic on the private
  • Discuss the potential long range economic
    problems that may result from a pandemic.
  • Discuss inter-jurisdictional issues (including
    international coordination) in a pandemic

Vocabulary Reviewfrom Session 7
  • Public health Use of the sciences of
    epidemiology, medicine, sociology, microbiology
    and health education to investigate and protect
    the health of a population.
  • Epidemiology The discipline within public health
    that investigates the causes and pathways of
    diseases and injuries, as well as their
    distribution within a population.

Vocabulary Reviewfrom Session 7 - 2
  • Surveillance The monitoring of behavior, in this
    case the behavior (infection pattern) of an
    infectious disease.
  • Pandemic An epidemic that affects the entire
    world, or substantial portions of it.
  • e.g. the 1918 Influenza pandemic
  • Etiology The causes and pathway of a disease.
  • e.g. the bacteria or virus, its incubation
    period, the ways it propagates and enters the
    body, etc.

Disease Control Mechanisms
  • Disease control
  • Epidemiologic investigation to determine causes,
    mechanisms of spread, extent of spread.
  • Vaccination, use of medication to induce herd
    immunity, treatment of ill individuals.
  • Social distancing, quarantine, isolation,
    reducing vectors.
  • Treatment of individuals to reduce their
    infectivity (ability to spread the infection).

  • Public Health and epidemiology are scientific
    methods to prevent or reduce the spread of
    illness in a population.
  • Endemic and epidemic infectious diseases are the
    leading cause of death worldwide.
  • There are specific tools used to reduce the
    spread of infections.

Pandemic Influenza
Why Do We Care?
  • Historically pandemics have killed millions and
    destroyed entire societies
  • The Black Plague in Europe in the Middle Ages
    killed as much as 50 of the entire population,
    and wiped out entire communities.
  • The 1918 Influenza Pandemic killed more than 20
    million people worldwide in less than a year,
    some now estimate that it was 100 million.Gina
    Koleta Flu, The Story of the Great Influenza
    Epidemic of 1918 and the Search for the Virus
    that Caused It. ISBN-10 1417618019

  • A virus that causes predictable, seasonal
    (winter) epidemics.
  • Not a cold, but an infection with high fevers
    and muscle aches. It can lead to pneumonia and
  • There are an estimated 20,000 deaths from
    influenza each year in the USA, usually among the
    elderly and immunocompromised. www.cdc.gov/flu/niv

Pandemic Flu Scenario
  • Each year the influenza virus mutates slightly so
    that it is different enough to infect even people
    who were infected before and are immune to the
    old virus.
  • Occasionally the virus mutates greatly and
    becomes more deadly and a novel flu virus to
    which almost nobody has immunity (e.g. the 1918

Pandemic Flu Scenario - 2
  • The influenza virus lives in humans, birds and
    some mammals.
  • The H5N1 virus is widely endemic in birds and has
    the potential to become a very deadly pandemic in
  • Spreads via waterborne droplets, close contact,
    and fomites.
  • The most common cause of spread is dirty hands.

Pandemic Flu Scenario - 3
  • When H5N1 spreads to humans (usually directly
    from birds) the case fatality rate (2010) is over
  • There is no vaccine for a novel virus it takes a
    minimum of 4-6 months to produce a vaccine,
    longer to produce a large quantity.
  • H5N1 is showing resistance to some current
    antiviral medications.
  • CDC www.pandemicflu.gov/vaccine/index.html

Pandemic Flu Scenario - 4
  • Potential Effects in the USA
  • Deaths ranging from the hundreds of thousands to
    many millions.
  • The pandemic could last 3-9 months, or more,
    likely coming in 2 to 3 waves.
  • Demand for medical care would vastly overwhelm
    all available resources.
  • Up to 40 of essential services employees may not
    show up to work, including medical/health care,
    law enforcement, food transport and grocery
    stores, school personnel, fire/rescue, etc.

Pandemic Flu Scenario - 5
  • Potential Effects in the USA, cont.
  • Lawlessness may break out related to a lack of
    access to basic services and resources.
  • Cities may be particularly hard hit if food
    resources become limited.
  • Banking and financial services may be restricted
    or cease to function.
  • People with many non-influenza-related health
    conditions may find it difficult to obtain
    medical care or medications.

Pandemic Flu Scenario - 6
  • All, or virtually all US jurisdictions will be
    affected, therefore
  • Mutual aid is unlikely, however
  • Sharing of resources may be more necessary than
    ever before.
  • Competition between jurisdictions is a real
  • All response coordination must be
    multi-jurisdictional and multi-level.

Class Exercise 1
  • Before going any further, break into groups and
    discuss what the challenges will be for emergency
    managers, and what functions EM can play in
    responding to a pandemic. Groups report back to
    the larger class. Consider areas such as

Class Exercise 1, cont.
  • Communications
  • Equipment
  • Supplies
  • Personnel
  • Safety/security
  • Population fears

The Principles of Pandemic Response
Principles of Pandemic Response 1
  • WHO Alert Phases for Avian Influenza
  • 1 Low risk of human cases 
  • 2 Higher risk of human cases 
  • 3 Not any, or very limited human-to-human
  • 4 Evidence of increased human-to-human
  • 5 Evidence of significant human-to-human
  • 6 Efficient and sustained human-to-human
  • Source http//www.pandemicflu.gov/faq/pandemicinf

Principles of Pandemic Response -2
  • Needs assessment
  • 3 realms of concern
  • Control of the pandemic
  • Meeting other health care needs
  • Basic societal requirements

Principles of Pandemic Response - 3
  • First and foremost Scene safety!!!
  • Research has shown that a significant percentage
    of health care workers, and, by extension, other
    priority personnel who will come in contact with
    the public, such as law enforcement, will not
    come to work in a pandemic out of fear of self
    contamination or contamination of their families.
    Plans will need to be made to provide protection
    to these personnel, or very little else will go
    according to plan.
  • http//emergency.cdc.gov/cerc/pdf/CERC-PandemicFl

Principles of Pandemic Response - 4
  • Control of the Pandemic
  • Epidemiologic surveillance and updating.
  • Institution of prevention social distancing,
    quarantine, isolation (who takes care of these
  • Distribution of vaccines and meds (how to
    distribute and to whom?).
  • Surge/overflow where, and with what health care
  • Family-centered self-care information.

Principles of Pandemic Response - 5
  • Other health care needs
  • How to meet routine care and normal emergency
    care needs when hospitals are overflowing, and
    health care workers are absent?
  • How to encourage health care workers to return to
  • How to keep supplies available in a system that
    depends on just-in-time deliveries?

Principles of Pandemic Response - 6
  • Basic societal needs
  • Law enforcement
  • Food deliveries
  • Fuel deliveries
  • Utilities
  • Monetary system
  • Power plants
  • Continuity of government
  • How to prioritize among competing needs?

Overview of Federal Plans
  • Two lead agencies
  • Department of Health and Human Services (DHHS,
    also called HHS), including the Centers for
    Disease Control and Prevention (CDC), the Public
    Health Service (USPHS) and the HHS Office of the
    Assistant Secretary for Preparedness and Response.

Overview of Federal Plans - 2
  • Second lead agency
  • Department of Homeland Security (DHS),
    particularly the Office of Health Affairs, which
    is directed by the Assistant Secretary/Chief
    Medical Officer.
  • Many federal support agencies

Plans are nothing, Planning is
everything General Dwight D. Eisenhower
HHS Pandemic Flu -1
  • HHS will collaborate with the World Health
    Organization (WHO) and other nations in all
    related pandemic flu efforts.
  • The HHS plan assumes high importance for
    preparedness at all jurisdictional levels, as
    well as cross-agency, multi-jurisdictional
    response efforts designed to strengthen local
    response effectiveness.

HHS Pandemic Flu Plan - 2
  • Major components of the critical preparedness and
    ready response actions include
  • Intensifying surveillance and collaborating on
    containment measures both international and
  • Stockpiling of antivirals and vaccines and
    working with industry to expand capacity for
    production of these medical countermeasures
  • Creating a seamless network of federal, state and
    local preparedness, including increasing health
    care surge capacity and
  • Developing the public education and
    communications efforts that will be so critical
    to keeping the public informed.

HHS Pandemic Flu Plan - 3
  • Preparedness plan based on
  • Funding to state health departments with planning
    requirements, some of which must go to
    county/city health departments.
  • Provision of required forms that need to be
    filled out by jurisdictions, demonstrating
    planning accomplishments.
  • CDC-funded evaluation teams.
  • Some money for exercises.

HHS Pandemic Flu Plan - 4
  • HHS Response Plan based on
  • Federal roles
  • Provide definitive reference labs and
    epidemiologic surveillance/information
  • Provide Strategic National Stockpile (SNS) of
    pharmaceuticals, vaccines and other critical
    medical supplies and equipment
  • Coordinate distribution to states of key medical
    supplies and personnel
  • Coordinate with international agencies

HHS Pandemic Flu Plan - 5
  • State roles in HHS plan
  • Coordinate delivery of Stockpile to counties and
  • Provide front-line pathology labs
  • Coordinate health sector response within the
  • (In some states) State health departments serve
    as the lead response agency for the duration of
    the pandemic.

HHS Pandemic Flu Plan - 6
  • State roles, continued
  • Coordinate flow of medical supplies and
  • Coordinate designation of alternate treatment
  • Coordinate placement of those needing treatment.
  • Work with counties/cities in the designation of
    quarantine and isolation sites, and provide
    enforcement where necessary.

HHS Pandemic Flu Plan - 7
  • State roles, continued
  • Revise, amend, suspend state laws addressing
    quarantine/isolation and medical practice codes.
  • Report epi findings back to CDC and request
    targeted assistance from HHS
  • Provide state law enforcement manpower where
    local law enforcement may fall short on
    protecting vital sites and functions.

HHS Pandemic Flu Plan - 8
  • County/city roles
  • Prioritize use of local health care resources
    among competing interests.
  • Receive, store, distribute SNS supplies.
  • Provide law enforcement for key sites and
  • Establish/enforce quarantine/isolation.
  • Set up/maintain alternate treatment sites.

HHS Pandemic Flu Plan - 9
  • County/city roles, continued
  • Coordinate coroner and mortuary operations.
  • Provide home care information to the public.
  • Provide/ coordinate vaccine distribution.
  • Coordinate distribution of food supplies where
  • Provide epi findings to state health department.

Department of Homeland Security (DHS) Pandemic
Plan -1
  • Pillars of pandemic preparedness are
  • Preparedness and communication
  • Surveillance and detection
  • Response and command
  • Goals
  • Limit spread and damage
  • Protect commerce and infrastructure
  • Assure governmental and economic continuity

Department of Homeland Security (DHS) Pandemic
Plan -2
  • Preparedness
  • State and community level planning
  • Build SNS and distribution plan
  • Build national vaccine production capacity
  • Work with WHO and other international orgs
  • Build and exercise plans at all levels of gov.
  • Plan for medical and veterinary surge capacity

Department of Homeland Security (DHS) Pandemic
Plan -3
  • Surveillance and response
  • Similar to HHS plan, with the exception of a
    section on sustaining infrastructure, critical
    services and the economy.
  • Roles and Responsibilities
  • Lead technical roles DHHS and Dept. Ag.
  • Lead federal coordination DHS

Barriers -1
  • Most funding is stovepiped to either emergency
    management or health, but not to both. Funding
    for non-governmental partners is virtually nil.
    Funding to one jurisdiction is not shared with
  • In many jurisdictions, EM and health rarely
    include each other in planning and exercises.
  • Many emergency managers express some angst at
    dealing with health authorities.

Barriers - 2
  • Many decision-makers in the health sector are
    poorly informed about emergency decision-making
    or the national emergency management systems.
  • Public health personnel tend to make decisions in
    a slow-moving democratic fashion based on data
    collection and analysis.

Barriers - 3
  • Despite guidance from the CDC and other agencies,
    many health jurisdictions simply do not have
    anyone with emergency planning expertise, and do
    not conduct serious pandemic planning.
  • Mechanisms for the US to receive international
    aid are still poorly developed and conflictive.

Potential Long-Range Problems -1
  • Both short- and long-term economic losses due to
    loss of employees at all levels of economic
  • Possible surplus of housing leading to more
    financial loss in this market.
  • Significant disruption of education, training
    systems, and career development.

Potential Long-Range Problems - 2
  • Potential threat to continuity of the democratic
    form of government if martial law is needed
    during the pandemic (See Session 5).
  • Health care resources spent in the pandemic may
    significantly decrease resources available to
    other health and social issues.

Capstone Discussion or Writing Assignment
  • Now that you have reviewed the pandemic scenario
    and have some familiarity with the federal
  • What is missing in the current preparedness
  • What roles/interventions/responsibilities should
    EMs take in both the preparedness and response
    stages of a pandemic?
  • How does pandemic preparedness contribute to
    bioterrorism preparedness?
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