1. ‘Catching the Wave’ Pandemic Flu Awareness September-October 2009 Peter Richardson Emergency Preparedness Trainer NHS Lincolnshire

2. ‘Catching the Wave’ Objectives To raise awareness of: ‘Lessons learned’ from Swine Flu response so far The Virus: what we know - and what we don’t! Planning for the ‘worst case scenario’ The difference between Vaccine and Antiviral Answers to some Frequently-Asked Questions And to: Take onboard concerns, to feed back for response

3. Just to recap…2009: From Freeze… … to Sneeze!

4. …by late April:

5. WHO 3WHO 4WHO 5WHO 6 Much ado about Pan flu! (or Mexican flu…or Swine flu...!)

6. The UK & Lincs Response… … beginning late April 09, comprised 2 phases: 1. Containment - Testing individuals & their contacts. - Antivirals issued - Regional Response Centres set up

7. …and 2… Mitigation/Treatment: Antivirals for symptomatic persons - via ‘Hybrid’ Antiviral Collection ‘Centres’ Moving to: National Pandemic Flu Service. - Fully-mobilised ACPs And, currently: - Pharmacy based issue of Antivirals

8. ACPs* and Antivirals… ‘Attack rate’ of the Swine flu Virus described as a ‘slow burn’ (but some regional hot- spots such as ‘Greater Nottingham’) 7 ACPs mobilised in Lincolnshire- mostly staffed by NHS employees - normally open afternoons & evenings By early September 09, c5,000 Antivirals issued ACP Map for illustration only

9. ACPs: What did we learn? # 1 Consistency worked best: same team, in same rooms, in same building, with same Manager – with backup staff available when needed Some problems with access to buildings, keys, lone working (locking up at night) security of Antiviral stock etc Some difficulties with stock management/records Time for more detailed training on individual procedures, spreadsheets, etc., would have helped ….as would have Managers adhering to required process and procedures! Source: ACP Manager Debrief Aug 24 th 2009 Lincolnshire Echo

10. So, What did we learn? # 2 ACP ’Go Boxes’ successful (where opened and used!) Uniformed security welcomed where initially larger numbers of Flu friends attended Difficulties rostering staff Sometimes Manager Briefings sent too late, or too large Most problems communicated to HIT/’Flu Control Centre’ quickly resolved National Pandemic Flu Service caused some problems Which brings us to… Source: ACP Manager Debrief Aug 24 th 2009

11. The National Pandemic Flu Service! Most problems at ACPs were around ‘typos’: wrong initials, DoBs, etc Lacked ability for timely updating of local changes to ACP opening hours, weekend arrangements, etc. Source: ACP Manager Debrief Aug 24 th 2009 Once URN issued, details could not be changed – had to start all over again The phone line was sometimes difficult to access Some of the key issues, in no particular order of importance:

12. The A(H1N1)v Virus… What we know - and what we don’t!

13. The A(H1N1)v Virus…What we know: #1 Most experience a ‘mild self-limiting illness’ Clinical attack rates highest in children and younger adults As for seasonal influenza…a few people without any known underlying condition, and outside the risk groups, experience severe disease…and some die despite medical care The risk groups are: people with chronic underlying medical conditions, immunocompromised, pregnant women and very young children (under 1 year) Source: European Centre for Disease Prevention Risk assessment, Pandemic H1N1 2009 Influenza (21 August 2009)

14. The A(H1N1) Virus…What we know: #2 There are no reports of unusual presentations or transmission routes The virus spreads …by droplets from coughing and sneezing and direct/indirect contact with respiratory secretions from infected persons Source: European Centre for Disease Prevention Risk assessment, Pandemic H1N1 2009 Influenza (21 August 2009)

15. The A(H1N1)v Virus…What we know: #3 Pandemic viruses unpredictable, and can change characteristics as evolve… According to ECDC, the term ‘swine flu’ is inaccurate and confusing! A shorthand for the virus is influenza A(H1N1)v (for ‘variant) Source: European Centre for Disease Prevention Risk assessment, Pandemic H1N1 2009 Influenza (21 August 2009) ?

16. The A(H1N1)v Virus… what we don’t know #1 Each Pandemic virus is different ….. no ‘predictions’ can yet be made about the impact of ‘mix’ with seasonal influenza this winter Source: European Centre for Disease Prevention Risk assessment, Pandemic H1N1 2009 Influenza (21 August 2009)

17. The A(H1N1)v Virus… …what we don’t know #2 Characteristics of the Swine flu virus as yet not definitive e.g. incubation period The duration, shape, number and tempo of the waves of infection are unknown

18. So, plans have to be based on how a Pandemic may behave The ‘15 week’ chart

19. Planning Assumptions… …are not Predictions!!! A second Wave anticipated Autumn/Winter 09/10 Planning Assumptions: * 30% “reasonable worst case” attack rate * 1% hospitalisations * of which 25% ICU, * 0.1% case fatality (of clinical cases) Source: European Centre for Disease Prevention Risk assessment, Pandemic H1N1 2009 Influenza (21 August 2009)

20. 3x ‘peak profiles’ based on a 30% total clinical attack rate

21. Planning Assumptions #2 Lincolnshire ‘Peak Week’ : >32,000->54,000 cases Need ‘Surge Capacity’: - prioritise services; prioritise patients - avoid hospital admission/ earlier discharge - pathways to Health and Social Care

22. Antiviral v Vaccine #1 Antivirals (such as Tamiflu)- primarily for treatment - MAY reduce flu-like symptoms/severity - by around a day Vaccines - prevent people becoming infected Uptake of seasonal flu vaccine by at risk staff is around 15%

23. Antiviral v Vaccine #2 Swine flu Vaccination Programme may run at same time as: - the programme for Seasonal Flu - the issue of Antivirals Planning is under way Some Groups, including front-line Health and Social Care workers to be prioritised for vaccination

24. ? Any Questions?