1. Pandemic Influenza & Other Emergencies Planning for the Possibilities Bob Mauskapf, MPA Colonel, USMC (ret) State Emergency Planning Coordinator

2. “Thus the wise win before the fight, while the ignorant fight to win” The Art of War

4. State Roles in Planning Public information and education Involvement of all Secretariats and agencies in planning, with oversight by Governor and Cabinet Assuring surge capacity of the healthcare and public health communities Establish community control and infection control guidelines, policies for stockpiling of antivirals, guidelines for allocation of vaccine and antivirals (specific priority categories) Isolation/quarantine guidelines and decisions Laboratory testing

5. Command and Control Issues Chain of command Common Operating Picture Real-time Situational Awareness Situational Assessment— Situation Reporting Decision-making Process Interoperability

6. HAN / SWAN Enhancement SNS management Volunteer Management Polycom / VTC Satellite Phones STARS Support LHD Wireless Linkages Cell, Pagers (Dig, msg and voice) 24/7 Hotline Priority to Landline and Wireless (GETS) Current Rosters Search for the Perfect Communications System (Reliable, Redundant, Reasonable, Scalable, Mobile) COMMUNICATIONS

7. Partners VDH MMRS(s) MRCs / Other Volunteers 139 Jurisdictions / EOCs DOD Installations Local Law Enforcement Local School Districts Colleges and Universities Local EP&R Partners DC / Neighbor States (89) Hospitals and (6) Hospital Regions VPCA Private Sector Feds –HHS / CDC –DOD –DHS / FEMA –OTHERS OCP VDEM –VEOC –VFC VDOC VSP VNG VDOT VDACS VDMHMRSA VDOF VITA VDGS –DCLS

8. Local Response Entities Requires support of County/City leadership (139) Partnership among: –Colleges and Universities –School systems –Hospitals –Law enforcement –Social Services –Emergency Management –Responders (Fire / EMS) –Private sector partners –Regional Mutual Support –Community Health Clinics

9. Risk Communication Essential at all stages, beginning before pandemic spread Constantly changing situation Messages must be relayed in appropriate/timely manner Recommendations will change over time Effective response to pandemic requires public support – decisions will not be easy but must be fair and balanced

10. Federal Role in Planning Set general guidelines and criteria Provide federal stockpile of medications, supplies Support enhanced supply of antivirals Enhance vaccine production and support new vaccine production techniques Support laboratory identification procedures

11. Local Roles in Planning Public information and education Community involvement and ownership of community plans Assuring surge capacity of the healthcare and public health communities Many decisions on community control, stockpiling of antivirals, specific allocation of vaccine and antivirals (numbers of people and identification of people in specific categories) made at local levels

12. Local Response Entities Requires support of County/City leadership (139) Partnership among: –Colleges and Universities –School systems –Hospitals –Law enforcement –Social Services –Emergency Management –Responders (Fire / EMS) –Private sector partners –Regional Mutual Support –Community Health Clinics

13. April 16, 2007

14. Cross Functional Coordination Incident Command –Joint Information Center (JIC) ESFs –Law Enforcement Campus, Local, VSP, FBI –Health and Medical 5 Hospital / EMS (16 Squads) Coordination Medical Examiner Mental Health: CSBs, TADBHAC, DMHMRSAS –Mass Care Family Services Center Relocation

15. VEOC Notification VDH ECC EMAIL HAN Voice PIO JIC OCME RHCC HHQ ESF-8 VA Tech Communications Public Information Hosp Coord Fatality Mgt. Mental Health Local HDs Regional Teams

16. Lessons Learned Hotwash After Action Report –Reinforce (+) and ID (–) Policy Planning Organization Funding Training Resources (facilities, equipment, supply blocks)

18. H5N1 Asian Epizootic: Avian flu Highly Pathogenic Avian Influenza (HPAI) Dec 2003 to present –Poultry outbreaks in numerous countries in Asia, Indonesia, Europe, Middle East and Africa – millions of birds culled –291 human cases in 11 countries (as of March 5, 2007): 172 deaths (>59% mortality) Historically unprecedented –Geographical scope –Economic consequences

19. Unique Features of Pandemic Flu Multiple areas affected at the same time –More difficult to shift resources Could go on for months in a community, with 2-3 different waves over 18-24 mo Healthcare workers will be affected Preventive and therapeutic agents delayed and in short supply –New vaccine must be made for the pandemic virus Widespread illness would impact essential services

20. In Virginia, pandemic flu impact estimates include: 2,700 to 6,300 deaths 12,000 to 28,500 hospitalizations 575,000 to 1.35 million outpatient visits 1.08 million to 2.52 million people becoming sick

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22. Issue: Antivirals Federal stockpile of antivirals growing States have option to stockpile antivirals at discounted federal contract price Virginia has purchased full allotted amount – distribution plan in development (treatment) Goal: antivirals to treat 25% of VA population Increasing supply and production capacity – discussion of increased prophylaxis use

23. Issue: Community Containment Limiting community spread: social distancing –School closures –Recommendations about telecommuting –“Snow days” –Isolation/quarantine: mainly voluntary –Discouraging/banning large gatherings (indoor/outdoor) New recommendations based on severity of pandemic, on a scale of 1-5

24. Pandemic Influenza Planning Include involvement of: –DOD Installations –Schools/Colleges and universities –First responders – fire, EMS/Public safety, Law enforcement –Business community/Private sector –Media –Assisted living and other social services programs –Volunteer, non-profit groups/Faith community Coordinated planning of federal, state, local governments and agencies

25. Pandemic Influenza Planning: Health Risk communications Community containment Antiviral distribution plan Mass vaccination Medical surge, healthcare coalitions Surveillance and investigation Laboratory services Fatality management Altered standards of care due to resource limitations

26. Pandemic Influenza Planning: Non-Health Command and Control Community containment measures –Economic impact –School closure –Isolation –Voluntary quarantine Continuity of Operations: –Government entities –Critical infrastructure: economy, trade, business –Agriculture, water and food chain safety Human resource issues, policies (public and private)

27. Future Exercises Cabinet tabletop, Sep 4: Focus on non-health components of state plan NGA Regional exercises, Late Sep: Planned at national level: Test interstate and regional collaboration Exercise to test state antiviral distribution plan Exercise to focus on school/college/daycare closure issues within state

28. CDC/DHS State EOC Distribution POD RSS Security Communications Public Information Inventory Transportation Local EOC

29. http://www.vdh.virginia.gov/epr http://www.vdh.virginia.gov/pandemicflu http://pandemicflu.gov