1. Be Prepared for Pandemic Flu: Key Tools for Local Public Health Pandemic Case Scenario The Massachusetts Department of Public Health and The Local Public Health Institute of Massachusetts Spring 2006

2. Objectives Describe the potential impact of an influenza pandemic in Massachusetts Increase understanding of responsibilities of public health, focusing on: Risk communication Vaccine prioritization and distribution Ensuring the provision of essential services & operations in your agency and community during a pandemic

3. Objectives Determine whether current plans adequately address anticipated events Provide public health professionals with tools and action steps for addressing gaps in planning Identify what tools are needed for your tool kit Actions Resources Plans

4. Exercise Framework One scenario with 3 sections Discussion following each section Add tools to our pandemic tool kit Assume scenario events occur as presented No right or wrong answers

5. Section 1 The Virus Begins to Spread WHO Pandemic Alert Phase 3

6. Initial Situation JANFEBMARAPRMAYJUNJULAUG ■100 million chickens die in 8 countries ■Confirmed human cases in Vietnam and Thailand ■2 cases of human-to-human transmission

7. Novel Virus Alert Novel virus detected in one or more humans: H7N3 Little or no immunity in the general population Potential precursor to a pandemic JANFEBMARAPRMAYJUNJULAUG

8. Actions U.S. heightens disease surveillance and readies for a possible pandemic MDPH sends novel virus advisory to local health departments and health care providers State and local agencies review continuity of operations plans, surge capacity plans and other emergency protocols JANFEBMARAPRMAYJUNJULAUG

9. 6.4 million Mass. residents will need 2 doses of vaccine, 1 month apart Vaccine is not currently available State issues general guidelines on priority groups for vaccine Vaccine Availability JANFEBMARAPRMAYJUNJULAUG

10. Increased Media Attention Possibility raised of a situation not as significant as the 1918 flu pandemic but much more serious than the 1968 pandemic, and potential vaccine shortage Some media sources declare that the government is “not doing enough to prevent a potential catastrophe” JANFEBMARAPRMAYJUNJULAUG

11. Section 1 Summary So far the following has occurred: ■Confirmed human cases in Vietnam and Thailand ■2 cases of human-to-human transmission U.S. heightens disease surveillance and is on guard for possible pandemic Vaccine is not yet available and supplies of antiviral drugs are severely limited State agencies and regional local health coalitions meet and review emergency response plans WHO Pandemic Alert Phase 3

12. Section 1 Questions 1. What groups should you meet with now? 2. What plans should be reviewed and/or activated at this point to assist with: Risk communication Vaccine prioritization & distribution Provision of services and operations

13. Section 1 Questions (con’t) 3. How will your local health department/agency respond to media attention and the need for public information at this point? 4. What kinds of messages need to be crafted for the public before the outbreak occurs?

14. Section 1 Questions (con’t) 5. How will your agency and community prepare to ensure the provision of essential services and operations during pandemic for your agency and community?

15. Section 2 The Virus Reaches the U.S. WHO Pandemic Phase 6

16. Pandemic Declared By mid-April, human cases of H7N3 have been reported in Hong Kong, Singapore, South Korea, and Japan. Although cases are reported in all age groups, young adults appear to be the most severely affected. Vaccine production has begun. In late April, human cases are identified in the United States. JANFEBMARAPRMAYJUNJULAUG

17. Pandemic Declared H7N3 spreads throughout multiple continents Cases reported in 18 U.S. states Three cases identified in Boston hospitals in early May President makes formal pandemic declaration JANFEBMARAPRMAYJUNJULAUG

18. Media Scrutiny JANFEBMARAPRMAYJUNJULAUG Media coverage escalates Cable stations devote 24-hour coverage to worsening public health crisis Residents contact elected officials about frustrations over vaccine supply

19. Impact in MA Residents demand vaccine Mayor of Boston urges Massport to close Logan Airport Some residents stay at home for fear of exposure to the flu JANFEBMARAPRMAYJUNJULAUG

20. Demand for Vaccine Labor unions and elderly advocacy groups complain of lack of vaccine for their constituents Demand for vaccine becomes stronger and serious questions raised about priority setting JANFEBMARAPRMAYJUNJULAUG

21. Large Crowd Warning Several mayors suggest that Fourth of July celebrations be cancelled Questions raised over whether summer activities for children should be cancelled JANFEBMARAPRMAYJUNJULAUG

22. Section 2 Summary President makes formal pandemic declaration Three cases hospitalized in Boston Hospital admissions begin to rise Residents demand vaccine Some residents staying at home to avoid exposure Questions raised about Fourth of July activities and other gatherings WHO Pandemic Phase 6

23. Section 2 Questions 1. As you make plans for vaccinating, how are you responding to the angry public that wants vaccine? 2. What plans have been developed to vaccinate priority groups after the first shipments of vaccine arrive?

24. Section 3 The Pandemic Escalates WHO Pandemic Phase 6

25. The Pandemic Escalates in MA Hundreds of deaths reported in MA Traditional health care services incapable of managing pandemic Clinics and hospitals face staff shortages JANFEBMARAPRMAYJUNJULAUG

26. The Pandemic Escalates in MA Many towns report 30% absenteeism among public safety workers because of illness Local officials discover that existing emergency operations plans do not adequately address pandemic-related needs JANFEBMARAPRMAYJUNJULAUG

27. The Pandemic Escalates in MA Communities across the state report difficulty in staffing essential services Prisons and jails on 24-hour lock-down Day care centers for children and the elderly are closed JANFEBMARAPRMAYJUNJULAUG

28. Vaccine Distribution MDPH receives first 50,000 doses of vaccine (of 12 million doses needed) Vaccine distributed to state, local health depts and hospitals for people in vaccine priority groups JANFEBMARAPRMAYJUNJULAUG

29. Media Saturation All media attention on the pandemic State and local authorities are being challenged about the effectiveness of pandemic preparedness policies AUGSEPOCTNOVDECJANFEBMAR

30. Final Situation Update 6,000 Mass. residents have died from influenza Based on past experience with pandemics, a second wave of outbreaks is expected to occur within 3 - 9 months of the end of the initial wave AUGSEPOCTNOVDECJANFEBMAR

31. SECTION THREE SUMMARY So far the following have occurred: Traditional health care services incapable of managing pandemic Assistance and relief efforts hampered by severe staff and resource shortages Trade and travel impacted Media pressure intense Another wave is expected WHO Pandemic Alert Phase 6

32. Section 3 Questions 1. With 30% of your workforce out sick, how will you provide services to maintain consistent risk communication to your partners and the public? 2. With 30% of your workforce out sick, how do you plan to safeguard and monitor your vaccine?

33. Next Steps: Tool Kit

34. Next Steps: Filling the Tool Kit What actions, resources, plans and support must be taken at the local, regional and state level?

35. Questions?