1. Disasters & Emergencies How Infectious Diseases Cause Emergencies Nancy Blackmore, Coordinator Preparedness, Planning & Equipment Resource, EHS,

2. Outline Infectious diseases by category Bioterrorism New & emerging Pandemic influenza Impact & planning considerations

3. Infectious [Communicable] Diseases Endemic –Normal expected level of disease Epidemic –An outbreak with unusual high numbers Pandemic –A world wide outbreak Bioterrorism –3 categories –E.g. anthrax Newly emerging –West Nile virus, –SARS, etc. Naturally occurring –E.g pandemics of influenza

5. Definition Bioterrorism is the use of biological agents to intentionally produce disease or intoxication in susceptible populations to meet the aims of terrorists. In addition to the potential medical consequences is the likelihood of human panic – a worthwhile goal in itself for the terrorist group.

6. Public Reaction Cannot see, touch or feel it People cant get to a safe place, but sit and wait Panic! Increased psychosomatic illnesses Increased visits to an already overtaxed emergency department Health workers themselves may be fearful and stressed Hoarding of medical supplies and resources

7. The Threat The Good News - low probability The Bad News - huge impact

9. Organisms & Diseases of New Concern to Us: West Nile Virus Lyme disease Hantavirus Human Granulocytic Ehrlichiosis Son of SARS???

10. What is Pandemic Influenza? A new influenza virus arising from a major genetic change [antigenic shift or adaptive mutation] The population will be very susceptible with little or no immunity The virus will transmit efficiently from person to person The virus will be virulent with the capacity to cause serious illness and death

11. Each Pandemic is Different H1N1H2N2H3N2 1918: Spanish Flu1957: Asian Flu1968: Hong Kong Flu 40-50 million deaths2-4 million deaths1 million deaths Credit: US National Museum of Health and Medicine Source: WHO

12. 75% of people will be infected 15 – 38% will be clinically ill 6.8 – 17% will require outpatient care 0.1 – 0.3% will require hospitalization 0.03 – 0.1% will die Based on a flu aid formula developed by Meltzer & colleagues, CDC Atlanta http://www.cdc.gov/ncidod/eid/vol5no5/ meltzer.htm http://www.cdc.gov/ncidod/eid/vol5no5/ meltzer.htm 681,005 will be infected 136,201 – 345,042 will be clinically ill 61,744 – 154,361 will require out-patient care 908 – 2724 will require hospitalization 272 – 908 will die Based on population numbers from 2001 census Estimating the Impact for Nova Scotia:

13. Pandemics are Unpredictable Direct impact of influenza: –Attack rate [15>35%] –Affected age groups [unknown until it begins] –Virulence of the strain and rates of adverse outcomes/complications [mild, moderate or severe?] –Speed of spread from country to country and within a country [1-3 months to arrive? 2-3 waves? 12-18 months duration?] Effectiveness of the response: –Vaccines [not available for 1 st wave] –antivirals [in stockpile now for treatment] –non-pharmaceutical interventions [public health measures] Psychologically induced impacts/public behaviour

14. Potential Challenges: Must maintain mandatory business [BCM] Reduce elective or optional services Cope with simultaneous emergencies [e.g. hurricanes, storms, etc.] Prepare for economic consequences Increased demand for health & social services Increased demand for volunteers Cope with loss of employees [permanent or temp]

15. Consequences of Absenteeism: All sectors impacted: e.g. manufacturer, transportation, municipal services, etc. Possible shortages: e.g. food, fuel, cash in bank machines Issues for workers: ill themselves; need self-care info; may have elder or child care needs; fear; may be asked to work outside of usual environment, etc.

16. Questions? The hardest part of responding to an emergency is explaining why we didnt prepare