Understanding the Threat of an Influenza Pandemic

Introduction to Pandemic Planning and Response What are seasonal, avian, and pandemic influenza, and how do they differ from each other? What are the symptoms of influenza? How is influenza transmitted, and how is it treated? How will a pandemic start in my municipality? What will life be like during a severe pandemic? How can municipalities be prepared?

What is Seasonal Influenza ? The breathing sickness that affects people every year, usually during the cold season. It makes many people sick, but not as sick as pandemic influenza because our bodies can fight it better than pandemic influenza. Seasonal influenza is similar to the pandemic influenza but is less severe.

What are the Symptoms of influenza? One or more of these symptoms may mean influenza: Fever Muscle aches and pains Tiredness Coughing Sneezing Shortness of breath Sore throat Runny or stuffy nose

More Symptoms—Especially in Children Nausea and vomiting Stomach cramps Diarrhea (all of these symptoms can also be caused by other diseases)

What is Pandemic Influenza? Pandemic influenza is a respiratory (or breathing) illness that is new to humans and can make them very sick. It happens about 3 times per century and spreads around the world, killing many people and making many people sick. Pandemic influenza also causes many serious problems in municipalities, such as problems with food, water, and electricity.

What is Avian Influenza (Bird Flu)? It is a disease that spreads from bird to bird, causing some birds to become very sick or die. It can spread from birds to humans, but not easily. It is not yet capable of spreading from human to human except in very rare cases. There is a risk that it could become pandemic influenza, but this has not happened yet with the type of bird flu that has recently killed so many chickens.

What is Swine Influenza? An influenza A virus that causes illness predominately in pigs The disease is spread from pigs to pigs Like avian influenza in birds, it can sometime infect humans in close contact with infected pigs, but humans cannot transmit it to other humans

What is H1N1? A new virus that emerged in 2009 in Mexico City and quickly spread across the globe H1N1 declared a pandemic in June 2009 Initially referred to as “swine” influenza because the virus was found to contain genetic material from swine influenza A strains, as well as avian and human strains A human virus, and people get it from people – not from pigs

How Do Seasonal and Pandemic Influenza Spread? They are spread through the air when infected people cough, sneeze, or talk, and healthy people then breathe in the virus.

How Do Seasonal and Pandemic Influenza Spread? (2) They are also spread when healthy people touch things that are contaminated with the virus (like door knobs, light switches, and table tops) and then touch their eyes, nose, or mouth. They could be spread by people who do not feel or look sick. They spread most quickly in crowded places— especially indoors.

What Have We Learned from Past Pandemics of Influenza? In 1918, tens of millions of people died all over the world from pandemic influenza. Local outbreaks last about 6–12 weeks. A pandemic can happen in the same municipality 2 or 3 times in 1–2 years (in waves). Pandemics can vary in severity. Hospitals and clinics will become completely overloaded, and most people will have to be treated at home.

What Have We Learned from Past Pandemics of Influenza? (2) Services may be interrupted when many people are sick— including police, water, electricity, food supplies, banks, telephones, etc. Outside help will probably not come because many people will be sick everywhere. Some families may need community help if everyone in the family is sick. Schools, churches, and some workplaces may need to close during the pandemic to try to decrease the spread of the disease and minimize the number of people who get sick or die.

What Can Be Done to Slow or Decrease the Impact of a Severe Pandemic? Municipalities can prepare before the pandemic starts or before it reaches them. Municipalities can help their residents understand how to protect themselves. Municipalities can implement “social distancing” policies and actions.

How Will a Pandemic Start in My Municipality? The pandemic will probably start somewhere else in the world. It will probably arrive in this country through infected humans, not infected birds. Municipalities need to be prepared to communicate that the pandemic has not entered the country, and that people should continue daily life as usual. Once cases have been confirmed in the country, the government will enact its alert and response system. At that time, municipalities should implement their response plans.

WHO Phases

WHO Pandemic Phases and Currently Circulating Novel Viruses H1N1 –April 25, 2009: Declaration of a Public Health Emergency of International Concern –April 28, 2009: WHO declares Phase 4 –April 29, 2009: WHO declares Phase 5 –June 11, 2009: WHO declares Phase 6 H5N1 –First human cases reported 1997 –Increase in reports of human cases began in 2003 –WHO Phase 3

What Will Life Be Like in a Severe Pandemic?

Shortages of Essential Goods Lost work days (absenteeism) will result in decreased production, reduced international and national cargo transports, and missed deliveries to local areas. The supply chain will be very vulnerable. Shortages of essential goods may occur—including food, water, fuel, medicines, and many more. Available goods may be subject to personal consumption, looting, and hoarding. Hostilities may break out over scarce resources. Locally available goods and stockpiles may be needed to sustain the population.

Disruption in Routine Services Schools, government offices, and the post office may be closed. Electricity, telephone service, the Internet, and commercial radio and TV broadcasts could also be interrupted if the electric power grid falters or fails. Local automated teller machines (cajeros automaticos) and banks may be shut down, and cash will be in short supply.

Changes in Public Transportation and Other Municipal and Private Services Buses, taxis, and other transportation services may be stopped or limited. Gasoline supplies may be limited or unavailable. Trash removal, road repair, water, and other services may be limited. Utility service and repairs may be delayed.

Restrictions of Personal Movement Travel may be restricted. Restrictions on public gatherings—such as funerals, parties, and other events—may be necessary. Schools and markets may be closed. Isolation and quarantine may be necessary.

How Can Municipalities Be Prepared? Municipalities need to be able to rely on their own resources to care for sick people, provide essential services, and maintain social order. Municipalities must understand the likely local impact and develop plans to address it. Municipalities must have a good response team who knows what has to be done before a severe pandemic hits. Strong leadership is critical!

PREPAREDNESS CAN MAKE ALL THE DIFFERENCE! Who would you rather be like—the mayor of Philadelphia from 1918 or the Mayor of Saint Louis from 1918?

SOURCES CDC (Centers for Disease Control and Prevention). Pandemic influenza planning checklists. CDC. Risk communication. CDC Interim pre-pandemic planning guidance: Community strategy for pandemic influenza mitigation in the United States. Atlanta, GA: CDC. WHO (World Health Organization) WHO influenza pandemic preparedness checklist. Geneva: WHO E-E96484D14D69/0/WHOInfluenzaPandemicPreparednessChecklist.pdf WHO Pandemic Influenza Preparedness and Response. WHO Pandemic influenza preparedness and mitigation in refugee and displaced populations. 2nd ed. WHO/HSE/EPR/DCE/ Geneva: WHO. WHO WHO guidelines for pandemic preparedness and response in the non- health sectors. Geneva: WHO. pic.org/pic/web/documents/english/WHO%20WOS%20Pandemic%20Readiness% pdf