Association of Health Care Journalists Preparing Communities For Pandemics Houston, Texas March 18, 2006 Georges C. Benjamin, MD, FACP Executive Director Planning & Coordinating The Response: Pandemic Influenza
United States of America: “In Boston the stock market closed. In Pennsylvania a statewide order shut down every place of amusement, every saloon. In Kentucky the Board of Health prohibited gatherings of any kind, even funerals …..Deadly influenza, the so- called “Spanish Flu,” was sweeping the country, spreading terror everywhere” David McCullough ,000 Americans died; 40 million people died worldwide --- National Museum of Health & Medicine Armed Forces Institute of Pathology
Are We Prepared For Pandemic Flu? A process not a point in time! Always ask - Prepared for what? Use real life events to measure preparedness First step is to get annual flu right Under prepared for pandemic influenza Goal: To go from chaos to controlled disorder
We Already Have A Bird Pandemic Three Likely Initial U.S. Presentations* 1. First H5N1 solitary positive bird could be in U.S. this year 2. First outbreak of highly pathogenic avian flu in birds 3. An outbreak in birds with sick people * Assumes no human to human transmission in world Management crisis will be the birds; and will be immediate health threat Community preparedness efforts need to focus in five broad areas: Family preparedness Avoiding sick or dead birds Surveillance for sick people Disease containment Treatment
HHS Planning Assumptions Global susceptibility Incubation period ~2 days with 1:2 spread > 30% attack rate 50% will seek outpatient care Hospitalizations / mortality depends on virulence Absenteeism will occur Will last 6-8 weeks & may come in waves
Plan For Three Clinical Scenarios 1.There are enough effective vaccine & antivirals Vaccination & antivirals Some community disease control efforts 2. The amount of vaccine / antivirals are insufficient in efficiency or amount Vaccination & antivirals Mild to moderate community disease control efforts Medical management of clinical complications Manage societal disruption 3. There is no vaccine or useful antivirals Maximum community disease control efforts Medical management of clinical complications Mange societal disruption
Prepare To Respond Bird surveillance & response Early disease surveillance – will transform to disease differentiation Laboratory capacity Disease control Mass vaccination Antiviral distribution Exposure reduction, social distancing Health system surge capacity Patients, workforce, supplies & equipment, space Risk communication Mortality management Routine health management Coordination: regional, national
Prepare For Societal Disruption Continuity of government Business continuity Food, water Transportation Public safety Trash, sanitation Goods & supplies Services Critical infrastructure
Social Distancing Strategies Voluntary home curfew Suspend group activity Cancel public events Close public places Suspend public travel Restrict travel Snow days Non-essential workers off Work quarantine Cordon sanitaire Primary hygiene: Hand washing & coverage of nose & mouth Barriers: Surgical Masks vs. N - 95 Masks Isolation Separation of infected persons Usually in a hospital setting (Other settings may be difficult) Quarantine Restriction of persons presumed exposed Community or individual level
Plan To Care For Sequestered Persons Food & Water Housing Hygiene & sanitation Social support systems Treatment & prophylaxis for disease Disease monitoring Dependent care Compensation & liability issues
Georges C. Benjamin, MD, FACP Executive Director American Public Health Association “Public Health: Prevent, Protect, Promote”