1. Pandemic Flu ‘The Bigger Picture’ Response! Shayne Ward Emergency Planning Officer NHS Lincolnshire

2. Presentation Overview  Pandemic Flu – dispelling the myths!  Seasonal vs. Pandemic  Vaccines, Antivirals and Antibiotics  Bird Swine vs Human Influenza  Activation & Predicted Impact  Current International & National Levels  Activation vs. Response  Predicted Impact  The wider impacts of Pandemic Flu

3. ‘SEASONAL’ FLU Occurs every year during the winter Affects up to 10% - 15% of the population The very young, the very old and people with certain chronic illness are most at risk Annual vaccination available Antiviral drugs available for the at risk PANDEMIC FLU Occurs about 3 times each century – at any time of the year May affect up to 50% of the population People of every age may be at risk (Currently, its mainly under 19 Year Olds) Vaccine won’t be available initially - in the first wave (Hope to be available in Autumn 2009) Antiviral drugs available for up to 50% of the population (80%) Seasonal ‘flu vs Pandemic ‘flu

4. Previous ‘flu Pandemics PandemicSpanish FluAsian FluHong Kong Flu Strain:A(H1N1)A(H2H2)A(H3N2) Year:1918-19191957-19581968-1969 Origin:Not knownChinaChina Estimated Deaths Global20-40 million1million1-4 million UK250,00033,00030,000 Age Group20-50 yrsunder 14 yrsunder 5 yrs over 65 yrsover 65 yrs Swine Flu 2009 A(H1N1) Shortest interval = 11 years Longest interval = 39 years Current interval = 40 years

5. Vaccines, Antivirals and Antibiotics Not Silver Bullet Solutions!  Vaccines  Offer protection against a ‘specific’ strain  Up to 4-6 months to develop specific vaccine  Longer to manufacturer in sufficient quantities  Pre-pandemic vaccines – may offer Health Care Workers some protection but will not be exact ‘fit’ of pandemic strain (not applicable isn’t a strain of H5N1!)  Antivirals  Is a counter-measure rather than protection  Reduces length of infection  Reduces severity and therefore secondary infections  Antibiotics  For counteracting secondary bacterial infections e.g. affecting lungs and heart

6. DOMESTIC BIRDS MIGRATORY WATER BIRDS From Birds to Humans followed by re-assortment in Humans Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London H5N1

7. DOMESTIC PIGS! MIGRATORY WATER BIRDS From Birds to Humans followed by re-assortment in Humans Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London H1N1

8. Pandemic Flu Activation

9. World Health Organisation (WHO) pandemic flu alert levels Swine flu was declared a pandemic on 11 June 2009 with the announcement of phase 6

10. NATIONAL ACTIVATION United Kingdom When the international situation reaches WHO Phase 6 there will be 4 alert levels in the UK: UK alert level 1 No cases in the UK UK alert level 2 Virus isolated in the UK UK alert level 3 Outbreak(s) in the UK UK alert level 4 Widespread activity cross the UK

11. The UK Government pandemic flu response Antiviral stockpile – enough for 80% of UK population Antibiotic stockpile – to treat and prevent secondary bacterial infections Advanced purchase agreements for up to 132 million doses of pandemic-specific vaccine, when it becomes available. Enough for 100% of the UK population. Face masks (for front line health and social care workers) National Pandemic Flu Service Guidance from the Department of Health and other bodies Communication programme that includes TV, radio, internet, and leaflet drop

12. The National Service Framework Objectives of the National Flu Service Framework to ensure that the right people get the right treatment at the right time, whilst enabling people who have flu to stay at home ; and to minimise the impact of influenza on the NHS.

13. Local Response Strategy Mitigation Response The basis of a large scale response strategy will be that the person with flu stays at home antivirals are collected on their behalf from a designated local Antiviral Collection Point by a ‘flu friend’1. Antivirals will only be issued if the patient fulfils the criteria set out in a clinical algorithm used by the National Pandemic Flu Service by Phone or Internet assessment. UNDER 1’S & PATIENTS WITH CO-EXISTING CONDITIONS WILL BE SEEN BY GPs/HCPs Plan for accessing antivirals for Care Homes <15 residents use Flu Line >15 residents – Health Professional / delivery arrangements in line with local protocol.

14. SOCIAL CARE NATIONAL ACTIVATION

15. Social care communications challenges To ensure that swine flu messages reach those who may be excluded from the national door drop and other mainstream communication channels, such as: –older people, especially if they live alone –people living in care homes –young people (research suggests under 24s are less likely to receive/read the leaflet) –people for whom English is not a first language and/or who have literacy issues –people with a visual or hearing impairment –people with learning disabilities or mental health issues –street homeless and other groups without regular accommodation Social care workers may need to act as ‘flu friends’ for vulnerable people who have no-one else to help them Effective communication between local authorities and independent and third sector providers

16. Pandemic Flu Predicted Impact

17. PAN FLU – SURGE CAPACITY & PRIORITISATION STAGES 3

18. Predicted Impact in Lincolnshire, based on a population of 750,000, 50% Attack Rate WeekClinical Cases GP Consultations Minimum total excess hospitalisations Excess deaths 1375 107159 2750 2143019 33000 85512075 411625 3313465291 539750 113291590994 681000 2308532402025 779500 2265831801988 853625 1528321451341 936375 103671455909 1028125 80161125703 1119500 5558780488 129750 2779390244 136000 1710240150 143375 96213584 152625 74810566 Total375375 106984150159386

19. What are the solutions ? Resilience –Business Continuity Management System (BCMS) embedded into your organisation – no matter how small –Regularly updated and tested continuity plans –Plan for accessing antivirals <15 residents use Flu Line >15 residents – Health Professional / delivery arrangements Infection Control –Stay at home & isolate yourself where possible –Contact the National Flu Line –Infection control methods and PPE –Masks – Only useful if within 1 metre of a possibly symptomatic patient. (Aerosols generated) – see Social Care Guidance

20. Infection Control & PPE Emma Lee, NHS Lincolnshire