1. 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

2. United States of America: 1918 - 1919 “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 --- 675,000 Americans died; 40 million people died worldwide --- National Museum of Health & Medicine Armed Forces Institute of Pathology

3. 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

4. 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

5. 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

6. 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

7. 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

8. Prepare For Societal Disruption  Continuity of government  Business continuity  Food, water  Transportation  Public safety  Trash, sanitation  Goods & supplies  Services  Critical infrastructure

9. 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

10. 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

11. Georges C. Benjamin, MD, FACP Executive Director American Public Health Association WWW.APHA.ORG “Public Health: Prevent, Protect, Promote”