1. Stanislaus County It’s Not Flu as Usual It’s Not Flu as Usual Pandemic Influenza Preparedness Renee Cartier Emergency Preparedness Manager Health Services Agency

2. “It might not happen tomorrow, or in the next few years, but it is certain that there will be a bird flu pandemic which will affect humans within the next 10 years... People need to wake up to this now.” --Michael T. Osterholm, PhD, MPH Testimony before the House Committee on International Relations Avian Flu: Addressing the Global Threat. Dec 7, 2005

3. Goals 1.Describe differences between annual and pandemic flu 2.Depict the possible impact of a flu pandemic on California and Stanislaus County for healthcare facilities 3.Explain some mitigation activities during a pandemic flu 4.Next steps

4. Differences between Annual and Pandemic Flu ANNUAL Occurs every year within the winter months Affects 5-20% of the US populationPANDEMIC Occurs 3-4 times a century and can take place in any season. May come in “waves” of flu activity that could be separated by months Experts predict an infection rate of 25-30% of population depending on the severity of the strain

5. Differences between Annual and Pandemic Flu Globally kills 500,000 to one million people each year—36,000 to 40,000 in US Most people recover within a week or two The worst pandemic of the last century, the “Spanish Flu” of 1918, killed 500,000 in the US and 50 million worldwide Usually associated with a higher severity of illness, and consequently, a higher risk of death

7. Differences between Annual and Pandemic Flu Deaths generally confined to “at risk” groups, such as the elderly (over 65), the young (aged 6-23 months), those with medical conditions like lung, heart, and kidney disease, diabetes, cancer or compromised immune systems All age groups may be at risk for infection, not just “at risk” groups. Otherwise fit adults could be at a relatively greater risk, based upon patterns of previous epidemics. For example, adults under age 35 (a key segment of the US workforce) were disproportionately affected during the 1918 pandemic

8. Differences between Annual and Pandemic Flu Vaccination is effective because the virus strain in circulation each winter can be fairly reliably predicted. A vaccine against pandemic flu may not be available at the start of a pandemic. New strains of viruses must be accurately identified, and producing an effective vaccine could take six months.

9. Differences between Annual and Pandemic Flu Antiviral drugs are generally available for those most at risk of serious illness. Antiviral drugs may be in limited supply, and their effectiveness will only be known definitively once the pandemic is underway.

10. Projected Impact on Healthcare Facilities (Assumed Attack of 8 Week Duration) 25% (127,500) of the population will become ill Based upon severity, 4.4% (5,610) of those affected will require hospitalization Of admitted patients 35% (1,964) will need critical care and 30% (1,683) will need ventilators Of those hospitalized, 26.7% (1,498) will die

11. Projected Impact on Healthcare Facilities (Assumed Attack of 8 Week Duration) Hospital capacity would begin to exceed the State’s hospital bed capacity in week 2. By week 5 capacity exceeded by 319% By week 5, the total number of critical beds would exceed capacity by 1212% and the need for ventilators would exceed the number available by 1350% Deaths are estimated at 102,795 during an eight week period in the first wave

12. Key Functional Areas to Control Spread of Disease Surveillance Epidemiological investigation Vaccine and antiviral operations Non-Pharmaceutical Community Containment Surge Capacity Infection Control Risk Communication

13. Mitigation Activities during Pandemic Educating public on respiratory and hand hygiene etiquette Planning for continuity of operations Planning for inventory scarcity and disruption of essential supplies Developing pharmaceutical solutions –Vaccine & antiviral distribution Implementing non-pharmaceutical community containment measures

14. Non-pharmaceutical community containment Non-pharmaceutical community containment is a “social distancing” between members of the community by restricting or limiting public gatherings, events, or group activities.

15. Non-Pharmaceutical Community Containment Measures Objectives Prevent human cases before it’s efficiently transmitted Slow the spread of disease and gain time to strengthen preparedness measures Reduce the morbidity and mortality associated with pandemic Measures can be applied at individual or community level to persons either ill or well

16. Non-Pharmaceutical Community Containment Measures Individual Measures –Isolating ill persons (those with symptoms) –Quarantining well persons who have had contact with an ill person –Practicing good hand and respiratory hygiene –Using personal protective equipment (PPE) such as masks or gloves

17. Non-Pharmaceutical Community Containment Measures Community Measures –Community Activity Restrictions Mass/public gatherings School closures –Limiting domestic and international travel

18. Next Steps Inform and educate partner agencies: Determine actions needed to prepare and respond to a pandemic flu. Initiate community-wide planning: The patient care surge capacity needed during a pandemic will exceed hospital capacity and must be a community responsibility. Develop Continuity of Business Plans: Likely to affect everyone in California, no amount of planning will allow business as usual in any sector of society or government