Introduction to Indianas Pandemic Influenza Preparedness Plan Mary

Introduction to Indiana’s Pandemic Influenza Preparedness Plan Mary L. Hill, RN, Esq. Deputy State Health Commissioner Indiana State Department of Health

Indiana’s Pandemic Influenza Preparedness Plan • Overview of pandemic influenza • Overview of the Indiana Pan Flu Preparedness Plan • Overview of the Indiana Pan Flu Operations Plan • Ethical Issues

ISDH – It’s not just a job…it’s an adventure

Seasonal Flu v. Pan Flu Seasonal Flu – Annual US data: • Causes of 200, 000 hospitalizations • Results in the death of 36, 000 people Pandemic Flu - Potential US impact: • Virulent human flu causing a global outbreak • Little immunity, spread easily person to person • Could cause 9. 9 million hospitalizations • Could result in 1. 9 million deaths (2% of population) if similar in scope to 1918 pandemic flu

Pandemic Influenza of 1918 – At least 40 million deaths worldwide – More fatalities than occurred in WWI – Half of those dying were in their 20 s and 30 s, representing as many as 8 to 10% of all young adults – More died in 24 weeks than AIDS has killed in 24 years

Health System Implications – Widespread illness and death – Overwhelmed hospitals and clinics – Inadequate medical resources – Many people with chronic conditions or emergency needs may not be treated Importance of personal preparedness stockpile (don’t forget the pet supplies)!

Other Implications – Disruption of business – • SARS 2003: Cases – 8400, Deaths – 916 • Resulted in loss of $12 - $30 billion to Asia • Canada – 50% reduction in international travel – School closures – Feeding children and families who rely on school meals. – Community events – Colts, Pacers, Black Expo, church, social, etc.

Indiana’s Pandemic Influenza Preparedness Plan • Pandemic Influenza Plan • Developed in 2005, updated in 2006 • Available at www. isdh. in. gov

Indiana’s Pandemic Influenza Preparedness Plan Contents • Strategies and Policies • Planning, Coordination, and Command Structure • Surveillance and Investigation • Laboratory Testing • Health Care Planning • Infection Control • Clinical Guidelines • Vaccine and Antiviral Distribution and Use

Indiana’s Pandemic Influenza Preparedness Plan Contents • Community Disease Control and Prevention (Community Containment) • Managing Travel-related Risks • Public Health Communication and Education • Workforce Support: Psychosocial Considerations and Info Needs • Checklists for medical offices, clinics, health depts. , hospitals • Ethical Considerations

Planning includes Engagement of Community and Stakeholders • Community Advisory Groups – Community containment – Antiviral and vaccine prioritization – Mental health issues – Altered standards of care • Strategic and Policy Considerations – Community Containment – Special Populations – Vaccine and Antiviral Medication – Continuity of Operations Plan (COOP) – Volunteers

Mary Meets Her Idol, Sergeant Harvey Walden VH 1 Celebrity Fit Club

ISDH Responsibility “prepare for and execute an effective response to pandemic influenza that assures promotion of health and protection from harm for Indiana citizens. ” “Execution Trumps Strategy” “Git ‘er done!” Larry the Cable Guy

ISDH Responsibilities: – Department Operations Center (DOC) – Technical Advisory Group (TAG) – Incident Command Structure (ICS) – Communication During the Pandemic Recent flood response activities provided opportunity for ISDH to implement and evaluate these functions

State Surveillance Activities – Influenza Sentinel Providers Surveillance Network – Reporting to CDC via State and Territorial Epidemiologists – Influenza-associated mortality – Public Health Emergency Surveillance System (PHESS) – Hospital Bed Tracking System

Laboratory Testing The Indiana State Department of Health (ISDH) Laboratory A hospitalized patient may be tested for H 5 infection if: a. Severe respiratory illness for which an alternative diagnosis has not been established; and b. Travel within 10 days to a country with documented infections

Laboratory Testing If the patient is hospitalized or ambulatory and has: a. Temperature >100. 4°F (>38°C); and b. Cough, sore throat, or shortness of breath; and either: c. Contact within 10 days prior to symptoms with: i. Poultry or domestic birds or ii. A patient with known or suspected influenza A (H 5) infection. Specimens require prior approval from a member of the ISDH Epidemiology Resource Center Surveillance Team (ERC ST)

Health Care Planning • Planning for mass care • Alternate care sites • Altered standards of care • Mass fatalities • Protection of the health care workforce

“Old Fashioned” Infection Control Practices • Droplet precautions • Isolation • Social distancing • Frequent hand washing Why do we continue to shake hands?

Clinical Guidelines • Epidemiologic criteria • Clinical criteria

Vaccine Distribution and Use • Manufacturing Vaccine Requires 6 months • Pre-Pandemic Vaccine – 13 million doses stockpiled • Priority Group Recommendations • Large-scale Vaccination – Requires public-private partnerships – Shared responsibility

Antiviral Distribution and Use • Classes of Antiviral medications – Amantadine derivatives (Symmetrel, Flumadine) – Neuraminidase inhibitors (Tamiflu, Relenza) • Treatment of ill patients • High Priority Groups for Treatment • Stockpiling Antiviral Medication • Delivery of Public Stockpiles of Antivirals

Containment • Isolation • Quarantine • Social distancing • Limitations on public gatherings

Managing Travel Related Risks • The CDC provides current information on outbreaks – Travel notices – Traveler’s Health section of the CDC Web site at www. cdc. gov/travel/outbreaks. htm – Indiana Health Alert Network (IHAN) messages

Managing Travel Related Risks • Four different categories of travel notices – Disease transmission, – Containment measures, – Quality of surveillance, and – Quality and accessibility to medical care.

Managing Travel Related Risks • Protocols for management of suspect pandemic influenza passengers on flights landing in Indianapolis are under development • Collaboration between MCHD and ISDH Recent suspected XDR TB case and international travel

Communication and Education • Crisis Communication Plan • Identified vehicles of dissemination • Education and engagement “The media is to public health as the scalpel is to the surgeon. ”

Workforce Support • A pandemic poses personal and emotional challenges • Stress levels may reach varying degrees of severity • Family and Social Services Administration, Division of Mental Health and Addiction (FSSA/DMHA), has developed guidelines for mental health support during a pandemic

Workforce Support • Early mental health interventions important – Should support reducing mortality and morbidity, offering psychological first aid, and identifying serious mental illness – It will be necessary for primary care providers to be enlisted to assist in the provision of these support services.

National Requirement for State Pandemic Influenza Operations Plans – Strategic Goals • Ensure Continuity of Operations for State Agencies • Ensure Continuity of State Government • Protect Citizens • Sustain and support Critical Infrastructure and Key Resource Sectors

Critical Infrastructure and Key Resource Sectors • • • Agriculture and Food Banking and Finance Chemical Commercial Facilities Commercial Nuclear Reactors, Materials, and Waste Dams Defense Industrial Base Drinking Water and Water Treatment Emergency Services

Critical Infrastructure and Key Resource Sectors • • Energy Government Facilities Information Technology National Monuments and Icons Postal and Shipping Public Health and Health Care Telecommunications Transportation Systems

Indiana’s Pandemic Influenza Preparedness Plan Ethical Issues

Ethical Considerations • An influenza pandemic will create a shortage of medical personnel and resources – Vaccines, antiviral medications, mechanical ventilators, and hospital bed space – Decisions must be made regarding which persons should receive the scarce resources available. • Community containment, isolation, and quarantine – Involve considerations such as civil liberties

Ethical Considerations • Processes and policies on a variety of similar issues should be carefully considered and fairly implemented. • The ISDH is working with CAGs, the Indiana University Center for Bioethics, community leaders, and the ISDH Office of Legal Affairs (OLA) in developing these approaches.

Indiana’s Pandemic Influenza Preparedness Plan • Resource allocation - Antivirals, vaccine, human resources • Triage - Access to care, ICU beds, mechanical ventilation • Altered standards of care – Change in priorities and expectations for delivery of care • Workforce management - Obligations of health care workers • Restriction on liberty - Quarantine and isolation