Seminar on Transatlantic Civil Security STACS WG 4

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Seminar on Transatlantic Civil Security (STACS) WG 4 – Pandemic Disease Outline 00: 00

Seminar on Transatlantic Civil Security (STACS) WG 4 – Pandemic Disease Outline 00: 00 – 00: 50 – Student Exercise Background Directions Activity Discussion 00: 50 – 01: 00 – Break 01: 00 – 01: 45 – Discussion 01: 45 – 02: 00 – Review Dr. Jack Clarke

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Protocols • Vaccine –

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Protocols • Vaccine – 20 million pre-pandemic – 300 million 6 months after outbreak (all U. S. ) • Antiviral Medication – 6 million to contain – 75 million to treat 100% 75% 50% 25% Antivirals 75 M Vaccine 20 M

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Objectives 1. Primary goal

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Objectives 1. Primary goal to decrease health impacts including severe sickness and death. 2. Secondary goal to minimize social and economic impacts.

Seminar on Transatlantic Civil Security (STACS) Treatment Groups Antiviral Medications Pre-Pandemic Vaccine 1. 2.

Seminar on Transatlantic Civil Security (STACS) Treatment Groups Antiviral Medications Pre-Pandemic Vaccine 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 20 Million Courses People 6 mos. + with 2+ risk factors Communications workers Pregnant women Other key government personnel Home care givers People 6 mos. + with 0+ risk factors People 6 mos. + with 1+ risk factors Emergency medical personnel Key government leaders People 65 yrs. + with 0+ risk factors Vaccine & drug manufacturers Police, fire, & public safety workers Medical & public health workers Utility workers People 65 yrs. + with 1+ risk factors Transportation workers Dr. Jack Clarke 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 75 Million Courses Pandemic health responders People 12 – 23, & 65+ Nursing homes & residential outbreaks Highest risk outpatients Emergency health care workers Critical infrastructure personnel including police, fire, public safety, utility, transportation, communications, and health care workers without patients Other outpatients Patients admitted to hospital Other health care workers without patients Health care workers with patients Immuno-compromised & pregnant outpatients

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Team Exercise Matter of Priority.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Team Exercise Matter of Priority. Given that there will be insufficient prepandemic vaccine and antiviral medication to distribute to the U. S. population, who should have priority? Students will form medical advisory groups and assign treatment priority to treatment groups defined by the U. S. Department of Health & Human Services (HHS).

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Directions 1. Divide into small

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Directions 1. Divide into small groups. 2. Distribute Student Exercise Worksheets.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Directions 1. Assign priorities to

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Directions 1. Assign priorities to Pandemic Treatment Groups. 2. Please remain quiet and wait until everybody’s done. 3. At the end, we will compare your answers to U. S. designated priorities assigned by the Department of Health & Human Services (HHS). 4. You will have 10 minutes.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke 10 -Minute Timer 10: 00

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke 10 -Minute Timer 10: 00 09: 00 08: 00 07: 00 06: 00 05: 00 04: 00 03: 00 02: 00 00: 01 00: 02 00: 03 00: 04 00: 05 00: 06 00: 07 00: 08 00: 09 00: 10 00: 11 00: 12 00: 13 00: 14 00: 15 00: 16 00: 17 00: 18 00: 19 00: 20 00: 21 00: 22 00: 23 00: 24 00: 25 00: 26 00: 27 00: 28 00: 29 00: 30 00: 31 00: 32 00: 33 00: 34 00: 35 00: 36 00: 37 00: 38 00: 39 00: 40 00: 41 00: 42 00: 43 00: 44 00: 45 00: 46 00: 47 00: 48 00: 49 00: 50 00: 51 00: 52 00: 53 00: 54 00: 55 00: 56 00: 57 00: 58 00: 59 01: 00 Go Ready? WALK STOP Start Timer

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Exercise Discussion • • •

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Exercise Discussion • • • Who should receive highest treatment priority? Who should receive lowest treatment priority? Will governments be able to enforce priorities?

Seminar on Transatlantic Civil Security (STACS) Break! Break Timer 10: 00 09: 00 08:

Seminar on Transatlantic Civil Security (STACS) Break! Break Timer 10: 00 09: 00 08: 00 07: 00 06: 00 05: 00 04: 00 03: 00 02: 00 00: 01 00: 02 00: 03 00: 04 00: 05 00: 06 00: 07 00: 08 00: 09 00: 10 00: 11 00: 12 00: 13 00: 14 00: 15 00: 16 00: 17 00: 18 00: 19 00: 20 00: 21 00: 22 00: 23 00: 24 00: 25 00: 26 00: 27 00: 28 00: 29 00: 30 00: 31 00: 32 00: 33 00: 34 00: 35 00: 36 00: 37 00: 38 00: 39 00: 40 00: 41 00: 42 00: 43 00: 44 00: 45 00: 46 00: 47 00: 48 00: 49 00: 50 00: 51 00: 52 00: 53 00: 54 00: 55 00: 56 00: 57 00: 58 00: 59 01: 00 Go Ready? WALK STOP Start Timer Dr. Jack Clarke

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Discussion Points • • •

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Discussion Points • • • What can be done to prevent a pandemic outbreak? What can governments do to contain pandemic disease? What will be the potential impact on citizens in the event of a pandemic outbreak? How can international cooperation curb the impact of pandemic disease? What can you do as an individual to survive a pandemic outbreak?

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Review

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Review

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Six Phases of Pandemic 1.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Six Phases of Pandemic 1. 2. 3. 4. No new flu virus. New flu in animals. New flu in humans. Localized human transmission. 5. Expanded human transmission. 6. Sustained human transmission.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Influenza vs. Pandemic • Seasonal

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Influenza vs. Pandemic • Seasonal Influenza is characterized by fever, fatigue, body pain, headache, dry cough, and sore throat. • Pandemic Influenza is a worldwide outbreak of a new influenza virus that is efficiently transmitted between humans.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke 20 th Century Pandemics Year

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke 20 th Century Pandemics Year U. S. Deaths Risk Group 1918 – 1919 500, 000 Young, Healthy Adults 1957 – 1958 70, 000 Infants & Elderly 1968 – 1969 34, 000 Infants & Elderly

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Avian Flu Threat • Avian

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Avian Flu Threat • Avian viruses played a role in the last three influenza pandemics. • The current threat stems from an unprecedented outbreak of the H 5 N 1 avian flu virus in Asia and Europe.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke H 5 N 1 Threat

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke H 5 N 1 Threat • H 5 N 1 is widespread in Asia, Europe, and Africa. • Wild birds and domestic ducks provide growing reservoir for mutating virus. • Humans can contract virus from direct contact with infected birds & bird feces. • High potential virus may mutate into form for efficient human-tohuman transmission.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Probable Not Inevitable • H

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Probable Not Inevitable • H 5 N 1 hasn’t yet exhibited efficient human transmission. • H 5 N 1 may become efficiently transmissible between humans, but it’s not inevitable. • It can happen anytime, anywhere, or never.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Catastrophic Potential • Larger, denser

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Catastrophic Potential • Larger, denser global population. • Greater international contact and travel. • Increasing numbers of elderly and infirm.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Planning Assumptions • Universal susceptibility.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Planning Assumptions • Universal susceptibility. • 30% contraction rate (40% for school-aged children). • 50% will seek medical care, overwhelming hospitals. • Infected people will spread virus 1 – 2 days before exhibiting symptoms. • The pandemic will sweep in at least 2 successive waves lasting 6 – 8 weeks each.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke H 5 N 1 U.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke H 5 N 1 U. S. Pandemic Projections Moderate (1958/68) Severe (1918) Illness 90 million Outpatients 45 million Hospitalization 865, 000 9. 9 million Intensive Care 128, 750 1. 5 million 64, 875 742, 500 209, 000 1. 9 million Ventilation Deaths

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Vaccine Treatment • The optimal

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Vaccine Treatment • The optimal way to control the spread and halt pandemics is through the use of vaccines. • Vaccines stimulate the immune system to recognize and neutralize viruses.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke • Pandemic Control Vaccine Types

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke • Pandemic Control Vaccine Types Pre-Pandemic vaccines are developed against strains of animal influenza viruses. – Limited effectiveness against human pandemic virus. • Pandemic vaccines are developed against strains that have evolved the capacity for human-to-human transmission. – More effective, but can’t be produced until virus mutates and emerges as human pandemic outbreak.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Vaccine Production 1. 2. 3.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Vaccine Production 1. 2. 3. 4. 5. Isolate infectious virus. Adapt weakened strain. Multiply in chicken eggs. 1 egg = 1 vaccine dose. 6 – 9 months to prepare.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Antiviral Protection • Antiviral drugs

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Antiviral Protection • Antiviral drugs disrupt a virus’ ability to reproduce, but don’t confer immunity. • Used in treatment, antiviral drugs can reduce symptoms and shorten illness. • Used in “prophylaxis”, antiviral drugs can prevent the onset of infection. • Prevention requires more drugs than treatment.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Antiviral Medication • • •

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Antiviral Medication • • • In the absence of a viable vaccine, antivirals may be the “first line of defense”. Tamiflu® and Relenza® are neuraminidase inhibitors that have shown limited effect against H 5 N 1. The National Strategy set a goal to stockpile enough antiviral medication to treat 75 million people, plus 6 million courses to help contain an outbreak.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Countermeasures 1. Stop, slow, or

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Countermeasures 1. Stop, slow, or otherwise limit the spread of a pandemic internationally. 2. Limit the domestic spread of a pandemic, and mitigate disease, suffering, and death. 3. Sustain infrastructure and mitigate impact to the economy and the functioning of society.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Priorities • Pre-pandemic vaccines

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Treatment Priorities • Pre-pandemic vaccines may be reserved for health care providers and first responders. • Antiviral mediation may be reserved for infected people at high risk for serious complications or death. • Vaccines will be distributed on a priority basis after they are developed.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Transmission Control • Modes of

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Transmission Control • Modes of Transmission: – Droplet Transmission – Contact Transmission – Airborne Transmission • Influenza transmission principally takes place in the respiratory tract.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Mitigation Actions • Social Distancing

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Mitigation Actions • Social Distancing – Maintain 3 -foot separation. – Avoid public gatherings. – Avoid public places. • Respiratory Hygiene – Covering cough & sneezes. – Washing hands. – Wearing mask. * * Unproven benefit not recommended as a public health control measure, but not discouraged either.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Containment Strategies • • •

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Containment Strategies • • • Individual Isolation Event Cancellation Voluntary “Snow Days” Building Quarantine Travel Restrictions Community Quarantine

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Individual Containment • Individual isolation

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Individual Containment • Individual isolation and quarantine have limited impact due to the short incubation period of the disease. • Infected individuals may be contagious two days before they show symptoms. • Nevertheless, individual containment may slow spread of the disease after the initial outbreak.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Voluntary Quarantine • 2003 SARS

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Voluntary Quarantine • 2003 SARS experience suggests quarantine applied on a voluntary basis can be sufficient to reduce disease transmission. • “Snow Days”, asking everyone to stay home for an initial 10 days is acceptable to most people, and easy to implement.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Community Measures • Focused measures

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Community Measures • Focused measures to increase social distancing include canceling events and closing buildings. • Forced closures may disrupt basic services and must be evaluated carefully. • School closures may be particularly effective at reducing the spread and magnitude of disease throughout the community.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Involuntary Quarantine • A Cordon

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Involuntary Quarantine • A Cordon Sanitaire legally restricts movement in and between communities. • Unlikely to prevent the introduction or spread of pandemic disease, except in uncommon or unique circumstances, such as when a community is completely selfsufficient.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Legal Ramifications • Containment measures

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Legal Ramifications • Containment measures raise legal, logistic, and social challenges that should be addressed before pandemic arrives. • Most US quarantine laws were written in the 19 th century.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Individual Impact • The first

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Individual Impact • The first wave of pandemic may occur simultaneously in many locations, preventing targeted concentration of emergency resources. • A vaccine won’t be available, and the supply of antiviral drugs will be limited. • Each locality may have to depend on its own resources to respond.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Family Planning Checklist • Store

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Family Planning Checklist • Store a two week supply of food and water. • Ask your doctor for an extra supply of prescriptions. • Stock health supplies including pain relievers, stomach remedies, cough and cold medicines. • Talk with family members about how they would be cared for if they got sick.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Limiting Infection • Teach your

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Limiting Infection • Teach your children to wash hands frequently with soap and water. • Teach your children to cover coughs and sneezes with tissues. • Teach your children to stay away from others as much as possible if they are sick.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Non-Perishable Foods • • •

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Non-Perishable Foods • • • Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups Protein or fruit bars Dry cereal or granola Dried fruit Crackers Canned juices Bottled water Canned or jarred baby food and formula Pet food Other non-perishable foods

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Example Medical & Emergency Supplies

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Example Medical & Emergency Supplies • • • • Prescribed medical supplies such as glucose and blood-pressure monitoring equipment Soap and water, or alcohol-based hand wash Medicines for fever, such as acetaminophen or ibuprofen Thermometer Anti-diarreal medication Vitamins Fluids with electrolytes Flashlight Batteries Portable radio Manual can opener Garbage bags Tissues, toilet paper, disposable diapers

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke It’s Up to You l

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke It’s Up to You l l l Effective response will require planning and preparation. It will require flexibility and decisions guided by epidemiologic data. It will depend on an informed public that understands the dangers and accepts the need for control measures to save lives.

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Questions? ESC

Seminar on Transatlantic Civil Security (STACS) Dr. Jack Clarke Questions? ESC