Update on Influenza and Pandemic Preparedness April 20

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Update on Influenza and Pandemic Preparedness April 20, 2011 Charles W. Mackett III, MD,

Update on Influenza and Pandemic Preparedness April 20, 2011 Charles W. Mackett III, MD, MMM, FAAFP Senior Vice President and Chief Medical Officer Clinical Assoc Professor of Family Medicine UPMC

Educational Objectives • Review Latest Flu Vaccine Recommendations • Plan & Prepare Your Office

Educational Objectives • Review Latest Flu Vaccine Recommendations • Plan & Prepare Your Office For a Pandemic • Evaluate Partnering With Local & State Agencies • Discuss How to Register in the Medical Reserve Corps

Cycle of Avian Influenza viruses in animals & humans Domestic birds Natural avian influenza

Cycle of Avian Influenza viruses in animals & humans Domestic birds Natural avian influenza cycle Shore birds Direct bird to human transmission is also common Pandemic disease cycle Waterfowl Mammals (primarily swine) Humans

Pandemic Influenza Bird flu kills in Indonesia and picks up speed across Asia” •

Pandemic Influenza Bird flu kills in Indonesia and picks up speed across Asia” • The China Post 10 January 2007 Licensed from Reuters

Pandemic Influenza Licensed from Reuters

Pandemic Influenza Licensed from Reuters

Novel Influenza A/H 1 N 1/2009 • April 15 - first infection confirmed CDC

Novel Influenza A/H 1 N 1/2009 • April 15 - first infection confirmed CDC • April 26 - public health emergency declared • June 11 - World Health Organization raises pandemic alert to Phase 6 (i. e. , pandemic in progress) • June 2010 - US public health emergency expires • August 2010 pandemic ended http: //www. cdc. gov/h 1 n 1 flu/

Current Situation H 1 N 1 • • Confirmed Human Cases – Dominant Strain

Current Situation H 1 N 1 • • Confirmed Human Cases – Dominant Strain Case Fatality Rate < 1% (WHO) Severe Pneumonia/Respiratory Failure Most virulent in children and young adults – Most deaths under age 50 – Rare in elderly • Never disappeared Northern Hemisphere • School clusters – CMU

Vulnerable Populations • • Children and Elderly Pregnant Women Respiratory Disease Cardiovascular Disease Diabetes

Vulnerable Populations • • Children and Elderly Pregnant Women Respiratory Disease Cardiovascular Disease Diabetes Obesity Immunosuppression Minority Groups/Indigenous Populations WHO August 2009

Vaccine Recommendations • Universal Vaccination Age 6 Months and Older Annually • When Vaccine

Vaccine Recommendations • Universal Vaccination Age 6 Months and Older Annually • When Vaccine is Limited, Focus: – – – – Ages 6 months – 4 years & over age 50 Chronic conditions including children on ASA (Reyes) Immunosuppression Pregnant women Nursing home residents Indigenous populations Health care workers & household contacts MMWR 2010

Pandemic Influenza “Don’t forget about H 7, H 9 or perhaps even H 2”

Pandemic Influenza “Don’t forget about H 7, H 9 or perhaps even H 2” • Robert Webster, St. Jude’s Hosp 2007 No one anticipated A/H 1 N 1/2009!

“Bird Flu” Highly Pathogenic Avian Influenza H 5 N 1 “The most lethal influenza

“Bird Flu” Highly Pathogenic Avian Influenza H 5 N 1 “The most lethal influenza virus we have ever seen” • Robert Webster, St. Jude’s Hosp 2005

Current Situation H 5 N 1 • The First Known Highly Pathogenic Avian Influenza

Current Situation H 5 N 1 • The First Known Highly Pathogenic Avian Influenza (HPAI) Panzootic – Continues to smolder • Confirmed Human Cases • Case Fatality Rate ~ 60% (WHO) • No Sustained Human To Human Transmission • Indonesia Family Cluster

Reported Infections in Birds and People: since 2003 UPMC Center for Biosecurity

Reported Infections in Birds and People: since 2003 UPMC Center for Biosecurity

Pandemic Influenza “The world will experience another human influenza pandemic sooner or later. ”

Pandemic Influenza “The world will experience another human influenza pandemic sooner or later. ” • Margaret Chan, Director WHO, September 9, 2007

“I’ve been through some terrible things in my life some of which actually happened!”

“I’ve been through some terrible things in my life some of which actually happened!” - Mark Twain

Human H 5 N 1 Licensed from Reuters

Human H 5 N 1 Licensed from Reuters

Pandemic Influenza Impact on Average U. S. Hospital • Flu. Surge model (CDC) •

Pandemic Influenza Impact on Average U. S. Hospital • Flu. Surge model (CDC) • HHS planning assumptions • At peak (week 5 of 8) with 25% attack rate Moderate Scenario (1968 -like) Severe Scenario (1918 -like) 19% of non-ICU beds 191% of non-ICU beds 46% of ICU beds 461% of ICU beds 20% of ventilators 198% of ventilators UPMC Center for Biosecurity

Morbidity And Mortality Within 12 -16 Weeks PA US Require Outpatient Care 50 Million

Morbidity And Mortality Within 12 -16 Weeks PA US Require Outpatient Care 50 Million 1. 6 Million Hospitalizations 2 Million 37, 800 Deaths 9, 100 500, 000 UPMC Center for Biosecurity

Potential Health Impact • Demand Will Far Outstrip Capacity • Critical Shortage of Health

Potential Health Impact • Demand Will Far Outstrip Capacity • Critical Shortage of Health Care Workers – RN’s, MA’s, EMS & Technicians • Critical Shortage of Supplies & Equipment – PPE, Meds, Vaccines, Oxygen & Ventilators • “Graceful Degradation of Services” (Joint Com) – – Standard of Care to Sufficient Care Shift From Chronic/Preventive to Acute Care Defer Elective Procedures Vulnerable Populations & “Chronic Critically ILL” UPMC Center for Biosecurity

Federal Role in Pandemic Response "Any community that fails to prepare with the idea

Federal Role in Pandemic Response "Any community that fails to prepare with the idea that somehow, in the end, the federal government will be able to rescue them will be tragically wrong. " • Michael Leavitt, U. S. Secretary of Health and Human Services at Pennsylvania Summit 3/31/06

UPMC File Photo

UPMC File Photo

UPMC Pandemic Plan

UPMC Pandemic Plan

What Can You Do? Licensed from Reuters

What Can You Do? Licensed from Reuters

Begin Planning Now • Review Available AAFP, CDC & HHS Guidelines & Checklists –

Begin Planning Now • Review Available AAFP, CDC & HHS Guidelines & Checklists – “Checklist to Prepare Doctor’s Offices for Pandemic Influenza” – “Business Planning Checklist …” – CDC/ACIP “Recommended Immunization Schedule” • Adopt & Tailor to Your Practice • Flexibility is Critical

AAFP Resources & Links Clinical Care & Research Searching for clinical information? Check out

AAFP Resources & Links Clinical Care & Research Searching for clinical information? Check out American Family Physician, AAFP's Clinical Recommendations and Annual Clinical Focus. Looking for patient handouts? Visit AAFP's patient information Web site: familydoctor. org. Interested in primary care research? Visit AAFP's National Research Network and Annals of Family Medicine. Need disaster preparedness or pandemic flu resources? Check out AAFP's disaster preparedness and pandemic flu resources. www. aafp. org/online/en/home/clinical

Pandemic Flu: Physician Resources AAFP Resources Checklist to Prepare Doctor’s Offices for Pandemic Influenza

Pandemic Flu: Physician Resources AAFP Resources Checklist to Prepare Doctor’s Offices for Pandemic Influenza -- Updated September 2010 Current Information Latest Information About Pandemic Flu -- From the World Health Organization (WHO) Checklists and Other Planning Materials Planning Checklist for Medical Offices and Clinics -- From the HHS Pandemic Information for Health Professionals -- From the CDC General Information Pandemic Influenza: State Public Health Agency Preparation and Response -- From the Association of State and Territorial Health Officials www. aafp. org/online/en/home/clinical

www. aafp. org/online/en/home/clinical

www. aafp. org/online/en/home/clinical

Epidemic Surveillance & Detection • Emerging Pathogen Case Definitions – Fever & Sore Throat,

Epidemic Surveillance & Detection • Emerging Pathogen Case Definitions – Fever & Sore Throat, Cough or Dyspnea – GI & Neuro Sx • • • Travel History & Exposures Monitor Media & Public Health Alerts Appoint Single Point of Contact Maintain High Index of Suspicion Report Suspected Cases to Appropriate Authorities

Infection Control – Stop the Spread • • Identification, Triage & Isolation Cough Etiquette

Infection Control – Stop the Spread • • Identification, Triage & Isolation Cough Etiquette & Hand Hygiene “Flu Bags” (mask, tissue, sanitizer) Appropriate PPE & Masks for Staff “Wash In & Wash Out” of Every Encounter Appropriate Immunization & Treatment Master Seasonal Flu & CAP Use hospital disaster drills to prepare for mass casualties (AHRQ – SORT C)

Office Preparedness AAFP Booth

Office Preparedness AAFP Booth

Office Preparedness AAFP Booth

Office Preparedness AAFP Booth

Coordinate With Public Health • • • Isolation of Sick Quarantine of Exposed Contacts

Coordinate With Public Health • • • Isolation of Sick Quarantine of Exposed Contacts Social Distancing Clinical Epidemiology Monitor Homebound Patients Don’t Forget Vulnerable Populations & “Chronically Critically ILL” (Katrina) • Understand Local Plans & Potential Roles of Family Physicians

Coordinate With Public Health • • Florida Medical Reserve Corps Information and registration Visit

Coordinate With Public Health • • Florida Medical Reserve Corps Information and registration Visit www. servfl. com Local County MRC websites

Surge Capacity • • • Reschedule or Postpone Routine Services “Worried Well” (India 2006)

Surge Capacity • • • Reschedule or Postpone Routine Services “Worried Well” (India 2006) Revise Schedule Templates Telephone Triage & “E” Communication Alternate Care Sites Community Points of Distribution (PODS) – Anti-virals (Oseltamivir) – Pandemic Vaccines if available

Communicate At Every Level • • • Language Appropriate Signage Alert Patients to Report

Communicate At Every Level • • • Language Appropriate Signage Alert Patients to Report Symptoms Individual Preparedness & Self-Care Hotlines & Nurse Advice Lines Open Lines of Communication – Patients – Staff – Colleagues -- Hospitals -- Business Associates -- Public Health • Designate Single Practice Spokesperson

Business Continuity Issues • Clear Expectations to Work – “All Hands” Needed to Stop

Business Continuity Issues • Clear Expectations to Work – “All Hands” Needed to Stop the Epidemic – It’s What We Do Everyday (Flu, HIV, TB) • Protect & Support Staff – Infection Control & PPE – Non-punative Sick Leave Policies • Return to Work Guidelines & Screening – Recovered Staff – Volunteers

Business Continuity Issues • Cross Train to Maintain Essential Tasks • Engage Vendors &

Business Continuity Issues • Cross Train to Maintain Essential Tasks • Engage Vendors & Alternative Suppliers • Coordinate With Payers, Banks & Creditors – Streamline billing processes – Ensure cash flow & payroll • Anticipate Behavioral Health Needs – Patients & Staff • Security

Cross Functional Training Mackett Baghdad File Photo

Cross Functional Training Mackett Baghdad File Photo

Recovery & Reconstitution • Prepare for Pandemic Waves – 1918 -1920 Experience • •

Recovery & Reconstitution • Prepare for Pandemic Waves – 1918 -1920 Experience • • • Equipment & Supplies Billing & Collections Replace Sick, Disabled or Expired Staff Behavioral Health Needs Contact & Recall Deferred Patients Clear Backlog of Postponed Services

Pandemic Influenza “Right now, a growing … challenge is overcoming … bird flu fatigue”

Pandemic Influenza “Right now, a growing … challenge is overcoming … bird flu fatigue” • Henk Bekedam WHO January 29, 2007 Licensed from Reuters

What Will You Do? AP

What Will You Do? AP

Take Home Points • Begin Planning & Preparing Now • Master Seasonal Flu &

Take Home Points • Begin Planning & Preparing Now • Master Seasonal Flu & CAP – Universal Vaccination Age 6 Months and Older • Infection Control – “Wash In & Wash Out” • Communicate At All Levels & Coordinate With Public Health • Personnel Management & Business Continuity Matter! • Adopt & Tailor Available AAFP, CDC & HHS Checklists

Resources • www. aafp. org/online/en/home/clinical/disaster prep/pandemicflu/mdresources • www. aafp. org/online/en/home/clinical immunizations • www. flu.

Resources • www. aafp. org/online/en/home/clinical/disaster prep/pandemicflu/mdresources • www. aafp. org/online/en/home/clinical immunizations • www. flu. gov • www. pandemicflu. gov/plan/healthcare/medical • Family Practice Management July/August 2009 • Chuck Mackett – charles. mackett@irmc. cc/772 -563 -4776

“Plans are useless but planning is indispensable” - Dwight David Eisenhower

“Plans are useless but planning is indispensable” - Dwight David Eisenhower

Questions?

Questions?