Report on meeting Pandemic Influenza: Unique Planning Challenges

[Guest guest]

- Kimberly Dawley

Kimberly Dawley

Tuesday, July 03, 2007 11:54 PM

Report on meeting "Pandemic Influenza: Unique Planning Challenges"

 

Report on the meeting dated [February 2006] titled "Pandemic Influenza: Unique Planning Challenges."

 

Speaker: Steven A. Harrison, Assistant State Exercise & SNS Coordinator, Office of Emergency Preparedness & Response Programs, Virginia Department of Health.

-- Consider that avian H5N1 influenza has now spread to about 20 countries.

-- Consider that we are most contagious with the flu the day before any symptoms appear.

-- Consider that while human cases of avian H5N1 influenza remain relatively low and so far there are no actual "verified" cases of human-to-human transmission, the fatality rate is 50% for those persons who have become ill.

In Virginia, "medium level" (only 35% attack rate) pandemic avian flu impact estimates include:

 

2.700 to 6,300 deaths

12,000 to 28,500 hospitalizations

575,000 to 1.35 million outpatient visits

1.08 million to 2.52 million people becoming sick

A pandemic would last much longer than most other emergency events and may include waves of flu activity separated by months. The numbers of health-care workers and first responders available to work can be expected to be reduced as they will be at high risk of illness through exposure in the community and in health care settings and some may have to miss work to care for ill family members. Resources in many locations could be limited because of how widespread the pandemic could be. Effects on communities will be months, not weeks. Critical infrastructures such as electrical companies, nuclear power plants, water stations, and telephone and internet companies could be affected if many employees become ill. Supplies like gasoline, food groceries, medications could be affected if there are travel restrictions or, again, many employees become ill. There is also a question of morgue capacity and temporary holding sites with refrigeration for storage of bodies.

Only one antiviral medication (Tamiflu) has been shown beneficial in treating H5N1 avian influenza victims, however, flu strains mutate and have and can become resistant to antiviral medications. The supply of Tamiflu is very limited worldwide and no pharmaceutical company in the United States manufactures it. In addition, because it takes several months to develop and distribute vaccinations, a vaccine probably would not be available in the early stages of the pandemic and once a vaccination is made available the flu strain could mutate. Vaccinations are also manufactured using chicken embryos, and poultry is implicated in the spread of avian influenza.

Legal issues will arise with the question of who will get the first antiviral medications and vaccines. Should it be the first responders, like health care workers, police and fire? Should it be the special needs population like the immune compromised and elderly? Mr. Harrison indicates that so far they have not even been able to "define" what a first responder is or who consists of the special needs population. For instance, in the first round of trying to decide who a first responder was, morticians were not included. Legal issues will also arise for physicians with triage, do they treat those most likely to survive or those most likely to die, especially if medical supplies for treatment are in short supply?

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Executive orders:

 

Mandatory vaccination (also falls under "BioShield" legislation). This will be problematic in the eyes of the public because of Section 6 of S. 1873, the Biodefense and Pandemic Vaccine and Drug Development Act of 2005, sponsored by Senator Richard Burr, R-N.C., which declares vaccine manufacturers immune from any liability except in the case of willful misconduct. The vaccine industry already has indemnification under Bush Executive Order 10789. Mr. Harrison believes, however, that mandating vaccinations will be a better alternative than mass quarantine of the population. However, he also again stressed that because it takes several months to develop and distribute vaccinations, a vaccine probably would not be available in the early stages of the pandemic and that once a vaccination is actually made available the flu strain could mutate. A legal issue also arises in does a person have the right to refuse to be vaccinated for religious or other reasons, and what happens to that person if they refuse, will they be quarantined?

President Bush signed an executive order in April, 2005 adding pandemic influenza to the government's list of communicable diseases for which a quarantine is authorized. Mr. Harrison defined "isolation" as the isolation of sick persons and "quarantine" as the isolation of well people. Mr. Harrison believes it is not feasible to put in use Rex 84 detention camps (located throughout the country) as there are not enough policemen to enforce this and, furthermore, the pandemic will spread too quickly to contain it. However, citing concern that state and local authorities might be unable to contain such an outbreak, President Bush has also asked Congress to give him the authority to call in the military. In addition, this January, 2006, the Army Corps of Engineers awarded Halliburton subsidiary Kellogg Brown & Root a $385 million contract to revamp these Rex 84 detention camps to deal with "an emergency influx of immigrants into the U.S., or to support the rapid development of new programs." Later the New York Times reported that "KBR would [revamp] the centers for the Homeland Security Department for an unexpected influx of immigrants, to house people in the event of a natural disaster or for new programs that require additional detention space." Less attention centered on the phrase "rapid development of new programs" and what kind of programs would require a major expansion of detention centers.

Mandatory call up of the Medical Reserve Corps., a national network of volunteer medical and public health professionals established in 2002 who can contribute their skills and expertise throughout the year and during times of community need. Mr. Harrison is knowledgeable in the fact that many of Richmond's hospitals have quite frequently in the last year or more been on what is called "Black Alert", the highest state where the hospital is full, no more patients can be accepted and are diverted to other hospitals. When queried as to what Richmond hospitals will do if an avian influenza pandemic occurs, he stated the following: (1) There is a new "Community Surge" plan for hospitals in the works whereby hospitals are identifying how much space they have to put multiple patients in each room, in hallways, and every place possible. (2) There are 3,500 Federal Medical Shelters (FMS) (like Army "MASH" units) available for deployment in Virginia; however, he has no doctors to staff them and presumably some of the Medical Reserve Corps. would assist.

In Virginia, Code Sections 32.1-35-48.04 authorizes the following:

Sections 32.1-35, 36, 37 -- Requires reporting of selected diseases to the Board of Health by physicians practicing in Virginia and others, such as those in charge of a medical care facility.

Sections 32.1-39 -- Authorizes the Board of Health to provide for surveillance and investigation of preventable diseases and epidemics, including contact tracing.

Sections 32.1-40 -- Authorizes the Commissioner or his designee to examine medical records in the course of investigation, research or studies. Requires that the anonymity of each patient and practitioner be preserved.

Sections 32.1-13 and 32.1-20 -- Authorizes the Board of Health to make orders and regulations to meet any emergency for the purpose of suppressing nuisances dangerous to public health and communicalbe, contagious and infectious diseases and other dangers to public life and health. Authorizes the Commissioner to act with full authority of the Board of Health when it is not in session.

Sections 32.1-42, 43 and 48 -- Authorizes the Commissioner to require quarantine, vaccination or treatment of any individual when he determines it is necessary to control the spread of any disease of public health importance. Permits the Commissioner to require immediate vaccination of all persons in the event of an epidemic.

Sections 32.1-48.02-48.04 -- Authorizes the Commissioner to order individuals with airborne communicable diseases to be taken into custody. Authorizes the Commissioner to petition for a hearing on temporary detention of individuals infected with a communicable disease. Provides guidelines for isolation hearings.

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The Virginia Department of Agriculture and Consumer Services (VDACS) maintains surveillance on animal populations in Virginia, including surveillance for avian influenza in poultry and presumably factory chicken farms like Tysons. The Virginia Division of Zoonotic and Environmental Epidemiology monitors epizootic and zoonotic disease events.

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Mr. Harrison believes that washing hands frequently, covering coughs and sneezes with tissues will not be very effective in preventing avian H5N1 influenza, nor will the donning of masks and gloves. Rather, it will be staying away from others as much as possible which could be the most effective. Businesses should have a contingency plan in the works for as much as a 50% or more reduction of employees. Businesses should have a contingency plan in the works for staff to work out of their homes. He suggested the following from a ready.gov website:

Carefully assess how your company functions, both internally and externally, to determine which staff, materials, procedures and equipment are absolutely necessary to keep the business operating.

 

 

Review your business process flow chart if one exists.

Identify operations critical to survival and recovery.

Include emergency payroll, expedited financial decision-making and accounting systems to track and document costs in the event of a disaster.

Establish procedures for succession of management. Include at least one person who is not at the company headquarters, if applicable.

Identify your suppliers, shippers, resources and other businesses you must interact with on a daily basis.

 

 

Develop professional relationships with more than one company to use in case your primary contractor cannot service your needs. A disaster that shuts down a key supplier can be devastating to your business.

Create a contact list for existing critical business contractors and others you plan to use in an emergency. Keep this list with other important documents on file, in your emergency supply kit and at an off-site location.

Plan what you will do if your building, plant or store is not accessible. This type of planning is often referred to as a continuity of operations plan, or COOP, and includes all facets of your business.

 

 

Consider if you can run the business from a different location or from your home.

Develop relationships with other companies to use their facilities in case a disaster makes your location unusable.

Plan for payroll continuity. Decide who should participate in putting together your emergency plan.

 

 

Include co-workers from all levels in planning and as active members of the emergency management team.

Consider a broad cross-section of people from throughout your organization, but focus on those with expertise vital to daily business functions. These will likely include people with technical skills as well as managers and executives.

Define crisis management procedures and individual responsibilities in advance.

 

 

Make sure those involved know what they are supposed to do.

Train others in case you need back-up help.

Coordinate with others.

 

 

Meet with other businesses in your building or industrial complex.

Talk with first responders, emergency managers, community organizations and utility providers.

Plan with your suppliers, shippers and others you regularly do business with.

Share your plans and encourage other businesses to set in motion their own continuity planning and offer to help others.

http://www.ready.gov/business/index.html

This will conclude the Report on the meeting dated [February 2006] titled "Pandemic Influenza: Unique Planning Challenges."

If you wish to contact Mr. Harrison directly:

Steven A. Harrison Assistant State Exercise & SNS Coordinator Office of Emergency Prepared & Response Programs Virginia Department of Health 109 Governor Street, 13th Floor Richmond, Virginia 23219 Telephone: 804-864-7033 Fax: 804-864-7029 Email: steve.harrison