County-Wide Pandemic Influenza Preparedness & Response Plan Presented by the Santa Clara County Public Health Department to the Emergency Managers Association April 27, 2006
Why the Concern About Why the Concern About Pandemic Influenza? Pandemic Influenza? � Influenza pandemics are Influenza pandemics are � inevitable; naturally recur at more- - inevitable; naturally recur at more or- -less cyclical intervals. less cyclical intervals. or � Current bird flu strain has great Current bird flu strain has great � potential to become next human potential to become next human influenza pandemic. influenza pandemic. � There will be little warning. There will be little warning. �
Pandemic Influenza in Pandemic Influenza in Today’s World Today’s World
About Seasonal Flu About Seasonal Flu � Virus that infects the respiratory system and Virus that infects the respiratory system and � people have some immunity – – or protection or protection – – people have some immunity against it. against it. � It is predictable, typically seen in the winter It is predictable, typically seen in the winter � months. Vaccine developed every year. months. Vaccine developed every year. � Minor impact on the community and Minor impact on the community and � economy with people home sick from work economy with people home sick from work and school. and school.
What is Avian Influenza? What is Avian Influenza? � Literally “bird flu”, a non Literally “bird flu”, a non- -human virus that human virus that � causes illness in birds. causes illness in birds. � Very contagious among birds, Very contagious among birds, � wild birds ‘carry’ the virus wild birds ‘carry’ the virus and infect domesticated birds. and infect domesticated birds. � Does not usually infect people, but the latest Does not usually infect people, but the latest � outbreak has caused human illness and deaths. outbreak has caused human illness and deaths. People get bird flu from close contact with People get bird flu from close contact with infected birds. infected birds. � Hasn’t been able to effectively Hasn’t been able to effectively � pass from person- -to to- -person. person. pass from person
Pandemic Influenza Pandemic Influenza An outbreak of disease that occurs when a new An outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human influenza A virus appears or “emerges” in the human population, causes serious illness, and then spreads population, causes serious illness, and then spreads easily from person- -to to- -person worldwide. person worldwide. easily from person
Influenza Pandemics in the Influenza Pandemics in the th Century 20 th Century 20 Global pandemics are unpredictable. They don’t happen often Global pandemics are unpredictable. They don’t happen often th Century. – only three times in the 20 only three times in the 20 th Century. – Years Flu Virus Deaths 1918-1919 “Spanish” Type A (H1N1) 550,000 US 1957-1958 “Asian” Type A (H2N2) 70,000 US 1968-1969 “Hong Kong” Type A (H3N2) 34,000 US
Infectious Disease Mortality Infectious Disease Mortality th Century United States – – 20 20 th Century United States 1918 Pandemic Flu
Mode of Transmission Mode of Transmission � Primarily close contact Primarily close contact – – large droplets large droplets � spread by coughing, sneezing, talking spread by coughing, sneezing, talking
Impact of Pandemic Influenza Impact of Pandemic Influenza � Estimates for a major pandemic in Santa Estimates for a major pandemic in Santa � Clara County: Clara County: � 25% to 35% clinical attack rate (people getting sick) • 450,000 to 620,000 � Hospitalizations • 61,000 to 143,000 � Fatalities • 22,500 to 31,000
Impact on Healthcare System Impact on Healthcare System � Staffing and bed shortages. Staffing and bed shortages. � � Shortages of key supplies and equipment; Shortages of key supplies and equipment; � anti- -virals, ventilators, etc. virals, ventilators, etc. anti � Demand will outpace supply for months Demand will outpace supply for months � (waves of illness for up to 2 years). (waves of illness for up to 2 years). � Vaccine not available for 6 to 8 months. Vaccine not available for 6 to 8 months. � � Vast majority of ill people will be taken care Vast majority of ill people will be taken care � of at home by family members. of at home by family members.
Surge and Capacity Challenges Surge and Capacity Challenges 20000 15000 s e s 10000 a C 5000 0 1 2 3 4 5 6 7 8 9 10 11 12 56 225 394 563 731 844 844 731 563 394 225 56 Deaths Hospitalizations 256 1,023 1,790 2,556 3,324 3,835 3,835 3,324 2,556 1,790 1,023 256 Illnesses 1,125 4,500 7,875 11,250 14,625 16,875 16,875 14,625 11,250 7,875 4,500 1,125 Week 2000 No. of Beds 0 -2000 -4000 1 2 3 4 5 6 7 8 9 10 11 12 920 229 -461 -1,150 -1,841 -2,301 -2,301 -1,841 -1,150 -461 229 920 Avail Hosp beds 204 76 -51 -205 -358 -486 -538 -486 -358 -205 -51 76 Avail ICU beds Week
Pandemic Impact: Infrastructure Pandemic Impact: Infrastructure � Initially, limited or no assistance from Initially, limited or no assistance from � State and Federal governments State and Federal governments � Significant disruption of transportation, Significant disruption of transportation, � commerce, utilities, public safety and commerce, utilities, public safety and communications communications � Social distancing strategies may include Social distancing strategies may include � closing schools, and canceling public closing schools, and canceling public events events
Pandemic Impact: Pandemic Impact: Government and Business Government and Business � High absenteeism will necessitate High absenteeism will necessitate � continuity of operations plans continuity of operations plans � Psychological impacts on workforce will Psychological impacts on workforce will � be extreme be extreme � Changes in workplace policies and Changes in workplace policies and � practices critical to minimize the spread of practices critical to minimize the spread of disease (mandatory sick leave) disease (mandatory sick leave)
Pandemic Influenza Doctrine: Pandemic Influenza Doctrine: Preparedness Minimizes Impact Preparedness Minimizes Impact I mpact • Human Illness/Death • Economic Losses Unprepared • Social Disruption • Disruption of Essential Services Prepared Time
Purpose of Plan of Plan Purpose � Guides the Public Health Department and Guides the Public Health Department and � other County departments to prepare for and other County departments to prepare for and respond to pandemic influenza respond to pandemic influenza � Provides guidance and tools to the many Provides guidance and tools to the many � partners in the community who will be partners in the community who will be involved in a response involved in a response � Guides activities to educate and prepare the Guides activities to educate and prepare the � general public regarding this public health general public regarding this public health threat threat
Public Health Preparedness & Public Health Preparedness & Response System Response System A NETWORK of Shared Responsibility to Minimize Impact! A NETWORK of Shared Responsibility to Minimize Impact! Healthcare Federal/ Delivery State/ Local System Partners Community Public Health Education & Preparedness & System Faith-based Response Groups System � People � Plans Business Media & Workers � Products � Practice Adapted from CDC
Overall Mission: Overall Mission: Minimize Impact through Coordinated Action to Minimize Impact through Coordinated Action to Protect Public’s Health Protect Public’s Health � Limit number of illnesses Limit number of illnesses � � Limit number of deaths � Limit number of deaths � Preserve continuity of essential services and � Preserve continuity of essential services and functions functions � Minimize social disruption and economic � Minimize social disruption and economic losses losses
Plan Components: Plan Components: Critical Capacity Modules Critical Capacity Modules I. Legal Authority: I. Legal Authority: Clearly defines authority and powers of the Health Officer, Clearly defines authority and powers of the Health Officer, ie, Isolation and quarantine, restricting of public , Isolation and quarantine, restricting of public ie gatherings, school closures gatherings, school closures II. Surveillance: II. Surveillance: Early identification and reporting of cases, laboratory Early identification and reporting of cases, laboratory surveillance for disease surveillance for disease III. Health Care: III. Health Care: Hospital planning guidance, specifications for Influenza Hospital planning guidance, specifications for Influenza Care Centers Care Centers IV. Limiting Spread of Disease: IV. Limiting Spread of Disease: Infection Control Guidelines at home, Personal Protection Infection Control Guidelines at home, Personal Protection Equipment, social distancing, ie ie “snow days” “snow days” Equipment, social distancing,
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