H1N what?: Planning for the Next Pande Influenza O utbreak in M aryland Karim Medlej, MHS Student
The Maryland Department of Health ● First formed in 1969 and includes the Office of Preparedness and Office of Preparedness and Response Response [1] [1] ● Mission: Mission: to maintain the health and safety of all residents through disease prevention, access to care, and quality management [1] . ● Objectives [2] : 1. Monitoring and improving public health services public health services to Maryland residents 2. Assisting residents with addictions and psychiatric disorders addictions and psychiatric disorders to recover 3. Coordinating a service delivery system to provide appropriate services to residents with developmental and intellectual disabilities developmental and intellectual disabilities
Project Overview 1. Complete preparatory courses preparatory courses online provided by FEMA to get familiarized with the Incident Command System (ICS) 2. Assist in the facilitation of the OP&R facilitation of the OP&R Pandemic Influenza Pandemic Influenza planning workgroup planning workgroup by preparing meeting materials and gathering recommendations and feedback from successive meetings 3. Present an updated draft of the Maryland Pandemic Influenza updated draft of the Maryland Pandemic Influenza Plan Plan that is consistent with federal, state, and local planning and recommendations
What is an Influenza Pandemic? ● Influenza (flu) is a very contagious viral infection contagious viral infection that attacks a person’s respiratory system [3] . ● An Influenza pandemic is a “ global outbreak of a new influenza A global outbreak of a new influenza A virus virus that is very different from current and recently circulating human seasonal influenza A viruses” [3] . ● 3 documented cases 3 documented cases of a pandemic influenza outbreak, with the most severe one caused by Spanish flu pandemic of 1918 Spanish flu pandemic of 1918 (H1N1 virus) [4] .
The 1918 Spanish Flu Pandemic Deadliest Deadliest pandemic in history [5] ● 500 million people 500 million people globally were infected ( ⅓ of the entire world) [5] ● ● 50 million people died, including 675,000 US Americans 50 million people died, including 675,000 US Americans [5] ● Hospitals did not have any effective treatments or a vaccine, so efforts to contain the pandemic were only limited to public health procedures (quarantine, good hygiene, and disinfection of public spaces) ● All procedures were inefficient due to the lack of a proper preparedness plan [4]
During the first 6 months of each pandemic... 25 M illion 244k D eaths from the D eaths from C O V ID - Spanish F lu [7] 19 [6]
[8]
Public Health Significance 1) 1) Prepares Prepares local organizations to stop the spread of a deadly Influenza virus, saving the lives of numerous individuals 2) 2) Prevents Prevents collateral damage to the economy, schools, or government 3) 3) Promotes Promotes primary prevention where organizations such as supermarkets and universities offer free flu vaccines to the community and spread awareness
Methods 1. 1. Review and understand Review and understand current Pandemic Influenza and Infectious Disease Response plans 2. Conduct literature reviews and crosswalk tables literature reviews and crosswalk tables about the influenza virus and preparedness programs of other states 3. 3. Suggest modifications for the updated draft Suggest modifications for the updated draft of Pandemic Influenza Plan while assisting in the facilitation of the OP&R planning workgroup
General Planning Activity Process Overview Checklists December 10, 2019 December 10, 2019 February 18, 2020 February 18, 2020 January 28, 2020 January 28, 2020 March 19, 2020 March 19, 2020 (cancelled) (cancelled) Final Plan Goals, Objectives, Review Assumptions
Major Findings A) The Most Prepared States A) The Most Prepared States B) The Importance of Communication B) The Importance of Communication ● Most prepared state for a possible Usage of common language common language among ● outbreak is Massachusetts Massachusetts [9] team members ● Maryland Maryland ranks second, proven to be a Poor communication with the public ● highly equipped state drastically decreases the effectiveness decreases the effectiveness Evaluation Indicators include: of a preparedness plan of a preparedness plan (as seen in today’s ● 1. Funding commitment COVID-19 pandemic) [11]. 2. Number of hospitals that meet Poor communication could lead to a “loss loss ● the criteria for antibiotic of trust of trust in the government’s ability to resistance and flu vaccines protect the nation in the future” [11]. 3. National Health Security Preparedness Index influenced by preparedness plans [10] .
1. 1. Pace Pace of a government job Limitations and 2. Government processes processes and procedures and procedures C hallenges 3. Incident Command System terms terms
Reflection and Lessons Learned 1. Really enjoyed enjoyed working with my preceptors and task force 2. A much better understanding of government work and processes government work and processes 3. Reinforcement of significance of a state’s department of health significance of a state’s department of health 4. The experience of being part of a task force being part of a task force 5. The importance of proper communication proper communication 6. 6. Patience Patience goes a long way
References 1. Maryland Department of Health (2017). Maryland State Archives. Annapolis, Maryland: Maryland Manual On-Line. Retrieved from https://msa.maryland.gov/msa/mdmanual/16dhmh/html/dhmhf.html 2. Maryland Department of Health (2020). About MDH. Retrieved from https://health.maryland.gov/pages/about.aspx 3. CDC (2018). Frequently Asked Questions about Estimated Flu Burden. Retrieved from https://www.cdc.gov/flu/about/burden/faq.htm. Retrieved on November 25, 2019 4. HISTORY (2019). Spanish Flu. A&E Television Networks. Retrieved from https://www.history.com/topics/world-war-i/1918- flu-pandemic. Retrieved on November 25, 2019 5. CDC (2019). Influenza Historic Timeline. Retrieved from https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline- 1930-and-beyond.htm. Retrieved on November 25, 2019
6. Johns Hopkins University (2020). Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. Retrieved from https://coronavirus.jhu.edu/map.html 7. Gunderman, R. (2018). Ten Myths About the 1918 Flu Pandemic. Retrieved from https://www.smithsonianmag.com/history/ten-myths-about-1918-flu-pandemic-180967810/ 8. Plaue, N. (2020). Photos show how the 1918 flu pandemic brought the world to its knees. Retrieved from https://www.businessinsider.com/1918-flu-pandemic-pictures-2012-8 9. Galvin, G. (2017). These States Are Best Prepared for Public Health Emergencies. Retrieved from https://www.usnews.com/news/best-states/articles/2017-12-21/these-states-are-best-prepared-for-public-health-emergencies 10. Harrington, J. (2019). Among all states, Massachusetts best prepared for disasters, outbreaks and emergencies. Retrieved from https://www.usatoday.com/story/money/2019/06/06/states-most-and-least-prepared-for-a-disaster/39544679/ 11. Sell T. K. (2017). When the Next Disease Strikes: How To Communicate (and How Not To). Health security, 15(1), 28–30. https://doi.org/10.1089/hs.2016.0100
Acknowledgements My preceptors and mentors: - Jessica Acharya Jessica Acharya , Career Epidemiology Field Officer (CEFO), Centers for Disease Control and Prevention (CDC) - Kristin Dietz Kristin Dietz , Chief, Local Health and Health Planning Office of Preparedness and Response Maryland Department of Health - Veronica Black Veronica Black , Deputy Director, Office of Preparedness & Response, Maryland Department of Health
Questions? Karim Medlej, MHS Student Karim Medlej, MHS Student Johns Hopkins Bloomberg School of Public Health Johns Hopkins Bloomberg School of Public Health kmedlej1@jh.edu kmedlej1@jh.edu
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