from pandemic preparedness to management: uk experience professor lindsey davies cbe frcp ffph
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From Pandemic Preparedness to Management: UK experience
Professor Lindsey Davies CBE FRCP FFPHNational Director of Pandemic Influenza Preparedness
UK preparation and response
Planning and preparation 1997-
Slowing the spread
April-June 2009
Managing outbreaks
June 2009
Treatment phase
July 2009-
Potential impact
25 - 50% people with symptoms
50,000 - 750,000 deaths
80,000 – 1,115,000 needing hospital care
15-20% absent from work at the peak
£1,242 bn cost to society
Pandemic impact
Staff will be ill / have personal responsibilities as carers
Supply chains could be disrupted
Hospitals will fill up quickly
Community services will need to care for people with a wider range of needs that usual
Scope for mutual aid will be very limited
Reducing spread
Distance, hygiene, masks
Reducing infection
Vaccines
Reducing illness and complications
Antiviral drugs
ReducingDeaths:
Antibiotics
4
Influenza care
Key messages:
– Stay at home – Don’t spread it around– Phone a friend– Phone the Flu Line
Communication strategy
During a Pandemic
Public leaflets (all UK homes) TV Press briefings Telephone Information Line Websites
NHS self assessment
Wide variation across the country
Plans in hospitals and ambulance services generally more robust than primary care and mental health services
Major gaps:– Joint working with other organisations– Recovery– Business Continuity– Making plans ‘real’ to individuals
Additional PCT gaps: – supporting self-care– immunisation
Response is informed by :
Science Surveillance Service monitoring
Slowing the spread
Laboratory confirmation of cases Treating all suspected and confirmed cases Collecting detailed case data Tracing close contacts and offering prophylaxis Closing schools Public health campaign Leaflet to all households Swine Flu Information Line Building resilience – countermeasures, health and social care
preparations
Reasonable Worst Case30% Clinical attack rate - peaks in early September
New Cases per day
0
100,000
200,000
300,000
400,000
500,000
600,000
21/03/2009 21/05/2009 21/07/2009 21/09/2009 21/11/2009 21/01/2010 21/03/2010
New
co
nfi
rmed
cas
es p
er d
ay
Move to treatment
Initially in ‘hotspots’ only, later UK-wide Antiviral treatment for people with symptoms. Limited prophylaxis Launch of National Pandemic Flu Service Local risk assessment
National Pandemic Flu Service (NPFS)
On-line and phone self care service for the public which allows them to check their symptoms and access antivirals if required, or receive advice on symptom relief
Antivirals collected by ’flu friends’ from Antiviral Collection Points
Mobilised when needed
Capacity adjusted in response to demand
0800 1 513 100
www.pandemicflu.direct.gov.uk
National Pandemic Flu ServiceCompleted self-care: daily rate
Source: NPFS, to 6 October
0
10
20
30
40
50
60
70
80
90
23 25 27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 1 3 5
July August September October
Rat
e p
er 1
00,0
00 p
op
ula
tio
n
Current position: England(8 October 2009)
Estimated 18,000 new cases in England in previous week (range 9,000 –38,000)
290 patients in hospital, 47 in critical care Majority of cases continue to be mild 76 confirmed swine flu related deaths
Influenza-like illness: Weekly GP consultation rate, England & Wales
Source: RCGP, to 4 October
Week ending 4 October: 26.3 per 100,000
Epidemic activity
Normal seasonal activity
Baseline threshold
0
50
100
150
200
250
41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39
Week number
Ra
te p
er
10
0,0
00
po
pu
lati
on
1999/00
2006/07
2007/08
2008/09
Influenza-like illness: Daily GP consultation rateEngland, by age
Source: QSurveillance, to 6 October
0
50
100
150
200
22-J
un-0
9
29-J
un-0
9
06-J
ul-09
13-J
ul-09
20-J
ul-09
27-J
ul-09
03-A
ug-0
9
10-A
ug-0
9
17-A
ug-0
9
24-A
ug-0
9
31-A
ug-0
9
07-S
ep-0
9
14-S
ep-0
9
21-S
ep-0
9
28-S
ep-0
9
05-O
ct-09
Ra
te p
er
10
0,0
00
po
pu
latio
n o
f th
at
ag
e
under 1 year 25-44 years
1 - 4 years 45-64 years
5-14 years 65-74 years
15-24 years 75+ years
Hospitalised patients in England:Once-weekly snapshot
0
100
200
300
400
500
600
700
800
900
1000
8 Jul 15 Jul 22 Jul 29 Jul 5 Aug 12 Aug 19 Aug 26 Aug 2 Sep 9 Sep 16 Sep 23 Sep 30 Sep 7 Oct
Nu
mb
er o
f p
atie
nts
Number hospitalised in Critical Care Number hospitalised - not in critical care
Source: Sir Liam Donaldson, Department of Health,
0
1
2
3
4
5
6
<5 5 to 15 16 to 64 65+
Age group (years)
Hospitalisation ratios by weekJuly
August
September
October 7
Source: Sir Liam Donaldson, Department of Health,
Chief Medical Officer’s confidential investigation: underlying conditions for fully investigated deaths
Healthy
Mild
Moderate
Severe
47%
21%
9%
23%
Source: Sir Liam Donaldson, Department of Health,
Lessons
The importance of planning and preparation The need to plan for a range of scenarios – H1N1v hasn’t
spread rapidly across the UK Uncertainty does (potentially) breed panic - and complacency Reliable and appropriate surveillance is essential Pre-existing relationships make a real difference Regular proactive communication is vital
0
200
400
600
800
1000
1200
1400
Janu
ary
Mar
chM
ay
Augus
t
Octo
ber
Decem
ber
Mar
chM
ay July
Septe
mbe
r
Decem
ber
Wee
kly
GP
Co
nsu
ltat
ion
Rat
es (
per
100
,000
)
Influenza-like illness: GP consultation ratesHistorical comparison
Source: Sir Liam Donaldson, Department of Health, 1969/70 and 2009 from RCGP. 1957/58 based on extrapolation from a small study
Indicative Scenarios - New Cases per day
0
100,000
200,000
300,000
400,000
500,000
600,000
21/03/2009 21/05/2009 21/07/2009 21/09/2009 21/11/2009 21/01/2010 21/03/2010
New
co
nfi
rmed
cas
es p
er d
ay
Indicative scenarios
Planning assumptions (September 09)
Reasonable worst case: – Clinical attack rate: 30%– Complication rate: up to 15% of clinical cases– Hospitalisation rate: 1%– Case fatality rate 0.1%– Peak absence rate: 12%
Next steps
Surveillance Vaccination NPFS flexibility Social care preparedness NHS preparedness Personal preparedness Tests and exercises Communications Plan for the next pandemic
To summarise….
Planning has paid off
Uncertainty about the timing, scale and impact of the next phase(s) remain
We must continue to prepare for a range of scenarios in this pandemic - and the next
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