Association of

Health Care Journalists

Preparing Communities

For Pandemics

Houston, Texas

March 18, 2006

Georges C. Benjamin, MD, FACP

Executive Director

Planning & Coordinating The Response: Pandemic Influenza

United States of America: 1918 - 1919

“In Boston the stock market closed. In Pennsylvania a statewide order shut down every place of amusement, every saloon. In Kentucky the Board of Health prohibited gatherings of any kind, even funerals …..Deadly influenza, the so-called “Spanish Flu,” was sweeping the country, spreading terror everywhere”

David McCullough

--- 675,000 Americans died; 40 million people died worldwide ---

National Museum of Health & MedicineArmed Forces Institute of Pathology

Are We Prepared For Pandemic Flu?

A process not a point in time!

Always ask - Prepared for what?

Use real life events to measure preparedness

First step is to get annual flu right

Under prepared for pandemic influenza

Goal: To go from chaos to controlled disorder

We Already Have A Bird PandemicThree Likely Initial U.S. Presentations*

1. First H5N1 solitary positive bird could be in U.S. this year

2. First outbreak of highly pathogenic avian flu in birds

3. An outbreak in birds with sick people

*Assumes no human to human transmission in world

Management crisis will be the birds; and will be immediate health threat

Community preparedness efforts need to focus in five broad areas:

• Family preparedness• Avoiding sick or dead birds• Surveillance for sick people • Disease containment• Treatment

HHS Planning Assumptions

Global susceptibility Incubation period ~2

days with 1:2 spread > 30% attack rate 50% will seek outpatient

care Hospitalizations /

mortality depends on virulence

Absenteeism will occur Will last 6-8 weeks & may

come in waves

Plan For Three Clinical Scenarios

1. There are enough effective vaccine & antivirals

Vaccination & antivirals Some community disease control

efforts

2. The amount of vaccine / antivirals are insufficient in efficiency or amount

Vaccination & antivirals Mild to moderate community

disease control efforts Medical management of clinical

complications Manage societal disruption

3. There is no vaccine or useful antivirals

Maximum community disease control efforts

Medical management of clinical complications

Mange societal disruption

Prepare To Respond

Bird surveillance & response Early disease surveillance –

will transform to disease differentiation

Laboratory capacity Disease control

Mass vaccination Antiviral distribution Exposure reduction,

social distancing Health system surge capacity

Patients, workforce, supplies & equipment, space

Risk communication Mortality management Routine health management Coordination: regional,

national

Prepare For Societal Disruption

Continuity of government

Business continuity Food, water Transportation Public safety Trash, sanitation Goods & supplies Services Critical infrastructure

Social Distancing Strategies

Voluntary home curfew

Suspend group activity

Cancel public events

Close public places

Suspend public travel

Restrict travel

Snow days

Non-essential workers off

Work quarantine

Cordon sanitairePrimary hygiene: Hand washing & coverage of nose & mouth

Barriers: Surgical Masks vs. N - 95 Masks

IsolationSeparation of infected persons

Usually in a hospital setting (Other settings may be difficult)

QuarantineRestriction of persons presumed exposed

Community or individual level

Plan To Care For Sequestered Persons

Food & Water

Housing

Hygiene & sanitation

Social support systems

Treatment & prophylaxis for disease

Disease monitoring

Dependent care

Compensation & liability issues

Georges C. Benjamin, MD, FACP

Executive Director

American Public Health Association

WWW.APHA.ORG

“Public Health: Prevent, Protect, Promote”