California Department of Aging (CDA) Presentation on Disaster Preparedness and

Avian/Pandemic Awareness March 23, 2006

By: Robert Ramsey-Lewis, Policy Manager

Prepared For: California Association of Area Agencies on Aging (C4A)

Materials From: California Department of Health Services, World Health Organization, US Health and Human Services, and Canadian Network for Emergency Preparedness and Response

Introduction

“Any community that fails to prepare with the expectation that the federal government will, at the last moment, be able to come to the rescue will be tragically wrong.

--Mike Leavitt, US Health and Human Services Secretary

• When is an Emergency a Disaster?– A disaster occurs when the impact on the community

exceeds its normal coping resources– A community’s coping resources are its people,

materials, equipment, and services used to meet demand created by an incident

• Preparedness moves the disaster threshold.– Preparedness measures, e.g., evacuating vulnerable

populations, increases the disaster threshold, permitting the community to cope better.

Source: Canadian Network for Emergency Preparedness and Response, 2004

Area Plan Guidance

• Appendix XI, Disaster Preparation Planning, is optional for the 2006-2007 planning period.

• Appendix XI will be required for the 2007-2008 planning period, in addition to an area plan objective concerning preparedness.

• Opportunity for input on the 2007-2008 Area Plan Guidance in the Fall, 2006.

Avian and Pandemic Influenza

Howard Backer, MD, MPHCalifornia Department of Health Services

Sandra Shewry, Director

Mark Horton, State Public Health Officer

WHO Lab Confirmed Human Cases

CasesCases DeathsDeaths

IndonesiaIndonesia 16 16 (29)(29) 11 11 (22)(22)

VietnamVietnam 9393 4242

ThailandThailand 2222 1414

CambodiaCambodia 44 44

ChinaChina 7 7 (15)(15) 3 3 (10)(10)

TurkeyTurkey

AzerbaijanAzerbaijan

IraqIraq

4 4 (12)(12)

77

22

2 2 (4)(4)

55

22

TotalTotal 146 146 (184)(184) 76 76 (103)(103)

As of Mar. 21 2006 Mortality 52%

Requirements for a Pandemic

• Unusual type of influenza virus found in humans

• Little or no immunity in the population

• Virus can multiply and cause disease in humans

• Easily spreads from person to person

WHO Pandemic PhasesPhase 1 Interpandemic No new subtype

Phase 2 Interpandemic Risk from novel type

Phase 3 Alert phase Human infection-rare spread to contact

Phase 4 Alert phase Limited human to human transmission

Phase 5 Alert phase Small clusters; poorly adapted

Phase 6 Pandemic period

sustained transmission

Human influenza transmission

Year Flu Virus Mortality

1918-1919 “Spanish” H1N1 20 million

550,000 US

1957-1958 “Asian” H2N2 70,000 US

1968-1969 “Hong Kong” H3N2 34,000 US

Glezen WP. Epidemiol Rev. 1996;18:65.CDC. Influenza Prevention and Control.

20th Century Influenza Pandemics Which will the next pandemic resemble?

CDC Estimates of Percent of Population Affected by the Next Pandemic*

Number Affected inCalifornia

(Pop. 36,363,502)**

15% to 35% of pop. will become ill with flu 5.5 – 12.9 Million

8% to 19% of pop. will require out-patient visits 2.9 – 6.9 Million

0.2% to 0.5% of pop. will require hospitalization 73 – 170 Thousand

0.07% to 0.16% of pop. will die of flu-related causes

25 – 59 Thousand

Pandemic Influenza Estimates for California

*Estimates from FluAid 2.0, CDC**California Department of Finance Pop. Projections for 2003

Components of CDHS Pandemic Planning

• Organization of response and authorities• Surveillance• Lab Capacity• Infection control• Case Management• Vaccine and antiviral• Community Outbreak Control--nonmedical• Health care planning--surge capacity • Communications

Planning Assumptions

• It will not be business as usual

• All sectors of society and government will be involved

• Widespread impact limits mutual aid

• Sustained response required

• Workforce will be impacted, adding to disruption

Major response challenges

• Health care capacity – Estimates of hospitalizations and deaths vary by

factor of 10, based on prior pandemics

• Pharmaceutical solution overly optimistic• Need to maintain critical infrastructure• Coordination of volunteers• May introduce extreme and unusual measures • Public will adopt their own measures• Communication

Avian H5N1 VaccineCurrent influenza vaccine is not protective

Federal government – Support R&D, production capacity, and stockpile

Federal HHS plans to buy vaccine for 20 million

– Distribute vaccine to states

Estimate 6 month to produce enough vaccine

CDHS – Distributes to local health departments– Technical assistance for mass vaccination– Sets prioritization policy

National Vaccination Priority Recommendations*Tier Element

1A • Health care involved in direct patient contact and essential support• Vaccine and antivirals manufacturing personnel

1B • Highest risk group (6 mos to 64 yrs with 2 or more risk conditions)

1C • Household contacts of children <6 months and severely immune compromised, and pregnant women

1D • Key government leaders and critical public health responders

2 • Remainder of high risk group (1 risk condition, healthy 6-23 mo)• Other public health responders and infrastructure personnel

3 • Other key government health decision makers and mortuary services

4 • Healthy 2-64 years not in other groups

*Approved by NVAC/ACIP committee on July 19, 2005

# indv

9 m

40 K

26 m

11 m

151 K

60 m

8.5 m

500 K

180 m

• Single manufacturer• Worldwide shortage• Use for treatment or

prevention• Prioritization

challenges• Virus may develop

resistance• Federal and state

stockpiles

Anti-viral Medication

Outbreak Containment Measures vary as pandemic develops

• Steps to reduce individual exposure to virus—(respiratory hygiene, masks)

• Isolation (confinement) of ill persons

• Quarantine of exposed persons

• Pharmaceuticals

• Community-based containment– Cancellation of events, schools, public

meetings, malls, businesses, transportation– Snow days: nearly everyone stays home

Surge CapacityFlexibility of health care delivery system to accommodate large number of patients

• Beds– Emergency regulatory changes, increase in beds in

existing facilities, alternative facilities, home care

• Personnel– ESAR-VIP; Medical Reserve Corps; citizens

volunteers; staffing ratios; scope of practice changes

• Equipment– SNS; HRSA grant

HOSPITAL BED CAPACITY

Country Rank Beds per 1,000 population

Switzerland 1 17.9

Japan 2 16.5

Germany 9 9.1

France 14 8.2

UK 42 4.1

Canada 45 3.9

USA 46 3.6The Economist. World in Figures, 2005 Ed, p 85

January 4, 2006Flu  outbreak in Phoenix metro area

• Flood of visits to the emergency department and from illnesses on their own staff.

• Medical Center temporarily closed ED.• Half-day waits in overcrowded EDs. • Ambulance rides to other hospitals miles away. •  Postponements of routine elective surgeries

and other medical procedures.•  Ambulance patients diverted to other hospitals.•  Staff sick calls are up 25 percent from last year.

Risk Communications• Prepare the public with realistic scenarios and

likely containment measures

• Inform public of actions they can take

• Train spokespersons at state and local levels

• Prepare health care and public health for their involvement

• Develop rapid communication channels with medical care

• Involve non-health sectors in preparedness activities

HHS Department Collaboration

• Identify roles and responsibilities• Coordinate response in CA• Partners for social distancing decisions and

implementation• Continuity of government and operations• Communication channels• Educating workforce• Essential personnel for pharmaceuticals• Plans for institutional populations