Disasters & EmergenciesHow Infectious Diseases Cause Emergencies

Nancy Blackmore,

Coordinator Preparedness, Planning & Equipment Resource, EHS,

Outline

• Infectious diseases by category

• Bioterrorism

• New & emerging

• Pandemic influenza

• Impact & planning considerations

Infectious [Communicable] Diseases• Endemic

– Normal expected level of disease

• Epidemic– An outbreak with

unusual high numbers

• Pandemic– A world wide

outbreak

• Bioterrorism – 3 categories – E.g. anthrax

• Newly emerging– West Nile virus,– SARS, etc.

• Naturally occurring – E.g pandemics of

influenza

Definition

• Bioterrorism is the use of biological agents to intentionally produce disease or intoxication in susceptible populations to meet the aims of terrorists.

• In addition to the potential medical consequences is the likelihood of human panic – a worthwhile goal in itself for the terrorist group.

Public Reaction• Cannot see, touch or feel it• People can’t get to a safe place, but sit and

wait• Panic!• Increased psychosomatic illnesses • Increased visits to an already overtaxed

emergency department• Health workers themselves may be fearful

and stressed• Hoarding of medical supplies and resources

The Threat

• The Good News - low probability

• The Bad News - huge impact

Organisms & Diseases of “New” Concern to Us:

•West Nile Virus•Lyme disease•Hantavirus•Human Granulocytic Ehrlichiosis•Son of SARS???

What is Pandemic Influenza?

• A new influenza virus arising from a major genetic change [antigenic shift or adaptive mutation]

• The population will be very susceptible with little or no immunity

• The virus will transmit efficiently from person to person

• The virus will be virulent with the capacity to cause serious illness and death

Each Pandemic is Different

H1N1 H2N2

H3N2

1918: “Spanish Flu”

1957: “Asian Flu”

1968: “Hong Kong Flu”

40-50 million deaths

2-4 million deaths

1 million deaths

Credit: US National Museum of Health and Medicine

Source: WHO

• 75% of people will be infected

• 15 – 38% will be clinically ill

• 6.8 – 17% will require outpatient care

• 0.1 – 0.3% will require hospitalization

• 0.03 – 0.1% will die Based on a “flu aid” formula

developed by Meltzer & colleagues, CDC Atlanta http://www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm

• 681,005 will be infected

• 136,201 – 345,042 will be clinically ill

• 61,744 – 154,361 will require out-patient care

• 908 – 2724 will require hospitalization

• 272 – 908 will die

Based on population numbers from 2001 census

Estimating the Impact for Nova Scotia:

Pandemics are Unpredictable• Direct impact of

influenza:– Attack rate [15>35%]– Affected age groups

[unknown until it begins]

– Virulence of the strain and rates of adverse outcomes/complications [mild, moderate or severe?]

– Speed of spread from country to country and within a country [1-3 months to arrive? 2-3 waves? 12-18 months duration?]

• Effectiveness of the response:– Vaccines [not

available for 1st wave]

– antivirals [in stockpile now for treatment]

– non-pharmaceutical interventions [public health measures]

• Psychologically induced impacts/public behaviour

Potential Challenges:• Must maintain mandatory business

[BCM]• Reduce elective or optional services• Cope with simultaneous emergencies

[e.g. hurricanes, storms, etc.]• Prepare for economic consequences• Increased demand for health & social

services• Increased demand for volunteers• Cope with loss of employees

[permanent or temp]

Consequences of Absenteeism: • All sectors impacted: e.g.

manufacturer, transportation, municipal services, etc.

• Possible shortages: e.g. food, fuel, cash in bank machines

• Issues for workers: ill themselves; need self-care info; may have elder or child care needs; fear; may be asked to work outside of usual environment, etc.

Questions?

•The hardest part of responding to an emergency is explaining why we didn’t prepare”