Planning for an Influenza Pandemic

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1 Overview It is unlikely that a new pandemic influenza strain will first emerge within Elgin County. The World Health Organization (WHO) uses a series of six phases, as outlined below, of pandemic alert to identify the seriousness of the threat of a pandemic. The Director-General of WHO makes the decisions regarding the designation of phases and when to move from one alert phase to another. Each phase coincides with recommended activities to be undertaken by the various stakeholders including WHO, the international community, governments, and industry. The change from one phase to another is triggered by several factors. These include the epidemiological behaviour of the disease and the characteristics of circulating viruses. It is important to recognize that the declaration of the pandemic in Canada will most likely occur some time after WHO phase 5. Once Canada is affected, different communities within the Province of Ontario may move through the phases at different times and rates. These distinct phases have been defined by WHO to facilitate pandemic preparedness planning, with roles defined for governments, industry, and health organizations. Phase 1. No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low. Phase 2. No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza subtype poses a substantial risk of human disease. Pandemic Alert Period Phase 3. Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to close contact. Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Phase 5. Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic Period Phase 6. Pandemic: increased and sustained transmission in the general population. At the time of writing this document (June 2006), the present situation is categorized as phase 3: A virus new to humans is causing infections, but does not spread easily from one person to another. 5.1

2 The pandemic influenza planning process used by the Elgin St. Thomas Health Unit is primarily based on the Ontario and Canadian pandemic plans. The planning process addresses the following issues: Antiviral distribution Business continuity Communications Emergency services Health services Human resources Laboratory services Mass fatality management Outbreak management Public health measures Surveillance Social support mechanism Vaccine distribution Many of the above issues are addressed in this preliminary report, while others will be addressed in future revisions. The Elgin St. Thomas Health Emergency Advisory Group, is being struck to assist and support the Health Unit pandemic influenza planning process. The membership and Terms of Reference for this advisory group are outlined on the next page. The Group also supports pandemic planning for Elgin County, as well as the regional and municipal emergency planning processes. A planning framework for the group is being developed and ad hoc working groups will be established to move the planning process forward. The aim of these working groups is to provide further refinement to the issues addressed in this plan and to work through issues not currently reviewed in this plan. Further work is still required to determine how to plan the social support mechanism required for pandemic planning and other community emergencies. Proposed members of the Advisory Group include representatives from: Emergency Medical Services (Ambulance and Paramedic services) Fire Services Police Services St. Thomas Elgin General Hospital Regional Mental Health Care St. Thomas Community Health Centres and Walk-In Clinics Physicians and Nurse Practitioners Elgin Community Care Access Centre Contract Nursing Agencies Long Term Care Homes Veterinary Consultants and Veterinarians Funeral Directors and Cemeteries Laboratories 5.2

3 Pharmacies Elgin County Emergency Management Canadian Red Cross Ontario Works Family & Children s Services Licensed Child Care Centres Group Homes and Shelters Schools Chamber of Commerce Essential municipal services May, 2006 TERMS OF REFERENCE Elgin St. Thomas Health Emergency Advisory Group (Proposed) Mandate: The mandate of the Elgin St. Thomas Health Emergency Advisory Group is to enhance the capacity of the County of Elgin and member Municipalities, including the City of St. Thomas, when responding, from a health perspective, to chemical, biological, radiological and nuclear events, including pandemic influenza and other large scale communicable disease events. This mandate involves a review of the current level of preparedness, identifying the gaps in the current response capacity, and putting plans in place to address these gaps. Plans developed by the Elgin St. Thomas Health Emergency Advisory Group will be integrated with federal, provincial, municipal and other local emergency response plans. In the future, the Elgin St. Thomas Health Emergency Advisory Group may also assist in the management of large-scale emergencies with health impacts. With regards to pandemic preparedness, the Elgin St. Thomas Health Emergency Advisory Group will address the following areas: St.Thomas Elgin General Hospital (STEGH) Emergency Room / Urgent Care Issues o How to deal with contaminated patients; o Personal protective suits how many, what type; o Training of staff for chemical and biologic response; o Plans for large numbers of ill people during pandemic influenza and chemical, biological, radiological and nuclear (CBRN) events; o Plans for the emergency room itself being affected by pandemic influenza or as a site of a CBRN event; plans for large number of ill staff members; o Decontamination of the emergency room 5.3

4 St. Thomas Elgin General Hospital (STEGH ) o Hospital planning for large numbers of ill people; o Isolation rooms; o Infection control precautions; o Hospital emergency plans to free up beds and call in more resources; o Off-site hospitals for extra capacity if needed; o Plans for hospital staff being affected by pandemic influenza or by a CBRN event; o Plans for large number of ill staff members Emergency Service Providers o Transfer of contaminated patients; o Transfer of infectious patients; o Capacity in the system; o Ability to assist at off site locations and decontamination locations; o Plans for large number of ill staff members; decontamination of ambulances Public Health Issues o Sites to distribute drugs and vaccines; o Policies, procedures and medical directives for distributing drugs and vaccine; o Communications and information dissemination including web site, telephone information lines, communication with local physicians Pharmacy Issues o Stockpiling of drugs Communication Issues o Who communicates what to whom; process for determining who takes the lead for coordination and who the spokesperson(s) will be Training Issues o What do health care workers need to know to enhance their capacity to respond to biologic and chemical weapons, pandemic influenza and other communicable disease events Resources Issues o What type of resources do we need to request to deal with stockpiling of drugs, personal protective equipment, enhanced capacity of emergency rooms to respond, training etc.; o Staffing of alternate sites Dead Body Disposal o How to deal with mass casualties in terms of body disposal 5.4

5 Human Resources o Ensuring that all agencies have contingency plans to manage in case of mass illness among their employees; o Ensuring that child care plans are in place for workers who may be needed during emergencies but whose usual child care is unavailable; o Developing plans to access health care workers from other sources or non-traditional health care workers Laboratory Issues o What types of tests will be required; which laboratory can do what tests; o How will specimens be transported to the appropriate laboratory Disease Containment / Infection Control Issues o When would schools be closed or other large gatherings cancelled; o When would travel be limited and/or borders closed; o When would masks be recommended Business Continuity o Develop best practice advice for health care organizations and other community businesses and organizations regarding maintaining their business and services during a pandemic Planning Uncertainties There are many uncertainties in relation to pandemic influenza planning. How these uncertainties impact us could significantly affect how we respond to a pandemic. Some of these uncertainties include: How much warning will there be before the arrival of an influenza pandemic in the Elgin St. Thomas region? What age groups will be predominantly affected? What percentage of the population will be affected, requires outpatient care, require hospitalization, require intensive care support and what percentage will die? Will vaccines and antiviral drugs be available/effective in preventing transmission, hospitalization and/or death? Will public health measures such as closing schools and child care centres have any effect, or will they be warranted because absenteeism will not allow them to continue to operate? How long will the pandemic last? Will it return bringing another wave of illness? 5.5

6 Due to these uncertainties, it is very difficult to develop a firm response to pandemic influenza. Pandemic plans must be flexible. This plan will attempt to provide options that are available, and to provide an inventory of resources to aid in a pandemic response. Planning Parameters Despite the uncertainties described above, the Ontario Health Pandemic Influenza Plan has outlined estimates of illness, by public health unit area, that can be used for planning purposes. The estimates are based on a model called the Meltzer model that was designed in the United States and applied to the Ontario population. The estimates are calculated using a software program called FluAid 2.0 that was designed by the U.S. Centers for Disease Control and Prevention (CDC). The model provides estimates of outpatient visits, hospitalizations and deaths based on 15%, 25% and 35% of the population becoming ill. It provides these parameters assuming a most likely, minimum and maximum scenario. The estimated impact of pandemic influenza in the Elgin St. Thomas region is based on a population of 86,863 people, as presented in the Ontario Health Pandemic Influenza Plan appendix 1 pages 65 and 66. Assuming that 35% of the population will become ill and using the most likely estimates provided in the table, the following represents the possible impact on Elgin St. Thomas residents: 23,188 people will require an outpatient visit due to influenza illness over an eight week period 462 people will be hospitalized as a result of their influenza 139 people will die These figures reflect the overall influenza pandemic projected impact over two or three waves, not just one single wave. The Meltzer model makes assumptions regarding the impact of pandemic influenza based on past pandemics and health care utilization in the United States. It does not take into account the use of antiviral drugs or vaccines. It is therefore possible that the estimates provided in Ontario Plan may underestimate or overestimate what actually occurs. Next Steps Revised versions of the Canadian and Ontario Pandemic Plans are due to be released in These plans will be reviewed in detail and their implications to the pandemic planning in the Elgin St. Thomas region will be considered. The formation of the internal Elgin St. Thomas Health Unit committees as per the Incident Management System model will assist in future planning and plan execution. As the Elgin St. Thomas Health Emergency Advisory Group prepares for a pandemic and other health emergencies, the improved working relationship between the various stakeholders will only benefit the citizens and assist the Health Unit in achieving its goal of minimizing the impact of a pandemic. 5.6

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