Pandemic Influenza Planning in New York City

Transcription

1 Pandemic Influenza Planning in New York City Jessica Cole, MA Senior Incident Specific Planner NYC Department of Health and Mental Hygiene October 14, 2016

2 What is pandemic influenza? Pandemic characteristics Pandemic planning in NYC Leveraging your capabilities Identifying vulnerability Questions?

3 What is pandemic influenza? A pandemic is a global disease outbreak An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-toperson worldwide

4 What is pandemic influenza? All that is called flu, is not necessarily flu Pandemic characteristic: Occurs in waves (approximately 3, 8-12 weeks each) Attack rate of up to 40% in school-aged children and 20% in working adults Fatality rate of up to 2% in infected Symptoms: Sudden onset Fever (usually high) Headache Extreme tiredness Dry cough Sore throat Runny or stuffy nose Muscle aches Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults Lasts up to 5 days, with some symptoms lasting up to 2 weeks

5 Pandemic Severity Mild/ Moderate Attack rate between 5-20%; million estimated to be infected Case fatality rate (CFR) < 0.1%; < 1,000 estimated fatalities Impact can be similar to seasonal flu, but may be worse Severe Attack rate between 20-25%; million estimated to be infected CFR approximately 2%; 33,062-41,328 estimated fatalities 50% of infected require outpatient care (~ million) and 11% of those require hospitalization (~ 88, ,000)

6 1918-The Spanish Flu First identified in Ft. Riley, KS Within a month 1,100 soldiers were ill Took appox. 6 months to travel worldwide before commercial air flight! Approximately million deaths worldwide Mortality rates as high as >5% among some groups Unusual pattern of mortality young, otherwise healthy adults

7 1957 & 1968 Known as the Asian and Hong Kong flus Far less deadlyapproximately 1-2 million global deaths each More localized outbreaks 1957 noted for increased susceptibility and mortality in children

8 2009 H1N1 aka Swine Flu Rapid response, long-term impacts April 15: CDC report on CA/TX H1N1 cases April 23 (Thurs): CDC call re: Human-Human trans. in CA DOHMH sends Lab Alert requesting all flu A isolates be sent to PH Lab Report of school cluster of strep throat April 24 (Fri): 1 st reports received of H1N1 in Mexico Increasing # cases at school outbreak DOHMH team sent to obtain swabs April 25 (Sat): Lab identifies non-subtypeable flu A DOHMH Incident Command System activated April 26 (Sun): CDC confirms novel H1N1 NYC press conference with Mayor and Commissioner of Health

9 Many infections, particularly in children In NYC, an estimated 750,000 to 1 million people became ill with H1N1, with 65 identified deaths (April-Sept. 2009) Approximately half saw a healthcare provider Most recovered completely within 4 to 5 days Rapid spread, high rates of illness in children Low rates among elderly

10 Pandemic Planning in NYC Highlights of pandemic planning in NYC Includes tips on what the private sector can do to help

11 Communication & Outreach Communicate quickly, clearly, consistently and frequently with large, diverse and targeted audiences What can you do? Amplify the message

12 Healthcare Systems Support Provide support to NYC hospitals and other medical service providers during an outbreak What can you do? Encourage staff to only seek emergency care if needed

13 Non-Pharmaceutical Interventions (NPI) Provide guidance on care, social distancing and prevention, and technical guidance on non-pharmaceutical countermeasures and infection control What can you do? Encourage staff to stay home if ill

14 Antiviral Distribution Ensure access to antiviral drugs to all New Yorkers who need them, regardless of ability to pay

15 Surveillance & Epidemiology Monitor and track emerging novel influenza

16 Vaccine Management Coordinate the ordering, receipt, storage, distribution, and use of vaccine, deliver to targeted groups and monitor for adverse events once vaccine is available What can you do? Encourage staff to get vaccinated

17 Mental Health Publicize LIFENET Consider mental health impacts to vulnerable populations when planning and responding Participate in creation of risk communication What can you do? Help get self-care messaging out

18 Pandemic Intervals & Phases It s complicated CDC WHO We are currently in the WHO Alert Phase for H3N2v &H7N9

19 Anatomy of a Pandemic Wave

20 Investigation, Recognition, & Initiation Impacts City will likely be impacted early Might not know epi information yet DOHMH will provide messaging to providers and media ERs and medical offices might start seeing more patients as illness spreads & media reports fuel concerns Likely DOHMH Recommendations Social distancing, hand hygiene, cover your cough, stay home if you are sick

21 Acceleration Phase Impacts Increase in medical visits Medically vulnerable groups susceptible Increased staff absenteeism may be seen Increasing mental health concerns Likely DOHMH Recommendations Continue standard public health messaging Social distancing, hand hygiene, cover your cough In a severe scenario, schools might be closed Public transportation expected to be operational

22 Deceleration & Preparation Phases Impacts Decreased illness Returning workforce Residual mental health/ medical impacts Possible loss of staff Schools reopened (if closed) Likely DOHMH Recommendations Prepare for possible 2 nd / 3 rd waves Promote vaccination, once available

23 Identifying Vulnerable Populations Classic medically vulnerable populations associated with pandemic influenza: Children under 2 Pregnant women People with asthma Diabetes Heart disease Weakened immune system But also: Economic: lack of access to care, medication, self-care, & support while ill Structural: population densities, healthcare workers Communication: ability to get and understand public health messaging

24 Who is Most Vulnerable? Self-Care (difficulty dressing or bathing) Hearing, Vision Independent Living (difficulty doing errands alone such as visiting a doctor s office or shopping) Ambulatory (serious difficulty walking or climbing stairs) Cognitive (serious difficulty concentrating, remembering, or making decisions)

25 Preparing for a Pandemic: What is your role? Before: Who is your population? Are they vulnerable? How can you assist them? What is your expertise? What are your resources? Can you expand? Who do you work with? What partners do you have? Will they be able to provide more or less during a pandemic? What is your breaking point? At what point does your group fail at its mission? How can you prevent that? During: Emphasize preventive measures: Stay home from work if they have fever and cough and not to return to work until 24 hours after symptoms resolve Wash/sanitize hands often Avoid touching mouth and nose Cover coughs and sneezes Be an information leader for your audience Encourage seasonal and pandemic influenza vaccinations Disasters are a time of increased vulnerability. Be present!

26 Questions? Jessica Cole, MA (347)