**Legal Consultation Meeting - Hypothetical Scenario**

**For each of the three sets of questions, each table should be prepared
to report:**

1.  **Gaps in viability and sufficiency of legal authorities available
    to restrict the movement of persons, and to close public places or
    limit/prohibit gatherings of people, in the event that the
    jurisdiction was threatened by pandemic influenza. Gaps should
    include legal, procedural, or logistical problems related to using
    the authorities, and enforcement of social distancing measures.**

2.  **Questions that arose.**

**[Scenario --]{.underline}**

**[Worldwide]{.underline}**

> ![](media/image1.png){width="0.15625in" height="0.15625in"} In last 30
> days, World Health Organization and Centers for Disease Control and
> Prevention confirm novel, virulent influenza A (H5N1) on several
> continents
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} November
> 16 CDC confirms isolation of same strain from ill persons in several
> U.S. cities
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} None yet
> in Michigan
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Illness
> typically presents as classical influenza with abrupt onset of fever,
> malaise, myalgia (muscle aches), cough, and runny nose.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} In
> approximately 20% of cases, illness rapidly progresses to a primary
> viral pneumonia, acute respiratory distress syndrome, and death.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} At-risk
> populations include persons in all age groups regardless of their
> previous health (i.e., includes persons who previously have been in
> good health, as well as those with pre-existing chronic disease
> conditions).
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} The
> average incubation period (i.e., time from patient's exposure to an
> infected person to time of onset of initial symptoms) is approximately
> 36-48 hours
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Available
> information includes:
>
> ![](media/image2.png){width="0.125in" height="0.125in"} No info on
> effectiveness of current influenza vaccine on prevention
>
> ![](media/image2.png){width="0.125in" height="0.125in"} Marginal
> effectiveness seen with use of antivirals to attenuate or prevent
> disease.

**[Michigan]{.underline}**

> ![](media/image1.png){width="0.15625in" height="0.15625in"} Activation
> of Michigan Department of Community (MDCH) Health Pandemic Influenza
> Plan for intensified morbidity, laboratory and mortality surveillance.
> This includes:
>
> ![](media/image2.png){width="0.125in" height="0.125in"} Influenza Like
> Illness (ILI) reporting from sentinel physicians throughout state
>
> ![](media/image2.png){width="0.125in" height="0.125in"} Syndromic
> Surveillance:
>
> ![](media/image3.png){width="0.125in" height="0.125in"} Emergency Room
> visits for ILI
>
> ![](media/image3.png){width="0.125in" height="0.125in"} Sale of Over
> the Counter medications for Influenza
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Requested
> Local Health Departments to report suspect cases electronically into
> Michigan Disease Reporting System

**[Today- November 20]{.underline}**

> ![](media/image1.png){width="0.15625in" height="0.15625in"} ILI
> reports in Metro Detroit and elsewhere in Michigan
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"}
> Notifications made: MDCH Surveillance Section
> ![](media/image4.png){width="0.13541666666666666in"
> height="0.13541666666666666in"} Dr. Corinne Miller, State
> Epidmiologist ![](media/image5.png) Dr. Gregory Holzman, Chief Medical
> Executive ![](media/image6.png) Janet Olszewski, Director of MDCH
> ![](media/image7.png) Governor Granholm
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} State
> Emergency Operations Center activated

# Present Situation

> ![](media/image1.png){width="0.15625in" height="0.15625in"} Small
> numbers of cases of ILI have been reported in all age groups in
> Detroit
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} A cluster
> of ILI cases in residents and staff of one large stepped-care facility
> in Detroit. This facility transfers patients daily to two acute-care
> hospitals for management of routine medical issues.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} A cluster
> of ILI cases in and teachers at one middle school in the metropolitan
> area.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} A small
> cluster of ILI cases among city bus drivers and other transit workers.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Detroit
> Metro Airport: 2 inbound transoceanic planes coming from locations
> with novel influenza have passengers with ILI. Estimated Time of
> Arrival: 1 and 2 hours from now

**[Upcoming Events]{.underline}**

> ![](media/image1.png){width="0.15625in" height="0.15625in"} Statewide
> pre-Thanksgiving school events planned for this year to commemorate
> new historical discoveries about the first Thanksgiving.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Family and
> social seasonal Thanksgiving gatherings.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"}
> Thanksgiving Day Parade in downtown Detroit, expected to draw
> thousands of spectators huddled along the parade route.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} A sold-out
> Thanksgiving Day (November 22) Detroit Lions football game to be
> played in Ford Field in downtown Detroit.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} The
> opening of a new, nationally promoted blockbuster film the day
> following Thanksgiving in movie theater chains.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"} Kickoff of
> the traditional post-Thanksgiving holiday shopping season in malls
> across the state.
>
> ![](media/image1.png){width="0.15625in" height="0.15625in"}
> Multi-denominational services planned to be held in memory of victims
> of a recent flood disaster Thanksgiving eve including a candlelight
> vigil and walk to begin at 8:00 pm with a gathering in front the
> Blessed Sacrament Cathedral, downtown Detroit

**Given this scenario, the Governor, and state and local officials, are
all asking their key agencies and staff to assess the situation and
offer opinions as to options for response, including social distancing
measures that may be implemented. To provide advice at the state or
local level, it essential that you are familiar with the law and
applicable response and operational plans. Please discuss the following
questions, to assist you in formulating your advice for responding to
this situation.**

**Consider the types of actions, which may be needed to prevent the
spread of a pandemic influenza virus at various stages of evolvement.**

## Question Set #1

1.  What types of actions may be considered in response to an increase
    in ILI reported from Michigan hospitals in a metropolitan area?

2.  Who takes these actions?

3.  What is the legal authority to support these actions?

4.  What (which) agencies will supply the resources necessary to take
    these actions?

5.  Are there procedural requirements, limitations, or conditions on
    taking these actions?

6.  How would you respond to the above questions if the Governor issues
    a declaration of a state of disaster? ("disaster" includes
    occurrence or threat of epidemic; declaration could be statewide or
    for specific counties/cities)

**[Question Set #2]{.underline}**

As a result of notification that two airliners will be landing at
Detroit Metro Airport within 2 hours and that they are carrying
passengers from an area with documented cases of pandemic influenza who
are symptomatic of the illness themselves:

1.  Describe what actions, if any, should be taken in response to the
    captains' reports?

2.  Who makes this decision?

3.  Who implements the decision?

4.  What is the legal authority to support these actions?

5.  What (which) agencies will supply the resources necessary to take
    these actions?

6.  Are there procedural requirements, limitations, or conditions on
    implementing these actions?

> **[Question Set #3]{.underline}**

Consider the mentioned upcoming events, which would involve large social
gatherings.

1.  Describe threat or danger to Michigan's residents, if any, that each
    event presents.

2.  What responses/measures might be used to mitigate the potential
    danger or threat? (List each response or measure, include "do
    nothing" as one of the options)

3.  For each response or measure:

    a.  What is the legal authority for the response or measure?

    b.  Who has the legal authority to take the response or measure?

    c.  Who/how are decisions made when there is more than one
        governmental body or official with authority (i.e. concurrent
        jurisdiction)? "Who" is responsible for "what"?

    d.  How would the response or measure be implemented?

    e.  Are there procedural requirements, limitations, or conditions on
        implementing this response or measure? If so, describe.

    f.  How would the response or measure be enforced?

    g.  What are the pros for this response or measure (political,
        economic, health or other)?

    h.  What are the cons for this response or measure (political,
        economic, health or other)?

    i.  What do you recommend to the Governor, or state or local
        officials?