# Presentation: 416490

## Pandemic Scenario:  Bird FluPersonal/Professional Implications

- Holly Shipp Buchanan, EdD
- SCC/MLA Annual Meeting
- Disaster Preparedness Symposium
- October 20, 2006
- College Station, TX

## Acknowledgements

- National Infrastructure Simulation and Analysis Center, Sandia National Laboratories
- Hospital Table-Top Exercise, UNM Center for Disaster Medicine, Greenberg, Platt, and Richards
- Based on CDC Modeling Tool
- Assumes 35% attack rate;  >1% mortality rate
- UNM Hospitals MIS Dept. Pandemic Disaster Drill Scenario

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Influenza Pandemic

*Global outbreak of disease that occurs when new Influenza A virus appears or “emerges” in human population, causes serious illness, and then spreads easily from person to person worldwide; different from seasonal outbreaks of “epidemics”...caused by subtypes of influenza viruses that already circulate among people...*
- CDC Fact Sheet, Oct. 17, 2005

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Why worry, it hasn’t yet occurred in the U.S...

- H5N1 avian influenza virus is highly pathogenic within and among multiple species, wild and domesticated (since 1997, 16 countries, Asia & eastern Europe)
- Viruses can “jump” between species
- Humans have no natural immunity

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Why worry, cont’d

- Long lead time for vaccines; antiviral drugs in short supply and not fully effective
- Since 2003, 252 people infected, Southeast Asia, death rate 55%
- Spanish influenza of 1918 (avian that jumped to humans) killed 50 M worldwide

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Next Pandemic, W/O Control Measures Could Cause in US...

- Long public health emergencies that may include “waves” of activity
- Deaths, 89K to 207 K
- Sick, 20 – 47 M
- Affect, 15 – 35% of population
- Cost, $71.3 - $166.5 B

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Possible Scenario – Week 1

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Week 1, Day 1, 1:00 pm

- 2 school buses full of sick elementary children show up at the ER with what is initially thought to be food poisoning.
- New (1 week) hospital library manager gets advisory from NLM announcing WHO alert for “influenza pandemic”, which librarian takes to medical director.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Week 1, Day 1, 2:00 pm

- Library manager returns to library to find note that reference librarian and the library tech got calls that their kids are very sick and they are needed at home---this leaves manager and student in library.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Week 1, Day 1, 3:30 pm

- The sick kids who arrived on buses are diagnosed with new strain of avian flu.
- Entire hospital is quarantined, with no one allowed in or out.
- Manager goes online to look at hospital disaster manual...and notes that library staff aren’t included in list of essential personnel.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Week 1, Day 1, 4:30 pm

- Email from hospital PR announces hospital is being further shut down and no one can move out of current work area.
- Manager is in library alone as student has gone to HR to track down emergency contact information for his mother as he can’t remember his mother’s cell phone number (programmed into his own cell phone which he left in the car).
- COO calls manager about using library as communication center and possibly triage area as the hospital ER is overflowing.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## 5:30 pm

- Manager repositions furniture to facilitate call center and gurneys now being wheeled into library.
- Manager runs PubMed search for a new admission who came in at 3:25 before hospital was shut down.
- Internet connection freezes...contractor building hospital addition has cut through main cable to hospital feeding phones and internet connection.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Week 1

- Phones at physician offices, health department, and hospitals ring constantly
- Rates of absenteeism in schools and many businesses rise (from illness and taking care of sick family members); absenteeism is 10-15%
- Police & fire departments, and ambulance services experiencing 10% absenteeism rate

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Weeks 2 - 4

- Schools and staff have 20% absentee rate by wk 2; by wk 4, 30% of  population is ill with H7N3
- Complete traffic gridlock around hospital
- 20% staff absentee rate wk 3, increasing to 40% staff attrition at wk 4
- Only 3 days of expendable supplies remaining, and previous re-supply orders have been delayed and only 40% rec’d
- Pharmacist beaten up by crowd demanding antiviral medication

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Weeks 5 - 7

- More than 50% of physicians and other health providers are absent due to home illnesses or fear for safety
- Shortage of ventilators and other equipment to treat patients
- Family members distraught/outraged when loved ones die in days; funeral homes overwhelmed
- Shortages of food, gas (av. $4.90/gallon)

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Weeks 8 - 10

- Antiviral meds becoming available
- New cases declining, and no new cases in weeks 9 & 10

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## WHO Guidelines, Stages 1 - 6

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Early phases (1-6), pre-pandemic

- Animal sources linked to human infections should be controlled and human exposure to infected animals minimized
- Aggressive measures to detect and isolate case-patients and to quarantine their contacts, accompanied by restrictions on movement in and out of affected communities

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Pandemic phase (#6):  Reduce impact, delay spread to allow time for vaccine development

- Ill should remain at home as soon as symptoms develop
- Consider increase in **“social distancing”** in affected communities
- Nonessential domestic travel to affected areas should be deferred
- Encourage hand washing and respiratory hygiene/cough etiquette; make hand-hygiene facilities available
- Disinfect household surfaces likely to be contaminated

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Resources

- “Planning Checklists,” Center for Disease Control and Prevention, http://www.pandemicflu.gov/plan/checklists.html
- “HHS Pandemic Influenza Plan.” U.S. Dept. of Health and Human Services, Nov. 2005
- “Local Mitigation Strategies for Pandemic Influenza”, SAND # 2005-7955J, Dec. ‘05
- National Infrastructure Simulation and Analysis Center, Sandia National Laboratories
- “Pandemic Influenza Hospital Table-Top Exercise, Sept. 7, ‘06
- Designed for NM Dept. of Health by UNM Center for Disaster Medicine, Greenberg, Platt, & Richards

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Resources, cont’d

- Fauci, A.S.  Pandemic influenza threat and preparedness.  2006, Jan. _Emerging Infectious Diseases_, 12(1)  73 - 77.
- Juckett, G. _American Family  Physician,_ 2006 Sep 1;74(5):783-90.
- World Health Organization Writing Group.  Nonpharmaceutical interventions for pandemic influenza, national and community measures.  _Emerging Infectious Diseases_, 2006, Jan. 12(1): 88 – 94.

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC

## Questions?

- Contact:
- Holly Shipp Buchanan, MLn, MBA, EdD
- Associate Vice President for Knowledge Management and IT
- University of New Mexico
- Health Sciences Library and Informatics Center
- hbuchanan@salud.unm.edu

- Buchanan, H.S.   Oct. 20, 2006  Univeristy of New Mexico HSLIC