# Presentation: 220768

## PANDEMIC INFLUENZA PLANNING	

**The State of Minnesota’s Perspective**

## Steps to Develop Minnesota’s Response Plan

- Hosted first state Pandemic Influenza Summit - 	   Dec 2005
- Wrote State of Minnesota Highly Pathogenic Avian Influenza (HPAI) and Pandemic Influenza MEOP Supplement – Feb 2006
- Developed Service Continuation Planning Guides for local jurisdictions, businesses, and all state agencies – May 2006
- Conducted executive-level tabletop exercise on avian and pandemic influenza outbreaks – Sept 2006

**Notes:**
SUPPLEMENT:  Due to the unique challenges inherent to either a HPAI or pandemic influenza events, planning and response information have been compiled into the Minnesota Highly Pathogenic Avian Influenza and Pandemic Influenza Supplement.
The level of the state’s response is based in part upon several factors, the extent and location of the outbreak, availability of federal agency personnel and extent (if any) of the outbreak within the United States. This supplement provides planning guidance and outlines operational concepts for a HPAI or Pandemic Influenza outbreak in Minnesota and delineates state agency responsibilities.
SERVICE CONTINUATION:  The State of Minnesota explored incorporating pandemic planning into current Continuity of Operations plans. It was determined that pandemic planning presents unique differences from current Continuity of Operations templates. Instead of loss of physical structures, we are faced with reduction of workforce and significant human health concerns in the workplace environment. Due to these particular circumstances, the State of Minnesota developed the concept of “Service Continuation.” 
GOVERNOR’S EXERCISE:  Governor’s exercise addressed policy-level decisions on community containment levels (closing schools is good, closing daycares as well is better, initiating curfews is best) and limiting recreational activities and gatherings.

## MINNESOTA RESPONSE TO HPAI OUTBREAK

| WHO Phases | U.S. Stages | MN Response Phases |
| --- | --- | --- |
| 
WHO Phase 1
Low Risk of Human Cases
 | 

U.S. Stage 0
New Domestic Animal Outbreak in 
At-Risk Country
 | MN Response Phase A0
HPAI Outbreak – Non-Existent or Overseas |
|  |  | MN Response Phase A1
HPAI Outbreak in Wild Animal in North America |
| 
WHO Phase 2
Higher Risk of Human Cases |  | MN Response Phase A2
HPAI Outbreak in Wild Animal in Minnesota |
|  |  | MN Response Phase A3
HPAI Outbreak in Domestic Animal in 
North America |
| 
WHO Phase 3
No or Very Limited Human-to-Human Transmission
 |  | MN Response Phase A4
HPAI Outbreak in Domestic Animal in Minnesota |
|  |  | MN Response Phase A5
Recovery |

**Notes:**
Don’t know if we want this slide

MN currently ranked #1 for turkey production in US
47.5 million birds in 2005
90% shipped out of MN

## MN Response Phases for Pandemic Influenza Outbreaks

| WHO Phases | U.S. Stages | MN Response Phases |
| --- | --- | --- |
| WHO Phase 3
No or Very Limited Human-to-Human Transmission | U.S. Stage 1
Suspected Human Outbreak Overseas | MN Response Phase P0
Suspected Human Outbreak Overseas |
| WHO Phase 4
Evidence of Increased Human-to-Human Transmission | 
U.S. Stage 2
Confirmed Human Outbreak Overseas | 

MN Response Phase P1
Confirmed, Sustained Human-to-Human Transmission Overseas |
| WHO Phase 5
Evidence of Significant Human-to-Human Transmission |  |  |
| 

WHO Phase 6
Efficient and Sustained 
Human-to-Human Transmission | U.S. Stage 3
Widespread Human Outbreaks in Multiple Locations Overseas |  |
|  | U.S. Stage 4
First Human Case in North America | MN Response Phase P2
Suspected/Confirmed Human Case in North America |
|  | U.S. Stage 5
Spread Throughout the U.S. | MN Response Phase P3
Outbreak in United States |
|  |  | MN Response Phase P4
Suspected/Confirmed Human Case in MN |
|  |  | MN Response Phase P5
Limited Outbreak in MN |
|  |  | MN Response Phase P6
Widespread throughout MN |
|  | U.S. Stage 6
Recovery and Preparation for Subsequent Waves | MN Response Phase P7
Recovery and Preparation for 
Subsequent Waves |

**Notes:**
Following governor’s exercise, HSEM refined the MN Response Phases to better define our state’s trigger points.

## Service Continuation“Priority Service Levels”

**Priority Service Level 1** – immediate threat to life safety, health, or welfare
**Priority Service Level 2** – direct economic impact, constitutionally or statutorily mandated time frames, or potential civil disorder
**Priority Service Level 3** – regulatory services required by law, rule, or statute that can be suspended or delayed by governor’s executive order during an emergency
**Priority Service Level 4** – all other services that could be suspended, not required by law or rule

**Notes:**
Service Continuation:
Each agency within state government and local government is using the same definitions to develop their own service continuation plan to deliver priority service functions
HSEM will be rolling out business service continuation guide by the first of January.

## MN Dept of Health

- Looking at easing ways of obtaining WIC coupons – no face-to- face requirement to apply for the program, maintain eligibility, or receive the vouchers during a pandemic.
- Working with Administration to develop single application form to apply for all types of public assistance.

**Notes:**
Presently, people have to go in person for all of these.

## MN Dept of Health

**Federal Support For:**
- Larger quantity/stockpile option.
- Maximum flexibility to purchase food items during pandemic.
- Development of rapid notification to grocery stores when/if food list changes.

**Notes:**
Currently, WIC recipients receive a limited number of coupons at one time. 
Ideal: provide larger quantity of coupons so people can stock up and not have to go out to shop as often. 
Clients must purchase items from an approved list. Looking for ways to modify the list so alternatives can be purchased when items are unavailable; stores must be notified rapidly.

##  MN Dept of Human Services

- Continue payments during a pandemic to nursing homes and other facilities receiving state support to ensure ongoing services.
- Base payments to nursing homes and related facilities on recent history and reconcile afterward.

**Notes:**
Having operating funds is a prominent concern for the variety of facilities funded by DHS, as evidenced by a recent conference of long term care facilities.
(Info on slide per Glenn Olson) 

## MN Dept of Human Services

-  Sponsored 7 regional food shelf conferences throughout the state
- Disaster preparedness and response
- Roles of food banks and food shelves in a community or statewide emergency
- Looking into a waiver request to USDA to curtail face-to-face interviews for Food Support Program during pandemic

**Notes:**
(notes from Ramona Scarpace)
Office of Economic Opportunity sponsored food conferences along with Minnesota Hunger Partners. 
Workshops and breakout sessions on disaster planning for foodshelves and emergency feeding programs. 
Sessions facilitated by MN VOAD and Second Harvest Heartland Food Bank.

## Potential use of school kitchens to prepare meals to be delivered by school buses, voluntary agencies, community partners, human service organizations.	
Recognize issue of home meal delivery because of USDA restrictions to congregate settings.

- Recognize issue of home meal delivery because of USDA restrictions to congregate settings.

**Notes:**
Schools closing – no National School Lunch Program or School Breakfast Program

In order for Food and Nutrition Services to be permitted to assist in preparing or distribution of food to other locations these guidelines from USDA would need revision:  
Congregate dining
Food allocated for students in need (free and reduced meals)  (and provisions for not disclosing the identify of students/families who require assistance)
Nutrient and serving type and size requirements
Guidance on food preparation and distribution without compromising the safety of the food
Liability lifted if food is prepared at the school, then distributed and not cared for properly (not heated, not refrigerated) so that it would not be safe to consume

## MN Homeland Security and Emergency Management

- Coordinating agency for all state response planning
- 	Convening regional business symposiums to bring business and government entities together.
- 	Collaborating with MN Dept of Health to produce  	statewide “umbrella” public information campaign.
- 	Partnering with critical infrastructure businesses 	to ensure continuity of operations.
- 	Planning essential supplies for SEOC stockpile.

**Notes:**
Several symposia to be held throughout the state to bring together EMs, LPH, elected officials, businesses.
(more on public info campaign on next slide)

## Statewide Public Information Campaign

- Designed as an overarching umbrella campaign with a memorable “brand” that impacts people and motivates them to prepare.
- Purpose: motivate and encourage individuals, families and communities in Minnesota to plan and prepare for the impacts of a serious emergency, such as a natural disaster, pandemic influenza outbreak or terrorist incident.
- Partnership with wide variety of stakeholders to reach all communities.

**Notes:**
Effort funded by Legislature
Contractor selected for campaign by steering committee of HSEM, MDH, Local EM, LPH
Example: ECHO (Emergency and Community Health Outreach) is a particularly important partner in reaching people with limited English proficiency. They’ve done a number of broadcasts in 6 languages re: both general preparedness as well as specific challenges, such as flu vs. pandemic flu, and isolation and quarantine care.

## Business Planning Example: SYSCO Minnesota

- Developing corporate pandemic plan.
- Reviewing operating company (branch) plans.
- Identifying key positions/jobs.
- Revising and updating emergency contact lists.
- Making emergency menu plans for healthcare facilities available (3 and 7 days).
- Prioritizing customers – healthcare and relief entities first.

**Notes:**
OPTIONAL SLIDE – but no one on list of presenters is from food distribution.
Headquarters in Houston – recent contact with MN rep at a care providers’ conference.
Leading supplier to "meals-prepared-away-from-home" operations in North America. 
Operating from 170 locations throughout the contiguous United States and portions of Alaska, Hawaii, and Canada.

## Business Solutions: Simon Delivers

- Home grocery delivery service
- Idea of “blizzard boxes” = prepackaged food for five days
- Discussions with HSEM on contents and possibilities
- Surge capacity and driver safety issues

**Notes:**
Serves Twin Cities, W Wisconsin, and Rochester
Only take electronic payment such as credit card, not available for food stamps or WIC
You may have similar service in your area

## Questions?

- Kris Eide, Director			651-201-7404
- 	 _[kris.eide@state.mn.us](mailto:kris.eide@state.mn.us)_
- Onalee Grady-Erickson		651-201-7438
- Infectious Disease Outbreak Program Coordinator
- 	_[onalee.grady-erickson@state.mn.us](mailto:onalee.grady-erickson@state.mn.us)__ _