# Presentation: 416472

**Social Distancing in **
**Pandemic Influenza Planning:**
**Meeting the Needs of Vulnerable Populations at the Community Level**
**Alex Cole-Corde****North Dakota State University**

## Presentation Overview

**Presentation Overview**
**20****th**** Century Pandemics;**
**21****st**** Century Pandemics; **
**Pandemic Mitigation **
**  ****Strategies; **
**Social Distancing Effects;**
**Vulnerable Populations;**
**Social Distancing Effects on **
**  ****Vulnerable Populations;**
**Planning Deficiencies;**
**Pandemic Research Planning; **
**  ****and,  **
**Conclusion.****  **

** **

**20****th**** Century Pandemics**

**1968 Hong Kong Influenza****    *US 34,000+**
***Global 700,000+**
**Attack Rate 25% – 40%**
**Mortality Rate ≤ 1.0%**

**1957 Asian Influenza****             *US 70,000+**
***Global 1 million to 2 million**
**Attack Rate 25% ****–**** 35%**
**Mortality Rate ≤ 1.0%**

**1918 Spanish Influenza       ****  *US 500,000+**
***Global 40 million+**
**Attack Rate 25% – 35%**
**Mortality Rate ≥ 2.5%**

***Conservative Estimate of Pandemic-Related Deaths - USDHHS**

## Bridge to the 21st Century Pandemic

**Bridge to the 21****st**** Century Pandemics:**** **
**Not If, but *****How Many *****and *****How Bad*****?**
**States are required to have Pandemic Influenza Plans (funding dependent); **
**Most State Plans emphasize health services, pharmaceutical distribution, and limiting viral transmissions; *****Not*****  societal effects; **
**  **
**20****th**** Century Pandemics occurred in two to three ‘waves’ from six to eight weeks over 12 to 18 months;**

## Bridge to the 21st Century Pandemics:

**How Bad*****, Continued...***
**Pharmaceuticals may not work (viral strain resistant) or be in limited quantities (six to nine months to distribute nationally);**
**USDHHS estimates up to 40% Americans ill (≤1% death rate) →** **90 million ill, **
**45 million outpatient, 10 million hospitalized, between 200,000 to **
**2 million dead;** and,
**Federal, State, tribal, and local governments will implement  pandemic mitigation strategies.**

## Pandemic Mitigation Strategies

- Non-Pharmaceutical Interventions (NPI)
**NPI(s)** are pandemic containment measures engaged  without the use of pharmaceuticals to minimize viral transmission by limiting person-to-person contact.
- NPI types include*:*
**Isolation.**
**Quarantine.**
**Social Distancing.**

## Community Effects of  Social Distancing 

**Community Effects of  Social Distancing**** **
**Depending upon Pandemic Severity...**
**Close nonessential businesses and noncritical services;**
**Close public gathering places;**
**Cancel public gathering community events;**
**Close, limit, or restrict nonessential movement; and,**
**Limit or cancel community services for socially dependent or vulnerable populations.**

## Social Dependence of 

**“****In disaster preparedness, the terms ****vulnerable**** ****or special needs ****people or populations**** are used to define groups whose needs are not fully addressed by the traditional service providers. It also includes groups that may feel they cannot comfortably or safely access and use the standard resources offered in disaster preparedness, response and recovery.” **
**~CDC**

**Social Dependence of **
**Vulnerable Populations in Disasters**

## Vulnerable 

**Vulnerable **
**Populations**
**Abused Women and Children and Shelter Dependent;**
**Animals, Display, Livestock, Pets, and Show;**
**Blind, Legally Blind;**
**Caregiver Dependent (Human Assistance and/or Service Animal); **
**Chemically Dependent (drugs, alcohol, or other);**
**Children, Infants-Teens;**
**Chronically-Lonely, Depressed, or Suicidal;  **
**Cultural, Ethnic, or Religious Restricted;**
**Deaf, Deaf-Blind, Deaf-Dumb, Hard of Hearing;**
**Educationally Challenged, Illiterate;**
**Elderly;**
**Emerging, Traveler, or Transient Special Needs; **
**(Institutionalized or Facility Dependent  Individuals not listed)**

## Vulnerable 

**Vulnerable **
**Populations**** **
**Habitually Dependent upon Social Services**
** ****or Social Programs;**
**Homeless Adults and Children and/or Shelter Dependent;**
**Illegal and/or Legal Alien: Limited English or Non-English Proficiency;**
**Impoverished, Low income, Substandard Housed;**
**Medically Dependent or Medically Compromised;**
**Mentally Challenged;**
**Mentally Ill;**
**Mobility Limited;**
**Physically Disabled; **
**Pregnant Women;**
**Racial and Ethnic Minorities;**
**Single Parents;**
**University Students.**
**(Institutionalized or Facility Dependent Individuals not listed)**

##  Negative Effects of Social Distancing 

|                                                                                                                                           |       |
| --- | --- |

** ****Negative Effects of Social Distancing **
**on Vulnerable Populations**
**Limited accessibility to services and resources:**
**Consumables;**
**Pharmaceuticals;**
**Financial resources;**
**Public transportation;**
**Health care, medical treatment facilities/professionals;**
**Hospice, home care or assisted living professionals;**
**Child care assistance and education;**
**Mentally and physically challenged programs;**
**Social support and guidance persons;**
**Shelters and missions;**
**Welfare, social security, disability, and unemployment programs; and,**
**Animal/pet food, supplies, and welfare services.**

## Mitigate Planning Deficiencies 

|                                                                                                                            |
| --- |

**Gap Analysis to **
**Mitigate Planning Deficiencies**** **

**Gap analyses of state and community pandemic plans to identify disparities between planning strategies and needs of vulnerable population;**
**Reassess normal disaster aid distribution mechanisms –  POD to DOP;**
**No Vacuum Planning – include Community Stakeholders; and,**
**Build Community Capacity to meet population needs.**
**Planning challenge is to identify the right resources to deliver to the right residents.**

## Pandemic Research 

**Pandemic Research **
**and Planning**** **
**Build Community Resiliency**
** ****and Capacity**** ****  **

**Identify Community Vulnerable Populations;**
** ****Identify and Assess the Community Needs of Vulnerable Populations;**
**Identify and Assess Community Stakeholders, Capabilities, and Resources; and,**
** **
**Bring Community Stakeholders Together.**

## Building Community 

**Building Community **
**Resiliency and Capacity**
**The Community Stakeholders**
**Governmental Officials;**
**Governmental Social Agencies; **
**Non-Governmental Organizations; **
**Faith-Based Organizations;**
**Community-Based Organizations;** and,
**Private Businesses.**** **

## University Pandemic Planning Challenges

**University Pandemic Planning Challenges**

**Student Dependency upon **
**the University System **
**In-Residence Universities,   **
** ****Programs, and Classes;**
**On-Campus Residents; and,**
**Off-Campus Residents.**
** **
**Coordinate University Pandemic Plans with Community Pandemic Plans.**** **

## Reinventing the 

** ****Conclusion**
**Review State and Community Pandemic Plans;**
**Identify Vulnerable Populations;**
**Identify and Assess General and Specific Needs;**
**Assess Existing Community Resources and   **
**    ****Capabilities;**
**Identify Planning Deficiencies;**
**Build Community Resiliency and Capacity through **
**    ****Stakeholder Partnerships;**
**Reassess and Retool the Planning Process;**
**Bridge the Gap of Planning Deficiencies; and,**
**Maintain Stakeholder Relationships Over Time.**
** **

**Reinventing the **
**Planning Process?**

## Pandemic Planning is not a discrete event that produces a ‘snapshot’ document for posterity; it is an organic, continual process that evolves over time and changes as situations and environments change.  Therefore planning is NOT an end product, but a beginning process.

**Thank You**** ****for your Energy, Attendance, and Time (E=MC2).**
**Questions or Comments?**

**Sources and Acknowledgements**
**Sources **
- Glass R.J., L.M. Glass, W.E. Beyeler, and H.J Min.
-  www.cdc.gov/ncidod/EID/vol12no11/06-0255.htm
-  Cindy Lambdin
- _[www.idready.org](http://www.idready.org/)_
- Minnesota Department of Health
- _[www.health.state.mn.us/divs/idepc/diseases/flu/avian/index.html](http://www.health.state.mn.us/divs/idepc/diseases/flu/avian/index.html)_
- North Dakota Pandemic Flu Information
- www.ndpandemicflu.gov/
- U.S. Centers for Disease Control and Prevention** **
- _[www.cdc.gov/flu/avian/ENTER](http://www.cdc.gov/flu/avian/ENTER)_
** **U.S. Department of Homeland Security
** **http://www.dhs.gov/xlibrary/assets/NIPP_Plan.pdf.
- U.S. Department of Human Health Services
- www.pandemicflu.gov/
- World Health Organization
- www.who.int/csr/disease/avian_influenza/en/index.html
**Acknowledgements**
**׳****הוה****,**** ****Carol Cwiak, and Jeanine Neipert**
**North Dakota State University**