# Presentation: 029757

## Planning for Pandemic Influenza

- Pegi McEvoy, MN, ARNP
**	****	****Safety and Security Department**
**	****	****Seattle Public Schools**

## When 3 criteria are met:

Novel subtype where people do not have immunities, AND
Humans are infected and severe illness is caused, AND
Virus spreads easily

H5N1 meets criteria 1 and 2

- Novel subtype where people do not have immunities, AND
- Humans are infected and severe illness is caused, AND
- Virus spreads easily
- H5N1 meets criteria 1 and 2

*A Pandemic Occurs.....*

**Notes:**
New to Humans and  has infected more than 100 humans killing over 1⁄2 of patients

## World Health Organization

**Phases of an Influenza Pandemic**

| Phase | Definition |
| --- | --- |
| 1 
 | Inter-pandemic Period 
No new flu subtypes in humans.
Possibly present in animals.
Risk to humans is low. 
 |
| 2
  | Inter-pandemic Period 
No new flu subtypes in humans.
A circulating animal flu subtype poses a substantial risk of human disease.
 |

**Notes:**
The difference between Phase 1 and 2 is based on the risk of animal disease to humans.

## World Health Organization

**Phases of an Influenza Pandemic**

| Phase | Definition |
| --- | --- |
| 3
 | Pandemic Alert Period 
Human infections with a new subtype. 
No human-to-human spread, or rare instances of spread to a close contact. |
| 4
 | Pandemic Alert Period 
Small clusters, limited human-to-human transmission. 
Spread is highly localized: Virus is not well adapted to humans. |
| 5
 | Pandemic Alert Period 
Larger clusters, but human-to-human spread still localized: Virus becoming better adapted to humans. |
| 6
 | Pandemic Period 
Increased and sustained transmission in general population. |

**Notes:**
WHO changed the phase structure to highlight:

Risk risks posed by animals
Link phase changes more closely with PH response
Focus on early events when rapid interventions may slow the spread

Phases 2-5 can be subdivided by each country, locality depending on whether it is affected or not affected.

Phase 6 can be subdivided depending on whether its affected, not affected or in a specific wave.

## The World Health Organization (WHO) defines six pandemic alert phasesWe are currently at Phase 3

**Notes:**
SOURCE:
Pandemic Influenza Update
CDC Public Health Prepares, November 9, 2005
PanFluNewsletter_11-08-05.pdf

## Potential Impact of Pandemic Flu in the US and Locally

## Who are We?

- 46, 000 students
- 7,000 staff
- 97 different home languages
- 93 schools
- Funding issues
- Leadership issues

## Who are We?

- Near the Canadian border
- 6,000 persons per day arrive from Asia
- City Emergency Management Office
- County Emergency Management Office
- City/County Public Health Department

## Integrating NIMS and          		School All-Hazard Plans

## All Hazard Plan

| Basic Plan | Mission and responsibilities |
| --- | --- |
| Appendices | Authorities, terms, and acronyms |
| Emergency Support Functions | Policies, planning assumptions, and concept of operations |
| Implementing Procedures | Details |

## Integrating NIMS and          				Pandemic Plans

*Integrating NIMS *and          				*Pandemic Plans*

## Local Impact: Health Status

- In the first 6 weeks of a pandemic:
- 1.2 million people are infected
- 245,000 - 612,000 are clinically ill
- 180,000 - 470,000 outpatient medical visits
- 24,436 - 57,216 people are hospitalized
- Up to 11,500 people are dead

**Notes:**
Washington state has 6,203,788 residents (2004 estimate), approximately 19% are school aged and 11% are over 65 years.

## So What Did that Mean to Us?

- Schools may be closed for up to 2 months for health and safety reasons, but we may run out of staff first (and soap)
- Essential functions are different in a pandemic
- Acronyms are different
- Lead agency is different (plans are vague in city emergency plan)
- Pandemic table tops start off slow
- Legislature has not dealt with funding issues for prolonged emergencies
- School staff resist planning- **"This is not an emergency." **

## Goals in a Pandemic: Public Health      Protecting the Public's Health

- Limit death and illness
- Preserve continuity of essential government and business functions
- Minimize social disruption
- Minimize economic losses

**Notes:**
Whether you're from the business sector, government, or the health care system, you share the same overarching goals in a pandemic:

 Limit death and illness

 Preserve continuity of essential government and business functions

 Minimize social disruption and

 Minimize economic loss

## Goals in a Pandemic - Schools

- Limit death, illness, and emotional trauma
- Preserve continuity of essential business   functions
- Minimize social and educational disruption
- Minimize economic losses

**Notes:**
Whether you're from the business sector, government, or the health care system, you share the same overarching goals in a pandemic:

 Limit death and illness

 Preserve continuity of essential government and business functions

 Minimize social disruption and

 Minimize economic loss

## Phases of an Influenza Pandemic 

***and***** School Incident Management**

| Phase | Definition |  |
| --- | --- | --- |
| 3
 | Pandemic Alert Period 
Human infections with a new subtype. 
No human-to-human spread, or rare instances of spread to a close contact. |  |
| 4
 | Pandemic Alert Period 
Small clusters, limited human-to-human transmission.  
Spread is highly localized. |  |
| 5
 | Pandemic Alert Period 
Larger clusters, but human-to-human spread still localized: Virus becoming better adapted. |  |
| 6
 | Pandemic Period 
Increased and sustained transmission in general population. |  |

**Notes:**
WHO changed the phase structure to highlight:

Risk risks posed by animals
Link phase changes more closely with PH response
Focus on early events when rapid interventions may slow the spread

Phases 2-5 can be subdivided by each country, locality depending on whether it is affected or not affected.

Phase 6 can be subdivided depending on whether its affected, not affected or in a specific wave.

## Updating Plans: Pandemic Influenza

**It is different than other types of planning**
**Get ready for lots of questions**
**Have the answers or ...**
** ****	****talk about where the community is in the process**

**Notes:**
Where are your school nurses, health aides/secretaries on the list?  Should they be considered differently from other staff?  What about those who are performing essential functions?

## Pandemic Influenza: Prevention/Mitigation

- With the Community:
- Review newest World Health Organization (WHO), Centers for Disease Control (CDC), PHD recommendations, PHD plan, and local emergency plans

## Public Health DepartmentProactive Measures

- School closures

**Notes:**
Recommendations such as defer travel, close schools (in green) pandemic staffing plans, suspend large gatherings, close churches, theaters, and other plances, public transit for essential travel only

## Public Health DepartmentProactive Measures

- School closure authorities

**Notes:**
Recommendations such as defer travel, close schools (in green) pandemic staffing plans, suspend large gatherings, close churches, theaters, and other plances, public transit for essential travel only

## Pandemic Influenza: Prevention/Mitigation

- At the District Level:
- Review District                                    Emergency Management Plan and update:
- Basic Plan: 			Authorities
- 			  	control and direction
- Appendices:                        Continuity of business					acronyms
- ESF # 8: 			Beyond biological 						terrorism
- Implementing Procedures: 	Surveillance
- 				resource management

##  F. A. Q. S #1, 5, 6, 7,  & 16

-    How is it spread and how do we protect our staff and students?   How sure are we of the information we are relaying?

## Pandemic Influenza: Prevention/Mitigation

- Isolation & Infection Control Procedures
- Isolation precaution options:
- Standard, contact, droplet, airborne
- Respiratory hygiene and cough etiquette
- CDC ***Division of Healthcare Quality Promotion***
- Precaution recommendations ratings:
- 	Category	1A 	Lots of Empirical
- 	Category	1B 	Suggestive Evidence
- 	Category	II 	Strong Theoretical
- 	Category	NR	No Recommendation; 				             Unresolved Issue

## Pandemic Influenza: Prevention/Mitigation

**Isolation Precautions**               Category
- Administrative controls	          1B
- Education
- Adherence to precautions
- Infection control precautions      1B
- Hand washing, gloves, gowns
- Environmental controls
- Use of masks
- Social distancing techniques      1B, II, NR

##      F. A. Q. #2

- If a child comes to school ill, when should avian flu be suspected?

## Pandemic Influenza: Preparedness 

-      Influenza-like Illness (ILI)
-      Surveillance
- Temperatures above 100.4o F
** ****AND**
- One or more of the following: cough, sore throat, ***or*** shortness of breath
**AND**
- History of contact with domestic poultry ***or*** known or suspected case of H5N1 in an H5N1 affected county within 10 days of symptoms

## F. A. Q. #3

- What is social distancing?

## Pandemic Influenza: Prevention/Mitigation

- Authorities
- Social distancing
- District closures (snow days vs. labor strike)
- School closures
- Libraries, malls, after school day care centers
- Transportation
- Public
- Private/contractors
- School owned
- Isolation and quarantine
- Union contracts

**Notes:**
Some PHDs are not recommending school closures because the kids tend to scatter and congregate elsewhere.  Further they have probably already been exposed.  However, schools may elect to close for administrative reasons, e.g. lack of staff....

## Pandemic Influenza: Prevention/Mitigation

-    Continuity of Business
- Maintenance of essential services
- Information technology
- 	capacity
- Telecommuting

##      F. A. Q. #4

- How long will it take the avian flu to spread throughout the U.S.?

## ...a newly emerging influenza virus can wreak catastrophic damage worldwide in a matter of months.Anthony S. Fauci, M.D.Director, National Institute of Allergy and Infectious Diseases

- <date/time>

**...a newly emerging influenza virus can wreak catastrophic damage worldwide in a matter of months.*****Anthony S. Fauci, M.D.****Director, National Institute of Allergy **and Infectious Diseases*

##      F. A. Q. #8

- What is the local government plan related to pandemic events?

## Pandemic Influenza: Prevention/Mitigation

- 	Surveillance
- Sentinel program -
- 	Absences beyond 10% with respiratory   symptoms:
- Monitored by IT/safety & security & schools
- Student absences
- Staff absences

##      F. A. Q. #9

- What is the best way to teach students about avian flu?

## Pandemic Influenza: Preparedness

*Pandemic Influenza: **Preparedness*

## Pandemic Influenza: Preparedness

- Education
- Staff

## Pandemic Influenza: Preparedness

- Education
- Staff
- Students:
- Posters

- Education
- Staff
- Students:
- Posters

## Pandemic Influenza: Preparedness

- Education
- Staff
- Students:
- Posters
- Curricula

## Pandemic Influenza: Preparedness

- Education
- Staff
- Students
- Parents/volunteers
- Vendors/agencies

## Pandemic Influenza: Preparedness

**Education**
**Resource management**
**Simulations and drills:**
**Table top**
**Functional exercises**

##      F. A. Q. #10

- How is mortality and morbidity predicted for the avian flu?

## Formula for Estimating Health Impacts   (per 1000 persons)

-         Meltzer, M., Cox, N. and Fukuda, K.  1999.  _The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention._  Emerging Infectious Diseases, vol. 5:5.

|  | Health risk | Students  | Staff |
| --- | --- | --- | --- |
| Outpatient visits | High  | 289     -    403 |  70      -     149 |
|  | Other | 165     -    230 |  40      -       85 |
| Hospitalizations | High  | 2.1      -     9.0 | 0.9      -      5.1 |
|  | Other | 0.2      -     2.9 | 0.18    -      2.8 |
| Deaths | High  | 0.13    -   7.65 | 0.1      -      5.7 |
|  | Other | 0.014  -     .13 | 0.025  -      .09 |

**Notes:**
Add Emory Study

##      F. A. Q. #12

- How does the district predict how many staff might be affected?

## Estimated Health Impacts  for a District of 50,000 students and 7,000 staff

| District with.... | Other students  | 5% High-risk students | Other
 staff | 10% High- risk staff |
| --- | --- | --- | --- | --- |
| Outpatient visits | 8,250  11,500 | 8,560  11,933 | 280   595 | 256.9               639.8 |
| Hospitalizations | 10                                    145 | 14.25   160.25 | 1.3   19.6 | 1.73                 21.21 |
| Deaths | 0.7          6.5 | 1.65    25.3 | 0.2       0.6 | 0.2
4.6 |

## Estimated Health Impacts  for a District of 50,000 students and 7,000 staff

| District with.... | Other students  | 5% High-risk students | Other
 staff | 10% High- risk staff |
| --- | --- | --- | --- | --- |
| Outpatient visits | 8,250  11,500 | 8,560  11,933 | 280   595 | 256.9               639.8 |
| Hospitalizations | 10                                    145 | 14.25   160.25 | 1.3   19.6 | 1.73                 21.21 |
| Deaths | 0.7          6.5 | 1.65    25.3 | 0.2       0.6 | 0.2
4.6 |

##      F. A. Q. #18

- What are essential services for schools and school districts?

## Pandemic Influenza: Preparedness

- Resource Management
- Human resources
- Flex time
- Telecommuting
- Reassignment of staff to
- 	essential services:
- Retraining
- Union contracts
- Personal protective equipment
- Vaccination priority list

##      F. A. Q. #20

- What can the schools do to help the community during a pandemic?

## Pandemic Influenza

-     **If schools and day care centers are closed, who will take care of our responder's children?**
-  Develop a volunteer roster to
-   help support their families

**Notes:**
What happens if SN or aides get sick?
What happens if SN or aides get sick?