# Presentation: 212847

## Pan Flu II     Tabletop ExerciseA Facilitator’s Guide

- Pandemic Influenza strikes Minnesota
- Federal Executive Board of Minnesota
- October 3, 2006

## Agenda

- 07:30 – 08:00 	Registration
- 07:15 – 07:30 	Facilitator Meeting
- 08:00 – 08:25 	Session Opening (Auditorium - All)
- 08:35 – 09:00	Scenario I (Groups)
- 09:00 – 09:30	Scenario II (Groups)
- 09:30 – 10:00	Scenario III (Groups)
- 10:00 – 10:30 	Scenario IV (Groups)
- 10:30 – 11:00	Scenario V (Groups)
- 11:00 – 11:30	Scenario VI and VII (Groups)
- 11:30 		Small Group Reporting and Closure 				(Auditorium - All)

## Nuts & Bolts – Prior to the Session

- Set up room
- Post “Training in Room” sign outside of door
- Review participant list
- Take notes of general findings and conclusions
- Report out to large group following exercise – 5 minutes maximum
- Have group select a recorder/reporter
- Take notes of general findings and conclusions
- Report out to large group following exercise – 5 minutes maximum

## Nuts & Bolts – During the Session

- Advise participants that handouts available outside of auditorium
- Post “Training in Room” sign outside of door
- Have group select a recorder/reporter
- Take notes of general findings and conclusions
- Report out to large group following exercise – 5 minutes maximum
- Manage discussions to stay focused and within timelines/constraints
- Manage group impasses – focus conclusion and move on
- Read scenarios while participants follow along via PowerPoint
- Take notes of general findings and conclusions
- Report out to large group following exercise – 5 minutes maximum
- Have group select a recorder/reporter
- Take notes of general findings and conclusions
- Report out to large group following exercise – 5 minutes maximum

## Objectives for Today’s Program

- Explore the major consequences of a highly pathogenic pandemic influenza outbreak on your agency/business
- Review your current preparations
- Explore the HR concerns that will affect your agency/business as a result
- Understand the potential outcomes

## Objectives: Continued

- Assess your leadership’s role and function
- Explore the impact of the permanent loss of key personnel
- Impact of the employees family concerns on your agency/business
- What long term concerns will follow the pandemic that will challenge your agency/business

## Expectations

- Active engagement to the exercise and each other
- Not all participants in each group will have the same knowledge/experience
- Find out your organization’s current strengths and weaknesses
- Find out your organization’s current strengths and weaknesses
- _A strict non-attribution clause in effect for all conversations today_

## Scenario I Approximately 8:35 a.m

***	******Increased Human-To-Human Transmission of H5N1 Influenza in Southeast Asia***
- 	November 3, 2006
- 	The World Health Organization (WHO) reports a strain of avian influenza H5N1 has mutated allowing easy human-to-human transmission in China.  The WHO has upgraded the Pandemic Influenza Alert to Phase 4, signaling that the virus is adapting to humans.  WHO officials have been working on the ground in Tianjin (75 miles SE of Beijing) to stem the outbreak.  They are focusing on the areas surrounding two urban bird markets.  Health workers are administering anti-viral drugs to people showing symptoms of influenza, and to those who have had close contact with victims of the virus. There are currently no reports of influenza H5N1 cases outside the city where the outbreak began.

## Discussion and Exploration

***Question Set #1***
- Does your agency/business have complete and up-to-date orders of succession and delegation?
- What are the essential functions of your agency/business?
- Have you identified the corresponding vital records and databases to sustain your essential functions?
- How will they be safeguarded, accessed, and maintained?
- If your agency/business plans to rely on telework during a pandemic, how will you ensure access to important data, and how will you ensure the security of that data?
- Who are the personnel critical to the performance of your essential functions? Have you trained additional personnel to perform these functions, if necessary?
- What are the physical and information systems necessary for the performance of your essential functions? Do these systems required human interaction? If so, how long, if at all, can these systems function without human intervention and maintenance?
- Who are the supplies and contractors whose services are necessary for the performance of your essential functions? Have you conducted planning sessions to determine actions that will be taken during a pandemic?
- What organizations does your agency/business work closely with? What plans are in place to ensure effective communication and coordination with them during a pandemic?
- Does your agency/business have a pandemic coordinator? If so, what are their specific responsibilities?

## Scenario IIApproximately 9:00 a.m.

***	******Phase 5 Pandemic Alert Declared***
- 	December 10, 2006,
- 	World Health Organization (WHO) officials report that the influenza H5N1 virus is spreading outside the control area in China.  It has now shown up in several more Chinese cities including Beijing and Shanghai. The World Health Organization has upgraded the Pandemic Influenza Alert to Phase 5. Airlines and federal agencies have started discussions on limiting flights from China and Southeast Asia, but have yet to do so. Students studying in China and Southeast Asia are returning home, causing an increase in flights from the region. The number of people flying to Southeast Asia has declined steeply as business and educational trips to affected areas are cancelled.
- 	Meanwhile, Minnesota and the rest of the U.S. are in the middle of a worse-than-normal annual flu season. The U.S. Centers for Disease Control and Prevention (CDC) issues an early report that the annual flu vaccine may not be effective against the A/Wisconsin strain and that the vaccine will not work at all against the pandemic H5N1 strain.  A pandemic flu vaccine is six months away from distribution.

## Discussion and Exploration

***Question Set #2***
- What critical positions in your agency/business will receive priority prophylaxis anti-viral medications if they become available? If they are not made available, what will be your course of action?
- Does your agency/business have a pandemic response plan? If so, what are the triggers which activate your pandemic response plan? What is your concept of operations? What are the procedures involved in activating the response plan?
- Does your agency/business have a Pandemic Influenza Communication Plan?
- How will your agency/business ensure that employees have timely and accurate information during a pandemic? Who will be in charge of such communications, and what are the key messages you will send?
- What key messages does your agency/business need to send to the public and what plans are in place to get the word out?
- How will your agency/business help to calm the fears of your employees as it becomes apparent that a pandemic is developing?  What information is necessary to make available?

## Scenario IIIApproximately 9:30 a.m.

***The Pandemic Hits Minnesota***
- January 15, 2007
- Several thousand people have contracted pandemic influenza in China with several hundred deaths reported so far. Both Regions Hospital in St. Paul and Hennepin County Medical Center are reporting suspected cases of pandemic influenza in young adults who recently returned from a university program in China. Other North American cities including Chicago, New York, Los Angeles, San Francisco,  Seattle, and Vancouver have confirmed cases of H5N1.  The early symptoms of H5N1 present like the current flu in many people, making initial diagnosis difficult. In addition, there is a 2-3 day period where individuals are most infectious, but do not yet show symptoms. Local health officials prepare for a worst-case scenario.

## Discussion and Exploration

***Question Set #3***
- What policies does your agency/business have in place for reducing the spread of influenza among your employees?
- What policies does your agency/business have in place for dealing with employees who come to work while ill, or who become ill while at work?
- What measures will your agency/business take to protect employees who are required to have frequent contact with the public?
- Who will be in charge of keeping track of who among your workforce is ill, is absent, or has died?
- How will your agency/business assist their families who are suffering from illness or grief?
- How will your agency/business assist your transitioning workforce with health, grief, and trauma issues?
- What policy is in place to address employees who have exhausted their sick time and/or vacation time?

## Scenario IV – Part 1Approximately 10:00 a.m.

***The Virus Spreads Throughout Minnesota***
- February 14, 2007
- The virus is spreading quickly, and people are reacting in different ways. Some people are stocking up on food, batteries, over the counter medications, and other supplies, leading to a growing shortage of these items in local stores. Others have relocated to small towns and cabins. H5N1 cases are now being reported in these areas, likely carried there by the people coming from outside areas. There have now been approximately 200,000 cases of H5N1 in Minnesota, with roughly 4,000 deaths, and additional cases are being diagnosed every day. The virus is attacking seemingly healthy people and appears especially lethal to those between the ages of 15 and 39.
- Local hospitals are reporting that 25-35% of their staff is absent, due to illness, fear of illness, and illness of family members. Hospitals do not have enough ventilators to provide assistance to all patients requiring ventilators, and many hospitals are beginning to decide which patients will be given such assistance. Several altercations have been reported between hospital staff and influenza victims’ families, when hospital staff attempted to disconnect patients from ventilators in order to use them for other patients. Hospitals are also out of beds, and more and more influenza patients are now being cared for in their homes. Those without family in the area are often without anyone to care for them, and there are reports of many such people dying in their homes.

## Scenario IV – Part 2

***The Virus Spreads Throughout Minnesota – Continued***
- The Governor has officially declared a State of Emergency in Minnesota. The National Guard has been activated to assist state agencies in maintaining essential services. With roughly 30% of the Minnesota National Guard currently deployed to national priorities or in training status, the available troops are assigned to priority services throughout the state. Due to the widespread nature of the pandemic, medical assistance supplies is available from the Federal Government at this time. U.S. Department of Homeland Security has elevated the Security Advisory System nationwide to Orange (High Risk of Terrorist Attacks) due to the compromised nature of the country’s law enforcement and preparedness system.
- Schools and daycare facilities have been closed in an attempt to slow the spread of the virus. The closure of schools is compounding staffing issues for businesses and government agencies, as those with school age children must now stay home to care for them. College students without family in the area are remaining in dormitories; the virus is spreading through college campuses, due to the close quarters and the susceptibility of young adults to the virus. Students requiring healthcare overwhelm campus services.
- As H5N1 continues to spread throughout the area, local stores have run very low on food and other essential supplies, and no shipments are expected in the near future from other areas of the country.  National “just in time” delivery of goods has slowed due to increased illness among truck drivers.

## Discussion and Exploration

***Question Set #4***
- How will your agency/business handle the potential shortage of basic supplies such as batteries, office supplies, and hygiene products?
- Will your agency/business assist in providing supplies for your employees (e.g. water?)
- What policies does your agency/business have in place for handling the needs of employees with small children, in the event of a closure of schools and daycare centers?
- What policies does your agency/business have in place for handling the needs of employees who stay home during a pandemic to care for ill family members?

## Scenario V – Part 1Approximately 10:30 a.m.

***The Virus Continues In Minnesota***
- March 18, 2007
- The H5N1 pandemic influenza virus has now spread throughout the United States. Within Minnesota, many businesses have experiencing high absenteeism (40%) and having difficulty maintaining business operations.
- Public gatherings are discouraged, although not forbidden. Many people who are not yet infected with the influenza virus are avoiding leaving their homes for any reason, due to fear of illness. Public transportation is sustained at a basic level and gasoline is in short supply making it difficult for people to commute. The price of gasoline has skyrocketed, and long lines at gas stations have become commonplace.
- There have been reports of looting, as people desperate for supplies break into closed businesses in search of them. Police departments and emergency services are overwhelmed and understaffed. Police, Fire and Rescue response to 911 calls are now subject to prioritizing of emergency needs. Ambulance and public safety personnel respond first to calls affecting life and safety concerns.

## Scenario V – Part 2

***The Virus Continues In Minnesota – Continued***
- Hospitals and pharmacies have run out of antiviral medications and are running low on prescription medications unrelated to influenza. Federal officials announce that a pandemic vaccine will be ready in June at the earliest.  While most recent deaths in Minnesota have been due to influenza, a growing number of deaths are occurring among those with serious chronic medical conditions, as they are unable to get the care they need.
- Periodic interruptions of services such as water, power, trash, and snow removal have become common, as so many of the personnel responsible for maintaining such services are absent or ill. This situation exacerbates the staffing shortage experienced by local business, hospitals, and government agencies. Internet services offered by Internet Service Providers are no longer reliable due to an unprecedented national demand from their subscribers, causing problems for businesses and agencies who had been relying on social distancing and telework to continue operations.
- Cemeteries have become overwhelmed with burials and are experiencing delays. Temporary morgues have been established as cemetery locations.  Some children have lost both parents to the H5N1 virus. Although relatives are now caring for many of these children, this sudden influx of orphans is putting stress on the Minnesota Department of Human Services, especially since many of these children are ill with influenza themselves.
- While not as susceptible to the virus as young adults, there have also been substantial deaths among elderly people who had previously depended on younger family members for care and assistance. Local charities and volunteers are lending assistance where they can, providing basic supplies to vulnerable elderly, as well as care and comfort to those infected with the influenza virus. In addition, they are providing mental health services to the families of those who have died from the virus, first responders, and health care workers.

## Discussion and Exploration

***Question Set #5***
- What plans does your agency/business have in place for ensuring the continuation of essential services in the event of interruptions in gas, water, telephone, and electrical services?
- If your agency/business plans to rely on telework during the pandemic, how will you respond to a disruption of internet service?
- What policies does your agency/business have for handling employees who have difficulty getting to work during a pandemic due to their dependence on public transit or carpooling?
- If your regular suppliers are unable to deliver services, what plans does your agency/business have in place for procuring those supplies from another source?
- What plans does your agency/business have in place for supporting the mental and emotional health of your employees as the pandemic continues and deaths of friends and family members occur?

## Scenario VIApproximately 11:00 a.m.

***First Wave of Pandemic Begins To Wane***
- April 20, 2007
- Weeks after the initial outbreak, the pandemic is showing signs of waning. Roughly 20,000 Minnesotans have died to date from pandemic influenza and associated causes.  Fortunately, few new cases are currently being reported within the state at this time.  A similar drop in new pandemic influenza cases is being reported throughout the United States.
- “Real time” shipments and deliveries of food, gasoline, and other supplies have resumed in Minnesota.  Most survivors who were hospitalized during the pandemic have now been released to continue their recovery at home; many are well enough to return to work.   Government agencies and businesses that remained open throughout the first wave are starting to assess the steps necessary for recovery, and preparing for the next wave of the pandemic. Smaller businesses are finding it difficult to recover from the economic losses they suffered over the last nine weeks. Financial losses have been especially devastating for airlines and for businesses like professional sport teams, theaters, and malls. Several airlines announced they are going out of business, and are petitioning the government for assistance and threatening to close down.
- Schools and daycares have reopened, although they remain short-staffed. Schools have suffered many deaths among their student population, and are setting up long-term counseling services to help surviving students deal with the deaths of family and friends.

## Discussion and Exploration

***Question Set #6***
- What plans does your agency/business have in place for replacing employees who are deceased, permanently disabled from pandemic influenza, or have chosen not to return?
- What plans does your agency/business for dealing with the press and the public, regarding your performance during the pandemic?
- What steps will your agency/business take to prepare for the next wave of the pandemic?

## Scenario VII – Rhetorical Approximately 11:25 a.m.

***Second wave of Pandemic Begins***
- August 26, 2007
- After several months of no new pandemic influenza cases, several suspected H5N1 cases were reported early last week by three hospitals in the Twin Cities metro area, as well as several hospitals in other areas of Minnesota. Many more cases have now been diagnosed throughout Minnesota, and a similar resurgence of the pandemic appears to be occurring throughout the United States. As with the first wave, the highest infection rate is among young adults between 15 and 39. This second wave of the pandemic has caused very few deaths but is causing high rates of employee absences for both businesses and government agencies. With most businesses and agencies still recovering from the devastating first wave of the pandemic, the second wave is threatening to derail recovery efforts.
- A much milder third wave of pandemic is also predicted. The rates of employee absenteeism for businesses and government agencies will likely be manageable during a third wave, and schools and stores remain open.  It is anticipated that the H5N1 vaccine will be part of the coming winter’s annual influenza vaccine.

## If Time Permits or Just Read for Thought

***Question Set #7***
- How will your agency/business continue recovery efforts during this second wave of the pandemic?

## End of the Scenario

- Thank the Group and Advise
- Return Promptly to the main auditorium for the group reports
- And concluding remarks