From Pandemic Preparedness to Management: UK experience

Professor Lindsey Davies CBE FRCP FFPHNational Director of Pandemic Influenza Preparedness

UK preparation and response

Planning and preparation 1997-

Slowing the spread

April-June 2009

Managing outbreaks

June 2009

Treatment phase

July 2009-

Potential impact

25 - 50% people with symptoms

50,000 - 750,000 deaths

80,000 – 1,115,000 needing hospital care

15-20% absent from work at the peak

£1,242 bn cost to society

Pandemic impact

Staff will be ill / have personal responsibilities as carers

Supply chains could be disrupted

Hospitals will fill up quickly

Community services will need to care for people with a wider range of needs that usual

Scope for mutual aid will be very limited

Reducing spread

Distance, hygiene, masks

Reducing infection

Vaccines

Reducing illness and complications

Antiviral drugs

ReducingDeaths:

Antibiotics

4

Influenza care

Key messages:

– Stay at home – Don’t spread it around– Phone a friend– Phone the Flu Line

Communication strategy

During a Pandemic

Public leaflets (all UK homes) TV Press briefings Telephone Information Line Websites

NHS self assessment

Wide variation across the country

Plans in hospitals and ambulance services generally more robust than primary care and mental health services

Major gaps:– Joint working with other organisations– Recovery– Business Continuity– Making plans ‘real’ to individuals

Additional PCT gaps: – supporting self-care– immunisation

Response is informed by :

Science Surveillance Service monitoring

Slowing the spread

Laboratory confirmation of cases Treating all suspected and confirmed cases Collecting detailed case data Tracing close contacts and offering prophylaxis Closing schools Public health campaign Leaflet to all households Swine Flu Information Line Building resilience – countermeasures, health and social care

preparations

Reasonable Worst Case30% Clinical attack rate - peaks in early September

New Cases per day

0

100,000

200,000

300,000

400,000

500,000

600,000

21/03/2009 21/05/2009 21/07/2009 21/09/2009 21/11/2009 21/01/2010 21/03/2010

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Move to treatment

Initially in ‘hotspots’ only, later UK-wide Antiviral treatment for people with symptoms. Limited prophylaxis Launch of National Pandemic Flu Service Local risk assessment

National Pandemic Flu Service (NPFS)

On-line and phone self care service for the public which allows them to check their symptoms and access antivirals if required, or receive advice on symptom relief

Antivirals collected by ’flu friends’ from Antiviral Collection Points

Mobilised when needed

Capacity adjusted in response to demand

0800 1 513 100

www.pandemicflu.direct.gov.uk

National Pandemic Flu ServiceCompleted self-care: daily rate

Source: NPFS, to 6 October

0

10

20

30

40

50

60

70

80

90

23 25 27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 1 3 5

July August September October

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Current position: England(8 October 2009)

Estimated 18,000 new cases in England in previous week (range 9,000 –38,000)

290 patients in hospital, 47 in critical care Majority of cases continue to be mild 76 confirmed swine flu related deaths

Influenza-like illness: Weekly GP consultation rate, England & Wales

Source: RCGP, to 4 October

Week ending 4 October: 26.3 per 100,000

Epidemic activity

Normal seasonal activity

Baseline threshold

0

50

100

150

200

250

41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Week number

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1999/00

2006/07

2007/08

2008/09

Influenza-like illness: Daily GP consultation rateEngland, by age

Source: QSurveillance, to 6 October

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50

100

150

200

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9

29-J

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9

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27-J

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under 1 year 25-44 years

1 - 4 years 45-64 years

5-14 years 65-74 years

15-24 years 75+ years

Hospitalised patients in England:Once-weekly snapshot

0

100

200

300

400

500

600

700

800

900

1000

8 Jul 15 Jul 22 Jul 29 Jul 5 Aug 12 Aug 19 Aug 26 Aug 2 Sep 9 Sep 16 Sep 23 Sep 30 Sep 7 Oct

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Number hospitalised in Critical Care Number hospitalised - not in critical care

Source: Sir Liam Donaldson, Department of Health,

0

1

2

3

4

5

6

<5 5 to 15 16 to 64 65+

Age group (years)

Hospitalisation ratios by weekJuly

August

September

October 7

Source: Sir Liam Donaldson, Department of Health,

Chief Medical Officer’s confidential investigation: underlying conditions for fully investigated deaths

Healthy

Mild

Moderate

Severe

47%

21%

9%

23%

Source: Sir Liam Donaldson, Department of Health,

Lessons

The importance of planning and preparation The need to plan for a range of scenarios – H1N1v hasn’t

spread rapidly across the UK Uncertainty does (potentially) breed panic - and complacency Reliable and appropriate surveillance is essential Pre-existing relationships make a real difference Regular proactive communication is vital

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Influenza-like illness: GP consultation ratesHistorical comparison

Source: Sir Liam Donaldson, Department of Health, 1969/70 and 2009 from RCGP. 1957/58 based on extrapolation from a small study

Indicative Scenarios - New Cases per day

0

100,000

200,000

300,000

400,000

500,000

600,000

21/03/2009 21/05/2009 21/07/2009 21/09/2009 21/11/2009 21/01/2010 21/03/2010

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Indicative scenarios

Planning assumptions (September 09)

Reasonable worst case: – Clinical attack rate: 30%– Complication rate: up to 15% of clinical cases– Hospitalisation rate: 1%– Case fatality rate 0.1%– Peak absence rate: 12%

Next steps

Surveillance Vaccination NPFS flexibility Social care preparedness NHS preparedness Personal preparedness Tests and exercises Communications Plan for the next pandemic

To summarise….

Planning has paid off

Uncertainty about the timing, scale and impact of the next phase(s) remain

We must continue to prepare for a range of scenarios in this pandemic - and the next