American Medical Association

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Influenza Pandemic: CitizenReady Training

American Medical Association

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This project was supported by Cooperative Agreement Number 2007-GT-T7-K002 administered by the U.S. Department of Homeland Security, Office of Grants and Training. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the U.S. Department of Homeland Security.

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Introductions

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Housekeeping

– Turn off mobile phones

– Coat closet

– Restrooms

– Food and refreshments

– Session length

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CitizenReady Program

– Designed to help the American public prepare

– Provides basic life-saving and support information for public health emergencies

– Helps build physical and mental health resilience in the community

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Potential for Pandemic

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Program Objectives

– The difference between seasonal and pandemic influenza

– The role of the public health system during an influenza pandemic

– What actions you and your community can take to prepare for a pandemic

– The importance of developing and exercising personal, workplace, school and community emergency plans

– What public health directives may be issued in a pandemic and why they should be followed

– What actions you can take to limit the spread of influenza

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Problem Overview

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What Is Seasonal Influenza?

– Seasonal Influenza • Caused by a virus; commonly called “flu”• Symptoms: fever, headaches, sore throat, body aches,

congestion• 200,000 hospitalized and 36,000 deaths annually• Virus is spread through respiratory droplets (coughing/sneezing)• Most Vulnerable (elderly, pregnant, children, chronic disease

Preventing Seasonal Flu

Get Seasonal Flu Vaccine

Hand-washing

Practice cough etiquette

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What Is Pandemic Influenza?

– Affects wide geographic area, high proportion of population

• New virus to which the population has limited to no immunity

• Can spread across US in 5 weeks

• Will infect communities for 6-8 weeks before receding

• No vaccine will be present in the early stages

• The effectiveness of antivirals are unknown

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Emergence and Spread of a Pandemic Virus

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Can a Pandemic Happen Again?

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Progression to a Pandemic

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Possible Pandemic Toll in U.S.

– >50% who become ill will seek medical care

• Illness: 90 million (30%)• Outpatient medical care:

45 million• Hospitalization: 9.9

million• Intensive care: 1.5

million• Mechanical ventilation:

750,000• Deaths: 1.9 million

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Shift in Healthcare Priorities

– With so many people sick, health care authorities will identify three categories in the community: • Susceptible, but not yet exposed to the virus• Exposed but do not have symptoms yet• Sick and contagious

– Of the sick and contagious, which ones are likely to survive?• Resource allocation based on that answer

Susceptible

Exposed

Sick and Contagious

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By taking action

1. Delay the spread of the virus and peak of the outbreak:

2. Reduce number of cases at peak

3. Control virus and health impacts

Dai

ly C

ases

Days since First Case

Pandemic outbreak:No intervention

Pandemic outbreak:No intervention

Pandemic outbreak:With intervention

Pandemic outbreak:With intervention

Delay

Red

uce

Control

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Community Preparedness

– Enforce social distancing• E.g., close/dismiss schools, cancel sports events

– Establish a community hotline

– Set up local alternatives to conventional hospital care• E.g., Flu clinics

– Encourage employers to ensure that exposed and sick workers stay home

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Hospitals will be Overwhelmed

– Hospitals will be overwhelmed with flu patients

– Going to hospital could make you sick• And you could contribute to

spread of infection

– Alternative Sites:

Primary care clinics,

Designated flu clinics,

Point of Distribution sites

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Breaking News

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Community Responsibilities

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Community Response Part A

– Assume assigned roles in the community• Head of household• Businessperson• Children’s sports

coach

– Divide into groups– Determine actions your

group will take– Share your decisions

with the group

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Community Response Part B

– In your group, discuss:• Who will care for the

children?• How can families plan

ahead for school dismissal?

• What steps should employers take to plan for absenteeism?

• How will children be entertained and taught at home?

• How will needed school services be replaced?

• Are there concerns about unsupervised children?

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Why Social Distancing?

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This Approach Works

300

250

200

150

100

50

0

Excess mortality over 1913-1917 baseline in Philadelphia and St. Louis

21-Sep28-Sep

5-Oct12-Oct

19-Oct26-Oct

2-Nov9-Nov

16-Nov

23-Nov30-Nov

7-Dec14-Dec

21-Dec28-Dec

Source: Hatchett, Mecher, & Lipsitch. Public health interventions and epidemic intensity during the 1918 influenza pandemic. PNAS Early Edition. April 6, 2007

Dea

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ate/

100

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0 P

op

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tio

n Philadelphia

St. Louis

Date

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Individual Responsibilities

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Taking Action As Individuals

– Get Seasonal Flu Vaccine

– Contact community hotline if:• You think you are sick• A family member is sick

– Wash hands well

– Practice cough etiquette

– Identify vulnerable individuals in your community

– Establish social networking for local updates (facebooks, twitters)

– Get trustworthy information and follow directions from public heath authorities

– Stay home if you are sick

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Gaining Resilience

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Summary

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Become CitizenReady

– Take early, quick action as:• Individuals• Communities

– Taking action:• Makes you feel more in control• Can dramatically decrease transmission of the virus• Allows you to be helpful to others

– All community groups need to work together• Community citizens need to be ready and willing to act• Learn about local agencies and organizations involved in

pandemic preparedness