Pandemic Influenza &Other Emergencies

Planning for the Possibilities

Bob Mauskapf, MPAColonel, USMC (ret)

State Emergency Planning Coordinator

“Thus the wise win before the fight, while the ignorant fight to win”

The Art of War

State Roles in Planning

• Public information and education• Involvement of all Secretariats and agencies in

planning, with oversight by Governor and Cabinet• Assuring surge capacity of the healthcare and public

health communities• Establish community control and infection control

guidelines, policies for stockpiling of antivirals, guidelines for allocation of vaccine and antivirals (specific priority categories)

• Isolation/quarantine guidelines and decisions • Laboratory testing

Command and Control Issues

• Chain of command• Common Operating

Picture• Real-time Situational

Awareness• Situational Assessment—

Situation Reporting• Decision-making Process• Interoperability

HAN / SWAN EnhancementSNS management

Volunteer ManagementPolycom / VTCSatellite Phones

STARSSupport LHD Wireless Linkages

Cell, Pagers (Dig, msg and voice)24/7 Hotline

Priority to Landline and Wireless (GETS)Current Rosters

Search for the Perfect Communications System(Reliable, Redundant, Reasonable, Scalable, Mobile)

COMMUNICATIONSCOMMUNICATIONS

Partners

• VDH• MMRS(s)• MRCs / Other Volunteers• 139 Jurisdictions / EOCs• DOD Installations• Local Law Enforcement• Local School Districts• Colleges and Universities• Local EP&R Partners• DC / Neighbor States• (89) Hospitals and (6) Hospital

Regions• VPCA• Private Sector• Feds

– HHS / CDC– DOD– DHS / FEMA– OTHERS

• OCP• VDEM

– VEOC– VFC

• VDOC• VSP• VNG• VDOT• VDACS• VDMHMRSA• VDOF• VITA• VDGS

– DCLS

Local Response Entities• Requires support of County/City leadership (139)• Partnership among:

– Colleges and Universities– School systems– Hospitals– Law enforcement– Social Services– Emergency Management– Responders (Fire / EMS)– Private sector partners– Regional Mutual Support– Community Health Clinics

Risk Communication

• Essential at all stages, beginning before pandemic spread

• Constantly changing situation• Messages must be relayed in

appropriate/timely manner• Recommendations will change over time• Effective response to pandemic requires public

support – decisions will not be easy but must be fair and balanced

Federal Role in Planning

• Set general guidelines and criteria• Provide federal stockpile of medications,

supplies• Support enhanced supply of antivirals• Enhance vaccine production and support new

vaccine production techniques• Support laboratory identification procedures

Local Roles in Planning

• Public information and education• Community involvement and ownership of

community plans • Assuring surge capacity of the healthcare and

public health communities• Many decisions on community control, stockpiling

of antivirals, specific allocation of vaccine and antivirals (numbers of people and identification of people in specific categories) made at local levels

Local Response Entities• Requires support of County/City leadership (139)• Partnership among:

– Colleges and Universities– School systems– Hospitals– Law enforcement– Social Services– Emergency Management– Responders (Fire / EMS)– Private sector partners– Regional Mutual Support– Community Health Clinics

April 16, 2007

Cross Functional Coordination• Incident Command

– Joint Information Center (JIC)• ESFs

– Law Enforcement• Campus, Local, VSP, FBI

– Health and Medical• 5 Hospital / EMS (16 Squads) Coordination• Medical Examiner• Mental Health: CSBs, TADBHAC, DMHMRSAS

– Mass Care• Family Services Center• Relocation

VEOCNotification

VDH ECC

EMAILHANVoice

PIOJIC

OCME RHCCHHQ

ESF-8

VA TechCommunicationsPublic InformationHosp CoordFatality Mgt.Mental Health

Local HDsRegional Teams

Lessons Learned

• Hotwash• After Action Report

– Reinforce (+) and ID (–)• Policy• Planning• Organization• Funding• Training• Resources (facilities, equipment, supply blocks)

H5N1 Asian Epizootic: Avian flu

• Highly Pathogenic Avian Influenza (HPAI)• Dec 2003 to present

– Poultry outbreaks in numerous countries in Asia, Indonesia, Europe, Middle East and Africa – millions of birds culled

– 291 human cases in 11 countries (as of March 5, 2007): 172 deaths (>59% mortality)

• Historically unprecedented – Geographical scope– Economic consequences

Unique Features of Pandemic Flu

• Multiple areas affected at the same time– More difficult to shift resources

• Could go on for months in a community, with 2-3 different waves over 18-24 mo

• Healthcare workers will be affected• Preventive and therapeutic agents delayed and in

short supply– New vaccine must be made for the pandemic virus

• Widespread illness would impact essential services

In Virginia, pandemic flu impact estimates include:

• 2,700 to 6,300 deaths • 12,000 to 28,500 hospitalizations • 575,000 to 1.35 million outpatient visits • 1.08 million to 2.52 million people becoming

sick

9

Issue: Antivirals

• Federal stockpile of antivirals growing• States have option to stockpile antivirals at

discounted federal contract price• Virginia has purchased full allotted amount –

distribution plan in development (treatment)• Goal: antivirals to treat 25% of VA population• Increasing supply and production capacity –

discussion of increased prophylaxis use

Issue: Community Containment

• Limiting community spread: social distancing– School closures– Recommendations about telecommuting– “Snow days”– Isolation/quarantine: mainly voluntary– Discouraging/banning large gatherings

(indoor/outdoor)• New recommendations based on severity of

pandemic, on a scale of 1-5

Pandemic Influenza Planning

• Include involvement of:– DOD Installations– Schools/Colleges and universities– First responders – fire, EMS/Public safety, Law

enforcement– Business community/Private sector– Media– Assisted living and other social services programs– Volunteer, non-profit groups/Faith community

• Coordinated planning of federal, state, local governments and agencies

Pandemic Influenza Planning: Health

• Risk communications• Community containment• Antiviral distribution plan• Mass vaccination• Medical surge, healthcare coalitions• Surveillance and investigation• Laboratory services• Fatality management• Altered standards of care due to resource

limitations

Pandemic Influenza Planning:Non-Health

• Command and Control• Community containment measures

– Economic impact– School closure– Isolation– Voluntary quarantine

• Continuity of Operations: – Government entities– Critical infrastructure: economy, trade, business– Agriculture, water and food chain safety

• Human resource issues, policies (public and private)

Future Exercises

• Cabinet tabletop, Sep 4: Focus on non-health components of state plan

• NGA Regional exercises, Late Sep: Planned at national level: Test interstate and regional collaboration

• Exercise to test state antiviral distribution plan• Exercise to focus on school/college/daycare

closure issues within state

CDC/DHS

State EOCDistribution

PODPOD POD POD

RSSSecurityCommunicationsPublic InformationInventoryTransportation

Local EOC

• http://www.vdh.virginia.gov/epr

• http://www.vdh.virginia.gov/pandemicflu

• http://pandemicflu.gov