Avian Flu: The Issue, The Relevance and What We Can DoAvian Flu: The Issue, The Relevance and What We Can DoCreated for Oshkosh, WICreated for Oshkosh, WI

P. Anderson, S. Sillito, J. Rose, R. Schmitz, S. XiongP. Anderson, S. Sillito, J. Rose, R. Schmitz, S. Xiong““The Flu-Man Group”The Flu-Man Group”

Virology 2006Virology 2006

The IssuesInfluenza pandemics occur at a rate of 3-4 times every century. Within the last century, there were three major pandemic outbreaks, including; 1918, 1957 and 1968 (Kilbourne ED. Influenza pandemics of the 20th century. Emerging Infectious Diseases http://www.cdc.gov/ncidod/EID/vol12no01/05-1254.htm. 2006 Jan.) Every year influenza causes minor-moderate problems for Americans and others around the world. Known as “Antigenic Drifts”, these outbreaks usually do nothing more than incapacitate a person for a few days, a week at the most. However, a new strain of influenza is making its way across the globe from south-east Asia. H5N1, a strain of avian influenza, is making its impact on the minds of people everywhere as it slowly progresses across the globe. Table 1 illustrates the timeline and incidences of human infection with H5N1 since 2003.

CountryCountry  

20032003 20042004 20052005 20062006 TotalTotal

casecasess

deathdeathss

casecasess

deathdeathss

casescases deathdeathss

casecasess

deathdeathss

casecasess

deathdeathss

AzerbaijaAzerbaijann

00 00 00 00 00 00 88 55 88 55

CambodiaCambodia 00 00 00 00 44 44 22 22 66 66

ChinaChina 00 00 00 00 88 55 99 66 1717 1111

EgyptEgypt 00 00 00 00 00 00 44 22 44 22

IndonesiaIndonesia 00 00 00 00 1717 1111 1515 1313 3232 2424

IraqIraq 00 00 00 00 00 00 22 22 22 22

ThailandThailand 00 00 1717 1212 55 22 00 00 2222 1414

TurkeyTurkey 00 00 00 00 00 00 1212 44 1212 44

Viet NamViet Nam 33 33 2929 2020 6161 1919 00 00 9393 4242

TotalTotal 33 33 4646 3232 9595 4141 5252 3434 196196 110110

Table 1: WHO incidence table of H5N1 cases since 2003

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_04_19/en/index.html

So Who Will Help?During the initial outbreaks of H5N1, very few countries were prepared for the possibility of a pandemic outbreak. Since 2005, more governments have taken to the notion that H5N1 is more serious than first expected. As a result, pandemic flu planning was initiated for many countries across the globe. However, the United States did very little to plan for a pandemic until late 2005-2006. Since April of 2006, every state has developed a pandemic flu preparedness plan that will help the local and state governments deal with possible outbreaks.

A major issue concerning Americans is what will we do if, or when, a pandemic outbreak occurs?

According to the director of Health and Human Services Michael Leavitt,

“Any community that fails to prepare and expects the federal government will come to the rescue is tragically wrong. It’s not because we don’t care, don’t want to, or don’t have the money, but because it’s logistically impossible.”

Since the Hurricane Katrina catastrophe, many states have upped their planning methods to be more “self-sufficient”. As Mr. Leavitt stated, the government will be able to act only in limited ways, so its up to each state to develop their own plan.

An idea of the primary duties of the federal government during a pandemic situation is outlined in Fig 1. (http://dhfs.wisconsin.gov/preparedness/pdf_files/WIPandemicInfluenzaPlan.pdf)

Where Does Wisconsin Stand on the Issue?Wisconsin has recently updated its pandemic flu response to include the developments of the past several months and the supposed stance of the federal government to providing aid to individual states. The “Wisconsin Pandemic Influenza Preparedness” plan can be found at (http://dhfs.wisconsin.gov/preparedness/pdf_files/WIPandemicInfluenzaPlan.pdf).

Primary Responsibility of the Federal Government

1. Vaccine research and development.2. Coordinating national and international surveillance.3. Assessing and potentially enhancing vaccine and antiviral capacity and coordinating public sectorprocurement.4. Devising a suitable liability program for vaccine manufacturers and persons administeringthe vaccine.5. Developing a national “clearinghouse” for vaccine availability information, vaccinedistribution and redistribution.6. Developing a national vaccine adverse events report system.7. Developing a national information database/exchange/clearinghouse on the Internet.8. Developing “generic” guidelines and “information templates” that can be modified and/oradapted as needed at the state and local levels, including:• Fact sheets on influenza, influenza vaccine, and antiviral medications.• Guidelines for triage and treatment of influenza patients in outpatient, inpatient andnon-traditional medical care settings.• Guidelines for state and local government for development and implementation of massvaccination programs.• Guidelines for distribution and use of antiviral agents.9. Pursuing mechanisms by which influenza vaccine can be made more rapidly availableand in larger quantities prior to and during the next pandemic.10. Issues travel alerts and advisories to areas where the novel strain of influenza is in widecirculation.

What can YOU do to prepare?Taking responsibility for yourself and ones family are top priority when it comes to health issues. Considering the lack of support that the federal government will be able to provide in response to a global outbreak of influenza, individual families will need to prepare themselves for the worst. Surviving a pandemic does not mean isolating yourself from society in a bomb shelter or concealing yourself in a plastic bubble. It does however demand that you isolate yourself from large numbers of people and animals, carefully choose where you travel and what supplies you put aside for the duration of the outbreak. The following is a list of supplies that should hold out for 6-8 weeks and includes medical and emergency equipment.

1. Thermometer2. Medication (pain, prescription and others)3. Emergency supply kit4. Breathing masks (i.e. Explore FFP 2)5. Radio, Flashlight, Batteries6. Plastic Wrap, Duct Tape7. Cash ($500 +)8. Clothes9. Waste Receptacles10. Fresh Water Supply (55-gallon drum for every 2 people)11. Water Purification tablets12. Freeze dried foods, canned goods, cereal (non-perishable foods)

Other supplies not listed should be included in the supply list of a family planning on at most an 8 week isolation. The estimated cost of all supplies for 8 weeks of in-house isolation is about $600.00, a small price to pay for your life and the life of your family.

Local Government PlanningAlthough the state will offer assistance to individual cities during a pandemic outbreak, smaller,

less populace cities and towns will be overlooked. Therefore, it is important that each city, town, and village prepare itself for an outbreak.

Development of an emergency management team in the event of a pandemic is a high priority that must be accomplished BEFORE any outbreak occurs. This team may include individuals already employed by the city for similar duties or may include new individuals that may be hired for the strict purpose of dispatching and coordinating the team.

The team should consist of five parts:Fire Dept / EMTPoliceHazmat Coordinating teamLaboratory

The five parts of the emergency response team (ERT) are explained as follows:

Fire Dept/ EMT

The duties of the fire dept/ EMTs are to provide safe transport of individuals showing symptoms of infection to a proper healthcare facility. The fire dept is to assess immediate danger and

provide support for EMTs. Their duties will be similar to their current operation.

Police

The police are to provide safe passage of EMTs to a healthcare facility and prevent violence or altercations that may arise as a result of intense situations. The police are also to assist hazmat in quarantining infected households or businesses and preventing the possible contamination of bystanders and other civilians. Their duties will include their current operational procedures.

Hazmat

Hazmat is to assess the situation of reported infections by: a) creating a secure and quarantined area of the reported infection location, b) performing immediate scans and tests of the areas in which the infected individual was located, c) collecting samples and sending them off to be tested for possible influenza presence. After test samples are taken the hazmat team is responsible for fully quarantining and disinfecting the immediate area. The quarantine is to be assisted by local or state police and fire dept personnel.

Coordination Team

The coordination team is to consist of a panel of local and state healthcare officials, city council members and an epidemiology/pandemic expert. The purpose of the team is to develop strategies for the following:Quarantine procedures

Emergency response procedureHospital and Clinic procedure *Treatment options and procedure **Disposal and sanitation of medical waste and personal propertyBurial and body disposal procedureDirection of human services for children and elderlyTransportation and city wide quarantine efforts

Access and shipment control of flu vaccine and specialty medical supplies

*hospital administration will retain their current duties and have control of their healthcare facilities

** Discussed in conjunction with the hospital administration and lead attending physician

LaboratoryThe laboratory team is to consist of individuals trained in the proper handling of biohazardous

agents who are capable of performing the required tests to analyze samples collected from suspected outbreak incidences and determine the cause of illness. Laboratories may be located in local hospitals, outside clinics, universities, and private facilities. Suspect samples are considered top priority and have precedence over other projects.

Community Communication (e.g. moving goods and services)During a pandemic, critical supplies shall be transported by the National Guard to designated pick up areas. From there individual cities are required to transport their own goods. Local city workers will transport goods from pick up areas to drop off sites within the city. Police may accompany workers to ensure safe transport.

Critical supplies shall include:food

water and water filtration productsgasoline

flu drugs and vaccinesmedical supplies (IV’s, masks, gloves etc.)

Quarantine measures/Prevention/Travel/Crime PreventionDuring a pandemic, all individuals residing in Oshkosh (except for essential workers such as doctors, nurses, police officers, firefighters, grocery store workers, etc.) will have to stay in their homes until the pandemic subsides. Individuals from neighboring towns in Winnebago County shall be prevented from entering Oshkosh. Only individuals involved in the transport of critical supplies, i.e. city workers, shall be allowed to the city. The police shall enforce the quarantine with the aid of the military should National Guard become available. Curfews may be enacted to ensure safety of individuals after hours. Police will have full authority to detain persons found outside after curfew.

Public GatheringsIn the event of a flu pandemic, all public gatherings shall be prohibited. Schools will be closed. No church services shall be performed in a public setting. If church leaders (priests, pastors etc.) choose to do so, they may give religious talks over the radio at the discretion of station personnel. Station broadcasts are at the discretion of the station personnel but will include hourly updates on local flu situations. Public libraries as well as movie theatres shall be shut down until the pandemic subsides.

Local HospitalsLocal HospitalsAurora Medical Center

855 North Westhaven DriveOshkosh, WI 54904(920) 456-6000

Mercy Medical Center500 S. Oakwood RdOshkosh, WI 54904(920) 223-2000

VaccinesVaccine Recipients: 1. Doctors

2. Nurses/Nurse Practitioners

3. Community/Pandemic City Board Members

4. City Servants (firefighters, police, EMTs, Hazmat)- Only city servants over the age of 17 and under the age of 35 will receive the vaccine. Since this is the

most vulnerable age group, priority is given to them.

5. Essential workers between the ages of 17 and 35, such as gas station attendants, grocery store clerk, etc.

6. All remaining vaccine will be administered to anyone under 35 years and over 17 years because they are the individuals who are most at risk. This will be done on a first come first serve basis.

7. Elderly and intensive care patients will receive vaccinations only if additional vaccines are available.

Pharmacies/Health Plans Many individuals require medications every day, unfortunately, during a pandemic; pharmaceuticals may be in short supply because most of them are not manufactured in the United States. This will place the burden of divvying out medications on local pharmacies (such as Walgreen’s, Morton’s, Wal-Mart Pharmacy). During a situation like this, pharmacies should run on a first come first serve basis and they should be guarded 24/7 by police to prevent theft and rioting.

Many health plans will not pay for medications purchased from other countries, therefore making the individual responsible for financing his or her own medicinal needs.

Long-term care (nursing homes, and elderly living alone)Recipients of antiviral drugs shall include (in order of priority):

•people who work in essential occupations: -healthcare workers: doctors, nurses, physician assistants, CNAs -city servants: firefighters, police, EMTs, HAZMAT

Individuals in long-term care facilities shall continue to receive care from such facilities, but they shall not receive special treatment in regards to the pandemic. Antiviral medications shall be reserved solely for young adults who are more susceptible to the virus. Unfortunately, resources during a pandemic will be very limited and checks on the elderly will not be a possibility. The majority of the efforts will be in preventing further spread of the disease and treating sick individuals between 17 and 35.

City Issues

Employees Critical to Maintaining the City

- healthcare workers

- firefighters/police officers

- grocery workers

- gas station employees

- water treatment plan employees

- garbage collection employees

- Wisconsin public works employees

The impact of a pandemic on local business will be devastating. All non essential businesses shall be forced to shut down until the ban on public gatherings as well as the quarantine is lifted. There are no immediate sick leave policies in place for individual businesses. Each business shall decide their own sick leave policies until bans on public gatherings and quarantines are imposed on the city of Oshkosh.

Essential Businesses Include:

- healthcare facilities

- pharmacies

- grocery stores

- gas stations

- water treatment plants

- garbage collection agencies

- mortuaries

The city will not provide infection-control supplies to the general public because Oshkosh will not be able to handle the financial burden of doing so during a crisis, and mass distribution of supplies would pose a problem (people’s skills and time will mostly be required in healthcare, and maintenance of order in the city). Each individual is responsible for obtaining their own infection control supplies such as tissues, masks, gloves, etc. The city will provide general information about the flu, proper cough etiquette and glove disposal in the form of pamphlets.

References

CDC Website (cdc.gov)Aurora Medical Center Human Resource DeptMercy Medical Center Human Resource Dept

WHO Website (who.int)Professor Todd Sandrin, Ph.D, University of Wisconsin-OshkoshProfessor Teri Shors, Ph.D University of Wisconsin-Oshkosh

Oshkosh Board of Health