Estimating the Potential Economic Impact of the Next
Influenza Pandemic upon Belize
Paul Edwards – MOH BelizeRony Maza – PAHO/WHO Belize
San Jose, Costa RicaDecember 16, 2005
Age Group Population
0-14 yrs 115,795
15-59 yrs 150,250
+ 60 yrs 16,555
Belize’s Population, by Age
Country Information
Country Information-Cont.
Source: CSO mid-year estimates, Belize 2004.
Total licensed non-ICU beds: 418
% licensed non-ICU beds staffed: 100%
Total staffed non-ICU beds: 418
Total licensed ICU beds: 12
% licensed ICU beds staffed: 100%
Total Staffed ICU beds: 12
Total number of ventilators: 4
% ventilators available: 100%
Total number of ventilators available: 4
Basic Hospital Resources
Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario
Population: Numbers and distribution by age and risk group
Risk groups0-14 yrs 15-59 yrs 60+ yrs
Totals % total
Non-high risk* 108,385 128,614 9,933 246,932 87%
High risk* 7,410 21,636 6,622 35,668 13%
Totals 115,795 150,250 16,555 282,600 100%
Note: High risk refers to pre-existing medical conditions (e.g., asthma, diabetes, heart and lung conditions) that increase risk of influenza-related adverse health outcome
Deaths: By age group
Gross attack rate Distribution of deaths by risk group
Age groups15% 25% 35% % high risk
% all deaths
0-14 yrs most likely 2 3 4 0-14 yrs 1% 3%
min 1 2 2 15-59 yrs 54% 62%
max 25 42 59 60+ yrs 29% 36%
15-59 yrs most likely 47 78 110 Totals 84% 100%
min 7 11 16
max 88 147 206
60+ yrs most likely 27 45 63
min 26 44 61
max 34 56 79
TOTALS most likely 76 126 177
min 34 57 79
max 147 245 344
Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario –
Cont’d
Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s scenario –
Cont’d
Hospitalizations: By age groupDistribution of hospitalizations by
risk groupGross attack rate
Age groups 15% 25% 35%
% high risk
% all hospital
0-14 yrs most likely 32 54 76 0-14 yrs 2% 8%
Min 16 27 3715-59 yrs
11% 73%
Max 136 227 318 60+ yrs 12% 19%
15-59 yrs most likely 278 463 648 Totals 25% 100%
Min 51 86 120
Max 303 505 707
60+ yrs most likely 72 121 169
Min 52 86 121
Max 91 152 213
TOTAL most likely 382 638 893
Min 119 199 278
Max 530 884 1,238
Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario –
Cont’dOutpatients: By age group
Gross attack rate Distribution of outpatients by risk group
Age group 15% 25% 35% % high risk% all
outpatient
0-14 yrs most likely 10,273 17,121 23,970 0-14 yrs 5% 44%
Min 8,582 14,304 20,025 15-59 yrs 7% 50%
Max 11,963 19,939 27,915 60+ yrs 2% 6%
15- 59yrs most likely 11,593 19,322 27,050 Totals 14% 100%
Min 8,324 13,873 19,422
max 17,695 29,492 41,288
60+ yrs most likely 1,285 2,142 2,999
min 1,213 2,021 2,830
max 1,995 3,325 4,655
TOTAL most likely 23,151 38,585 54,019
min 18,119 30,198 42,277
max 31,653 52,756 73,858
Total Estimates, per Health Outcome, from two Scenarios of Potential Impact of Next Influenza
Pandemic in Belize: Most likely (min, max)
Health Outcome
Scenario 1960s/70s † Scenario tipo-1918 ‡
Gross attack rate 35%* Gross attack rate 35%*
Deaths177
(79-344)1,456
(657-2,820)
Hospitalization893
(278-1,238)7,336
(7,280-10,181)
Outpatient54,019
(42,277-73,858)49,565
(47,250-50,035)
Ill without medical care43,821
(23,470-56,276)40,553
(38,659-40,938)
Outpatient + ill without medical care
90,118(85,909-90,973)
Demand for Hospital-based Resources: 1960/70s Scenario: 35%
Attack Rate: 8 Weeks DurationPandemic Influenza Impact / Weeks 1 2 3 4 5 6 7 8 9 10
Hospital Admission Weekly admissions 61
102
152
193
193
152
102 61
Peak admissions/day 30 30
Hospital Capacity
# of influenza patients in hospital 45 75
112
142
147
129 99 65
% of hospital
capacity needed 11%18%
27%
34%
35%
31%
24%
16%
ICU Capacity# of influenza patients in ICU 9 19 30 39 43 41 33 23
% of ICU capacity
needed 76%162%
248%
328%
355%
345%
274%
189%
Ventilator Capacity
# of influenza patients on ventilators 5 10 15 20 21 21 16 11
% usage of ventilator114%
243%
372%
492%
532%
518%
412%
284%
Deaths# of deaths from
influenza 11 18 27 34 34 27 18 11
# of influenza deaths
in hospital 7 12 19 24 24 19 12 7
Distribution of admissions: By day, 8 week outbreak 35% attack rate
0
10
20
30
40
50
1 8 15 22 29 36 43 50Days of outbreak
Da
ily #
of
ad
mis
sio
ns
Most likely Minimum scenario Maximum scenario
Hospital Admissions by Week: 1960/70s Scenario: Hospital Admissions (most likely, min,
max weekly admissions): 8 weeks duration
Pandemic Influenza Impact / Weeks 1 2 3 4 5 6 7 8 9 10
Hospital Admission Weekly admissions 501 836 1,253 1,587 1,587 1,253 836 501
Peak admissions/day 247 247
Hospital Capacity
# of influenza patients in hospital 368 614 921 1,167 1,208 1,062 814 534
% of hospital capacity
needed 88% 147% 220% 279%289% 254% 195% 128%
ICU Capacity# of influenza patients in
ICU 75 159 245 323 350 341 271 187
% of ICU capacity
needed 627%1329
%2041
%2696
%2917
%2838
%2255
%1557
%
Ventilator Capacity
# of influenza patients on ventilators 38 80 122 162 175 170 135 93
% usage of ventilator 940%1993
%3061
%4043
%4376
%4257
%3383
%2336
%
Deaths# of deaths from
influenza 11 18 27 34 34 27 18 11
# of influenza deaths in
hospital 7 12 19 24 24 19 12 7
Demand for Hospital-based Resources: 1918-type scenario: 35% attack rate: 8
weeks duration
Distribution of admissions: By day, 8 week outbreak 35% attack rate
050
100150200
250300
350400
1 8 15 22 29 36 43 50Days of outbreak
Da
ily #
of
ad
mis
sio
ns
Most likely Minimum scenario Maximum scenario
Hospital admissions by week: 1918-type scenario: 35% attack rate (most likely, min,
max weekly admissions): 8 wks duration
Workdays Lost due to an Influenza Pandemic: Two scenarios, 8 weeks duration, 35% attack rate †
Workdays lost
1960s/70s scenario
% all workdays full time*
1918-type scenario**
% all workdays full time**
Most Likely 416,099 12.3 561,734 16.6
Minimum 382,739 11.3 516,698 15.3
Maximum 466,249 13.8 629,436 18.6
* Percent of annual workdays, calculated as 132,821 fulltime equivalents employed of those aged 15-59 years age (88.4% of 150,250), multiplied by 250 workdays per year.† See Appendix III for details of methods and assumptions** Estimated based on other studies which demonstrate a 30-40% increase for the 1918-type scenario as compared to the 1960/1970 scenario therefore an average of 35% was utilized
Distribution of days lost from work, 8 week outbreak, 35% attack rate
0
2
4
6
8
10
12
14
16
1 8 15 22 29 36 43 50
Days of outbreak
# of
day
s lo
st f
rom
wor
k (in
1,0
00s)
Mostlikely Minimum Maximum
Economic Impact: Work-days Lost
Value of Lost Workdays
Value of lost workdays
Lost work days
1960s/70s scenario BZ$
1918-type scenario
BZ$
Most Likely 416,099days $25,964,577 $35,052,179
Minimum 382,739 $23,882,914 $32,241,933
Maximum 466,249 $29,093,938 $39,276,816
GDP 2004 = $2,071,200,000
Workday lost equivalent to % GDP: 1.25 1.69
Source: CSO: [GDP/(workforce X employment rate)]/250 work days/year= $62.4
Value of Direct Medical Care
Direct Medical Costs BZ$
Health outcomes
1960s/ 70s scenario†
1918-type scenario
Gross attack rate 35%*
Gross attack rate35%
Deaths* $263,139.00 $355,238
Hospitalized no ICU
$827,220.00 $1,116,747
Hospitalized ICU
$23,865,141.00 $32,217,940
Outpatients $34,417,666.00 $46,463,849
Ill, no medical care
$1,095,525.00 $1,478,959
Totals $60,468,691.00 $81,632,733
* Assumed 70% of deaths require medical care equivalent of 10 days ICU Source:
# Cost per
day**
# of days Total
Death 177 $212.38 7 $263,138
Hospitalizationa.No ICUb.ICU
1016
779*237*
$212.38$212.38
510
$827,220$23,865,140
Outpatient 54,019 $212.38 3 $34,417,665
Ill no medical attention
43,821 $212.38 0 $1,095,525
TOTAL $60,468,691
* Total of 1016 (893 + (70% of 177)** KHMH Budget $7M. Bed occupancy 78.5% of 115 beds (90.3). Therefore ($7M/90.3)/365=$212.38
MINISTRY OF HEALTH INFLUENZA PANDEMICPREPAREDNESS PLAN
NOVEMBER 2005BELIZE
100 nm
Planning Process
1. National Committee established with technical sub-committees
2. 3 preparatory meetings organized3. Meeting with stakeholders4. Presentation to Cabinet and
approval5. Development of guidelines and
SOPs
Background Information
Belize is free of both LPIA and HPIA
Surveillance in both poultry and wild birds
Factors Considered in Developing the Plan
Large population of migratory birds: 28% of bird species are migratory (from North and South America)
Significantly large poultry industry 3% of national population from Asian descent –
who travel to and from affected areas Importation of supplies/equipment from Asian
countries
The longest distance migrant is the Arctic Terns. They migrate from the Arctic circle to Antarctica each
year – an annual distance of approximately 25,000 miles.
Purpose and Objectives of the Plan
Purpose: To protect the Belizean population from the predicted outbreak of the avian flu
General Objective: To reduce the risk and the impact of the avian flu on the country
Specific Objectives:
•Reduce opportunities for human infection•Minimize the economic impact on the
agricultural/poultry industry•Strengthen early warning systems•Control or delay spread at the source•Reduce morbidity and mortality, and social
disruption
Periods Phases Response Actions
Pre-pandemic I.Virus confirmed in humans outside of Belize (bird to human transmission) II.Virus confirmed in humans in Belize (bird to human transmission)
Pandemic I.Human to Human transmission outside of Belize II.Human to human transmission in Belize
Post Pandemic I – The first wave of human to human transmission in Belize is controlled
Response Periods and Phases
Budget Summary
Component Prepandemic Pandemic Total
I II I II
Planning & Coordination
13,000 3,000 -- 10,000 26,000
Situation Monitoring & Assessment
22,500 6,000 29,000 5,000 62,500
Prevention & Control
143,500 57,500 120,000 -- 321,000
Multisector Response 500 40,000 --- -- 40,500
Communication 34,000 20,000 15,000 -- 69,000
213,500 126,500 164,000 15,000
340,000 179,000 519,000
66% 34%
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