get the facts, not the flu: preparing your business for the next pandemic
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Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic. Catherine Slemp, MD, MPH 2006 Human Resources Summit and Governor’s Safety Conference November 1, 2006. Objectives / Overview. Review Influenza Basics Putting Pandemics into Perspective - PowerPoint PPT PresentationTRANSCRIPT
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Get the Facts, Not the Flu: Preparing Your Business for the Next
Pandemic
Catherine Slemp, MD, MPH
2006 Human Resources Summit and
Governor’s Safety Conference
November 1, 2006
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Objectives / Overview
• Review Influenza Basics
• Putting Pandemics into Perspective
• Why the Concern Now (Avian Flu-H5N1)
• Discuss Pandemic Control Measures
• Implications for Business
• Pan Flu All Hazard Preparedness
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• Incubation period ~1-4 days
• Transmission: Respiratorydroplet (coughing, sneezing); Contact? Aerosol?
• Seasonal Flu causes– 200,000 hospitalizations– 36,000 deaths / yr
• Flu Viruses are constantly changing, evolving, reassorting
INFLUENZA – Key Facts
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Influenza Pandemic Viruses
Requirements:– A new influenza A subtype that can infect humans
AND– Causes serious illness
AND– Spreads easily from human-to-human
H5N1 meets the first two prerequisites,
but not the last
Next pandemic virus may or may not be due to a variation of current H5N1 virus
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Putting Flu Pandemics in Perspective
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Impact of 1918 Pandemic on US Life Expectancy
1918: heavy impact on young healthy adults –nation’s workforce
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Daily Deaths in Ohio - 1918
Brodrick OL. Influenza and pneumonia deaths in Ohio in October and November, 1918. The Ohio Public Health Journal 1919;10:70-72.
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West Virginia in 1918
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The Bluefield TelegraphOct. 8, 1918
Flu stops court,BluefieldOct. 8, 1918
Huntington mayor diesOct. 19, 1918The New Dominion,
Morgantown, WVOct. 24th
Business
Court System
Local GovernmentNewspapers
COMMUNITY INFRASTRUCTURE
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“Less than half a dozen families in Fayetteville have illness…Dr. Grose was one of the first victims….”Oct. 10, 1918, The Fayette Tribune
“The Mt. Hope-Kilsyth community is credited with over 500 cases and the death rate is on the increase….”Oct. 31, 1918, The Fayette Tribune
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Why the Concern Now?
“AVIAN” OR “BIRD” FLU: THE H5N1 VIRUS
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Update
As of 10/31/06: 256 cases; 152 deaths; most poultry related
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H5N1 in Humans – 2003-2006
• As of October 31, 2006: 256 cases, 152 deaths (~60%)– Ten countries
• Sporadic, with occasional clusters
• Most had touched or handled sick poultry
• A few cases of probable, limited human-to-human transmission
• All lived in countries with poultry outbreaks
•
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Sample Estimate of Morbidity/MortalityWest Virginia*
• Characteristic Moderate (1957-68-like) Severe (1918-like)• Illness 540,000 (30%) 540,000 (30%)• Outpatient 270,000 (50%) 270,000 (50%)• Hospitalization 5,314 60,813• ICU Care 791 9,123• Ventilators 399 4,558• Deaths 1,284 11,690
* based upon DHHS U.S. estimates applied to WV population numbers. These are in the absence of potential interventions.
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Much we don’t know … about the next pandemic
• When will it occur?• Which virus will cause it, H5N1 or another?• Who will be most at risk (Elderly and infants? Healthy
adults? Children?)• How severe an illness will it cause?• Will there be multiple waves?• Will antiviral medication work?• How long until we have a vaccine?• What are the best control measures?
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Understanding Disease Spread
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Ro = 2R0 = 1
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Ways to Increase “Social Distance”
Implement “Community Shielding” recommendations Close or alter high risk transmission environments e.g. schools,
daycare centers if supported by epidemiology Cancel large public gatherings (concerts, theaters) Minimize other exposures (markets, churches, public transit) Encourage ill and exposed persons to stay home (isolation and
quarantine) Encourage telecommuting; other worksite adaptations Scaling back or altered transportation services (holiday schedule)
Consider additional community measures COOP to minimize economic impact Distribution of surgical masks, barrier precautions, hand hygiene
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Planning Pandemic Control Measures
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Potential Tools in Our Toolbox• Our best countermeasure – vaccine – will probably be
unavailable during the first wave of a pandemic
• Antiviral treatment may improve outcomes but will have only modest effects on transmission
• Antiviral prophylaxis may have more substantial effects on reducing transmission
• Infection control and social distancing should reduce transmission, but strategy requires clarification
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Community interventions
What does history and modeling tell us?
What planning can be done now?
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Weekly mortality data provided by Marc Lipsitch (personal communication)
1918 Death Rates: Philadelphia v St. Louis
0
2000
4000
6000
8000
10000
12000
14000
16000
9/15
/22
9/22
/22
9/29
/22
10/6
/22
10/1
3/22
10/2
0/22
10/2
7/22
11/3
/22
11/1
0/22
11/1
7/22
11/2
4/22
12/1
/22
12/8
/22
12/1
5/22
12/2
2/22
12/2
9/22
Date
Dea
ths
Rat
es /
100
,000
Po
pu
lati
on
(A
nn
ual
Bas
is)
PhiladelphiaSt. Louis
A Tale of Two CitiesA Tale of Two Cities
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Value of combining strategies – Longini model
0
10
20
30
40
50
60
70
Clinical attack rate Antiviral stockpile needed
Base case (Ro=1.9)Generic social distancingSchool closureSchool closure + generic social distancing60% Case treatment + 60% household prophylaxis60% Case treatment + 60% household prophylaxis + 60% social prophylaxis (60% TAP)60% TAP + School closure + generic social distancing
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Workplace / Classroom Social Density
http://buildingsdatabook.eren.doe.gov/docs/7.4.4.xls
11.7 feet 3.9 feet
7.8 feet
Elementary Schools
Hospitals
Offices
16.2 feet
Residences
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Spacing of people: If homes were like schools
*Based on avg. 2,600 sq. ft. per single family home
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Spacing of people: If homes were like schools
*Based on avg. 2,600 sq. ft. per single family home
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66 million
18 million
9 million8 million5 million
Labor Status of Parents in U.S.
Source: U.S. Census Bureau, Population Division, Current Population Survey, 2003 Annual Social and Economic Supplementhttp://www.census.gov/population/www/socdemo/hh-fam/cps2003.html
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What are limits of this data?
• Observational data from 1918; data incomplete; cannot link cause and effect
• Modeling impact of different interventions. Useful, but
• Doesn’t yet incorporate impact of people’s behavioral responses to interventions
• Doesn’t incorporate secondary consequences of interventions (e.g., effects of school closure on education, workforce, etc.)
• Does help shape discussion.
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A Targeted and Layered Approach
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A Layered Approach
Individual / Household / Business
Hand hygieneCough etiquetteInfection controlLiving / working space adaptationIsolation of ill & designated care provider
Community
Isolation of illTreatment of illQuarantine of exposedProphylaxis of exposedSchool closureProtective sequestration of childrenSocial distancing
- Community- Workplace
Liberal leave policies
International
Containment-at-sourceSupport efforts to reduce
transmissionTravel advisoriesLayered screening of travelersHealth advisoriesLimited points of entry
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Epidemiology Drives Approach(Targeted)
Mild Moderate SevereCase Fatality Rate ≤ 0.1% 0.1 - 0.5% ≥ 0.5%
Isolation Yes Yes Yes
Treatment Yes Yes Yes
Quarantine No ??? Yes
Prophylaxis High-risk individuals High-risk individuals Yes
School Closure Reactive Punctuated ??? Proactive
Protective sequestration High-risk individuals High-risk individuals Children
Community social distancing
High-risk individuals Encouraged Encouraged + selective closures
Workplace protections Encourage good hygiene
Social distancing Aggressive social distancing
Liberal leave policies Confirmed influenza Influenza-like illness ILI and/or sick family members
SAMPLE
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Remember: We have a Tool Kit of Control Measures to Use
• Community Shielding (many methods)
• Hygiene measures
• Antivirals (treatment; prevention, if supplies sufficient)
• Vaccine
• Continuity of Operations Planning
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Current Thoughts on Control Measures
• Earlier rather than later implementation of measures more likely to be effective
• Targeted and layered application of measures (e.g., combinations are more effective than a single measure at a time; scale response based on severity of pandemic)
• Communities must consider practicality and ethics of implementing any measure.– Transparency– Public discussion and dialogue– Planning– Coordination across jurisdictions
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Tackling This from the Business Perspective
• Educate Leadership and Staff• COOP, COOP, COOP (Continuity of Operations)• Personnel Policies• Knowing your Workforce• Employee and Family Safety• Employee Communications• Contributions to / Participation in Community
Response
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Interesting Correlation
Businesses truly embracing a culture of preparedness
High performing businesses everyday
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Leadership
Imagination
Resiliency of Businesses and Communities
What does this take? (Now and when the time comes)
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Contributors to Historical Analysis and Modeling
HSC/NSPI Writing Team
Richard Hatchett, MD
Carter Mecher, MD
Laura McClure, MS
CDR Michael Vineyard
NIH
James Anderson, PhD
Irene Eckstrand, PhD
Peter Highnam, PhD
Ellis McKenzie, PhDCDC
David Bell, MD
Martin Cetron, MD
Rachel Eidex, MD
Lisa Koonin, MN, MPH
Anthony Marfin, MD
Modelers
Joshua Epstein, PhD
Stephen Eubank, PhD
Neil Ferguson, PhD
Robert Glass, PhD
Betz Halloran, PhD
Nathaniel Hupert, MD
Marc Lipsitch, MD
Ira Longini, PhD
HSC
Rajeev Venkayya, MD
Ken Staley, MD, MPA
RTI
Philip Cooley, PhD
Diane Wagener, PhDUniversity of Michigan
Howard Markel, MD
Department of Education
Camille Welborn, MS
Department of Labor
Suey Howe, JD
Department of Finance - Canada
Steven James
Timothy Sargent
Department of the Treasury
Nada Eissa, PhD
Chris Soares, PhDJohn Worth, PhD
NVPO
Bruce Gellin, MD
Ben Schwartz, MD
NSC
Rita DiCasagrande, MS
CEA
Steven Braun, PhD
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Get Informed, Be Prepared!
RESOURCES
WV Bureau for Public Health: http://www.wvflu.org
Your Local Health Department or Emergency Management Agency
USDHHS: http://www.pandemicflu.gov Seattle-King County Health:
http://www.metrokc.gov/health/pandemicflu/ CDC: www.cdc.gov