Pandemic Flu‘The Bigger Picture’

Response!

Shayne WardEmergency Planning Officer

NHS Lincolnshire

Presentation Overview Pandemic Flu – dispelling the myths!

Seasonal vs. Pandemic Vaccines, Antivirals and Antibiotics Bird Swine vs Human Influenza

Activation & Predicted Impact Current International & National Levels Activation vs. Response Predicted Impact The wider impacts of Pandemic Flu

‘SEASONAL’ FLU

• Occurs every year during the winter

• Affects up to 10% - 15% of the population

• The very young, the very old and people with certain chronic illness are most at risk

• Annual vaccination available

• Antiviral drugs available for the at risk

PANDEMIC FLU

• Occurs about 3 times each century – at any time of the year

• May affect up to 50% of the population

• People of every age may be at risk (Currently, its mainly under 19 Year Olds)

• Vaccine won’t be available initially - in the first wave (Hope to be available in Autumn 2009)

• Antiviral drugs available for up to 50% of the population (80%)

Seasonal ‘flu vs Pandemic ‘flu

Previous ‘flu Pandemics

• Pandemic Spanish Flu Asian Flu Hong Kong Flu• Strain: A(H1N1) A(H2H2) A(H3N2)• Year: 1918-1919 1957-1958 1968-1969• Origin: Not known China China• Estimated Deaths • Global 20-40 million 1million 1-4 million• UK 250,000 33,000 30,000• Age Group 20-50 yrs under 14 yrs under 5 yrs• over 65 yrs over 65 yrs

Swine Flu 2009 A(H1N1)Shortest interval = 11 yearsLongest interval = 39 yearsCurrent interval = 40 years

Vaccines, Antivirals and Antibiotics

Not Silver Bullet Solutions! Vaccines Offer protection against a ‘specific’ strain Up to 4-6 months to develop specific vaccine Longer to manufacturer in sufficient quantities Pre-pandemic vaccines – may offer Health Care

Workers some protection but will not be exact ‘fit’ of pandemic strain (not applicable isn’t a strain of H5N1!)

Antivirals Is a counter-measure rather than protection Reduces length of infection Reduces severity and therefore secondary

infections

Antibiotics For counteracting secondary bacterial infections e.g.

affecting lungs and heart

DOMESTIC BIRDS

MIGRATORY WATER BIRDS

From Birds to Humans followed

by re-assortment in Humans

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

H5N1

DOMESTIC PIGS!

MIGRATORY WATER BIRDS

From Birds to Humans followed

by re-assortment in Humans

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

H1N1

Pandemic Flu Activation

World Health Organisation (WHO)

pandemic flu alert levels • Swine flu was declared a pandemic on 11 June 2009 with the

announcement of phase 6

NATIONAL ACTIVATION

United Kingdom• When the international situation reaches

WHO Phase 6 there will be 4 alert levels in the UK:

• UK alert level 1 No cases in the UK• UK alert level 2 Virus isolated in the UK• UK alert level 3 Outbreak(s) in the UK• UK alert level 4 Widespread activity cross

the UK

The UK Government pandemic flu response

• Antiviral stockpile – enough for 80% of UK population • Antibiotic stockpile – to treat and prevent secondary bacterial

infections• Advanced purchase agreements for up to 132 million doses of

pandemic-specific vaccine, when it becomes available. Enough for 100% of the UK population.

• Face masks (for front line health and social care workers)• National Pandemic Flu Service• Guidance from the Department of Health and other bodies• Communication programme that includes TV, radio, internet, and

leaflet drop

The National Service Framework

Objectives of the National Flu Service Framework

• to ensure that the right people get the right treatment at the right time, whilst enabling people who have flu to stay at home ; and to minimise the impact of influenza on the NHS.

Local Response Strategy Mitigation Response

The basis of a large scale response strategy will be• that the person with flu stays at home• antivirals are collected on their behalf from a

designated local Antiviral Collection Point by a ‘flu friend’1.

• Antivirals will only be issued if the patient fulfils the criteria set out in a clinical algorithm used by the National Pandemic Flu Service by Phone or Internet assessment.

• UNDER 1’S & PATIENTS WITH CO-EXISTING CONDITIONS WILL BE SEEN BY GPs/HCPs

• Plan for accessing antivirals for Care Homes• <15 residents use Flu Line• >15 residents – Health Professional /

delivery arrangements in line with local protocol.

SOCIAL CARE NATIONAL ACTIVATION

Social care communications

challenges• To ensure that swine flu messages reach those who may be excluded

from the national door drop and other mainstream communication channels, such as:

– older people, especially if they live alone

– people living in care homes

– young people (research suggests under 24s are less likely to receive/read the leaflet)

– people for whom English is not a first language and/or who have literacy issues

– people with a visual or hearing impairment

– people with learning disabilities or mental health issues

– street homeless and other groups without regular accommodation

• Social care workers may need to act as ‘flu friends’ for vulnerable people who have no-one else to help them

• Effective communication between local authorities and independent and third sector providers

Pandemic Flu Predicted Impact

PAN FLU – SURGE CAPACITY & PRIORITISATION STAGES

3

Predicted Impact in Lincolnshire, based on a population of 750,000, 50% Attack Rate

Week ClinicalCases

GPConsultation

s

Minimum total excess hospitalisations

Excess deaths

1 375 107 15 9

2 750 214 30 19

3 3000 855 120 75

4 11625 3313 465 291

5 39750 11329 1590 994

6 81000 23085 3240 2025

7 79500 22658 3180 1988

8 53625 15283 2145 1341

9 36375 10367 1455 909

10 28125 8016 1125 703

11 19500 5558 780 488

12 9750 2779 390 244

13 6000 1710 240 150

14 3375 962 135 84

15 2625 748 105 66

Total 375375 106984 15015 9386

What are the solutions?

• Resilience– Business Continuity Management System (BCMS)

embedded into your organisation – no matter how small

– Regularly updated and tested continuity plans– Plan for accessing antivirals

• <15 residents use Flu Line• >15 residents – Health Professional / delivery

arrangements

• Infection Control– Stay at home & isolate yourself where possible– Contact the National Flu Line– Infection control methods and PPE– Masks – Only useful if within 1 metre of a

possibly symptomatic patient. (Aerosols generated) – see Social Care Guidance

Infection Control & PPE

Emma Lee, NHS Lincolnshire