Social Distancing in Pandemic Influenza

Planning:

Meeting the Needs of Vulnerable Populations at

the Community Level

Alex Cole-Corde

North Dakota State University

Presentation Overview

•20th Century Pandemics;•21st Century Pandemics; •Pandemic Mitigation Strategies; •Social Distancing Effects;•Vulnerable Populations;•Social Distancing Effects on Vulnerable Populations;•Planning Deficiencies;•Pandemic Research Planning; and, •Conclusion.

20th Century Pandemics

1968 Hong Kong Influenza *US 34,000+

*Global 700,000+Attack Rate 25% – 40%Mortality Rate ≤ 1.0%

1957 Asian Influenza *US 70,000+

*Global 1 million to 2 millionAttack Rate 25% – 35%Mortality Rate ≤ 1.0%

1918 Spanish Influenza *US 500,000+

*Global 40 million+Attack Rate 25% – 35%Mortality Rate ≥ 2.5%

*Conservative Estimate of Pandemic-Related Deaths - USDHHS

Bridge to the 21st Century Pandemic

Bridge to the 21st Century Pandemics:

Not If, but How Many and How Bad?

•States are required to have Pandemic Influenza Plans (funding dependent);

•Most State Plans emphasize health services, pharmaceutical distribution, and limiting viral transmissions; Not societal effects; •20th Century Pandemics occurred in two to three ‘waves’ from six to eight weeks over 12 to 18 months;

Bridge to the 21st Century Pandemics:

How Bad, Continued…

•Pharmaceuticals may not work (viral strain resistant) or be in limited quantities (six to nine months to distribute nationally);

•USDHHS estimates up to 40% Americans ill (≤1% death rate) → 90 million ill, 45 million outpatient, 10 million hospitalized, between 200,000 to 2 million dead; and,

•Federal, State, tribal, and local governments will implement pandemic mitigation strategies.

Pandemic Mitigation Strategies

Non-Pharmaceutical Interventions (NPI)

•NPI(s) are pandemic containment measures engaged without the use of pharmaceuticals to minimize viral transmission by limiting person-to-person contact.

NPI types include:

•Isolation.

•Quarantine.

•Social Distancing.

Community Effects of Social

Distancing Depending upon Pandemic

Severity…

•Close nonessential businesses and noncritical services;

•Close public gathering places;

•Cancel public gathering community events;

•Close, limit, or restrict nonessential movement; and,

•Limit or cancel community services for socially dependent or vulnerable populations.

“In disaster preparedness, the terms vulnerable or special needs people or populations are used to

define groups whose needs are not fully addressed by

the traditional service providers. It also includes groups that may feel they

cannot comfortably or safely access and use the standard resources offered in disaster preparedness, response and

recovery.” ~CDC

Social Dependence of

Vulnerable Populations in

Disasters

Vulnerable Populations

Abused Women and Children and Shelter Dependent;

Animals, Display, Livestock, Pets, and Show;

Blind, Legally Blind;Caregiver Dependent (Human Assistance

and/or Service Animal); Chemically Dependent (drugs, alcohol, or

other);Children, Infants-Teens;

Chronically-Lonely, Depressed, or Suicidal;

Cultural, Ethnic, or Religious Restricted;Deaf, Deaf-Blind, Deaf-Dumb, Hard of

Hearing;Educationally Challenged, Illiterate;

Elderly;Emerging, Traveler, or Transient Special

Needs;

(Institutionalized or Facility Dependent Individuals not listed)

Vulnerable Populations

Habitually Dependent upon Social Services or Social Programs;

Homeless Adults and Children and/or Shelter Dependent;

Illegal and/or Legal Alien: Limited English or Non-English Proficiency;

Impoverished, Low income, Substandard Housed;

Medically Dependent or Medically Compromised;

Mentally Challenged;Mentally Ill;

Mobility Limited;Physically Disabled;

Pregnant Women;Racial and Ethnic Minorities;

Single Parents;University Students.

(Institutionalized or Facility Dependent Individuals not listed)

                                                        

                                                                                                                                                                    

                                                  

    

Negative Effects of Social Distancing

on Vulnerable PopulationsLimited accessibility to services and

resources:

•Consumables;

•Pharmaceuticals;

•Financial resources;

•Public transportation;

•Health care, medical treatment facilities/professionals;

•Hospice, home care or assisted living professionals;

•Child care assistance and education;

•Mentally and physically challenged programs;

•Social support and guidance persons;

•Shelters and missions;

•Welfare, social security, disability, and unemployment programs; and,

•Animal/pet food, supplies, and welfare services.

                                                      

                                                                                                                                                

                                          

Gap Analysis to Mitigate Planning

Deficiencies •Gap analyses of state and community pandemic plans to identify disparities between planning strategies and needs of vulnerable population;

•Reassess normal disaster aid distribution mechanisms – POD to DOP;

•No Vacuum Planning – include Community Stakeholders; and,

•Build Community Capacity to meet population needs.

Planning challenge is to identify the right resources to deliver to

the right residents.

Pandemic Research and Planning

Build Community Resiliency

and Capacity

• Identify Community Vulnerable Populations;

• Identify and Assess the Community Needs of Vulnerable Populations;

• Identify and Assess Community Stakeholders, Capabilities, and Resources; and,

• Bring Community Stakeholders

Together.

Building Community Resiliency and

Capacity

The Community Stakeholders

•Governmental Officials;

•Governmental Social Agencies;

•Non-Governmental Organizations;

•Faith-Based Organizations;

•Community-Based Organizations; and,

•Private Businesses.

University Pandemic Planning

ChallengesStudent Dependency

upon the University

System

•In-Residence Universities, Programs, and Classes;

•On-Campus Residents; and,

•Off-Campus Residents.

Coordinate University Pandemic Plans with

Community Pandemic Plans.

Conclusion

•Review State and Community Pandemic Plans;•Identify Vulnerable Populations;•Identify and Assess General and Specific Needs;•Assess Existing Community Resources and Capabilities;•Identify Planning Deficiencies;•Build Community Resiliency and Capacity through Stakeholder Partnerships;•Reassess and Retool the Planning Process;•Bridge the Gap of Planning Deficiencies; and,•Maintain Stakeholder Relationships Over Time.

Reinventing the Planning Process?

Pandemic Planning is not a discrete event that produces a ‘snapshot’ document for posterity; it is an organic, continual process that evolves over time and changes as situations and environments change. Therefore planning is NOT an end product, but a beginning process.

Thank You for your Energy, Attendance, and Time (E=MC²).Questions or Comments?

Sources and Acknowledgements

Sources

Glass R.J., L.M. Glass, W.E. Beyeler, and H.J Min. www.cdc.gov/ncidod/EID/vol12no11/06-0255.htm

Cindy Lambdinwww.idready.org

Minnesota Department of Healthwww.health.state.mn.us/divs/idepc/diseases/flu/avian/index.html

North Dakota Pandemic Flu Informationwww.ndpandemicflu.gov/

U.S. Centers for Disease Control and Prevention www.cdc.gov/flu/avian/ENTER

U.S. Department of Homeland Security http://www.dhs.gov/xlibrary/assets/NIPP_Plan.pdf.

U.S. Department of Human Health Serviceswww.pandemicflu.gov/

World Health Organizationwww.who.int/csr/disease/avian_influenza/en/index.html

Acknowledgementsהוה׳ , Carol Cwiak, and Jeanine Neipert

North Dakota State University