THE BEST LAID PLANS: PREPARING FOR A PANDEMIC

J. Barry Mascari, Ed.D., LPC, LCADC

DRCC(NJ)

Kean University (NJ)

I had a little bird, Its name was Enza. I opened the window And in-flu-enza. 1918 children’s jump rope rhyme

Ring-around-the rosie, pockets full of posie, ashes, ashes, we all fall down Bubonic Plague children’s rhyme

Camus, The Plague

4 THINGS COUNSELORS SHOULD KNOW1. There will be a pandemic2. There will be many deaths3. Counselors will be needed to help people cope with

illness, death, mistrust, and scarcity4. The delivery system for counselors may have to be

altered5. Counselors will simultaneously serve as caregivers to

family members and others

1. There will be a pandemic A new virus subtype with little immunity in the

population That can replicate in humans Transmitted from one human to another efficiently

to cause community wide outbreaks

World Health Organization

PANDEMIC

Epidemic - when the observed number of cases exceeds the expected number of cases of a given disease in a given time period

Pandemic - when an epidemic spreads rapidly across many geographic locations (different countries or continents) 10 pandemics in 300 years 3-4 times every 100 years

Spanish Flu 1918 (H1N1) Asian Flu 1957 (H2N2) Hong Kong Flu 1968 (H3N2) [1 to 4 Million deaths] Recent - HIV/AIDS, SARS, West Nile Virus H5N1? Swine Flu 2009 (H1N1)?

QuickTime™ and a decompressor

are needed to see this picture.

Pandemic is not a Seasonal Flu

Infects 15-50% of population All ages are at risk Severe illness and high death rate Effective vaccine may not be available for 4-6 months after onset Effectiveness of antiviral drugs is unknown Drugs in short supply

Avian Flu (H5N1)

Epidemic in migratory birds and poultry Identified in 1997 in Asia

Bird-to-human (or human to human?) infection Vietnam, Cambodia, Thailand, Indonesia, Russia,

Azerbaijan, Egypt, India, Iraq, Laos, Nigeria, Turkey

Mammals: pigs, domestic cats, tigers Air travel increases pandemic risk

reaching all continents in three months vs. sea travel of 1918

2. There will be many deaths

Current world-wide death rates from H5N1 approach 50% US - 200 Million infected (66% of population)

90,000-207,000 deaths 314,000-713,000 hospitalized

NJ - most densely populated state nearly half of the population in 1/3 of state near

NYC Expect 8,000 deaths (5,700 in hospitals) - 1% rate 41,000 hospital admissions

Spanish Flu of 1918: The Great Flu

200 Million to 1 Billion infected 50 Million to 100 Million died 20-40 year old population suffered most deaths (not just

elderly and children, or at risk) In 2 years, nearly half the world was infected (3 waves)

3. Counselors will be needed to help people cope with illness, death, mistrust, fear, and scarcity

Fear and anxiety common in health crisis Contagious fear in groups

Perceived threat may be greater than real threat Large group irrational actions, potentially disruptive to

leaders Stress, fear leads to somatic complaints -more health care

sought

“...understanding and managing the public’s psychological and behavioral reactions to an unexpected outbreak of infectious disease are integral to successful response and containment.” CIA (2003). SARS: Lessons learned from the first epidemic of the

21st Century

5. Counselors will simultaneously serve as caregivers to family members and others

Safety: physical and emotional preparation Increased risk of contracting illness

Connectedness stay attached - phone, internet, video

Efficacy: don’t let crisis destroy inner resources to help selves

Resilience Vicarious traumatization

ATTITUDES QUIZ (1 No - 5 Yes)1. It’s always better to avoid a crisis if you can2. People usually make their own crises3. Crises just happen, often there is nothing you can do to

prevent them4. It takes about 3 months to recover from bereavement5. It is best to try to take your mind off things if you are upset6. There is always something to be learned from a crisis7. Once a person is very anxious or depressed, there is not

much they can do about it themselves8. If someone is experiencing horrifying ‘flashbacks’ to a

crisis event, it means they are suffering from PTSD

QUIZ (continued)9. Professional health workers generally know how to handle

a crisis10. You are more likely to have an accident following a

stressful event11. Professional help is usually needed if someone has had a

severely stressful event12. After most crises, it is best to get things back to normal

ASAP13. It’s just a matter of luck if you get the right kind of help

during a crisis14. Crisis is what happens when your emotions get out of

control.

PEOPLE DON’T PLAN TO FAIL…

THEY FAIL TO PLAN!!!!

PLANNING Who calls whom? Who is on charge of what? How fast can we mobilize our team? What if we need help? Whom can we call? How to avoid confusion:

ReadWrite a policyWrite clear procedure (steps to follow)Rehearse

Planning is more than a document…

The plan in relation to other plans (Red Cross, FEMA, etc.)

Not just the deployment of a responseConsidering the effects on caregiversAlways have a Plan B? C?Practice…

Determining Expected Degree of TraumaOates, M. D. (1988)

WHO STUDENT

Popular/well known (6) Other (3)

TEACHER Popular/well known (4) Under 32 yrs. old (2) Not well known (1)

HOW Murder/suicide (6) Accident (3)

Natural causes Unexplained (4) Short-term illness (3) Long-term illness (2)

WHERE At school (4) Local community (2) Other (1)GRAND TOTAL_______

DEGREE OF TRAUMA 12+ High 8-11 Moderate 0-7 Low

KEYS TO AN EFFECTIVE RESPONSE

SUPPORT CONTROL STRUCTURE

Normal people experiencing a normal response to an abnormal situation

AFTERMATHEmotional ventilation within 24 - 48

hours It takes a chunk out of you…

87% affected emotionally93% felt debriefing was necessary

Debriefing proceduresResponse plans for the future

Non-Anxious presence

Self-validated caregiving

Connection with others

Self-care

Skills building

RESOURCES

FEMA: www.fema.gov FEMA for kids: www.fema.org/kids/ NEA: www.nea.org/crisis/resources Red Cross: www.redcross.org ACA: www.counseling.org U.Colorado: www.colorado.edu/cspv/ Sidran Institute: www.sidran.org/trauma CDC flu: http://www.cdc.gov/h1n1flu/index.htm

Web Resources http://realage.typepad.com/avian_flu/ http://www.birdflubreakingnews.com/ Breaking news

http://virus.stanford.edu/uda/ http://www.pandemicflu.gov US Govt. Pandemic site http:///www.who.int/csr/disease/influenza/en/ http://www,pandemicflu.gov/plan/tab3.html Family planning guide

http://www.pandemicflu.gov/plan/tab4.html Business guide http://www.who.int/csr/en/ WHO Epidemic & Pandemic site www.cdc.gov/flu/pandemic CDC/P Pandemic Influenza Worldwide

Preparedness