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Best Practice - Orange City Schools Hold Pandemic Flu Seminar During In-service Day
Orange City Schools (OCS) in Cuyahoga County worked with numerous local organizations and agencies to offer a full day of pandemic flu planning that included multiple presentations and a tabletop exercise for its school staff. As part of the district’s annual safety drills, building and district command teams conducted a staff training program on pandemic influenza in November 2006. The goal was to provide staff the opportunity to evaluate plans, procedures and decision-making processes in response to an influenza pandemic. This was an in-service day for the district’s employees.
OCS also invited first responders, government agencies and community members to the seminar as well as private businesses, schools and colleges. More than 300 attended. The morning sessions consisted of presentations by planning partners on preparing communities, schools and individuals for a flu pandemic. The Cleveland Clinic Foundation presented an overview of pandemic flu. The Cleveland City and Cuyahoga County health departments presented on community preparedness strategies and the local American Red Cross discussed personal preparedness. The Case Western Reserve University (featured in Autumn 2006 newsletter) presented community strategies and a representative from the Centers for Disease Control and Prevention discussed school preparedness. The morning session concluded with the Pike Fire Department discussing local planning efforts of Community Emergency Response Teams (CERT).
The afternoon session contained a tabletop exercise divided into three phases: The Flu is Coming, The Flu is Here and The Flu is Bad. (Click here to view the exercise, PDF, 6MB.) Topics covered in the exercise included education, prevention, surveillance, investigation, isolation, health and communications. The emergency preparedness partners and cross-categorical staff who participated in the exercise were:
- Hunting Valley, Moreland Hills, Orange, Pepper Pike and Woodmere police departments
- Chagrin Falls, Orange, Pepper Pike and Woodmere fire departments
- Orange City Schools administration, teachers and staff
- Orange Community Education and Recreation
- CERT of Moreland Hills, Orange and Pepper Pike
- Cuyahoga County Board of Health
- Cleveland Department of Health
- American Red Cross
- Centers for Disease Control and Prevention
- Cleveland Clinic Foundation
- Case Western Reserve University School of Medicine
"The seminar showed how commitments and coordinated efforts on the part of schools, emergency responders and the community will yield plans to protect lives and resources,” said Philip Dickinson, Director of Operations and Business for OCS, in a letter of thanks to participants.
“The seminar evaluation by the participants indicated that they were very pleased with the information provided and we are discussing the next possible direction and actions to be taken,” said Dickinson.
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Community Containment – Historical Evidence it Works
Health experts tell us it will almost certainly be several months after the start of an influenza pandemic before adequate supplies of vaccine are ready. In the meantime, all of us will need to take other precautions to help ensure we don’t get exposed to the flu virus. The Centers for Disease Control and Prevention (CDC) have given a name to the various protective activities that do not include vaccine – they are nonpharmaceutical interventions.
One such intervention is called “community containment." While the term may sound as though it’s from an urban planner’s drawing board, it’s actually a collection of effective methods to reduce the spread of the flu during a pandemic.
Essentially, community containment has four parts. Current research and historical review of the 1918 pandemic show that using four interventions together early in the pandemic is effective at reducing the number of cases. The four parts of the modern-day community containment plan are (a) keeping sick people away from those who are not ill; (b) having those who are well voluntarily stay home if a family member is sick with flu; (c) temporarily dismissing school and keeping children from gathering; and (d) avoiding large crowds when possible.
The decision to limit public gatherings, stagger work shifts, close schools and cancel other functions and isolate those who were sick had a beneficial effect during the 1918 pandemic. The key to the actions’ success; however, was when they began.
Two days or two weeks? Big difference.
Recent studies funded by the National Institutes of Health reviewed the sickness and death rates from flu during the 1918 pandemic along with a search of newspaper archives and found some fascinating results. The research looked at more than a dozen U.S. cities to see which community containment measures were implemented and what the sickness and death rates were.
Both studies found a correlation between how quickly the restrictions on gathering and other interventions were put in place and a lower peak death rate. Put simply, fast action saves lives. For example, one set of researchers looked at 16 U.S. cities including St. Louis and Philadelphia. Within two days of the first reported cases of influenza, officials in St. Louis put into action a series of measures to reduce close gatherings of people. Other cities including Philadelphia implemented similar restrictions but waited as long as two weeks to do so; Philadelphia even permitted a parade to take place before curbing gatherings.
The peak death rate in Philadelphia was eight times that of St. Louis.
Community containment - How long should it be?
Research shows past pandemics appear to move through communities in waves; the 1918 pandemic occurred both in spring and autumn. The second study looked at how long cities put community containment measures in place and the effects of the disease in those places where restrictions were relaxed between waves of illness.
Cities that relaxed their restrictions often saw infections increase, thus creating the second disease wave. The study analyzed the influenza death rate in San Francisco from 1918 and 1919 and concluded if the city had not relaxed restrictions, the death rate may have been reduced by more than 90 percent.
Both studies bring evidence the modern-day recommendations from CDC should provide a degree of protection until adequate supplies of vaccine are ready.
Want to know more?
Read about community containment and other recommendations from CDC at: http://www.pandemicflu.gov/plan/community/mitigation.html
Read the two research studies of the 1918 pandemic and community containment efforts shown to slow the spread of the disease.
Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic
The Effect of Public Health Measures on the 1918 Influenza Pandemic in U.S. Cities
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The Centers for Disease Control and Prevention (CDC) recently issued guidance for use of masks during an influenza pandemic. The guidance stresses the necessity of using other preventive measures such as hand washing and social distancing in conjunction with the limited use of masks. The best way to avoid contracting a pandemic strain of influenza virus before vaccine is developed is to avoid others.
Following are links and information from CDC:
Community Settings
Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic: Provides recommendations of when to use each device, in conjunction with other prevention actions, such as hand washing, covering coughs and avoiding crowds.
Summary of Mask guidance
Workplace Settings
Guidance on Preparing Workplaces for an Influenza Pandemic (PDF - 313KB) (Occupational Safety & Health Administration): Provides guidance and recommendations on infection control in the workplace including information on proper mask and respirator use.
Health Care Settings
Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic: Provides background information on influenza transmission, pathogenesis and control. Gives recommendations on kinds of mask and respirators, as well as their proper use.
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On April 17, the U.S. Food and Drug Administration (FDA) approved a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu.
According to the FDA, the vaccine could be used in the event the current H5N1 avian virus was to develop into a pandemic strain. That is, has the capability to efficiently spread from human to human, resulting in the rapid spread of the disease around the globe. Should such an influenza pandemic emerge, this vaccine may provide early, limited protection in the months before a vaccine tailored to the pandemic strain of the virus was developed and mass produced.
Because it could take months for a vaccine specific to the pandemic strain of the virus to be mass produced, it is important to take actions to prepare and prevent for a flu pandemic. One of these actions is to begin stockpiling food, medicines and goods for an extended stay at home in the event of school closures and cancellations of public gatherings. Developing healthy habits like hand washing, covering coughs and sneezes and staying home when sick could help Ohioans prevent contracting or spreading illnesses. Making daily healthy choices like eating a balanced diet, exercising regularly and getting plenty of sleep could help prevent illness.
The H5N1 virus is one type of the influenza A virus commonly found in birds. Unlike seasonal human influenza, where symptoms range from mild to serious in most people, when humans become infected with the highly pathogenic avian H5N1 virus, the illness is far more severe and happens quickly, with pneumonia and multi organ failure commonly seen.
While there have been no reported human cases of the highly pathogenic H5N1 virus in the United States, almost 300 people worldwide have been infected with this virus since 2003 and more than half of them have died. To date, H5N1 influenza has remained primarily a bird disease but should the virus acquire the ability for sustained transmission among humans, people will have little immunity to this virus and an influenza pandemic would have grave consequences for global public health.
“The timing and severity of an influenza pandemic is uncertain, but the danger remains very real,” said Jesse L. Goodman, M.D., M.P.H., director of FDA’s Center for Biologics Evaluation and Research in an FDA press release. “We are working closely with other government agencies, global partners and the vaccine industry to facilitate the development, licensure and availability of needed supplies of safe and effective vaccines to protect against the pandemic threat.”
With the support of FDA, the National Institutes of Health and other government agencies, sanofi pasteur and other manufacturers are working to develop the next generation of influenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation’s ability to protect those at increased risk of exposure.
For more information, visit the FDA Web site.
As part of the Ohio Department of Health’s (ODH) communications plan, the Office of Public Affairs is printing educational materials and running a statewide media campaign this summer to supplement local health departments’ efforts. In the fall materials will be shipped to every local health department later this year. Quantities are based on the health jurisdiction’s population served.
An online survey completed by public health professionals such as health commissioners, health educators, nurses and epidemiologists indicates Ohio health departments are actively engaged in their communities’ pandemic flu planning and those activities could be boosted with additional materials. The kit will include brochures, fact sheets, emergency planning booklets, posters, vinyl clings and coloring calendars for children. ODH will have extra copies of materials available to community groups, schools and businesses by request until supplies are depleted. Be sure to contact your local health department to get involved in their planning efforts.
ODH also has surplus copies of the Pandemic Influenza Preparedness Guide for Retail Food Establishments developed in partnership with the Ohio Food Industry Foundation. This was a statewide effort to assist grocers in planning for an influenza pandemic and was distributed to more than 14,000 retail food establishments in 2006. Bundles of 50 are available by sending an e-mail indicating the number of bundles requested and your shipping address.
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There were three pandemics in the last century and experts believe it is just a matter of time before the next. The Ohio Department of Health (ODH) has two key goals. The first is helping Ohioans prepare for a pandemic now and the second is being ready to slow the spread of the disease when the pandemic begins, when a vaccine is unavailable and antiviral medicines are in short supply.
Protecting Ohioans
Recognizing the importance of “buying time” at the start of a pandemic, ODH continues to develop a community containment plan to limit transmission of the flu virus. A draft plan will be submitted to the Centers for Disease Control and Prevention (CDC) March 1; future versions of the plan will reflect feedback from our Ohio partners.
To help protect Ohioans who become ill with the pandemic strain of flu, the Ohio General Assembly appropriated $17 million to purchase antiviral medicines. These medicines will be securely stored in the state for rapid distribution when needed. ODH’s draft plan for antiviral use adopts the CDC recommendations: using antiviral medicines for treatment to prevent deaths and decrease the severity of the illness.
ODH is working to protect Ohio’s most vulnerable residents. ODH is now identifying alternatives and resources for those in need of dialysis, prescription medicines and home care supplies. ODH is drafting a plan to help immunocompromised populations and is also developing a general response plan to provide local health departments a model to address special needs populations in their area. With the Ohio Department of Jobs and Family Services, ODH completed a plan for migrant populations and has worked with the Ohio Legal Rights Council to distribute a special needs emergency planning booklet.
To effectively prepare for a pandemic, Ohio’s governments, businesses, community organizations and families must have science’s best and latest information about the disease. ODH has focused significant time and effort ensuring our partners and Ohio residents are well informed about pandemic influenza and what the State of Ohio is doing to prepare. After hosting a statewide planning summit in February 2006, ODH launched an interagency “one-stop” Web site http://www.ohiopandemicflu.gov. ODH publishes quarterly planning newsletters for businesses, schools, local government and faith-based and community organizations. ODH has conducted various print and broadcast paid media campaigns informing Ohioans what they can do to prepare for pandemic flu and other emergencies. An informational video DVD and several thousand copies of printed information (e.g., fact sheets, guides) on avian, seasonal and pandemic flu were distributed at the Ohio State Fair. ODH continues to receive requests for these materials and distributes them upon request.
Assisting the Medical Community
During an influenza pandemic, the number of patients will likely overwhelm health care resources quickly. ODH is collaborating with medical partners on medical surge issues by determining what needs to be addressed in anticipation of an increased demand on medical services (med surge) during an influenza pandemic. To this end, ODH has established a Medical Surge Committee; partners participating on the committee include long-term care, primary care providers and institutions, free clinics, hospitals, Ohio National Guard, Ohio EMA, health professional boards, home care, Ohio Division of EMS, Ohio Department of Mental Health, Ohio Department of Youth Services, and Ohio Department of Corrections. The Medical Surge Committee is working on the following tasks:
- Scope of practice issues: Develop tiers of care when resources are scarce along with altered standards of care guidance, including how implementation should be communicated.
- Ethical issues: Develop guidance document to assist decision making regarding when and how scarce resources are allocated – use a public process to discuss putting values on lives based on the likely ability to save the greatest number of individuals.
- Legal issues: Draft language for inclusion in the Ohio Revised Code to create immunity or assume liability for health care providers practicing under altered standards of care when declared by the State of Ohio.
- Insurance/reimbursement issues: Assure coverage under private insurance irrespective of where care is provided; Address malpractice insurance considerations.
- Hospital and community issues: Determine hospital capacity (e.g., bed capacity, negative airflow room capacity and number of ventilators). ODH has purchased more than 500 ventilators (used to help the patients breathe) for use during a pandemic and is developing a distribution plan with regional hospital coordinators and other designated medical professionals (e.g., respiratory therapists) to guide placement at sites throughout Ohio
- Public information and guidance: Develop instructions for families who will care for their sick at home.
Internal Preparations
With the creation of an on-site department operations center, ODH will be able to operate from one location and more easily gather and disseminate crucial information. Policies and procedures for the department operations center are nearly complete.
ODH utilizes the nationally-adopted and standardized incident command system (ICS) during substantial public health events. During a pandemic, up to 40 percent of employees may be home sick or caring for sick family members. By this summer, all ODH employees will be trained on ICS, as well as the National Incident Management System and the National Response Plan. Upon completion of this training, ODH’s table of organization for pandemic influenza will be three-deep with employees trained to serve in identified capacities.
ODH developed a business continuity plan, identifying its critical business functions and developing strategies to ensure that they can continue. This required looking at not only the physical needs of each business function but the personnel needs since pandemic influenza will impact. ODH, DAS and Ohio EMA then worked with the other state agencies to insure that all state agencies had a workable plan. These plans were exercised with the Governor’s office in June and again in November 2006.
Because of the large number of deaths possible during a pandemic, fatality management is an important issue. ODH has implemented a new electronic death registry system.
Support Agency Functions
ODH serves as a support agency on other projects related to an influenza pandemic. ODH is working with the Ohio Community Service Council on volunteer management and donations and mass care; all state agencies on continuity of operations planning for a pandemic; and the Ohio Emergency Management Agency on mass fatality planning and community recovery and mitigation.
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The Centers for Disease Control and Prevention (CDC) recently exercised its national pandemic influenza operations plan. The exercise took place over two days and involved the Ohio, Arkansas and Florida state health departments. The three states served as simulators to add to the realism of the exercise.
The Ohio Department of Health (ODH) used the opportunity to orient staff to the newly created ODH Department Operations Center (DOC). During the exercise, ODH staff reviewed DOC procedures and evaluated DOC resources, technology and support functions. |
Ohio Department of Health (ODH) partners become oriented to the ODH Department Operation Center during a CDC exercise April 25 – 26. |
By providing realistic simulated problems to CDC, staff members were able to experience potential roles and duties during the course of a flu pandemic and review the ODH pandemic influenza response plan. Members of City of Columbus and Cuyahoga and Franklin County local health departments also participated. Representatives from other partner agencies included Shoshanna Shelton, The Ohio State University Center for Public Health Preparedness; Bob Armstrong, The Ohio State University emergency coordinator; Bobbie Erlwein, CDC; and Matthew Pitts, United State Public Health Service.
The ODH DOC will be used during public health emergencies to enhance a coordinated response by the agency.
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