Druckman flu presentation

Pandemic Preparedness: What Companies Need to Know Myles Druckman, MD NEMA ConferenceMarch 2006: 

Pandemic Preparedness: What Companies Need to Know Myles Druckman, MD NEMA Conference March 2006

Slide2: 

Does my organization need a Pandemic Plan? Is the threat real??

What Are Companies Doing Today?: 

What Are Companies Doing Today? Where does your organization stand in preparing for a pandemic? (From SOS Webinar Participants) Feb 2006 Dec 2005 Sept 2005 a. Pandemic will not be an issue 2% 2% 2% b. We are investigating options 61% 72% 75% c. Implementing plan 36% 26% 16% d. Implementation complete 0% 1% 4%

Why the Concern?: 

Why the Concern? Influenza A / H5N1 Avian Flu is present in poultry flocks in an increasing number of countries Human cases are occurring with high mortality rate World is “overdue” for another influenza pandemic World is not adequately prepared If virus changes (mutates) to be able to be transmitted from “human-to-human”  could become PANDEMIC INFLUENZA

The Present Avian Flu Threat: 

The Present Avian Flu Threat An Influenza Virus must have three (3) attributes to become a Pandemic Virus: A novel (new) virus which humans have no immunity  The virus causes significant human illness and death  The virus can spread easily from person to person x Avian Flu H5N1 has 2 out of 3 today…

WHO Situational Assessment : 

WHO Situational Assessment Risk of Pandemic is great… The risk will persist… The evolution of the threat cannot be predicted… The early warning systems are weak… Preventative intervention is possible, but untested… Preparation is the best protection…

Slide7: 

Key Pandemic Learning Points

Key Pandemic Learning Points: 

Key Pandemic Learning Points Pandemic “means” the whole world 1918-19 Spanish Flu – the benchmark H5N1 – “The Basics” WHO Pandemic Phases Pandemic “Waves” Business Implications Surveillance limitations Role of Antivirals, Vaccines Corporate Planning to protect staff and delay/prevent infection to keep the business running

Whole World Affected: 

Whole World Affected A Pandemic means THE WHOLE WORLD will ultimately be affected: NOT ONLY AN “ASIAN PROBLEM”

1918-19 “Spanish Flu” – the Benchmark: 

1918-19 “Spanish Flu” – the Benchmark Avian strain of influenza virus Spread around the globe in 4-6 months Had several "waves" of infection (each lasted 6-12 weeks) Infected between 25-30% of the world population (attack rate) 0.5-3% of those infected died (40-100 million world-wide) Majority of deaths were in persons 18 to 40 years old (Cytokine Storm?) Called “Spanish Flu”, however the disease struck all continents Virus reconstructed - has similarities to H5N1

Slide11: 

An Influenza Ward

H5N1 - The Basics: 

Avian influenza H5N1 virus is now affecting wild birds and poultry flocks in an increasing number of countries Aggressive infection - quickly kills whole flocks Control in poultry: Culling Vaccination (controversial - EU) Can infect humans - mainly only people living/working with poultry Over 150 people infected - half have died (mortality rate 50%) Cannot yet easily spread from person to person H5N1 - The Basics H5N1 has similarities to 1918-19 virus

H5N1 - The Basics: 

H5N1 - The Basics Who is being infected? At this time, workers and families living in/near poultry farms and live animal markets Infected How? Bird flu virus is contained in the feces of infected birds Is it spreading from human-to-human? No confirmed cases to date Sept 2004: One Thai family – family cluster of 4 cases – inefficient spread, one generation only Increasing small human clusters. Human-to-human transmission possible

Slide15: 

How could Avian flu develop the ability to spread from human to human? Genetic mutation or Genetic recombination

How is Influenza Spread?: 

How is Influenza Spread? Mainly by “droplet” spread: Droplets containing the virus are produced when coughing, sneezing and talking If deposited in mouth, nose, eyes – can infect another Virus active on hard surfaces for 48 hours “Aerosol” spread: Unusual Possible in very crowded conditions ?? Subways ?? Planes

Slide17: 

WHO Pandemic Classification

Slide18: 

Pre-pandemic Period

Slide19: 

Pandemic Alert Period

Slide20: 

Pandemic Period Post Pandemic Period ----return to interpandemic period

Slide21: 

Pandemic Waves Flu “waves” last 2-12 weeks Waves fade, then recur multiple times “Peak” of wave lasts 1-3 weeks Implication: Some locations will be affected when others are not Periods where up to 50% of work force affected (directly or indirectly)

Slide22: 

Newly Affected Region Resolving Affected Region Mid-Pandemic Scenario

Pandemic Implications: 

Pandemic Implications Effect in the community: In the USA: 90,000 to 200,000 deaths 18 to 42 million outpatient visits, 314,000 - 734,000 hospitalizations Another 20 to 47 million falling sick Health care systems may become overwhelmed Essential services may break down as key personnel are infected Businesses and schools may close International travel may be limited as governments restrict entry. Good planning should limit loss of essential services

Implications to Business: 

Implications to Business Effect on business: Crisis lasting 9-15 months Prolonged reduction of workforce HR issues (medical plan, benefits packages, etc.) Supply issues Distribution and sales issues

Pandemic’s Unpredictable Course: 

Pandemic’s Unpredictable Course At any one time, could have high percentage affected in: A continent A country A city A neighborhood An office / factory A specific department in your office Virus can affect multiple locations simultaneously or may be significantly delayed affecting certain locations

Implications to Personnel: 

Implications to Personnel Sickness, anxiety and death among workforce: Up to 30% could be infected (over a 12-18 month period) Of those, up to 1-3% or more of these could die (1% of staff) Up to 50% of workforce may be absent at peak of wave – either ill, caring for sick family members, lack of transport, anxiety

Personnel Implications: 

Personnel Implications At any one time, could have employees: Well Just developing influenza Severely ill In hospital Recuperating Recovered (“immune”) Off work caring for family “Pandemic Manager” to track personnel

Personnel - Operational Implications: 

Personnel - Operational Implications Identify Employees Likely to be off work: Family with children Family with parents (elderly) Public transport to work Who CAN work VS who SHOULD work: “Shut down and survive” vs. “Business Critical”

Slide29: 

Surveillance Limitations Local Public Health Issues: Cases in rural areas with limited public health resources Locals affected where poultry is livelihood “PR” issue with major business implications if outbreak occurs CDC and WHO limitations: Must collect and check all details before confirm Implication: Announcements regarding Phase change or escalation may be delayed International SOS will “call” a phase change, if necessary

LATEST NEWS PAGE: 

LATEST NEWS PAGE Available in Public Area See our Pandemic Preparedness website: via www.internationalsos.com

The Antiviral Drug Issue: 

The Antiviral Drug Issue Antivirals drugs MAY be effective (not proven) to protect and treat during initial “wave” of pandemic – before a vaccine is produced Questions to resolve: Is it available at present location? Is the expiry date acceptable? Is there a medical facility capable of prescribing/storing? Who gets it, how much to buy, what cost? How to distribute?

Antiviral Drugs: 

Antiviral Drugs Tamiflu (capsule) Treatment – 1 cap twice daily for 5 days Protection – 1 cap daily for 30-90 days Best to take within 6 hrs of symptoms, before 48 hrs Relenza (inhaler) Treatment only Some respiratory side effects

Pandemic Vaccines: 

Pandemic Vaccines Pandemic Vaccine – what virus are we protecting against? Possibly four (4) groups of H5N1 strains in the world Many sub-strains (even within one patient) Any of these could become the pandemic strain Ideal vaccine can only be produced once Pandemic Virus is known – production time > 6months

Pandemic Vaccines: 

Pandemic Vaccines Several current “candidate” H5N1 Vaccines: Virus could mutate – effectiveness unsure Made in eggs -> 6 month delay for bulk production Some governments are stockpiling small quantities Don’t produce strong immunity - 2 shots required Experimenting with adjuvants May not protect against final pandemic virus Cannot assume that this vaccine will protect your staff

Pandemic Vaccines: 

Pandemic Vaccines Recent vaccine developments: Early development H5 vaccine Took parts of H5 hemaglutanin and put on adenovirus No eggs required / faster production Protective to mice Potentially effective against all H5 (so genetic drift not a problem) Not ready for human trials M protein vaccine Potentially effective against all influenza viruses Not ready for human trials [see www3.niaid.nih.gov]

Slide36: 

Pandemic Planning Strategy

Purpose of Pandemic Planning: 

Purpose of Pandemic Planning Reduce sickness and mortality in staff Business continuity

Steps in Pandemic Planning: 

Steps in Pandemic Planning Step 1: Create a Pandemic Planning Team High level / Cross functional / Has authority Step 2: Educate Team Members – Pandemic issues and Implications Step 3: Develop a WHO phase based Corporate Pandemic Plan Link corporate policies to actions, based on phases and affected regions Step 4: Customize Corporate Plan to Local Corporate Locations Step 5: Implement Plan – orient and train key management Educate and orient staff Step 6: Test Plan (drills) to ensure that the plan works Step 7: Monitor situation, and modify plan as required

SOS Pandemic Planning Methodology: 

Reinforce Knowledge Base Corporate Policies & Rationale Corporate Action Plan Site Specific Action Plans SOS Pandemic Planning Methodology Tabletop Scenarios Briefings Develop company-wide Policies to drive actions Phase-specific Action Table linked to deliverables Customize down to local environment

Phased Pandemic Planning: 

Phased Pandemic Planning “Policies” will drive “Actions” Policies define “What” and “Why” the company is planning; Actions are SPECIFIC PROCESSES that commence when certain criteria are met – pandemic phases / affected regions E.g.. - Door screening, travel restrictions, work from home policies, evacuation plan, training documents, communications, etc.

Phased Pandemic Planning: 

Phased Pandemic Planning Actions will be triggered by: When we move to a new Pandemic “Phase” and; Whether the location is in an “Affected” region or not Example: Phase 4 declared in Bangkok (affected) – actions taken Phase 4 (global) – Washington (non-affected) – different actions taken (I.e. no door screening in non-affected)

Slide42: 

Sample Corporate Action Table Phase 3 Phase 4 Phase 5 Phase 6

Slide43: 

Pandemic planning 2. Optimizing employee health 3. Vaccines 4. Risk reduction 5. Personal hygiene 6. Personal protective equipment 7. Cleaning 8. Antivirals 9. Management of influenza infections 10. Travelers 11. Evacuation 12. Management of the Deceased Pandemic Topics to Cover

Slide44: 

6.1 FAQ: Masks 6.2 FAQ: Mask use in phase 3 6.3 FAQ: Mask use in phase 4 & 5 6.4 FAQ: Mask use in phase 6 6.5 Poster: Using masks 6.6 FAQ: Gloves 6.7 Poster: Wearing gloves 6.8 FAQ: Gowns 6.9 FAQ: Calculating stockpiles of personal protective equipment Level of Detail Required

Once Plan Completed…Next Steps: 

Once Plan Completed…Next Steps Plan Implementation Management Training Local Staff Training E-Learning Tools Pandemic Drills On-going Plan maintenance Modify to meet changing Pandemic issues

Slide49: 

Corporate Pandemic Planning Benchmarking

What Are Companies Considering & Implementing?: 

What Are Companies Considering & Implementing?

What Industries are Engaged?: 

What Industries are Engaged? Since July 2005, SOS has consulted to organizations in many industries to assist with developing their pandemic plans:

Pandemic Assistance Required?: 

Pandemic Assistance Required? In which of the following areas might your organization require outside assistance for pandemic preparation? High-level briefings or discussion papers for senior management ( 17%) Education on clinical matters and pandemic preparation ( 29%) Assistance in developing customized pandemic plans ( 43%) Support in assessing potential antiviral stock ( 14%) Other ( 3%) None

Q & A: 

Q & A