Influenza planning

Citation

(2010), "Influenza planning", Disaster Prevention and Management, Vol. 19 No. 1. https://doi.org/10.1108/dpm.2010.07319aab.005

Influenza planning

Article Type: News items From: Disaster Prevention and Management, Volume 19, Issue 1

Cooperation and communication are still central

While the complexity of preparing for a flu pandemic is not lost on anyone, at least two fundamentals of disaster planning have been reinforced at the state, local, and federal levels – communication and cooperation.

A report by the Trust for America’s Health (www.healthyamericans.org) released in September, 2009, said, “Overall, the H1N1 outbreak has shown that the investment the country has made in preparing for a potential pandemic flu has significantly improved US capabilities for a large scale infectious disease outbreak, but it has also revealed how quickly the nation’s core public health capacity would be overwhelmed if the outbreak were more widespread and more severe.” At the National After Action Workshop on a Federal Public Health Emergency: The Novel Influenza A/H1N1 Epidemic of Spring 2009, hosted in September by the UCLA Center for Public Health and Disasters, public health officials said they were finding it difficult to convey messages from epidemiological studies to the “Joe Black” general public.

Misconceptions such as H1N1 being a “mild” virus, misguided school closings, undeveloped virus exposure reduction strategies, and complicated “layman” guidance documents are but a few examples of the inability to convey the right information. The divide, according to Capt. Stephanie Zaza, of the Coordinating Office for Terrorism Preparedness and Emergency Response at the Centers for Disease Control and Prevention, can partially be explained by difficulties in the communication of guidance in a situation of genuine uncertainty.

The Trust for America’s Health report echoed these concerns. “Communication between the public health system and health providers was not well coordinated”, the report says. “During the outbreak, many private medical practitioners reported that they did not receive CDC guidance documents in a timely fashion. Other practitioners noted that CDC guidance lacked clinically relevant information and was difficult to translate into practical instructions.”

On the ground, communication and cooperation took center stage. In Austin, Texas, an emergency operations center was activated May 1, 2009, and deactivated at the end of that month. This area was one of the first in the United States to be affected by the new influenza strain when it originally crossed over from Mexico. In their after action plan, according to Billy Atkins of Austin’s emergency management office, “Some of the areas that worked well during this recent event included the strong relationships that have been established over the years with regional partners. These partnerships have been developed through joint planning efforts as well as exercises.”

“Some areas that we will focus on improving include what I’ll call for lack of a better word the ‘scalability’ of the pan flu plan. The plan as currently written assumes a worse case scenario. It assumes that in any pan flu situation there will automatically be a 40 percent absenteeism rate with high morbidity. In the future we’ll remember that the primary definition of a pandemic relates to geographic spread and not necessarily severity”, Atkins says.

At the UCLA conference, W. Craig Vanderwagon, assistant surgeon general at the US Department of Health and Human Services, agreed there is no “one size fits all solution”. But some pointed out that this very idea has created problems with a lack of standard CDC guidance on field data reporting. There is a divide between researchers and policy makers with no field experience and people on the field.

Atkins says, “We learned that what has been preached over and over again really holds true when it comes to communications during a pandemic.” Initially, he says, Austin focused almost entirely on external communications, but “We’ve learned from this event the importance of keeping in touch with your own employees – even when you don’t have any new information to share with them.”

“The following key points stood out from this recent event: Not all novel strains of a new flu virus are severe … Be prepared for a novel virus to spread quickly. This will create a very fluid situation. During this event information seemed to be changing hourly. Be prepared, and prepare your employees.”

The America’s Health report cautions, “Even with a mild outbreak, the health care delivery system was overwhelmed. Even this relatively mild outbreak proved to be a low-level ‘stress test’ on the health system. It revealed significant problems and lack of preparedness particularly for outpatient settings where there was inadequate personal protective equipment and a limited understanding of infection control measures. At many hospitals, the ‘worried well’ overwhelmed emergency departments.”

Indeed, the Houston Chronicle reported in late September, “Parents panicked over whether their sick children might have swine flu are unnecessarily clogging Houston’s emergency rooms.” One hospital opened an assessment clinic in a tent to handle a 40 percent increase in patients, the paper said.

Austin’s Atkins says, “Relationships will be the greatest strength we have to rely on in a severe pandemic event. During the recent H1N1 event, we witnessed first hand the benefit of having close relationships with our partner agencies. Every partner agreed early on to speak and act as one … ”

“Like the rest of the world we’re wondering if this event is just a precursor of something worse to come in the fall. However we do take a great deal of satisfaction from our response to this opening salvo”, he says.

Matthew Beres and Dan Whipple

(Abstracted from Natural Hazards Observer, November 2009)