As some of you know I have been trying to get answers from our local emergency manager regarding avian flu planning for my town. I have been very unsuccessful. So today I read we are having a public health forum. I have some planning assumptions that has issues listed as to what is being done about this and that. Our speaker will be the emergency manager and a Dr of public health who has written some articles and has been following avian flu for a few years. I would like some questions to ask that challenge them. I don’t think the EM will speak much. One of the topics will be vaccinations and point of distribution plans. Any help would be appreciated! Thanks
Ask him - There will be no vaccines for at least the first 6 months of a pandemic. Why are you so focused on that?
All industries are expecting 30% or higher worker absences. How do you figure that into your plan?
There may be shortages of gas and food. There is talk from the energy industry that power may not stay on for a number of reasons. If that occurs, people will not have access to clean water - what is your plan for that?
Do the police, fire and med dept have protective equipment?
When will you close the schools? Most school plans are for seasonal flu - not a H5N1 pandemic with a high CFR of young people.
Thats a start - print out InKy’s Panflu Flyer and ask if you can hand them out. Maybe around town too.
(I know this is too much for you to ask, and, for them to answer! Thanks for letting me vent. Ahem.)
When are you going to tell the public to stock up for months of possible supply chain disruptions; to meet their own needs locally during illness or quarantine, as federal and state authorities have said is a local responsibility? (If you wait until pandemic has started, it will be too late for them to do so. Even if you think they won’t/can’t do it, they deserve the chance of a clear warning.)
(How long ago was your state pandemic influenza summit??)
Have the local “stakeholders” been given those checklists from pandemicflu.gov for business, schools, families, faith communities, ect?
Does the public have information in hand now about basic fire, cooking, and lighting safety, first aid, water treatment, and other considerations, before pandemic?
Learning curves (and adjustment reactions) take time, and better to start on some things now (and tell them why; “Pandemic Influenza”), rather than suddenly tell the public (possibly coping with power or fuel shortages and pandemic illness) or let them find out the hard way, that fire, EMS, or police are overwhelmed and can’t help them.
What is the plan, if pandemic keeps to 2006 fatality rate of 66%?
Have you met with local funeral homes/mortuary workers/Clerk of records/cemetery workers? Are they stocked up against a pandemic influenza year?
Mass fatality surges planning/preparation needs revision now; will authority be given to front-line responders (any two people from two different sectors agreeing on basic cause of death might work; a town employee and a health care worker, ect), to expedite id/pronouncing death/filling out death certificates, letting next of kin see (or take a photo, if next-of-kin can’t be contacted?) and burial? (or, let citizens help with transport and burial?)
There will not be enough “refrigerated body storage” for the scope and length of a pandemic. How can you avoid needing it?
(Minimizing deaths by telling the public how to prepare for 1918 or worse might help.)
“By the book” current legalities will just get too backlogged and traumatize survivors. “Unattended” deaths may be too frequent to demand autopsy/Medical Examiner. Will normal cemetery (graveliners, coffins, whatever is local) rules be lifted?
How will bodies be transported from the proposed influenza care centers (whatever your local acronym is for those) and does your climate need to dig before the ground freezes? Who cross-trained for equipment, and how much fuel is stored? How will bodies that die at home be heard about and processed?
What are the plans to cope during pandemic for local nursing homes, prisons, group living homes, populations that don’t speak english, (who else?) illegal aliens, local gang/drug dealer problems, ect?
Birdie Kate As you may know, I do not believe that vaccines or antivirals will be of much use in a pandemic, mainly because they are both primitive in design.
The question I would like asked in as many places as possible would be how are regulatory authorities going to supply broad spectrum antibiotics, oral electrolyte powders, anti-fever and anti-shock drugs to millions of people at the same time…pharmaceuticals with proven track records that definitely would save lives.
When they give you have an answer, ask them to suggest to Governments and the American Medical Association that it might be wise to give the general public prescriptions so that they can be stockpiled ahead of time…and also be considered with respect to Government stockpiles as well…
…the return on investment will far outweigh the investments on antivirals and vaccines.
Good questions. I have to laugh though. I can hear the EM’s response. “Again Ms Birdie, we have given you all the information you asked for and yet you are still not satisfied”, or maybe “I cannot discuss that because of **** law”, or maybe We have it all under control, I know an avian flu expert”. Or how about “Officer, can you remove Ms. Birdie from the room she is being disruptive” LOL
These are all statements made to me by the EM (except the last one, but there is still time!). I plan on going with a least 10 questions and having a few select friends in the audience with some select questions. I don’t expect to gain anything from the meeting but will enjoy attending :)
I also plan on asking them how with 22 police officers are they planning on dealing with over 2500 plus gang members within a 10 - 20 mile radius.
And how can they be planning for mass vaccinations and POD’s when our own state public health director has said there will be no vaccine. Oh I wish the meeting was sooner that later!
Here are my planning assumptions I plan on picking my other questions from - besides the ones you all posted.
Assumption 1. An influenza pandemic will result in the rapid spread of infection with outbreaks throughout the world. Communities across the state and the country may be impacted simultaneously.
Questions Should an avian flu informational campaign be started before the crisis or after it has begun? What plans are in place to educate the public on social distancing, isolation, food and medicine supplies, sheltering in place, quarantines, etc?
What populations in the community may not be reached through traditional public information methods? What alternative ways could information be provided? Which organizations in the community could provide assistance?
Assumption 2. Localities will not be able to rely on timely or effective mutual aid resources, State or Federal assistance to support local response efforts.
Questions What are the plans for the town if a projected 40% absenteeism rate happens? If law enforcement/public safety has insufficient personnel, either to do the jobs assigned to them or because of absenteeism because of the pandemic, how will these tasks be accomplished? How will they be prioritized?
Assumption 3. An influenza pandemic may occur in waves and last for 6 to 8 weeks.
Question What plans are in place for closing schools and cancelling events?
Assumption 4. Residents will be required to stay in their homes for a significant period during an influenza pandemic; thus, residents will need public information, education and tools so they are prepared to take responsibility for basic needs (food, water, prescription meds, over-the-counter medications, etc.).
Questions When will residents be informed of these issues? What about residents who do not prepare or think it will never happen? Is the town planning on supplies for these people? What about the elderly and homebound?
Who develops information about home health care? What methods will convey the urgency of keeping individuals home unless meeting a certain threshold of symptoms that indicate need for medical care?
Assumption 5. Antiviral medications will be in extremely short supply.
Questions Is the Town planning on supplying antivirals for its citizens or first responders and their families? How many courses of antivirals does the town have or have access to?
Assumption 6. A vaccine for the pandemic influenza strain will likely not be available for 6 to 8 months following the emergence of a novel virus and then there will still not be enough to treat everyone.
Questions Who will decide priority groups to be vaccinated? Who will administer vaccines? What protection will there be for families of these volunteers? Is there a volunteer database already in place?
Assumption 7. The number of ill people requiring outpatient medical care and hospitalization will overwhelm the local health care system. In other words, the normal amount and level of hospital care will not be available. Hospitals in our surrounding towns will not be able to handle patients from neighboring towns
Questions Where will individuals be directed to go if they cannot use regular avenues for health care (primary physician not available, no primary physician)?
What are the plans for setting up a town clinic? Has the town purchased supplies including beds, linens, and emergency and maintenance medicines and other necessary supplies to treat their ill citizens?
What about regular illness? Is the town prepared to take on the task of a walk in medical center for people who are ill, hurt or otherwise need medical assistance?
What about mental health issues?
Assumption 8. There will be mass fatalities. The current rate of fatalities in avian flu victims is over 60%.
Questions How will the town communicate about delicate topics, such as growing numbers of dead that may overwhelm the community’s day-to-day ability to process bodies? How will funeral homes and churches be engaged in this process? How will necessary supplies be obtained for mass fatality management? Are there alternative sites in addition to morgues and funeral homes that have the capacity to be utilized for this purpose? Where will additional staff to assist with fatality management be drawn from? What guidance is given to individuals working with bodies to allow them to feel protected from infection? What restrictions exist on mass internment within the town? Are there any existing legal requirements for autopsies or other processes (such as deaths at home)? What triggers would be used to indicate a need to change those requirements? Can these requirements be waived? How will concerns regarding religious beliefs be addressed? How will the jurisdiction communicate any inability to provide usual level of care and speed during a pandemic to the bereaved? How will memorial services be conducted in order to minimize potential spread of disease among attendees?
Assumption 9. Emergency Medical Service responders will face extremely high call volumes, and may face 40% reduction in available staff.
Questions How will ambulances be sterilized once an avian flu victim is transported? Will private cars and trucks be used? How will decisions be made as to priority calls?
Assumption 10. There will likely be significant disruption of public and privately owned critical infrastructure including transportation, commerce, utilities, public safety and communications.
Questions What is our current electrical companies plan for a potential pandemic to make sure that electrical needs are met? They are not being met now.
Assumption 11. Social distancing strategies aimed at reducing the spread of infection such as closing schools, community centers, and other public gathering points and canceling public events will likely be implemented during a pandemic.
Questions Is the school districts plan good enough? Is good enough the best we can do? What about church planning?
Assumption 12. Some people will be unable or unwilling to comply with isolation directives. For others, social distancing strategies may be less feasible. It will be important to develop and disseminate strategies for infection control appropriate for these environments and populations sooner rather than later.
Questions Will quarantine and isolation orders be voluntary or enforced?
Who will enforce isolation of individuals suspected (or confirmed) to be infected with new influenza strain at home or in an available facility (if needed)? Isolation should be for at least seven days after onset of illness, unless proven not to be new strain. How will quarantining of contacts of individuals for seven days work?
Assumption 13. The more that community partners and residents not normally a part of such activities can be made to understand the rationales behind pandemic planning, and the critical roles that they can play in mitigation and response as the outbreak unfolds, the easier it will be to elicit their participation and cooperation.
Assumption 14. Dissemination and sharing of timely and accurate information with the health care community, the media, and the general public will be one of the most important facets of the pandemic response. Advising the public in actions they can take to minimize their risk of exposure or actions to take if they have been exposed, will reduce the spread of the pandemic and may also serve to reduce panic and unnecessary demands on vital services.”
“Assumption 3. An influenza pandemic may occur in waves and last for 6 to 8 weeks.”
Isn’t that the length of a wave, not a pandemic? (CBO macroeconomic report - no great source to quote, but said 3 to 5 months with next wave possible 1 to 3 months later.)
Found this: http://www.hhs.gov/pandemicflu/plan/part1.html#2
…”In an affected community, a pandemic outbreak will last about 6 to 8 weeks. At least two pandemic disease waves are likely. Following the pandemic, the new viral subtype is likely to continue circulating and to contribute to seasonal influenza”…
“ ‘’‘In advance of an influenza pandemic, HHS will encourage all Americans to be active partners in preparing their states, local communities, workplaces, and homes for pandemic influenza and will emphasize that a pandemic will require Americans to make difficult choices.
An informed and responsive public is essential to minimizing the health effects of a pandemic and the resulting consequences to society.’‘’ “
Birdie Kate, I like your questions. May have to print out something like that for myself. (They sound like good questions to give journalists, too. But, I know the plans say, “manage the media” so, maybe some have been told not to ask and not to tell?. Invoking national security? haha.)
May need that HHS quote on a leaflet, too…
Testimony Before the House Committee On International Relations December 7, 2005 Michael T. Osterholm,…
“Rather, I believe an influenza pandemic will be like a 12 to 18 month global blizzard that will ultimately change the world as we know it today.”
…”One part of pandemic preparedness planning that must receive immediate attention is the implementation of a concept that I have called “critical product continuity” (CPC). “Critical product continuity is the determination of those products and services that our country routinely enjoys that must be available during a pandemic in order to minimize potentially catastrophic collateral health and security consequences and the subsequent comprehensive actions that must taken by both governments and the private sector to ensure their availability.”
For example, in the health care delivery system, regardless of where routine and influenza-related patient care takes place, we will need even more of our routine drugs and vaccines, medical devices and other products such as needles, syringes, IV bags, gloves, masks and routine diagnostic materials such as standard laboratory and diagnostic tests. Most of these products have supply chains and production locations that are primarily outside of the United States. Other critical product categories include both domestic and foreign suppliers of our food supply and for essential parts for the maintenance of critical infrastructures such as our water supplies, electricity and vital communications. We must also ensure a source of heating during the winter months for our northern climates; gasoline for critical domestic and international transportation; routine waste management and sanitation; and even corpse management. It is difficult to imagine how discretionary items such as non-vital electronics, jewelry, automobiles and entertainment will be needed during this time to ensure our health and safety. While any negative impact to our economy will beunfortunate, we must make difficult strategic decisions about which products and services our government, together with selected private sector companies, must maintain through critical supply chain support, the maintenance of adequate workforces and necessary transportation assurance whether domestic or abroad.”…
yes I believe our plan falls under National Security too LOL. can’t have the sheeple having a clue!
Goodness, even our state All Hazards plan and pandemic plan are on the web!
Closed to maintain Forum speed.