Community Mitigation of Pandemic Influenza What Key Stakeholders Need to Know Poudre School District Board of Education November 13, 2007.

Community Mitigation of Pandemic Influenza What Key Stakeholders Need to Know Poudre School District Board of Education November 13, 2007

What is a flu pandemic? Influenza pandemics occur when an animal flu virususually a bird flu virusthat has never infected people alive today changes in ways that it can Infect humans Spreads easily between them, causing illness throughout the world.

What is a flu pandemic? Pandemics are natural events that happen about 3 times per century (in 1918, 1957, and 1968) They can be mild (not much worse than a bad seasonal flu outbreak) or severe (killing millions all over the world)

Infectious Disease Deaths in the 20 th century 1918 1957 1968 Deaths per 100,000 per year United States, 1900-1996 JAMA.1999; 281: 61-66.

Currently we cant stop a pandemic We cant stop a pandemic, but we can lessen the harm through control measures Impact Weeks Without control measures With control measures

What actions should we take in a pandemic? Mandatory or voluntary? Which combinations of actions? At what point in the outbreak? What evidence is there that these actions will work?

Potential Tools in Our Toolbox Our best countermeasure vaccine will probably be unavailable during the first wave of a pandemic Antiviral treatment may not be available in sufficient quantities. The effectiveness of antiviral treatment is not clear.

Recent CDC guidance Community strategies recommended for pandemic flu when vaccines and antivirals are not available http://www.pandemicflu.gov/plan/community/community_mitigation.pdf

4 Key Community tools 1.Asking those who are ill to remain at home 2.Asking household members of ill persons to remain at home 3.Child social distancing closure of schools and places children gather 4.Workplace/community Adult social distancing

Control measures will be based on pandemic severity Severity measured by case-fatality rate (# that die / # that become ill) as determined in region where a pandemic begins (likely not CO, nor even USA) Pandemic Severity Index created to help communicate level of danger to the public, similar to the well-known hurricane index.

For comparison, the case-fatality rate of the 1918 pandemic was 2.5% in the U.S. the case-fatality rate of H5N1 in 2006 was 69%

Aggressive social distancing Social distancingEncourage good hygiene Workplace protections RecommendedConsiderNot recommendedCommunity social distancing RecommendedConsiderNot recommendedDismissing classes RecommendedConsiderNot recommendedVoluntary Quarantine Recommended Voluntary Isolation 1%-2% or higher0.1 -

66 million No children 18 million >= age12 9 million Non- working adult 8 million 5 million Labor Status of Households (U.S.) Source: U.S. Census Bureau, Population Division, Current Population Survey, 2003 Annual Social and Economic Supplement http://www.census.gov/population/www/socdemo/hh-fam/cps2003.html

Possible solutions for working parents Family or friends to provide care Volunteers to provide care to small numbers of children (no more than 6) Teleworking option for parents Shift changes allowing parents to be home at different times

Possible solutions for child instruction Use email, web lessons, mailed assignments, cable TV, phone calls to continue learning Provide parents with home- schooling materials appropriate for their child

Possible solutions of loss of school meals Weekly parent pick-up or home delivery of food items for child Other community food providers

Possible solutions for state funding of schools Governor has the power to waive state statutes and regulations in emergency School districts should work now with legislators and governor to ensure funding of school operations if severe pandemic sends children home

Community Mitigation Summary Ill persons should be isolated Voluntary home quarantine for household contacts Social distancing measures Dismissing students may have profound impact Workplace social distancing and liberal leave NOT closure (for most) Cancellation of public events, closure of entertainment venues (movies, sports,etc.), even church services may be cancelled

Key Stakeholders must Understand reasons for public health recommendations Participate in discussions about such interventions with a goal of reaching consensus Work together to do what need to be done to save lives.

Charlie, 45 Jessie, 40 Florence, 19 Tommy, 16 Harry, 10 Bobbie, 8 Davie, 6 Willie, 4 A Larimer County family -- all 8 died in a 10-day period, Oct Nov. 1918

With H5N1, children have high mortality

Community Mitigation of Pandemic Influenza What Key Stakeholders Need to Know Poudre School District Board of Education November 13, 2007.

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