Page 1
ALL SECTORS
PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
1
TOOL
2
This tool will help you to:
• Provideathoroughintroductiontoyourstaffandvolunteersaboutthekeyaspectsofaninfluenzapandemicthatshouldinformtheirplanningandresponseefforts
Who will implement this tool:
• Themayorormembersofthemunicipal leadership team,emergency response team,disaster management team,andcommunications support team,amongothers
• Leadstafffromanyofthesectorsofthemunicipality
ThistoolwasdevelopedasaslideshowpreparedusingPowerPoint®presentationsoftwarethatyoucanusetoprovideanorientationtoplanningandresponsestaffandvolunteers(e.g.,emergencyresponsepersonnel,communityhealthresponders)whoarenotfamiliarwithpandemicinfluenzaoritspotentiallywide-rangingeffectsoncommunities.
Thetoolintroducestheviewerto:
1. Thediseaseanditssymptoms,andhowthediseasespreads
2. Themeasuresthatcanbetakentolimitthespreadofthediseaseandreduceitsimpact
3. Backgroundinformationaboutpastpandemics,theirimpactoncommunities,andlessonslearnedfromtheplanningandresponseeffortsthattookplacethen
4. Howapandemicisexpectedtostartinamunicipality
Thistoolconsistsoftwoparts:aPowerPointpresentationwithnotesandaseparateslide-by-slidePresenterGuide.Thenotesprovidedintheslidesandintheguidearetoassistyouinpresentingthematerial.Itisimportanttonote,however,thatasthepresenter,youshouldreviewandmodifytheslidesasneededtoaccuratelyreflectthelocallanguageandthelocalcontext.
PREPAREDNESS RESPONSE
NOTE: A print-out of the PowerPoint slide presentation and the presenter guide immediately follow. For the electronic version of the presentation, please refer to the companion CD-ROM in this toolkit.
TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
Page 2
2 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 3TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
FACILITATOR GUIDE TABLE OF CONTENTS
Slide1:UnderstandingtheThreatofaSevereInfluenzaPandemic............................3
Slide2:IntroductiontoPandemicPlanningandResponse........................................3
Slide3:WhatisSeasonalInfluenza?..........................................................................3
Slide4:WhataretheSymptomsofSeasonalinfluenza?.............................................4
Slide5:MoreSymptoms...........................................................................................4
Slide6:WhatisPandemicInfluenza?........................................................................4
Slide7:PandemicIllness...........................................................................................4
Slide8:TheDifferencebetweenSeasonalandPandemicInfluenza............................5
Slide9:WhatisAvianInfluenza(BirdFlu)?..............................................................5
Slide10:WhatisSwineInfluenza?.............................................................................6
Slide11:WhatisH1N1?...........................................................................................6
Slide12:HowdoSeasonalandPandemicInfluenzaSpread?......................................6
Slide13:HowdoSeasonalandPandemicInfluenzaSpread?(2)................................6
Slide14:WhatHaveWeLearnedfromPastPandemics?............................................7
Slide15:WhatHaveWeLearnedfromPastPandemics?(2)...................................... 7
Slide16:WhatCanbeDonetoSloworDecreasetheImpact?...................................7
Slide17:HowWillaPandemicStartinMyMunicipality?.........................................8
Slide18:WHOPhases...............................................................................................8
Slide19:WHOPandemicPhasesandCurrentlyCirculatingNovelViruses...............9
Slide20:WhatWillLifebeLikeinaSeverePandemic?..............................................9
Slide21:ShortagesofEssentialGoods......................................................................10
Slide22:SupplyChainDelaysorDisruptions..........................................................10
Slide23:DisruptioninRoutineServices..................................................................11
Slide24:ChangesinPublicTransportationandOtherServices................................11
Slide25:HealthcareSystemsOverwhelmed.............................................................11
Slide26:RestrictionsofPersonalMovement............................................................12
Slide27:HowCanMunicipalitiesbePreparedforaSeverePandemic?....................12
Slide28:TwoCitiesin1918....................................................................................13
Slide29:Sources......................................................................................................13
SLIDE 1: UNDERSTANDING THE THREAT OF A SEVERE INFLUENZA PANDEMIC
WhetherfromamorelethalstrainofH1N1,oracompletelynewvirusthatemerges,thethreatofasevereinfluenzapandemic(globalinfluenzaoutbreak)isreal.Leadershipfrommunicipalauthoritiesandfromrespectedcommunitymembersisneededtoprepareourmunicipalities,reducetheimpactofaninfluenzapandemiconindividualsandfamilies,andreduceorevenpreventseriousdamagetotheeconomy.
Amildpandemicmayresembleasevereoutbreakofseasonal(usual)influenza,butaseverepandemiccouldresultineconomicandsocialcatastrophe.Whileitmaynotbepossibletopreventaseverepandemicfromreachingyourlocalarea,thereismuchthatlocalgovernmentsandtheirleadershipteamscandotopreparetolessentheimpact.
Ifacountryisnotadequatelyprepared,aseverepandemicwillnotonlycausemanyinfluenzacasesanddeaths,itwillalsoimpactthecountry,municipalities,andfamilieseconomically.Thecentralgovernmentalonecannotpreparethenationforaninfluenzapandemic—thischallengerequiresyourhelp.Asaleaderinyourmunicipality,youcanplayapowerfulrolebyprovidinginformationandguidancetoencouragepeopletoprepare—eitherthroughyourpositionofauthorityinthemunicipalityorthroughcontactswithyourcolleagues,friends,neighbors,andothers.Youcanalsosendapowerfulmessagebypreparingforthepandemicyourself.
SLIDE 2: INTRODUCTION TO PANDEMIC PLANNING AND RESPONSE
Thegoalofthispresentationistogiveyouasenseofwhatapandemicis,howweexpectittobegin,whatwillhappentopeopleandtotheeconomy,andhowyoucanprepareforit.Duringthispresentation,wewillanswerthefollowingquestions:
• Whatisseasonalinfluenza?
• Whatisaninfluenzapandemic?
• Whatisavianinfluenza(birdflu)?
• Howdoseasonal,avian,andpandemicinfluenzadifferfromeachother?
• Whatarethesymptomsofinfluenza?
• Howisinfluenzaspreadandhowisittreated?
• Whathavewelearnedfrompastpandemics?
• Whatcanbedonetoslowordecreasetheimpactofapandemic?
• Howwillthepandemicstartinmyarea?
• Whatwilllifebelikeduringthepandemic?
• Howcanmunicipalitiesprepare?
SLIDE 3: WHAT IS SEASONAL INFLUENZA?
Thisslidesummarizesseasonalinfluenza.Nearlyeverycountryintheworldexperiencesseasonalinfluenzaoutbreakseveryyear.Itisacauseofmanycasesofillness,deaths,andincreasedhealthcarecosts.
3
2
1
Page 3
4 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 5TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
SLIDE 4: WHAT ARE THE SYMPTOMS OF SEASONAL INFLUENZA?
Althoughthesymptomsofthepandemicinfluenzaaresimilartotypicalseasonalinfluenza,itispossiblethatothersymptomsmayappear.ContinuetochecktheWorldHealthOrganizationWebsite(www.who.org)andnationalauthoritiestoobtainupdatedinformationonsymptoms.
SLIDE 5: MORE SYMPTOMS
Influenzainchildrenisoftenhardertodiagnosebecausethemostcommonsymptomsinchildrenmaydifferfromthoseinadults.
SLIDE 6: WHAT IS PANDEMIC INFLUENZA?
Apandemicisaglobaloutbreakofacontagiousdisease.Apandemicofinfluenzaoccurswhenanewvariety—orstrain—ofinfluenzavirusemergesthatisabletospreaddirectlyfromonehumantoanotherhuman.Becausepeoplehavenotbeenexposedtosuchanewvirus,theywillhavelittleornoimmunity (resistance)toit.Therefore,thediseasecanspreadeasilyamongpeopleandtravelquicklyaroundtheworld.
Inadditiontothe2009emergenceoftheH1N1pandemicvirus,threeinfluenzapandemicsoccurredinthepastcentury:theverysevereSpanishInfluenzapandemicin1918,andtwomilderonesin1957–1958and1968–1969.Thelasttwopandemicswererelativelymild,resultinginaworldwidedistributionofsevereillnessinpeopleofallages,manylostdaysofschoolandwork,andanestimated2.5milliondeaths,mostlyinpeopleovertheageof60.Thefirstofthesepandemics—thatof1918–1919—causedanestimated40milliondeathsinpeopleofallages,withmanydeathsofotherwisehealthyyoungadults.Articlespublishedinscientificandmedicaljournalsatthetimedescribesevereillnessanddeath,withabreakdownofroutinehealthandburialservicesinalmostallmajorcities,closureofpublicgatheringplaces,andisolationorquarantineofthoseinfectedorthoseexposedtoinfectedpeopleinanattempttostopthespreadofinfection.
SLIDE 7: PANDEMIC ILLNESS
[Photos:Scenesfromthe1918pandemic.]
Apandemiccausesmanyillnessesanddeathsfortwomainreasons:(1)theentireworld’spopulationisvulnerablebecausetheyhavenoimmunityagainstthevirus,and(2)itoftencausesamoreseriousversionoftheillnesswithmorecomplications—suchaspneumonia,dehydration,andanacuterespiratorydistresssyndrome—comparedwithatypicalseasonalinfluenza.
Inapandemic,nearlyallpeopleworldwidearesusceptibletothevirus,andaround30%ofthepopulationbecomessick.Thepercentageofthepopulationthatgetstheillnessisnearlytwicethatofatypicalseasonalinfluenzaepidemic.Thenumberofpeoplethatdiefromapandemicisrelatedtotheseverity.Inausualinfluenza,thedeathrateisverylow.In1918,thecasefatalityratio(theratioofpeoplewhodiefromthediseasedividedbythenumberofpeoplewhogetthedisease)wasaround2%.Thismeansthat2ofevery100peoplethatgotthediseasediedfromit.Itiswellacceptedthatpopulationsthathavefewerresourcesandotherriskfactorsexperiencemuchhigherdeathrates.
SLIDE 8: THE DIFFERENCE BETWEEN SEASONAL AND PANDEMIC INFLUENZA
[Photos:Peoplesickwithinfluenza]
Itisveryimportanttorememberthedifferencesbetweenseasonalinfluenza(usualinfluenza),andpandemicinfluenza.Seasonalandpandemicinfluenzaaresimilarinanumberofways,suchasthemodeoftransmissionofthevirus.However,theyalsodifferinimportantways.
First,incontrasttopandemicinfluenza,peoplehavesomeimmunitytoseasonalinfluenzabuiltupfrompreviousexposuretotheviruses.Second,symptomsofpandemicinfluenzamaybemoreseverethanseasonalinfluenza,andmorepeoplearelikelytodiefrompandemicinfluenzathanfromseasonalinfluenza.Third,pandemicinfluenzacouldhappenatanytimeoftheyear,whereasseasonalinfluenzausuallyoccursinthefallandwinterinnon-tropicalareas.Finally,vaccinesforseasonalinfluenzaareavailableeachyearandarebasedonknowncirculatinginfluenzastrains,whereasvaccinesforpandemicinfluenzamaynotbeavailablefor4–6monthsafterapandemicstarts.Thisisbecauseittakes4–6monthstodevelopavaccineoncethenewviralstrainisidentified.
SLIDE 9: WHAT IS AVIAN INFLUENZA (BIRD FLU)?
Manypeopleconfusebirdfluwithapandemic,buttheyareverydifferentdiseases.Avianinfluenza(birdflu)isadiseaseofbirds,nothumans.Itinfectswildbirds(suchasducks,gulls,andshorebirds)anddomesticpoultry(suchaschickens,turkeys,ducks,andgeese).ThestrainknownasH5N1isonlyoneofmanystrainsofbirdfluviruses.(Similarly,seasonalhumaninfluenzahasmanystrains.Thisiswhywehavetodevelopanewvaccineeveryyear.)
Birdfluoutbreaksresultinhigheconomiclossesbecauseitisnecessarytokillbirdstocontainthespread,buttheseoutbreaksarenotusuallyarisktohumanhealth.H5N1isaverydeadlystrainthatisrapidlyspreadinginsomepartsoftheworld.Althoughthevirusdoesnotusuallyinfectpeople,itispossibleforhumanstobecomeinfectedundercertaincircumstances,suchasdirectcontactwithinfectedpoultry.Infact,morethan400humancasesin15countrieshavebeenreportedsince2004.Mostpeoplewhohavebecomesickordiedfromthisvirushavehadextensive,directcontactwithsickpoultry.However,evidencesuggeststhatH5N1ischanging,andexpertsareconcernedthatthevirusmaybecomecapableofdirectlyinfectinghumansandspreadingfrompersontoperson,potentiallyresultinginahumaninfluenzapandemic.ThisiswhytheWHOiswatchingthisvirussoclosely.
Atthistime,H5N1isstillabirdvirus,notahumanvirus.Ifitbecomesahumanvirus,wewillseemorehumancasesclusteredtogether,andultimatelytheappearanceofastraincapableofspreadingbetweenhumans.However,aswesawwiththeemergenceofH1N1,itisalsopossiblethatanentirelynewinfluenzaviruscanappearatanytime,orH1N1couldchangeovertimeintoamoreseverestrain.ScientistsworrythatthecurrentsituationofthepresenceofH5N1(averylethalanimalvirus)andH1N1(amilderhumanvirus)couldresultinanewvirusthatcouldcauseaveryseverepandemic.
8
9
4
5
6
7
Page 4
6 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 7TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
SLIDE 10: WHAT IS SWINE INFLUENZA?
SwineinfluenzaisaninfluenzaAvirusthatcausesinfectioninpigs.Likeavianinfluenzainbirds,itcansometimescauseillnessinhumansinclosecontactwithinfectedpigs,buthumanscannottransmitittootherhumans.
SLIDE 11: WHAT IS H1N1?
H1N1isthenewvirusthatemergedin2009inMexicoCityandquicklyspreadacrosstheglobe.
ItwasdeclaredapandemicinJune2009.Theviruswasinitiallyreferredtoas“swine”influenzabecausetheviruswasfoundtocontaingeneticmaterialfromswineinfluenzaAstrains,aswellasavianandhumanstrains.However,whiletheH1N1virusappearstohaveemerged,atleastinpart,fromapigvirus,thisisahumanvirus,andpeoplegetitfrompeople—notfrompigs.
SLIDE 12: HOW DO SEASONAL AND PANDEMIC INFLUENZA SPREAD?
Thepandemicinfluenzavirusisexpectedtobetransmittedinthesamewayasseasonalinfluenza—throughlargerespiratory“droplets”thatcontaintheinfluenzavirus.Thesedropletsarereleasedthroughcoughingandsneezingandcanthencomeincontactwiththenoseormouthofahealthyperson—ortheymaybebreathedinbyahealthyperson.Thedropletsreleasedthroughcoughingandsneezingtendtosettlewithin3feet.Undermostconditions,theyrapidlydryoutandthevirusdies.Therefore,thekeytopreventinginfectionistostayawayfromthesedropletsbytryingtostayatleast1meterawayfromsomeonewhoissickwithinfluenza.
SLIDE 13: HOW DO SEASONAL AND PANDEMIC INFLUENZA SPREAD? (2)
Seasonalandpandemicinfluenzacanalsobespreadwhenhealthypeopletouchthingsthatarecontaminatedwiththevirusandthentouchtheireyes,nose,ormouth.
Therefore,thesameprecautionsusedtocombatseasonalinfluenzaareexpectedtobeeffectivebarrierstoinfectionswiththepandemicvirus:goodhandwashing,coveringofone’scough,andstayingawayfromsickpeople.
Thesevirusescouldbespreadbypeoplewhodonotfeelorlooksick,andtheyspreadmostquicklyincrowdedplaces—especiallyindoors.
However,thepandemicinfluenzavirusisverymuchlikeacommonseasonalinfluenzavirusinthatitisspreadinthesameway,throughrespiratory“droplets”fromcoughsandsneezes.
SLIDE 14: WHAT HAVE WE LEARNED FROM PAST PANDEMICS?
Pandemicshavebroad,complex,andcatastrophicimpacts—includinghealth,societal,andeconomicimpacts.Theytendtorecurin1–3wavesofillnesslastingapproximately6–12weekseachoveraperiodof1–2years.Thenumberofsickanddyingpeoplefarexceedstheavailablehealthcareresources,andshortagesofmanyothercriticalresourcesoccurs.
SLIDE 15: WHAT HAVE WE LEARNED FROM PAST PANDEMICS? (2)
Wehaveeveryreasontobelievethatpreparednessandresponseatthemunicipallevelwillprobablydeterminehowseverelyamunicipalityisimpacted.Themunicipalitiesthatwillbebestabletocopewiththeimpactsofaseverepandemicwillbethosethatarewellprepared;havelocalstockpilesofessentialgoodsorplanstoobtainthem;andthatcanrelyontheirownpopulationsandlocalresourcestohelpcareforthesick,provideessentialservices,andmaintainsocialorder.Aswehaveseenrepeatedlyduringotherdisasters,theabilityofamunicipalitytokeepthepublicwellinformedandcalmisthekeytoaneffectiveresponse.
SLIDE 16: WHAT CAN BE DONE TO SLOW OR DECREASE THE IMPACT OF A SEVERE PANDEMIC?
Municipalitiesareunlikelytohaveaccesstosufficientquantitiesofanti-viralmedications,andavaccineisnotexpectedtobemanufactureduntilafterthefirstwaveofapandemic.However,evidencesuggeststhatsimultaneouslyusinggoodhygienicpracticesand“socialdistancing”strategies,whichareintendedtokeeppeopleawayfromeachother,candramaticallyalterthespreadofthevirusinamunicipality.Interventionssuchasgoodhygieneandsocialdistancingstrategiesarecallednon-pharmaceuticalinterventions(becausetheydonotinvolvemedicines).Theseinterventionscanbeusedto(1)delaythestartofthepandemic,allowingmoretimeforfinalpreparednessactivities;(2)decreasethepeakimpact,minimizingthepeakoverloadofthehealthcaresectoranddecreasingpeakratesofworkforceabsenteeism(lostdaysofwork);and(3)decreasethetotalnumberofpeoplewhobecomesickanddiefromthedisease.
13
12
11
10
16
15
14
Page 5
8 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 9TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
SLIDE 17: HOW WILL A PANDEMIC START IN MY MUNICIPALITY?
Mostlikely,thepandemicwillarrivethroughexposedorsickpeopleenteringthecountryfromanotherarea.Becauseofthecharacteristicsoftheillnessandthewayitcanbediagnosed,itwillnotbepossibleorpracticaltoclosebordersortoeffectivelyscreentravelersduringapandemic.Thisisbecauseitispossibleforpeopletospreadthediseasebeforetheyhaveanysymptoms,andtherearenolabtestscurrentlyavailabletodetectasymptomaticcasesinapracticalandcosteffectiveway.Whilegovernmentscouldpreventpeoplewithfevers,cough,orothersymptomsfromenteringanarea,otherswhohavenotyetdevelopedthesymptomswillpassthroughandspreadtheillness.Healthresourcesarebetterusedtodetectandtreatcasesratherthanwastedthroughattemptstopreventthevirusfromenteringanarea.
AswasseenwithH1N1,itmaybeweekstomonthsbeforealocalareaexperiencescasesofanewinfluenzavirus.Thisisaveryvulnerableperiodforthecountry.Aspeoplehearthenewsthatapandemichasstarted,theymaybegintofeargettingsickandmaybereluctanttogoabouttheirusualactivities,eventhoughnocaseshaveyetoccurredinsidethecountry.Thiscould(1)slowdownlocalcommerce;(2)causechildrentomissschool;and(3)leadpeopletobuywhatevergoodsareavailableforstockpiling,depletingtheavailabilityofthesegoodsanddecreasingfamilywealth.Thecountryanditsmunicipalitiesmusthaveaclearplaninplaceforthisperiodtopreventunnecessaryharmtothepeopleandtheeconomy.
SLIDE 18: WHO PHASES
WHOhasdefinedphasesofpandemicalert,asfollows:
Innature,influenzavirusescirculatecontinuouslyamonganimals,especiallybirds.Eventhoughsuchvirusesmighttheoreticallydevelopintopandemicviruses,inPhase 1novirusescirculatingamonganimalshavebeenreportedtocauseinfectionsinhumans.
InPhase 2ananimalinfluenzaviruscirculatingamongdomesticatedorwildanimalsisknowntohavecausedinfectioninhumans,andisthereforeconsideredapotentialpandemicthreat.
InPhase 3,ananimalorhuman-animalinfluenzavirushascausedsporadiccasesorsmallclustersofdiseaseinpeople,buthasnotresultedinhuman-to-humantransmissionsufficienttosustaincommunity-leveloutbreaks.ThisisthecurrentphasefortheH5N1avianinfluenzavirus.
Phase 4ischaracterizedbyverifiedhuman-to-humantransmissionofananimalorhuman-animalinfluenzavirusabletocause“community-leveloutbreaks.”Phase4indicatesasignificantincreaseinriskofapandemicbutdoesnotnecessarilymeanthatapandemicisaforegoneconclusion.
Phase 5ischaracterizedbyhuman-to-humanspreadofthevirusintoatleasttwocountriesinoneWHOregion.Whilemostcountrieswillnotbeaffectedatthisstage,thedeclarationofPhase5isastrongsignalthatapandemicisimminentandthatthetimetofinalizetheorganization,communication,andimplementationoftheplannedmitigationmeasuresisshort.
Phase 6,thepandemicphase,ischaracterizedbycommunity-leveloutbreaksinatleastoneothercountryinadifferentWHOregioninadditiontothecriteriadefinedinPhase 5.Designationofthisphasewillindicatethataglobalpandemicisunderway.ThisisthecurrentphasefortheH1N1virus.
Thepost-peak periodsignifiesthatpandemicactivityappearstobedecreasing;however,itisuncertainifadditionalwaveswilloccurandcountrieswillneedtobepreparedforasecondwave.
Inthepost-pandemic period,influenzadiseaseactivitywillhavereturnedtolevelsnormallyseenforseasonalinfluenza.
SLIDE 19: WHO PANDEMIC PHASES AND CURRENTLY CIRCULATING NOVEL VIRUSES
Theemergenceofanovelvirusthatiscapableofinfectinghumansmarksthesevirusesashavingpandemicpotential.TheH5N1viruscontinuestocausewidespreadanimaloutbreaksandsporadichumancaseswithhighcasefatalityratios.Despitetheongoingconcernthatthisvirusmayonedaydevelopefficienthumantohumantransmissionandresultincasesacrossgeographicareas,tothisdateitremainsatPhase3.
Incontrast,H1N1escalatedtoaPhase6declarationwithintwomonthsofthefirstreportedhumancases.Thisvirusdemonstratedefficienthuman-to-humantransmissionfromtheonset,andquicklyspreadaroundtheworld.
ThesetwovirusesdemonstratetheuseoftheWHOpandemicphasestodescribegeographicspread,notseverity.DespiteremainingatPhase3,theH5N1viruscontinuestohaveamuchhighercasefatalityratiothantheH1N1virus.Thereisgreatconcernthatifthesetwovirusesshouldmixinahumanorananimal,anewvirusthathasthehighdeathrateoftheH5N1virusandthecapabilitytospreadeasilyfrompersontoperson,likeH1N1,couldresult.
SLIDE 20: WHAT WILL LIFE BE LIKE IN A SEVERE PANDEMIC?
Dailylifewillchangedramatically,andmostofthechangeswillbedirectlyrelatedtothelossoftheworkforcethroughillnessandfear.Thehighratesofabsenteeismacrosssectorswillresultinshortagesofessentialgoods,disruptionsinroutineservices,alteredorcancelledpublictransportationandotherservices,andahealthcaresystemthatisunabletomeettheneedsofthelargenumbersofsickanddyingpeople.Inaddition,personalmovementmayberestrictedinanattempttoslowthetransmissionoftheviruswithincommunitiesandtodecreasethenumberofpeoplewhogetsick.
Economiclossesareexpectedtobesevere,andalossofpublicordermayoccur.Recoverymaybedifficultbecauselocalcommercewillhavesuffered,andpeoplemaybeafraidtoresumenormalactivities.
Wewillexploreeachoftheseareasinmoredepthinthenextsetofslides.
17
18
19
20
Page 6
10 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 11TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
SLIDE 21: SHORTAGES OF ESSENTIAL GOODS
Anythingthatdependsonresupplywillbevulnerabletodelaysorinterruption.Thesesupplychainshortageswilllikelyresultincriticalshortagesoffood,fuel,medicalsupplies,sparepartsforinfrastructuremaintenance,andotheressentialgoods.Concernaboutbecomingsickmaycausepeopletostopgoingtoworkorthemarketortostopsendingtheirchildrentoschool.Commercewillsloworwillbesuspendedasbusinessesandmarketsclosebecauseoflossoftheworkforce,lossofcustomers,orbyordertocontaintheillness.Thiswillresultinalossoffamilyincomeandlivelihoodsformany.
Fearandpanicmayleadtoexcessconsumptionandpersonalhoarding,furtherdepletingthewealthofindividualsandfamiliesandreducingtheavailabilityofgoodsforothers.Hostilityandviolencemayeruptoveraccesstoscarcegoodsandservices,andthemostvulnerablepeople(forexample,thosewhoarepoor,illiterate,chronicallyill,ordisabled)maybethemostseriouslyaffected.
Municipalitieswillneedtohaveaplantomaintainsocialorderandtoensurethatresidentsremaincalm.Thisisbestdonethroughacombinationofeffectiveleadership,theuseoftrustedspokespeople,effectivepubliceducationandcommunicationaboutrisk,theuseoflawenforcementofficialsasneeded,andlocallyavailablegoodsandstockpilestosustainthecommunity.
Availablegoodswilllikelybeconsumedearlyinthepandemic.OnceWHOdeclaresapandemic,itwillbedifficulttobringgoodsintothecountrytoincreaselocalstockpiles.Therefore,municipalitieswillonlyhavewhattheyhaveonhandattheonsetofthepandemic,plusanygoodstheycancontinuetoproduce,orthataidorganizationsareabletogettothem.Itslikely,therefore,thatmostareaswillexperiencesevereshortagesofessentialitems,suchasfood,potablewater,medicines,andfuel.
SLIDE 22: SUPPLY CHAIN DELAYS OR DISRUPTIONS
[Photos:Supplychain]
Mostareasoftheworldaredependentonaninternationalsupplychain,aswellasnationalandlocaltruckingandotherdistributionanddeliverysystems.Aspeoplebegintogetsick,andothersstayhomefromworkbecauseoffearorotherresponsibilities,allsectorswillexperiencehighratesofworkerabsences.Deliveriesofgoodstotheareawillbedisruptedastruckdrivers,loadingdockpersonnel,andallotherpeopleneededtomovegoodsfromoneplacetoanotherarenotavailabletowork.
Availablegoodswillprobablybeconsumedearlyinthepandemic.Duringaseverepandemic,itwillbedifficulttobringgoodsintothecountrytoincreaselocalstockpiles.Therefore,municipalitieswillonlyhavewhattheyhadonhandattheonsetofthepandemic,aswellasanygoodstheycancontinuetoproduceorthataidorganizationsareabletobringtothem.Therefore,mostareaswillprobablyexperiencesevereshortagesofessentialitems,suchasfood,potablewater,medicines,andfuel.
SLIDE 23: DISRUPTION IN ROUTINE SERVICES
Schools,governmentoffices,andthepostofficemaybeclosed.Utilities,communicationservices,andinformationnetworksmaybedisrupted,resultinginalossofservice.Banksmaycloseormayexperienceahighrateofcashwithdrawals,andautomatedtellermachinesmaynotbeserviced.
SLIDE 24: CHANGES IN PUBLIC TRANSPORTATION AND OTHER MUNICIPAL AND PRIVATE SERVICES
Publicandprivatetransportationmaybeslowedorstopped.Fuelmayneedtoberationed.Municipalworkers,suchasgarbagecollectors,utilityrepairpeople,waterandsewermaintenanceworkers,andotherswhoprovideothercriticalinfrastructureneedswillalsobecomeill.Municipalitieswillprobablyexperienceadecreaseinservicesintheseareas.
SLIDE 25: HEALTHCARE SYSTEMS OVERWHELMED
[Photo:Ascenefromthe1918pandemic.]
Healthcaresystemswillcertainlybeoverwhelmedinaseverepandemicandcriticalshortagesofdoctors,nurses,andcommunityhealthworkerswilloccur.Infact,justwhentheneedforhealthcareisthegreatest,atthepeakofthepandemic’simpact,thehighestabsenteeismratesareexpected.Inaddition,non-pandemichealthissueswillcontinueandmayevenincreasebecauseofanoveralldecreaseinaccesstohealthcare.Difficultdecisionswillneedtobemadetoallocatethescarcemedicalresources,andboththepublicandthehealthcareproviderswillneedmentalhealthsupport.
Manycasesoftheinfluenzawillbemild,andwillnotrequireanyspecializedcareorattention.Mostofthesickerpatientswillneedtocareforthemselvesorwillneedfamilymembersorcommunityvolunteerstoassistintheircare.Themunicipalitysimplywillnothaveenoughdoctors,nurses,orhealthcareworkerstoprovidecaretoalloftheinfluenzapatientsaswellasthosewithnon-pandemichealthissues.Itisveryimportantformunicipalitiestoknowwhothemostvulnerablepeopleare(forexample,medicallyvulnerablechildren,elderlypeople,pregnantwomen,andthosewithcompromisedimmunesystems)andtohaveincorporatedthemintotheresponseplan.Thebestwaytodecreasetheoverallimpactofthepandemicistohelpthemunicipalitybecomeasself-sustainingaspossible—thiswillincludeensuringthatinfluenzapatientscareforthemselvesasmuchaspossible.
21
22
23
24
25
Page 7
12 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO 13TOOL 2: PRESENTATION ON THE THREAT OF A SEVERE INFLUENZA PANDEMIC
SLIDE 26: RESTRICTIONS OF PERSONAL MOVEMENT
Communitycontainmentmeasuresmaybeneededtolimitthespreadofaseverepandemicinthemunicipality.Personalmovementmayberestrictedbecauseoftraveladvisoriesandotherlimitsonmovement.Publicgatheringsandeventsmayalsobecancelledorprohibited.Schoolsmaybeclosed,andpeoplemaybeaskedtolimittheirinteractionswithothers,suchasatmarkets.
Peoplewhoaresickmayberequiredtostayathomeorawayfromothersuntiltheyrecover(referredtoasisolation),andpeoplewhomayhavebeenexposedtoasickpersonmayalsobeaskedtostayawayfromothersforafewdaystodetermineiftheyareill(referredtoasquarantine).Isolationandquarantinearetwoimportantpublichealthmeasuresthatwillprobablybeneeded.Yourhelpmaybeneededtoeducatepeopleaboutthesemeasures,andtoenforcetheirimplementation.
Althoughtheseeffortswillbeimportanttothesurvivalofthecommunityinaseverepandemic,theymayleadtofurtherimpactsonthecommerceandsocialwell-beingofresidents.Municipalitiesmustalsoworktopreventhumanrightsviolationsthatcouldresultfromthemisuseordiscriminatoryuseofthesemeasures.
SLIDE 27: HOW CAN MUNICIPALITIES BE PREPARED FOR A SEVERE PANDEMIC?
Themostimportantthingtodoistostartplanningforyourmunicipalitynow.
Understandthelikelyimpactonyourmunicipalityanddevelopplansforthepeakimpactandforimpactsineachsector.
• Planforpubliceducationandeffectivecommunicationofrisk.
• Planwaystoensurethatthenecessaryfunctionsandservicesofgovernment,businesses,andorganizationscancontinue.
• Planforpreparednessandresponserelatedtohealth,foodavailabilityandaccesstofood,andincomeandlivelihoodissues.
Toplanforthepandemic,youcanbuildongeneraldisasterplanning.Besureto:
• Includenongovernmentalorganizationsandotherpartnersintheplanningprocesstodevelopcontingencyplansforessentialgoods.
• Includebankingandothercommercerepresentativestodevelopeconomicmitigationandrecoveryplans.
• Identifyresponseleadersandpublicspokespeople.
• Developpoliciesonschool,market,andbusinessclosingandre-openingandwaystoreassurethepublicwhenitissafetoresumeactivities.
• Maximizestockpilingbeforethepandemic(NOW!).
SLIDE 28: TWO CITIES IN 1918
ThisgraphisbasedondatafromtwocitiesintheU.S.duringthe1918pandemic.Philadelphiaexperiencedmanydeaths,whereasSt.Louisexperiencedrelativelyfew.Thedifferencebetweenthesetwocurvesisduetotheactionstaken(andnottaken)bythemunicipalgovernmentsinthesetwocities.Bothcitieswerehitbythepandemic,andtheywereunderthesamenationalgovernment.However,theyhadverydifferentexperiences.
St.Louisinstitutedsocialdistancingpoliciesassoonastherewerecasesinthearea.Philadelphiadelayedtheirusefor1–2weeksaftercasesbegan.ItisbelievedthattherapidimplementationofthesocialdistancinginterventionswastheprimaryfactorresponsibleforthelowermortalityrateexperiencedbySt.Louis.
Whatwillthegraphlooklikeforyourmunicipalitywhenwestudytheimpactsafterthenextseverepandemicisover?WhatcanyoudonowtobesurethatyourmunicipalitycanprotectitselfthewaythatSt.Louisdid?
SLIDE 29: SOURCES
• CDC(CentersforDiseaseControlandPrevention).Pandemicinfluenzaplanningchecklists.www.pandemicflu.gov,http://pandemicflu.gov/plan/states/statelocalchecklist.html
• CDC.Riskcommunication.http://www.pandemicflu.gov
• CDC.2007.Interim pre-pandemic planning guidance: Community strategy for pandemic influenza mitigation in the United States.Atlanta,GA:CDC.http://pandemicflu.gov/plan/community/community_mitigation.pdf
• WHO(WorldHealthOrganization).2004.WHO influenza pandemic preparedness checklist.Geneva:WHO.http://www.wpro.who.int/NR/rdonlyres/25885074-7A3B-442A-834E-E96484D14D69/0/WHOInfluenzaPandemicPreparednessChecklist.pdf
• WHO.2009.Pandemic Influenza Preparedness and Response.http://www.who.int/csr/disease/influenza/PIPGuidance09.pdf
• WHO.2008.Pandemic influenza preparedness and mitigation in refugee and displaced populations.2nded.WHO/HSE/EPR/DCE/2008.3.Geneva:WHO.http://www.who.int/diseasecontrol_emergencies/guideline/en/index.html
• WHO.2009.WHO guidelines for pandemic preparedness and response in the non-health sectors.Geneva:WHO.http://www.un-pic.org/pic/web/documents/english/WHO%20WOS%20Pandemic%20Readiness%202009-05-05.pdf
26
27
28
29
Page 8
14 LEADERSHIP DURING A PANDEMIC: WHAT YOUR MUNICIPALITY CAN DO