Download Preface Pandemic

DRAFT AURA PANDEMIC RESPONSE PLAN
The Pandemic Threat
In the last century, three influenza pandemics have swept the globe, each resulting in illness in
approximately 30 percent of the world population and death in 0.2 percent to 2 percent of those
infected. In 1918, the first pandemic (“Spanish Flu”) killed over 500,000 Americans and more
than 20 million people worldwide. One-third of the U.S. population was infected, and average
life expectancy was reduced by 13 years. Pandemics in 1957 and 1968 killed tens of thousands of
Americans and millions across the world. Scientists believe that viruses from birds played a role
in each of those outbreaks.
A new strain - influenza A (H5N1) - is spreading through bird populations across Asia, Africa,
and Europe. The first recorded appearance of H5N1 in humans occurred in Hong Kong in 1997.
Since then, the virus has infected over 200 people in the Eastern Hemisphere, with a mortality
rate of over 50 percent. It is impossible to predict whether the H5N1 virus will lead to a
pandemic, but history suggests that if it does not, another novel influenza virus will emerge at
some point in the future and threaten an unprotected human population.
At this time of May 2006, avian influenza is primarily an animal disease. Human infections are
generally limited to individuals who come into direct contact with infected birds. If the virus
develops the capacity for sustained, efficient, human-to-human transmission it could spread
quickly around the globe as humans have little immunity to the new virus thus causing a
pandemic. Influenza viruses’ diversity and propensity for mutation have thwarted efforts to
develop both a universal vaccine and highly effective antiviral drugs. Using historical
information and current models of disease transmission, it is projected that a modern pandemic
could lead to the deaths of 200,000 to 2 million people in the United States alone.
Unlike many other catastrophic events, an influenza pandemic may not directly affect the
physical infrastructure of an organization. While a pandemic will not directly damage power
lines, banks, or computer networks, it will ultimately threaten all critical infrastructures by
removing essential personnel from the workplace for weeks or months.
The influenza virus is transmitted from person-to-person primarily via virus-laden droplets (>5
μm in diameter) that are generated when infected persons cough, sneeze, or speak. These
droplets can then be directly deposited onto the mucosal surfaces of the upper respiratory tract of
susceptible persons who are typically within 3 feet of the droplet source. Transmission also may
occur through direct and indirect contact with infectious respiratory secretions.
Patients with influenza typically become infectious after a latent period of about 1 to 1.5 days and
prior to becoming symptomatic. At about 2 days, most infected persons will develop symptoms
of illness although some remain asymptomatic throughout their infection. This is important
because even seemingly healthy asymptomatic individuals in early stages of influenza could be
infectious to others.
When a pandemic begins, only a limited stockpile of partially matched pandemic vaccine may be
available. A virus-specific vaccine will not be available until 4 to 6 months after isolation of the
pandemic virus. The supply of antiviral drugs will be limited throughout a pandemic, and most
likely be issued to medical providers. Until sufficient stockpiles of antiviral drugs have been
established, these medications may be available for treatment of only some symptomatic
individuals. Therefore, the appropriate and thorough application of infection control measures
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remains the key to limiting transmission, delaying the spread of a pandemic, and protecting
personnel.
The U.S. Federal Government has implemented the “National Strategy for Pandemic Influenza”
document that clarifies the roles and responsibilities of governmental and non-governmental
entities and provides preparedness guidance for all segments of society. Much of this document
is information excerpted and condensed from the National Strategy for Pandemic Influenza.
Federal Government Planning Assumptions
While history offers useful benchmarks, there is no way to know the characteristics of a pandemic
virus before it emerges. U.S. Federal Government planning efforts assume the following:
1. Susceptibility to the pandemic influenza virus will be universal.
2. Efficient and sustained person-to-person transmission signals an imminent pandemic.
3. The clinical disease attack rate will be 30 percent in the overall population during the
pandemic. Illness rates will be highest among school-aged children (about 40 percent) and
decline with age. Among working adults, an average of 20 percent will become ill during a
community outbreak.
4. Some persons will become infected but not develop clinically significant symptoms.
Asymptomatic or minimally symptomatic individuals can transmit infection and develop
immunity to subsequent infection.
5. While the number of patients seeking medical care cannot be predicted with certainty, in
previous pandemics about half of those who became ill sought care. With the availability of
effective antiviral medications for treatment, this proportion may be higher in the next
pandemic.
6. Rates of serious illness, hospitalization, and deaths will depend on the virulence of the
pandemic virus and differ by an order of magnitude between more and less severe scenarios.
Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to
include infants, the elderly, pregnant women, and persons with chronic or
immunosuppressive medical conditions.
7. Rates of absenteeism will depend on the severity of the pandemic. In a severe pandemic,
absenteeism attributable to illness, the need to care for ill family members, and fear of
infection may reach 40 percent during the peak weeks of a community outbreak, with lower
rates of absenteeism during the weeks before and after the peak. Certain public health
measures (closing schools, quarantining household contacts of infected individuals, “snow
days”) are likely to increase rates of absenteeism.
8. The typical incubation period (interval between infection and onset of symptoms) for
influenza is approximately 2 days.
9. Persons who become ill may shed virus and can transmit infection for one-half to one day
before the onset of illness. Viral shedding and the risk of transmission will be greatest during
the first 2 days of illness. Children will play a major role in transmission of infection as their
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illness rates are likely to be higher, they shed more virus over a longer period, and they
control their secretions less well.
10. On average, infected persons will transmit infection to approximately two other people.
11. Epidemics will last 6 to 8 weeks in affected communities.
12. Multiple waves (periods during which community outbreaks occur across the country) of
illness are likely to occur with each wave lasting 2 to 3 months. Historically, the largest
waves have occurred in the fall and winter, but the seasonality of a pandemic cannot be
predicted with certainty.
Stages of the U.S. Federal Government Response for a Pandemic
The U.S. Federal Government approach to the pandemic response, characterize the stages of an
outbreak in terms of the immediate and specific threat a pandemic virus poses to the U.S.
population. The following stages provide a framework for Federal Government actions and serve
as a basis for our actions:
Stage 0:
Stage 1:
Stage 2:
Stage 3:
Stage 4:
Stage 5:
Stage 6:
New Domestic Animal Outbreak in At-Risk Country
Suspected Human Outbreak Overseas
Confirmed Human Outbreak Overseas
Widespread Human Outbreaks in Multiple Locations Overseas
First Human Case in North America
Spread throughout United States
Recovery and Preparation for Subsequent Waves
Considerations for All AURA Centers at Various Stages of a Pandemic Threat
Planning for Any Crisis
Centers should consider developing procedures that define how to respond to unplanned
disruptions to operations including pandemics. An example in place is the NOAO-NSO Business
Contingency Plan, which can serve as a model. At a minimum, the Director of each Center
should consider establishing a “Strategic Management Team” (the Team) that will help the
Director determine actions in the event of a disaster including a pandemic threat. The topics
below loosely follow the U.S. Federal Government’s Pandemic stages as a method to provoke
discussion:
Stage 0: New Domestic Animal Outbreak in At-Risk Country
Planning for Pandemic Influenza
The persons of the Center Strategic Management Team (the Team) shall review this
document in detail. This document and possibly other documents shall be made available
to all employees ASAP, hopefully well before a Stage 2 threat. The Team should at least
discuss possible strategies for the organization before the threat of a pandemic. The
Team should also consider how people respond to a disaster as the response will not be
linear, we first may see acts of heroism, and then disillusion as time passes, especially if
“local” conditions are slow to improve.
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Stage 1: Suspected Human Outbreak Overseas
Define Essential Functions
Depending on the level of the threat and governmental mandates, the Team may consider
which staff, materials, procedures and equipment are necessary to keep the business
operating by location and function during a pandemic. Special consideration shall be
made to AURA leadership and those people that maintain the accounting systems,
facilities, utilities, telephone systems, and computer systems. Critical functions should be
listed in advance. The severity of a pandemic can change and the Team may have to
adapt to those changes.
Delegations of Authority and Orders of Succession
Because absenteeism may reach a peak of 40 percent at the height of a pandemic wave,
the Team shall establish alternatives for the delegation of authority and an order of
succession (up to three tiers of personnel if possible) to ensure personnel know who has
authority and responsibility if the leadership is incapacitated or unavailable. Since an
influenza pandemic may affect regions of the world differently in terms of timing,
severity, and duration, and AURA has geographically dispersed assets and personnel, the
Team may consider dispersing their order of succession across Center leadership (i.e.
NOAO Director to Gemini Director or AURA President to a Center Director). This
should be documented before the threat arises.
Stage 2: Confirmed Human Outbreak Overseas (expected Eastern Hemisphere)
We should expect that the U.S. Federal Government would announce a Stage 2:
Confirmed Outbreak Overseas. At a Stage 2 outbreak, the threat becomes real as there is
efficient and sustained person-to-person transmission of the virus. During this time, any
person on the Strategic Management Plan (the Team) can declare a “Crisis”. The Team
shall meet ASAP to discuss actions necessary to minimize the health, social, and
economic impacts of a pandemic to our organization and our visitors. The Team shall
base the decisions for the organization from governmental information and mandates,
information provided by public announcements, and at http://www.pandemicflu.gov/.
During this meeting, the following should be considered:
General
The Team should review the Essential Functions and Delegation of Authority for
the organization and consider immediate actions such as calling back travelers,
restricting business related travel, and limiting visitors. The Team may also
consider temporary closure of certain operations or locations, now or when the
threat becomes localized.
Communications
As the threat evolves, the Team shall establish regularly scheduled meetings (or
alternative means of communication, e-mail, telephone, or video conferencing) to
determine new actions. These actions might include developing policies and
strategies for isolating and excusing employees who become ill at work, allowing
unscheduled and non-punitive leave for employees with ill family, and
establishing guidelines for when employees who have become ill can return to
work.
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If power, telephone, and the AURA internet(s) are available, the Team may
choose to mandate and facilitate work place communication such as
teleconferencing and email to minimize person-to-person contact in the
workplace with all employees.
The Team shall prepare timely communication updates and disseminate these
communications to all employees via email, the AURA, Gemini, NOAO, NSO,
and STScI home (public) web pages (not intranet, as access may be overwhelmed
or limited), and phone messaging. One such communication shall state that if
you are sick, or the organizational web site is down, or there is no phone
messaging, stay home, and follow government mandates, while periodically
checking our company websites and telephone messaging for updated
information and instructions.
Critical Business Records and Databases
We have systems in place to protect and ensure the availability of electronic and
hardcopy documents, references, records, and information systems needed to
support essential accounting and payroll functions. For NOAO, NSO, and
Gemini most critical accounting and payroll functions can be managed remotely
via CAS leadership home systems and soon Gemini Hawaii. The Team should
consider the integrity of vital systems that require periodic maintenance and
those systems that require direct physical intervention by employees, such as
those functions that are the responsibility of CAS; like payroll, accounts payable
and receivable.
Stage 3: Widespread Human Outbreaks in Multiple Locations Overseas (Eastern Hemisphere)
Infection Control Measures
If operations are continuing to operate, the Team should mandate the actions below in
preparation to minimize the spreading of the virus in the workplace:
Personal Hygiene
Persons who are ill should stay home. All employees shall be instructed to cover
their nose and mouth when coughing or sneezing, use facial tissues to contain
respiratory secretions and dispose of them in a waste container. Washing hands
with soap and water or an alcohol-based hand rub is encouraged after having
contact with respiratory secretions and contaminated objects/materials.
Antibacterial hand washing products do not appear to offer an advantage over
soap and water in most settings for removing influenza virus from hands. The
posting of infection control guidelines in prominent locations is also advised.
Go to http://www.cdc.gov/flu/protect/covercough.htm for pre-made posters and
other information.
Social Distancing Measures
Depending on the severity of a pandemic, the Team shall consider social
distancing measures. The types of social distancing measures includes
modifying the frequency and type of face-to-face encounters that occur between
employees like hand-shaking, substitution of teleconferences for face-to-face
meetings, staggered breaks, establishing flexible work hours at the worksite,
telecommuting, liberal leave policies for persons with sick family members,
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restricting workplace entry of people with influenza symptoms (with the hope of
voluntary compliance by employees), and promoting of social distancing
between employees, visitors, and customers. Persons who are around individuals
with influenza-like symptoms should maintain spatial separation of at least 3 feet
from that individual; turn their head away from direct coughs or sneezes.
Stage 4: First Human Case North America (in our case the Americas)
Essential Personnel and Alternate Operating Facilities
Depending the how the virus is spreading in the world, the Team shall reevaluate the
sustainability of operations and the availability of personal due to the events in the
Center’s geographical area. The Team may consider the possibility of relocation and/or
redistribution of critical or essential staff among alternative facilities to reduce the chance
of infection affecting operations staff simultaneously. A possible idea is to station
volunteer leadership at one of our summits or other remote areas and possibly limit
access to that particular area.
Stage 5: Spread throughout United States
Business Continuity under Conditions of Staffing Shortages
Under normal situations, most critical functions have alternate personnel that provide
back up in the event of the primary employee is on leave. In the case of a major
pandemic, the alternates may not be available. The Team should consider methods to
supplement the current workforce for conditions of significant absenteeism associated
with a pandemic, such as increased cross-training and preparing ancillary workforce
members (e.g., contractors, employees in other job titles/descriptions, retirees) to
maintain daily functionality in the presence of anticipated staffing shortages. The Team
may also consider delaying some services during periods of high absenteeism.
Other community public health interventions (e.g., closure of schools and public transit
systems, implementation of “snow day” restrictions) may increase rates of absenteeism
and result in disruption of workflows and productivity.
Use of Face Masks
During this time, the Team may be posed with persons insisting to wear face masks. The
benefit of wearing disposable surgical or procedure masks at schools or in the workplace
has not been established. Mask use should be permitted, but is not required. For more
detailed information related to the use of facemasks, the CDC has developed interim
guidance on the use of masks to control influenza transmission.
http://www.cdc.gov/flu/professionals/infectioncontrol/pdf/flumaskguidance.pdf
Stage 6: Recovery and Preparation for Subsequent Waves
Cleaning of Facilities and Equipment
Transmission from contaminated hard surfaces is unlikely, but influenza viruses may live
up to 2 days on such surfaces. Surfaces such as sinks, handles, railings, and counters that
are frequently touched with hands should be cleaned at least daily during community
outbreaks. Employees should be encouraged to keep work areas clean by disinfecting
phones, keyboards, and personal items. There is no evidence to support the efficacy of
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widespread disinfection of the environment or air. Facilities and Safety offices should be
prepared to handle at least the first wave.
Reconstitution
Reconstitution is the process by which an organization resumes normal operations. The
objective during recovery and reconstitution after a pandemic is to expedite the return of
normal services and operations. Since a pandemic may not harm the physical
infrastructure or facilities of an organization, and because long-term contamination of
facilities is not a concern, the primary challenge for the Team after a pandemic will be
bringing systems and services back to full capacity. The mortality rate of a pandemic
will depend on characteristics of the causative virus that cannot be predicted in advance,
but for planning purposes, it may be helpful to consider historical examples of disease
transmission. During this time, we may be challenged with the loss of people caused by
the pandemic, reduced productivity of staff, and increased turnover.
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