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Planning for PandemicPlanning for Pandemic2009 H1N12009 H1N1
Key Interagency PointsKey Interagency Points
COOP / COGCOOP / COG CI/KRCI/KR Interact with the Public / Business CommunityInteract with the Public / Business Community 11stst Responder Support Responder Support Social DistancingSocial Distancing
School ClosureSchool Closure Higher EdHigher Ed Cancelling Public EventsCancelling Public Events
Behavioral HealthBehavioral Health
Ongoing InitiativesOngoing Initiatives Operationalized (for H1N1) State PanFlu Plan, Operationalized (for H1N1) State PanFlu Plan,
recently reviewed by Feds and updated. Monitor recently reviewed by Feds and updated. Monitor stock levels.stock levels. Coordinate with partners for deployment of state antiviral Coordinate with partners for deployment of state antiviral
stockpilestockpile
Provide daily Situation Reports to state leadership.Provide daily Situation Reports to state leadership. Posting H1N1 info on WebEOCPosting H1N1 info on WebEOC
Coordinating with DOE and DMHMRSASCoordinating with DOE and DMHMRSAS DOE working closely w/ PUBLIC SchoolsDOE working closely w/ PUBLIC Schools DMHMRSAS w/ CSBsDMHMRSAS w/ CSBs
Ongoing InitiativesOngoing Initiatives Develop Guidance Documents / Outreach: Develop Guidance Documents / Outreach:
DOE/ Higher Ed, Healthcare, Responders, Pharmacies, DOE/ Higher Ed, Healthcare, Responders, Pharmacies, etc.etc.
Received SNS material and operationalizing Received SNS material and operationalizing distribution plan.distribution plan.
Active Public Communications CampaignActive Public Communications Campaign Updating Website, Press Releases, FAQs, talking points Updating Website, Press Releases, FAQs, talking points
daily+.daily+. Daily Thematic Press Teleconferences, InterviewsDaily Thematic Press Teleconferences, Interviews Talking Point Virtual LibraryTalking Point Virtual Library
Incident Commander
Dr. Mark LevineDeputy Commissioner
Planning ChiefBob Mauskapf
Logistics/Administration/Financial ChiefStacey Ferrer
Operations ChiefDr. Diane Helentjaris
CHS Branch Director
Jeff Lake
Epi Branch Director Diane Woolard, PhD
35 Local Health Dept. Units District Directors
Situation Unit LeaderSteve Harrison
Education Branch DirectorSuzi Silverstein
Deputy Incident Commander
Rob Oldham, MD
35 District Health Planning Units
District Planners
TechnicalAdvisors
Hospital/Medical Community Branch DirectorBill Berthrong
Liaison OfficerJoe Hilbert
EMS Unit LeaderJim Nogle
HRBecky Bynum
Lab Branch DirectorDr. Jim Pearson
Fatality Mgmt DirectorDr. Leah Bush
Safety OfficerJoanne Wakeham, PhD
PIOPhil Giaramita
Behavioral Health Branch Director
Beth Nelson, DMHMRSAS
SWINE FLU ICSDR. KAREN REMLEY, COMMISSIONER
DCLS Laboratory TestingDCLS Laboratory Testing Initially performed validated seasonal flu assay for A/H1, Initially performed validated seasonal flu assay for A/H1,
A/H3, and influenza B; forwarding “untypeable” (probable A/H3, and influenza B; forwarding “untypeable” (probable swine flu) specimens to CDCswine flu) specimens to CDC
Modified test algorithms and performed Swine flu testing Modified test algorithms and performed Swine flu testing on specimens when the patient met the VDH/DCLS case on specimens when the patient met the VDH/DCLS case criteriacriteria
Implemented electronic system to pre-accession and Implemented electronic system to pre-accession and track swine flu samples; VDH Regional epidemiologists track swine flu samples; VDH Regional epidemiologists approved sample submission and assigned numbers approved sample submission and assigned numbers based on criteria prior to file transfer to DCLSbased on criteria prior to file transfer to DCLS
Prepositioned specimen collection kits in OCME regional Prepositioned specimen collection kits in OCME regional sites and all District HD for redistribution to medical sites and all District HD for redistribution to medical facilities statewide facilities statewide
Expanded courier schedule to 7 day pickup at District HD Expanded courier schedule to 7 day pickup at District HD locationslocations
DCLS Laboratory TestingDCLS Laboratory Testing Verified the CDC-Emergency Use Approval (EUA) Swine Verified the CDC-Emergency Use Approval (EUA) Swine
flu assay in 3 days; CDC certified to report confirmed flu assay in 3 days; CDC certified to report confirmed (positive) influenza A/H1 (swine) results(positive) influenza A/H1 (swine) results
Continued to test respiratory viruses and sub-type Continued to test respiratory viruses and sub-type seasonal influenza A for H1 and H3 to meet obligation as seasonal influenza A for H1 and H3 to meet obligation as a WHO reference laboratorya WHO reference laboratory
Updated website information, established a laboratory call Updated website information, established a laboratory call center, emailed and blast-faxed laboratory safety, center, emailed and blast-faxed laboratory safety, specimen collection and shipping information to Sentinel specimen collection and shipping information to Sentinel physicians, sentinel laboratories, and District HDs. physicians, sentinel laboratories, and District HDs.
Modified LIMS applications; implemented reports and Modified LIMS applications; implemented reports and queries; queries;
Enhanced electronic messaging to provide results to VDH Enhanced electronic messaging to provide results to VDH and CDC using HL7 reporting standards and CDC using HL7 reporting standards
Diverted and trained additional staff from other parts of Diverted and trained additional staff from other parts of DCLS to support accessioning, testing and reportingDCLS to support accessioning, testing and reporting
Pandemic Influenza Planning: Pandemic Influenza Planning: HealthHealth
Risk communicationsRisk communications Community containmentCommunity containment Antiviral distribution planAntiviral distribution plan Mass vaccinationMass vaccination Medical surge, healthcare coalitionsMedical surge, healthcare coalitions Surveillance and investigationSurveillance and investigation Laboratory servicesLaboratory services Fatality managementFatality management Altered standards of care due to resource Altered standards of care due to resource
limitationslimitations
Issue: AntiviralsIssue: Antivirals Federal stockpile of antivirals growingFederal stockpile of antivirals growing VA has 770 K courses on-handVA has 770 K courses on-hand
Rec’d 280K add’l courses from SNSRec’d 280K add’l courses from SNS For Treatment only: Distribution Through Pharmacies++For Treatment only: Distribution Through Pharmacies++
+, in accordance with VDH SNS / Medical +, in accordance with VDH SNS / Medical Countermeasure Distribution planCountermeasure Distribution plan
Increasing supply and production capacityIncreasing supply and production capacity Discussion of increased prophylaxis useDiscussion of increased prophylaxis use AV Prescription Abuse; Stockpile implications:AV Prescription Abuse; Stockpile implications:
Avg. Day: AB Co. receives orders for 6k coursesAvg. Day: AB Co. receives orders for 6k courses 5/3: 600k courses; Allocations established.5/3: 600k courses; Allocations established.
VaccinesVaccines
No H1N1 Vaccine yet developed; Working.No H1N1 Vaccine yet developed; Working. VDH has a robust and frequently tested VDH has a robust and frequently tested
Statewide Mass Vaccination Plan an Statewide Mass Vaccination Plan an element of VDH Strategic National element of VDH Strategic National Stockpile / Medical Countermeasure Stockpile / Medical Countermeasure Distribution PlanDistribution Plan
Pandemic Influenza Planning:Pandemic Influenza Planning:Non-HealthNon-Health
Command and ControlCommand and Control Public Safety SustainabilityPublic Safety Sustainability Community containment measuresCommunity containment measures
Economic impactEconomic impact School closure / Event cancellationSchool closure / Event cancellation IsolationIsolation Voluntary quarantineVoluntary quarantine
Continuity of Operations:Continuity of Operations: Government entitiesGovernment entities Critical infrastructure: Courts, economy, trade, businessCritical infrastructure: Courts, economy, trade, business Agriculture, water and food chain safetyAgriculture, water and food chain safety
Human resource issues, policies (public and private)Human resource issues, policies (public and private)
Extended Pandemic Influenza Extended Pandemic Influenza PlanningPlanning
Include involvement of:Include involvement of: DOD InstallationsDOD Installations CourtsCourts Schools/Colleges and UniversitiesSchools/Colleges and Universities First responders – fire, EMS/Public safety, Law First responders – fire, EMS/Public safety, Law
enforcementenforcement Business community/Private sectorBusiness community/Private sector MediaMedia Assisted living and other social services programsAssisted living and other social services programs Volunteer, non-profit groups/Faith communityVolunteer, non-profit groups/Faith community
Coordinated planning of federal, state, local Coordinated planning of federal, state, local governments and agenciesgovernments and agencies
Public Information IssuesPublic Information Issues
Integrity of media listsIntegrity of media lists Importance of setting clear guidelines and Importance of setting clear guidelines and
sticking to themsticking to them Control messages by maintaining consistent Control messages by maintaining consistent
news flownews flow Value of networking to dispel contradictory or Value of networking to dispel contradictory or
false informationfalse information Partnership support on staffing needsPartnership support on staffing needs Timely approval processTimely approval process
Lessons LearnedLessons Learned Refine human resource, purchasing, and financial Refine human resource, purchasing, and financial
management guidelines for statewide application. management guidelines for statewide application. Improve State Agency familiarity on Continuity of Improve State Agency familiarity on Continuity of
Government plans and policies, and develop Government plans and policies, and develop additional measures where gaps were identified.additional measures where gaps were identified.
Define and determine “essential personnel” in Define and determine “essential personnel” in consideration of a protracted event and assure consideration of a protracted event and assure measures are in place to provide for augmentation measures are in place to provide for augmentation personnel and cross-training.personnel and cross-training.
Lessons Learned (cont’d)Lessons Learned (cont’d) Identify state, local government and private sector Identify state, local government and private sector
essential infrastructure and services.essential infrastructure and services.
Consider Enforcement and Inspection waivers if Consider Enforcement and Inspection waivers if needed due to staff shortages and to assure needed due to staff shortages and to assure business continuity.business continuity.
Evaluate legality of suspending FOIA laws Evaluate legality of suspending FOIA laws pertaining to electronic meetings, quorums and pertaining to electronic meetings, quorums and public meeting requirements at the state and local public meeting requirements at the state and local levels, and determining if meeting requirements can levels, and determining if meeting requirements can be suspended, waived or modified so that state be suspended, waived or modified so that state boards can meet on the telephone or electronically.boards can meet on the telephone or electronically.
Develop social distancing messages/protocols and Develop social distancing messages/protocols and public countermeasures.public countermeasures.
Lessons Learned (cont’d)Lessons Learned (cont’d) Prioritize supply chain services and resources to Prioritize supply chain services and resources to
ensure essential needs are met. Consider ensure essential needs are met. Consider stockpiling of essential supplies where stockpiling of essential supplies where appropriate.appropriate.
Resolve misconceptions on responsibilities for Resolve misconceptions on responsibilities for fatality management.fatality management.
Work with the media in delivering educational Work with the media in delivering educational information to the public. information to the public.
Vigorously pursue improvements to telework Vigorously pursue improvements to telework policies and capabilities.policies and capabilities.
PanFlu COOPPanFlu COOP Discuss expectations with staff earlyDiscuss expectations with staff early Communications will be keyCommunications will be key
Need reliable, credible sources of informationNeed reliable, credible sources of information Need coordinated communication channelsNeed coordinated communication channels Rely on both internal/external channelsRely on both internal/external channels
May need to consider relief for regulatory May need to consider relief for regulatory requirementsrequirements
Coordinate vertically and horizontally.Coordinate vertically and horizontally. Cross-trainCross-train Succession is a two-way street.Succession is a two-way street.
Questions?Questions?
http://www.cdc.gov/swinefluhttp://www.cdc.gov/swineflu
http://www.vdh.virginia.govhttp://www.vdh.virginia.gov
http://www.vdh.virginia.gov/pandemicfluhttp://www.vdh.virginia.gov/pandemicflu
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