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