Natural Hazards Observer
| November 2006 | Volume XXXI | Number 2 |
Invited Comment
Preparing for a Flu Pandemic:
A Northwest Perspective
Influenza pandemics are naturally occurring events that impact our world on a recurring basis. Flu pandemics have occurred three times in the last century, in 1918, 1958, and 1967. The 1918 pandemic was the most severe disease outbreak in the history of the world. An estimated 20-40 million people died worldwide. With the recent renewed interest in pandemics, we should be asking not if there will be another pandemic, but when, and what its lethality will be. In King County, Washington, we do not now have the answers to these questions (nor does anyone else), but we are preparing our communities for when we do. It is this preparedness that we will discuss in this article.
King County , Washington, is the 12th largest county by population in the nation (Seattle is the largest of the county’s 39 cities). With a total of 168 government agencies within its geographic boundaries, the county has a complex governance setting. Our hazards include earthquakes, a volcano (Mt. Rainier), terrorism, flooding, avalanche, and the list goes on. Despite these significant and real threats, a flu pandemic tops the list of catastrophic events that we must be ready to mitigate, prepare for, respond to, and recover from. Flu pandemics are low frequency events, but they have the capability of being extreme impact disasters.
Challenges to Pandemic Planning
There are considerable challenges that are either unique or accentuated during a pandemic. The following realities are only some of the challenges that need to be considered in pandemic planning:
- No Mobilization of National Aid—The impact of a pandemic is going to be national as well as international. Outbreaks will impact multiple jurisdictions almost simultaneously. This means that there will be no national mobilization of resources to help impacted jurisdictions. Communities have to plan to respond with only the resources they have available locally.
- Limited Local Mutual Aid—Similarly, local mutual aid resources will be severely reduced or nonexistent due to the potential for outbreaks in each and every jurisdiction.
- Reduced Workforce—It is estimated that 35-40 percent of the workforce will be absent at any one time. This will be due to illness, at-home caring for ill family members, or perhaps a fear of going to work due to the contagious nature of the disease. Health care workers could have an even higher rate of absenteeism than that of the general populace. Fatalities, which could be between 2-3 percent overall, will also reduce the workforce.
- Long Duration of Outbreaks—A flu pandemic may come in successive waves, each lasting up to six weeks. These are long duration events that will be particularly difficult to manage with the limited resources and workers as noted above.
- Susceptibility—Since the viruses that cause pandemics are new, the entire world population is susceptible—everyone could become a victim. Typically, disasters affect those impacted by an event and the first responders who come to their aid. In the case of a pandemic, the responders will be placing not only themselves at risk, but there is the potential that they might infect their families as a result of their response activities.
Key Preparedness Activities
King County and New York City are often cited as examples of U.S. jurisdictions that have been investing wisely in pandemic preparedness. The reason for our level of preparedness is based on several critical actions:
- Responding to early recognition by key public and private sector leaders of the hazard and the need to aggressively prepare;
- Obtaining elected-official support for preparedness measures;
- Building coalitions to enhance preparedness that include the health care and business sectors, community-based organizations, first responders, critical infrastructure agencies, and emergency managers;
- Reaching out to the general public through an ongoing education and information campaign, reminding the public of the need for personal and family preparedness for all-hazards, including a flu pandemic; and
- Recognizing that our preparedness goals, activities, and resources must include the most vulnerable of our citizens.
Preparedness Strategies
Among the strategies that we are using to prepare for a pandemic are the following, which are applicable to all jurisdictions.
- Plan for a pandemic, but from an all-hazards perspective. For instance, business continuity planning (also known as continuity of operations planning), if done properly, will pay off in a number of hazard situations. We are not confining our thinking to a flu scenario.
- Engage community partners in the planning process. Planning for a pandemic is not just a government responsibility. It will take representatives from all sectors of a community (the general public, private business, and nonprofit sector in addition to government) working together to face up to the challenges of a pandemic. Public Health has conducted business forums on the impacts of a flu pandemic, and large corporations like Boeing and Washington Mutual Bank have been very proactive in local planning and exercising for a pandemic.
- Look at the health care system as a system and not as individual entities such as prehospital, hospital, urgent care, and family practice.
- Initiate a planning process that is continuous and iterative. A just-in-time inventory system makes communities extremely vulnerable to any disruption to the distribution system in this country. The more planning we do, the more issues we uncover. One of the hardest aspects of planning is identifying the interdependencies that exist within our community. The more modern and advanced a society is, the more dependent we are on one another.
- Identify your emergency powers and who has the authority to use them. In Washington State and King County, public law authorizes public health officer and chief elected official emergency powers. Under what circumstances they will be used and the timing for their use is critical to determine prior to an outbreak.
- Plan to enact social distancing measures early. Such measures include closing schools and theaters and canceling large indoor sporting events. This strategy is believed to be essential in the effort to limit the rapid spread of disease.
Additionally, a coordinated public education campaign prior to a pandemic and a coordinated public information response during a pandemic are top priorities. Given the life threatening nature of the disease, rumor control will be of utmost importance. The rapid dissemination of information to the media and directly to the public is important. Our Regional Public Information Network (RPIN) is a critical tool for imparting information to these audiences. The RPIN offers an e-alert service that issues breaking news and warning messages to subscriber e-mailboxes and mobile wireless devices.
Public Health Priorities
Previous regional disaster response planning has laid a foundation for the construction of our pandemic preparedness. From a public health perspective, we are concentrating on the following:
- Building a health care coalition comprising a wide variety of health care partners in King County, including Public Health, hospitals, ambulatory-care providers, large medical practices, medical associations, emergency medical service providers, pharmacies, and others. The coalition will promote coordinated preparedness activities among these partners and efficient information and resource management during disasters.
- Connecting with community partners to develop plans for closing facilities during a pandemic, including schools, day care centers, theaters, community centers, stadiums, and other places where crowds may gather. Although the effectiveness of social distancing has not been proven, its implementation will be necessary in hopes of slowing the spread of disease. The societal impacts will be extreme; therefore, close coordination among Public Health and community partners during planning is essential.
- Augmenting the capabilities of the health care system by increasing local supplies of antiviral medications, enhancing our ability to conduct rapid triage of flu patients, and identifying additional bed capacity to treat the extreme numbers of sick patients that will seek care during a pandemic wave.
- Developing new strategies that will enable all components of the health care system to provide appropriate levels of care to patients, and compassionate counseling to families, during the most challenging periods of a severe pandemic.
- Developing clear public messaging for dissemination during a pandemic that will inform and educate the public on the nature of the threat and, most importantly, how each person can protect themselves.
As a local jurisdiction, we do not have all the answers when it comes to preparing for a pandemic. We are struggling to deal with an event the magnitude of which we have not experienced in our lifetimes. However, we do believe that our regional approach to preparing together with our partners is the best option for getting through this worst-case event. We also know that taking advantage of the time available to us now will serve us well when the World Health Organization does declare that a Phase 4, 5, or 6 pandemic has commenced. Failing to plan and prepare for a pandemic and only hoping for the best is not a strategy; it is a prescription for failure—for which there is no cure.
Eric Holdeman (eric.holdeman@metrokc.gov)
King County Office of Emergency Management
King County, Washington
Michael Loehr (michael.loehr@metrokc.gov)
Public Health—Seattle and King County
Seattle and King County, Washington
Resources
Public Health—Seattle and King County
www.metrokc.gov/health/
King County Office of Emergency Management
www.metrokc.gov/prepare/
Regional Public Information Network
www.rpin.org/
U.S. Government Avian and Pandemic Flu Information
www.pandemicflu.gov/
World Health Organization Global Influenza Programme
www.who.int/csr/disease/influenza/en/