Pandemic Flu The Bigger Picture Response Shayne Ward

Pandemic Flu ‘The Bigger Picture’ Response! Shayne Ward Emergency Planning & Resilience Manager NHS Lincolnshire

Presentation Overview § Pandemic Flu – dispelling the myths! § Seasonal vs. Pandemic § Vaccines, Antivirals and Antibiotics § Bird Swine vs Human Influenza § Activation & Predicted Impact § Current International & National Levels § Activation vs. Response § Predicted Impact § The wider impacts of Pandemic Flu

Seasonal ‘flu vs Pandemic ‘flu ‘SEASONAL’ FLU PANDEMIC FLU • Occurs every year during the winter • Occurs about 3 times each century – at any time of the year • Affects up to 10% - 15% of the population • May affect up to 50% of the population • The very young, the very old • and people with certain chronic illness are most at risk • Annual vaccination available • • Antiviral drugs available for the at risk Vaccine won’t be available initially - in the first wave (Hope to be available in Autumn 2009) • Antiviral drugs available for up to 50% of the population (80%) People of every age may be at risk (Currently, its mainly under 19 Year Olds)

Previous ‘flu Pandemics • • • Pandemic Spanish Flu Strain: A(H 1 N 1) Year: 1918 -1919 Origin: Not known Estimated Deaths Global 20 -40 million UK 250, 000 Age Group 20 -50 yrs Asian Flu A(H 2 H 2) 1957 -1958 China Hong Kong Flu A(H 3 N 2) 1968 -1969 China 1 million 33, 000 under 14 yrs over 65 yrs 1 -4 million 30, 000 under 5 yrs over 65 yrs Shortest interval = 11 years Longest interval = 39 years Swine Flu 2009 A(H 1 N 1) Current interval = 40 years

Previous ‘flu Pandemics • • • Pandemic Spanish Flu Strain: A(H 1 N 1) Year: 1918 -1919 Origin: Not known Estimated Deaths Global 20 -40 million UK 250, 000 Age Group 20 -50 yrs Asian Flu A(H 2 H 2) 1957 -1958 China Hong Kong Flu A(H 3 N 2) 1968 -1969 China 1 million 33, 000 under 14 yrs over 65 yrs 1 -4 million 30, 000 under 5 yrs over 65 yrs Shortest interval = 11 years (H 1 N 1 v) 2009 v = variant Longest interval = 39 years Short version! Current interval = 40 years

Vaccines, Antivirals and Antibiotics Not Silver Bullet Solutions! § Vaccines § Offer protection against a ‘specific’ strain § Up to 4 -6 months to develop specific vaccine § Longer to manufacturer in sufficient quantities § Pre-pandemic vaccines – may offer Health Care Workers some protection but will not be exact ‘fit’ of pandemic strain (not applicable isn’t a strain of H 5 N 1!) § Antivirals § Is a counter-measure rather than protection § Reduces length of infection § Reduces severity and therefore secondary infections § Antibiotics § For counteracting secondary bacterial infections e. g. affecting lungs and heart

From Birds to Humans followed by re-assortment in Humans H 5 N 1 MIGRATORY WATER BIRDS DOMESTIC BIRDS Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

From Birds to Humans followed by re-assortment in Humans H 1 N 1 MIGRATORY WATER BIRDS DOMESTIC PIGS! Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

Pandemic Flu Activation

…by late April: Mexican Flu

…by late April: Oops! Mexican Swine Flu

World Health Organisation (WHO) pandemic flu alert levels • Swine flu was declared a pandemic on 11 June 2009 with the announcement of phase 6

NATIONAL ACTIVATION United Kingdom • When the international situation reaches WHO Phase 6 there will be 4 alert levels in the UK: • UK alert level 1 No cases in the UK • UK alert level 2 Virus isolated in the UK • UK alert level 3 Outbreak(s) in the UK • UK alert level 4 Widespread activity cross the UK

The National Service Framework Objectives of the National Flu Service Framework • to ensure that the right people get the right treatment at the right time, whilst enabling people who have flu to stay at home ; and to minimise the impact of influenza on the NHS.

The UK Government pandemic flu response • Antiviral stockpile – enough for 80% of UK population • Antibiotic stockpile – to treat and prevent secondary bacterial infections • Advanced purchase agreements for up to 132 million doses of pandemic-specific vaccine, when it becomes available. Enough for 100% of the UK population. • Face masks (for front line health and social care workers) • National Pandemic Flu Service • Guidance from the Department of Health and other bodies • Communication programme that includes TV, radio, internet, and leaflet drop

Local Response Strategy Mitigation Response The basis of a large scale response strategy will be • that the person with flu stays at home • antivirals are collected on their behalf from a designated local Antiviral Collection Point by a ‘flu friend’ 1. • Antivirals will only be issued if the patient fulfils the criteria set out in a clinical algorithm used by the National Pandemic Flu Service by Phone or Internet assessment. • UNDER 1’S & PATIENTS WITH CO-EXISTING CONDITIONS WILL BE SEEN BY GPs/HCPs • Plan for accessing antivirals for Care Homes • <15 residents use Flu Line • >15 residents – Health Professional / arrangements in line with local protocol.

SOCIAL CARE NATIONAL ACTIVATION

• Social care communications challenges To ensure that swine flu messages reach those who may be excluded from the national door drop and other mainstream communication channels, such as: – older people, especially if they live alone – people living in care homes – young people (research suggests under 24 s are less likely to receive/read the leaflet) – people for whom English is not a first language and/or who have literacy issues – people with a visual or hearing impairment – people with learning disabilities or mental health issues – street homeless and other groups without regular accommodation • Social care workers may need to act as ‘flu friends’ for vulnerable people who have no-one else to help them • Effective communication between local authorities and independent and third sector providers

Antiviral v Vaccine v Seasonal • Swine flu Vaccination Programme may run at same time as: - the programme for Seasonal Flu - the issue of Antivirals • Planning is under way • Some Groups, including front-line Health and Social Care workers to be prioritised for vaccination

Pandemic Flu Predicted Impact

PAN FLU – SURGE CAPACITY & PRIORITISATION STAGES 3

Predicted Impact in Lincolnshire, based on a population of 750, 000, 50% Attack Rate Week Clinical Cases GP Consultations Minimum total excess hospitalisations Excess Deaths (2. 5%) 1 375 107 15 9 2 750 214 30 19 3 3000 855 120 75 4 11625 3313 465 291 5 39750 11329 1590 994 6 81000 23085 3240 2025 7 79500 22658 3180 1988 8 53625 15283 2145 1341 9 36375 10367 1455 909 10 28125 8016 1125 703 11 19500 5558 780 488 12 9750 2779 390 244 13 6000 1710 240 150 14 3375 962 135 84 15 2625 748 105 66 Total 375375 106984 15015 9386

3 x ‘peak profiles’ based on a 30% total clinical attack rate

1918 H 1 N 1 FLU PANDEMIC

What are the solutions? • Resilience – Business Continuity Management System (BCMS) embedded into your organisation – no matter how small – Regularly updated and tested continuity plans – Plan for accessing antivirals • <15 residents use Flu Line • >15 residents – Health Professional / delivery arrangements • Infection Control – – Stay at home & isolate yourself where possible Contact the National Flu Line Infection control methods and PPE Masks – Only useful if within 1 metre of a possibly symptomatic patient. (Aerosols generated) – see Social Care Guidance (Module 4 of the Social Care Tools)

Infection Control & PPE Emma Lee, NHS Lincolnshire