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Community Pandemic Preparedness
Community Pandemic Preparedness
Preliminary considerations:
* There will most likely not be a targeted vaccine until about 6 months after pandemic has begun; any vaccine prepared ahead of the pandemic will likely render partial protection
* There will most likely not be enough antivirals for treatment, let alone prophylactic use
* Assume a quarter to a half of the public will become infected over a 3 month period (a flu wave, of which there usually are 3 ? the worst being the 2nd ? a few weeks or months apart) and 3/4 to a half staffing everywhere for various durations
* Virus will be shed before symptoms appear (which can be 3 - 6, up to even 17 days) and after symptoms (21 days for children, 3?5 days for adults, longer for the immunocompromised)
* Children and otherwise healthy young adults are disproportionately at risk
* All bodily excreta will be very dangerous, especially feces and sputum/mucus; virus often multiplies in gut and diarrhea is often first symptom, preceding respiratory symptoms
* We will probably need two or more times the beds and ICU facilities
* There will probably be mortality of at least an extra 50% beyond normal; a high percentage of these are likely to be under 65 years old, which comprise workers in essential services
* Most patients should probably be treated in the home, or if more critical, in secondary ICU-like set ups in schools or other unused locations
* Hospitals will need to continue their usual work and erect a firewall to protect vulnerable inmates
* Childcare and family nursing responsibilities will strain ability of healthcare workers and other essential infrastructure workers to provide services
* Public services such as water, power, waste disposal, communications, and transportation will likely be intermittently interrupted
* Deliveries of food and other essential commodities may be disrupted
* There may be civil disorder due to shortages and desperation
City functions:
* Close schools and other (nonessential) places where people congregate
* Stockpile materials, medicines, face masks, gloves, antiseptic cleansers, wipes, etc.
* Set up vaccination priorities (in conjunction with medical personnel) in a logical way that puts essential personnel first: medical, police, essential waterworks, power, communications, waste and morgue workers; then children and adults, preferably those latter who commit to serve as neighborhood or healthcare volunteers (if we should be so lucky to have vaccine at all)
* Policing will be needed to guard hospitals and pharmaceutical stockpiles
* Develop plans to keep essential services operational; establish minimum staffing level requirements
* Establish lines of succession in critical positions
* Coordinate essential commodities deliveries and rationing
* Set up a city-based delivery network with designated staging areas
* Essential pre-purchased supplies could be dropped at neighborhood staging areas for distribution. Delivery personnel should be sufficiently safe if they do not make contact
* Establish emergency fuel supplies
* Negotiate with private water companies to utilize water delivery trucks
* Include area for public information updates on website and arrange with local radio & TV for regular accurate official updates (assuming media is functioning); utilize ham radio
* Institute Cisco system linking emergency radio networks
* Establish guidelines or rules for (voluntary?) quarantine: home isolation, isolation of contacts of known cases, restriction of movement, requirements for use of face masks
* Restrictions on airports and international and national travel as well as public transportation
* Ports and shipping: sterilization procedures for certain goods entering
* Curfew should there be unrest
* Insure that institutions where people live together such as nursing homes or prisons are prepared
* Consider how to deal with the homeless, who will be particularly vulnerable and thus hazardous
* Set up temporary morgues; body recovery teams with prepared vans that completely isolate corpse and protect drivers; body disposal in least potentially infective way, cremation encouraged
* Videotape school classes to put on TV or the internet so education can continue at home
* Gilead, the company that created Tamiflu but licensed it to Roche (and is suing to get it back), is based in California: appeal to them to make it invoking compulsory license (long shot)
* Explore the possibility of temporarily taking over hotels or motels for secondary treatment centers. They would be preferable to school facilities, as they already have beds and bathrooms
* Issue recommendations to all employers to encourage and facilitate telecommuting and teleconferencing if possible
* Levy a tax for preparation; lobby state and federal government for city funding
* Fuel shortages are bound to cause difficulties. [If possible, acquire and use small fleet of electric or plug-in modified hybrid Prius (see calcars.com) cars, charged via solar panels (if possible using Toshiba?s high-capacity lithium ion batteries ? 80% charge in 3 minutes, 100% in 10; due to be made available commercially in 2006)]
Hospital functions:
* Provide vaccine (if available) or prophylactic and therapeutic antivirals to healthcare workers to encourage continued service
* Set up mobile nursing units (part of firewall) with portable antiviral air filters for using in sick rooms (to protect the workers) as well as traditional protection
* Establish some means for healthcare workers? children to be taken care of during shifts; possibly uninfected neighbors working at home
* Establish hotline for immediate assistance from mobile nursing units
* Establish teleconferencing and other communications capability for conferring with healthcare professionals
* Set up public information web pages and blog for Q&A; establish community liaison office; prepare and provide public education materials concerning flu and nursing procedures
* Stockpile supplies, vaccines, antibiotics, and antivirals, IV kits, fluids, O2 concentrators, ventilators, etc.
* Volunteer vetting and training: vaccination, administering meds, nursing assistance, testing for H5N1 (if possible), errands, etc.
* Establish minimum staffing levels; identify essential personnel; establish lines of succession
* Oversee secondary location set up and personnel (part of firewall)
* Suspend elective surgeries
* Close hospital wards to visitors
* Ensure critical functions such as waste disposal, backup power, supplemental water purification, laundry, sterilization, etc., with contingency plans for personnel shortages and service outages
* Transport seriously ill patients to secondary locations (EMT? City? neighborhood volunteers?)
* Documentation and data collection for analysis
* Air conditioning or forced air heating should be modified to eliminate viruses (UV, ozone, high filtration) in secondary facilities. Switch to radiant heat in winter and ice in summer
* Stockpile and establish a rental/delivery system for oxygen concentrators and ventilators
* Hire more respiratory therapists if possible but ensure their safety throughout the pandemic; train nurses in some RT techniques
* Pull doctors in from private sector corporate entities (which may be shut down anyway)
* Establish or lobby for a way to allow doctors licensed elsewhere or with lapsed licenses to practice during an emergency such as a pandemic
* Regular decontamination of patients? quarters in secondary facility; need expanded morgue facilities
* Grief counseling will be in high demand
* Probenecid apparently doubles the half-life of Tamiflu in the body (see link to Reuters news story)
Neighborhood functions:
* Organize neighborhood around avian flu contingency
* Archive information about each neighbor, emergency contact information, required medicines, pets, location of critical items on property such as medicines, special skills each can bring to bear in emergencies
* CERT training; first aid/CPR training
* Neighborhood education and news updates via newsletter, websites, email lists or phone trees
* Establish liaison with local hospital, healthcare professionals or city health services office
* Set up communications node (if communications are still up and running) or point persons and runners; maintain contact with neighbors
* Ham radio - have one licensed operator
* Keep track of all cases; transport afflicted when necessary (using personal protective equipment)
* Stockpile goods and move resources to where needed to prevent waste or shortage
* Establish staging areas for deliveries
* Immunized (via vaccination or flu survival) persons hopefully volunteer to run errands and help with nursing
* Consolidate errands to minimize contact in public places
* Purchase portable ventilator to share
* Elect a neighborhood ?sheriff?; consider an armed guard if there is civil disorder
Public Education:
* Hygiene considerations: hand washing, cough technique, awareness of infectivity on surfaces and cleaning techniques; special effort to train children; use video to demonstrate
* Importance of flu shots and pneumovax
* Importance of staying home when ill or if exposed to A(H5N1)
* Material preparations such as stockpiling food, water, household basics, etc
* Advance planning such as how to educate children pulled from school and working from home
* Teach basic nursing skills such as taking blood pressure, pulse, temperature, respiration rate
* Teach public how to identify A(H5N1) and specific nursing measures for home care; videotape classes for broadcast on TV and web for the public
* Encourage businesses to make contingency plans to accommodate social spacing via telecommuting, teleconferencing, etc; if employees can work from home, this is optimal
Preliminary considerations:
* There will most likely not be a targeted vaccine until about 6 months after pandemic has begun; any vaccine prepared ahead of the pandemic will likely render partial protection
* There will most likely not be enough antivirals for treatment, let alone prophylactic use
* Assume a quarter to a half of the public will become infected over a 3 month period (a flu wave, of which there usually are 3 ? the worst being the 2nd ? a few weeks or months apart) and 3/4 to a half staffing everywhere for various durations
* Virus will be shed before symptoms appear (which can be 3 - 6, up to even 17 days) and after symptoms (21 days for children, 3?5 days for adults, longer for the immunocompromised)
* Children and otherwise healthy young adults are disproportionately at risk
* All bodily excreta will be very dangerous, especially feces and sputum/mucus; virus often multiplies in gut and diarrhea is often first symptom, preceding respiratory symptoms
* We will probably need two or more times the beds and ICU facilities
* There will probably be mortality of at least an extra 50% beyond normal; a high percentage of these are likely to be under 65 years old, which comprise workers in essential services
* Most patients should probably be treated in the home, or if more critical, in secondary ICU-like set ups in schools or other unused locations
* Hospitals will need to continue their usual work and erect a firewall to protect vulnerable inmates
* Childcare and family nursing responsibilities will strain ability of healthcare workers and other essential infrastructure workers to provide services
* Public services such as water, power, waste disposal, communications, and transportation will likely be intermittently interrupted
* Deliveries of food and other essential commodities may be disrupted
* There may be civil disorder due to shortages and desperation
City functions:
* Close schools and other (nonessential) places where people congregate
* Stockpile materials, medicines, face masks, gloves, antiseptic cleansers, wipes, etc.
* Set up vaccination priorities (in conjunction with medical personnel) in a logical way that puts essential personnel first: medical, police, essential waterworks, power, communications, waste and morgue workers; then children and adults, preferably those latter who commit to serve as neighborhood or healthcare volunteers (if we should be so lucky to have vaccine at all)
* Policing will be needed to guard hospitals and pharmaceutical stockpiles
* Develop plans to keep essential services operational; establish minimum staffing level requirements
* Establish lines of succession in critical positions
* Coordinate essential commodities deliveries and rationing
* Set up a city-based delivery network with designated staging areas
* Essential pre-purchased supplies could be dropped at neighborhood staging areas for distribution. Delivery personnel should be sufficiently safe if they do not make contact
* Establish emergency fuel supplies
* Negotiate with private water companies to utilize water delivery trucks
* Include area for public information updates on website and arrange with local radio & TV for regular accurate official updates (assuming media is functioning); utilize ham radio
* Institute Cisco system linking emergency radio networks
* Establish guidelines or rules for (voluntary?) quarantine: home isolation, isolation of contacts of known cases, restriction of movement, requirements for use of face masks
* Restrictions on airports and international and national travel as well as public transportation
* Ports and shipping: sterilization procedures for certain goods entering
* Curfew should there be unrest
* Insure that institutions where people live together such as nursing homes or prisons are prepared
* Consider how to deal with the homeless, who will be particularly vulnerable and thus hazardous
* Set up temporary morgues; body recovery teams with prepared vans that completely isolate corpse and protect drivers; body disposal in least potentially infective way, cremation encouraged
* Videotape school classes to put on TV or the internet so education can continue at home
* Gilead, the company that created Tamiflu but licensed it to Roche (and is suing to get it back), is based in California: appeal to them to make it invoking compulsory license (long shot)
* Explore the possibility of temporarily taking over hotels or motels for secondary treatment centers. They would be preferable to school facilities, as they already have beds and bathrooms
* Issue recommendations to all employers to encourage and facilitate telecommuting and teleconferencing if possible
* Levy a tax for preparation; lobby state and federal government for city funding
* Fuel shortages are bound to cause difficulties. [If possible, acquire and use small fleet of electric or plug-in modified hybrid Prius (see calcars.com) cars, charged via solar panels (if possible using Toshiba?s high-capacity lithium ion batteries ? 80% charge in 3 minutes, 100% in 10; due to be made available commercially in 2006)]
Hospital functions:
* Provide vaccine (if available) or prophylactic and therapeutic antivirals to healthcare workers to encourage continued service
* Set up mobile nursing units (part of firewall) with portable antiviral air filters for using in sick rooms (to protect the workers) as well as traditional protection
* Establish some means for healthcare workers? children to be taken care of during shifts; possibly uninfected neighbors working at home
* Establish hotline for immediate assistance from mobile nursing units
* Establish teleconferencing and other communications capability for conferring with healthcare professionals
* Set up public information web pages and blog for Q&A; establish community liaison office; prepare and provide public education materials concerning flu and nursing procedures
* Stockpile supplies, vaccines, antibiotics, and antivirals, IV kits, fluids, O2 concentrators, ventilators, etc.
* Volunteer vetting and training: vaccination, administering meds, nursing assistance, testing for H5N1 (if possible), errands, etc.
* Establish minimum staffing levels; identify essential personnel; establish lines of succession
* Oversee secondary location set up and personnel (part of firewall)
* Suspend elective surgeries
* Close hospital wards to visitors
* Ensure critical functions such as waste disposal, backup power, supplemental water purification, laundry, sterilization, etc., with contingency plans for personnel shortages and service outages
* Transport seriously ill patients to secondary locations (EMT? City? neighborhood volunteers?)
* Documentation and data collection for analysis
* Air conditioning or forced air heating should be modified to eliminate viruses (UV, ozone, high filtration) in secondary facilities. Switch to radiant heat in winter and ice in summer
* Stockpile and establish a rental/delivery system for oxygen concentrators and ventilators
* Hire more respiratory therapists if possible but ensure their safety throughout the pandemic; train nurses in some RT techniques
* Pull doctors in from private sector corporate entities (which may be shut down anyway)
* Establish or lobby for a way to allow doctors licensed elsewhere or with lapsed licenses to practice during an emergency such as a pandemic
* Regular decontamination of patients? quarters in secondary facility; need expanded morgue facilities
* Grief counseling will be in high demand
* Probenecid apparently doubles the half-life of Tamiflu in the body (see link to Reuters news story)
Neighborhood functions:
* Organize neighborhood around avian flu contingency
* Archive information about each neighbor, emergency contact information, required medicines, pets, location of critical items on property such as medicines, special skills each can bring to bear in emergencies
* CERT training; first aid/CPR training
* Neighborhood education and news updates via newsletter, websites, email lists or phone trees
* Establish liaison with local hospital, healthcare professionals or city health services office
* Set up communications node (if communications are still up and running) or point persons and runners; maintain contact with neighbors
* Ham radio - have one licensed operator
* Keep track of all cases; transport afflicted when necessary (using personal protective equipment)
* Stockpile goods and move resources to where needed to prevent waste or shortage
* Establish staging areas for deliveries
* Immunized (via vaccination or flu survival) persons hopefully volunteer to run errands and help with nursing
* Consolidate errands to minimize contact in public places
* Purchase portable ventilator to share
* Elect a neighborhood ?sheriff?; consider an armed guard if there is civil disorder
Public Education:
* Hygiene considerations: hand washing, cough technique, awareness of infectivity on surfaces and cleaning techniques; special effort to train children; use video to demonstrate
* Importance of flu shots and pneumovax
* Importance of staying home when ill or if exposed to A(H5N1)
* Material preparations such as stockpiling food, water, household basics, etc
* Advance planning such as how to educate children pulled from school and working from home
* Teach basic nursing skills such as taking blood pressure, pulse, temperature, respiration rate
* Teach public how to identify A(H5N1) and specific nursing measures for home care; videotape classes for broadcast on TV and web for the public
* Encourage businesses to make contingency plans to accommodate social spacing via telecommuting, teleconferencing, etc; if employees can work from home, this is optimal
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