Old Flu wiki

The old Flu Wiki is closing down June 1, 2008. All the invaluable info will be lost forever.
I have decide to bring as much of it over here as I can. I don't have much time, and there is alot to try to bring over pending authorization from DemfromCt.

Authorization granted.

Community Preparedness for an Influenza Pandemic

includes public and private utilities, medical systems, basic government functions, insurance, tourism, etc. This area includes sections on: Dealing with Anticipated Problems

One of the biggest challenges of a rapidly developing and sustained influenza pandemic is its capacity to disrupt “essential services”, i.e. society’s critical infrastructures. The following areas of everyday life may break down during a pandemic, causing problems even for people who are not ill. Formulating a plan for each of these areas is essential for every community.


Medical and Health Services

Hospitals will be hard hit in any pandemic— not only from the volume of patients, but from staffing shortages, shortages of equipment and food deliveries, and from loss of revenue from various sources (cancelled surgeries, increased expenditures with critically ill etc.)(some posts here have been converted to links—click the relevant title)

Specific hospital pandemic plans, when available, will be found in the Geographic Category. List of Hospitals Worldwide A database of ~12,000 hospitals worldwide. Search by combination of country, alphabetical letter or keyword. The hospital database will eventually contain the address and contact details of every hospital in the world.

Health Care Workers
Health Care Worker Safety During a Pandemic?
sources of physicians
Nurses
Residents and Interns
Allied Health
Including: Respiratory Therapists, Phlebotomists, X-ray Techs, Laboratory Techs
Units
ER services
Triage and Screening
Pulmonary services
Support services (Laundry, Housekeeping, Maintenance)
Field hospital facilities
Surgical Services

Medical and Health Services Continued

How To Discuss Pandemic Preparedness With Medical People
Public safety issues for health care facilities
Health-related infrastructure (ambulances, helicopters, other vital transport and communications, power supply to critical facilities. etc.)
Emergency actions including triage, streamlining of paperwork, etc.

It’s been observed that trying to discuss pandemic preparedness with doctors, hospital administrators and other medical people, especially by those who may not be at the same perceived ‘rank’ (as a patient, a nurse, etc.) is not as easy as it could be. As in many other situations, the intended personnel may be uninterested, uninformed, or otherwise too busy to deal with the topic of interest.

One suggestion is to try and tailor the information to suit their background. For example, when talking to ER personnel, links from the American College of Emergency Physicians may mean more than links to news articles. Here are two links to pass along to ER doctors:

Emergency Physicians Say Federal Pandemic Flu Plan Doesn’t Address Nation’s Lack of Surge Capacity and Isolation Beds
http://www.acep.org/webportal/Newsroom/NR/general/2005/110905.htm

Nation’s Emergency Physicians Present 10-Point Plan For Avoiding Mass Casualties From Pandemic Flu Outbreak Or Other Disaster
(same link as above)

Medical Gases

Many hospitals use vaporized liquid oxygen for breathing gas with cylinders for backup. There are a limited number of facilities that produce this breathable liquid oxygen, and if there are power blackouts those plants will be shut down (they are large power users and are almost all on interruptible power) and their inventories will be extremely limited. Most hospitals also have a need for liquid nitrogen and liquid helium for cooling purposes (MRI magnets). If the probability of a pandemic starts approaching 100%, the local tanks should be kept as full as possible.

There are only about 7 ‘manufacturers’ of the industrial gases used by hospitals, and they function as an oligarchy. Past accusations of price fixing by this industry have always settled out of court without conclusive proof of collusion; based on unsubstantiable insider knowledge of this industry I will tell you that these companies *DO* collude on prices, most obviously with a ‘straw man’ sales policy of not offering competitive bids to prospective customers perceived to be in geographic areas ‘belonging’ to competitors, and on quoting ‘schedule’ (the maximum price where negotiations start and from which a discount is *always* given, to make the customer think they got a deal) whenever another company’s existing customer considers changing vendors and asks for a competitive bid. Quoting ‘schedule’ guarantees that the customer’s existing vendor will have a lower price and the customer will not change vendors. Most of the contracts are also structured so that if a customer *does* seek an outside bid, they are signed up for another 3 years of service obligation (the contracts have clauses that allow price-hikes during their course). (If you hate the behavior of your cell phone service, keep a wide berth from industrial gases!)

In the event of an emergency governmental agencies should scrutinize their behavior *VERY CLOSELY* to prevent collusive price-gouging or other unsavory tactics (shorting deliveries, etc.).


http://www.acep.org/webportal/Newsroom/NR/general/2005/110905.htm

Private practices: physician and non-physician, dental care, other

PHYSICIAN
In a true pandemic there would potentially be a reduced demand for outpatient non-emergent services, yet physician practices, especially group practices, might also be a pool of underutilized staff in the midst of a crisis. How to use them best would be a problem that shoud be tackled head on early in the pandemic. Individual hospitals or local Health Departments might pull from this pool to staff temporary holding units in schools and other community makeshift settings as well as understaffed (from staff illness or full capacity) hospital units.
Hospitals and health authorities might consider establishing a sliding scale of elective procedures that can be tightened as emergency demands worsen. This could be coupled with a roster of health care personnel (physicians, nurse practitioners/physician assistants, nurses and LPNs, nurses aides, medical assistants) who could be diverted to emergent and aftercare duties. Surgical specialties thus freed up could be used to put in central lines, ivs, do thoracenteses, intubation, etc. Such a scheme would require advance planning and discussions with the relevant specialties.
A pandemic planning guide for physician offices can be found here, prepared by Dr. Michael Parry (Stamford Hospital, CT) and used with permission.


NON-PHYSICIAN PROVIDERS
Here is a list of some medically trained non-physician providers who might be recruitable in an emergency:

Dentists—have training in medicine and surgery as it relates to their specialty, and would be capable of assisting physicians in an emergency. Many of them would need (and would want)refreshers on internal medicine.
Podiatrists—ditto
Pharmacists— have extensive education about medication, but limited hands-on experience with patients. In many areas of the US, pharmacists are in short supply and therefore likely be needed to remain in a pharmacy role, which will continue to be critical during an outbreak.
Physician assistants - licensed mid-level providers in many areas of the U.S.; see link
http://www.aapa.org/

Nurse practitioners - - licensed mid-level providers in many areas of the U.S. and world; see link
http://www.nonpf.com/

CRNAs - Certified Registered Nurse Anesthetists
Midwives
http://www.mana.org/

Former and current military and municipal medics, EMT's, etc.
First responders-
Consider if:
1/3 of staff is down with flu
tamiflu and vaccine are limited (who gets?)
what, if any, protocol changes (diversion, triage, long-distance medical control, etc)
From Wisconsin pandemic plan:
“Unlike the typical disaster, because of increased exposure to the virus essential community services personnel such as healthcare personnel, police, firefighters, emergency medical technologists, and other first responders, will be more likely to be affected by influenza than the general public.”

Legal issues
In the U.S., at least, there are legal sanctions for non-physicians providing care without training and certification— (i.e “practicing medicine without a license”). These issues, and issues of liability and reimbursement would also have to be solved if it became necessary to recruit non-physicians as providers. Physician Assistants and Nurse Practitioners already hold licenses - regulations vary from state to state as to degree of MD supervision necessary.

Medical and Health Services Continued

Pandemic Influenza Planning Guidance for Medical Reserve Corps Units.pdf
http://www.medicalreservecorps.gov/File/MRC_Pandemic_Influenza_Planning_Guidance.pdf

Homeless persons: risks, social services, and related issues
Disabled persons: accessibility and support considerations

First responders and EMS (link to/from “Public Safety” topic accordingly)
http://dhfs.wisconsin.gov/preparedness/pdf_files/WIPandemicInfluenzaPlan.pdf

Mental health services in emergency conditions

Mortuary and funeral services; handling of deceased persons and animals
http://www.newfluwiki2.com/showDiary.do?diaryId=446
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/sec7.pdf
http://www.iccm-uk.com/downloads/Preparing%20for%20a%20Pandemic.pdf
http://www.paho.org/English/dd/ped/DeadBodiesBook.pdf

Veterinary services: livestock (link this to / from “food supply” category)
Veterinary services: family animals (pets)
Additional resources can be found at
Health and Safety Information from Wikipedia
http://katrinahelp.info/wiki/index.php/Health_and_Safety

Food Supply and Distribution

Local farms, dairies, etc., including processing & bulk storage facilities
Poultry and hog farms & processing, as special cases deserving detailed plans
Distribution warehouses and transportation
Groceries and supermarkets
Home gardens, home livestock (rabbits, poultry(!)), hunting, fishing
Emergency food rationing & distribution
Food supply during strict quarantine
Public safety issues in safeguarding food supply & distribution
Poultry, meat and seafood handling and sanitation guidelines


Public Safety
Police department: priorities and continuity
http://www.policeforum.org/singlenews.asp?item_ID=4725
http://www.ojp.usdoj.gov/BJA/pandemic/pandemic_main.html

From the Massachusetts Draft Template for Local Infectious Disease Emergency Planning and Response:

Assumptions: Influenza Pandemic
An influenza pandemic is inevitable.
There may be very little warning. Most experts believe that we will have between one and six months between the time that a novel influenza strain is identified and the time that outbreaks begin to occur in the United States.
Outbreaks may occur simultaneously throughout much of the United States, preventing shifts in human and material resources that normally occur with other natural localized or regional disasters.
The effect of an influenza pandemic on individual communities will be relatively prolonged — weeks to months.
The impact of the next pandemic could have a devastating effect on the health and well being of the American public. MDPH estimates that in Massachusetts alone, during a 2 – 3 month period -
Up to 4 million persons will be infected
Up to 2 million persons will become clinically ill
Up to 1 million persons will require outpatient care
Up to 24,000 persons will be hospitalized
Up to 6,000 persons will die
Effective preventive and therapeutic measures — including vaccines and antiviral agents — will likely be in short supply, as well as antibiotics to treat secondary infections.
Health-care workers and other first responders will likely be at even higher risk of exposure and illness than the general population, further impeding the care of victims.
Widespread illness in the community will also increase the likelihood of sudden and potentially significant shortages of personnel in other sectors who provide critical community services, including but not limited to, military personnel, police, firefighters, utility workers, and transportation workers
http://www.mass.gov/?pageID=eohhs2subtopic&L=6&L0=Home&L1=Government&L2=Departments+and+Divisions&L3=Department+of+Public+Health&L4=Programs+and+Services+A+-+J&L5=Emergency+Preparedness&sid=Eeohhs2

Fire
See above

Government

Elections during pandemic emergency
Executive branch (Mayor’s Office etc.)
Legislative branch (City Council)
Judicial branch (local courts)
Administrative offices (personnel, as distinct from functions performed by same)
Continuity-of-government plans in the event of illness/death of elected & appointed officials

Utilities-Water Supply/Energy Supplies

Water Supply

People need to drink at least one-half gallon (1–2 liters) of water per day (ref). Dehydration due to lack of water can result in death within 3 days (ref), or earlier if there’s fever and hence need of more water intake. In a pandemic context, water is needed to wash hands frequently. Failure to properly purify water can result in a variety of diseases including dysentery, which may be especially dangerous for children. Thus, having access to appropriate quantities of clean water is essential.


Problems and Solutions
Problem 1
Approximately 94,000 people work in water and wastewater treatment plants in the United States (ref). During a pandemic, it is expected that a third of these workers will be seriously ill at the same time. In some places it will be less than a third, and in other places it will be more, always for a limited time (perhaps one or more weeks). It is essential that water treatment and other critical facility owners recognize that as sectors of the economy “shut down” talented volunteers will be available to help support critical services. A local water facility will be able to put a call out to the community it serves for “workers” just like dike builders and bucket brigades in fires and floods. Handyman support vs. master electrician, local civil engineer to support monitoring computer stations, etc.

Solutions


Cross-train other employees at the plant to perform essential functions.
Stockpile personal protective equipment, such as N95 masks and gloves, to help prevent infection of essential workers.
Consider moving water plant employees to the first tier for vaccine, when it becomes available.
have “instant training” materials prepared for many jobs on the site. Make the training available so outside professional volunteers from the community can volunteer to augment staff.
Problem 2
Electricity is essential for operating pumps that move water and to work the feeder systems to add chemicals for purification. During a pandemic, the electrical supply to water treatment plants may be interrupted. This would stop the flow of clean water to homes and businesses.

Solutions

Purchase back-up generators.
Make providing electricity to water treatment plants a top priority in the event of shortages.
Provide a manual way for manpower to crank up generators
Problem 3
Transport of supplies of chemicals used to treat water may be disrupted.

Solutions

Stockpile chemical supplies at the water treatment plants.
Groundwater may be safe to drink even without chemical treatment. Since lack of access to water will result in death in a very short time, it is preferable to pump untreated water to homes rather than to stop pumping it if chemicals are not available. Legislation may need to be introduced to permit this during an emergency. If possible, it would be beneficial to warn the public when untreated water is being pumped (possibly adding harmless color and telling the public in advance?). Water could be purified in homes using emergency water purification methods.
Make delivery route maps available. Set a process in place for volunteer driver teams to replace paid staff as needed. Figure out writing detailed training maps and documents volunteers would need to initiate and complete critical deliveries. Build redundancy and smaller cargo and containers that could be moved within family vans vs. large shipping trucks.
Map homes/businesses and facilities in community that still have well water.

References
http://www.awwa.org/
http://www.awwa.org/Advocacy/learn/info/3AskYourLocalUtility.cfm
http://www.nrwa.org/
http://en.wikipedia.org/wiki/Water_purification

Emergency Water Purification Methods
Emergency Disinfection of Drinking Water.
Information from EPA | CDC | FEMA
EPA:http://www.epa.gov/safewater/faq/emerg.html
CDC:http://www.bt.cdc.gov/disasters/foodwater/
FEMA:http://www.fema.gov/rrr/foodwtr.shtm

SODIS - Solar Water Disinfection
http://www.sodis.ch/Text2002/T-Howdoesitwork.htm
a simple and cheap method improves the microbiological quality of drinking water, using solar UV-A radiation and temperature to inactivate pathogens causing diarrhea.
Water Safety Precautions for Transient Public Water Systems
(Churches, Restaurants etc. with their own water system)
Word document from the North Carolina Department of the Environment

Other Issues

Water distribution and maintenance
Waterborne pathogens & disease transmission
Potable (drinking) water supply
Agriculture and industrial water supply
Graywater and other unconventional sources
Emergency water supply & distribution
Emergency conservation plans

Energy Supplies

Grid Risks

The power grids in most developed countries involve a high degree of complex interdependency between generation supply/facilities/staff, control facilities/staff, and transmission facilities/staff, as well as interdependency with external infrastructure/staff/supply to sustain the aforesaid. A full Reliability, Maintainability, and Availability (RMA) analysis would be required to reasonably quantify the probabilities and impacts, but the following is the first step of identifying key risks;

Power Generation

Coal (over 50% of U.S. electricity supply)
Miners and other staff must be able to extract coal at or near their current rates. Risks: absenteeism, interruption in food/water supply, loss of electricity.
Coal loading facilities must move the coal to the loading facilities and onto the coal cars. At the power plant, coal car unloading facitilies must move coal to temporary stockpile. Most coal plants require over 100 loaded coal cars every day. Risks: interruption in diesel fuel and electricity, interruption in food/water supply, absenteeism.
Trains must continue operating, including railroad crossing lights/gates (an accident would delay coal delivery). Risks: interruption in diesel fuel, electricity, absenteeism.
Communications between the loading facility, train dispatchers, and coal receiving facility must be operational. Risks: interruption in communications (dependent on electricity).
Nuclear (20% of U.S. electricity supply)
Must have sufficient external grid power (20–50 MW) to maintain operations in the event that the reactor(s) go offline. Risks: insufficient or unreliable supply of external grid electricity
Highly skilled staff must continue operations in all critical function areas. Risks: interruption in food/water supply, absenteeism.
Power Distribution

Skilled dispatch staff must be able to handle higher level of grid instability. Interconnections between control facilities are minimal in many areas; overuse during periods of high grid instability can cause failure due to thermal overload. Risks: interruption in food/water supply, absenteeism, increased staff stress, over-reliance on interconnects.
For each control area (over 150 in the US), the staff must be able to rapidly communicate power needs, availability, and decisions with local generation facilities and adjacent control areas. Strategic communication with the respective state Governor is also required. Risks: interruption in communications (dependent on electricity).
Repair crews must be able to restore outages to all portions of the distribution system (generation facility high voltage lines, control area interconnection lines, commercial/industrial/residental substations and lines). Risks: interruption in communications (dependent on electricity), interruption in food/water supply, absenteeism, increased stress.

(Need to integrate mitigations from Transmission infrastructure (grid / powerlines) operation & maintenance)

This page is being built after the template Monotreme created for Water Supply. Any small bit of help, well, helps!

The older coal and all nuclear baseload plants require attended operation, and the shutdown of only a few could take the entire grid down, similar to what happened two years ago. Without power, most residential and industrial gas and oil heating will not work, water pumping stations and residential and municipal well-fields would have to run on emergency power, which might only last for a limited time.

It is not clear how much reserve exists with respect to critical personnel (i.e., how much absenteeism can the system withstand and for how long) and whether there are concrete plans for back up, for example by using management personnel. Anyone with knowledge of planning in this sector is invited to contribute.

We need electricity for just about anything. The critical personnel would be the power plant operations and maintenance people (including linesmen in the field to handle storm damage, etc.).


Problems and Solutions
Problem 1
Approximately {I don’t know how many} people work in electricity plants in the United States (ref). During a pandemic, it is expected that a third of these workers will be seriously ill, or fearing to go to work, at the same time. In some places it will be less than a third, and in other places it will be more, always for a limitted time (perhaps one or more weeks).

Solutions


Cross-train other employees at the plant to perform essential functions.
Stockpile personal protective equipment, such as N95 masks and gloves, to help prevent infection of essential workers.
Consider moving electricity plant employees to the first tier for vaccine, when it becomes available.

References
Google for the data we need

Planning Efforts by major north-eastern U.S. grid operator PJM (Pennsylvania - Jersey - Maryland Power Pool): Includes presentations by PJM officials, Con-Ed emergency management director, Philadelphia Department of Health official, and others.

Motor fuels ( gasoline, petro-diesel, biodiesel, alcohol, aviation fuels, other. Peak Oil or other shortages as complicating factors)

Heating fuels ( wood, coal, natural gas, propane, other)

Mitigations (Emergency conservation measures & rationing, Point-of-use generating resources: residential & commercial)

see also Keeping The Grid Up, The North American Electric Reliability Council (use the search feature and type in “pandemic” for relevant links).
http://www.nerc.com/

Communications Networks/ Transportation Networks/Business Continuity/ Financial Services/ Education


Communications Networks

Postal services: delivery routes and post offices
Private carriers & parcel services, including private mailbox (PMB) services
Telephone network: landline and cellular
Internet and private data networks
Telecommuting: business continuity
Radio stations: vital broadcast capability
Television stations including cable facilities
Private radio networks e.g. “two-way radio,” commercial, industrial, governmental
Amateur Radio (Ham) community
International Amateur Radio Union
http://www.iaru.org/
American Radio Relay League
http://www.arrl.org/
Federal Communications Commission (FCC): Amateur Radio Service
http://wireless.fcc.gov/services/index.htm?job=service_home&id=amateur

Emergency backup communications networks
CUWiN model for free, self-organizing, self-healing community emergency networks using
http://www.saschameinrath.com/2005aug30disaster_recovery_cuwin

DCERN model for ad hoc, self-organizing, self-healing network using FRS radios
http://www.dcradio.org/

linking ham radio broadcasts via VoIP
http://www.irlp.net/

National SOS Network combining ham & FRS radios
http://www.nationalsos.com/

How to Lead during Bioattacks
hints for spokespeople on how to handle uncertainty and risk communication from the UPMC Center for Biosecurity
http://www.upmc-biosecurity.org/website/resources/index.html


Transportation Networks

Note: fuels are covered under Energy Supplies

Maintenance of private vehicles
Operation & maintenance of local public transport (urban/light rail, bus, etc.)
Health issues and public transport usage
Operation & maintenance of regional transport facilities (airports, seaports, rail stations, etc)
Trucking: continuity of service
Health issues and regional transport usage
Management issues vis-a-vis private passenger and freight carriers
Tourism and Avian Influenza?. A global look at planning for a pandemic in the tourism industry - scenarios - planning - questions - answers. “Repatriate tourists or not, how, at what cost, with what risks” - Link to the FW Forum to discuss this subject. Tourism and Avian Influenza


Business Continuity
Identifying vital businesses (e.g. hardware stores, pharmacies, plumbing contractors, etc.)
Identifying essential workers
Prioritizing resource allocation to maintain vital commerce
Interface between local government and local business during emergency
Impact of emergency measures on vital commerce
Mitigating harm to local business during and after pandemic emergency

Report from a local business forum in the Seattle / Tacoma area
http://dwb.thenewstribune.com/business/story/5228282p-4749472c.html


Financial Services
Identifying vital entities (banks, credit unions, insurance companies, etc.)
Continuity-of-business plans for each
Prioritizing resource allocation to maintain vital financial services (e.g. payroll processing, ATMs)
Local currencies and economic resilience?
Interface between local government and local financial
institutions during emergency
Interface between local individuals and entities, and larger (national or international) entities
Impact of emergency measures on local financial institutions and on individuals
Mitigating harm to individuals and institutions during and after pandemic emergency


Education
Schools (primary and secondary) and child-care facilities

Associations and US Government Departments
Pan Flu Guidance; Revised Nov. 21, 2007 US Department of Education
Pandemic Planning, US Dept of Education
Guidelines for Pandemic Planning American College Health Association (ACHA)
School Planning and checklists on US Pandemicflu.gov
US National Association of School Nurses
List of US State Associations of School Nurses
US National Parent Teacher Association PTA
Find Your Local Parent Teacher Association
School Closing Authority
Assessment of School Closure Laws in Response to Pandemic Flu from Center for Law snd the Public’s Health
What Do You Tell Your School Board When It Asks About Avian Flu Readiness?
Connie Harden is a nationally known HR consultant who wrote a chapter by that title for an upcoming book. The publisher, Thompson Publishing Group, has consented to its posting. It will be included as Chapter One in a book on various challenges facing schools at the K-12 level, to be published in the next month or so.

What Do You Tell Your School Board When It Asks About Avian Flu Readiness? The 22 page .pdf can be downloaded here.

We are very grateful to both the author and the publisher for graciously allowing us to post this text in the interests of furthering preparedness.


Funding for prep efforts:
“To assist in your efforts, we have also made a determination that funds from Title IV, Part A, the Safe and Drug-Free Schools and Communities Act State Grants program, may be utilized for general pandemic influenza planning activities. Please review the program guidance, which is available at http://www.ed.gov/programs/dvpformula/legislation.html, for additional information about administering these funds.” -Margaret Spellings, Michael O. Leavitt link

School closure
Tabletop exercise
Pandemic Influenza Tabletop Exercise: K-12 School Closure as a Disease Containment Measure from Minnesota Department of Health

Case for early school closure: Children will play a major role in transmission of infection as their illness rates are likely to be higher, they shed more virus over a longer period of time, and they control their secretions less well.

Evidence to Support School Closure

Children are thought to be the main introducers of influenza into households.
Children appear to be more susceptible to influenza and more infectious than adults in well-designed prospective studies of risk factors of influenza transmission in households.
Nationwide school closure in Israel during an influenza epidemic resulted in significant decreases in the diagnoses of respiratory infections (42%), visits to physicians (28%) and emergency departments (28%), and medication purchases (35%).
Non-pharmaceutical Strategies to Limit Spread of Pandemic Influenza
Martin Cetron, MD, Director, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 40 page presentation pdf
Evidence presented at IOM meeting:
1- Early interventions– before 3% cumulative infection, shown to have substantial effect.
2- Early school closure consistently related to reduction of epidemic peak, both from modelling and from 1918 data.
3- Closure of churches, theatres, and other ‘social distancing’ measures also work.
4- Multiple early interventions increase benefit further.
5- Social cohesion, local leadership, and trust in government important.
6- Measures not found to provide benefit – quarantine, banning of public funerals, making influenza notifiable.

Note: the IOM report does not conclude that there is definitive scientific or historical evidence. Models reviewed have mixed results:

Conclusion 5: In summary, the evidence suggests a role for community restrictions in reducing pandemic influenza virus transmission. The evidence does not allow for differentiating possible effects of specific types of community restrictions, nor does it allow differentiation between voluntary versus mandatory community restrictions. In general, evidence from modeling and from historical analyses confirm what is known for any infectious disease outbreak, that is, early intervention shows more promise than later intervention. The main effect might be to slow the time to peak of the outbreak in a community, which could be important for hospital-based management of ill patients and to allow for delivery of vaccine if available.
Basis for Targeted Layered Containment

1- at least 1/3 of all flu transmissions will be due to children.
2- closing schools early will reduce the attack rate (AR) for children and decrease overall number of cases, but will increase transmission in community and in households.
3- keeping kids at home will reduce community transmission but increase the relative importance of workplace transmission.
4- household quarantine ie keeping sick people and their family at home, especially with antivirals, will reduce overall transmission.
5- further but increase the relative importance of workplace and community transmission.
6- promoting social distancing will result in further reductions.
Once deaths occur, parents will take their kids out of school. Unplanned school closures will not happen early enough to reduce mortality, but resulting chaos and mistrust will reduce compliance for further interventions and damage social stability. Losing children is recognized as severest trauma by psychologists.

see also Homeschool


Specific school systems and planning tools:
Orange County, CA Pandemic Planning Kit
Contra Costa, CA Pandemic Planning Kit
Pandemic Influenza Preparedness for Schools from California Distance Learning Health Network
Satellite Broadcast • Tabletop Exercise • Online Toolkit
Launches: May 17, 2007 • Live Broadcast: 9:00–10:30 a.m. PT • Tabletop exercise to follow


News stories:
Taunton, MA

If an influenza outbreak occurs, the school - one of the district’s largest - will be used as a makeshift hospital.
40,000 Marin Schoolkids Get Bird Flu Warning

Health officials recently sent 40,000 fliers home with Marin County schoolchildren warning parents to prepare for a possible bird flu pandemic in California.
NY School district seeks flu plan

The Horseheads Central School District is taking steps to prepare for an outbreak of flu — anything from a local epidemic to a national or even global pandemic.

Public, private, and religious-affiliated
Post-secondary educational institutions -
Colleges, Post-secondary and Graduate Institutions
Discussion here

See also Schools

Colleges, universities and other higher educational institutions are beginning to offer their own web sites and plans to cope with a pandemic. Here are some first offerings from University of California and Chinese University, Hong Kong.

See also URMIA Pandemic Response.

Students Prep America is an organization of College students aimed at spreading awareness about Pandemic Influenza and promoting preparation at the individual, community, and national levels.

“This group was created as a response to the developing crisis involving the H5N1 virus, or “Bird Flu”, which experts believe could be responsible for the next severe pandemic. With increasing human cases, confirmed cases of human-to-human transmission and a case fatality rate of roughly 60%, this potentially pre-pandemic virus is cause for concern and immediate action. Visit our site below for more information on the threat posed by Pandemic Influenza and how you can help prepare your family, your community and your nation.”
Students Prepare America

Associations and US Government Departments
Pandemic Planning, US Dept of Education
Guidelines for Pandemic Planning American College Health Association (ACHA)
Colleges Planning and Checklist and checklists on US Pandemicflu.gov
Campus Safety Health and Environmental Management Association
Colleges have a different set of pandemic issues than secondary and primary schools, including the issues of whether students should stay or return home. For example, a Jan 2007 PowerPoint presentation from the University of Michigan by Dr. Robert Winfield, Chief Health Officer, can be downloaded here.

Specific School Examples:
Specific Schools

Pandemic Preparedness - Lab And Research Safety from U Michigan:
Attachments are located at the following URL’s:
http://www.research.umich.edu/news/Attachment.A-OSEH.doc
http://www.research.umich.edu/news/Attachment.B-ULAM.doc
http://www.research.umich.edu/news/Attachment.C-ULAM.doc

Articles of Interest:
Gannett Prepares for Possible Flu Outbreak Cornell, Feb 07
Disease expert pushes pandemic plans Yale, CT Post, Feb 07
How Colleges Can Plan for Bird Flu From: The Chronicle for Higher Education
Facing Down the Flu From: The Chronicle for Higher Education
CPCUeJournal Preparing for the Pandemic Flu from a Risk Management Perspective, .pdf
Colleges were among the “provisional influenza escape communities” in 1918, including Bryn Mawr, Princeton University and Western Pennsylvania Institution for the Blind (WPIB).

Public libraries
Emergency measures: closures and viable alternatives

Public Life/ Personal & Family Preparedness/

Identifying high-risk instances
Business, cultural, and religious entities: restaurants, laundromats, salons, parks, pubs, bars, entertainment venues (theatre, music, sports, etc.), cultural institutions, houses of worship, other religious institutions
Educational and emergency measures for risk mitigation
Sensitive issues: weddings, funerals, etc.; significant public observances, major holidays, religious services. Relevance of diverse cultural practices in these and other areas


Personal & Family Preparedness

This sub-category contains personal preparedness guides, including “How to Prepare for a Pandemic”, information on prevention, vaccines, medical therapy, complementary and alternative medicine, adjustment reactions and how to cope. When posting, link with related sub-categories and topics such as Legal (e.g., isolation and quarantine) where relevant.

Preparation Planning
Determining where to ride out the pandemic-

Where to Stay

Evaluate your current abode; is it urban, suburban, or rural? There is no one single clear-cut definition for any of these, as urban can mean apartment, townhouse, or single family home. It can mean a high- or low-crime city. It can mean reasonable room to store provisions for several months, or a highly space-restricted efficiency (i.e., the sleeper couch serves as the bed every night). How well prepared might the nearest neighbors be? How about the larger community? How about the city itself? Will there be sufficient vaccine distribution arrangements, measures to continue electricity/water/sewage, and contingencies for law enforcement absenteeism? An aid to understanding where can be found in the Decision Support Matrix below. You have to determine the feasibility of any potential location based on the potential for who and what, primarily.


If the urban area you reside in is prepared (or preparing), then provisioning for and riding out a pandemic at home could be entirely feasible. Indeed, you will likely be safer at home when the pandemic hits than on the crowded road in the midst of potential fuel shortages with other pandemic refugees (and opportunists preying upon them). If you have concerns with the security potential of your current residence for any combination of reasons, then consideration of all alternatives is prudent.

Questions to answer:

Do I plan to ride out the pandemic with my immediate family? Extended family? Friends? Other like-minded people? Some combination?
What is the potential of the current location for civil unrest that may jeopardize my (family’s) safety? What is the potential for household, neighborhood, community, and town/city protective measures?
What is the potential for food and water storage in the residence? What is the potential for food and water resupply?
Distancing vs. Stay-in-Place (SIP)

At some point, you will have to determine the approach you will take to isolating yourself from others during the pandemic. The major choices are;

No isolation; continue as normal
“Distancing” (keeping at least 3 feet from anyone in public)
Staying home when sick or to care for children when schools are closed
Staying home altogether when a pandemic wave is in your region
There is no one approach that will fit everyone’s family and work situation; after reading the rest of this book, have a frank discussion with those you plan to ride out the pandemic with and work out an agreement that all can support.

State and local government preparation

Part of your evaluation will be to determine the breadth and depth of the approach to preparedness your regional and local government is undertaking. Different localities will have different needs and will require a variety of responses to a pandemic. Often, this is because of the scope of involvement the State/Province/National authority has elected to assume. The direct effects of the pandemic on yourself, your family, and neighborhood will depend, in part, upon local government preparedness, so that should be your starting point.

The primary criteria you can use to gauge the local government’s current response status are:

Does the municipality have a local health official tasked as the designated health advisor for a pandemic?
Does the municipality have an Emergency Operations Center? This operations center will be the fulcrum for command and control of health, security, transportation, utility coordination, and local public information dissemination. (There can be backup sites and/or distributed operations as well.)
Have critical government functions been identified, and has training been established to shift staff around in case of high absenteeism
Has the local municipal critical infrastructure (i.e., electricity, water, sewage) been evaluated for sufficient capacity and operational mitigations to the risk of a pandemic event? How long could the water supply continue if the electrical grid were inoperable for an extended time?
If in the U.S., does the utility have in place a Continuity of Operations Plan - Extended (COP-E) as described in the Department of Homeland Security’s Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure? Simply having a standard Continuity of Operation Plan (COOP) is not sufficient, as described in the DHS guide.
If privately owned, what plans and procedures does the utility have to continue operations during a pandemic?
If in the U.S., does the utility have in place a Continuity of Operations Plan - Extended (COP-E)?
If not in the U.S,;
Have critical functions been identified with staff trained to cover absentees in these areas?
How secure is the fuel supply from disruption to extraction, transportation, refining, and distribution operations?
What level of spare parts will be stockpiled to mitigate supply disruption risks?
How will maintenance be prioritized during high levels of absenteeism?
What are the arrangements with other neighboring electrical service providers to maintain grid synchronization?
What procedures are in place in case power plants lose functionality (i.e., rolling blackouts)?
Have alternative treatment and triage sites been established to handle a pandemic treatment surge?
Has there been coordination with grocery stores and pharmacies to ensure that citizens will be able to resupply without fear of infection?
Are policies established to identify which public areas will be closed and the specific criteria for closing? Have policies and criteria been established for reopening?
Are plans and detailed procedures established for the mass distribution and administration of vaccinations (if and when a vaccine is developed and produced for the pandemic strain)?
Has there been coordination with private, volunteer, and neighborhood organizations to develop and synchronize local response?
Has a plan been established to account for surge operations at the mortuary and related services?
Has the local government coordinated completely with State/Province/Regional authorities and satisfied their requirements?
Is there a public health education campaign underway that addresses the local government’s response, as well as recommended citizen responses?
Are there mutual aid agreements with neighboring localities?
Are there any considerations for controlling the movement of people and commodities or out of the community?
Have the health, social service agencies, and fire departments created a registry of former and retired personnel and suitable volunteers?
Has the law enforcement agency created a registry of former and retired law enforcement personnel and suitable volunteers who could provide continued civil order, traffic control/restrictions, security at clinics, etc.?
Has a public communications medium been established that will reach people during power outages? Do citizens know what communications devices they need (e.g., solar/crank powered radios)?
If local preparations appear to be slow, stalled, or too narrowly focused (i.e., predominantly medical), then seek to improve the chances of you, your family, and your community by contacting local officials and advocating timely and sufficient pandemic preparedness measures. Appendix I contains a sample letter to local council members/supervisors/assemblypersons that can also be used for speaking notes during a citizen’s input session normally provided at council meetings or public hearings. Don’t be shy, your local officials are “servants of the people,” and pandemic preparedness is relevant to their mission of ensuring the health, safety, and welfare of you and your family.

Consideration of Other Locations

Regardless of the type of disaster, you should always have another location identified and confirmed in case the situation at your home or primary site becomes unsafe for any reason. If you decide to consider riding out the next pandemic at a site other than your home, reflect first on the benefits you and your family can bring to that site. Are you going to bring extra food for your hosts and pre-position it so that you can leave for the site without extensive preparation time and the potential for an overloaded vehicle? Do you bring a special skill to the group (i.e., medical, electrical, mechanical, security, food preparation, gardener, etc.)?

There are three important measures to take when traveling during an elevated pandemic state:

Take an emergency supply kit with at least 3 days worth of supplies
Take spare vehicle fuel (or if biking, spare tires, patch kit)
Have an extensive map of the areas you will travel through. Plan at least 2 alternate routes.
Questions that must be answered when meeting up with others at another site include:

What is the specific trigger point/event at which you leave?
Will you impose restrictions on when members of your Support Group are allowed into the refuge due to possible contagion?
How might these trigger points align with possible quarantining of the local metropolitan area?
What supplies do you promise to pre-position?
When are they to be in place?
What skills do you bring, and what tools are required for you to exercise your skills?
What contingency plans will the group at the refuge execute? Are you expected to be a part of the site’s security arrangements?