Travis County Commissioners Court
March 21, 2006
Item 20
Number 20, receive briefing from Austin/Travis County health and human services department regarding preparedness and response plan for pandemic influenza.
>> morning, judge Biscoe, Commissioners. I’m david lurie, director of the Austin-Travis County health and human services did department. And with me this morning is dr. Valdez, who is our medical director. We appreciate the opportunity to give you kind of a progress or status report in terms of our planning related to pandemic flu. I can assure you it's a much more condensed version, judge, than you heard at the capcog meeting a week or so ago. First of all, I really want to emphasize that to date the risk for our community remains extremely low, although we are monitoring very closely what's occurring internationally and have a very robust system of reporting and information available through our health alert network system that keeps us posted on what's occurring throughout the world related to this particular issue. , given the potential magnitude of a pandemic, no community can in effect say they are totally prepared, but I do want to assure you that given the emphasis in recent years on public health preparedness and also given our experience and lessons learned from the recent hurricanes, we feel that we are much better prepared today than we've ever been for this possibility. Dr. Valdez will kind of walk through on a very high level the components of our plan. What you see is that the public health principles related to this plan are very consistent with what we do everyday in terms of our role related to protecting the community from infectious diseases and potential outbreaks. I also want to emphasize that there's very close planning in our community with the office of emergency management. Pete baldwin who is here this morning works very closely with us around preparedness overall and we have a very effective partnership with the city and the county around emergency preparedness. Some of the things that I would encourage you to be thinking about from a public policy perspective and as elected officials in our community have to do with some of the interventions and decisions that you may need to consider in the event of a pandemic. One of the issues, of course, is social distancing. And so there may in fact be a situation where you would be looking at cancelling a large public gatherings. We've been meeting with local school districts about the possibility of school closures should that become necessary. Also, business continuity planning. Some of the projections in terms of pandemics suggest that we may be faced with a disease rate or illness rate of 25 to 30% of the population. So you could be in a situation where your workforce is significantly impacted by this and some decisions would need to be made about what are critical or essential services and how can those be sustained during a pandemic. Dr. Valdez can talk a little bit about isolation and quarantining and again the numbers would potentially be such that they would far exceed our sort of basic capacity in terms of health care, for example, and so we'd be looking at a tiered system where a lot of people would be asked to be isolated at home, basically self-care. Then there would be a second tier where there would be some intermediate facilities for people who need more care. And then, of course, for those extreme cases, hospitalization. And of course again, we would have to mobilize a lot of resources in our community for that to be effective. And the other area that would be extremely important is your role in terms of communications. Communications is really the critical part of this in our view. That is, communicating information in advance of an event because there are a number of things that people as individuals can do to minimize their risk, protect themselves, and then, of course, during an event, really important to keep people posted, up to date in terms of what's occurring, where they can go for assistance. And we'd be looking to our local elected officials to convey those messages to the community and support the overall efforts. So with that introduction, we would ask dr. Valdez to share with you, and I think you have copies of the slides in terms of the plan itself.
>> thank you, david. Good morning.
>> good morning.
>> I just want to quickly speak to you about pandemic influenza and influenza briefly. Influenza we seasonal. And typically we are able to respond to it. A few years ago we had a rise in influenza cases. That sometimes even stressed our current health care system. Pandemic influenzas are different. By its very definition it is a new strain of virus that we do not have immunity to and therefore we are all at risk to contract this disease. Similarly because it's a new strain, typically there is not a vaccine available and therefore not an ability to prevent the spread of this disease, at least at its initial onset. And when we talk about pandemic, what a pandemic is basically it's a global epidemic. And we could use an example such as hiv, which occurred across the world over time and continues to be a scourge on here in the u.s. And elsewhere. And I think what's important for that is because of the potential impact of a pandemic influenza on our community because there is no immunity, because it can be easily spread from human to human, there's potential for it to rapidly spread. In the 1918 pandemic we saw it spread from the east coast of the united states to the west coast of the united states in 1918 without air travel, within five weeks and certainly transported throughout the world by ships. And certainly this is there is the potential and with that comes a high risk for disability, death and social disruption and economic costs. Again, seasonal flu outbreaks, much lower impact, much lower impact in terms of health. We estimate in the united states approximately 36,000 deaths a year from flu. When we talk about pandemics, when we talked about the 1918 pandemic, we saw over 675,000 deaths, so we're talking about different orders of magnitude here. What we have done in the city and part of our plan is to work with partners and partners include the Travis County office of emergency management, city emergency management, our health and hospital groups, stakeholders in the community, Travis County medical society and others to begin to coordinate our efforts in terms of planning and preparing for the pandemic. And we, particularly the health department, are responsible in the lead in that early detection role, prevention of disease transmission and working also to support primary care, hospital care, motor twear services and wherever else we can be of service to the community. Let me give you a brief history of pandemics, at least in the past century there have been three documented pandemics of influenza here and of course the most highly visible or spoken and talked about is the 1918, 1919 spanish flu pandemic that impacted the entire world. It struck down anywhere from 20 to 50 million people. And here in the united states it was estimated to be about 675,000 people. As we look back on that pandemic, recently we've been able to actually jean know type that virus and actually reconstruct the virus and infect mice and this article appeared in the journal of science a few months ago. And basically what we determined from that is the original 1918 flu strain was an avian flu strain. And that's what -- again, why there's so much concern currently with avian influenza, a new strain circulating now on several continents because we have documented proof now that that type of strain was able to jump the species barrier and infect humans. But we've had other strains. In the late to mid 50's we had asian flu strain which was not as severe and affected approximately 70,000 persons who died from that and about a million people infected here in the u.s.: and again in late 60's, 1968, '69, the hong kong flu, which again impacted approximately 34,000 persons dying from that and 700,000 worldwide. The reason, just so that you're aware, influenzas do this is just the genetic nature of the virus. It's an rna, very unstable. They reasort, they mix. They mix with other viruses and this is how you get this new virus strain. So this happens every year and this is the reason why we have to have a flu vaccine every year. They change. But the pandemic flu virus strain, what happens is it completely changed so that it's completely unrecognizable to our immune system and hence we have no immunity. Our plan consists of five components. Planning and coordination, situation monitoring and assessment. Prevngs and containment strategies, health systems response. And communications. And I’m just going to walk you through those briefly. Planning and coordination is what it says. We meet with various stakeholders and groups to coordinate, plan, run through scenarios, practice, exercise and drill. We've been doing that for the past several years, we continue to do that recently enacting some of those plans in the hurricane relief efforts with katrina and rita and currently going through the exercise of reviewing what went well, what didn't, lessons learned and improving those plans. That's happening currently and we continue to have a series of meetings with those stakeholders. And just as an example, meeting with Travis County medical society to coordinate planning with their physician groups, looking at some of the ethical considerations that arise from a pandemic flu and just met with their board of ethics yesterday to begin to process how we would work with standards of medical care and practice during the pandemic, working with our funeral home directors to see how they would work with us in terms of mass fatalities, if we expected them, working with religious groups soon to discuss those ethical and spiritual considerations that we need to take account into in our planning and most importantly recently working with our social service agencies this we clearly felt a great asset during the hurricane relief effort and in fact really was the long-term recovery effort of working with them, and so including them now in how we would support people when we tell them to stay home, isolate themselves and keep from spreading the I willance and how to have the support to keep them there. That is happening and continues. Situation monitoring and assessment is really what we do everyday in the health department. It's bread and butter disease surveillance and epidemiology. We have a number of systems in place to monitor what we call preclinical. Before you get sick and go to the doctor most people will try something and typically that's go to the pharmacy and pick up the cough and cold remedy and see if I can take care of this at home. We monitor sales of over the counter drug sales such as tylenol and cough and cold and anti-dreer I can't and thermometers and a number of other items through various wholesalers here. And so in order to see if we can pick up something early before they start to see the doctor. We do that by zip code and correct for time of day, time of year. We also monitor clinical visits. When you go to the doctor, we work with two of our largest groups here, arc, adc, also scott & white in temple, looking at central Texas office advice it's. Every night we look at this information and basically sort it by bucket and in this case we would look for influenza like illness and we look at that by zip code and correct for time of day, time of year. Trying to see is there an outbreak occurring sooner than within doctors' offices. We also monitor emergency room visits. If you get sick at the doctor awnd end up in the emergency room, we try to monitor that and pick it up early. And lastly, we monitor hospitalizations through our network of infection control practitioners and we work with them daily and weekly we send out alerts and check with them, have you seen any of x? And we really ask them and work with them really closely. And then ultimately we monitor deaths through our office of vital records and registrar and looking and monitoring deaths from influenza and pneumonia. That's a very comprehensive surveillance system that we're working on daily. And in addition we monitor the international and national news through secure networks such as the health alert networks, fbs, that let us know what is occurring beyond our borders here and in the state and nationally and internationally. Then a main piece of the plan is prevention and containment. In this point we speak to vaccination. Just to be clear I think there's been a lot of talk around vaccines, but for now I want you to understand that though there are trials for a specific vaccine currently, there currently is not a vaccine available and our assumptions and our planning efforts is that there will not be a vaccine available at least in the first wave. And that's important to note because if there were a vaccine available, we most likely would find that there would not be sufficient amount and we would have to look at prioritizing who serves that vaccine. Secondly you may have heard a lot about Texas a&m my flu or -- tami flu or these other vaccinations. What you need to understand when we look across the world, the supply is very limited. Locally it's more limited. When we ran some of the numbers, there really is not sufficient tami flu to prevent in a whole population, let alone within first responders and families. So if we look at tami influence as a potential cure all, we're saying it's not. It may be used as a targeted treatment and control strategy, but not for use and we do not recommend stockpiling and I strongly urge people not to stockpile and not to use it inadvertently. It is an anti-viral or antibiotic and there is evidence to suggest that resistance occurs when it is used inappropriately to treat wrong viruses and therefore eliminating a potential tool. So we ask that it not be stockpiled and we are not currently stockpiling tami tamiflu. Mass vaccination, if there is a vaccine, we do have a medical distribution plan in place as part of a bioterrorism and emergency preparedness funding. Those plans have been in place for several years now. It really began with some of the smallpox vaccination campaigns, but we have that and we've drilled those plans before. As I mentioned with the tammy flu, if there is some drug available, there may be potential to implement what called ring vaccination, which is where you find a case and you find the contacts to that case and in the days of smallpox, this is how you vaccinated everyone, you vaccinated those people who came in contact and you basically expand the rings until you eradicated the virus. Similarly we may use tami flu in that nature. If we found a case in Austin we could treat a case and perhaps prevent transmission of the disease and then treat contacts and see if that can stop or prevent or buy us time in the progression of an outbreak. And then there's isolation and imairn teen. And my that we mean restricting the movement of someone who is ill, so if someone has influenza, we isolate them, put them in a separate room, we keep them away from people who are well. Quarantine is a restriction of movement, of persons who have been exposed to potentially communicable disease, but may not have the disease. And that's very important to understand because basically what we're saying is these are healthy individuals who we're asking not to leave their home or go into public or work until a specified time period to ensure that they indeed do not have the disease and that also limits transmission. We both know that those tools are very effective in preventing outbreak. And in the broader ones are the broader community control measures, looking at social distancing, cancelling large gatherings such as in schools or movie theaters or sporting events. These are other potential tools that we can use, and I would ask you to consider. In the health systems response speaks to health care worker surveillance, monitoring health care workers. In 1918 pandemic and in sarz, the first people that became ill and you lost your infrastructure was health care workers. So we need to protect them. They need to be there to take care of the sick. Hospital plans, this is a plan that we've already worked through often with hospital where's they cancel elective procedures, discharge patients and basically build capacity within their systems to provide care for large number of ill. And then our temporary hospital plan, which was implemented during katrina and rita. And then lastly is the communications piece, which I think mr. Lurie alluded to, but working with our city, county public information officials to get official accurate, timely information to the public through various channels and that will be key to preventing this. So we speak to what the public can do now and should be doing now for itself. It's basic public health, hygiene, hand washing, covering mouth and nose when coughing, trying to avoid touching eyes, ears, nose, mouth, that can spread disease. Staying home when sick. I know that's very difficult for our culture here in america to stay home when sick, but it's absolutely key to prevent spread of any disease in the workplace. Avoiding close contact with those who are sick. Monitoring travel and where you're going and avoiding hot spots currently. Working from home and of course the basics of staying healthy, regular exercise, eating nutrition food and getting enough sleep.
>> everything your mother told you to do when you were in elementary school basically.
>> exactly, judge. Now we just have data for it to support mom's good judgment. [ laughter ]
>> it res son naits with me.
>> absolutely.
>> so I think the action items for your consideration is as we look at the temporary hospitals, within the city of Austin we've determined some sites for that, and again the convention center would be one, but consider also an alternate site such as Travis County expo center may be one for consideration. Another is again looking at protocols and those procedures that you would implement if indeed we requested a cancellation of large gatherings, how would we do that in the county. Identifying, modifying any current plans with independent school districts within the county for cancelling school days and school related activities and coordinating plans with the business community again and also looking and working with us to develop those isolation and quarantine guidelines if indeed we needed them as a tool to prevent disease transmission. And lastly, working with us to identify county critical services and critical personnel and therefore prioritizing who would be on that list to receive vaccinations in the event that vaccine were available. And I think the more we continue to work together and plan, the better prepared we'll be. As mr. Lurie mentioned, this is a living document and plan. We're constantly updating it and revising and learning more from our colleagues. Maybe we can start with having some hand sanitizer at the die is as well. I really appreciate your time today, Commissioners.
>> these guidelines are good at all times, not just during the pandemic outbreak?
>> that's correct.
>> thanks.
>> last time we spent a little time talking about how we spread disease through handshakes. Which is really common in our culture. And that's kind of hard to get around, isn't it?
>> it's very difficult. I think it speaks back too some of this culture. Even as Commissioner Gomez pointed out, really we're talking about if we started making some changes now, we could probably prevent other diseases, the common cold, influenza daily. I think washing hands frequently and using measures such as kleenex or hand sanitizer and just trying to make people more aware that that is a common method of disease transmission. And then as david and I have alluded to, the elbow bump is perhaps a new way to greet people rather than shaking hands. [ laughter ]
>> questions? Is there like a best practices manual or document that addresses business continuity in the event of some pandemic?
>> there is, guidance, judge, from the central disease control, actually checklists. And we're currently looking to find some better information because I think -- it helps to provide a framework, but it doesn't get too much of the detail of business continuity.
>> and in that respect, judge, what we were planning on doing is taking that checklist and working through with both city and county government how we would work on continuity planning. And hopefully then develop a model that we could take out into the broader community for other businesses. So that is part of the planning process that we intend to pursue.
>> okay. Most of this is pretty important whether there's an influenza problem or some other sort of disease that spreads.
>> absolutely. And in fact, we were talking about this pandemic influence planning as relates to preparedness as becoming our benchmark in terms of overall preparedness because we feel if we could do a good job of this, it's somewhat of -- I hate to use the term worst case scenario, but obviously very extreme. If we can put together a solid plan using this potential, we can scale back and apply it to any other challenge that we might be faced with from a preparedness perspective.
>> did we prop the remghts that we treat the medical professionals first and the politicians last? [ laughter ]
>> I don't know if we have dropped that recommendation, but in general we want to start with the folks who help other people, so you've got to put it in that context.
>> (indiscernible).
>> it's interesting. In the last week -- I don't know whether I heard it or read, but one of the places where you really have to watch the most transmittal of diseases is your grocery carts in your large stores. I thought that was pretty odd. But given that there are just a number of things that we just take hold of in our society where there have been millions of hands on it. I don't know whether you need to wear gloves.
>> I am familiar with that and I think it goes back to frequent hand washing, cleaning, being aware of that. The good news is that may be the case. I’ve not seen large outbreaks occurring in area grocery stores, but it certainly is -- it made us aware of that. And how do we get the message out to those places? They can do simple things to eliminate that risk by wiping down the handles on grocery carts everyday. And something like that. So even working with businesses now to begin to say how can they work to limit transmission amongst their customers and workforce. They're very simple, straightforward measures.
>> I’m just shopping -- my wife told me to go get six apples. I must have picked up 30 apples just looking -- you know how you do, this looks good. No, I don't like this one.
>> I never go shopping! [ laughter ]
>> it's really brought a different awareness for me at the grocery store.
>> that's why you wash vegetables and fruit when you get home. Wash them before you eat them.
>> so more about this later?
>> yes, judge. We again appreciate the opportunity to update you. As you can see, the way in which our community responds as individuals, employers and institutions would really be critical in this context. So we think the more information we can provide in advance and the more we provide during an event and your help with that would be critical in terms of our success.
>> prevention plan. Thank you.
>> thank you, judge.
>> I’m sure at some point in the future we'll have action steps to consider. Okay. Thanks again.
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Last Modified:
Tuesday, March 22, 2006 7:57 AM