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Home My WebLink AboutMINUTES - 07222008 - D.5 TO: BOARD OF SUPERVISORS ��- �`�-��' Contra FROM: Health Services Department x, ��.�.,,,,,,,�.p� _ z Costa William Walker.; M.D., Director . r coax County DATE: July 22, 2008 SUBJECT:. Health Services Workshop — Update on Pandemic Flu Preparation SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: CONSIDER accepting the report and update provided by the Health Services Director and staff on preparations that have been made by the County, State, and Federal government to respond to an outbreak of pandemic flu. FISCAL IMPACT: No impact from this update. BACKGROUND: Pandemic Influenza is a virus which constantly mutates, every flu season is different. It is naturally occurring in birds and jumps species barriers regularly. It can cause serious disease in humans and spreads easily. CONTINUED ON ATTACHMENT: X YES SIGN TURF: _ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE f" APPROVE OTHER SIGNAT6E(S: ACTION OF BOARD ON ap APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. UNANIMOUS(ABSENT �� ) AYES: NOES: ABSENT: ABSTAIN: Contact: Dorothy Sansoe(5-1009) cc: Health Services Department ATTESTED County Administration J N C LEN,CLERK OF THE BOARD OFSUPERVISORS BY: DEPUTY �3 f �ti Page 2 of 2 The Health Services Department will present information to update the Board of Supervisors on the current pandemic influenza response planning efforts. Included in this report and update will be a presentation by the Sheriff's Office on the Coroner's role in the response efforts and a presentation by Emergency Medical Services on their role. Objectives of the Workshop: 1. Orient Board of Supervisors to current County pandemic influenza planning in three areas: medical supplies management and distribution; alternate care site planning and; fatality management; 2. Identify what's in place locally and the State, region and federal levels; 3. Describe vulnerabilities in pandemic influenza preparedness and what's being done to address them Pandemic Influenza Board of Supervisors Briefing July 22,2008 , 4, , 513j =i CONTRA COSTA HEALTH SERVICE Presentation Objectives CONT.A CO TA_ IIEALT 1 SC0.l ICr5 Describe current County pandemic influenza planning in three areas: medical supplies management and distribution; alternate care site planning and; fatality management Identify what's in place locally and the State, regional, and federal levels Describe vulnerabilities and what's being done to address them 1 _CONTA_COST�_ HEALTH SE0.'IC Ei Is Pandemic Influenza sti I I a threat? CONT'.A CO TA Why pandemic influenza is a concern IIEALTtI SC0.lICC3 ■ The virus constantly mutates Every influenza season is different - New vaccine needed every year - Developing resistance to antivirals ■ Naturally occurring in birds - Regularly jumps species barrier ■ Can cause serious disease in humans ■ Spreads easily 2 Average Impact of CO NTIA COSTA ., Seasonal Influenza in U.S. ■ 5-20% infected ■' Over 200,000 hospitalized About half in 65+ ■' 36,000 deaths - >90% in 65+ K fONTvA,COTA.. Seasonal Influenza IIEALTH SIk'ICCS ■ High infectivity ■ Short incubation period ■ Clinical illness is non-specific ■ Easily transmitted Routes of transmission Large droplets (sneezing, coughing, contact with saliva) Fomites: doorknobs, Kleenex, etc. Rarely airborne overlong distance 3 . \ / \ \ \ � Is 1-15141 Avian influenza still athre@� � 385 Cases with 243 Deaths from 15 . Countries ' 60% Case fatality ratio ° 2. Cumulative since 2003 Word Health Organization 19 June 2008 . ` 4 CONTRA^OSTA M[nLT ti SFFVIC[3 Pandemic influenza is different from the current avian influenza. Influenza pandemics are recurring events. N, A Definition of an Influenza Pandemic: II[AlT!I t[FVICFS ■ A new (novel) influenza virus subtype in humans causing serious illness; . ■ Little or no immunity in the population; and, ■` It spreads easily from person to person. i r 5 ,. Pandemic Severity Index _CONTA_COSTA... N[A lT!1 SFNL'ICES Gale Fatality; Projected rAdeimber or Deaths"' RMio US Population,2006 #.Q_]-2-0'4300.000;-<1.800Ofl0 4Q <9Q0.00.1% Q . 90.000-<450*000'' :: --- -- Cat gory:1 "+,, c90 000 "hssumes�30°i6 illness rate ' arid'u cleiriic; without"tri to rve ntio n s; Pandemic Severity Index (PSI) C�NT]lA CC1cTA ' IIEALTtf SEk\ICCS ■ 5-point scale based on the case fatality ratio to categorize the severity of a pandemic - Category 1: seasonal Category 2: 1957, 1968 - Category 5: 1918 6 CONT0.A COSTA ' M[n LT!1 SFRVICEi Pandemic Influenza: Community Mitigation Outbreak Containment: CbNTAA COSTA. IIEAIT!1 SCRl'IClS Measures vary as pandemic develops Pharmaceutical interventions Vaccine and antivirals Non-pharmaceutical Interventions (NPIs) —Community mitigation measures 1 7 CO H.T in COSTn_ Community Disease Mitigation H EALT!i SE0.�"IC['S ■ The Center for Disease Control (CDC) issued new guidance based upon non- pharmaceutical interventions (NPIs) ■ NPIs may be the only interventions available early in a pandemic ■ No intervention other than mass vaccination of the public will dramatically reduce transmission when used alone Changing the Outbreak Curve IIEAIT fI Sf0.\'ICS ' �.,Dolay outbreak peak. . .Decprnpresa peau burden on,bospitals7 iofiastrocture. , Q3 Diminish overall cases and bealth impacts a Pandemic outhreak6 No intervention cP T R O f Pandemic outbreak- Withintervention: ..... Days Smce Fist Case: Ht'T9F0.�C_S Disease Containment Measures CONTAA..COSTA ■ Isolation: restriction of movement/separation of ill persons with a contagious disease ■ Quarantine: restriction of movement/sopa ration of well persons presumed exposed to a contagious disease ■ Social distancing: reducing interactions between people to reduce the risk of disease transmission ■ Closure days: days on which offices, schools, transportation systems are dismissed, closed or cancelled 18 month estimates CONTnA COSTA IIEAITH SC0.VICF5 (moderate to severe pandemic 1,025,000 pop) nfected 3372630 Outpatient 1682815 Hospital 162882 Cly 32022 Ventilator 12519 Deaths 31950 9 What's in Place CONT .COSTn_ HCxLTN 3EItt'It ci ■ County Level ■ Draft Contra Costa Pan Flu Plan ■ Interim Healthcare Surge Plan ■ Coroner's Mass Fatality Plan ■ Surge capacity supplies for hospitals and health centers ■ Toolkit for Schools and Day Care Centers (created with partners) - What's in Place .C(NT,nA Ctl..i A,. IIFAlT 11 SIk'lli ■ Stockpile of N95s respirators for County operated sites ■ Exercises - School TTX May 2006, Communications April 2007, mass. vaccination Dec 2007, mass vaccination fall 2008 ■ Strategic National Stockpile Plan 10 oSTA- What's in Place ML 1i.1 SERIC.i ■ Crisis and Risk Communication Plan ■ CCHS Department Operations Center Coordination with County Emergency Operations Center - _CQHTzA CTA Regional and Bay Area Levels IIEAtT EI SERVICES ■ ABAHO Regional Planning and Coordination ■' Draft Health Officer Guidance Documents: ■ Mask Use and Social Distancing ■ Modified Workplace ■ Public Gathering ■ Public Transit ■ Child care ■ Draft Health Officer Order: ■ Student Dismissal ■` Participation in Cross-sector coordination - Summits in W and `08 '11 Vis.. State Level C0NT0.�.COSTA... - HCn LT i1 SE0.�'IL�i ■ Antiviral stockpile for 30% of CCC Population ■ Guidance on antiviral stockpiles for local agencies and businesses ■ Guidance on public's use of facemasks and respirators ■ Guidance for student dismissals ■ Standards and Guidelines for Medical Surge ■ Coordinating antiviral and vaccine prioritization ■ Gov's Standby Orders for Statutory Suspension ■ Pan Flu Satellite Tabletop exercise spring 2009 - - Federal Level CONT.w.A,COSTA IIEALT!I SEII�'ICCS ■ Community Strategy - Non-pharmaceutical interventions Vaccine development ■ Funding states to develop Pan Flu Plans ■ Proposed guidance on: - Workplace Stockpiling of respirators and facemasks - Antiviral stockpiling by employers - Use and purchase of facemasks and respirators by the public 12 Pandemic Vaccines o , l y�� s i I�I II Ili I�, i CaUimia Oevartment at J`4_, Public Health ®)c:ra1F 1 Pre-Pandemic Vaccine • Vaccine Stockpile Only at the federal level Based on H5N1 virus If released, support critical infrastructure — very limited supply available Ca€Homto DcP.d cnt d tee Public Health 011H '13 'I Pandemic Vaccine • Only one manufacturer in US By 2010, additional manufacturers • Production Currently, lag time 4-6 months • Allocation Proportional to project area population size ■ E.g., CA 12% USA population Ca!dorn#a Department of ®� Public Health Pandemic Vaccine Planning • Vaccine availability First shipment, worth 10 weeks production CA: - 500,000 doses at once :➢ CA: 79,000 doses per week thereafter • Shipped directly to local health department sites Local health jurisdictions need to be ready • CDPH will maintain control over how much vaccine designated to sites • Issue California has 37 million people Cal3omia Depadeanxnt vi • e Public Hlth • c;�r�� 14 Local Health Department Planning • Prepare.for receipt of vaccine Storage and monitoring (temperature) Security • Prepare for administration Identification of and allocation to priority groups Transportation and security Distribution—Mass vaccination Monitoring and tracking Risk communication messages Ca,M®mia VeaanmeM at Public Health ®)Con-i CDPH Vaccine Prioritization Guidance Process • State Health Department developing process to help advise and recommend Pandemic Vaccine (allocation, distribution, administration) Establish priority by occupational & health risk groups Antivirals (use, allocation, distribo 19e"'' th yxs_i ill 15 Vaccine Prioritization Framework • ;Four broad categories Homeland and national security (federal except CA National Guard) . Health care and social services Critical infrastructure Health-vulnerable and general population • Created target groups All persons are assigned a specific target group based on age,.health status, risk level and/or occupation • E.g., pregnant women Every person is included in at least one target group All target groups are assigned to a category - California Department of Public Health ®p)CDFf 1 CDPH Prioritization Framework (cont.), • Level: Multiple target groups within each category Target groups are assigned an order of priority within each category and clustered into priority "levels" • Tier: All target groups assigned a tier Five tiers represented Those in Tier 1 vaccinated first Target group tier assignment will vary depending on pandemic severity CrriSomio Dcpexahnant ct -• • . Public Health c:Dri� 16 8.4 million .' Medical Supplies Management and Distribution coNrxa casra HEALTH SERVICE ffiRkwhawaffm 17 Flow of Mutual Aid Requests and ,CQNT,R,A CDSTA_ Assistance under SEMS MCnLTH SF0.VIC[5 -------------------------------- f Other Regions,State Agendes, ; InrarSrate Mutual Aid,Lo�l State ......• Government,Federal,Tribal, Opam lon5 Center """.. Volunleers,Private Organlz,ti— Other Operational Area,Local i! n ,,,,,,,,,� Gsvemraen4 Federal.State, f vaac Regionai.n.%t., Tribal,Volunteers,Private •a Upera,IuiiB Cerner ••••••• Organiaaoom ' oua;Longi Government. Operational Aro® Foeorai,State,Tribal,Vda tae,a •�� Private Organhatiorrs Support& Coordination Local Em 9—ir lonI Government,Federal, Operaliens Center.., tate,Tribal,Volunteers,Private , Organizall— comma nd& Control Incident Unified Command --------- Local Medical Mutual Aid / IIEnLT!1 S[0.�'ICES Assistance in Contra Costa ■ Internal - vendors/sister facilities ' ■ Local government - Health Services Department Operations Center(DOC)/ EMS for medical - City government/city EOC for non-medical all Region II (Northern California Coastal Region)via County all State/federal via Region II 18 Healthcare Surge Equipment fONTiA,COSTA,.. N[ LT:i SF0. IC:i ■ PPE (gloves, N95 masks,gowns) ■ Shelter Tents (13'X 29', cots, generators) ■ Portable HEPA Filters ■ Heat/AC Unit for Shelter Tents ■ , Trailers for Cache Storage ■ Ventilators-Vortran Adult Sets (4 cases & 2 manifolds) and Pediatric ■ ' Body Bags ■ Pharmaceutical caches **See handout in folders EMS Disaster Preparedness and CONT"A COSTA Response Trailer a za Contra Costa County EMS tt ��" �p �u��' 3 Oisest�preparednew and fAEAps�� K n �. i � u 19 » Shelter Tents Portable Generator . ...... ....../\< QQ Portable HEPA Filters 11Ee LT ii 3E RVIC[5 � µ h l� A t d cgarxncu}rn Portable Ventilators IIEAI.I'tl S[k\'ICES �Y 21 » Contra Costa County _CONT��..GOSTA_ H CA LT!1 SF 0.VIC ES ' y L", ✓ u. at I Harry Ebyd ✓5x; c Percx• �� Csfmy Bay.; ' IEI lT Tom}pg k 4 � (Cs; b i l✓/ ��/�t �. - ,�,.��.� � Bay� �. �' �S: r to M Beni 7 ''mow L Fdtt y 4Tmr1vCY _EUI- Ei b_a e f a'hA' Sw,�.`•�i'e - "yy u*``? ,wlM✓.. o �wc.•-�n _ ¢ :.PaWo� »l �'� �`� � e rya : ? - `' �,. as!Rrrwluf Mi � `3F lT ''S i RCtksreMd✓��, / `» Kc cfry �� " t O U F F M adt�;� 2zs 7q Pa, hfPS � Virtual Earth y �a ,8eaoleyo .r.�". ' x�'� ua. ", 7 w� ,y� R7� err�E ALARMS Database - CONTiA CO<TA - "`ALT""""ICrS Facility Details View Eat%es `+• Ca t C [a E.......y M d cal e s(E..) v Mao ........... Eft ee, ela 553 � t Y dPc.avei V .. AemYMieelae:rO, V .. .. :Phone Numbers `E ME �f bm� t 14M»�� } Aae a n aNIM 3 '.'5 II Ph (23e)219 s 3 0/1/zoo ; 13 0 O Mytv�n � 11 recoMs(s) U'.,; 13 22 O N,T,0.A COSTA Antiviral and N95 Stockpiles . j;[ALT t1 SF RVIC.i ■ Contra Costa County Antiviral Stockpile - 275,000 courses ■ N95 Respirators - 44,000 - -�- Current Vulnerabilities Ci JTA.CO$TA , IIEALTN SERVICES ■ Everyone will be counting on the same vendors and resources ■ Likely that traditional mutual aid systems will not work (everyone will need,what they have) ■ Coordination of public education and risk communication messaging throughout Bay Area and California ■ What happens when PPE runs out? 23 s i Healthcare Surge and Alternate Care Site Planning � a tdfiS t ` ` F CO;�TRA COSTA - =- Healthcare Surge Levels (State) _c�NTvn c.uci�.. IIEntT!1 SC0.'ICFS Green - normal, day-to-day Yellow- surge managed within organization framework of healthcare facilities Orange - local governmental assistance _4 i Red - State assistance sought Black- maximum outside assistance sought;Alternate Care Sites may be activated. 24 CONTRA.COSTA... Categories of Healthcare Surge HYALtN SE F'IC'S 'I ■ Existing healthcare facility surge Clinics and health centers - SNFs and longterm care facilities - Acute care hospitals ■ Supplementary resources -Federal/State/ local CaIMATs/ DMATs - EMSA mobile field hospitals/federal medical stations - Alternate Care Sites Roles for Existing Healthcare Facilities HEAIT!I SCRVIt CS ■ Clinics and health centers - Minor treatment - Primarycare - Immunization/ dispensing - Triage ■ SNFs/longterm care facilities - Low acuity hospital patients/ higher acuity patients for whom resources are not available ■ Acute care hospitals - High acuity patients (care may be limited based on resources) 25 i CONT0.n COjT___ Hospital Surge Capacity N[ LTH SERIC Ei ■ A planning scenarios: 1. Traumatic, injuries/ burn 2. Hazardous materials exposure 3. Radiological 4. Infectious disease Infectious Disease Hospital Surge CONTRA CVTA„ t1EALT!1 iI0.1'ICES pandemic Influenza su "IR esourceCapaci�r Total hospital surge 1,076 Critical care surge 286 Standard ventilator surge 156 Portable, disposable 340 ventilators 26 Alternate Care Sites ' _GONTiA_COSTA Operations Partners • Contra Costa Health Services ■ .Contra Costa Employment& Human Services Department ■ American Red Cross CQNiv_A.COST�_. Alternate Care Sites - Key Assumptions t1EALT tl.tltiV IC LS ■. Comfort and minimal medical care for persons for whom hospitalization in not available ■ American Red Cross shelters - high schools ■ Access to persons of limited means ■ Staffing by Disaster Service Workers and by medical volunteers 27 CONTiA COSTA Current Vulnerabilities. li[ALTN SE NVICi ' ■ State developing medical standards of care for surge ■ Governor has developed standby orders for statutory suspension of regulatory requirements ■ Level of care to be provided at alternate care sites ■ Quantity of PPE available and who gets it ■ Staffing: Government Disaster Service Workers, medical and non-medical volunteers, role of CERT • Contra Costa has no Medical Reserve Corps ■ Coordination of public education and risk communication messaging throughout Bay Area and state Fatality Management w � = Fi CONTRA COSTA HEALTH SERVICE 28 c,oeiA�.cosT__ Mass Fatality Management M CALT NSF0.t'IGcS r CONTiA CO<TA Goals for Mass Fatality Management IIEAIT fl,4 C0.1'I C-i5 ■ Protect the living and identify and preserve the dead . ■, Tag, Wrap, and Hold the bodies ■ Leave all personal effects on the body ■ Do not release the bodies or property to relatives (this is the job of the Coroner after positive identification has been established) 29 liL LtTS[C CA Code of Regulations 27491 Duties and responsibilities of the Coroner: ■ Investigate and determine the cause of death in certain circumstances ■ Handle the collection, identification, and disposition of decedents during conditions of disaster or mass fatality Additional Responsibilities CONT 3A COSTA of the Coroner ■ Identify human remains ■ Provide adequate and appropriate storage ■ Determine the cause and manner of death ■ Inventory and protect personal effects found on the decedent ■ Locate and notify the Next-of-Kin ■ Release of remains 30 Current Capabilities CONTRA,COSTA ME LT-1 SF0.VIC-i ■ Contra Costa County averages 6,800 deaths annually ■ Coroner's Office handles approximately 3,000 cases and 700 autopsies or inspections annually ■ Forensic Medical Group has 5 forensic pathologists servicing 15 counties ■ County Coroner's Office capacity: 25 bodies �gat • - ~ Hospital Morgue Capabilities _C.�NT vA_CV�TA._ IIEAI.TH3 CR�'ICCS f �raab If W1, Truck, s c P y , Facill ;,.!.Contracts Contra Costa Regional Medical Center 4 Yes No Doctors Medical Center,San Pablo 16 Yes No Kaiser-Walnut Creek 18 Yes Yes Kaiser-Antioch 4 No Yes Kaiser-Richmond 2 No Yes John Muir-Walnut Creek 4 No No John Muir-Concord 6 No No San Ramon Regional Medical Center 2 Yes Yes Sutter Delta Medical Center 4 No No VA-Martinez None No No 31 I =� County. Mortuary Capabilities GONTA_A COSTA HL LT:i SF0. IC ■ There are 25 mortuaries in Contra Costa County ■ Combined mortuary capacity of the region is 360 (only 150 are currently within.Contra Costa County) • Most mortuaries usually run at or close to capacity ■ Many mortuaries utilize outside service for body retrieval Mass Fatality Management IIEALTH SC0.VICL5 During a Pandemic The Coroner's Division: ■ May not be able to provide assistance for many days following a surge of decedents ■ May lack resources to address a prolonged response in a pandemic In extreme circumstances: ■ The public may need to take action to ensure the safe handling and storage of decedents until the Coroner or Coroner-designated personnel can respond ■ Special training is needed to handle decedents when the Coroner cannot respond 32 Special Handling of Decedents H[AI.T ii S[IlY'IC[i ■ , Designate a collection point area for fatalities ■ ' Determine if the decedents can be safely moved ■ When handling decedents,follow precautions for infection control ■ Wear protective clothing, heavy duty gloves,face masks ■ Do not place bodies where body fluid can be absorbed, such as wooden floors or linoleum covered floors. ■ Secure the body in plastic sheeting or vinyl body bag (although vinyl body bags leak) ■ Complete Body Identification Sheet _C(!NT AA_COSTA, Body Identification Information iIEAITH 3[0.VIC5 ■ Record name, sex, race, apparent age, location found, and assign each body a number • Record identity, if known and any important details upon ,discovery of the body. ■ Keep a log sheet for number of bodies stored and a grid showing the location of each body ■ Establish security to prevent looting of.the bodies Leave valuables such as rings, wristwatches, necklaces, etc., on the body in a sealable bag 33 coNTxn[osTn_ Current Vulnerabilities MC lT:i SFRICEi ■ Transportation of decedents ■ Tracking of decedents during a pandemic ■ Refrigeration storage capabilities for mass fatalities ■ Mortuary and morgue capacities ■ Lack of forensic pathologists ■ Competition with other counties/government agencies for scarce resources Next Steps CONTRA COSTA lIEALT!1 5[0.VIC ES Continue to address vulnerabilities in planning through: ■ Med/Health Preparedness Forum ■ Community Clinic Consortium Meetings ■ Operational Area Planning Meetings ■ Other opportunities for collaboration 34