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Emergency management--United States. I. Ryan, Jeffrey R. [DNLM: 1. Influenza, Human--epidemiology. 2. Influenza, Human--history. 3. Disease Outbreaks--history. 4. Disease Outbreaks--prevention & control. 5. Emergency Medical Services--organization & administration. 6. Health Planning--organization & administration. WC 515 P1886 2008] RA644.I6P366 2008 614.5’18--dc22 2008015483 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Foreword .................................................................................................................vii Preface ......................................................................................................................xi About the Editor ..................................................................................................xvii About the Contributors ........................................................................................xix Acknowledgments ..............................................................................................xxiii Part I Defining the Threat of Influenza Chapter 1 Past Pandemics and Their Outcome ...................................................3 Jeffrey R. Ryan, PhD Chapter 2 The Spanish Flu of 1918 ...................................................................23 Linda M. Olson, EdD Part II Natural History of Influenza Chapter 3 Natural History of the Influenza Virus .............................................55 Jeffrey R. Ryan, PhD Chapter 4 Clinical Aspects of Influenza ...........................................................73 Allen W. Kirchner, MD Chapter 5 Avian Influenza .................................................................................97 James C. Wright, DVM, PhD, Kenneth E. Nusbaum, DVM, PhD, and James G.W. Wenzel, DVM, PhD Part III Defining the Response Chapter 6 Federal and International Programs and Assets .............................117 Jane Thomas Cash, PhD and Martha Griffith Lavender, DSN v vi Contents Chapter 7 Defining the Response at the Local Level ......................................147 Jeffrey R. Ryan, PhD and Jan F. Glarum, EMT-P Chapter 8 Service Continuation Planning for Businesses ...............................187 Onalee Grady-Erickson, BS, CEM Chapter 9 Fatality Management during a Pandemic .......................................207 Lori J. Hardin, MFS and John P. Ahrens, MPA Chapter 10 Epilogue Putting It All Together ....................................................................237 Jeffrey R. Ryan, PhD and Jan F. Glarum, EMT-P Index ......................................................................................................................245 Foreword We don’t know when a pandemic might strike. But we can be sure of two things. Every- thing we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate. This is the dilemma we face, but it should not stop us from doing what we can to prepare. We need to reach out to everyone with words that inform, but not inflame. We need to encourage everyone to prepare, but not panic. Michael O. Leavitt Secretary, Department of Health and Human Services Pandemic Influenza Leadership Forum, June 13, 2007 Many experts warn that a catastrophic influenza pandemic and its resulting impact are not only likely to happen, but overdue. They agree that if the next pandemic is caused by the currently circulating H5N1 avian (bird) flu, it could be as deadly as or even more deadly than the 1918 Spanish flu. That pandemic, caused by the similar H1N1 avian virus, infected more than one-third of the world’s population and killed as many as 50 to 100 million people. The massive loss of life caused by the 1918 influenza pandemic is unimaginable. Yet, today, a pandemic with the same rates of infectivity and mortality would result in more than 2 billion infections with 180 million to 360 million deaths worldwide. The Centers for Disease Control has esti- mated that a pandemic could cost the United States alone between $730 billion and $1.6 trillion depending on its severity, a bill far larger than what most corporate and governmental leaders have imagined or are prepared for. According to the World Health Organization (WHO), the cumulative number of confirmed cases of H5N1 avian influenza as of December 1, 2007, is 335 cases and 206 deaths. The global fatality rate is 61 percent, compared to just 2 percent in 1918. Within 10 years, the H5N1 virus has entrenched in five countries, and has spread to an additional 60 countries. Disease in birds has resulted in the culling of millions of birds worldwide, negatively impacting local economies that depend on open bird markets for food supplies and livelihoods. As a result, some countries have become reluctant to report disease or share viral samples to help scientists track the progression of viral mutation. This information blackout leads many to question whether reported cases and deaths reflect the current situation or are just the “tip of the iceberg.” Despite enormous economic losses and horrible statistics, it is hard to find any reports from a major media outlet telling the story. Reports of avian influenza and even isolated reports of clusters of human disease have all but disappeared from the radar. We are in the midst of a “pandemic fatigue.” Where is the rush to prepare? On November 1, 2005, President George W. Bush sounded the alarm and unveiled the National Strategy for Pandemic Influenza. The document outlines the respon- sibilities that federal, state, and local governments; industry; and individuals have for preparing and responding to a pandemic. Only six months later, the Homeland vii viii Foreword Security Council released the Implementation Plan for the National Strategy, which translates the Strategy into more than 300 actions for federal departments and agen- cies and sets clear expectations for state and local governments and other nonfederal entities. The Plan requires that all federal departments and agencies develop their own pandemic plans based on standardized criteria. Government leaders have vis- ited every state and territory to try and raise awareness and encourage planning at state and local levels. For the first time, there is a joint federal website that provides a “one-stop shop” for information. Unprecedented amounts of preparedness guidance are available on topics such as pandemic planning and the use of physical barriers, masks, respirators, and antiviral medications. After providing more than $400 million in cooperative agreement emergency supplemental funds intended to help the 50 states, the District of Columbia, three local jurisdictions (New York City, Chicago, and Los Angeles County), five U.S. Territories and three Freely Associated States of the Pacific, state and regional plans continue to be health-centric and fail to include emergency management and the pri- vate sector in planning efforts. Many remain in early draft form. Few real exercises have been held to date. States have been provided with more comprehensive guid- ance and have been asked to re-examine their planning efforts to improve coordina- tion, yet many have turned their attention and resources elsewhere. Why is there a reluctance to recognize an imminent threat? It is easy to dismiss these avian influenza events because they have occurred on foreign soil. We are complacent — it’s not on our shores or in our backyard, so many see no need to take notice or begin planning. Yet, the threat of an influenza pandemic still remains very serious with no signs of slowing down. The fact of the matter is any of these cases or deaths could have just as easily happened anywhere in North America or in one of our cities. Pandemics are diseases without borders. The influenza virus will not respect economic, political, and geographic boundaries. National estimates indicate that a pandemic could infect more than one-third of the world’s population, killing mil- lions. A severe pandemic outbreak will result in absenteeism of up to 40 percent of the workforce, dramatically decreasing the number of available workers and signifi- cantly disrupting the movement of people and goods. When a pandemic occurs, life as we know it will change — in culture and in politics as well as in the prosperity of any nation it touches. We need to be prepared, both personally and professionally, to respond. Our businesses need to know how to stay operational for society to remain functional. While there is no way to predict when the next pandemic will strike, it is only a matter of time before it does. Knowing the facts is the best preparation. Pan- demic Influenza: Emergency Planning and Community Preparedness is an amazing resource that you can count on for reliable information. Whether you are an elected official; homeland security, animal, or human health care professional; emergency manager; business owner; student; or a member of the general public, this book offers valuable information that can help YOU. Dr. Ryan has assembled some of the best experts in the field to guide you in under- standing the threat of pandemic influenza and how it can affect you and the people you are responsible for. In this book you’ll learn about the history of pandemics and Foreword ix their outcomes, the makeup of the virus and how it transmits disease, and finally what you can do to protect yourself and others. This text pulls it all together, giving you timely and accurate information that you can put into action. It’s one of the best sources of information available today. Unlike a hurricane or wildfire, there will be no resources to move to your aid — the cavalry is NOT coming! Your ability to meet and survive a pandemic depends on you and your plans, and the time to begin planning is NOW! Lynn A. Slepski, PhD, RN, CCNS* Captain, United States Public Health Service Graduate School of Nursing, Uniformed Services University U.S. Department of Homeland Security * The views expressed here are those of the author and do not represent the official policy or position of the U.S. Public Health Service, the Department of Homeland Security, the Uniformed Services University of the Health Sciences, or the United States government.