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