Stats verified after the event – during the outbreak numbers were reported verbally through teleconferences – there was no opportunity to systematically assess the profiles of these patients, the utilization of antiviral regimes, their responses to therapies, outcomes or dispositions.
Critical Care Network: Pandemic Influenza Planning - Perspectives for Critical Care
Pandemic Influenza Planning –Perspectives for Critical Care Dr Kelly Barnard Health Authorities Division
Why we need to plan • Influenza pandemics represent global emergencies with catastrophic impact. • Pandemics have been documented every ten to forty years dating back to the 1600s, and likely long before that - three during the last century alone. • In 1918 /1919 over 20 million people died worldwide. • “The last pandemic occurred in 1968. Experts agree – we are overdue for another.” Dr. Perry Kendall 2005 • In 2009 H1N1….Operational Monitoring, Health Authorities Division 2
Hospitalizations – 1032Deaths – 55Peak Hosp demand – Oct / Nov
Age Distribution BC pH1N1 case fatality rate ~0.006%
Some lessons learned from H1N1— Clinical care: Enhance the bridge between primary care, public health and clinical health professionals in future emergency / outbreak response planning efforts— Refine acute care and critical care surge planning— Need to have real time information to guide clinical response Human resources :Develop plans and guidelines to ensure highest and best use of scarce health sector resources Public health: Surveillance/ antivirals/ immmunizations Logistics: Standardization – of supply items, priorities, planning, forecasting and SC approach
Lessons in Clinical Care Antivirals can play a role in mitigating morbidity but risk of resistance is real. Need to study this with each new pandemic. Administrative data can be used in real time to track utilization – physician visits / medication use Active surveillance needed for Hospitalizations / ICU beds / staffing levels. Active surveillance needed to guide clinical care Many of the assumptions that underlie the logistics planning require adjustment with real time information about severity
Health Impacts of Next Pandemics Assumptions: The majority of the population (over 50% - 70%) will be infected over the course of the pandemic 15%-35% clinically ill over the course of the pandemic and of these: most of cases occur first wave (plan for 25% CAR in peak 6 wks) 50% will not require clinical care up to 50% will seek outpatient care 1 % will be hospitalized PHAC - U.S. Meltzer Model adapted 0.4 % will die 9
Health Impacts of Next Pandemic in BCAssumptions(without any Vaccines or Rx interventions) Infected Up to 3,000,000 Clinically ill 635,000 – 1,400,000 See HC provider 317,500 – 740,000 Hospitalized 8,000 – 19,000 Die 2,500 – 5,900 Economic effects – KPMG 2006 BC study – 1.9 – 4.4 % dec GPP 10
Outcome assumptions with No Interventions PopulationClinically Ill (CAR (100%)= 35%)Outpatient care Infected(50% of CAR) (70%)Hospitalized(1% of CAR)Fatal cases(0.4% of CAR) 11
The Pandemic Influenza Operational Planning Project - A group of coordinated projects covering a wide range of topics including: Communications and Education Planning Assumptions Family Physician Communication Legislation and Regulatory Changes First Nations/Small and Remote Operational Governance Structure Communities Information Management Laboratory Plan Logistics and Provincial Stockpile Surveillance Plan Mass Fatality Management Self Care Guide Maintenance Plan Antiviral Distribution Human Resources – Gap Analysis Vaccine Storage, dist, and security Human Resources – Scope of Practice Testing Guidelines Provincial Ethics Framework Physician Infection Control Ventilator Allocation Guidelines Home and Community Care Acute Care Surge Plan Antibiotic Therapy Immunization Response Plan Psychosocial Plan for HCW Updated PPE Recommendations Community Psychosocial Plan Operational Monitoring, Health Authorities Division 12
Questions??Operational Monitoring, Health Authorities Division 13
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