Pandemic Influenza Citizen's Guide

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Pandemic Influenza Citizen's Guide

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Pandemic Influenza Citizen's Guide

  1. 1. Mid-Peninsula Citizen’s Preparedness Committee Pandemic Influenza Preparation and Response: A Citizen’s Guide Version 1.5 November 2007 Written by Sarah Booth & Kelsey Hills-Evans
  2. 2. This Guide is for you! It was written so that you can educate yourself, your family, and your community about pandemic influenza. The Guide covers many subjects, so please refer to the Appendices for quick-reference information and essential lists.We hope this Citizen’s Guide will help you stay safe, aware and healthy!
  3. 3. Table of Contents Licensing - iii Acknowledgments - iv Foreword - v Chapter 1: An Introduction to Pandemics - 1 Chapter 2: Prevention and Preparation - 14 Chapter 3: Response - 26 Chapter 4: Communication and Volunteering - 36 Chapter 5: Recovery and Waves - 42 Bibliography - 46Version 1.5
  4. 4. • ii Table of Contents (Continued) Appendix - 47A. World Health Organization and Pandemic Phases - 48B. World Health Organization Advice for Travelers - 49C. Items to Stockpile for an Influenza Pandemic - 50D. Items for Treatment of Severe Influenza - 51E. Homemade Oral Rehydration Solution - 52F. Possible Roles for Community Volunteers - 53G. Example: Home Patient Medical Record - 54H. Overview of Influenza Surveillance in the United States - 55I. A Doctor’s Letter during the Height of the 1918 Pandemic - 57 Glossary - 59 Version 1.5
  5. 5. iii • Creative Commons License Deed Attribution—ShareAlike 3.0 United States You are free to: Share: to copy, distribute, display, and perform the work Remix: to make derivative works Under the following conditions: Attribution: You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). Share Alike: If you alter, transform, or build upon this work, you may distribute the resulting work only under the same, similar or a compatible license. For any reuse or distribution, you must make clear to others the license terms of this work. The best way to do this is with a link to the website where you found this document. Any of the above conditions can be waived if you get permission from the copyright holder. Apart from the remix rights granted under this license, nothing in this license impairs or restricts the author’s moral rights. This work is licensed under the Creative Commons Attribution—Share Alike 3.0 United States License. To view a copy of this license, visit http://creativecommons.org/licenses/bysa/3.0/us/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.Version 1.5
  6. 6. • iv Acknowledgments Conceived, Supported and Sponsored by Jane and Peter Carpenter Also Sponsored by Mid-Peninsula Citizen’s Preparedness Committee Lead Advisors Peter Carpenter Dennis Israelski, MD Samuel Perry Special Acknowledgment for Selected Medical Information and Content Grattan Woodson, MD, FACP Special Assistance Provided by Douglas G. DeVivo, Ph.D. Tessa Anderman Kenneth Dueker, JD Maya Guendelman Kathleen Sexton Christine Chang Denise Caruso Graphics and Design Glenda Lee Editing Luke Beckman Demi Rasmussen Use Doctrine This manual is meant to be a guide for many citizens in its present form, but we encourage individuals, communities, and organizations to revise and adapt it to their individual needs and cultures, and to translate it into other languages. We ask that such revisions reference the original document and remain in the public domain. Revisions should be posted on fluwikie.com so that those derivates will be widely available. To check for current updates to this manual, please visit http://www.fluwikie.com/pmwiki.php?n=Consequences.VersionHistory Corrections and Additional AcknowledgmentsIf you wish to correct an error in this manual or if you find material for which the original author or source is notproperly acknowledged (an increasingly common and unavoidable problem in the age of multiple postings and of extracts that do not retain identification of the original source), please document your concern and email it to PandemicPrepAndResponse@gmail.com. Version 1.5
  7. 7. v • Foreword by Dr. David L. Heymann Assistant Director-General World Health OrganizationMost public health specialists from around the world Recent examination of records from the years 1918–believe that there will be another human influenza 1919 in many cities across the United States haspandemic, a pandemic caused by an avian influenza shown that communities that put into practice socialvirus that can cause human illness and has mutated to distancing measures, such as closure of schools anda form that spreads from person to person. Such a public gathering places before infections were firstrandom event has occurred three times during the detected, were able to maintain lower levels ofpast century, causing three different influenza infection than others. Those persons at greatest riskpandemics. were those who lived closely together in confined spaces, such as men serving in the military.Since 2003 three major classes of avian influenzavirus—H5, H7 and H9—have caused sporadic human During the inter-pandemic period since 1968, sixinfections and, because of the instability of the levels of alert for pandemic influenza have beeninfluenza virus, any one of these viruses is thought to defined by the World Health Organization in orderbe capable of mutating in such a way as to cause a to best describe the pandemic risk: Phases 1 and 2,human pandemic. Presently the most widespread of during which no new influenza virus is infectingthese viruses is the H5N1 avian influenza virus, or humans: and Phases 3 to 6 when there is humansimply H5N1. Since an H5N1 outbreak in chickens in infection with a new influenza virus—Phase 3 whenHong Kong was first reported to infect humans in there is no human to human transmission to Phase 61997, the H5N1 virus has spread in poultry when there is increased and sustained transmissionpopulations throughout Asia, the Middle East and to of the new influenza virus in human populations.some parts of Africa and Europe causing a pandemic The world is currently at phase 3—a new (avian)of influenza in chickens and occasional human influenza virus, H5N1, that occasionally infectsinfections in persons who have come into contact humans and causes severe illness, but that is notwith infected chickens. Since 2003 there have been capable of sustained human-to-human transmission.more than 300 reported human infections withH5N1, all having caused severe illness, and with an Should the H5N1 virus mutate in such a way that itoverall death rate of more than 60%. can readily transmit from human to human in a limited geographic area, a collective internationalTwo of the three influenza pandemics of the past response would be made in an attempt to containcentury—one that occurred from 1957–1958 and one the outbreak by stopping human to humanin 1968–1969—are still in the memory of many transmission. The objective of such a containmentpersons living today. These pandemics spread rapidly activity would be to encircle the focus of humanthroughout the world, causing severe illness in infection by using an antiviral medicine, and/or apersons of all ages, massive absenteeism from school vaccine (should one be available), in all persons withand the workplace, and an estimated 2.5 million the potential of exposure to the H5N1 virus. Such adeaths, mostly in persons over the age of 60. The containment activity would be conducted under thethird pandemic—that of 1918–1919—caused an International Health Regulations (2005), anestimated 40 million deaths in persons of all ages. international law that requires countries to workArticles published in scientific and medical journals of together collectively in assessing and responding tothe time speak of severe illness and death, with a any public health emergency of internationalbreakdown of routine health and mortuary services in concern, such as the current threat of an H5N1almost all major cities, closure of public gathering pandemic.places, and quarantine and isolation of those infectedor exposed to infected persons in an attempt to stop (continued…)the spread of infection.Version 1.5
  8. 8. Foreword • viThe International Health Regulations (2005) came commerce and trade to health care, policeinto effect on 15 June 2007, four years after the enforcement and many other day-to-day activities.outbreak of Severe Acute Respiratory Syndrome Though efforts are being undertaken to increase(SARS). The worldwide response to SARS, which influenza vaccine production capacity so thatwas led by the World Health Organization where I enough vaccine would be available to preventwork as head of the Communicable Disease infection, and antiviral medications are beingProgramme, permitted development of control stockpiled nationally and internationally, the risk ofstrategies using information collected in real time by a pandemic remains, though lack of predictabilityepidemiologists working in all affected countries. precludes quantification of that risk.Within five months the SARS outbreak was fullycontained using these strategies, and the virus Pandemic Influenza Preparation and Response: A Citizen’sdisappeared from human populations. Though a Guide, this manual, describes possible consequencespandemic of influenza could not be contained using of an influenza pandemic, and makes it clear thatthe same strategies, an attempt at early containment individuals and families can and must know what towould require early detection with a focus on do should a pandemic occur. It also describes howhuman-to-human transmission, and effective use of those with this knowledge can help to educateantiviral drugs and/or a vaccine to “fence-ring” the others in the simple measures that will mitigate andoutbreak and prevent further spread. Because limit the negative impact of an influenza pandemiccontainment has never before been tried as a on the world’s communities. Public healthmeasure to prevent or slow the spread of an authorities throughout the world agree that theinfluenza pandemic, the success of this strategy responsibility to respond to a public healthcannot be predicted. If containment activities did emergency such as pandemic influenza cannot benot cover an area wide enough to stop transmission, fully placed on health workers and other primaryit would be only a matter of weeks or months until responders, who may themselves becomethe virus had spread throughout the world. We are incapacitated by illness and death. It is thus eachall vulnerable to the risk of pandemic influenza, no individual’s responsibility, alone or collectively, tomatter where we live, work or go to school. plan for and respond to a pandemic in the home and in the community. Pandemic Influenza PreparationThe most important public health measure at and Response: A Citizen’s Guide clearly describes, inpresent, however, has nothing to do with human lay terms, the actions that each of us can take.infections. That measure is to prevent a pandemicby eliminating the H5N1 virus from chicken David L. Heymann, M.D.populations either by culling of infected flocks, orby preventing infection in flocks through various Executive Director, Communicable Diseases andmeasures that include vaccination of chicks and Assistant Director-Generallimiting exposure of chickens to possible sources of World Health Organizationinfection. As long as H5N1 continues to circulateanywhere in animals, there is a potential for the virusto mutate in such as way that it could cause a humanpandemic.Should an influenza pandemic begin soon after2007, there would at best be 1.5 billion doses ofvaccine available for use in a world of over 6 billionpopulation—and even this amount would require24-hour production by the world’s influenzavaccine manufacturers. Absenteeism from schoolsand the workplace would rapidly occur worldwide,as well as a surge of patients seeking care throughthe medical system. Absenteeism at the workplacecould interfere with services ranging from Version 1.5
  9. 9. 1 • Chapter 1 An Introduction to Pandemics Chapter 1 An Introduction to Pandemics “Avian influenza is not a challenge. It is a predicament of extraordinary proportions.… As The Lancet wrote after the 1918 influenza pandemic, if only we had acted earlier with a “collective health conscience”, many millions of lives could have been saved. Today, we are repeating the same mistakes of a century ago.” -The Lancet, May 2006In this chapter you will learn: After reading this chapter, you will be able to:• What a pandemic is • Talk with your friends, family, and community members about the need for• About current governmental viewpoints on pandemic preparedness.pandemic response• The history of pandemics• The impact of pandemics on you and yourcommunity• Facts about Bird FluVersion 1.5
  10. 10. Chapter 1 An Introduction to Pandemics • 2 The authorities agree… “Pandemics are global in nature, but their impact is local. When the next pandemic strikes, as it surely will, it is likely to touch the lives of every individual, family and community. Our task is to make sure that when this happens, we will be a Nation prepared.” - Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services“No act of modern warfare…has the potential to threaten as many lives and cause as much disruption to the global economy as the H5N1 avian influenza would if it makes the evolutionary leap that allows it to spread among humans as quickly and as lethally as it has among birds.” - Stephen Flynn, homeland security expert and Senior Fellow, Council on Foreign Relations Version 1.5
  11. 11. 3 • Chapter 1 An Introduction to Pandemics The Importance of Information “If people have good information, they will generally make good decisions about what to do for themselves and their families. Helping families, neighborhoods, and communities think about how life will be impacted during a pandemic should equip them to react better during an actual pandemic.” - Pierre Omidyar, Founder and Chairman, eBay; Cofounder and Founding Partner, Omidyar NetworkVersion 1.5
  12. 12. Chapter 1 An Introduction to Pandemics • 4 The Impact of a PandemicOverview • Note that there is evidence that the 1918 flu was most likely an interspecies transfer• Communities will be affected simultaneously. between birds and humans, compared with• At least 30% of the overall population will the less severe pandemics of 1957 andbecome infected. 1968, suggesting that the impending• Absenteeism is expected to be upwards of 50%. pandemic with H5N1 may be more severe.• A pandemic is likely to last for 12 to 18 months.• Communities could be affected by several waves Three prerequisites for the start of alasting 6 to 8 weeks each.• Vaccines and antiviral drugs for pandemic pandemicinfluenza will be in short supply, may be of limited 1. A new influenza virus is introduced to whicheffectiveness, and are not likely to be available to humans have little to no immunity.most communities. 2. This virus must be able to replicate in humans• Most of the ill will seek medical care. and cause disease.• All healthcare systems will be overwhelmed. 3. This virus must be able to efficiently transmit• Health facilities are unlikely to be available to itself from one human to another.most, and may be inadvisable to enter owing toincreased chances of exposure to the virus.• People and communities will likely be on their Where is this happening?own without the help of mutual aid from other Since 2003, a growing number of human H5N1communities, hospitals, or other public services. cases have been reported in Azerbaijan, Cambodia,• Those who take steps to prepare ahead of time China, Djibouti, Egypt, Indonesia, Iraq, Laowill be much more resilient as pandemic influenza People’s Democratic Republic, Nigeria, Thailand,spreads . Turkey, and Vietnam. More than half of the people infected with the H5N1 virus have died. Most ofWhat is a pandemic? these cases are believed to have been caused by exposure to infected poultry. There has been noA pandemic is a global outbreak of an infectious sustained human-to-human transmission of thedisease. A pandemic of influenza A (ex: the H5N1 disease, but the concern is that H5N1 will evolvestrain) occurs when a new influenza strain emerges into a virus capable of that human-to-humanfor which people have little or no immunity and for transmission.which there is no vaccine. The infection spreadseasily from person to person, causes seriousdisease, and can spread around the world in a very Can humans get bird flu?short time. Yes. The Avian Influenza H5N1 strain started as an infection in birds, but has mutated so that it canHow dangerous will it be? now infect humans. Avian influenza strains can be transmitted from wild birds to domestic birds, andHealth professionals are concerned that the highly pathogenic strains can rapidly kill entirecontinued spread of a highly pathogenic avian flocks. Strains including H5N1 and others areH5N1 virus across Asia, Africa and Europe deadly to domestic fowl and can be transmittedrepresents a potentially significant threat to the from birds to humans. There is no human immunitygeneral public. The H5N1 virus has raised concerns and no vaccine is currently available.about a potential human pandemic because:• It is especially virulent (makes people very sick) Since 2003, a growing number of human cases of• It is being spread by migratory birds avian influenza strain H5N1 have been reported in• It can be transmitted from birds to mammals at least 12 countries worldwide, from China toand, in some limited circumstances, to humans, Egypt.and• Similar to other influenza viruses, it continues toevolve. Version 1.5
  13. 13. 5 • Chapter 1 An Introduction to PandemicsWho will get sick? would release vaccine outside of its borders without first ensuring that its own population is vaccinated.• All it takes is for one infected person to get on aboat, train, or airplane and enter a new country to Will there be enough doctors?start the global spread of the illness.• The percentage of infected individuals will most Should a pandemic occur on the 1918 scale, alllikely be about 30% of the overall population during medical systems will be overwhelmed. Current levelsa severe pandemic. of emergency, hospital, and outpatient care will not• Illness rates may be highest among school-aged be available owing to insufficient numbers of beds,children (40%) and decline with age. An average of ventilators, medical supplies, and personnel1 in 5 working adults will become ill during a (absenteeism in healthcare personnel is expected tocommunity outbreak. meet or exceed that of the general population). Long-term care and skilled nursing facilities, among others, will also be affected.When will it happen?3 How can I help prevent spreading theIt is currently impossible to predict the emergence illness?of a future pandemic (other than to strongly suspectthat one will eventually occur), or to predict when or • “Social distancing” strategies aimed at reducingwhere a future pandemic will occur, what subtype it the spread of infection, such as closing schools,will be, or what degree of death and disease it will community centers, small businesses, and otherproduce. public gathering places, and canceling public events, will likely be implemented during a pandemic wave.Can this be avoided? • Additionally, residents may be required to stay inThere is no sure way to stop a pandemic from their homes for a significant period of time during aoccurring. The best way to avoid a hard-hitting pandemic outbreak, depending on the action takenpandemic is to take personal responsibility for by their local health officer.isolating yourself if you may have been exposed, • Residents and communities will need to preparepreparing your family and house for an extended in advance to become self-reliant during thestay in your home, and encouraging your neighbors pandemic.and friends to do the same. What will happen when people die?What about a vaccine? The Medical Examiner’s Office, morgues andVaccines and antiviral drugs for pandemic influenza funeral homes will not have the resources to handlewill be in short supply. the high number of deaths, which in a severeCreating a pandemic influenza vaccine would take at pandemic is estimated to be approximately 2–5% ofleast six months. Vaccinating a majority of the those infected. The dead will need to be cared for atpopulation would take weeks on top of that. home until they are able to be removed.Vaccines currently in production against avian What will happen to my community?influenza A/H5N1 will confer immunity to onlythat strain of H5N1 and not necessarily to a new, Rates of absenteeism at work will soar during peakmutated form of that strain. They will also not offer periods of a pandemic. This will likely causeprotection against any of the other potential types of significant disruption of public and privately ownedinfluenza that could create a pandemic, such as critical infrastructure including transportation,H7N7, H9N2, and H2N2. commerce, utilities, public safety, andAdditionally, all facilities that produce influenza communications.vaccines are currently overseas. Should a pandemicoccur, it is unlikely that a foreign countryVersion 1.5
  14. 14. Chapter 1 An Introduction to Pandemics • 6How long could this last?A pandemic can last up to two years; locally,communities could be affected by several waveslasting six to eight weeks each.What else do I need to know?• During a severe influenza pandemic, individuals,families, and neighborhoods will likely be on theirown and should not count on aid from othercommunities. Healthcare systems will beoverwhelmed, and routine public services will beunavailable.• Owing to widespread effects upon society andthe toll on human life, some people mayexperience fear, and even panic, based on lack ofinformed preparation.• Skilled workers will be needed. They most likelywill serve, and come from within, their owncommunities.• Volunteer response workers will be invaluableresources in maintaining continuity in communityservices. “Any community that fails to prepare and expects the federal government to come to the rescue is tragically wrong.” - Michael O. Leavitt, Secretary of Health and Human Services at the Pandemic Influenza Summit in Baltimore, MD, 2006 Version 1.5
  15. 15. 7 • Chapter 1 An Introduction to Pandemics A Brief Pandemic History Influenza pandemics have been recorded for at least 300 years and occur at unpredictable intervals.• In the 20th century, there were three pandemics: • The pandemic had widespread social effects.1918–1919, 1957–1958, and 1968–1969. Historians There was reduced healthcare capacity becausehave estimated that the Spanish influenza of 1918– healthcare workers also became sick and were1919 killed between 40 and 50 million people unable to work. Organized gatherings were prohibited for fear of spreading the influenza.worldwide. Globally, more people died from Quarantines were enforced, but in many cases wereSpanish influenza than were killed in World War I. not very successful. The town of Prescott, ArizonaIn fact, more Americans died from the Spanish even outlawed shaking hands4.influenza than in all of the wars of the 20th century • Some public health departments distributed gauzecombined. masks to be worn in public. Stores could not hold• 0.64% of the U.S. population, or approximately sales, and funerals were limited to 15 minutes. Those675,000 people, died from infection in the pandemic who ignored the influenza ordinances had to payof 1918–1919. steep fines. Bodies piled up as the massive numbers• The strain was unusual for influenza in that this of deaths occurred. In addition to the lack ofpandemic killed many young adults and otherwise healthcare workers and medical supplies, there was ahealthy people. shortage of coffins, morticians, and gravediggers.• People were sometimes struck suddenly with • Cities that implemented social distancing in theillness and within hours were too feeble to walk. 1918 outbreak had a much lower incidence ofMany died the next day. infection spread than cities that did not.• Symptoms included a blue tint to the face (due toinsufficient oxygen) and coughing up blood becauseof severe obstruction of the lungs.• In fast-progressing cases, most victims died fromviral pneumonia. Slower-progressing cases oftenresulted in death from secondary bacterialpneumonias.Version 1.5
  16. 16. Chapter 1 An Introduction to Pandemics • 8 The Pandemic Severity Index5The Pandemic Severity Index was created in The SARS outbreak demonstrated that modernJanuary 2007 by the Center for Disease Control travel patterns may significantly reduce the time(CDC) to categorize the level of impact a pandemic needed for a pandemic influenza virus to spreadcould have. The scales are rated based on numbers globally to only a few months or even just weeks.of deaths that would occur. The major implication of such rapid spread of an infectious disease is that many, if not most, countries will have very little time to implementThe pandemic severity index levels are: their response once the pandemic virus has begun to(CFR = Case Fatality Rate) spread. While SARS infections spread quickly to multiple countries, the epidemiology and• Category 1, CFR of less than 0.1% (one death- transmission modes of the SARS virus greatlyper-thousand cases, such as seasonal flu) helped the ability of public health authorities to• Category 2, CFR 0.1% to 0.5% (such as the 1957 contain the spread of this infection in 2003.and 1968 flu outbreaks) Isolation and quarantine, as well as other control measures, were also helpful in containing spread• Category 3, CFR 0.5% to 1%• Category 4, CFR 1% to 2%• Category 5, CFR 2% or higher (one death-in-50cases or worse, such as the 1918 flu)The U.S. Department of Health and HumanServices estimates that in the United States alone, asevere, Category 5 pandemic like that of 1918–1919could cause 1.9 million deaths, 9.9 millionhospitalizations, 45 million outpatient visits, and 90million cases of illness.5Influenza pandemics have been recorded for at least300 years and occur at unpredictable intervals. Inthe 20th century, there were three pandemics: 1918–1919, 1957–1958, and 1968–1969. The pandemic of1957 originated in China and the pandemic of 1968originated in Hong Kong; estimated U.S. deathsfrom those pandemics were 70,000 and 34,000,respectively. Nonetheless, today seasonal influenzaalone is deemed responsible for about 36,000 U.S.deaths per year. By far, the most damaging influenzapandemic on record was the infamous Spanish Flupandemic of 1918–1919. Version 1.5
  17. 17. 9 • Chapter 1 An Introduction to Pandemics Deaths During a Pandemic Pandemic Death Toll Since 1900 1918-1919 U.S.... 675,000+ Worldwide... 50 million+ CDC statistics 1957-1958 U.S... 70,000+ Worldwide... 1-2 million 1968-1969 U.S... 34,000+ Worldwide... 700,000+A severe pandemic will likely lead to thousands, if A substantial percentage of the world’s populationnot millions of deaths, disruption of services, will require some form of medical care. Healthcareeconomic distress, and social disruption. Social facilities can be overwhelmed, creating a shortage ofdistancing should be implemented as soon as hospital staff, beds, ventilators, essential medicines, and other critical medical supplies. Surge capacity atevidence of an influenza outbreak occurs in your alternative care sites, such as pop-up clinics,area. Quarantine and isolation orders may schools, hotels, and industrial parks, may need to bebe ordered in the best interest of the public and created to cope with demand. For most people,should be taken seriously and obeyed. Citizens who their treatment will be at home, or some othertake responsibility for limiting the spread of the flu location where they can be cared for with minimalby using proper measures to control and prevent danger to others.transmission of influenza —e.g., by not shakinghands, wearing a mask, frequent hand washing,coughing into their elbows, and limiting theircontact to the outside -- will be invaluable in helpingto prevent transmission of i nfection to others.Version 1.5
  18. 18. Chapter 1 An Introduction to Pandemics • 10 Current InfectionsThis map from the CDC shows countries that are currently affected by the H5N1 influenza strain. H5N1 in wild birds H5N1 in poultry and wild birds H5N1 in humans Nations with Confirmed Cases of H5N1 Avian Influenza (as of June 2007) Version 1.5
  19. 19. 11 • Chapter 1 An Introduction to Pandemics Home vs. Community Response “What happens before [a pandemic] is far more productive, and individual preparations on a household basis are key. It’s not just state and local governments—every tribe, business and family needs to talk through a pandemic plan.” - Michael O. Leavitt, Secretary of Health and Human ServicesWe will all be affected Vulnerable populationsIn the event of a pandemic, all areas of our lives will “Where you live should no longer determinebe affected. Essential services such as access to whether you live.”medical, water and food suppliers; to schools and the -Bono, in ”Song for Africa”workplace; and to transportation, telecommunicationsand information technology services may all be limited Part of your neighborhood or communityor unavailable. preparedness plans should focus on assisting citizens with special needs or those who are disadvantaged.Begin your planning Attention needs to be paid to determining who willBefore you begin making your individual or family help the following populations:plan, you may want to review your state’s planning • Homelessefforts and those of your local public health and • Low incomeemergency preparedness officials. Planning • Elderlyinformation can be found at • Mentally illwww.pandemicflu.gov/plan/ checklists.html. • HandicappedYou can find your state plan at • Children with chronic medical conditionswww. pandemicflu.gov/WhereYouLive/index.html. • Pregnant women • Immunocompromised individuals (e.g., cancerPlanning outside the home patients, recipients of organ transplants, patients onLearn about the plans for your area and areas where chronic steroids, or with HIV/AIDS)you frequently travel, so you know what resources • Non-English speakersare available and what will you have to plan for on Plans should include assistance with stockpiling,your own. Planning ahead of time and being education, medical care, and surveillance. Theseprepared will give you a much needed plan of action populations need the help of others in theirwhen a pandemic hits. community, especially when it comes to disaster preparedness and response.Version 1.5
  20. 20. Chapter 1 An Introduction to Pandemics • 12 Checklist for Pandemic UnderstandingIf you decide not to read any further than this page, ❑ Accept the importance of learning aboutyou perhaps will have learned more than you realize. pandemic influenza and recognize the impact thatA severe influenza pandemic would constitute a a severe outbreak would have on your world.major disaster unlike anything experienced in the ❑ Understand that the national government willmodern world; a world where we are almost totally not be able to come to local aid during a full-reliant on computers, ‘just in time’ delivery of food scale pandemic.and goods, and cell phones to function in oureveryday lives. A pandemic will disrupt every aspect ❑ Start talking to your neighbors, family andof our lives, from access to health care to availability friends about preparedness, and begin yourof food and water. It will cause an increase in death own preparations.and disease in our communities. Even our disasterassistance and recovery plans have been based on ❑ Check with your business, school, house of‘mutual aid’—a system where resources and ‘first faith or worship, and other local businesses andresponders’ from an unaffected area can leap into organizations about their pandemic readinessaction to help people in the area of an earthquake, and, if they haven’t started, help them develop a plan.hurricane, or terror attack. But in a pandemic, nosuch unaffected areas are likely to exist. You now ❑ Critically review your local healthunderstand that it is up to each individual to care for department’s pandemic response. They arethemselves and their loved ones. We are fortunate the people in charge and you need to knowto have the ability to prepare for a pandemic that what they are planning.most public health scientists agree is inevitable atsome time in the future. While there is no way to ❑ Read more about the history of pandemics—predict the timing and severity of the next influenza what some cities did that worked (socialpandemic, we have time to prepare — and it’s our distancing) and what happened in those citiesresponsibility to do so! where lack of preparedness led to a delayed response. Version 1.5
  21. 21. 13 • Chapter 1 An Introduction to PandemicsVersion 1.5
  22. 22. Chapter 2 Prevention and Preparation • 14 Chapter 2 Prevention and Preparation “The most immediate and largest economic impact of a pandemic might arise not from actual death or sickness but from the uncoordinated efforts of people to avoid becoming infected....” - Milan Brahmbhatt, World BankIn this chapter you will learn: After reading this chapter, you will be able to:• How to minimize flu transmission • Practice safe hand washing techniques to prevent the spread of a virus and other simple• Strategies for pandemic preparation infection control and prevention methods• What to stockpile in the event of a pandemic • Start your preparation and stockpiling efforts Version 1.5
  23. 23. 15 • Chapter 2 Prevention and Preparation Flu Transmission The first step in preventing flu is to understand what it looks like and how it is transmitted so you can minimize your exposure.Version 1.5
  24. 24. Chapter 2 Prevention and Preparation • 16 What Exactly is Influenza?Influenza is an acute viral infection of the respiratory tract caused by one of threestrains of influenza virus (A, B, or C). Please note that many respiratory infections thatare commonly referred to as “flu” are actually not the flu. The term is used very loosely in everyday language. The terms influenza and flu are used here interchangeably and we are not describing other, ordinary, seasonal respiratory viral infections. Seasonal Flu Pandemic Flu• Outbreaks follow predictable seasonal patterns; and • Occurs rarely (three times in 20th century - last inoccur annually, usually in winter, in temperate 1968)7climates.• Usually some immunity built up from previous • No previous exposure, and little or no pre-exposure existing immunity• Healthy adults usually not at risk for serious • In addition to usual populations at risk for severecomplications. Those at increased risk for complications during outbreaks of seasonalcomplications are the very young, pregnant women, influenza, healthy people may be at increased riskthe elderly and those with certain underlying health for serious complications.conditions.• Health systems can usually meet population and • Health systems may be overwhelmedindividual patient needs• Vaccine developed based on the known circulating • Effective vaccines probably would not be availableflu strains and is available for the annual flu season. in the early stages of a pandemic• Adequate supplies of antivirals are usually avail- • Effective antivirals may be in limited supplyable• Average U.S. deaths: approximately 36,000 per year. • Number of deaths could be quite high (the 1918 flu killed 2.6 percent of those who got sick, killing 40-50 million people.6)• Symptoms: fever, cough, runny nose, muscle pain. • Symptoms may be more severe, withDeaths often caused by complications, such as complications and unusual symptoms morepneumonia. frequent• Generally causes modest impact on society (e.g., • May cause major impact on society (e.g.,some school closing, encouragement of people who widespread restrictions on travel, closings ofare sick to stay home). schools and businesses, cancellation of large public gatherings)• Manageable impact on domestic and world • Potential for severe impact on domestic and worldeconomy economy Version 1.5
  25. 25. 17 • Chapter 2 Prevention and Preparation Flu Facts• Seasonal influenza is responsible for an average of What does the flu look like?36,000 deaths every year in the United States. Influenza can encompass any or all of the• Although seasonal influenza may commonly have following symptoms:a greater impact on the young, the old, and • Begins abruptlyimmunocompromised individuals, a pandemic • Symptoms include fever, chills, body aches, lossinfluenza can cause serious illness in people of anyage. Currently, H5N1 has caused the most deaths in of appetite, headache, and fatiguepeople between the ages of 10 and 40. • Fever (Temp >100.4ºF) – usually lasts 2-3 days • Respiratory tract symptoms include cough with-• Antibacterial agents are antibiotics that may beused to treat bacterial complications of influenza; out phlegm, sore throat, and congestionthese agents, however, are not active against virusesand therefore cannot be used to treat influenza. It’s important to note that pandemic fluThe effective use of antiviral agents to treat symptoms may look very different frominfluenza depends on prompt treatment after seasonal flu symptoms.exposure or early in the course of the illness— Other pandemic symptoms can include:usually during the first 48 hours. Such a strategyhas the potential to significantly reduce the spread • Stomach and intestinal issues, such as diarrhea,of influenza in the community and to modify the nausea, and vomiting (most often seen in children)severity of disease in individuals. • Sluggishness or alterations in mental state (seen• Each virus has its own characteristics that make most often in the elderly and infants)vaccines effective against only one type. Scientists • Pneumonia can often result as a secondaryare able to predict how the seasonal virus may look, infection (most often seen in those withbut a pandemic virus will be unknown until it compromised immune systems)actually hits.• Being indoors where a virus can breed and bepassed on from one person to the next is a perfectway to pass on the illness. Viruses are more easilytransmitted in these closed situations.• You cannot be infected with the exact sameversion of influenza twice, but you can be infectedwith a newly mutated form of an influenza strain.That is, once your body has been exposed to aparticular strain of the virus, you will developimmunity and will no longer be susceptible tofurther infection from that strain. If the strainmutates enough, you may be susceptible to themutated strain and develop an illness again.Version 1.5
  26. 26. Chapter 2 Prevention and Preparation • 18 How Does Flu Spread From One Person to Another?Large droplet transmission Contact transmissionRespiratory droplets are generated by a person Contact can occur by direct bodily contact (such ascoughing or sneezing and can be propelled right into kissing) or touching something with virus on it (suchthe eyes, nose, or mouth of other individuals over as shaking hands with someone who has the flu) andshort distances. Large droplets are about the size of then touching your mouth, nose, or eyes. Virusesa droplet of water in fog or mist, or the width of a can last approximately 48 hours on an object.cotton fiber, and they contain viral particles. Large Regularly washing your hands and keeping commondroplets usually travel about the distance of an surfaces clean can reduce the occurrence of this typeextended arm, or about a yard. This is why infection of transmission.control advice suggests that people keep greaterthan an arm’s length from each other to avoidtransmission.Small droplet and airborne transmissionTransmission through ventilation systems inbuildings and over other long distance is not likely,but it is possible for saliva particles to stay in theair for a period of time in a room. These tinyparticles can hang around in the air in a roomwithout circulation and can be inhaled. This typeof transmission can be lessened with the use ofmasks and by keeping windows open. Version 1.5
  27. 27. 19 • Chapter 2 Prevention and Preparation Healthy Habits and Virus PreventionThe main responsibility for effective infection Practice social distancing.control rests on the contribution of each individual • If you or anyone in your home is ill, or if you maytoward reducing the spread of the virus. This means have been exposed to an ill person, stay at home andstaying vigilant in regard to your own health through isolate yourself as much as possible.proper hand and respiratory hygiene, coughetiquette, and social distancing, and staying at home • Stay in a separate room with good light andif you’re ill. This also means educating others about ventilation.how to care for themselves and their community. • Assign one person to care for the sick to minimize spread.Basic infection control procedures: • Avoid crowds and public gatherings.Clean hands frequently and thoroughly • Don’t send sick children to school or daycare.using soap and water or alcohol-based • Wear gloves and a mask when in contact withhand rubs. sick persons. Depending on proximity, a respirator• This should take at least 20 seconds, or the time it may be used.takes to sing ‘Happy Birthday’ twice. • If masks aren’t available, you can use layers of cloth to reduce droplet transmission.• Alcohol-based hand rubs are effective againstinfluenza virus and are not as drying as soap and • If gloves aren’t available, you can use householdwater. They can be used effectively unless your rubber gloves that have been disinfected usinghands are visibly soiled. bleach and water (1 part bleach to 10 parts water).• Remember to clean your hands before preparing Did you know there is a scientific methodor serving food, brushing or flossing teeth, inserting for washing your hands?or removing contact lenses, or treating wounds and According to the CDC, hand washing is the “mostcuts. important means of preventing the spread of• Clean your hands after any contact with potentially infection.” Here’s how to wash them well andinfectious individuals, coughing and sneezing, using perhaps avoid a cold or the flu. As we mentionedthe bathroom, caring for a sick person, after taking before, wash your hands for 20 seconds or the timeoff masks and gloves, or taking out the garbage. is takes to sing `Happy Birthday’ twice.Cover your coughs and sneezes and ask Instructions:others to do so as well. • Step 1: Turn on the sink and get your hands wet with warm water.• Use a tissue, or cough and sneeze into your • Step 2: Use plenty of soap and rubelbow. hands together vigorously for at least 10• Wash hands after sneezing/coughing, and dispose seconds. of the tissue in a waste basket. • Step 3: Wash palms, backs of hands, wrists, fingers and under fingernails.Keep living and work areas surfaces clean. • Step 4: Rinse hands thoroughly with• Use regular disinfectant to frequently clean warm water.commonly used surfaces, such as the TV remote, • Step 5: Dry hands with a clean toweldoorknobs, telephones, and kitchen and bathroom or paper towel.counters. You can also use bleach (1 cup bleach + 1 • Step 6: Turn off the sink with thegallon water). towel - this prevents reinfection of your hands.• Wash dishes with soap and warm water.Version 1.5
  28. 28. Chapter 2 Prevention and Preparation • 20 General Ways to PrepareInvolve your community Get your seasonal influenza andTalk to groups you’re involved with, such as religious pneumonia vaccinationorganizations, parent groups, clubs, and other social Even though the influenza vaccine does not includegroups about their level of preparedness. Exchange protection against avian influenza, be sure to get annotes and ideas. Talk to your neighbors and consider influenza shot anyway. If you have the influenzacreating “block teams” to organize neighborhood shot, it will protect you against the seasonalpreparation and response. Do your best to help influenza and prevent you from developing it duringform a cohesive group that you could rely on in the the same time that pandemic influenza may beevent of a pandemic. circulating in your community. Talk to your doctor about also getting the pneumonia vaccination – thisInvolve your family could help prevent secondary bacterial infections that can occur from having the flu.Talk to your family about where family membersand loved ones will go in an emergency, and howthey will receive care in case you cannot Prepare your records in case you diecommunicate with them. According to estimates, 1 in 40 people will notFor family members living far away, consider survive the flu during a severe pandemic. 7 Youpreparing an emergency travel bag that would should get your estate in order and make sure yourinclude an open, round-trip bus, train or airline will and life insurance are up to date so that yourticket, money, a change of clothes and essential family will be looked after. If you need to, buy moretoiletries, along with a picture ID. life insurance now since it takes time to get a policy.Involve your children in the planning process and You may wish to consider buying a life insurancemake it a family activity. Remember, children echo policy for your spouse and children. It would beyour behavior so be a good model. Be sure to prudent to select only the bluest of blue-chipinclude games and activities for yourself and your insurers, the most solid and reliable, since thechildren should you be required to stay at home for economic impact of a major pandemic will not belong periods of time. predictable and many companies may go out of business.Stay informedBe up to date on the current happenings in theworld of pandemic flu. Check your favorite newssource frequently so that you stay knowledgeableabout current events relating to the flu. Start withthese good sources of information:• www.who.int• www.pandemicflu.gov• www.fluwikie.com Version 1.5
  29. 29. 21 • Chapter 2 Prevention and Preparation Stockpiling for HomeStore 1–3 months of non-perishable food “If people are not able to avoid crowded places,for every family member [or] large gatherings or they are caring for people who are ill, using a facemask or aIn the event of a pandemic you should be prepared respirator correctly and consistently could helpto live without normal access to grocery stores and protect people and reduce the spread ofpharmacies. Prepare by: pandemic influenza.”• Selecting foods that do not require refrigeration, -Dr. Julie Gerberding, CDC Directorpreparation (including water), or cooking. Foods likecanned meats and fish, beans, soups, fruits, drycereal or granola, baby food, and salt and sugar are Other items in your pandemic flugood choices. Don’t forget pet food. emergency kit• Having materials for oral rehydration solution • Disinfectants and chlorine bleach(e.g., salt, sugar, instant baby rice cereal for example)with Pedialyte for kids, Gatorade for adults and • Supply of surgical face masks and plastic gloves; these can help protect you, especially if you areteens, or any other generic electrolyte solution. taking care of family members or need to go out in• Providing rehydration solution for adults and publicteens. • Supply of ibuprofen, acetaminophen, and cough• Having a supply of formulas for infants and other medicine for each person in the house for fever andperson’s special nutritional needs. pain• Storing a one-month supply of fresh water for • Cell phone and chargereach family member. Plan to use one to two gallons • Water purifier/purification tabletsper person per day.• Storing a month’s supply of food for pets. See Appendix C for a complete stockpiling list and Appendix D for Items for treatment of severe influenza. See• Ensuring that you have necessary medicalsupplies (e.g., glucose, insulin, and blood pressure Appendix E for an Oral Rehydration Solution recipe.monitoring equipment) if you have a chronic diseasecondition.• Talking to your healthcare provider to ensureadequate access to your medications and obtain anextra month’s worth of prescription medicines.Version 1.5
  30. 30. Chapter 2 Prevention and Preparation • 22 Ways That You and Your Neighbors Can HelpNeighborhood organizations can help fill Here are some suggestions for the types ofthe gap left by an overwhelmed neighborhood volunteer roles that you might need. Meet with your neighbors and family,infrastructure and talk about what would work best for you.During the 1918–1919 pandemic, community volunteers • Area Leadersuch as teachers and other persons who were out of work • Volunteer Recruiter and Coordinatordue to quarantine and closures were essential in facilitating • Supplies Managerquarantine implementation, documenting the sick, andalleviating overflowing healthcare facilities. Control of a • Medical Operations Managermodern pandemic will also benefit from a similar • Communications Leadervolunteer system. • Coroner FunctionDuring a pandemic, absenteeism at most businesses and • Public Educatorestablishments, including essential services, could involve • Mental Health Monitorup to 40% of their employees. This estimation will vary • Special Skillsaccording to characteristics of the virus.Highly desired volunteers include but are not limited See Appendix F for Communityto: Volunteer Roles and Responsibilities• Retired healthcare personnel• Skilled laborers• People who have recovered from previous infectionwith the circulating pandemic influenza strain• People with medical training who can aid in caring forill individuals• Mental health and spiritual counselors• People with disaster response trainingAlthough the threat of pandemic influenza may not seemimminent enough now to do anything, when it doesbecome an issue it can move very quickly from one stageto the next, and it will be helpful to think these thingsover ahead of time. The sooner you prepare, the betteryou will be able to respond.
  31. 31. 23 • Chapter 2 Prevention and Preparation Citizen Corps8Citizen Corps, a vital component of USA Citizen advocates can assist local fire departments in aFreedom Corps, was created to help coordinate range of activities including fire safety outreach, youthvolunteer activities that will make our communities programs, and administrative support. Fire Corpssafer, stronger, and better prepared to respond to provides resources to assist fire and rescueany emergency situation. It provides opportunities departments in creating opportunities for citizenfor people to participate in a range of measures to advocates and promotes citizen participation. Firemake their families, their homes, and their Corps is funded through DHS and is managed andcommunities safer from the threats of crime, implemented through a partnership between theterrorism, and disasters of all kinds. National Volunteer Fire Council, the International Association of Fire Fighters, and the InternationalCitizen Corps programs build on the successfulefforts that are in place in many communities Association of Fire Chiefs.around the country to prevent crime and respond toemergencies. Programs that started through localinnovation are the foundation for Citizen Corps andthis national approach to citizen participation incommunity safety. USAonWatch (UOW)-Neighborhood WatchCitizen Corps is coordinated nationally by the works to provide information, training and resourcesDepartment of Homeland Security. In this capacity, to citizens and law enforcement agencies throughoutDHS works closely with other federal entities, state the country. In the aftermath of September 11, 2001,and local governments, first responders and Neighborhood Watch programs have expandedemergency managers, the volunteer community, andthe White House Office of the USA Freedom beyond their traditional crime prevent on role to helpCorps. neighborhoods focus on disaster preparedness, emergency response and terrorism awareness. USAonWatch–Neighborhood Watch is administered by the National Sheriffs’ Association in partnership with the Bureau of Justice Assistance within the U.S.The Community Emergency Response Department of Justice (DOJ).Team (CERT) program educates people aboutdisaster preparedness and trains them in basicdisaster response skills, such as fire safety, lightsearch and rescue, and disaster medical operations.Using their training, CERT members can assist The Medical Reserve Corps (MRC) programothers in their neighborhood or workplace strengthens communities by helping medical, publicfollowing an event and can take a more active role health, and other volunteers offer their expertisein preparing their community. The program is throughout the year as well as during localadministered by the U.S. Department of Health and emergencies and other times of community need.Human Services (HHS). MRC volunteers work in coordination with existing local emergency response programs and also supplement existing community public health initiatives, such as outreach and prevention, immunization programs, blood drives, case management, care planning, and other efforts. TheThe Fire Corps promotes the use of citizen MRC program is administered by the Department ofadvocates to enhance the capacity of resource Health and Human Services.constrained fire and rescue departments at alllevels: volunteer, combination and career.Version 1.5
  32. 32. Chapter 2 Prevention and Preparation • 24Volunteers in Police Service (VIPS) works toenhance the capacity of state and local lawenforcement to utilize volunteers. VIPS serves as agateway to resources and information for and aboutlaw enforcement volunteer programs. Funded bythe DOJ, VIPS is managed and implemented by theInternational Association of Chiefs of Police. Version 1.5
  33. 33. 25 • Chapter 2 Prevention and Preparation Checklist for Pre-Pandemic PreparationYou are now ready to begin preparations to help You should now understand:protect and prepare yourself, your family and lovedones from an outbreak of pandemic influenza. You ❑ How the flu can be transmitted from person toalso have the knowledge to educate your neighbors personabout how to start their own pandemic emergency kits. ❑ How to recognize symptoms of the fluBecause, in most cases, governments won’t be able to ❑ How to properly wash your handshelp on a local level if a pandemic should occur, it is up ❑ How to prevent spread of infectionto each individual, family and neighborhood to carefor themselves. By being proactive, you are taking a ❑ Ways in which you may involve yourvital step in lessening the chaos that may occur during a communitypandemic. The more that people are prepared, thebetter off society will be in surviving a pandemic. ❑ How to plan with your neighbors and coordinate a response ❑ How to prepare your home and stockpile for an extended stay ❑ Some ways you should immediately begin to involve your family ❑ Ways to investigate pandemic preparedness in your city and neighborhood ❑ About the many different volunteer organizations that surround youVersion 1.5
  34. 34. Chapter 3 Response • 26 Chapter 3 Response “Being prepared does not apply only to those of us who respond at the time of need. All citizens must take this seriously and begin to plan for any potential disaster that may occur in our own community.” – Rebecca Patton, President of the American Nurses AssociationIn this chapter you will learn: After reading this chapter, you will be able to:• What life could look like during a severe • Administer basic homecare to an adult orpandemic child with influenza• Medical management of influenza • Know how to purify water• Home treatment during a pandemic• Complementary medicines• The importance of hydration• What you and your neighbors can do to help Version 1.5
  35. 35. 27 • Chapter 3 Response A Glimpse of Life During a PandemicRoutine services may be disrupted You, your family and your local community will need to be able to function independently during• Hospitals, schools, government offices, and thepost office may all be closed or severely impaired this period of time. One area of self-sustainability will be in managing influenza issues at home for• Telephone service, the Internet, commercial your family and local community members whoradio, and TV broadcasts could also be interrupted,especially if the electric power grid falters or fails are unable to care for themselves (for example, medically vulnerable children, the elderly, pregnant• Stores and businesses may be closed or, if open, women, and the immune-compromised).may have limited supplies• Local ATMs and banks may be shut down, andcash will be in short supplyPublic transportation services andcommunication may be disrupted• Gasoline supplies may be limited or unavailable• Travel could be restricted by fear, quarantineor curfew• Public gatherings may be canceled• Communications about pandemic status maybe limited due to changing circumstances andlimited communication servicesMental health impact• People in your community may be dying fromthe influenza virus. In fact, perhaps evenpeople within your household.• A nxiety, confusion, and fear will becommonplace and debilitating. Few people haveever had to face such circumstances.Version 1.5
  36. 36. Chapter 3 Response • 28 Medical Management of InfluenzaMedical services will be strained as they try to Keep a record of every person being cared for.manage the surge of patients during a pandemic. In • It is useful to write down health information aboutthe beginning of a pandemic, individuals will be the people that are being cared for at home.caring for their families and loved ones in an • Keep the record arranged chronologically and tryisolated fashion, most likely at home. Lay people to be as accurate and consistent as possible.will become caregivers, learning how to obtain vital • Note the person’s general appearance.signs such as pulse, blood pressure, temperature, • Take a patient’s vital signs three or four timesand respiratory rates of these sick family members each day or when a significant change in condition isand neighbors. There are also many people, such as observed. Include temperature, pulse rate (in beatselderly citizens living alone, who have no one to per minute), breathing rate (in breaths per minute)care for them; community members will need to be and, if possible, blood pressure as well. Othermindful of helping these individuals as well. important information is an estimation of fluid intake and output.Helpful hints for managing influenza athome See appendix G for a sample of a home patient medicalDiagnoses, treating physician, medications, recordand treatment schedules• Have a medical history available for every Blood pressure monitoringperson in your household. Learn to use an automated blood pressure monitor• Designate one person as the caregiver. to measure blood pressure. These devices come withKeep unexposed visitors out of the house if there good instructions that clearly explain how to useare persons inside the house who pose a threat them. “Practice makes perfect” applies to learningof influenza infection to them. and perfecting these skills. If you need help learning how to use these devices, ask your local doctor orMonitor exposed persons for signs of illness. nurse for help. They will be happy to help you develop these simple skills. All you need to do isIf exposed persons become ill, do what you ask.can to arrange for immediate medicalevaluation.• Those with symptoms should be isolatedinside the house.• If asymptomatic  , but exposed to the sick,best practice would be to stay inside. Version 1.5
  37. 37. 29 • Chapter 3 Response Treatment at Home “While researchers are working very hard to develop pandemic influenza vaccines and increase the speed with which they can be made, non-pharmaceutical interventions may buy valuable time at the beginning of a pandemic while a targeted vaccine is being produced.” -Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases (NIAID) within the National Institutes of HealthAnti-viral prescriptions Limitations on the use of anti-viralsThere are two main anti-viral medications (known • Antiviral medications are going to be in highas neuraminidase inhibitors) shown to be effective demand during the pandemic. Thus, most individualsin reducing the severity and duration of i llness will not have access to these medications once a pandemic begins.caused by seasonal influenza and may be helpfulagainst pandemic influenza. They can be prescribed • Anti-virals are most effective if taken within 48only by a physician. These are Oseltamivir (also hours after the onset of the first symptoms.known as Tamiflu) and Zanamivir (commonly • Anti-viral medications are not always effective, socalled Relenza). don’t rely on them completely.For antiviral medication dosages visit the CDC’swebsite: www.cdc.gov/flu.Version 1.5
  38. 38. Chapter 3 Response • 30 Basic Health Assessment and Treatment7 By recognizing the symptoms a patient describes, or the signs of the disease in the body, you can use the chart below to guide your treatment. Here’s how.Symptom or Sign Likely Assessment Treatment• Low urine output • Dehydration • Push fluids• High pulse rate (>80 but • Dehydration or fever • Push fluidsespecially > 90)• Shortness of breath • Pneumonia • Push fluids• Shaking chills and shivers • Viremia (virus in the blood) • Keep warm or pneumonia• Cyanosis (skin turns blue) • Respiratory failure. • Keep as comfortable as possible. Unfortunately, death is Give hydrocodone with likely promethazine for comfort, give diazepam for anxiety.• Bleeding from mouth, • A severe blood clotting • Keep as comfortable as possible.coughing up blood, passing abnormality has occurred due Give hydrocodone withred blood per rectum, severe to the virus (DIC). Death is promethazine for comfort, givebruising likely. diazepam for anxiety.• Vomiting • Virus affecting GI tract • Use promethazine for vomiting, push fluids• Diarrhea • Virus affecting GI tract • Push fluids, clear liquid diet• Severe stomach cramps • Virus affecting GI tract • Use hydrocodone and promethazine for comfort• Headache • Ibuprofen or acetaminophen, and with hydrocodone if very severe• Fever • Ibuprofen, acetaminophen, push fluids, keep warm or cool, consider tepid water baths if more than 103°F, but OK if <103° as this may help kill the virus.• Sore throat • Gargle with hot salt water, drink hot tea or hot water, ibuprofen and/or acetaminophen• Cough • Push fluids, drink hot tea for effect on lung tissues, use hydrocodone ½ tablet with or without a ½ tablet of promethazine to suppress cough if needed for sleep Version 1.5
  39. 39. 31 • Chapter 3 Response Over-the-counter (OTC) Medications 9• To prevent adverse reactions or to avoid extra Sore throat:medication that will have little or no effect, use anOTC remedy that treats only one symptom and/or Try cough drops or throat sprays. Dyclonine (forhas only one active ingredient. example Sucrets®) works best to numb the throat. Products containing honey, herbs or pectin soothe• If you are taking more than one medication at a the throat.time, check the labels to avoid taking the sameingredient twice. How to treat specific influenza symptoms• Try regular strength products before using extra in childrenstrength. Treat influenza symptoms in children with OTC• Follow instructions on the label. Note possible medications only if necessary. Based on recentside effects as well as the drug or health conditions information these medications may have seriouswhen the medication should not be used. risks in young children.• Check the expiration date on medications in your Muscle pain and fever:home. Take outdated medications to a pharmacy for Acetaminophen (i.e., Tylenol®) is best. You may trydisposal. Do not flush them or pour them down ibuprofen (for example, Motrin®) instead, but dosinks. not use it for babies less than four months old. Take• Keep all medications out of the reach of children. the child’s temperature before giving medication for fever. Do not wake a child to give the medication.How to treat specific influenza symptoms Children under 18 months should NOT takein adults acetylsalicylic acid (ASA), e.g., Aspirin® or any products containing ASA. Combined with influenza,Muscle pain and fever: ASA can cause Reye’s Syndrome, a very serious• Acetaminophen is the best choice for older condition affecting the nervous system and liver.adults (i.e., Tylenol®). Note that if you take Cough:acetaminophen for a long time or in high doses, itcan affect the liver and kidneys. Use a cough suppressant (DM) for a dry cough in children over two years of age, but only if the cough• Ibuprofen (i.e., Advil® or Motrin®)- Note: is disturbing the child’s sleep. Do not use DM for aibuprofen can irritate the stomach. moist cough or for children with asthma.Cough: Stuffy nose:Try a medication with Dextromethorphan(DM) Saline nose drops, such as Salinex®, may help afor a dry cough that prevents you from sleeping or stuffy nose and cough. You may use decongestantcauses chest discomfort. Delsym® and Benylin-Dry sprays for children older than six months. OtherCough® contain DM (without other ingredients). medications may require opinions from a healthcare provider.Stuffy nose: Sore throat:Use a decongestant. Nose drops or sprays actquickly and have fewer side effects than oral Cough drops or a warm salt water gargle maymedications. They should be used only for two to help children older than six years of age.three days to avoid rebound congestion. If stuffynose continues, consider an oral medication such as Other measures to reduce symptomspseudoephedrine. Decongestants may cause drymouth, sleep problems, rapid heartbeat, or other • Steam bath using a pot of hot water and a fewside effects. drops of eucalyptus oil to help clear congestion • Use of a humidifierPeople who have long-term health problems, orwho are on other medications, should not take • Warm salt water as a gargle for soothing soredecongestants until they talk to a healthcare throat.provider.
  40. 40. Chapter 3 Response • 32 The Importance of HydrationPeople with pandemic influenza are at high risk of Preventing dehydrationbecoming dehydrated, so maintaining adequateintake of liquids is a critically important function It is possible that potable (safe-to-drink) waterfor caregivers. supplies may be in short supply or not available in a disaster, so you may need to purify the water. Here’sSymptoms and signs of dehydration how:• Weakness• Headache Purifying water• Fainting You can purify water for drinking, cooking and• Dry mouth medical use with any of these methods:• Dry skin • Heat water to a rolling boil for one minute.• Thirst • Use water purification tablets.• Decreased alertness and change in consciousness • Add 8 drops of unscented liquid bleach per gallon• Decreased urine output of water (16 drops if the water is cloudy). Let the bleach/water solution stand for 30 minutes. Note• Dark-colored urine that if the solution does not smell or taste of bleach,• A rapid increase in heart rate upon rising to a add another 6 drops of bleach and let the solutionsitting or standing position stand for 15 minutes before using. Version 1.5
  41. 41. 33 • Chapter 3 Response Diet Recommendations7The clear liquid diet Step 1: Oral Rehydration Solution (ORS), water, fruit juice, Jell-O®, Gatorade® or PowerAid®, gingerA clear liquid diet is used to treat certain intestinal ale, Sprite®, tea.diseases, especially infectious diarrhea (a commonsymptom of influenza). Patients suffering from Step 2: Add white toast (plain), white rice, cream ofdiarrheal illnesses often experience abdominal wheat, soda crackers, and potatoes without the skin.cramping and frequent, loose stools if they eat solid Step 3: To Steps 1 and 2, add canned fruit andfoods. In addition, a great deal of water and minerals chicken noodle soup.(sodium, chloride and potassium) are lost in thewatery portion of the diarrheal stool. Step 4: To Steps 1-3, add poached eggs and baked chicken breast without skin, canned fish or meat.If you are not careful this can lead to dehydration. Step 5: To Steps 1–4, add milk and other dairyPatients with diarrhea have to drink much more products, margarine or butter, raw fruits andfluid than usual to prevent dehydration. This is vegetables and high-fiber whole grain products.especially important if the patient also has a fever;fever alone leads to increased loss of body waterthrough the skin as perspiration.Treating diarrheaIn most cases, patients with diarrhea can tolerate aclear liquid diet without cramping or more diarrhea.This is because the small intestine can absorb water,minerals and sugars fairly well even when infected.The diet starts off with clear liquids only. Assymptoms subside, simple-to-digest, low-residuefoods such as those described next are slowly addedone step at a time. Don’t advance to the next stepuntil the patient is completely symptom-free in thecurrent step. If the cramps and diarrhea return asthe patient progresses through each step, drop backto the previous step that they tolerated.This same Clear Liquid Diet approach is the one touse for patients who have been ill with the flu andhave been too ill to eat. They will have been on Step1 already to replenish fluids, so when they becomehungry, progress to Step 2 and advance themthrough the rest of the steps as described in the nextcolumn.Version 1.5

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