Flu Pandemic Preparedness
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PUBLIC-PRIVATE PARTNERSHIP QUESTIONS 2. What are the likely elements of a local-level response to a pandemic influenza? 3. What are the various levels of escalating federal response stages and actions? 5. How will the various levels of federal, state and local governments coordinate their actions? 10. What are the government's plans for monitoring industry progress and sharing key information? 11. How do we monitor the progress of industry/government preparedness? 12. What is the government's advice on a number of the most challenging issues for our industry? 1. What is the government's role in preparing for, responding to and recovering from a pandemic and how does/should it affect the private sector's planning activities? On November 1, 2005, The U.S. Federal Government issued its National Strategy for Pandemic Influenza aimed at guiding national preparedness for and response to an influenza pandemic. Specific elements of this plan are still evolving — see the Federal Government's one-stop website for pandemic flu information. The Federal Government describes its role as:
The private sector's pandemic flu planning activities will be most effective to the extent these take into account - and are coordinated with - national, state, and local government planning and preparation, and with the actions, etc[TU2]., governments (at all levels) will expect of the private sector. For instance, in this regard number 5, above, includes government outreach to our industry through The Real Estate Roundtable and other real estate associations. Business-related planning assistance is available through:
Guidance aimed more specifically at the "commercial facility sector" which includes office buildings, shopping centers, apartment buildings and hotels is under development by DHS. 2. What are the likely elements of a local-level response to a pandemic influenza? In the event of a pandemic, certain "non-pharmaceutical" and "pharmaceutical" public health measures, such as cancellation of large public gatherings and treatment of the ill with antiviral medications, will be important for containing or limiting the spread of infection to the extent possible. Interim planning guidance for appropriate pandemic mitigation measures is set out in the Centers for Disease Control and Prevention's "Interim Pre-pandemic Planning Guidance:Community Strategy for Pandemic Influenza Mitigation in the United States." This planning document introduces a "Pandemic Severity Index (PSI), "a scale based upon the proportion of deaths among critically ill persons during a pandemic, used to categorize the severity of the pandemic. Specific mitigation interventions are matched to their respective PSI levels, and as discussed in the CDC "Community Strategy" document include: Isolation and treatment (as appropriate) with influenza antiviral medications of all persons with confirmed or probable pandemic influenza. Voluntary home quarantine of members of households with confirmed or probably influenza case(s) and consideration of combining this intervention with prophylactic use of antiviral medications (where available). Use of social distancing measures to reduce contact between adults in the community and workplace, including, for example, alteration of work environments and schedules to decrease social density and preserve a healthy workplace to the greatest extent possible without disrupting essential services. Use of the above community-based strategies in combination with individual infection control measures, e.g., hand washing and cough etiquette. 3. What are the various levels of escalating federal response stages and actions? The federal government has coordinated its own stages of potential action to the World Health Organization (WHO) alert system. That system has six phases, with Phase 1 having the lowest risk of human cases and Phase 6 posing the greatest risk of pandemic. The world is currently (as of 2/07) in Phase 3 of the WHO Pandemic Alert system. This means that there is a new influenza virus subtype causing disease in humans, but is not yet spreading in an efficient (easily transmittable) and sustainable manner among humans.
As previously noted, the Federal Government has recently developed a set of pandemic response categories, its "Pandemic Severity Index," relative to the severity of the outbreak (see figure below).
Intervention strategies are listed as "Recommend" and "Generally not recommended" according to the pandemic severity category, with additional suggested implementation details (e.g., suggested duration of a given measure) also provided.
The Occupational Safety and Health Administration's "Guidance on Preparing Workplaces for Influenza Pandemic" sets up a classification scheme for different types of occupations. High volume retail[TU5] is part of the High-risk category while office workers are listed in the Low risk category. Recommendations for employee protection are presented for these and each of the four levels of anticipated risk and include engineering controls, work practices and use of personal protective equipment such as respirators and surgical masks and their relative value in protecting employees. Occupational Risk Pyramid for Pandemic Influenza
Very High Exposure Risk:
Medium Exposure Risk:
Lower Exposure Risk (Caution):
4. How do I find information on what the various government entities will do and what to expect at each level? The CDC Community Mitigation Guidance (which includes the charts above) is a good source of information regarding what various government entities are expected to do at these levels. It will also be important review your local and health state department websites and pandemic plans (accessible at: http[TU6]://www.pandemicflu.gov/whereyoulive/index.html) as local governments exercise an important degree of discretion in design and implementation of local pandemic flu strategies and responses. As always the U.S. Government's one-stop avian and pandemic flu website, managed by the Department of Health and Human Services (HHS), is a key source of comprehensive, up-to-date information. 5. How will the various levels of federal, state and local governments coordinate their actions? To help coordinate planning, the U.S. Department of Health and Human Services and other federal agencies are holding pandemic planning summits with public health, emergency management, and response leaders in each state. HHS has also prepared a State & Local Planning Checklist, and will work with states to design exercises to evaluate preparedness. As this process evolves there will be more information on how the coordination process will occur during an actual pandemic. As previously noted, the website has online access to all state plans. 6. How can the government help the real estate industry to build more awareness within the different sectors? How has the government helped raise awareness in other industries? Local governments are (to varying degrees) already providing some public awareness guidance on personal, family and business emergency preparedness strategies, although not very much on flu specifically. While there is a public awareness video on pandemicflu.gov, there doesn't seem to be a visible public awareness campaign emanating from HHS. DHS's Infrastructure Protection division and HHS public-private partnership coordinator are reaching out to the chamber of commerce and have participated in Real Estate Roundtable and other industry meetings. DHS has produced a "Critical Infrastructure Guide" to pandemic flu preparedness and is working to test HHS and DHS planning tools through exercises and "best practices" sessions with industry. 7. How might the government prioritize the allocation and distribution of medical and non-medical countermeasures in the event of a pandemic affecting the real estate industry? How the government may prioritize allocation of medical measures is likely to be highly influenced by a recent report of a Presidential working group developed in significant measure by DHS consultants called "Prioritization of Critical Infrastructure for a Pandemic Flu Outbreak in the U.S." The working group, is part of the Presidential task force known as the National Infrastructure Advisory Council (NIAC). It focuses on determining (via a survey of various "critical sectors") what parts of industry should be prioritized for distribution of "pandemic countermeasures" such as pharmaceuticals for "essential workers" in the event of a pandemic. Most sectors surveyed as part of the NIAC working group report identified electricity, followed by telecommunications, fuel, transportation and water as priorities in terms of the goods and services provided. Commercial facilities (of which commercial real estate, hospitality and retail are components) are ranked at the bottom of "critical sectors." Notably, the largest number of "critical employees" came from the health care, information technology, emergency services and financial services sectors. There is a detailed discussion of the "Commercial Sector" including real estate industry personnel, on pages 62-71 of the report. In this section, the report notes that in the commercial facility sector, senior key leadership and administrative personnel will of course, be "critical" but other than that small number of employees, the building engineering staff may be the most difficult to replace. This is because they are highly trained and licensed. "In addition, without adequate environmental conditions, most real estate facilities would be uninhabitable or, at a minimum, ineffective for their intended or emergency purpose." In discussing the Lodging sub-sector, the NIAC come to a similar conclusion. While noting that under normal circumstances, "management, administration, food and beverage, engineering, grounds maintenance, loss prevention (security), and housekeeping" are critical, the engineering group may be the most difficult to rapidly substitute for as they possess the additional technical training and licensure required to maintain the complex systems ensure electrical, HVAC, water, communications, and other infrastructure remain functional. Depending on the season and location, ensuring necessities such as effective heating or air conditioning can be critical to occupy a lodging facility. With respect to retail real estate, the report notes that "with more than 1.6 million U.S. retail establishments employing more than 24 million employees-nearly one in five American workers-the Commercial retail sub-sector is the largest CI/KR sector employer in the United States." Among the key retail operations cited by the report are "Food and beverage retailers (e.g., grocery and restaurant)" "fuel retailers (e.g., gasoline stations) and "pharmacies and drug stores." It then goes on to note that "while there are many different types of retail establishments still to consider (e.g. automotive, sporting goods, furniture and jewelry), arguably most of these operations could, and perhaps should, for the safety of their workers and customers be carefully managed for infection control and social distancing measures, and expect substantially curtailed operations during a pandemic wave. Curtailing or closing many non-essential retail operations may as well be in the national interest to reduce morbidity and mortality from the pandemic; however, the effects on the national economy and social stability from lost retail revenues, worker wages, and other impacts may prove nearly as devastating to the nation. 8. What are some of the best sources to help real estate industries prepare for their response to and recovery from a pandemic?
9. What lessons were learned from SARS and past influenza pandemics and what is the relevance to future potential pandemics? According to the CDC many of the specific recommendations with respect to pandemic flu are similar, if not the same as those required to combat other infectious diseases, such as Severe Acute Respiratory Syndrome (SARS). They point to their Public Health Guidance for Community-Level Preparedness and Response to SARS. In advising local governments on the "Legal Authority for Isolation and Quarantine" the CDC advises authorities to consult the CDC document on that topic prepared for the SARS outbreak. The Public Health Agency, Canada, summarizes key points on coordination, communication and information sharing more broadly in a recent presentation (PowerPoint (tm)) "Information Sharing, then and now Lessons Learned from SARS." A City of Philadelphia planner noted at the Roundtable Working Group meeting that key lessons learned included the fact that early recognition of cases and infection control measures are critical to pandemic mitigation. He also felt it pointed up that hand washing, respiratory etiquette and early involvement of local health authorities were critical. a.) What were the voids in planning for SARS that should be taken into account in our pandemic planning? According to a City of Philadelphia health official at our first Working Group Meeting, SARS was an emerging pathogen meaning it was a new disease — therefore no one understood the virology, pathology, transmissibility, incubation period, longevity of survival in the environment, efficacy of medications. Also, there was a lack of vaccine as it emerged. Therefore, there was a long period of investigation that occurred to understand these parameters and make correct mitigation recommendations. Infection control and hand washing is still the cornerstone of control. 10. What are the government's plans for monitoring industry progress and sharing key information? A Philadelphia heath official noted that local government has prioritized industries based on criticality of survival. Communication of key information will be via web updates, public forum presentations, & press releases. [Federal government response under development] 11. How do we monitor the progress of industry/government preparedness? Websites, government partners, communications. 12. What is the government's advice on a number of the most challenging issues for our industry?
The question of pathogen transmission by HVAC systems is addressed in some detail on the Pandemicflu.gov website. While it is important to review the entire section and the context of the discussion, the report concludes: "While some observational studies (1, 2) and animal studies (3, 4, 5) raise the possibility of short-range airborne transmission through small-particle aerosols, convincing evidence of airborne transmission of influenza viruses from person to person over long distances (e.g., through air-handling systems, or beyond a single room) has not been demonstrated. (6, 7, 8). ..... Special air handling and ventilation are not required to prevent droplet transmission"
In its "Guidance on Preparing Workplaces for an Influenza Pandemic," OSHA briefly discusses maintaining business operations during a pandemic, suggesting review of sick leave policies, cross-training and other approaches to assure key business functions are covered, and consideration of policies allowing employees to work from home, among other approaches. Further, the "Business Checklist" provides useful tools to consider human resource policies in other similar areas.
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