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  • NZ: Presentations made to Civil Defence

    I recently attended the launch of the Canterbury area pandemic plan. The plan is used in conjunction with the NZ plan which includes on going pandemic education of public, early school closure, at least 1.2 million courses of Tamiflu (pop. 4 million).

    Presentations were made by people who helped the plan designed and will be running the show during the event.

    Presentations made to Civil Defence teams in Canterbury area



    First Presentation.


    Began presentation with this line The take home message is a pandemic is imminent


    The plan makes extensive use of the historical 1918 information
    -Lower mortality is associated with easier transmission (WHO).
    -2% CFR
    -Attack rate 40%
    -CFR of pregnant woman 23-71% -Summary of 13 studies.
    -Lancet paper mentioned. 140 deaths with 40% mortality in Nov 1916 ( http://www.flutrackers.com/forum/showthread.php?t=8602)


    Disadvantages to this.
    -viral pneumonia
    -Government dependence
    -Anti viral resistance
    -Loss of neighbourhood support (due to fast moving population)


    Implications for New Zealand.
    -40% attack rate, 2% mortality = 32,000 deaths. (NZ pop is 4 million).


    Implications for Canterbury
    -Peak for Canterbury will be in week 5 (based on seasonal flu figures).
    -Will last 2-3 months
    -Essential services are not expected to be affected. Exception is the internet where congestion is expected, mostly due to people down loading movies.
    -Hospital beds 500
    -Population 400,000


    Health Service Workers
    -Mainly woman
    -Working population will be affected. Over 40's relatively ok


    Graph
    New infections against time for St. Louie (1918), Australia (1918).
    St. Louie implemented early NPI
    Australia closed borders and kept flu out for quite some time.


    Principle Pandemic Responses
    -6 cases is all services can handle
    -Believed main working population will be vulnerable (theory is that in this age group the ability to respire is greatest and so virus goes deeper)
    -Benefit of doubt will not be given at airport. Whole plane load will be quarantined.
    -Hotels have been identified for quarantine.
    -Temperature checking was used to screen for SARS. Will not be used in a pandemic.
    -Migrating birds are not considered a major risk to NZ.
    -What happens to patients who can't get in the hospital (he went quiet for a moment). Special hotels are being identified, still working on this.


    Break for light supper
    Viewed the pandemic road show. http://www.flutrackers.com/forum/showthread.php?t=24448




    Second Presentation.


    Mission: To avoid the worst by flattening the curve.


    -Planning has to happen before the event


    -In SARS more people died because of lack of access to healthcare than of SARS


    -Compared Canada with Singapore regarding SARS


    -For most cases surgical masks recommended due to risk of contamination from persons own mask (surgical mask is easier to take off). (Singapore SARS experience mentioned)


    CBAC Community Based Assessment Centres

    (the plan is to keep flu patients separate from regular patients)

    Levels:
    -self triage (at home)
    -phone triage
    -CBAC triage and treatment (in car park if possible or at door). People will be given their tamiflu and sent home.
    -CBAC assessment. Doctor will only see those with complications e.g. viral pneumonia


    Health Staff Availability
    30% unavailable: ill, unwilling to work, at home with children.
    20% in green stream
    10% in management
    20% waiting for peak, manning the phones
    20% in red stream

    Plan is to flatten curve from 60,000 cases to 30,000 cases. Less than 1% in hospital, 20% in holding, 80% home


    Admission criteria
    Staff availability is biggest criteria

    Group1. Those who are too sick will be sent home
    Group 2. Those who are sick enough will get in to hospital (or held in holding area)
    Group 3. Those who are not sick enough will be sent home


    At the peak of the pandemic the majority of people will be in group 1 and 3. Where do they go? They go home.

    CBAC Community Based Assessment Centres

    The first one to open will be near hospital.
    The first one open will also be the last one closed.
    Total of 7 CBAC planned. 6 in a ring around the city.
    Geographical location has greater importance than available facilities at the centre.

    Decentralised local response.

    Police expect domestic violence to be biggest problem. That and bored teenagers (joke made about handing out movies and condoms)


    Supermarkets are not going to run out of food. They are involved and have designed food parcels.

    The dying will be more of a problem than the dead

    Rural areas
    Centralise medical resources
    Community Treatment Centre (CTC)
    Give tamiflu and send home
    Holding area is for locals only.



    What Do You Need To Do

    Engage the community


    Connect with community leaders. (Information available to help with this.)


    What ever fear you have, get over it now

  • #2
    Re: NZ: Presentations made to Civil Defence

    WHY they are SO SURE TO BASE ALL on something far 90 years ago, and in a whole different world environment?

    "The plan makes extensive use of the historical 1918 information
    -2% CFR"

    "-Lower mortality is associated with easier transmission (WHO)."

    MAYBE, WHO did not proved that, this is only a speculation of an future event we don't know how it will be.

    Comment


    • #3
      Re: The Good, The Bad and The Realistic.

      I recently attended the launch of the Canterbury area pandemic plan. The plan is used in conjunction with the NZ plan which includes on going pandemic education of public, early school closure, at least 1.2 million courses of Tamiflu (pop. 4 million).
      Assuming that a pandemic virus does not become Tamiflu resistant, enough antivirals for 25% of the local population is impressive. Of course, we don't know if this is at the now recommended "double" dose per individual.

      One could argue that the 2% CFR rate is underestimated by a factor of 10 to 40X. In any case, the fact that Canterbury has had meetings and has a plan puts them way ahead of the curve on pandemic planning issues compared to other communities.
      http://novel-infectious-diseases.blogspot.com/

      Comment


      • #4
        Re: The Good, The Bad and The Realistic.

        "One could argue that the 2% CFR rate is underestimated by a factor of 10 to 40X."

        Well said.

        Maybe we can suggest at WHO that the plans implement an 0,2% CFR, like for seasonal flu, and than nothing will be necessary to prepare ...

        An balanced aproach must consider an supposed middle value CFR:
        (minCFR=2% + maxCFR~60% or more) / 2 = 62% / 2 =
        31% CFR for pandemic planing

        Comment


        • #5
          Re: The Good, The Bad and The Realistic.

          One of the features of this plan is it's flexibility. The same plan would be used for 50% as for 2%.

          Comment


          • #6
            Re: The Good, The Bad and The Realistic.

            Originally posted by AnneZ View Post
            ... The same plan would be used for 50% as for 2%.
            Thanks for NZ, and it's trying to prepare something.

            No doubt that the values of the plan input variables can be changed, but: does the plan variables (we didn't see them) be part of an probability math. model which give an detailed material result what quantity of what meds, goods, etc., must be stocked now for an 31% pandemic?

            The problem of CFR remains:
            why the citizens training for an "Good" 2% CFR,
            and not for an "Realistic" 31% CFR?
            An 31% CFR is so much psic. scarry, and have no real saving possibilities for the citizens, or is a matter of "not training for something so unbelievable to happen?

            In some FT post, when reading the elements of an plan on the web, seems that it create only the guidelines for, not the detailed horizontal implementation, which must be done apart.

            Any way, a good thing for starting.

            A good part of the plan for flu diagnostics/treat. is that:

            CBAC Community Based Assessment Centres

            (the plan is to keep flu patients separate from regular patients)

            Levels:
            -self triage (at home) - self-testers for all citizens an add. "must"
            -phone triage
            -CBAC triage and treatment (in car park if possible or at door). People will be given their tamiflu and sent home.
            -CBAC assessment. Doctor will only see those with complications e.g. viral pneumonia

            Comment


            • #7
              Re: The Good, The Bad and The Realistic.

              No doubt that the values of the plan input variables can be changed, but: does the plan variables (we didn't see them) be part of an probability math. model which give an detailed material result what quantity of what meds, goods, etc., must be stocked now for an 31% pandemic?
              Does the quantity of goods stocked need to change if CFR is higher?

              Comment


              • #8
                Re: The Good, The Bad and The Realistic.

                "Does the quantity of goods stocked need to change if CFR is higher?"

                Yes, the needed quantity value droped...

                The meaning was (", etc.") that the whole society will have a whole diferent organisation of work, sheltering, care, etc..., and a much more need for masks, meds, vents, etc - in the begining (if the goal is to try preserve lives) - to cope with such an surge of cases!
                For 15times minor mortality, it's obvious the country medical, and other systems, will probably work enaugh "good", and the drills will be "a peace of cake".
                Try the same with an 30% CFR.

                Comment


                • #9
                  Re: The Good, The Bad and The Realistic.

                  Originally posted by Laidback Al View Post
                  Assuming that a pandemic virus does not become Tamiflu resistant, enough antivirals for 25% of the local population is impressive. Of course, we don't know if this is at the now recommended "double" dose per individual.
                  I believe the numbers are for single courses.

                  Comment


                  • #10
                    Re: The Good, The Bad and The Realistic.

                    Originally posted by tropical View Post
                    The meaning was (", etc.") that the whole society will have a whole diferent organisation of work, sheltering, care, etc...,
                    Early school closure, telecommuting are planned.

                    Self triage, phone triage, CBAC, home care is a different system of care.

                    Originally posted by tropical View Post
                    and a much more need for masks, meds, vents, etc - in the begining (if the goal is to try preserve lives) - to cope with such an surge of cases!
                    " Staff availability is biggest criteria" for hospital admissions

                    Comment


                    • #11
                      Re: The Good, The Bad and The Realistic.

                      telecommuting
                      Maybe I'am the "bad" (eq. pesimist), but I doubt that will be much sense to "telecommute" if it will be CFR 30%. Things will go "rural" very fast.
                      The "telecommuting" will remain for the mil. and government functions.

                      "Staff availability is biggest criteria" for hospital admissions
                      I know it is, the "you are on your own policy"

                      Comment


                      • #12
                        Re: NZ: Presentations made to Civil Defence

                        What Do You Need To Do

                        Engage the community


                        Connect with community leaders. (Information available to help with this.)

                        Comment

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