California - Pandemic Preparedness

[Lyro]

California - Pandemic Preparedness

NEW BIRD FLU PLAN RATIFIED
Plan Favors Those Most Vulnerable
September 9, 2006 (Foxreno News)

San Francisco, Calif. -- California health officials have settled on a formula for resolving a wrenching question that would arise if a bird flu pandemic strikes the state: who gets doses of scarce vaccine?



The complex process for deciding who would receive bird flu shots is contained in the state's Pandemic Emergency Preparedness and Response Plan. State officials completed a new version of the plan last week.

The state did not draw up a hierarchy of Californians who would most need inoculation, though it hints at groups most vulnerable.

"Very young persons, elderly adults, and persons with underlying disease are at high risk of complications during interpandemic influenza outbreaks," it stated.

Instead of setting out a list of likely candidates, the state developed a scoring system that the report said, "produces a rank-ordered list of target groups prioritized for influenza vaccination."

The formula is designed to be flexible enough to accommodate variables in a pandemic.

The system considers rationing strategies designed to minimize illness, social disruption and economic losses. The strategies emphasizes people who perform essential emergency services and those especially vulnerable to disease

The state's formula represents a new attempt to grapple with the subject of a fierce debate over who should be inoculated in a worst-case scenario.

Vaccine factory employees and front-line health workers head the Bush administration's own list, but there is no consensus on who would get vaccinated next. Should it be school-age children who are flu's prime spreaders? Would it be the frail elderly who may be at highest risk of death? Or would it be police, firefighters and utility workers who would have to keep order and essential services running?

Congress allocated $3.8 billion last year with the goal of being able to distribute vaccines to every American within six months of a pandemic striking. The Bush administration leaves it up to states to determine how to distribute the vaccines.

While several pharmaceutical companies are conducting clinical trials, no vaccine currently exists. It would take time for researchers to develop a highly effective vaccine after they identified a lethal bird flu strain.

"It becomes a high-stakes process to the extent there's a shortage of vaccine, and early on, that's certainly likely to be the case," said Dr. Mark Horton, the state public health officer and chief deputy director in the California Department of Health Services.

The state plan envisions beginning vaccinations when a pandemic reaches the World Health Organization's "Phase 6" -- the most severe stage in a pandemic. At that stage, "sustained" human-to-human spread of the disease is occurring.

The virus has not mutated into a form easily spread among people. But the deadly Asian strain of bird flu has ravaged poultry and killed at least 141 people worldwide.

California, the nation's most populous state, is uniquely vulnerable the virus arriving via birds or people. In addition to having a citizenry with ties to Asia, where the disease has hit hardest, California has a $2.5 billion poultry industry, and millions of birds migrate along its flyways.

State Fish and Game authorities spent the past few weeks trying to catch some of those migrating birds, with limited success. They have been focusing especially on pintails, a type of duck with an exceptionally wide range of migration, said agency spokesman Patrick Foy.

Pintails fly all the way to Alaska and Siberia, where their flyways can intersect with those of birds that have traveled through Asia, Foy said.

Source: www.foxreno.com/news/9815176/detail.html

[Alex]

California - Pandemic Preparedness

State formula determines who gets shot during bird flu pandemic
SCOTT LINDLAW, Associated Press
September 9, 2006

SAN FRANCISCO - California health officials have settled on a formula for resolving a wrenching question that would arise if a bird flu pandemic strikes the state: who gets doses of scarce vaccine?

The complex process for picking who would receive bird flu shots is contained in the state's Pandemic Emergency Preparedness and Response Plan. State officials completed a new version of the plan last week, and a copy was obtained late Friday by The Associated Press.

The state did not draw up a hierarchy of Californians who would most need inoculation, though it hints at groups most vulnerable. "Very young persons, elderly adults, and persons with underlying disease are at high risk of complications during interpandemic influenza outbreaks," it states.

Instead of setting out a list of likely candidates, the state developed a scoring system that the report says "produces a rank-ordered list of target groups prioritized for influenza vaccination." The formula is designed to be flexible enough to accommodate variables in a pandemic.

The system considers:
_ The goals of a vaccination program, such as minimizing illness, social disruption and economic losses.

_ Rationing strategies, such as emphasizing people who perform essential emergency-services roles or who are especially vulnerable to disease.

_ Precise criteria for determining who qualifies as a member of those critical or vulnerable groups.

The state's formula represents a new attempt to grapple with the subject of a fierce debate over who should be inoculated in a worst-case scenario.

Vaccine factory employees and front-line health workers head the Bush administration's own list, but there is no consensus on who would get vaccinated next. Should it be school-age children who are flu's prime spreaders? The frail elderly who may be at highest risk of death? Police, firefighters, utility workers who would have to keep order and essential services running?

Congress allocated $3.8 billion last year with the goal of being able to distribute vaccine to every American within six months of a pandemic striking. The Bush administration leaves it up to states to determine how to distribute the vaccines.

While several pharmaceutical companies are conducting clinical trials, no vaccine currently exists. It would take time for researchers to develop a highly effective vaccine after they identified a lethal bird flu strain.

"It becomes a high-stakes process to the extent there's a shortage of vaccine, and early on, that's certainly likely to be the case," said Dr. Mark Horton, the state public health officer and chief deputy director in the California Department of Health Services.

The state plan envisions beginning vaccinations when a pandemic reaches the World Health Organization's "Phase 6" - the most severe stage in a pandemic. At that stage, "sustained" human-to-human spread of the disease is occurring.

Currently, the virus has not mutated into a form easily spread among people. But the deadly Asian strain of bird flu has ravaged poultry and killed at least 141 people worldwide.

The state released a draft bird-flu response plan in January. For nearly nine months, it worked on improvements. But the version released this month contained only "relatively minor, technical" changes, Horton said.

However, it is sure to evolve in the coming months and years. For instance, Horton said, it currently has no specific guidance on another potentially grisly issue - what to do with a large number of dead bodies.

California, the nation's most populous state, is uniquely vulnerable the virus arriving via birds or people. In addition to having a citizenry with ties to Asia, where the disease has hit hardest, California has a $2.5 billion poultry industry, and millions of birds migrate along its flyways.

State Fish and Game authorities have spent the past few weeks trying to catch some of those migrating birds, with limited success. They have been focusing especially on pintails, a type of duck with an exceptionally wide range of migration, said agency spokesman Patrick Foy.

Pintails fly all the way to Alaska and Siberia, where their flyways can intersect with those of birds that have traveled through Asia, Foy said.

On the Net
Pandemic Emergency Preparedness and Response Plan:
www.dhs.ca.gov/ps/dcdc/dcdcindex.htm

Source

[Lyro]

California - Pandemic Preparedness

DISASTER PLAN AIMS TO KEEP PEOPLE IN CARS
EAST VALLEY: Vaccine shots in drive-throughs would be safer and faster, according to a task force
By Naomi Kresge (The Press-Enterprise)
September 1, 2006

The drive-through flu vaccination sites being planned for the East Valley would be used for pandemic flu, not seasonal flu. Here's the difference:

Seasonal, or common, flu: A
respiratory illness that can spread from person to person. Most people have some immunity, and health officials recommend that seniors and children be vaccinated before the winter months.

Pandemic flu: Virulent flu that causes a widespread outbreak of serious illness. Humans have little natural immunity, so the disease can spread easily. Pandemic flu is not the same as avian flu, which is deadly to domestic birds and can spread from birds to humans. No vaccine is available for avian flu.

Source: U.S. Department of Health and Human Services, www.pandemicflu.gov

East Valley disaster-planning officials are working on a new way to provide a vaccine to residents in the event of a widespread flu outbreak.

Instead of having residents of Redlands, Highland, Loma Linda and Yucaipa congregate in school gymnasiums, convention centers or fairgrounds to get a vaccine, as other local jurisdictions may do, they're pushing for drive-through vaccine facilities.

Residents will pull in, get directions at one station, give their health information at a second station and stick an arm out the window for a shot at the third.

The goal is to prevent disease from spreading as people wait in line for a shot, officials said.

"That way we keep people in their cars, we keep people from talking to one another -- they just come in, get their shots and go home," said Redlands Fire Department Battalion Chief Mitch McKee, who oversees disaster preparedness for the city.

McKee is a member of San Bernardino County's Community Readiness Initiative Task Force. The group has been working for the past six months to compile a list of "points of dispensation," or pods, for flu vaccine in the event of a pandemic or epidemic, said Dr. Eric Frykman, county health officer.

The last flu pandemic was in 1968, according to the U.S. Department of Human Services. The world also experienced flu pandemics in 1918 and 1957.

The Community Readiness Initiative is funded with $600,000 in federal disaster preparedness money. Frykman said the goal is to be capable of dispensing vaccines or other medicines throughout the county within two days. The system could be used any time local public health officials need to dispense a treatment on a large scale, he said, including in bio-terrorism incidents.

"Historically, we haven't been able to do this very well," Frykman said. "The geography of the county is a barrier."

So far, Frykman said, the East Valley cities are the only place in San Bernardino County planning for drive-through vaccination sites.

"They're ahead of most other parts of the county in thinking about this," Frykman said.

McKee said Redlands has identified four primary drive-through vaccination sites and four secondary sites as backup. Loma Linda has identified three sites, he said.

Because Redlands Community Hospital has used drive-through vaccine clinics for seasonal flu shots, McKee said, members of the city-sponsored Redlands Disaster Council were familiar with that strategy. Corona Regional Medical Center also has used drive-through flu clinics.

"If we're really dealing with a pandemic and people are presenting some signs of illness, at least we can keep it contained in the vehicle," said Brenda Brennan, an emergency room nurse and Redlands Disaster Council volunteer for the past three years.

McKee said the Redlands sites haven't been finalized yet, but they most likely will be on major streets to allow officials to coordinate the flow of traffic more easily. Officials hope to have the capacity to inoculate 750 people an hour.

Officials want to identify areas where many residents don't have cars, McKee said, so alternate plans may be made for them. Nurses could travel to locations like retirement homes, he said. A public education program would target lower-income neighborhoods where residents might have more difficulty finding transportation to the drive-in clinic.

Source: www.pe.com/localnews/inland/stories/PE_News_Local_B_bflu02.3db160a.html

[Lyro]

California - Pandemic Preparedness

JUST IN CASE, COUNTY PREPS FOR AVIAN FLU
Public, private agencies partnering
By Nikki Cobb, Staff Writer (San Bernardino Sun)

Avian flu, which has struck more than 340 people in Asia, killing about 141, has yet to appear in California. But that doesn't mean state and local officials aren't hard at work preparing for it.

Many experts predict that if a worldwide influenza were to hit the U.S., it would first be seen in California. The state is uniquely situated to be the first hit by the virus: It borders Mexico, has trans-Pacific trade at its ports and airports, and is on the Pacific flyway used by migrating birds.

Any or all of those factors could make California an entry point for the H5N1 flu strain.

San Bernardino County officials say they're preparing now.

"We are planning for the potential and how it would impact everyone in the county," said Natalie Kessee, county program coordinator for preparedness and response. "We're planning what we as a department need to do."

The H5N1 strain of influenza is just one of the possible scourges that could lead to a pandemic, officials said. But by preparing for it, the state will become better equipped to deal with any natural or man-made disaster. officials said.

Avian flu is, as yet, largely a disease of birds, both wild and domestic. Its spread to humans has been spotty, but experts fear it could mutate into a form that could be transmitted human-to-human.

Kessee said the county has received $175,338 from the state Department of Health Services and expects additional funds to help prepare for a potential flu pandemic. Preparations have been under way for months.

Kessee said the county is working with private and public agencies to buy ventilators, respirators and sundries like sanitizers, gloves and masks.

They're also checking on how to best ensure that the county has supplies of a flu vaccine, such as Tamiflu, in the event of a pandemic. That's difficult to plan for, Kessee said, because such medicines have a limited shelf life.

And if supplies of a viral prophylactic are limited, the county will look to the national Centers for Disease Control and Prevention and the state to determine who gets inoculated. Likely, first responders such as medical professionals would be the priority, Kessee said.

The county will hire four or five more people devoted to emergency response in a pandemic, Kessee said.

Scott Smith, a registered nurse in the emergency room at Arrowhead Regional Medical Center in Colton and disaster coordinator for the hospital, said the county hospital holds regular drills to prepare for a pandemic disaster.

The hospital keeps caches of medications appropriate for a flu outbreak, Smith said. Also, there are plans to make room - in the hospital's clinics, conference rooms or in other community facilities - to accommodate hundreds more patients.

"We're hoping this never occurs," Smith said. "But we're doing drills much more frequently than in the past."

Kessee said partnerships between public agencies and private businesses is a main focus of county efforts, and noted that it would be dangerous to rely on a large-scale national effort to protect county residents.

"The event would affect the county in multiple agencies," she said. "It's beyond something public health would handle alone."

Dr. Mark Horton, state public health officer, said at a news conference Thursday that health experts worldwide are worried about avian flu. As many as one-third of the state's population could become ill if the virus hit California, he said.

"An influenza pandemic knows no borders," Horton said. "It would disrupt the health care system, the economy - all facets of life."

Officials from the Governor's Office unveiled a plan to work with the 10 states along the U.S.-Mexico border - four in the U.S. and six in Mexico - to study the threat of a pandemic and make plans.

"The governor wants to strengthen our safety at customs, border patrol and so on," said A.G. Kawamura, secretary of the California Department of Food and Agriculture.

"Smuggled birds could also pose a threat," Kawamura said. "The international movement of people, goods and services has increased our vulnerability."

The governor's plan calls for stronger border security, improving public health monitoring, increased international cooperation in both surveillance and response to the virus, and outreach to poultry owners.

Sandra Shewry, director of the California Department of Health Services, said that in creating a binational council the state is improving an already-strong network of surveillance and response.

"The council will strengthen California's already robust response," Shewry said. "It will also strengthen our ability to react to natural or man-made disasters."

Source: www.sbsun.com/news/ci_4244069

[Lyro]

California - Pandemic Preparedness

U.S. BORDER STATES PREPARING FOR PANDEMIC FLU THREAT
Editor: Mu Xuequan
August 25, 2006 (Chinaview.cn, source: Xinhua)

Los Angeles -- California and Arizona, two states bordering Mexico, are working together to address the emerging threat of an influenza pandemic.


Photo: Governor Arnold Schwarzenegger. Source

CA Governor Arnold Schwarzenegger and Arizona Governor Janet Napolitano have co-sponsored a joint declaration at the on-going 24th annual Border Governors Conference to establish a border state council to coordinate regional response and preparedness. The council will focus on both preparedness and response.

Source: http://news.xinhuanet.com/english/20...nt_5003830.htm

[ruthbeme]

State spends millions on flu medicine

State spends millions on flu medicine
Caliofrnia is one of only 13 states in the nation to order the antivirals

Gina Faridniya
Special to The Desert Sun
<!--PUBLICATION DATE--><SCRIPT language=JavaScript type=text/javascript><!--var GetURL = location.search;var CheckDateURL = GetURL.substr(6,8);if(CheckDateURL!=99999999) {document.write("August 7, 2006");}//--></SCRIPT>August 7, 2006

If 25 percent of California's population became infected during a flu pandemic, the state would want every person to be treated. That's the rationale behind California's decision to spend $53 million on anti-flu medication.

The federal government will partially subsidize the cost of the antivirals that states purchase. To date, California is one of only 13 states to order the medications.
Through a combination of state purchases and federal stockpiling, California will have access to enough antivirals to treat 25 percent of its population - the number of people anticipated to become infected in a pandemic, said Betsey Lyman, deputy director of Public Health Emergency Preparedness for the California Department of Health Services.
California will spend $53 million for 3.7 million doses at the 25 percent federal discount. Each dose treats one person. The state also has another 68,000 doses at the full price of $1.5 million.
The total will ensure that 10 percent of Californians have access to antivirals. The state is also entitled to more than 5 million doses in the national stockpile, paid for by the federal government. Combined, the state will have enough antivirals to treat roughly 25 percent of its population during a pandemic.
Public health experts worldwide are concerned that a strain of bird flu, or some other flu for which no vaccine exists, could soon emerge. The outbreak could lead to a pandemic infecting hundreds of thousands of people and ravage the global economy.
But not everyone agrees that an antiviral created today would work in the future. Some states turned down the federal government's discounted antivirals because of fears the virus would mutate, making today's treatments ineffective.
The antivirals used to treat the symptoms of influenza include Tamiflu and Relenza, although government stockpiles will contain mostly Tamiflu. Both antivirals have a five-year shelf life, say representatives for the drugs' manufacturers, Roche and GlaxoSmithKline. A possible pandemic
The nature of the influenza virus is irregular and volatile. The bird flu virus, known as H5N1, is deadly in birds, but rarely infects humans and does not easily spread from person to person. But its ability to change may create a subtype that could harm humans. With little or no immune protection in the human population, an influenza pandemic could result.
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Tamiflu and Relenza reduce influenza symptoms and lower the risk of transmission. But there is no vaccine that protects humans against the bird flu virus. The changeability of the virus may also reduce the effectiveness of the antivirals.
Arizona and Colorado are two states that didn't invest in the antivirals offered by the government for fear they may not work.
Even a vaccine may not prevent a pandemic that would require the H5N1 virus to evolve into a highly contagious form. That new form may not be sensitive to a vaccine created for the current virus.
"A pandemic requires a totally naive or susceptible population," said Kim Saruwatari, chief of bioterrorism preparedness and response in Riverside County.
Until this virus is introduced to the population, a vaccine cannot be created.
During a flu pandemic, state antiviral supplies, like the one California is stockpiling, will quickly deplete. The Department of Health and Human Services will then forward Tamiflu and Relenza from the national stockpile to local storage sites. State and local authorities are responsible for distribution of antivirals to counties.
"We are working with federal and local health agencies to test and improve our emergency dispensing plans," Lyman said. "In simulated exercises, we receive mock emergency shipments from the federal government and then disperse those shipments to local health jurisdictions." Distributing the antivirals
Each county will receive a baseline share, followed by a proportionate share of the antivirals that remain.
To get the antivirals to the public as efficiently as possible, Monterey County officials are planning to store them in a wide number of places throughout the county.
"We are not looking at huge sites like the fairgrounds, but small operations," said Dr. Hugh F. Stallworth, health officer for Monterey County.
The antivirals purchased from Roche and GlaxoSmithKline have not been distributed to the state. When they are received, the state will store them in a central location for statewide distribution. Is California prepared?
California's budget allocates $214 million to prepare for a public health emergency such as pandemic flu, said H.D. Palmer, spokesman for the Department of Finance. The question remains: After all this money has been spent, will California be prepared?
Levin said that no matter how much the state prepares, a pandemic flu is still a disaster. The state can only plan to minimize the effects of a disaster that is, in many ways, inevitable. Dr. Robert M. Levin, health officer for Ventura County said, "It's a talk about nothing. All of the work we are doing now is work, in essence, for nothing that yet exists. All we can do to prepare is to do our best. We are going to do our best, but we are going to fail."

http://www.thedesertsun.com/apps/pbc...plate=printart

[Mellie]

http://www.newspress.com/Top/Article/article.jsp?Section=NATIONAL&ID=564733400205885442

Schwarzenegger to propose new spending in budget
CLEA BENSON
May 11, 2006 7:39 PM

Scripps-McClatchy Western Service
Sacramento Bee

SACRAMENTO, Calif. - With state revenues running more than $5 billion ahead of expectations, Gov. Arnold Schwarzenegger is planning to present a revised budget Friday that will pay off some debts, set aside some money for a rainy day, and significantly increase spending in some areas.

The governor's proposal for the fiscal year that begins July 1 will include $400 million in new funds to help the health-care system prepare for a crisis such as pandemic flu, administration officials said.

The governor will also recommend spending millions to boost the number of children who have health insurance while earmarking billions of dollars in additional money for schools.

The governor will add those funds to the $125.6 billion in spending he proposed in January for the 2006-07 fiscal year, before it became clear that a surge in personal incomes would create a tax windfall.

Schwarzenegger's Department of Finance now estimates the state will earn $94 billion next year, up from an estimate of $91.5 billion in January. At the same time, the state is about $4 billion ahead in tax receipts for the current year.

Schwarzenegger Thursday urged legislators, who must approve the budget before it goes into effect, to exercise caution with the sudden rise in the state's fortunes.

''Some may think this is a moment when we can dramatically increase spending, but I urge them to resist that temptation,'' the governor said in a speech before a conference of county officials.

The spending plan will not include a tax increase, Schwarzenegger said.

Schwarzenegger will propose using about $1.6 billion of the tax windfall to pay off debts and placing another $1.6 billion into a reserve account.

At the same time, the budget proposal would boost spending by amounts that would have been unheard-of just a few months ago.

About $2 billion will go to schools to settle a dispute with education advocates who said he shortchanged them when money was tight.

The governor is proposing a new $400-million disaster-preparedness effort that would include about $50 million to buy face masks for medical workers, $100 million to buy ventilators, and $164 million for other medical supplies in the event of an outbreak of avian flu.

California Health and Human Services Secretary Kim Belshe said Thursday the governor would add $22.8 million to the budget to help counties buy health insurance for children who are not currently eligible for government programs. The funds would cover about 24,000 children who are now on waiting lists for coverage, out of the estimated 900,000 uninsured children statewide.

Schwarzenegger, who has said expanding health insurance for children is a priority, also included more than $70 million in his January budget to enroll children who are currently eligible for government programs such as Medi-Cal and Healthy Families.

But the governor has drawn criticism from advocates for his veto last year of a $300 million bill that would have established universal insurance for children.

Anthony Wright, director of Health Access, a nonprofit group that supports insuring children, called the new budget proposal, ''a relatively small step. . . . This was the governor's last budget opportunity to fulfill his campaign promise to cover all the state's children, and the proposal only covers about a tenth of the currently uninsured population.''

Democrats are leaning toward spending even more on children's coverage than Schwarzenegger will propose. An Assembly budget subcommittee, led by Democrats, this week approved a plan to devote $50 million to expanding children's health insurance.

Belshe said the $22.8 billion was a ''transitional'' proposal, designed to provide help while a ballot initiative that would provide new funds for children's insurance is pending. The measure, which is expected to appear on the November ballot, would add a $2.60 tax on cigarettes to pay for children's insurance and other health programs.

''We believe this is a very prudent and responsible investment,'' Belshi said.

In Thursday's speech, Schwarzenegger said his spending plan reflected the values of Californians.

''It is an expression of who we are and what we really care for,'' he said.

(Distributed by Scripps-McClatchy Western Service, http://www.shns.com.)

AP-NY-05-11-06 2236EDT