PROMISING PRACTICES FOR PANDEMIC PLANNING Experts stress need for personal, community preparedness

Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (www.publichealthpractices.org) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.

Jun 30, 2009 (CIDRAP News) – If you don't have an emergency preparedness plan for yourself, your family, and even your community, now is a good time to make one. That's the message public health officials are sending as cases of the novel H1N1 influenza virus continue to rise nationally and globally.

"If you don't have a plan, you need one now," said Roger Pollok, special projects manager for Emergency Preparedness at the San Antonio Metropolitan Health District in Texas. "The stakes are a little different now."

The World Health Organization (WHO) officially declared the current outbreak a pandemic on Jun 11. "We are in the earliest days of the pandemic," said WHO Director-General Margaret Chan that day in a statement to the press. "The virus is spreading under a close and careful watch."

Health experts say there is no way to predict what is still in store, but they have concerns that the coming fall flu season might bring a second wave of illnesses, potentially more severe.

As of Friday, 27,717 novel flu cases have been laboratory-confirmed in the United States, with 127 fatalities, according to the Centers for Disease Control and Prevention. But some experts say the actual number of sick is probably more than 1 million.

"Everybody should consider this a time to be better educated" said Jennifer Wooleyhand, a spokeswoman for the Delaware Division of Public Health, adding that preparation is everything. "We need to create the time to prepare and defend ourselves."

While most infections have generally been moderate so far, people need to understand that things could get worse, Wooleyhand said. "People need to know the facts, where to go for resources, and be ready," she said.

Individual and family preparedness
Since the early stages of the H1N1 outbreak, public health officials have focused primarily on disease prevention.

"The message was, 'People, y'all need to take precautions,'" Pollok said.

These precautions include covering coughs with tissue, cleaning hands frequently and thoroughly with soap or alcohol-based sanitizers, sanitizing surfaces such as shopping cart handles, and staying away from others when ill. Pollok said these are healthy habits people always need to maintain.

But many health departments are now also working on reinforcing messages on personal and community preparedness. Being informed is the first step, health officials say.

Pandemicflu.gov and various health departments offer checklists on what individuals and families can do to get ready for a pandemic. They include:

  • Learn about pandemic H1N1 influenza, its symptoms, how it spreads, and how to prevent infections.
  • Stock up on water and non-perishable food. Although the recommendations vary from days' to months' worth, most experts agree it's important to have extra key supplies on hand.
  • Ensure you have a supply of your prescription medicines.
  • Keep other emergency and health supplies handy such as flashlights, manual can openers, face masks, and painkillers.
  • Make a list of people who are willing to help and can be contacted in case of emergencies.
  • Make plans for potential disruptions at work, curtailed social gatherings, and school closures (for example, is it possible to work from home if you are unable to go into work?).

Other useful skills for pandemic preparedness include learning how to care for the sick at home, rehydration therapy, and isolation measures, said, Joy Alexiou, public information officer for the Santa Clara Department of Public Health in California.

"Get things in order. Have the supplies in hand so you are not surprised when you go to the store and it's not there," said Alexiou, noting that in the first days of the HINI outbreak, some stores ran out of hand sanitizer.

Because infections can spread quickly among children and in school settings, constantly reminding kids about necessary health precautions is also important. Hundreds of schools around the world have closed to help contain the spread of infection. Pollok said his department is planning a back-to-school campaign with information about the flu.

Public health officials also encourage a broad approach when it comes to emergency planning—individuals should not only be ready for a pandemic, but other disasters that may affect their area, such as floods, hurricanes or earthquakes. "When you develop a plan, make sure it's all-hazards," Pollok said.

Community preparedness
Community-based organizations (CBOs), faith-based organizations (FBOs), and local businesses also need to evaluate their pandemic plans, consider how a pandemic might affect services, and what alternatives are available, according to pandemicflu.gov.

In the early days of the current outbreak, for instance, CBOs and FBOs in many communities were advised to limit public gatherings, and some had to change practices. Some Catholic churches, for example, opted not to share the communion cup or shake hands to exchange a sign of peace at mass.

Community planners also need to have a strategy to communicate with staff and the people they serve. Dan Kinsey, emergency management coordinator for Guadalupe County in Texas, said consistent communications, including having a unified message among preparedness partners, is essential during emergencies.

Health officials say that the current outbreak revealed that many pandemic plans were based on worst-case scenarios, and communities may need to identify how to scale those plans to work for different levels of severity and conditions.

"Identify gaps [in your plan] and fill those gaps," Pollok said.

Bexar County in Texas, for instance, chose not to close schools or limit gatherings, Pollok said, because officials there felt the severity of illness did not warrant such action

"What impacts one community differs from another," Pollok said, adding that no standardized response will work in every community.

Since you cannot "plan a disaster," flexibility is important, Kinsey said. "If your plan isn't working, it's probably too specific."

Alaric Bien, of the Chinese Information and Service Center in Seattle, said his organization has worked closely with Seattle-King County to develop an emergency preparedness plan. Bien said. He has been working with staff to ensure they are prepared.

Bien said his organization wants to prepare the community by focusing not only on increasing people's knowledge, but also encouraging appropriate behavior. He noted that even though people may have the information they need, they may not think about preparing on a day-to-day basis unless there's an imminent threat.

The early days of the outbreak showed that it helps to have accurate messages "in language" from an organization that community members trust, Bien said. The organization plans to send a reminder through ethnic media of simple things people can do to get ready every week.

Dealing with a pandemic will also require communication and cooperation among health officials, community leaders, and different groups, Kinsey said, adding that now is a good time to build community ties and develop community channels.

Alexiou said her department is planning a public awareness campaign in multiple languages about influenza. Past campaigns on pandemic preparedness received a lot of visibility, she said, but communities need to reinforce these messages.

"If community efforts are not sustained, then people forget," Alexiou said, adding that the timing for education is now ideal, because people are more likely to pay attention.

One family's experience
For Amy Bates Grant, preparing for a pandemic has been a process since 2006.

"I've learned everything that I could about pandemics," said the mother of two who lives outside Portland, Ore.

Grant said she used resources such as the Flu Wiki forum to learn how an influenza pandemic might affect her and her family, how to reduce exposure, and how she would cope if family members were infected.

"I'm not a nurse. I don't have a medical background. I've done a lot of reading on home healthcare," she said. It's important to know what symptoms require immediate medical attention and what can be handled at home to avoid trips to the doctor at a time when the health system is likely to be overwhelmed, she added.

Grant has also been collecting essentials, such as easy-to-prepare meals, thermometers for each person, gloves, face masks, and pain relief medication. All the family members know where everything is and what needs to be done, Grant said.

"It's given us the resiliency to face things a lot more easily," she said.

Grant acknowledges that the cost of preparing is a concern for some people, which is why she recommends getting what's needed over time.

"Every week when I go shopping, I'll pick up a few cans of soup. I didn't want to go into debt doing this. Grant said. "I don't recommend people run out and buy a bunch of stuff."

Grant said families should consider what they need and see what they already have that may be useful. Creativity and resourcefulness can go a long way. For instance, Grant said she found 55-gallon storage drums for $5 from a local food storage business that she is using to store water. She has learned how to create a makeshift toilet for an isolation sick room using a toilet seat, a bucket, and cat litter.

"If you're willing to think, there are low-cost options out there," she said.

Grant has also been talking to others in her community about how to get ready for a pandemic. She serves on the board of the ReadyMoms Alliance, an organization of volunteers who educate the public about influenza preparedness.

"If my community isn't prepared, it doesn't do me a whole lot of good," Grant said, noting that everyone needs to understand the disruptions that are likely to occur. Parents of school-aged kids, for instance, need to think about what will happen if schools close for a long time.

If different segments of the community are even a bit more prepared and resilient, it may make a big difference in reducing the impact of the pandemic and in delaying people's exposure to infection, she said.

Even a small amount of preparation is worthwhile. "Any preparation is better than no preparation," Grant said, adding that families who can prepare should do so. "I would rather that our limited public resources focus on those who cannot prepare."

For more information visit:

American Red Cross: Preparing for a Swine Flu Pandemic

CIDRAP's Personal Preparedness Resource List

CIDRAP's Promising Practices include:
Ready in 3
Disaster Readiness Tips for People with Disabilities
Ready or Not? Have a Plan
Providing Care at Home During a Pandemic

Pandemicflu.gov: Plan and Prepare

Pandemicflu.gov: Pandemic Flu Planning Checklist for Individuals and Families

Pandemicflu.gov: Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist

World Health Organization: Guidance for Communities

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