most countries will have the good fortune to have several weeks or even months to prepare for a pandemic once a threatening outbreak has occurred.
this period is critical to act upon to ensure adequate preparation based upon the known features of the outbreak and the likely stress points and likely procedures needed to keep it as controlled as possible.
to end an epidemic, R0 must be kept below 1.0 in a sustained fashion.
Development of a phased mitigation procedures approach
each phase of the pandemic will require different measures to be put in place which balance impact on people and the economy with control of the pandemic
phase 1
the infected can be readily isolated from the community
initiation of detection measures for at risk individuals
at risk individuals quarantined until proven negative or resolved infection
public health education on infection prevention
consideration of border control measures and lockdown of non-essential travel and services
general preparation of healthcare systems for later phases:
access expert advice on epidemiology and pandemic control
EARLY ordering of equipment and supplies especially PPE, antiseptics, medicines, ventilators, viral filters, airway circuits and body bags recognizing that these are likely to become in short supply due to:
community panic buying
private sector industries pre-purchasing
countries closing borders for export of needed supplies such as PPE, medications
industries being forced to close due to lockdowns or becoming unable to produce due to supply chain issues
rapidly increasing demands
development of later phase planning to create hospital / medical / nursing / ICU ventilator capacity with separation of infected and non-infected patients
establishing community systems to reduce the need for patients to come to hospitals where they are likely to become infected either en route in ambulances or at the hospital 1)
mobile clinics
home care - early oxygen Rx, oxygen saturation monitors and nutrition delivered to homes of mild-mod cases
aged residential care supports
community panic buying is likely:
fear of shortage of sanitary products such as hand wipes, antiseptics, toilet paper, baby needs, etc
fear of food shortages hence panic buying of:
freezers, minced meat that can be frozen
long shelf life staple foods such as pasta, rice, cereals
phase 2
community spread commenced
heavy emphasis on infection transmission prevention to decrease R0 and flatten the infection curve to reduce impact on the health system and reduce mortality:
hand hygiene
cough / tissue hygiene
cleansing of objects
social distancing
banning of gatherings of more than 5 people including most sports and social events
ensuring people stay at least 1.5-2m away from each other if droplet spread
for an infective agent with a R0 of over 2, the community needs to be at least 80% compliant with strict social distancing to control the spread
home quarantine if at risk
increased testing of possible infections or exposed individuals
early testing of healthcare workers
opening of “fever clinics” or “respiratory assessment clinics” to enable high levels of testing and advice whilst keeping these patients away from emergency departments
hospitals and healthcare systems should have developed clear capacity planning
governance structures to specifically oversee pandemic planning
expansion of ED and ICU capacity
closure of elective surgery which will free up:
beds
theatre space and recovery for temporary ICU
anaesthetists and theatre nurses to assist in expanded ICU capacity
surgical teams can be re-deployed to assist ED
closure of outpatients and replacement with tele-medicine
frees up space which could be used for fever clinics or ED
reduces transmission risk through social distancing
re-purposing other parts of the hospital
purchasing marquees to add physical space capacity eg. for ED triage and streaming
review staffing capacity recognizing that many staff will need to be off work due to illness or quarantine whilst recruitment from overseas will not be possible due to border control measures
utilize medical and nursing students
up-skilling juniors
these control measures will have massive impacts upon industry and employment levels
airlines and tourist/travel services are likely to be forced to rapidly close down and mothball planes, etc
restaurants and hospitality are likely to be forced to close
sports clubs will need to retrench most of the staff +/- players
this will result in:
increased unemployment and impact upon ability for many to pay rents or loans
dramatic downturn in stock markets of perhaps 25% during this phase although essential services such as grocers may see a rise in value
this will require governments to be pro-active and mitigate these issues
create business confidence through loan guarantees, economic stimulus packages, etc
address the rapidly rising unemployment needs to ensure these will have sufficient money
phase 3
rapidly rising infection numbers in the community
strict lock down of non-essential industries, public gatherings, public transport and services