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pandemic_preparation

pandemic preparation

Introduction

  • 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
  • strict lock down of the community to their houses
  • hospitals now ready to implement their capacity planning measures and introduce them as demand necessitates
pandemic_preparation.txt · Last modified: 2020/03/28 09:11 (external edit)