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Prepare for the H5N1 Flu Pandemic

Written by Trisha Olson

The Department of Health and Human Services describes the situation as a “race”—a race against a quickly changing virus. From November 2005 to March 2006, the avian influenza virus has spread from 16 to 37 nations, and affected people and poultry on three continents. There is no vaccine available for the avian flu. Moreover, there is only a limited supply of antiviral medicine, and there is no guarantee that antiviral medicine will continue to be effective against bird flu.

At the time of the government report, of the 175 people who had been infected, 96 had died. This is an unusually high lethality rate of 55%, compared to other pandemics with 2% fatalities. More unnerving, the department’s report highlighted that it is not a question of if the virus will arrive in North America; it is a question of when it will arrive in North America.

Background: Flu Virus and Transmission

Everyone has felt the effects of the seasonal flu. For most departments, this causes a setback to scheduling and is an annoyance for afflicted officers, but little more. The current worry over a virus called H5N1, otherwise known as avian influenza or bird flu is quite different from the common flu.

H5N1 seems to be the next outbreak in a string of recent, natural epidemics (including mad cow, SARS and monkey pox, for example). The reaches and impact of this current infection are yet to be known. It has, however, given departments, state and national government officials, and people in general a lot to worry about.

Through developing a response plan and early mobilization strategy, and through dispensing education information, departments can best attack the virus and the fear surrounding bird flu.

More and more, governmental Web sites are gathering and posting information readily for the public. Sites like the Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Center for Infections Disease Research & Policy (CIDRAP), AlertNet and the United States Geological Survey (USGS) provide a wonderful resource in learning more about the virus.

The avian flu is among a variety of infections that afflict birds. Wild birds carry viruses in their intestines, but usually never become ill. The particular strain known as H5N1 not only impacts the wild birds that carry the virus, but also domesticated birds like chickens and ducks. H5N1 is both contagious and deadly. The CDC estimates that those certain strains of the disease can cause a bird mortality rate of 90–100% often within 48 hours.

As of early-April 2006, there have been reports of the virus throughout Asia, much of the Middle East, large parts of Europe, and a handful of countries in Africa. Since the virus is transmitted between wild birds and often to domestic birds, researchers have been looking to migratory patterns and fowl flyways to gauge where infected birds might next appear. It is especially important for officers in the impacted migratory pathways and flyways to understand the risks to humans from any infected birds, which may migrate into their region.

Human Transmission

The virus can spread to humans who come into contact with birds that have been infected. The United States Department of Agriculture’s Food Safety and Inspection Service has reported that the avian flu virus is destroyed in poultry that is cooked to an internal temperature of 165 degrees, and has suggested there is no threat of transmission through properly cooked meat and poultry. Although it is reassuring that poultry as a food supply can be protected through proper cooking, humans are still at risk of transmission.

It is estimated that the birds’ secretions or excretions are the greatest causes of transmission to humans. Much like E.coli or salmonella, the virus is passed from secretion or excretion through oral contact. This is why it is of the utmost importance for poultry handlers or wildlife officials to take extra precautions when handling possibly infected birds. Moreover, any officers who come into contact with potentially infected birds should take extra precautions when approaching and handling the birds.

Once the virus transfers to humans it is known as H1N1, H1N2 or H3N2. The outbreak affects humans in a variety of flu-like ways. Some symptoms include sore throat, fever and muscle aches, while others can have more acute symptoms like pneumonia and respiratory diseases.

What is just as worrisome is the fact that influenza viruses can change or mutate over time. Anyone who has received a flu shot in the fall and still gotten sick in the wintertime has felt the first-hand effects of a mutated strain of the flu. Although this strain of the avian flu is currently spread only from secretions and excretions of the poultry, there is a great concern that a mutation in the strain will allow airborne transmission—meaning that any cough or sneeze could pass the virus.

If the virus strain goes airborne, there would likely be an influenza pandemic—a global outbreak of the disease, which could lead to high levels of illness and death, not to mention the economic and first responder impact it would have on individual departments. Departments will have to plan for officers’ response to emergencies involving a potentially infected person, how to cover shifts when officers themselves become infected, how to provide for medical expenses in the event that department health care coverage does not cover medicine or supplies, and a number of other problems.

Vaccine

Simply put, there is no vaccine. President Bush has asked Congress for over $7 billion for influenza preparation. Much of this would be put toward developing and producing vaccines. In the meanwhile, other countries have discovered that antiviral drugs have had beneficial influences when given within 48 hours of developing symptoms of avian flu. Antivirals, such as Tamiflu, are currently limited to prescription, and are in short supply. While part of the Congressional budget will likely be applied toward antivirals, it is questionable if the amount of antiviral prescriptions will be able to meet the estimated demand for the drug.

In the instance of an outbreak and a shortage of vaccines, officers should follow the same precautions they would follow in the outbreak of the seasonal flu. While health departments usually recommend frequent hand washing and avoiding coughing or sneezing into the air, officers often do not have such a luxury. Instead of frequent hand washing, departments should make antibacterial hand sanitizer readily available for officers, and make sure that tissues are available for use.

Departments should also consider budgeting for additional medical expenses for officers, should the department health plan not cover antiviral medication for officers. Additionally, departments should experiment with schedules by extending or reducing shifts for optimum officer coverage, and re-evaluate days off and vacation days.

Government Response

If national response to recent natural disasters is any indication of a future response, then it is easy to presume that local and regional officers will bear the brunt of the identification, containment, and economic and social consequences to an avian flu pandemic. Even though there has already been executive and legislative action on a national level in preparation for H5N1 contagion, every department should begin preparations for how to control the avian flu locally.

Currently, the international community is reacting to the avian flu on a day-by-day basis. The newswires are hot with where the latest outbreak has happened, mostly because no one truly knows where the next outbreak might be. If it is so hard to gauge the outbreak patterns, and human infection, the hope of a quick federal government response to an outbreak is small. Bluntly, there will be little, if any assistance. There are measures that local organizations and departments should take to make up for any national breakdown or delay in assistance.

A great place to start is with the CDC, which has put out a checklist of preparations for different groups in the community. It offers suggestions for state and local officials, colleges and universities, businesses, school districts, medical offices and clinics, emergency medical transport organizations, and faith-based and community organizations. The CDC also has information for those in the poultry industry, travelers and those in the airline industry. These are all available at www.cdc.gov/flu/avian/groups.htm. These checklists are a great place to start for departmental planning.

Multi-Agency Leadership and Networking

The CDC suggests using interventions, which departments have already created to handle similar situations. For instance, departments often have strategies to handle prevention of human harm from other agents—chemical, biological or other naturally occurring human threats. Implement strategies, which your department already has in place and can confirm as effective.

If your department already has a crisis plan for a toxic material emergency, for example, this plan can be borrowed and adapted to suit the needs of an influenza pandemic. If this is the first time your department has prepared such a strategy, be sure to plan out the leadership and networking necessary to create a crisis influenza plan.

An important first step is to establish a Pandemic Preparedness Coordinating Committee (PPCC) composed of department members with training or specialty knowledge in this area. Include officers who have particular knowledge in the following areas: animal and wildlife control, elderly officers, officers with psychosocial training, officers with medical training, officers with tactical skills that could be modified to quarantine an area, and other applicable areas of specialty.

Be sure to also include local government, healthcare workers, other emergency responders and community members. After establishing this committee, be sure to define each member and each agency’s role during an emergency. For instance, be sure to define whether your department’s first priority is to dispense information to the public and control public anxiety, or if your primary role will be to provide security to testing facilities and pharmacies.

In addition to dispensing information and providing security to facilities, departments must consider containment procedures, the psychosocial support services in the community, local healthcare quarantine security, daily updates to medical and biological protocols, and how public information officers can best dispense information.

The committee also needs to address how departments will respond to populations, who are at a higher risk of influenza infection, including infants and children, pregnant women and the elderly, immunosupressed people, and homeless populations and those living in shelters. Clearly define what role your department will have in assisting people in those groups.

While addressing the at-risk populations, always remember that the public in general is likely to react with great anxiety to an outbreak of the avian flu. Furthermore, it is important to remember that different people will react in very different ways to anxiety. For instance, a number of people may react similarly to the preparations for the Y2K disaster by stocking up with food, water and medicine. This reaction is a positive, active response to being confronted with a disaster situation, which departments should encourage.

On the other hand, others may react with denial about a pandemic or in defiance of authorities. Unfortunately, society’s preference to question the transmission and impact of the avian flu is what may leave whole communities under-prepared to handle the impact of a possible pandemic. Be sure to strategize ways to contain or limit the negative responses to an outbreak and encourage the positive preparations.

Interoperable Communication

Whether your department has a high-tech interoperability device or whether your commanding officer and other committee leaders need to sit down in a meeting room together, it is important to keep communication as your forefront concern. Task forces and specialized groups simply cannot contain an influenza pandemic by working independently. Without communication from other members of the PPCC, any agency is assured to fail at managing an influenza outbreak.

For starters, in the event of a pandemic, each agency will presumably experience a cut in its active workforce due to officer illness. Only by communicating with other PPCC members, can your committee be assured to have a fully manned response.

Additionally, agencies working to solve problems within its own territory, region, state or jurisdiction will fail in being able to contain a pandemic. The very nature of how influenza spreads does not keep it within county or state boundaries. Coughs and sniffles spread outside of jurisdictions all the time. The flyway patterns of birds span across continents. Through communication with neighboring jurisdictions—even if this means international jurisdictions—each department can best address an operation plan.

To ensure that each department will have an open communication network, set up a test date. The moment of an outbreak, with public concern and a possible pandemic, is not the moment to try out a phone tree or begin to work with fancy communication gadgets. Instead, set up a test run of your communication system. Alert all applicable local, regional, state and national offices of your operation test, and test your network.

Once you have tested your plan, isolate the breakdowns and fix them immediately. For instance, if there is a clear breakdown in delegation of responsibilities at a certain department, do not gloss over the problem in hopes that someone will emerge as a future spokesperson. Tackle the problem and appoint representatives to specific positions, if need be.

Animal and Wildlife Agency Communication

In the planning and committee meetings, be sure to utilize animal and wildlife officers or local wildlife officials. Departments often already have a wealth of untapped knowledge regarding natural emergencies: animal and wildlife officers. Make these officers an integral part of the planning process since they have specialized information regarding wildlife-human interaction. Even a K-9 officer who may not have had specific training on how to handle migratory birds or other wildlife has skills, which will come to his and the department’s benefit.

The United States Geological Survey offers safety guidelines for handling wild birds, as well as up-to-date information on the geographical boundaries of the influenza-infected birds. By making this information readily available to officers, you can best contain the range of the virus.

Impact on Departments

Although preparing a PPCC and testing the communication response of the committee will put departments in a better position to handle a potential outbreak, there will inevitably be personal and professional difficulties that arise. One essential preparation is to provide vaccinations and medication to first responders as soon as they become available or necessary. Through working with local healthcare officials, you should minimize the likelihood that your officers will be afflicted. A proactive medical stance will keep absences to a minimum and hopefully keep down insurance and medical costs.

Be prepared for any insurance coverage problems that might arise. It would be a good idea to review preventative medication coverage of officer plans and supplement the coverage if necessary. Have disability and leave-of-work paperwork available, and be prepared to process the paperwork. Additionally, in the event that officers become ill, be prepared to make practical alterations to shifts.

Wherever possible, set up sanitation stations and enforce the CDC guidelines for preventative health measures. Post signs and information regarding the transmission of influenza should it become airborne. First responders will have the difficult problem of interacting with potentially sick members of the community who may not follow guidelines regarding covering your mouth when you cough and sneezing into a tissue. However, interacting with potentially sick people does not mean that officers are doomed to also become sick. Through encouraging hand washing and maintaining health precautions, officers can lessen the likelihood of getting sick.

Although it may seem like an odd preparation, suggest non-smoking strategies to officers. The impact of influenza is particularly difficult on smokers, who have an increased likelihood of influenza infections when compared to nonsmokers, and who have a higher mortality rate than nonsmokers from influenza. By quitting smoking, officers will be less likely to get the upper and lower respiratory infections which accompany influenza. To help officers, consider making nicotine replacements or quitting strategies available at work. Every little step helps in containing the impact on your department, including minimizing smoking.

Overall Impact by Avian Flu

The avian flu is currently a situation, which can be contained and monitored to some extent. Although the migratory birds that spread the disease are continuing to do so through the flyways, the governments, which have identified the illness, have been proactive in containing the outbreak and minimizing the effects to humans. The problem is it continues to spread. With the human mortality rate at or above 50%, the avian flu is not like a seasonal flu or minor illness. It is life threatening and requires intense medical treatment and antiviral medication to combat.

Should the virus mutate, like other influenza strains have done in the past, the avian flu could be a full-fledged pandemic. The last three influenza pandemics in the 20th century saw at least 600,000 American deaths and over 42,000,000 worldwide deaths.

The impact on law enforcement and first responders would be substantial. Not only could departments face 30 to 40% fewer officers on the streets, but also an increase in services. The time to plan for a natural emergency of this scale or variety is now. This is a race against time with the avian influenza. The question remains how ready local departments are for handling the inevitable crisis.

Presidential Update

In early May, the White House updated its emergency response plan from November 2005. The latest information included updated response plans as a nation and coping mechanisms for individuals and businesses. Most importantly, the White House stressed that the national borders would not close in the event of an epidemic. Medical officials stressed that closing the borders would result in a minimal delay in the transmission of the influenza virus, and would not stop the transmission of the virus to the continental United States.

The latest projections from the government assume that an influenza virus related to the avian flu strain could result in the absence of 40% of the workforce. Additionally, the White House update suggested additional tactics for how the public can avoid transmission. The latest reports suggest strategies like allowing liberal school closures to stop children from becoming vehicles for spreading the virus. In the best turn of news, the report suggests that scientists are beginning to make progress toward finding a vaccine. There are suggestions that scientists have had success in animal tests with early vaccine trials.

Significantly, the burden of the pandemic will be borne by local government, communities will be on their own, and federal support will be limited.

Trisha Olson is the former Associate Editor of LAW and ORDER.

Published in Law and Order, May 2006

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