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CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016

CCCHD Pandemic Influenza preparedness and Response Plan 1

PANDEMIC INFLUENZA

PREPAREDNESS AND RESPONSE

PLAN

Clark County Combined Health District

529 East Home Road Springfield, OH 45503 **** (937)390-5600 www.ccchd.com



TABLE OF CONTENTS

I Introduction 3

1.1 Purpose/Goals 6

1.2 References and Resources 6

II Situations and Assumptions 6

III Concept of Operations 9

3.1 General Overview 9

3.2 Command and Coordination Overview 9

3.3 Communication Overview 10

3.4 Pandemic Phases and Associated Activities 12

3.5 Pandemic Severity Index 44

IV Roles and Responsibilities 46

V Authorities 52

VI Attachments Listed 54

Plan Maintenance: Description of Change or Action 55



Introduction

I. INTRODUCTION

Severe influenza pandemics represent one of the greatest potential threats to the public’s health and are ranked as global public health emergencies.

Pandemics are distinct from seasonal influenza epidemics that occur nearly every year and are caused by influenza viruses, which circulate around the world.

Pandemics occur when a novel Influenza A virus emerges through major changes in genetic composition (antigenic shift) that enables a strain to jump the species barrier. Protective immunity in the population does not exist following an antigenic shift due to the absence of past exposure to the strain. See illustration below to note three ways an antigenic shift can occur: Source: National Institue of Allergies and Infectious Disease, Last Updated January 14, 2011 http://www.niaid.nih.gov/topics/flu/research/basic/pages/antigenicshiftillustration.aspx

http://www.niaid.nih.gov/topics/flu/research/basic/pages/antigenicshiftillustration.aspx



Historically, three criteria are necessary for a global influenza pandemic:

A novel subtype of human Influenza A virus emerges

Human infection causes serious illness due to minimal population immunity

Rapid and sustained person-to-person transmission occurs. Four influenza pandemics occurred within the 20th century.

20th Century Influenza Pandemic Human Deaths

Year Known As Antigen Classification

Worldwide Deaths United States Deaths

1918 Spanish Flu H1N1 20-40 million 500,000

1957 Asian Flu H2N2 1-2 million 70,000

1968 Hong Kong Flu H3N2 700,000 34,000

2009* Swine Flu H1N1 18,449 12,470 CDC estimate

*The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related. An influenza pandemic is a public health threat that could overwhelm existing public health, public safety, and health care system infrastructures in Clark County, Ohio. Related vulnerabilities include:

absence of an adequate stockpile of vaccines, antiviral medication, and possibly antibiotics for secondary bacterial infections

high absenteeism in critical positions in all workforces may result in a disruption of key resources and critical infrastructures (transportation, commerce, utilities, public safety, agriculture, and communications), limiting the provision of essential community services.

For planning purposes, it is appropriate to assume the course of the disease to be either consistent with or longer than seasonal influenza epidemics, which typically last three to six weeks. The management of the human health consequences of an influenza pandemic will require efficient coordination and collaboration among local response partners, as well as regional, state, and federal assistance when needed. To prepare for an influenza pandemic, the Clark County Combined Health District (CCCHD) has developed and continues to maintain the Pandemic Influenza Preparedness and Response Plan to address preparedness issues.



1.1. Purpose / Goals

The purpose of this plan (hereinafter referred to as the Plan) is to provide a coordinated community response to an influenza pandemic in Clark County to limit illness and death, preserve continuity of essential government functions, and minimize social disruption and economic losses. This document details CCCHD’s preparedness activities and response and recovery actions associated with an influenza pandemic. It is designed to accomplish the following goals:

Reduce morbidity

Reduce mortality

Minimize essential service / social disruption

Facilitate planning for recovery

1.2. References and Resources

1.2.1: Clark County Emergency Support Function (ESF) # 8 under the Clark County Emergency Operations Plan (EOP); maintained by the Clark County Emergency Management Agency (EMA)

1.2.2: Clark County Combined Health District Emergency Response Plan (ERP) 1.2.3: West Central Ohio Regional Plans, including but not limited to the Regional Epidemiological

Response Plan and the Biological Response Plan 1.2.4: Ohio Department of Health Infectious Disease Control Manual (IDCM)

http://www.odh.ohio.gov/healthResources/infectiousDiseaseManual.aspx 1.2.5: Holloway, R., Rasmussen, S., Zaza, S., Cox, N., Jernigan, D., (2014). Updated Preparedness and

Response Framework for Influenza Pandemics. Centers for Disease Control and Prevention MMWR, Sept 26, 2014. Vol 63, No.6. http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf

II. SITUATIONS AND ASSUMPTIONS

Situations: 2.1 CCCHD is the public health authority for Clark County and is responsible for the protection of the health and

welfare of its citizens.

2.2 The Clark County Public Health Jurisdictional Risk Assessment identifies these hazards as priorities for

planning:

Severe Thunderstorm Hazmat Spill Tornado

Severe Ice Flooding Biological Terrorism

Severe Winter Storm Pandemic Nuclear Terrorism

http://www.odh.ohio.gov/healthResources/infectiousDiseaseManual.aspx

http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf



2.3 Characteristics of the threat addressed in this plan include:

2.3.1 Influenza is an acute viral disease of the respiratory system. 2.3.2 Symptoms, often classified as “Influenza Like Illness (ILI)” typically include:

fever (usually 101-102 degrees F) chills headache nonproductive cough sore throat exhaustion muscle aches Additional symptoms may include: ocular symptoms such as eye pain, sensitivity to light runny nose substernal chest burning Gastrointestinal symptoms may occur: Nausea vomiting diarrhea

2.3.3 Transmission of novel influenza viruses from person to person or from birds or mammals:

by droplet spread

direct contact with nasopharyngeal secretions

via objects recently contaminated with secretions 2.3.4 Communicability, human to human transmission of novel influenza may or may not occur. The

period of communicability specific to a novel influenza virus will not be known until the virus begins to circulate; however, for planning purposes, the period of communicability of seasonal influenza begins 1 day before symptoms develop and up to 5 days after onset of illness. Children may be infectious for up to 7 days after onset of illness.

2.3.5 The incubation period for novel influenza is unknown until virus begins to circulate, however, for

planning purposes, incubation periods of seasonal influenza are 1 – 4 days, usually 2 days. usually one to three days.

2.3.6 Complications include secondary viral and bacterial pneumonias, as well as febrile

seizures/convulsions. 2.4 A large-scale public health emergency in Clark County will exhaust local resources. 2.5 Clark County has a population of 135, 959 (Census population estimates, July1, 2015) and

includes two municipalities, ten townships, and eight villages.



2.6 A public health emergency in Clark County will require a coordinated, multi-disciplinary,

multijurisdictional, local response as well as regional, state, and federal assistance if needed. The organization and concepts used for the response are based on the National Incident Management System (NIMS) set forth by FEMA.

Assumptions 2.7 On average, an infected individual will transmit the virus to at least two other individuals. 2.8 Multiple waves of infection / illness may occur in a community, each lasting six to eight weeks. 2.9 The number of ill individuals needing outpatient medical care and hospitalization may overwhelm

the local health care system. Prioritization criteria for limited health care services and resources may be needed. Medical standards-of-care may be adjusted.

2.10 Influenza-related illness may occur in thirty percent (30%) of the Clark County population during

an outbreak. Outpatient medical care may be needed for fifteen percent (15%) of the Clark County population and four percent (4%) of the population may require hospitalization.

2.11 The health care system should expect an increase (25% or more) in demand for inpatient beds and

needed respiratory equipment. The health care system may need to open alternate treatment sites to relieve demand on hospital Emergency Departments.

2.12 The number of influenza-related fatalities may overwhelm mortuary and burial services. 2.13 Demand for home care and social services may increase significantly. Individuals may need to

assume responsibility for the care of family members with mild to moderate influenza symptoms at home due to limited health care system services and resources.

2.14 Antiviral medicines may be in short supply, and may be prioritized by for high risk groups. 2.15 A vaccine may not be available for six to eight months following the emergence of a new human

Influenza A subtype. CCCHD will distribute / administer available vaccine based on national and state guidelines.

2.16 Insufficient supplies of vaccines and antiviral medications may require social distancing strategies

and public education to control the spread of disease in Clark County. 2.17 The Plan will be updated periodically as required to incorporate new directives / strategies, new

information technology, legislative changes, and procedural changes based on lessons learned



and best practices identified during exercises and actual events. A full review, update, and approval of the plan will be conducted annually.

III. CONCEPT OF OPERATIONS

3.1 Overview

3.1.1 CCCHD will be the lead agency in coordinating the local health and medical response to a pandemic along with state and federal agencies and government officials when appropriate.

3.1.2 CCCHD will coordinate response actions with the ODH and local health jurisdictions, primarily in the West Central Ohio (WCO) Region.

3.1.3 CCCHD will respond under the auspices of this plan as well as the Clark County Emergency

Operations Plan (EOP), Emergency Support Function (ESF) # 8 coordinating with the local EMA. 3.1.4 CCCHD’s response actions will emphasize disease surveillance and investigation, social

distancing measures to reduce the spread of infection, and provide timely communication and education to the public regarding the pandemic, the public health response, and measures the public can initiate to reduce the risks of infection.

3.2 Command and Coordination

3.2.1 CCCHD has adopted an Incident Command Structure (ICS), consistent with the structures outlined in the National Incident Management Structure (NIMS) and National Response Plan (NRP).

3.2.2 To realize a consistent approach in the management of a pandemic event, Clark County response partners have adopted NIMS as the framework for preparation, response, recovery, and mitigation actions.

3.2.3 The Health Commissioner or designee will participate as the Public Health Incident Commander or as part of Unified Command.

3.2.4 After establishment of the overall incident objectives, the foremost responsibility of the Incident Commander will be to formulate the initial public health response strategy.

3.2.5 CCCHD has developed and maintains a Continuity of Operations Plan (COOP) to ensure the continuation of essential public health functions as much as possible during a pandemic.

3.2.5.1 As part of the COOP planning, the CCCHD Board of Health and CCCHD’s Health Commissioner have established a line of succession for the agency.

3.2.5.2 It is possible that nonessential public health functions may be suspended for a period of time in order to direct available resources to pandemic-related response actions.



3.2.5.3 During a pandemic event, essential services will include, but are not limited to:

Incident Management

Surveillance and Epidemiology

Facilitating and assuring access to Laboratory Services

Community Mitigation

Facilitating the distribution of appropriate Medical Care and Countermeasures

Facilitating Vaccination if appropriate and available

Risk Communication

Coordination with local, state and federal partners as applicable. 3.3 Communication

3.3.1 Messaging to the General Public and CCCHD Staff

3.3.1.1 Responsible Party: CCCHD’s Public Information Officer{s} (PIOs) will coordinate appropriate

county-wide communication and public education during an influenza pandemic.

3.3.1.2 Dissemination of printed and web-based pandemic preparedness planning information to staff, community partners, elected officials, and the news media.

3.3.1.3 Utilization of radio, television, and print media as needed to disseminate information regarding public health interventions.

3.3.1.4 Identification of functional needs and traditionally underserved populations to disseminate

pandemic influenza educational messages. 3.3.1.5 Promotion and dissemination of pandemic influenza preparedness planning information to

community partners, county agencies, businesses, schools, and community-based organizations.

3.3.1.6 PIOs work with program personnel to assure that CCCHD staff is informed of situation.

3.3.2 Messaging to Partners as part of Information Sharing or Situational Awareness

3.3.2.1 Responsible Party: CCCHD’s Liaison, Planning Section or program personnel will be coordinate situational awareness among partners. Various methods may be utilized.

3.3.2.2 Ohio Public Health Communication System (OPHCS)

3.3.2.3 Clark County Combined Health District Public Health Directory for Health Alerts



3.3.2.4 Strategic communication through Health District Liaisons as outlined in the procedure in Public Health Preparedness Capability 1, Community Preparedness.

3.3.3 Communicating Operational Information to Clinicians or other System Partners

3.3.3.1 Responsible Party: Operations or program personnel, such as the communicable disease staff

3.3.3.2 Examples would include case definitions, specific Personal Protective Equipment, precautions for shipping labs, etc.

3.3.4 Communication Resources / Methods include the following:

Public Health Directory for Health Alerts

MARCS (Multi-Agency Radio Communication System) Radios

OPHCS (Ohio Public Health Communication System)

JIC (Joint Information Center)

EOC (Emergency Operations Center)

Cell and land-line phones

CCCHD Telephone Tree

Clark County Hyper-Reach Notification System

Ohio Responds System

3.4. Pandemic Phases and Associated Activities 3.4.1 According to Holloway, R., Rasmussen, S., Zaza, S., Cox, N., Jernigan, D., (2014). Updated

Preparedness and Response Framework for Influenza Pandemics. Centers for Disease Control and Prevention MMWR, Sept 26, 2014. Vol 63, No.6. http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf the coexistence of CDC intervals is demonstrated in figure and chart below.

TABLE. Preparedness and response framework for novel influenza A virus pandemics: World Health Organization phases and CDC intervals, with federal and state/local indicators

http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf



World Health Organization phases

CDC intervals Federal indicators for CDC intervals

State/Local indicators for CDC intervals

Interpandemic phase: Period between influenza pandemics

Alert phase: Influenza caused by a new subtype has been identified in humans

Investigation: Investigation of novel influenza A infection in humans or animals

Identification of novel influenza A infection in humans or animals anywhere in the world with potential implications for human health

Identification of novel influenza A infection in humans or animals in the United States with potential implications for human health

Recognition: Recognition of increased potential for ongoing transmission of a novel influenza A virus

Increasing number of human cases or clusters of novel influenza A infection anywhere in the world with virus characteristics, indicating increased potential for ongoing human-to-human transmission

Increasing number of human cases or clusters of novel influenza A infection in the United States with virus characteristics indicating increased potential for ongoing human-to-human transmission

Pandemic phase: Global spread of human influenza caused by a new subtype

Initiation: Initiation of a pandemic wave

Confirmation of human cases of a pandemic influenza virus anywhere in the world with demonstrated efficient and sustained human-to-human transmission

Confirmation of human cases of a pandemic influenza virus in the United States with demonstrated efficient and sustained human-to-human transmission

Acceleration: Acceleration of a pandemic wave

Consistently increasing rate of pandemic influenza cases identified in the United States, indicating established transmission

Consistently increasing rate of pandemic influenza cases identified in the state, indicating established transmission

Deceleration: Deceleration of a pandemic wave

Consistently decreasing rate of pandemic influenza cases in the United States

Consistently decreasing rate of pandemic influenza cases in the state

Transition phase: Reduction in global risk, reduction in response activities, or progression toward recovery actions

Preparation: Preparation for future pandemic waves

Low pandemic influenza activity but continued outbreaks possible in some jurisdictions

Low pandemic influenza activity but continued outbreaks possible in the state

3.4.2 Using the CDC intervals as thresholds for particular interventions, the following 6 charts provide a

guideline for suggested response activities:



Investigation

Interval

Investigation Interval: Investigation of novel influenza A infection in humans or animals

Indicator: Identification of novel influenza A infection in humans or animals in the United States with potential implications for human health.

Domain Local Activities Responsible

Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS

Notes for Public Health

Inve

stig

atio

n In

terv

al

Inci

den

t m

anag

emen

t

Review state/local response plans. All agencies All Staff All Staff CCCHD Plans are reviewed and

revised annually.

CCCHD Plans reflect intersection with

other the Clark County Emergency

Operations Center.

Coordinate activities and response plans with animal health officials, as appropriate.

Public Health

Operations Communicable

Disease Staff

Review and exercise all aspects of influenza response. All agencies All Staff CCCHD Emergency Response Team

meets no less than 10 times a year to

review and exercise responses.

Inve

stig

atio

n In

terv

al

Surv

eilla

nce

an

d e

pid

emio

logy

Maintain and enhance influenza and respiratory virus

surveillance systems

Public Health


Disease Staff

Surveillance reflects regional effort

with other counties in West Central

Ohio.

Novel A Influenza Virus is a Class A

reportable Disease

Non Novel Influenza Viruses are

reportable when they are linked to

pediatric mortality or hospitalization.

During a pandemic, CCCHD’s

Epidemiologist and Infectious Disease



Investigation

Interval

Control Nurse, along with other

trained back-up staff will enhance

existing surveillance activities.

Implement case-based investigation of novel

influenza infections in humans and animals.

Public Health

OSU Extension

OSU School of

Veterinary

Medicine

OSU School of

Agriculture

Farm Bureau

Veterinarians


Disease Staff

Environmental

Health Staff

Assess contacts of ill persons to determine human-to-

human transmission and risk factors for infection.

Public Health

Healthcare

Providers


Disease Staff

Report cases according to the Ohio Department of

Health (ODH) and identify whether state or local

assistance is necessary

Public Health

Healthcare

Providers


Disease Staff

Reporting to be consistent with Ohio

Revised Code and Ohio

Administrative Code, as well as ODH.

If only animal cases are identified, assess human

exposures and risks for infection.

Public Health

OSU Extension

OSU School of

Veterinary

Medicine

OSU School of

Agriculture

Operations Environmental

Health Staff

Communicable

Disease Staff



Investigation

Interval

Farm Bureau

Veterinarians

Coordinate activities with animal health

representatives as appropriate.

Public Health

OSU Extension

OSU School of

Veterinary

Medicine

OSU School of

Agriculture

Farm Bureau

Veterinarians


Health Staff

Inve

stig

atio

n In

terv

al

Lab

ora

tory

Assess laboratory capacity available to detect and

characterize influenza cases.

Public Health

Healthcare

Providers


Disease Staff

Coordinate activities with state/local veterinary

diagnostic laboratories.

Public Health

OSU Extension

OSU School of

Veterinary

Medicine

OSU School of

Agriculture

Farm Bureau

Veterinarians


Health Staff



Investigation

Interval

Inve

stig

atio

n In

terv

al

Co

mm

un

ity

Mit

igat

ion

Public Health Public

Information

Officers

Operations

Public

Information

Officers

Communicable

Disease Staff

If human-to-human transmission is suspected,

consider recommending isolation of ill persons and

voluntary quarantine of close contacts (e.g.,

household members).

Public Health

Healthcare

Providers

Public Health

Incident

Commander

Operations

Health

Commissioner

Communicable

Disease Staff

Enhance all usual influenza pandemic preparedness

activities with schools and businesses.

Public Health

Schools:

School Nurses

Superintendents

Public Health

Incident

Commander

Operations

Health

Commissioner

Communicable

Disease Staff,

Nursing Division

Medical

care and

counter-

measures

Advise health-care providers to promptly diagnose

influenza and promptly treat ill persons.

Public Health

Healthcare

Providers


Disease Staff

Based on current recommendations: Public Health Operations Communicable Distribution of Public Health Advisory:



Investigation

Interval

1) Implement infection-control practices;

2) Distribute health advisory notices with information on

case definitions and infection-control measures to

hospitals and outpatient care centers.

Healthcare

Providers

Safety Officer

Disease Staff

Safety Officer

Respiratory

Protection

Coordinator

Emergency

Preparedness

Coordinator

__Healthcare Providers, Clinics:

__Use fax list

__Use groups on CCCHD Outlook

* Other Partners, use CCCHD/EMA Gmail

lists, including:

__Churches (partial coverage)

__ Veterinarians (partial coverage)

__ Pharmacies (partial coverage)

__Extended Care/Assisted Living

__Law Enforcement

__EMS

__Functional Needs Representatives

__Dialysis Clinics

__EMS Medical Directors (partial)

If human-to-human transmission is suspected,

monitor and assist with early access to post-exposure

chemoprophylaxis for case contacts per current

recommendations.

Public Health

Hospital

Healthcare

Providers

Operations

Communicable

Disease Staff

Review all guidance documents, update as needed for

the situation, and communicate with key

Public Health Operations Communicable



Investigation

Interval

stakeholders. Disease Staff

Medical Director

Nursing Division

Emergency

Preparedness

Coordinator

Conduct all usual influenza pandemic preparedness

activities with health-care facilities.

Public Health

Healthcare

Providers

Operations

Liaison

All Staff

Emergency

Preparedness

Coordinator

Vaccine Evaluate all usual influenza pandemic preparedness

activities, including:

o review and update of vaccine distribution

and administration plans

Public Health Public Health

Incident

Commander

Operations

Planning

Nursing Division

Emergency

Response Team

o process for rapid contract negotiation and

staffing

Public Health Planning,

Finance/

Logistics

Finance Officer

Administrative

Assistant to

Health



Investigation

Interval

Commissioner

o mechanisms to identify and provide vaccine

and document vaccination for critical

infrastructure personnel and possible

priority groups for vaccination

Public Health

Hospital

Emergency

Services

Other

Operations,

Planning,

Finance/

Logistics

Nursing Division

o plans and staffing for mass vaccination

clinics and points of dispensing


Operations

Nursing Division

Review guidance documents, update as needed for

the situation, and communicate to key stakeholders.


Operations

Nursing Division

Risk

communi

cation

Frequently update clinicians and veterinarians

through the health alert network.

Public Health Operations

Nursing Division

Emergency

Preparedness

Coordinator

Share information with key federal and local

partners, such as animal and human health public

affairs officers and other agencies or organizations.

Public Health Planning (Sit

Unit) or Liaison

Emergency

Preparedness

Coordinator

Information Sharing:

__Healthcare Providers, Clinics:

__Use fax list



Investigation

Interval

__Use groups on CCCHD Outlook

* Other Partners, use CCCHD/EMA Gmail

lists, including:

__Churches (partial coverage)

__ Veterinarians (partial coverage)

__ Pharmacies (partial coverage)

__Extended Care/Assisted Living

__Law Enforcement

__EMS

__Functional Needs Representatives

__Dialysis Clinics

__EMS Medical Directors (partial)

Disseminate timely and relevant messages to the

public as appropriate.


Information

Officers

Public

Information

Officers

Public Education could include:

Pandemic Influenza: What it is, signs

and symptoms, prevention including

respiratory etiquette and increased

hand hygiene, treatment, how to

care for someone at home,

stockpiling for a medical emergency,

information about social distancing

and community containment plan,

and resource for public information.

Consider Joint messaging with local



Investigation

Interval

partners such as the hospital.

State/Loc

al

coordinati

on

Determine whether state or federal assistance is

required

Public Health

Emergency

Management

Agency

Command and

General Staff

All Staff



Recognition

Interval

Recognition Interval: Recognition of increased potential for ongoing transmission

Indicator: Increasing number of human cases or clusters of novel influenza A infection in the United States with virus characteristics indicating increased potential for ongoing

human-to-human transmission.


Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS


Incident

management Continue or initiate actions described for the investigation

interval for all domains. See above See above See above See above

Consider activation of the local emergency operations center.

Emergency

Management

Agency

Public Health

N/A N/A If EOC opened, Public Health must

provide a representative for the EOC.

Forecast future resource needs for a potential response All agencies Incident

Commander,

Planning,

Operations

Emergency

Response Team

Surveillance

and epi-

demiology

Conduct enhanced novel influenza A surveillance. Public Health


Disease Staff

Continue case-based investigation and control using

standard methods.

Public Health


Disease Staff

Per the Ohio Infectious Disease Control

Manual or other guidance from CDC,

ODH



Recognition

Interval

Report cases according to Ohio Department of Health’s

Reportable Disease and Ohio Disease Reporting System

(ODRS) Guidance

Public Health

Healthcare

Providers


Disease Staff

If animal cases are identified, expand implementation of

joint investigation plan with agriculture officials

Public Health

OSU Extension

OSU School of

Veterinary

Medicine

OSU School of

Agriculture

Farm Bureau

Veterinarians


Health Staff

Laboratory Facilitate confirmation all suspected cases at a public

health laboratory as per ODH and CDC guidance

Public Health

Ohio

Department of

Health


Disease Staff

Facilitate Healthcare Provider compliance with ODH or

CDC guided specimen triage plans as directed.

Public Health

Healthcare

Providers

Hospital

ODH


Disease Staff

Implement surge plans as necessary to facilitate timely

collection and delivery of specimen to appropriate labs

Public Health


Disease Staff



Recognition

Interval

Healthcare

Providers

Hospital

Community

mitigation

Prepare for implementation of community mitigation

measures, such as:

o voluntary home quarantine of contacts

o use of face masks

o temporary closure of child care facilities and

schools

o social distancing measures

o These items are in addition to voluntary home

isolation of ill persons, respiratory etiquette, hand

hygiene, and infection control.

Public Health

Childcare

Facilities

Schools

Public Health

Incident

Commander

Operations

Safety Officer/

Respiratory

Protection

Officer

Public

Information

Officers

Health

Commissioner

Communicable

Disease Staff

Nursing Division

Safety Officer/

Respiratory

Protection

Officer

Public

Information

Officers

CCCHD Respiratory Health and Safety

Plan

Medical care

and counter-

measures

Consider implementation of voluntary contact

chemoprophylaxis based on current recommendations.

o Educate clinicians about recommended

treatment, prophylaxis, and infection-control

guidelines.

Public Health

Hospital

Healthcare

Providers/Clinici

ans


Disease Staff

o Initiate contact with local EMA to discuss Public Health Public Health Health Ohio has cache of antivirals



Recognition

Interval

coordination of Strategic National Stockpile (SNS)

request regarding the potential receipt and

distribution of SNS countermeasures, as

appropriate.

o Consider local caches of supplies

Emergency

Management

Agency

Hospital

Incident

Commander

Operations

Liaison

EOC rep

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Consider local supply through retail

pharmacies

o Assess impact on medical care facilities; Identify

whether medical resources are sufficient to

manage ill persons and conduct case-based

control efforts; determine if assistance is

required.

Public Health

Emergency

Management

Agency

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Vaccine Prepare for vaccine availability and vaccine campaign;

refine vaccine distribution and administration plans if

a campaign will be initiated, including mass

vaccination initiatives and coordination with

pharmacies and other groups, as appropriate.

Consider enrolling adult, obstetrical, and pediatric

health-care providers, including pharmacies, to

promote vaccine access to persons in all indicated age

and risk groups and ability to identify and vaccinate

critical infrastructure personnel.

Ensure that all identified vaccinators are authorized,

and review policies and procedures regarding

identification, authorization and training of

Public Health

Hospital

Healthcare

providers

Closed PODS

Pharmacies

EMS

Public Health

Incident

Commander

Command and

General Staff

Incident

Commander

Nursing Division

Emergency

Preparedness

Coordinator

Emergency

Response Team



Recognition

Interval

nontraditional vaccinators.

Confirm vaccine providers have access to the

immunization information system (IIS) or alternative

systems (IMPACT SIIS via HDIS).

Review capacity and capabilities of Impact SIIS:

o for use by vaccine providers

o in mass vaccination clinics

o for the required dosing schedule anticipated

o with or without adjuvant

Risk

communicati

on

Develop or update a media relations and outreach

plan.

Disseminate risk communication messages, including

what is known, what is not known, and what is being

done by public health officials.

Disseminate messages for travelers, as well as

community mitigation messages, when to seek care,

and how to care for ill persons at home as

appropriate.

Public Health

Hospital

Public

Information

Officers

Public

Information

Officers

Conduct briefings with local, regional, and state

response partners, businesses, tribes, and health-care

facilities on the potential for escalation, response

actions underway, and preparedness steps that

Public Health

Operations

Planning (Sit

Unit)



Recognition

Interval

partners should consider. Liaison

Work with CDC, the U.S. Department of Agriculture,

and the Food and Drug Administration to disseminate

messages to address food safety concerns as

appropriate.

Public Health Operations

Planning

Public

Information

Officers

Environmental

Health

Nursing Division

Public

Information

Officers

State/Local

coordination Continue to coordinate with all partners All Agencies All Staff All Staff



Initiation

Interval

Initiation Interval: Initiation of pandemic wave

Indicator: Confirmation of human cases of a pandemic influenza virus in the United States with demonstrated efficient and sustained human-to-human transmission.


Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS


Incident

management Continue or initiate actions described for the recognition


Consider activation of the local emergency operations center.

Emergency

Management

Agency

Public Health

N/A N/A If EOC opened, Public Health must

provide a representative for the EOC.

Consider declaring a Public Health Emergency Public Health Incident

Commander,

Public Health

Incident

Commander

Process:

Surveillance

and epi-

demiology

If affected, continue enhanced novel influenza A

surveillance.

Conduct case investigation and control using standard

methods.

Public Health


Disease Staff

Per the Ohio Infectious Disease Control

Manual or other guidance from CDC,

ODH

If unaffected, prepare for investigation and response Public Health


Disease Staff

Conduct surveillance for influenza hospitalizations and

deaths as per ODH.


Disease Staff



Initiation

Interval

Healthcare

Providers

Hospital

Laboratory Facilitate confirmation all suspected cases at a public

health laboratory as per ODH and CDC guidance

Public Health

Ohio

Department of

Health


Disease Staff


CDC guided plan to limit testing using surveillance criteria.

Public Health

Healthcare

Providers

Hospital

ODH


Disease Staff

Community

mitigation

Consider implementation of community mitigation

measures in selected locations or institutions as indicated

by the Pandemic Severity Assessment Framework

Public Health

Public Health

Incident

Commander

Operations

Safety Officer/

Respiratory

Protection

Officer

Public

Health

Commissioner

Communicable

Disease Staff

Nursing Division

Safety Officer/

Respiratory

Protection

Officer

Refer to Pandemic Severity Framework



Initiation

Interval

Information

Officers

Public

Information

Officers

Medical care

and counter-

measures

Facilitate and support implementation of:

o voluntary quarantine contacts

o chemoprophylaxis of exposed persons

based on current recommendations

Public Health

Hospital

Healthcare

Providers/Clinici

ans


Disease Staff

Consider deployment of state and local caches Public Health

Emergency

Management

Agency

Hospital

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Ohio has cache of antivirals


pharmacies

Monitor the surge in health-care needs and assess

whether assistance is needed to mitigate the surge.

Public Health

Emergency

Management

Agency

Hospital

Healthcare

Providers

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator



Initiation

Interval

Review and prepare to deploy Mass Fatality Plan Coroner

Public Health

Emergency

Management

Agency

Public Health

Incident

Commander

Operations

Liaison

EOC Rep

Health

Commissioner

Vital Statistics

Communicable

Disease Staff

Vaccine If vaccine available, implement vaccination campaign in

accordance to guidance from ODH and CDC.

Update the state distribution plan based on CDC

prioritization, estimated allocation, epidemiology.

Public Health

Hospital

Healthcare

providers

Closed PODS

Pharmacies

EMS

Public Health

Incident

Commander

Command and

General Staff

Incident

Commander

Nursing Division

Emergency

Preparedness

Coordinator

Emergency

Response Team

Risk

communicati

on

Disseminate updated risk messages, including

information on what might be expected.

Share information regarding:

o antivirals

o possibility of implementation of community

mitigation measures as appropriate

Public Health

Hospital

Public

Information

Officers

Public

Information

Officers



Initiation

Interval

Provide regular updates to

o key partners, stakeholders,

o elected officials

Public Health

Public Health

Incident

Commander

Planning (Sit

Unit)

Liaison

Health

Commissioner

Nursing Division


o Media


Information

Officers

Public

Information

Officers

State/Local


Prepare to receive funds to support response, if

available.

?????

Public Health

Emergency

Management

Agency

Hospital

Finance/

Logistics

Finance Officer



Acceleration

Interval

Acceleration Interval: Acceleration of pandemic wave

Indicator: Consistently increasing rate of pandemic influenza cases identified in the state, indicating established transmission.


Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS


Incident

management Continue or initiate actions described for the initiation


Maintaining processes to monitor effectiveness of response.

Emergency

Management

Agency

Public Health

Command and

General Staff

All staff

Surveillance

and epi-

demiology

If affected, transition surveillance from individual case

confirmation to:

severe disease surveillance

syndromic surveillance

as appropriate and as indicated by ODH.

Public Health


Disease Staff

If unaffected, continue individual case confirmation as

directed by ODH.

Public Health


Disease Staff

Monitor for changes in epidemiology Public Health


Disease Staff

Laboratory Facilitate laboratory confirmation as directed by ODH and

CDC. (Sample of cases may be requested for virology


Disease Staff



Acceleration

Interval

surveillance.)

Ohio

Department of

Health


CDC guided and revised specimen submission protocol.

Public Health

Healthcare

Providers

Hospital

ODH


Disease Staff

Community

mitigation

Consider implementation or expansion of community

mitigation measures for affected communities, examples:

o Temporary closure of child care facilities and

schools

o School and workplace social distancing measures

o Postponement or cancellation of mass gatherings

Public Health

Public Health

Incident

Commander

Operations

Health

Commissioner

Communicable

Disease Staff

Monitor effectiveness of community mitigation measures

Monitor Adverse Impact of Community Mitigation

measures on society; coordinate with local response

agencies as needed

Public health

All Agencies

Planning (Sit

Unit)

Public

Information

Officers

All Staff

Public

Information

Officers

Medical care

and counter-

measures

Educate clinicians about the need for prompt treatment of

ill persons.

Public Health

Hospital


Disease Staff



Acceleration

Interval

Healthcare

Providers/Clinici

ans

Educate the public about the need for prompt treatment

of ill persons.

Public health

All Agencies

Public

Information

Officers

Public

Information

Officers

Consider deployment of state and local caches Public Health

Emergency

Management

Agency

Hospital

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Ohio has cache of antivirals


pharmacies

Monitor antiviral use to identify possible shortages. Public Health

Pharmacies

Hospital

Healthcare

Providers

Operations Nursing Staff

Monitor and respond to surge in health-care needs,

including setting up alternative care sites.

Hospital

Public Health

Emergency

Management

Public Health

Incident

Commander

Operations

Health

Commissioner

Nursing Staff

Emergency



Acceleration

Interval

Agency

Healthcare

Providers

Liaison

EOC rep

Preparedness

Coordinator

Review and prepare to deploy Mass Fatality Plan Coroner

Public Health

Emergency

Management

Agency

Public Health

Incident

Commander

Operations

Liaison

EOC Rep

Health

Commissioner

Vital Statistics

Communicable

Disease Staff

Vaccine If vaccine available, implement vaccination campaign in

accordance to guidance from ODH and CDC.

Public Health

Hospital

Healthcare

providers

Closed PODS

Pharmacies

EMS

Public Health

Incident

Commander

Command and

General Staff

Incident

Commander

Nursing Division

Emergency

Preparedness

Coordinator

Emergency

Response Team

Monitor vaccination coverage levels Public Health Operations Epidemiology

Monitor adverse effects Public Health Operations Nursing Division VAERS



Acceleration

Interval

Risk

communicati

on

Disseminate updated risk messages.


o vaccine

Public Health

Hospital

Public

Information

Officers

Public

Information

Officers


o key partners, stakeholders,

o elected officials

Public Health

Public Health

Incident

Commander

Planning (Sit

Unit)

Liaison

Health

Commissioner

Nursing Division


o Media


Information

Officers

Public

Information

Officers

State/Local


Support maintenance of critical infrastructure and key

resources as appropriate.

Public Health

Emergency

Management

Agency

Liaison

EOC rep



Deceleration

Interval

Deceleration Interval: Deceleration of Pandemic Wave

Indicator: Consistently decreasing rate of pandemic influenza cases in the state.


Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS


Incident

management Continue or initiate actions described for the acceleration

interval as appropriate See above See above See above See above

Review plans, evaluate whether response activities are proportionate to the situation.

Emergency

Management

Agency

Public Health

Command and

General Staff

All staff

Surveillance

and epi-

demiology

Continue

severe disease surveillance

syndromic surveillance

as appropriate and as indicated by ODH.

Public Health


Disease Staff

Monitor for changes in epidemiology Public Health


Disease Staff

Laboratory Facilitate laboratory confirmation as directed by ODH and

CDC. (Sample of cases may be requested for virologic

surveillance.)

Public Health

Ohio

Department of

Health


Disease Staff



Deceleration

Interval

Community

mitigation

Assess, plan for and implement targeted cessation of

community mitigation measures if appropriate.

Public Health

Public Health

Incident

Commander

Operations

Health

Commissioner

Communicable

Disease Staff

Medical care

and counter-

measures

Initiate targeted cessation of surge capacity strategies as

appropriate.

Maintain aggressive infection-control measures in the

community

Hospital

Public Health

Emergency

Management

Agency

Healthcare

Providers

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Vaccine Continue vaccination as appropriate.

Public Health

Hospital

Healthcare

providers

Closed PODS

Pharmacies

EMS

Public Health

Incident

Commander

Command and

General Staff

Incident

Commander

Nursing Division

Emergency

Preparedness

Coordinator

Emergency

Response Team

Risk

communicati

on



Public Health

Hospital

Public

Information

Officers

Public

Information

Officers



Deceleration

Interval

o Measures to prepare for and respond to

possible additional pandemic waves


o Media


Information

Officers

Public

Information

Officers

State/Local




Preparation

Interval

Preparation Interval: Preparation for future pandemic waves

Indicator: Low pandemic influenza activity with possible continued outbreaks in certain jurisdictions.


Agencies

Public Health

Staff in ICS

Public Health

Staff if not in

ICS


Incident

management Continue or initiate actions described for the deceleration

interval as appropriate See above See above See above See above

Consider deactivation of the EOC Emergency

Management

Agency

Public Health

Command and

General Staff

All staff

Prepare for subsequent waves All agencies Command and

General

All Staff

Create an after-action report to document lessons learned Public Health Planning Emergency

Preparedness

Coordinator

Consider suspending the public health emergency declaration

Public Health Public Health

Incident

Commander

Health

Commissioner

Surveillance

and epi-

demiology

Continue case confirmation of selected cases to monitor

progress of the pandemic and detect next acceleration.

Conduct interpandemic surveillance

Public Health


Disease Staff



Preparation

Interval

Laboratory Return to routine interpandemic virologic surveillance. Public Health

Ohio

Department of

Health


Disease Staff

Community

mitigation

Modify Community mitigation measures as necessary.

Continue to promote community mitigation preparedness

activities on standby for a subsequent wave.

Public Health

Public Health

Incident

Commander

Operations

Health

Commissioner

Communicable

Disease Staff

Medical care

and counter-

measures

Monitor medical surge trends.

Hospital

Public Health

Emergency

Management

Agency

Healthcare

Providers

Public Health

Incident

Commander

Operations

Liaison

EOC rep

Health

Commissioner

Nursing Staff

Emergency

Preparedness

Coordinator

Replenish stockpiles and caches as able. All agencies Planning,

Finance/Logistic

s

All Staff

Finance Officer

Monitor antiviral dispensing and usage trends. Public Health Planning Communicable

Disease Staff

Nursing Division



Preparation

Interval

Vaccine Facilitate vaccine recovery as directed.

Continue to vaccinate with focus on hard to reach

populations.

Public Health

Hospital

Healthcare

providers

Closed PODS

Pharmacies

EMS

Public Health

Incident

Commander

Command and

General Staff

Incident

Commander

Nursing Division

Emergency

Preparedness

Coordinator

Emergency

Response Team

Risk

communicati

on



o Measures to prepare for and respond to

possible additional pandemic waves

Public Health

Hospital

Public

Information

Officers

Public

Information

Officers

State/Local




3.5. Pandemic Severity Index

Pre-Pandemic Planning: the Pandemic Severity Index

Future pandemics will be assigned to one of five discrete categories of increasing severity (Category 1 to Category 5). The Pandemic Severity Index provides communities a tool for scenario-based contingency planning to guide local pre-pandemic preparedness efforts. Accordingly, communities facing the imminent arrival of pandemic disease will be able to use the pandemic severity assessment to define which pandemic mitigation interventions are indicated for implementation.



Community Mitigation Strategies by Pandemic Severity

Part 1

Generally Not Recommended = Unless there is a compelling rationale for specific populations or jurisdictions, measures are generally not recommended for entire populations as the consequences may outweigh the benefits.

Consider = Important to consider these alternatives as part of a prudent planning strategy, considering characteristics of the pandemic, such as age-specific illness rate, geographic distribution, and the magnitude of adverse consequences. These factors may vary globally, nationally, and locally.

Recommended = generally recommended as an important component of the planning strategy.



*All these interventions should be used in combination with other infection control measures, including hand hygiene, cough etiquette, and personal protective equipment such as face masks. Additional information on infection control measures is available at www.pandemicflu.gov.

†This intervention may be combined with the treatment of sick individuals using antiviral medications and with vaccine campaigns, if supplies are available

§Many sick individuals who are not critically ill may be managed safely at home

¶The contribution made by contact with asymptomatically infected individuals to disease transmission is unclear. Household members in homes with ill persons may be at increased risk of contracting pandemic disease from an ill household member. These household members may have asymptomatic illness and may be able to shed influenza virus that promotes community disease transmission. Therefore, household members of homes with sick individuals would be advised to stay home.

**To facilitate compliance and decrease risk of household transmission, this intervention may be combined with provision of antiviral medications to household contacts, depending on drug availability, feasibility of distribution, and effectiveness; policy recommendations for antiviral prophylaxis are addressed in a separate guidance document.

††Consider short-term implementation of this measure—that is, less than 4 weeks.

§§Plan for prolonged implementation of this measure—that is, 1 to 3 months; actual duration may vary depending on transmission in the community as the pandemic wave is expected to last 6-8 weeks.

IV. ROLES AND RESPONSIBILITIES

4.1 Public Health, State, Federal, and World Health Organization

4.1.1 Local Public Health (may)

A. Facilitate countywide pandemic planning and preparedness efforts. B. Coordinate the county-wide emergency public health response as outlined in ESF # 8 (Health and

Medical Services). C. Educate staff, the public, health care system partners, response partners, businesses, community

based organizations, and elected officials regarding influenza pandemics, expected impacts and consequences, and preventive measures.

D. Conduct countywide surveillance to track the spread of the human disease and its impact on the community. Encourage, through liaison with agriculture and wildlife agencies, influenza surveillance in animals, if indicated, and monitor surveillance data.

E. Implement public health infection control measures to limit the spread of disease, illness, and death.

F. Coordinate planning for and implementation of disease containment strategies and authorities.

http://www.pandemicflu.gov/



G. Assist with technical support to the health care system including current surveillance guidelines, recommendations for clinical case management, infection control measures, and laboratory testing.

H. Support the health care system’s planning and response efforts for medical surge capacity including mass casualty and mass fatality incidents.

I. Coordinate receipt and distribution of Strategic National Stockpile (SNS) assets. J. Develop and implement protocols for the use of limited supplies of influenza vaccine and antiviral

medicines consistent with national guidelines and in consultation with the ODH. K. Direct distribution and administration of vaccine, including mass vaccination efforts. L. Provide effective communications to the public, the media, elected officials, health care providers,

business and community leaders throughout the public health emergency. M. Participate in a Joint Information Center, if needed, to ensure consistency of public health

messages. N. Participate in information-sharing, planning and response actions among the WCO Region hospitals

and health districts.

4.1.2 Ohio Department of Health (ODH)

A. Coordinate statewide pandemic planning and preparedness efforts. B. Coordinate statewide surveillance activities. C. Operate a CDC Laboratory Response Network public health reference laboratory for novel influenza

virus testing. D. Coordinate submission of pandemic epidemiological data to CDC and dissemination of statewide

data and situation updates to local health jurisdictions. E. Coordinate development and implementation of disease containment strategies across multiple

counties and regions within the state. F. Request federal assistance to support the local health and medical response, including antiviral

medicines and vaccines from the Strategic National Stockpile, when local and state resources are depleted.

G. Educate and inform the public on the course of the pandemic and preventive measures.

4.1.3 Department of Health and Human Services (DHHS)

A. Provide overall guidance on pandemic influenza planning within the United States. B. Coordinate the national response to an influenza pandemic. C. Provide guidance and tools to promote pandemic preparedness planning and coordination for

states and local jurisdictions. D. Provide guidance to state and local health districts regarding prioritization of limited supplies of

antiviral medications and vaccines. E. Determine and communicate the pandemic phase for the U.S. based on the global pandemic phase

(established by WHO) and the extent of disease spread throughout the country.

4.1.4 Centers for Disease Control and Prevention (CDC)

A. Conduct national and international disease surveillance. B. Serve as a liaison to the WHO.



C. Develop reference strains for vaccines and conduct research to understand transmission and pathogenicity of viruses with pandemic potential.

D. Develop, evaluate, and modify disease control and prevention strategies. E. Support vaccination programs; monitor vaccine safety. F. Investigate pandemic outbreaks; define the epidemiology of the disease. G. Monitor the nation-wide impact of the pandemic. H. Coordinate the stockpiling of antiviral drugs and other essential materials within the Strategic

National Stockpile (SNS). I. Coordinate the implementation of international and U.S. travel restrictions.

4.1.5 World Health Organization (WHO)

A. Monitor global pandemic conditions and provide information updates. B. Facilitate enhanced global pandemic preparedness, surveillance, vaccine development, and health

response. C. Declare global pandemic phase and adjust phases based on current outbreak conditions.

4.2 CCCHD (Specific Responsibilities of CCCHD Divisions)

A. The CCCHD Continuity of Operations Plan (COOP) should be consulted as a guide to filling the role of Health Commissioner when he/she is unavailable. Likewise, when staff roles are open due to illness, death or other impacts of the disaster, the CCCHD would make every effort to reassign the remaining personnel into roles in order to maintain essential services. Prioritizing Essential Services is discussed in the COOP.

4.2.1 Health Commissioner

A. Communicate and coordinate directly with the city and county officials, CCCHD Board of Health, and the local health care organization executives regarding pandemic preparedness and response activities.

B. Coordinate directly with partners and make decisions regarding strategies, thresholds, and methods for reallocating resources.

C. Authorize and communicate public health directives regarding social distancing strategies and other protective actions to elected officials, the business community, schools, and other partners.

D. Assign responsibilities to CCCHD staff for planning and responding to the pandemic. E. Ensure business continuity of critical CCCHD functions during all phases of the pandemic – see

Continuity of Operations Plan (COOP). F. Direct isolation and quarantine of individuals and groups, if feasible, based on recommendations

from ODH and CDC. G. Oversee the development of protocols for prioritizing limited supplies of antiviral medicines and

vaccines in Clark County.

4.2.2 Public Information Officer Team (one lead and two back-ups)

A. Provide accurate, timely information to the public regarding preparations for the pandemic, the impacts of the outbreak, local response actions and disease control recommendations.



B. Educate the public as to how they can protect themselves from becoming infected and infecting others.

C. Activate and direct the management of public information call centers focused on providing health information to the public.

D. Provide updates to CCCHD staff regarding the status of the pandemic response. E. Communicate with or participate in the regional JIC if established. F. See Public Information and Warning Plan.

4.2.3 Epidemiology and Communicable Disease Control A. Develop contact investigation protocol for pandemic influenza. B. Coordinate isolation and quarantine protocols if feasible. C. Lead surveillance and epidemiological data tracking and investigation efforts and keep the CCCHD

ERT apprised at all times of the local, national, and global status of the pandemic influenza outbreak.

D. See Epidemiological Response Plan.

4.2.4 Nursing Division A. Participate in planning activities focused to develop capacity for community-based influenza

evaluation and treatment clinics. B. Lead and coordinate all mass vaccination response activities. C. Lead efforts with community partners to manage a client care call center. D. Develop infection control plans for CCCHD sites to protect staff and clients. E. Coordinate countywide pandemic planning, education, and outreach efforts with:

School systems

Business community

Community and faith-based organizations

Hospital, Home Health agencies

Long-term care and Assisted living facilities

Other critical agencies such as EMA, Fire, and Law Enforcement (first responders)

4.2.5 Preparedness Staff

A. Lead pandemic planning and preparedness efforts for CCCHD in conjunction with local, regional, state, and federal response partners.

B. Conduct on-going training, drills, and evaluated exercises to enhance CCCHD’s readiness to respond to a pandemic.

C. Coordinate planning and response activities with hospitals and other community health clinics and stakeholders.

4.2.6 Environmental Health Services Division

A. Assist in surveillance for animal influenza viruses through liaison with the State Departments of Agriculture and Fish & Wildlife if appropriate.

B. Work with the CCCHD PIO to develop and disseminate risk communication messages to the public concerning zoonotic influenza virus transmission, food safety, and animal waste disposal issues.



4.2.7 All Divisions

A. Identify mission critical functions that must be maintained during all hazards including a pandemic. B. Identify staff that can be cross-trained to perform emergency response functions. C. Identify functions that could be temporarily discontinued or performed via telecommuting for

several weeks. D. Be prepared to mobilize all necessary staff to support the CCCHD pandemic influenza response, as

directed by the CCCHD Incident Commander. E. See Continuity of Operations Plan

4.3 Local Stakeholders / Response Partners

4.3.1 Local Hospitals, Clinics, Providers, and other Health System Partners

A. Hospitals and other health care facilities will develop pandemic response plans consistent with the health care planning guidance from DHHS. Health care facility pandemic response plans will address medical surge capacity to sustain health care delivery capabilities when routine systems are overwhelmed.

B. Health care facilities and health care providers will participate in local influenza surveillance activities.

C. Hospitals will develop infection control plans to triage and isolate infectious patients and protect staff from disease transmission.

D. Fatality management will be addressed, as a large numbers of deaths will occur within the medical facility.

E. See Regional Healthcare Emergency Response Plan.

4.3.2 Local Law Enforcement

A. Local law enforcement agencies (Clark County Sheriff’s Office and Springfield City Police Division) cooperate with the CCCHD by assisting with security for isolation / quarantine, if feasible; increased security for antiviral and vaccine shipments and mass dispensing POD sites. They have assisted with developing security plans for each of the identified POD sites.

4.3.3 Fatality management

A. The CCCHD in partnership with the coroner and local funeral directors will develop within the pandemic response plan a description of the roles and responsibilities of the persons responsible for a mass casualty event

B. CCCHD Vital Statistics office will work closely with the morticians to ensure that the plan for death registration is complete and accurate and is consistent with the ODH Pandemic Influenza Mass Aftermath Casualty Plan.

C. The pandemic flu plan developed by the Coroner and local morticians will include mechanisms for handling aspects of fatality management such as: identification of sufficient refrigerated storage areas to serve as temporary morgues, plan for surge capacity when current morgue capacity has been exceeded, scene documentation, complete collection and recovery of the death victim’s personal effects and items of evidence, decontamination of remains and personal effects,



maintenance of a paper backup registration in the event the Electronic Death Registration System (EDRS) or internet is not available, establishment of Memorandum of Understandings (MOU’s), exploring the role of alternative burial processes and the role for volunteers and the necessary training required for their tasks.

D. See Mass Fatality Plan

4.3.4 Medical Reserve Corps (MRC)

A. The MRC Coordinator maintains the demographic information for MRC volunteers as well as credentialing information, training provided by the CCCHD staff as well as any training acquired elsewhere.

B. The Clark County Volunteer Reception Center (VRC) is coordinated through the United Way of Clark, Champaign, and Madison Counties and has established a Clark County primary site and an alternate site if needed. Volunteers are trained periodically.

C. See Volunteer Management Plan.

4.3.5 Emergency Medical Response A. CCCHD will cooperate with city and local emergency response divisions to provide pandemic

influenza training and to assist them with developing their pandemic influenza preparedness plans when appropriate.

B. The plans will be consistent with the guidelines set forth by the Ohio Department of Health and the Centers for Disease Control and Prevention.

4.3.6 School Districts

A. CCCHD will work closely with officials within the city and county school systems if social distancing becomes necessary.

B. Education will be provided as needed on an ongoing basis. C. The school staff will cooperate with the CCCHD epidemiology / surveillance staff in conducting

ongoing surveillance for influenza like illnesses during the school year. D. MOU’s are place with specific schools that are utilized as POD sites.

4.3.7 Clark County Emergency Management Agency (EMA) A. Coordinates continuity of government planning and preparedness for county political jurisdictions. B. Ensures prompt and efficient emergency response and recovery.

C. Activates the county Emergency Operations Center (EOC) as needed. D. Activates the Emergency Support Functions (ESF) of the county EOP as needed E. Manages and coordinates county response and recovery resources. F. Notifies the Ohio Emergency Management Agency of the situation in Clark County. G. Facilitates requests for state emergency management assistance as needed

4.3.8 Other Stakeholders

1. CCCHD will participate in educational activities, as time is available, for other stakeholders such as non-governmental and governmental organizations.



V. Authorities 5.1 State of Ohio 5.1.1 Ohio Revised Code (ORC) Section 5923.21 authorizes the Governor to call-up by proclamation the Ohio

National Guard to aid civil authorities acting in the event of a disaster to promote the health, safety and welfare of Ohio citizens.

5.1.2 The Ohio Emergency Management Agency (OEMA) is the central point of coordination within the state

for response and recovery to disasters. 5.1.3 The Ohio Department of Health (ODH) has supervision of all matters relating to the preservation of the

life and health of the people and has ultimate authority in matters of quarantine and isolation, which it may declare and enforce, when neither exists, and modify, relax, or abolish, when either has been established. Whenever possible, the ODH shall work in cooperation with the health commissioner of a general or city health district, and may make and enforce orders in local matters when an emergency exists, or when the board of health of a general or city health district has neglected or refused to act with sufficient promptness or efficiency (ORC Section 3701.13).

5.1.4 The Director of Health shall investigate or make inquiry as to the cause of disease or illness, including

contagious, infectious, epidemic, pandemic, or endemic conditions, and take prompt action to control and suppress it (ORC Section 3701.14).

5.1.5 Boards of Health of a general or city health district, health authorities and officials, officers of state

institutions, police officers, sheriffs, constables, and other officers and employees of the state or any county, city, or township, shall enforce quarantine and isolation orders, and the rules the Department of Health adopts (ORC Section 3701.56).

5.2 Clark County Administrator 5.2.1 The County Administrator, the chief operating officer for the County, reports directly to the County

Commissioners and is responsible for continuity of county government functions. 5.2.2 The County Administrator, under the direction of the Board of County Commissioners, shall perform

any or all functions conferred or incumbent upon the Board of County Commissioners in the case of a disaster or emergency, provided that the board, by resolution, has delegated the specific functions or all of the functions to the Administrator (ORC Section 305.30). Disaster and emergency have the same meanings as in Section 5502.21 of the Revised Code. The specific functions delegated to the County Administrator, as listed in ORC Section 5502.21, are civil defense, emergency management, and emergency preparedness/Homeland Security actions.

5.3 Municipalities



ORC Section 715.37 authorizes any municipal corporation to:

Provide for the public health

Secure the inhabitants of the municipal corporation from the evils of

contagious, malignant, and infectious diseases

Purchase or lease property or buildings for pesthouses (a house or hospital for

persons infected with pestilential disease; e.g., plague etc.)

Erect, maintain, and regulate pesthouses, hospitals, and infirmaries. 5. 4 Clark County Combined Health District Board of Health 5.4.1 The Board of Health is authorized to study and record the prevalence of disease within its district, to

provide for the prompt diagnosis and control of communicable diseases, and to take such steps as are necessary to protect the public health and to prevent disease (ORC Section 3709.22).

5.4.2 The Board of Health may make such orders and regulations as are necessary for its own government,

for the public health, and for the prevention or restriction of disease. In cases of emergency caused by epidemics of contagious or infectious diseases, or conditions or events endangering the public health, the Board of Health may declare such orders and regulations to be emergency measures, and such orders and regulations shall become effective immediately (ORC Section 3709.21).

5.4.3 The Board of Health has specific authority pertaining to the control of dangerous communicable

diseases as listed in the Revised Code, including quarantine and isolation, inspection and / or destruction of property, disposal of contaminated bodies, closure of schools, and prohibition of public gatherings (ORC Sections 3707.04 to 3707.26).

7.4.4 The Board of Health may seize, occupy, and temporarily use for a quarantine hospital a suitable vacant

house or building within its jurisdiction (ORC Section 3707.31). 5.5 Clark County Health Commissioner 5.5.1 The Health Commissioner is the executive officer of the Board of Health, and is authorized to carry out

all orders of the board and of the Ohio Department of Health (ORC Section 3709.11) 5.5.2 Quarantine and isolation authority granted to the Board of Health by the Ohio Revised Code has been

delegated to the Health Commissioner by Resolution #00-096 when the Health Commissioner finds that: (a) a threat to the public exists; or (b) the action is necessary to administer the provisions of ORC 3707.04 to 3707.32; and (c) circumstances have rendered a meeting of the board impractical or impossible; or,(d) delaying action until a meeting of the board would compromise the public health.



VI. Attachments Attachment 1 – Prioritization for Influenza Vaccine or Antiviral Medication Attachment 2 – Consideration of Items Included in other CCCHD Plans Attachment 3 – Links to Resources and Planning Guides for Community Agencies



Date Description of Change or Action Pages

Affected

Reviewed or

Changed by

10/2006 Created S Dobbins

09/2007 Revision JAndrews




03/2011 Review Only JAndrews

04/2012 Complete Revision JAndrews

04/25/2016 Format Change in multiples sections

Integrated Pandemic Phases as per MMWR September 2014

Minor language changes in Roles/Responsibilities

multiple C.Conover

05/06/2016 Reorganize sections of the plan

Refer to other parts of CCCHD Emergency Response Plan in place of maintaining set of

procedures in this Pan Flu Plan (former attachments, now Attachment 2)

Refer to weblinks for community planning guides in place of maintaining planning text as part

Pan Flu Plan (former attachments, now Attachment 2)

Minor language changes in Roles/Responsibilities

Reviewed content with Health Commissioner

multiple C.Conover

05/09/2016 Inserted page breaks between attachments

Corrected Table of contents (page numbers)

Added “interval overlays”

54-58

2

13-43



ATTACHMENT 1 Prioritization of Vaccine and Antivirals

Assumptions:

1. Antivirals are recommended by the Centers for Disease Control as an effective method for post exposure prophylaxis and/or treatment of influenza vaccination

2. Vaccine is recommended as an effective method of prevention of influenza

3. Supply shortages necessitate prioritizing which groups of the population should be targeted to receive vaccine or antiviral.

The Clark County Combined Health District will prioritize the county’s allocation and local cache of vaccine or medical countermeasures such as antivirals, in accordance to the guidance from Center for Disease Control (CDC). It should be noted that the approach of mitigating disease transmission includes the administration of vaccine in addition to an aggressive social distancing policy.



Attachment 2

Planning Items Related to Pandemic Influenza Plan

This list includes items which will be addressed in other sections of the CCCHD Emergency Response Plan.

Associated Concepts Refer to:

CCCHD Emergency Response Team PHP 1 Community Preparation

Periodic Testing of Pandemic Influenza Plan

Maintenance of Essential Services during Pandemic Continuity of Operations Plan

Dissemination of Information to Public for Pandemic Influenza Public Information and Warning Plan

Availability of Vaccinations for Personnel PHP 14 Responder Safety and Health Plan

Dissemination of OPHCS and Health Alerts PHP 6 Information Sharing

Influenza Surveillance PHP 13 Epidemiological Response Plan

Disease Investigation Orientation PHP 13 Epidemiological Response Plan

Reporting of Communicable Disease PHP 13 Epidemiological Response Plan

Monitoring Influenza-like Illness Among Staff PHP 14 Responder Safety and Health Plan

Employee Training for NIMS/ICS Multiyear Training and Exercise Plan

EOC Assignments and Responsibilities PHP 3 Emergency Operations Coordination

Medical Reserve Corp PHP 15 Volunteer Management



Attachment 3

Links to Planning Resources for Community Partners

1. http://www.flu.gov/planning-preparedness/school/index.html

Child Care and Preschool Pandemic Influenza Planning Checklist

School District (K-12) Pandemic Influenza Planning Checklist

Colleges and Universities Pandemic Influenza Planning Checklist

2. http://www.flu.gov/planning-preparedness/community/index.html

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist

3. http://www.flu.gov/planning-preparedness/business/index.html

Business Pandemic Influenza Planning Checklist

http://www.flu.gov/planning-preparedness/school/index.html

http://www.flu.gov/planning-preparedness/community/index.html

http://www.flu.gov/planning-preparedness/business/index.html

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