Since its 1907 founding in England by retired 50-year veteran British Army Lt. Gen. Robert Baden-Powell, the motto of Boy Scouting has been, very simply, to "be prepared."
"Be prepared for what?" someone once asked Baden-Powell.
"Why, for any old thing," he is said to have blithely replied.
With U.S. and global medical experts, including the federal government's Atlanta-based Centers of Disease Control and Prevention (CDC), increasingly concerned that the Avian Influenza A (H5N1) or "bird flu" virus is changing, possibly evolving into a pandemic flu virus, Vilas County school and government leaders borrowed a page from the Boy Scouting manual on Friday, May 30, gathering at Eagle River Memorial Hospital for the Vilas County Health Department's Pandemic Influenza Community Containment Tabletop Exercise.
The exercise was held to test the implementation of school closures in a pandemic influenza situation, reach group consensus on how and when to close and reopen schools and identify preparedness actions that need to be undertaken.
What is pandemic influenza?
Influenza pandemics - the worldwide epidemic of a new strain of an "A" type influenza virus - is a major concern because few, if any people, have immunity to the new virus, which spreads quickly and easily, causing serious illness and deaths. Vaccines against the new influenza virus would not be available for four to six months after the outbreak, and then likely only available in limited amounts.
Pandemic influenza differs from its season influenza counterparts in several key ways.
While rare in occurrence, unlike the mild Category 1 seasonal October-April seasonal flu viruses, pandemic influenza can strike any time of the year. While there is usually some natural immunity for the seasonal flu viruses, there is little to no immunity for pandemic flu. And where seasonal influenza tends to strike children and older adults hardest, pandemic influenza also strike healthy adults, the 20- to 60-year-old heart of the U.S. workforce.
Since the infamous global "Spanish flu" pandemic of 1918-19, a severe Category 5 outbreak, the U.S. has seen only two mild-to-moderate Category 2 pandemic outbreaks in 1957 and 1968 according to the CDC.
While models can be used to estimate possible pandemic impacts and data from past pandemic outbreaks can provide clues, it isn't possible to predict the severity of the next global influenza pandemic according to Pandemic Influenza Community Containment Tabletop Exercise facilitator Mary Texidor, a Wausau-based health educator with the Northwoods Consortium for Public Health Preparedness.
The Northwoods Consortium serves 14 Northwoods and north central Wisconsin counties, as well as three regional tribes.
Humans contract avian flu through birds that area infected with the virus. While no human cases have turned up in the U.S., a number of people have contracted and died of it elsewhere in the world, largely in southeast Asia.
According to figures from the Menlo Park, Calif.-based Henry J. Kaiser Family Foundation, a private non-profit organization focusing on U.S. and global health issues, there have been 383 confirmed global cases of H5N1 influenza and 241 confirmed H5N1 deaths through May 28, 2008.
H5N1 bird flu deaths were reported in Indonesia (108), Vietnam 952), Egypt (22), China (20), Thailand (17), Cambodia (7), Azerbaijan (5), Turkey (4), Iraq (2), Laos (2), Nigeria (1) and Pakistan (1).
According to the U.S. Department of Health and Human Services, a flu pandemic outbreak in the U.S. would have significant impacts on society, infecting large numbers of people, including children and young adults.
In addition to illness, many deaths could be expected in a pandemic situation based on past experiences.
The global 1918-19 H1N1 "Spanish flu" pandemic, a severe Category 5 outbreak, caused the deaths of at least 675,000 Americans and more than 25.1 million worldwide. It's estimated that a pandemic of similar severity today could sicken 90 million Americans and more than 1,000,000 Wisconsin residents, with mortality estimates set at two million Americans, including more than 10,000 Wisconsin residents, 126 Vilas County residents and 18 members of the Lac du Flambeau tribal community.
Texidor noted that in St. Louis, where local officials practiced social distancing and other community containment strategies during the 1918-19 Spanish flu outbreak, infection and death rates were dramatically lower than the national averages.
When a pandemic situation does occur in the future, the use of multiple early, targeted and layered non-pharmaceutical community-based local interventions - community containment initiatives, infection control measures and travel restrictions - are viewed as the best way to help reduce exposure to the virus and hopefully mitigate the effects of the pandemic, by delaying its outbreak and diminishing overall cases and health impacts.
In the event of a pandemic outbreak, federal, state and local agencies would provide guidance on the need for various community-based interventions, including voluntary quarantines of the ill and those in household contact with them and various "social distancing" initiatives - closing schools and day care centers, working from home and staggered work schedules, canceling public gatherings such as faith-based and community events and avoidance of public transportation and crowded public places like concerts, sporting events and shopping malls.
Community containment initiatives are seen as bringing three-fold benefits - limiting the spread of pandemic influenza, preventing disease and death and lessening the pandemic's impact on the economy and society in general.
As the Vilas County Health Department hosted a 2-1/2-hour Friday, May 30 community containment tabletop exercise at Eagle River Memorial Hospital. The exercise was held with the goals of testing the implementation of school closures in a flu pandemic situation, reaching group consensus on how and when to close and reopen schools and identifying preparedness actions that need to be undertaken.
School, community leaders gather
Concerned about the likelihood of a pandemic flu outbreak reaching U.S. shores, North Lakeland School superintendent Richard Vought sent school nurse Kirsten Olson to the Friday, May 30 Community Containment Tabletop Exercise at Eagle River Memorial Hospital.
"It's not if it's going to occur, but when it's going to occur," Vought told The Times. "It's good to start planning for this and have plans in place, instead of flying by seat of our pants. It (pandemic flu) is a great concern. I can definitely see it happening as the world continues to get smaller. A pandemic is likely to happen in some sort of fashion."
Olson was one of fourteen Vilas County school representatives and government officials attending the Community Containment Tabletop Exercise.
Vilas County representatives included Emergency Management Agency director Jim Galloway, Health Department director Gina Egan and Board of Supervisors vice chair Kathleen Rushlow, who also serves as chairperson of the county's Local Emergency Planning Committee (LEPC).
Over the course of the 2-1/2 hour gathering, Texidor educated attendees on influenza pandemics and then walked them through four possible pandemic scenarios. Wrapping up the program, Texidor also oversaw tabletop debriefing session.
A number of questions were raised for attendees in tabletop exercises discussing the various pandemic scenarios presented, including:
Would you elect to close schools and for how long?
Who has the authority to close schools, both public and private?
What is the procedure for routine school closings and would this be different if schools would be closed for 4-6 weeks.
Who would advise and assist in the decision to close schools beside school officials and the county health department?
Would closures be expanded to include pre-schools, child care facilities, private schools and post-secondary schools, including colleges and technical schools?
How would school closures be announced to the public and what would the likely reaction be?
How would schools monitor what other county offices and school districts are doing in response to the pandemic.
What special issues need to be considered related to the needs of students, families and staff and what kinds of services would be needed to assist children and their families during an emergency closure.
What other steps need to be taken beyond dismissing students from school?
How would school meal programs and school-based health services be maintained?
How and when would the decision be made to reopen schools and what procedures would be followed for resuming classes and other school-based activities?
How would students catch-up on learning requirements?
Noting she and the 205-student 4K-8 school already collaborate on medical issues with a medical advisor and the Vilas County Health Department, Olson told The Times that she found attending the Pandemic Flu Community Containment Tabletop Exercise was beneficial.
"Our schools really rely on their school nurses to inform the higher powers - superintendents, school board members - as to what's going on ... They rely on school nurses to keep them informed. This [Community Containment Tabletop Exercise] gives us a much better picture of what we need to be prepared for, the steps we need to take ... It'll make everyone more prepared. It's not a matter of if but when a [pandemic flu] outbreak occurs. We need to be prepared and educated. This is a great way to help us get prepared."
County officials praise tabletop exercise outcomes, collaboration
Last Friday's Pandemic Influenza Community Containment Tabletop Exercise drew high marks from participants, including Vilas County Board of Supervisors vice president Kathleen Rushlow.
"I think one of the most important things we can do is begin the process of training our minds to think in this fashion," said Rushlow, who also serves as chair of the county's Local Emergency Planning Council (LEPC). "That's the hard part - getting around that initial shock and working on, 'Oh my God! What are we going to do?' But once you go to a few of these, it becomes easier. You begin to start thinking in that vein, 'How do we handle this? How do we handle that?' All the little things you might overlook come to light and you become much more prepared."
Initiatives like the tabletop exercise and other emergency preparedness activities, she said, make a big difference in the effectiveness of emergency responses.
"We have found that through emergency management ... it really, really helps, it really makes a difference," she said. "There's no limit to the amount it can help..."
Jim Galloway, Vilas County's emergency management director, was pleased with the turnout and the progress made toward enhancing emergency preparedness in a pandemic flu situation.
"From my perspective, this was a very well carried out exercise with a very good blend of disciplines around the table," he said. "I think this was an eye-opening exercise for the various disciplines that were present. Often what you find out when emergencies happen is not every agency has a complete understanding of what another agency is going to do. I think there was a good exchange of information here. I think the schools now know what some of the county's responsibilities are and the county's aware now of some of the problems that the schools will encounter in this kind of scenario and then the broader effect on the community at large...
Levels of pandemic flu preparedness vary widely, based on the severity of an outbreak.
"If the pandemic occurs at the [moderate] level that was discussed in this exercise, the scenario we were given, I think the [local] level of preparation is good," Galloway said. "If the pandemic is much more serious in nature, I think the level of preparation across the entire country is not so good ... The whole country is ill-prepared."
Vilas County Health Department director Gina Egan said she welcomed the opportunity to bring a wide breadth of the community into pandemic emergency preparedness discussions.
"For me, it's a great thing to get people to the table that we normally don't have the opportunity to meet with and to bring them together and bounce some ideas off of them," she noted. "When you go school-by-school to talk to people, you don't get that synergy that Phelps says to Northland Pines says to Conserve says to North Lakeland says to Lac du Flambeau ... I think exercises like this are good for stimulating ideas. I think that's a good thing."
And for all the bird flu hype in the national media, Egan said most people fail to truly grasp the wide-ranging impacts that a severe global flu pandemic would bring.
"The idea of forty percent of your infrastructure being out at one given time, I don't think anyone can comprehend what that means," she said. "Is there someone to drive that bread truck up from Milwaukee? We're talking here about getting school lunches to people. Is somebody going to be getting the food to us to get it to people? If something like this happens in Milwaukee or Chicago and sixty percent of our homes are owned by out-of-county people, are they going to come up here and need medical services, thinking we're a safe place to be? How would we ever meet those needs? Our population can jump [from 22,215] to more than 150,000 people. If those people need medical care, medical services, how could we ever provide them..."
Emergency preparedness initiatives like the Pandemic Flu Community Containment Tabletop Exercise, Egan noted, go a long way toward fostering a realistic plan of attack for facing and responding to such situations.
"We've been meeting as a consortium for five years," she said. "Our plans at the beginning were very unrealistic. CDC guidance was very broad. We've evolved. It's not there yet, but it's a much more workable plan than it was in the beginning..."
Vilas County school officials attending the Health Department's May 30 Pandemic Flu Community Containment Tabletop Exercise found the session both eye-opening and informative.
Among those participating was Richard Parks, superintendent of the 168-student School District of Phelps, a single building K-12 district serving the 1,366-resident eastern Vilas County community.
"I thinks it's a great way to start the conversations," Parks said. "If this is something that may truly impact northern Wisconsin or any of the schools up here, the best way to start preparing for it is to have all the conversations. The more conversations you have with the stakeholders, whether it be community or schools, the greater your ability to hopefully plan for any possibility that's out there. Just like we've done with our other crisis plans, to be able to extend that into a pandemic potential and look at all those additional factors is a real good start for us for getting our minds wrapped around what we're going to need to do as a school district and as a community entity."
Melissa Hogenmiller, a school nurse at 135-student Conserve School, an environmentally-focused 135-student college preparatory boarding school in Land O' Lakes, also found the tabletop exercise helpful.
"We need to focus more on what our plan of action will be," she said. "We can have a closed campus if we need to, but we need to look into what we would do with our students. Would we close down completely and send our students home. 20 different countries? It raised a lot of good questions."
Hogenmiller said the information and group input gathered from the Pandemic Flu Community Containment Exercise provides the perfect impetus for getting the pandemic flu preparedness ball rolling at Conserve School.
"I've been wanting to get this started for awhile and now we can start," she said. "I can meet with all the people I need to meet with now and we can form our school group and come up with our plan. It's very important to know exactly what we would do."
Also impressed by the emergency preparedness exercises was Donna Clark, school nurse at 420-student K-12 Lac du Flambeau Public School, which also houses the Lac du Flambeau tribe's Head Start program.
"I thought it was a very good exercise as far as collaborating together and looking at who is making decisions," she said. "It opened my eyes to ... how far-reaching a pandemic may be, how all areas of life are going to be affected. It gives you things to think about."
Clark said she was looking forward to talking with district administrators about crafting a district preparedness plan for dealing with pandemic flu, either by enhancing the district's existing crisis intervention policy or creating a dedicated pandemic flu response plan.
Said Clark of the road ahead, "We have a lot to work on."
CDC recommends preparations
The U.S. Department of Health and Human Services, CDC and other health experts are also encouraging individual citizens to stock up on foods and other necessities, improve their personal health habits and plan ahead for how they will care for themselves and their family members in a flu pandemic situation.
Citizens are encouraged to store non-perishable foods, bottled water, over-the-counter medications, health supplies and other necessities, preferable a two-week supply. These supplies, it's noted, are also useful in dealing with other types of emergencies, including power outages.
Learn more about pandemic flu
Information and guidelines are available from the World Health Organization (WHO), as well as the federal CDC at their dedicated www.pandemicflu.gov web site.
Eric Johnson can be reached at firstname.lastname@example.org.
Posted: Monday, June 9, 2008
Article comment by:
Can you hear my applause all the way from another state? This tabletop exercise was critically important, and the detailed reporting here makes it one others can learn from.
Please let me bring to your attention another valuable resource for pandemic preparedness. Created by a grassroots team of physicians, an emergency manager, a first responder, parents, and teachers, Getpandemicready.org offers downloadable PDFs covering all aspects of pandemic preparedness for individuals and families. The site is easy to use and can help anyone take manageable steps to prepare for the next influenza pandemic