Overall Plan Assumptions (pandemicflu.gov)
1) Susceptibility to the pandemic influenza virus will be universal.
2) Efficient and sustained person-to-person transmission signals an imminent pandemic.
3) The clinical disease attack rate will likely be 30 percent or higher in the overall population during
the pandemic. Illness rates will be highest among school-aged children (about 40 percent) and
decline with age. Among working adults, an average of 20 percent will become ill during a
community outbreak.
4) Some persons will be infected but not develop clinically significant symptoms. Asymptomatic or
minimally symptomatic individuals can transmit infection and develop immunity to subsequent
infection.
5) Of those who become ill with influenza, 50 percent will seek outpatient medical care.
6) With the availability of effective antiviral drugs for treatment, this proportion may be higher in the
next pandemic.
7) The number of hospitalizations and deaths will depend on the virulence of the pandemic virus.
Estimates differ about 10-fold between more and less severe scenarios. Two scenarios are
presented based on extrapolation of past pandemic experience (Table 1). Planning should
include the more severe scenario.
8) Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to include
infants, the elderly, pregnant women, and persons with chronic medical conditions.
9) Rates of absenteeism will depend on the severity of the pandemic.
10) In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members,
and fear of infection may reach 40 percent during the peak weeks of a community outbreak, with
lower rates of absenteeism during the weeks before and after the peak.
11) Certain public health measures (closing schools, quarantining household contacts of infected
individuals, “snow days”) are likely to increase rates of absenteeism.
12) The typical incubation period (interval between infection and onset of symptoms) for influenza is
approximately two days.
13) Persons who become ill may shed virus and can transmit infection for up to one day before the
onset of illness. Viral shedding and the risk of transmission will be greatest during the first two days
of illness. Children usually shed the greatest amount of virus and therefore are likely to pose the
greatest risk for transmission.
14) On average, infected persons will transmit infection to approximately two other people.
15) In an affected community, a pandemic outbreak will last about six to eight weeks.
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16) Multiple waves (periods during which community outbreaks occur across the country) of illness
could occur with each wave lasting two to three months. Historically, the largest waves have
occurred in the fall and winter, but the seasonality of a pandemic cannot be predicted with
certainty.
17) Resources will be exhausted or in short supply, including vaccines, beds, care-givers, ventilators,
and many other necessities.
18) Plans must allow for flexibility in response.
19) Diversion of resources will be limited.
20) An Acute Care Site will be established at or around the time of an emergency declaration.
21) Community education is an ongoing part of the pandemic preparation procedure.
22) Patients could be triaged home for self care. Palliative care may occur at home or in non-hospital
settings.
23) All federal, state and local response plans will be implemented and followed.
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Ethics Committee Assumptions
1) During the course of an emergency, the ethical rules that govern the delivery of health care shift.
Under normal conditions the heaviest weight is given to considerations of individual autonomy and
rights, while considerations of the public good take second place. During an emergency the weight
shifts toward public good considerations and the more severe the emergency, the weightier the
public good becomes. This does not mean the individual autonomy disappears as a moral
consideration, only that it carries less weight and can more easily be overridden by considerations
of the greater good.
2) Assumptions concerning the public:
(a) The public is capable of understanding that standards of care must be adaptive to
emergency conditions, both during and after the event.
Two competing assumptions:
(b) There will be a rise in anti-social behavior and most citizens will refuse to help others
while hoarding/getting what they can for themselves.
(c) Citizens will rise to the occasion, support emergency care providers, volunteer as
assistants, obey public health rules, and generally act in ways that serve the greater good.
(There is quite a bit of evidence to support (b) when citizens feel that the authorities are
communicating honestly and proposing rules that are reasonably fair to all and connected
clearly to the common good.)
3) Medical care will not be provided as it usually is:
(a) Care givers will find themselves called to work outside their normal range of
professional activities.
(b) Care givers do have a moral duty to continue to provide care during a pandemic. At the
same time, a significant number of caregivers will not be able to serve or will be unwilling
to serve.
4) Ethical considerations will continue to guide actions during the course of a pandemic, and
emergency workers will receive some form of ethics training/basic guidelines in their preparation
for service.
5) Businesses (and other non-health related organizations) will continue to function at some level and
will cooperate with emergency planners.
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Infrastructure Committee Assumptions
1) Outpatient Care will be recording treatment on a paper system – door-to-door health care
provisions.
2) Pre-ED Triage will be developing a phone call tree system, and phone tree criteria.
3) Hospitals will have technology in place and they could maintain their networking system and data
collection between main campus and ACS.
4) The State of Michigan will allow their telecom systems such as MDOS, UIA, DHS and Treasury to
be used during a pandemic if needed and assume that these systems can meet our needs.
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Staffing Committee Assumptions
1)
Non-traditional staffing will be available to support proposed staffing models.
a) On-the-job trained or just-in-time training essential
b) There will be an expansion of traditional roles
2) There will be an increased number of patients in hospitals with a higher acuity level than “normal”
as pandemic intensifies.
a) Provide current standard of care as long as physically possible, then shift focus to
modified critical care staffing model for hospitals
b) 7-day stay at critical care acuity level as norm for the hospitalized patients per Flu-surge
calculations
c) Hospital logistics more difficult due to layout
i. Efforts will be made to separate infected patients from non-infected patients.
ii. Large wards not available for cohorting
3) Staff ACS as a support/palliative service –
a) Focus on modified nursing home staffing models for ACS
b) Basic model is for 50 bed units, which can be expanded or contracted as required
i. Physician offices/clinics/centers could be used to provide supportive care in
addition to already contracted ACS sites
(1) If office/clinic/center no longer able to provide care, staff may be asked
to supplement other emergency response areas
ii. Nursing homes are an additional resource for palliative care
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Legal Committee Assumptions
1) Limited availability of police department for security at hospital.
2) Personal physicians would “know what to do,” as to system-wide triage.
3) People will embellish history in order to get maximum care.
4) With the declaration of an emergency, the state will request an EMTALA waiver.
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Essential Services Assumptions
1) Staff available to support the essential services at the sacrifice of non-essential services (elective
surgery, etc.).
2) Hospital and community infrastructure will be available (power, fuel, sewage…) and intact.
3) Site protection and security in place.
4) Intact patient transport system.
5) Families will provide care at home if no room at hospital.
6) No other concurrent disasters.
7) Economy remains viable (payment and reimbursement, currency).
8) Warning of pandemic will provide time to prepare and mobilize resources.
9) Altered standards of care will be consistent for the Region.
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Multi-Disciplinary Committee Assumptions
1) Hospitals will not be able to share current resources.
2) We assume the CDC and MDCH will mandate guidance for the response and delivery of health
care services based on the severity of the event, the fluidity of information, the availability of
pharmaceuticals, etc.
3) We assume staffing will be scalable based on that guidance.
4) We assume that hospitals will provide resources to staff ACSs, and that EMS agencies with public
health departments will collaborate to provide staffing for NEHCs, depending on the function of the
NEHCs.
5) We assume that the plan will serve as a coordination and prioritization matrix within an ethical
framework.
6) We assume the current social system will be challenged (shopping, funerals, medical supply
delivery).
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State / Local Committee Assumptions
1) A novel influenza strain may enter Michigan in one of several scenarios, and the Lead Agency
would differ depending upon which scenario develops:
a) Novel strain (e.g., Avian) in domestic animals: MDA (USDA federal partner).
b) Novel Strain in wildlife/wild birds: MDNR (USDA federal partner).
c) Novel Strain in humans: MDCH (CDC/HRSA federal partners).
d) Pandemic strain (only seen in humans): MDCH.
e) The MDCH emergency coordination center, according to Emergency Support
Function #8 is the lead agency to coordinate the response to a pandemic influenza.
2) Pre-pandemic education is critical to have citizens of Michigan prepared for a pandemic.
a) Local health department personnel will be limited to direct public health response and
will not be available to supplement other response activities.
b) State and local health departments have included the special needs of diverse
populations in their communication and response plans.
3) The Director of MDCH, by statute, has the overall responsibility for decision-making for MDCH.
a) The Local Health Officer, by statute, has the overall responsibility for decision-making
for their respective Local Health Department.
b) This includes limitation of public gatherings, including church services, sporting events,
entertainment venues, etc.
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Outpatient Committee Assumptions
1) Pre-ED triage will provide medical dispatchers triage cards for flu patients.
2) Altered vehicle licensing and EMS personnel staffing for transport and transfers.
3) Primary care will rely on public communications to instruct patients where to seek out treatment.
4) MEMS will be followed for surge considerations. There will be a place to transfer patients whose
illness has progressed based on triage criteria.
5) Accessibility to health care will exist at some level no matter the level of pandemic flu.
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Cross Border Committee Assumptions
1) Federal / tribal agencies control their respective borders and border access.
2) We as a region cannot make international border agreements, but we can make recommendations
based on the objectives in the grant proposal and agreements currently developed.
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Pre-ED Triage Committee Assumptions
1) Recognize onset of out break is early enough to be proactive.
2) Lack of local control/empowerment will threaten local response efforts.
3) We will be operating at different levels of response for extended periods of time.
4) Primary care offices will be functioning.
5) ER/Hospitals will be overwhelmed.
6) We will have a functioning 911 system.
7) At some point, we will need to triage patients as expectant (black tag) by phone evaluations.
8) Appropriate pre-hospital real-time decision making by EMS medical directors, as it applies to
alternate treatment standards, will be supported retroactively by State authorities.
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