Virology 315
Group 6, The H5N1 Resistance
Mallory Weiland, Robert Haas, Maggie Ridder,
Kimberly Hoppe and Daniel Gehrke
Winnebago County Flu Plan
Part 1) Individual
a) Flu Care Kit:
 Bottled water – 1 gallon per person per day for 5-6 weeks
 4 bottles of Tylenol/or other fever and pain reducer
 4 boxes of crackers
 4 boxes of anti-diarrheals
 tamiflu, or other antiviral medications (As much as you can acquire as long as it
works)
 instant hot/cold packs (4)
 4 boxes (packages) of cough suppressants
 fluids with electrolytes – 2 bottles per person
 12 boxes of anti-viral tissues
 thermometer (2)
 4 boxes of decongestant (pseudoephedrine)
b) Food: Enough to last 5-6 weeks
 assortment of canned foods (including beans, vegetables, chili, fruits, tuna,
soups, etc.)
 dehydrated, packaged pasta and rice dishes
 granola bars
 powdered milk, potato flakes, oatmeal, dried fruit
 salt, sugar, seasonings
 assorted flavored beverages
 manual can opener
 protein bars
 dry cereal
 peanut butter
 nuts
 canned juices
 pet food
c) Water:
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At least 1 gallon of water per person per day (ideally for 5-6 weeks)
bulk water for washing, bathing, cleaning, etc. (20 + gallons)
d) Miscellaneous:
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4 bottles of Hand disinfectant and hand toilettes
Cash ($500-$1,000)
extra bottles of prescription drugs (3 months worth, if possible)
batteries (AA, AAA, C, D) 2 packs of each
masks (20 for a family of 4)
books/reading materials
extra pair of glasses (not contact lenses- reduce risk of infection by keeping
hands away from eyes)
band aids/gauze/athletic tape to heal wounds and prevent infection by open
wounds
blankets (4)
duct tape and plastic
soaps, bleaches, latex/vinyl gloves
change of clothes (7 sets)
personal identification card and contact information
toilet paper (36 rolls), paper towels (16 rolls), napkins, etc.
toothpaste, shampoo, deodorant, etc.
extra set of keys
insurance papers, birth certificate, vaccination records, etc.
pet supplies
candles/matches/lighter
chlorine/water purifiers
satellite phone/two-way radio/or coast to coast walkie-talkie
flashlights (4)
generator
10 bottles of rubbing alcohol
4 bottles of vitamins
e) Masks:
Respirator Masks, not surgical masks; 3M™ Health Care Particulate Respirator and Surgical
Mask 1860. This respirator features a soft inner shell for greater comfort against the face and,
because it's fluid resistant, it aids in reducing the potential exposure of the wearer to blood and
other body fluids. Meets CDC guidelines for TB exposure control. NIOSH-approved. Sold in
units of 20, can be purchased online or in stores.
Other good choices: 3M N95, Nano Mask. Will need one mask per person per day or any
respirator mask that fits tightly against the face, reducing exposure.
Part 2) Workforce Team
-Health Director - Paul Spiegel: help coordinate medical teams, police/firemen, and coroners,
implement organized system in hospitals and clinics to rapidly dispense vaccines, drugs, and
treatment
-Water treatment workers: to maintain water safety and usability of Lake Winnebago, to ensure
that it does not get contaminated, to ensure that enough chemicals are being used to prevent
contamination.
-Electricians/WPS: to keep vital electric operations and communications running and in the event
of an outage, do as much as possible to get the system back up and running.
-Doctors/Nurses/Emergency Staff (ambulance drivers, etc.): to care for the sick and try to find
more effective preventive measures. This includes Mercy Medical Center, Aurora Medical
Center, and Affinity Clinics along with their staff coming together to ensure great health care in
a time of emergency.
-Oshkosh Board of Education (President J. Thomas McDermott): monitor health conditions of
schools, carry out closings, inform students of risks
-Police: to help protect pharmacies/pharmacists, and food stores from being overwhelmed and
keep the population in control, carry out closings, restrict access, etc.
-Firemen: to assist police, medical staff, and also help keep the community under control and
panic free, organize/execute transportation systems for medical care
-Truck Drivers/Ground Transportation: to keep vital drugs, food, supplies and information
coming into and out of the community
-Woodworkers/Casket makers: and ground diggers to properly and quickly bury bodies to keep
spread of disease low
-Pharmacy workers: to distribute drugs to the care facilities and keep vital drugs in stock, if
possible.
-Food/Grocery workers: to keep a supply of non-perishable food on hand, and help distribute
and ration it in case of food shortage
-Garbage men: to maintain sanitary conditions and clean roadways for emergency vehicles and
the community
-Radio/TV personnel: to keep community informed and up to date on the pandemic
-Veterinarians/Oshkosh Animal Shelter: to keep pets healthy, and recognize birds, pigs or other
animals suffering from influenza so that they can destroy them and reduce the risk of spreading
the flu further, and to take in animals abandoned by their owners in the case of death or they get
separated for other reasons
-Coroner/Pathologists: handle the dead, conduct studies on the effects of disease, severity of
strain, look for possible alternatives of treatment, and keep samples of lung tissue in deceased
patients for further research. Might send these tissue samples to state and federal laboratories so
they can work on producing a vaccine.
-Vital Record Keepers (death records)
-Funeral Directors: to help keep order and control if the death toll skyrockets in a short period of
time
-Religious leaders: to comfort and console those individuals feeling lost, hopeless, or on the
edge
-Crematories: cremate bodies that are unclaimed and of those people that wish to be cremated.
Ones located in Oshkosh are: Affordable Funeral & Cremation Services LLC and Seefeld
Funeral & Cremation Service.
Part 3) Media
TV and Radio: This should be the main course of communication from leaders to the
community, as TV and Radio are accessible to everyone at anytime. A 24 hour up-to-date
hotline on the latest news pertaining to the pandemic such as Tamiflu availability and vaccine
shortages should be created and broadcast on a dedicated radio station. This service would be
run by the department of Health Services.
Telephones: In the event that telephones are still operational, we should use NurseDirect. This
is a service offered by Affinity Health Systems that answers health related questions and
provides health information. This service could supply callers with information on the statistics
of the disease and whether or not their symptoms are serious and/or related to the outbreak. The
number is (920) 231-6578 in Oshkosh and toll free at 1-800-362-9900. If phones fail, the next
possible communication would be on pre-set channels on two-way radios or walkie-talkies.
Newspapers: The Oshkosh Northwestern and other local papers should devote a regular
section to updates on the pandemic, with stories, warnings, closings, health care availability, etc.
being covered. The newspaper can be viewed online, as long as the internet is still functioning,
at www.thenorthwestern.com. Delivery will not be available during this time because of the
disease’s contagious nature.
Part 4: Community Communication
Some people who could move critical supplies are: truck drivers, cargo airplanes,
ambulances, police cars, fire engines, armored cars for Tami flu and/or vaccines and military
vehicles. The National Guard, police, fire department and other military units will be responsible
for guarding important supplies. This list of critical supplies would include: medications
(hospital and nursing home supplies), chlorine for water, water, Tami flu, masks, respirators,
hospital beds, vaccinations, clean linens, food, blankets, biowaste/biohazard bags and containers
for disposing used needles/materials with infected body fluids, body bags/caskets, pillows, fever
reducing drugs or other medications that help alleviate symptoms and electrolyte drinks. The
National Guard will play a large role in the guarding of supplies at hospitals and other isolation
areas. Since health care workers will be in these areas around the clock, they may help monitor
these supplies, but they are not in charge of looking after them. If a vaccine is created, it will be
transported in armored trucks to ensure its safe arrival at the hospital.
Part 5: Quarantine measures/Prevention/Travel/Crime Prevention
The quarantine of Oshkosh and surrounding cities in the event of a pandemic is extremely
necessary. This quarantine will be placed on each individual that has symptoms. Once they
have visited a health care provider, they must stay at home until they are no longer contagious.
If their symptoms place them in a hospital, they will be quarantined to their room with no
visitors. City wide quarantine will be placed on travel once the number of cases reaches in
Oshkosh and surrounding areas reaches 100. This will help contain the epidemic. This
quarantine will be enforced by police, sheriffs and the military setting up road blocks at the
freeway exits and watching other main routes in and out of the city. This quarantine might also
be enforced by stopping public transportation lines in the attempt to cut back on travel. There
will have to be some travel allowed in Winnebago County and in and out of the city. There will
be a list created of certain people allowed to travel. This list could include: city officials out on
public health business, health care personnel, garbage men, sewage treatment workers, critical
supply drivers, police, and military personnel.
A curfew is necessary to keep the disease under as much control as possible. A curfew
would help keep affected people away from unaffected people and prevent people from stealing
from businesses. During this time many people will not be going to work because their jobs are
not critical to the smooth running of the city. These types of business (travel agencies, bowling
alleys, car dealers, etc…) are subject to a higher chance of robbery. The curfew will help keep
people off of the streets late at night, but will not cure all of the problems of robbery away. We
think that the general patrolling of area will help deter people from stealing. Also all critical
good will be guarded to help lessen the stealing of necessary goods.
Some businesses need to stay open because they are critical to the functioning of the city.
These services are: pharmacies (in the hospital only), gas stations (one on each end of town),
water treatment plant, garbage pick-up, funeral homes, crematories, casket makers, newspaper,
and grocery stores (one at each end of town). These services are the minimal services needed to
keep the city functioning without any glitches. Recreational, educational, and personal grooming
services will not be offered.
Part 6: Public Gathering Policies
There will have to be many restrictions placed on mass gatherings. Mass gathering will
be prohibited. There will be no school, libraries, restaurants, malls, theaters and any other fun
activities. Grocery stores, gas stations (a select few), hospitals and clinics will remain open.
When it comes to closing churches our group was torn. The best thing to do is to close churches
and allow people to worship in their own homes. Priests, Ministers and other religious leaders
might be affected and be capable of spreading the disease to their entire congregation.
Individuals that wish to pray can do so from their homes with their loved ones. Large gatherings
need to be forbidden because these places will be a breeding ground for the disease.
Part 7: Hospitals
General Hospital
Beds
Intensive Care Beds
Standard Ventilators
Portable Ventilators
Possible Isolation
Beds
Table of Hospitals in Oshkosh and their Supplies
Mercy Medical
Aurora Medical
Total Available
Center
Center
Supplies for the
City of Oshkosh
157
48
205
15
6
1
10-11
12
7
0
10-11
27
13
1
20-22
Neither one of these hospital have much spare room for and isolation ward. Both
hospitals would probably be able to have 10-11 beds for isolation with an outside chance of
turning a whole floor to negative pressure which is needed for isolation. There are a total of 232
beds for the entire city of Oshkosh. This will be very affective in aiding the sick. It will be
difficult for either of the hospitals to handle the number of cases that will occur. Each hospital
will do what they can, but with the volume of cases that are possible, it will not be enough. There
are only 15 ventilators for the whole city of Oshkosh. There is a high probability of there being
more than 15 people that will need a ventilator at the same time during a pandemic. There
should be an isolation hospital set up at another location. Some suggestions for an isolation
hospital are: Affinity Clinics, located on Koeller Street and Jackson Street, and Kolf sports
complex. There would also be many supplies needed for this alternate hospital. These supplies
would include: beds, IVs, respirators, pillows, linens/blankets, water, food, chlorine, biohazard
receptacles, medical personnel, body bags, masks, Tami flu and bed pans. As was mentioned
earlier the city of Oshkosh is already short on a lot of these supplies so setting up an isolation
hospital might be very difficult. Another thing needed at this alternate site would be workers.
Health care personnel are already in short supply and we are not even experiencing an epidemic.
An alternative would be to have college students in their last year in the nursing field, medical
technology field, students in their medical school internship and retired personnel to help staff
these alternate locations.
8. Pharmacies/Health Plans
Since many drugs are outsourced to other countries pharmacies here should start back
stocking many life dependent drugs. All drugs have expiration dates, so that has to be taken into
account when ordering and keeping these drugs on hand. When cases of human to human
contracted bird flu start happening anywhere around the world, pharmacies should start a small
stock pile, as cases increase so should the stockpile until they are no longer able to import drugs.
Other commonly used pharmaceutical medications should also be stocked by the pharmacies on
the same terms. This will prevent shortage and widespread panic during a potential outbreak if
people have their medication.
Pharmacies should also contact the companies overseas that they purchase from and
create a plan with them as to what they should do in the event of an outbreak. The can discuss
with the overseas companies what alternative shipping methods they could use to get the drugs to
the people that need them. In addition, people who are depended on medications should begin
stockpiling a supply in their homes to last them at least 4 months. Since many major health
plans only allow 1 prescription to be filled a month, health insurance agencies will have to be
contacted and allow their client to purchase 4 months of advanced drugs. This type of policy
might need to be federally implemented. Local and state governments do not have the power to
make demands of health insurance companies.
What can be done now to ensure the cooperation of health insurance agencies is for the
federal government to create a flu plan of their own to deal with pandemics and health care.
Insurances companies might also look ahead and create some emergency procedures to be
followed in the event of a pandemic. Agencies to contact might be the Food and Drug
Administration because they control the distribution of prescription drugs and/or the Department
of Health and Human Services. State representatives and Congress members can also be
contacted to get bills written and placed into circulation.
People will need their drugs during this time or it will turn into total chaos and more
fatalities will occur. The high risk groups would be:
 AIDS patients
 infants and the elderly
 diabetics
 people currently under direct hospital care
 people with heart conditions (high/low blood pressure murmurs, etc.)
 mentally disabled
 handicapped
 cancer patients
 asthmatics
Winnebago County should also begin to stockpile their own supply of tamiflu and other
anti-influenza drugs. They should have it kept in an undisclosed location, such as the National
Guard Armory and keep it under heavy security only once an epidemic has been reached. Heavy
security is not needed until the avian flu as reached life threatening proportions. In the event of
an outbreak they can distribute it to either pharmaceutical companies in the area, hospitals, and
to healthcare workers. These drugs should not be used until there is an extreme need for them.
Alternative methods should be exhausted before the reserve of these drugs is used. They should
also be given to healthcare workers and certain city workers such as police and fire officers, and
utility workers in order to ensure their health so they can maintain the city’s health.
9. Long term care, nursing homes, and elderly persons living alone.
The antiviral drugs will be kept until the outbreak is massive and completely
uncontrollable. They should be saved as long as possible and then used to treat as many people
as possible. Hopefully this will then catch the flu at its peak and will prevent the virus from
mutating into a more lethal strain. Priority for the anti-virals will be given to:
 healthcare workers
 law enforcement
 firefighters
 emergency (ER) workers
 water treatment workers
 sanitation employees
 utility workers
 city manager
 mayor
 Board of Health
 military personnel
 school teachers (as long as schools are still in session)
Anti-viral drugs will only be used to treat server cases. Not everyone will be able to obtain these
drugs unless they are in critical health status or have created their own supply of medication. I
do not feel that anti-virals should be used to prevent other cases from occurring until the end of
the epidemic. It would not be wise to use up anti-virals in the beginning of the epidemic on
people who are not sick. It might be discovered that these drugs only work once the virus has
entered your system, not as a preventative measure.
Long-term living arrangements such as nursing homes will also be handled cautiously. If
an outbreak occurs there should be strict regulations as to who will be allowed to enter the
facility. There should be no outside visitors allowed to enter the facility, just the healthcare
workers needed to treat and care for the patients. This will hopefully lower the chances of an
outbreak within the facility. Health care workers and the maintenance people of these buildings
should also have priority in receiving the antiviral medications. Elderly that live alone in the
community will also be checked on by the nurses that usually care for them in their home.
Hospice care will not stop if an outbreak occurs. These workers will just have to be vaccinated
(if available) or given anti-virals to ensure their health.
10. Vaccines
A vaccine priority list for the city of Oshkosh should be created by the Board of Health,
Mayor and City Manager. They should assess the necessary people needed to keep the city
running and the citizens healthy. The priority list should look similar to this:
1.
2.
3.
4.
5.
6.
7.
8.
Healthcare workers
Funeral/Cremation workers
Police/Firefighters/Emergency workers
Sanitation/Water Treatment workers
Military
Truck/Transport drivers
Teachers/Daycare workers (only if schools remain open)
General public
11. City Issues:
Employees Critical to City:
City Manager - Richard Wollangk
Cemetery - William Sturm
Health department personnel - Paul Spiegel
Public works - David Patek
Sanitation - Sean Hutchison
Firemen
Police
Ambulance
Drivers: garbage truck, snow plow, school bus(assuming schools are not closed), city buses, food
distribution, medical supplies
Judges
Communications (Telephone, Radio, Television)
Businesses to Close:
All Entertainment Businesses (Bars, Bowling Alleys, Movie Theaters, etc.)
Schools (All schools grade, middle, high, tech, college)
Home delivery businesses
Restaurants
Public transportation
Outlet Mall and other retail stores
Businesses to Remain Open:
Gas Stations (one on each side of town)
Mercy Medical Center
Aurora Medical Center
Affinity Clinics on Jackson and Koeller Streets
Grocery stores (one on each side of town)
Public Works
Cemetery, Funeral, Cremation, etc.
Health Services
Police Stations
Fire Stations
Sick leave policies will have to be revised by the government and aid will be needed. If
the business closes they will not have an income to pay their employees and the government will
have to implement some form of aid to help pay everyone. Perhaps people will be able to use
their social security (only what they have put into the system) until the epidemic is over. This
might not work, however, because of the bad financial state that the federal government is in.
The city should provide masks to citizens at a specific pick up point once it is affirmed
that the virus has mutated to spread human to human, and a pandemic is imminent. Other
supplies such as tissues, gloves, and emergency supplies should be prepared by the citizens
beforehand to avoid a shortage problem when they are most needed. Drugs will be distributed at
medical facilities by trained doctors, nurses, and other trained medical staff. They should have
some supplies stock piled, but we feel it is the responsibility of the individual to keep supplies.
The waste water treatment plant in Oshkosh can operate anywhere from 45 to 15 days
depending on the feeding rate. (Per Stephen Brand, City of Oshkosh Utilities Superintendent)
The city has 9, 2000 lbs tanks = 18,000 lbs (9 tons) of chlorine. In an emergency, the city
can feed any where from 400 to 1200 lbs of chlorine a day. Which as stated above, could last
anywhere between 15 and 45 days, depending on the feeding rate.
A mass grave will likely become necessary in the case of a pandemic. However, our
group was torn as to whether or not they should be used. If space is limited, it may be necessary
if other arrangements have not been made prior to death (cremation), but others feel that the
practice of stockpiling bodies is a cruel and disrespectful treatment of humans and should not be
used. The best thing to do is to make arrangements for your body, whether it means you are to
be cremated, buy a plot, or take any other necessary actions for your body prior to a pandemic
taking place so there will be no question as to what to do with your body, and you can be sure
your body will be treated in the manner you desire. However, if a mass grave is in dire need, the
location for the grave should be well outside the city limits of Oshkosh for sanitation and area
availability reasons. If the pandemic occurs in the winter, un-insulated storage warehouses can
be used to temporarily store bodies until a proper burial can take place. If it occurs in the
summer months and morgue space becomes limited, bodies can be stored in large freezers at
various cooperating businesses such as meat markets, college walk-in cold rooms, and
processing plants. These businesses, or universities, would then be given subsidies by the
government for their services. Cremation as an alternative but must be handled case by case for
sensitivity reasons, and will not be mandatory for people with other plans in place. This will
only become mandatory in the case that new scientific evidence is found that suggests that
cremation is the only safe disposal method for the deceased to prevent the spread of the disease.
The following is a list of all mortuaries found for Winnebago County, 6 of which are in Oshkosh:
 Krause Funeral Home
 Poklasky Funeral Home
 Butzin-Marchant Funeral Home
 Konrad-Behlman Funeral Homes (1 2 3)
 Wachholz Family Funeral Homes
 Fiss & Bills-Poklasny Funeral Home
 Fiss & Bills Poklasny Funeral Homes
 Mueller Funeral Home Inc (1 2 3)
 Omro Funeral Homes
 Fiss & Bills-Poklasny Funeral Homes
 Wachholz & Sons Funeral Home & Cremation
 Barbola Funeral Chapel Inc (1 2)
 Home Works
 Seefeld Funeral & Cremation Services
 Affordable Funeral & Cremation Services Llc (1 2 3)
12. Winnebago County Health Department’s Board of Health and the Oshkosh Board of Health
Role.
A flu plan will be created by the board and can be modeled after successful plans other
cities use, assuming Oshkosh is not one of the first cities hit with the pandemic. The board will
be in charge of coordinating the public response to the pandemic, including the closing of
schools and public events, coordinating where and how hospitals are set up, address morgue
overcrowding problems, and informing law enforcement and fire personnel how to carry out the
necessary procedures to maintain order (closing bars, preventing looting, keeping the peace,
etc.). So far, the Oshkosh flu plan is only in its rough draft stage, and the plan will have to
extend to include the county. To do this, the Oshkosh Board of Health can adapt the city flu
plans to the county level, based on inputs from the Winnebago County Health Department.
Current Board of Health Members:
Dr. Barbara Strand – Chair, Affinity Medical Group
Jamie Bonell, CFNP, APNP, Aurora Medical Group
Burk Tower - Council Representative
Christine Kniep, UW-Extension
Susan Panek, United Way
Stan Kline- Alternate
Mardell Sowers – Alternate
City of Oshkosh Board of Health Members:
Jamie Bonell
Stan Kline
Chris Knup
Sue Panek
Mardell Sowers
Dr. Barbara Strand
Burk Tower
References:
1) World Health Organization; Avian Flu Preparedness Plan
http://www.who.int/csr/disease/influenza/pandemic/en/
2) CDC: Center for Disease Control and Prevention; Pandemic Flu
http://www.cdc.gov/flu/pandemic/
3) PandemicFlu.gov official government website
http://www.pandemicflu.gov/
4) City of Oshkosh Web Site
http://www.ci.oshkosh.wi.us/Health/Health.htm
5) City of Oshkosh School District Web site
http://www.oshkosh.k12.wi.us/aboutus/boe_members.cfm
6) Affinity Health Systems
http://www.affinityhealth.org/page/home
7) Michael Pfaffenroth of Affinity Medical Center
Email address mpfaffen@affinityhealth.org
8) Frances R. Finley, DHA, FACHE of Aurora Medical Center
Email address fran.finley@aurora.org
Phone number (920)456-7606
9) The U.S. Government’s Official web portal
http://www.firstgov.gov/
10) Yellow Pages: http://www.yellowpagecity.com/sys/pageserver.dll?b=7443&p=0&s=1&f=&gp=&go=Funeral+Homes
11) Oshkosh web page: http://www.ci.oshkosh.wi.us/Department_Contacts.htm
12) City Of Oshkosh Board Of Health home page:
http://www.ci.oshkosh.wi.us/Health/Health.htm