Preparation for Pandemic Influenza in Oshkosh and Surrounding Areas
Adams, I.; Graf, E.; Reid, B.; Stone, E.; and Strosahl, C.
Department of Biology and Microbiology
University of Wisconsin-Oshkosh
Phase Zero
Pandemic Workforce Team:
Emergency Preparedness Council for the City of Oshkosh
includes:
City Manager: Heads Emergency Preparedness Council (EPC)
and acts as liaison between the city council and the EPC.
City of Oshkosh Fire Chief: Coordinates efforts of the fire
department as described below.
City of Oshkosh Chief of Police: Coordinates efforts of the
police department as described below.
City of Oshkosh Health Director: Maintains communication with
area hospitals and coordinates efforts of healthcare workers as
described below; determine risk levels of specific health care
tasks (e.g. surgery, emergency room care)
City of Oshkosh Director of Public Works: Apprises council of
city services and determines level of need during quarantine;
also acts as liaison between EPC and other departments of
public works (e.g. sanitation, water distribution, etc.)
Oshkosh Community Access Television director: Provides
important preparedness and quarantine information via public
access.
President of the Chamber of Commerce: Will need to determine
essential businesses to remain open during a city wide
pandemic and prepare for business closings as well as enforce
immediate sick leave legislation.
President of the Oshkosh Board of Education: Provides
information on school closings and may work with healthcare
workers during Hospital overflow situations; can also
disseminate information through school district.
City of Oshkosh Transportation Director: Provide information on
street closings due to quarantine; assist police chief with
quarantine operations.
County Director of Emergency Management: ? Not sure if if the
position exists. If it douse directs placement of personnel and
supplies.
County Deputy: Coordinates efforts of county level police
department in similar fashion to that described below.
County Coroner: Manages disposal of bodies and post-mortem
disease spread12,13.
Winnebago County Department’s Board of Health and
the Oshkosh Board of Health’s Roles:
Individual Checklist:
Individual preparedness is essential during the time of a
pandemic. There are five basics areas of supplies that are
necessary to properly prepare residents of Oshkosh during a
time of crisis. The supplies are as follows:
Water
1 gallon of water per person per day
Minimum water supply for at least 4 weeks stored in
unbreakable plastic containers.
Water purification kit (Sorting goods store)
Food
Minimum supply to last 4 weeks
Ready to eat canned meats, fruits, and vegetables
Dried Meats (e.g. Beef Jerky)
High energy foods (e.g. protein bars and nuts)
Staples (e.g. sugar, spices, pepper, etc.)
Vitamins and other supplements
Canned juices
Fluids with electrolytes
Food for infants
Flu Care Kit
Tylenol, Ibuprofen, cough syrup, nasal decongestant, disposable
ice packs, and medical grade latex (or non-latex) gloves.
Masks (Recommended: 3M (TM) Particulate Respirator 8210,
N95 masks. Can be ordered online for $27.95 for a box of 20.
Minimum supply should consist of one mask per person per day
for 2-3 weeks).
Other prescription medications as needed (e.g. Tamiflu if
available)
General Kit
Cash, 10% Bleach and water solution in a spray bottle (or other
disinfectant), rags or paper towels, tissues, battery operated
radio, flashlight/batteries, non-electric can opener, utility knife,
matches, soap or other liquid detergent, and other special items
required by infants, disable, or the elderly
What to pack if you must move to the hospital or other restricted
area for treatment
Documents (identification, etc.) and extra clothes14,15.
The Boards of the health departments of Winnebago
County, Neenah, Menasha and Oshkosh will be among the
first public officials to know of an influenza pandemic.
Winnebago County’s Health Department is responsible for
rural area. It will make decisions similar to Oshkosh’s
Board of Health, but will coordinate Containment efforts
with Oshkosh, Neenah and Menasha.
Media:
A basic source of information for local residents prior to an avian
influenza pandemic is essential9. During Phase 0, the city of
Oshkosh and Winnebago County should utilize these media
outlets as a source for informing local residents of the current
situation. In addition, media outlets will be used to keep
residents up to date during Phase 1 and 2 of the pandemic.
Radio:
Information about the pandemic will be relayed to the public via
the National Warning System (NAWAS) which is based in
Madison. The East Central branch includes the local radio
stations 90.3 WRST and 99.5 WPKR.
Television:
The television stations OCAT, WLUK channel 11 and WGBA
channel 26 will be used to relay pertinent information.
Internet:
A local avian influenza website will be created, which will contain
relevant local (city/county) information.
General Information:
All information will also be delivered in Hmong, Spanish and
Bosnian. Information that will be provided through media
sources will be as follows:
Individual preparedness checklist
Cough etiquette
Information about the proper use of masks
Disinfecting tips
Number of flu cases
Quarantine measures
Business and school closings9
Critical Supplies:
During Phase 0, it is important for the city of Oshkosh to move and
protect critical supplies that will be vital to maintaining order during
an avian influenza pandemic. Critical supplies are defined as:
Food
Water
Medicine:
Insulin
Vaccines
Tamiflu
Tylenol
Cough Syrup
Nasal Decongestant
Blood
Phase Two
Phase One
Medical Supplies:
Respirators
Linens
Disposable ice packs
Syringes Cotton Balls
Medical grade masks
Medical grade latex
Gloves
Disinfectants
Gasoline and Propane
Body bags
The movement of these critical supplies during Phase 0 will be
provided by transportation workers (i.e. Truck drivers).
Initial Hospital Preparedness:
Local hospitals have general emergency plans to
respond to disasters in their community. In amore
widespread disaster, all hospitals fall under the
umbrella of command of FEMA. FEMA may not be
able to assist the City of Oshkosh residents if the
reported number of incidences are wide spread. It
will be essential for area hospitals to follow the
direction that is provided by the Winnebago
County Public Health Director.
For suspected cases of avian influenza, patients
should be quarantined in negative pressure
isolation rooms. Criteria for suspected cases
include:
Signs and symptoms of influenza
Recently returned from travel to Southeast
Asia, Iraq, or Turkey within 10 days prior to onset
of symptoms
At Mercy Medical Center, there are 12 designated
Isolation Room that are equipped to have negative
pressure. At Aurora Hospital there are 13 negative
pressure isolation rooms. All specimens will be
sent to the Wisconsin State Laboratory of Hygiene
(WSLH) within 24 hours. Specimen collection will
include:
1 oro/nasal pharyngeal swab in viral transport
media (for virus isolation)
1 oro/nasal pharyngeal swab in no media (for
PCR testing)
Based on the condition of patients, those with
symptoms that do not require hospitalization will
be asked to return home and remain under
quarantine until laboratory results are available.
Those that require critical care will remain in the
hospital in the negative pressure isolation room.
If results determine that a patient has contracted
the avian influenza virus, the County Department
of Public Health will identify individuals that have
had face-to-face contact with the infected patient.
These identified individuals will be requested to
remain at home under quarantine, and will also be
tested for the avian influenza virus. In the event
that more than 12 cases of confirmed avian
influenza are identified, and require hospitalization,
Mercy Medical Center is equipped to convert the
5th floor of the hospital into a negative pressure
isolation ward. This would accommodate
approximately 50 patients17,18.
Vaccinations:
If a vaccine is available, priority will be given to,
health care workers, essential service providers
(i.e. police and firefighters, and utility workers),
and persons at high risk for severe infection (i.e.
pregnant women, healthy adults between the
ages of 18 – 40 years).
Treatment Protocol for Patients in Long- Term
Care
Drugs Effective in Killing Avian Bird Influenza:
Osteltamivir (Tamiflu®)
Zanamivir (Relenza)
These drugs are neuraminidase inhibitors, which
stop the virus from spreading by interfering with its
ability to detach from cells and spread throughout
the body.
Priority groups for rationed antiviral drugs:
Health Care Personnel
Personnel needed to maintain a functional
community
Vulnerable patients and those in position to spread
disease (nursing homes and long-term care)
Emergency personnel
Public Gathering Policies:
After there are 50 confirmed cases of avian flu, and if
these cases are not localized, public gatherings will be
prohibited. The Department of Public Health will make
this decision. All public and private schools, colleges and
universities, and non-essential businesses will be closed.
This includes, but is not limited to:
The Public Library
Museums
Theaters (cinema and stage)
Church services
Sport events
Public meetings (i.e. town hall meetings)
Office buildings (i.e. Oshkosh City Center and the
Washington Building at 105 Washington Blvd.)
Shopping malls
Department stores (i.e. Shopko, Target) we realize that
stores such as Shopko have pharmacies; therefore
the inventories of department store pharmacies will
be transferred to other pharmacies, clinics and
hospitals.
Restaurants
Some examples of businesses that will remain open, but
with minimal staff if possible include:
Stand Alone Pharmacies (i.e. Morton’s or Walgreens)
Groceries
Gas stations
Power plants
Water treatment plants
Radio/Television stations
Clinics will remain open to filter out less severe flu
patients, and to provide care for non-flu related illnesses
and injuries.
Public transportation will also be suspended. The public
will be encouraged to stay home. The CDC recommends
that persons who show flu symptoms or have been
exposed to the flu not go to groceries or pharmacies, but
to ask other persons such as neighbors of family for home
delivery if possible8.
City Issues:
In Phase 2, most businesses and organizations will be
required to close. Exceptions are businesses and
organizations which provide essential city services.
These include,
Emergency Management Team
Winnebago County Waste Management. Garbage
collection is vital, and currently most collection services
are contracted to private companies such as Onyx.
Winnebago County Coroner’s Office. Winnebago County
is prepared to deal with a maximum of 1-2000 deaths
per year. During a pandemic, this rate will likely be
exceeded and overwhelm the Coroner’s office.
Other Health Care workers (i.e. registered nurses) will
be required to pronounce death. Cremation will
also be encouraged to accommodate the high death
toll and to avoid the use of mass graves4,5.
Winnebago County and Oshkosh City Health
Departments
Oshkosh City Cemetery
Oshkosh City Public Works and Sanitation. Oshkosh
currently pumps and treats water from Lake
Winnebago for its residents. The Oshkosh facility has
four elevated storage tanks and an additional station to
meet pressure requirements. It is likely the water
treatment facility will be unable to re-supply chlorine
and chloramines for disinfecting lake water should a
pandemic occur. Oshkosh can store enough chlorine
to last 4 ½ months and chloramines for 3 months1,2,3,16.
Winnebago County and Oshkosh Police and Fire
Departments
Park View Health Center
Winnebago County Dept. of Human Services
Wisconsin Public Service and WE
SBC Communications, CenturyTel, etc.
Pharmacies (i.e. Walgreens)
Groceries and Gas Stations
Local Radio/Television Stations
Clinics
American Red Cross, Salvation Army, Father Carr’s
Phase Two Hospital Preparedness:
When more than 50 cases of avian influenza are confirmed, public
gathering and other quarantine measures will be implemented for
the city of Oshkosh. Area hospitals will seize emergency room
activity, and surgeries. Local clinics will remain open to service all
non-flu related health issues. Hospitals will service all avian
influenza suspected cases. Local hospital capacity is as follows:
Hospital
Licensed Beds
Mercy Medical Center
157
Aurora
82
Winnebago Mental Health
315
Theda Clark
250
St. Elizabeth Hospital
352
During a disaster, FEMA typically distributes patients requiring
hospitalization evenly among area hospitals. Communication
between area hospitals will be pertinent to maintain a balance
between the number of patients, hospital beds open, ventilators
accessible, and medical staff currently available to work. Patients
that require hospitalization will be admitted, while case that are
less severe will be asked to return home.
Due to limited number of medical staff available for working,
volunteers will be requested from the community to assist in basic
care of patients. The American Red Cross would organize the
training of 1st Aid, and CPR to willing volunteers14,17,18.
Hospital Preparedness of Last Resort:
In the event that the number of patients requiring hospitalization
exceeds the capacity of all hospitals, the Grudenhagen
Conference Center located on the University of Wisconsin
Oshkosh campus will be commandeered as a 2nd hospital. All
patients that are in critical condition will remain at the hospital.
Patients that are less severe will move into Grudenhagen. All
patients will still be initially screened at the hospital, and medical
staff will determine the appropriate accommodation for each
patient.
Medical supplies/equipment, and medical staff will be available in
limited quantities due to the overwhelming number of cases.
Medical care will be provided to the best of ability, and will mainly
consist of basic care. Equipment possibly available will include:
Heart Rate monitors
IV
Blood pressure monitors
Pharmacies:
Individuals that need drugs on a regular basis will need
to:
Start stockpiling medications themselves
Rely on State and municipal health to provide
medication (Oshkosh health organizations must
begin to stock drugs.)
High risk groups for drug shortage:
Elderly (Medications for heart disease, high blood
pressure, and other chronic issues)
Patients with diabetes (Insulin)
Immuno-compromised patients (AIDS and
chemotherapy drugs)
Already infected Flu patients (antibiotics for
secondary bacterial infections)
Chronic Patients (asthma, allergy, birth control, and
mental health medication)
Groups to be assessed for drug stockpiling
preparedness:
Local hospitals: Aurora Medical Center, Mercy
Medical Health
Pharmacies: Morton’s, CVS, and Walgreen’s
Health Clinics: Affinity and Aurora affiliates
Nursing Homes
Winnebago County Dept. of Human Services
(Prevent lack of healthcare and insurance
coverage)
Flu Medications:
Tamiflu® may be a possible preventative measure for
the disease. Local health care organizations need to
stockpile this drug to distribute to vital workers.
Essential Drugs:
Local municipalities need to begin to stockpile
medications to continue common health care.
Insulin
Heart and HIV medication
Vaccines, antibiotics, and antivirals
Chemotherapy and Immunosuppressive drugs6
Resources:
1.
Quarantine Measures:
In the initial stages of a pandemic outbreak, hospital beds
will be available for isolation of those afflicted. If the spread
of the flu continues, isolation wards at outlying facilities
away from the hospitals will be established.
2.
3.
Those exposed but not showing signs of infection will be
quarantined for ten days to contain the flu. In the initial
stages of quarantine, patients will remain in their homes. In
the latter stages of an outbreak, it may be necessary to
quarantine entire city blocks or neighborhoods.
For medical personnel, when asymptomatic, they may be
allowed to continue to work at the facility where they were
exposed. Work quarantine may also be used for those who
are employed in areas crucial to the functioning of the
cities infrastructure, i.e. power plants, water treatment
facilities, police and fire departments.
4.
5.
6.
7.
8.
9.
10.
11.
If the flu outbreak remains on a small scale, city and
county police will be responsible for ensuring quarantine
conditions are met. In the case of a larger outbreak, it may
be necessary to bring in National Guard troops to maintain
order. Ultimately, in the case of wide-spread infection, it is
possible that access to Oshkosh will be limited to only
those delivering needed supplies and/or health care
specialists.
12.
13.
14.
15.
16.
17.
18.
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