Virology 315

Group 6, The H5N1 Resistance

Mallory Weiland, Robert Haas, Maggie Ridder,

Kimberly Hoppe and Daniel Gehrke

WinnebagoCounty 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:

  • 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:

  • 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 MercyMedicalCenter, AuroraMedicalCenter, 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 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 WinnebagoCounty 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

Table of Hospitals in Oshkosh and their Supplies

MercyMedicalCenter / AuroraMedicalCenter / Total Available Supplies for the City of Oshkosh
General Hospital Beds / 157 / 48 / 205
Intensive Care Beds / 15 / 12 / 27
Standard Ventilators / 6 / 7 / 13
Portable Ventilators / 1 / 0 / 1
Possible Isolation Beds / 10-11 / 10-11 / 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

WinnebagoCounty 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.