Tri-County Planning for a Pandemic  Influenza Out-Break

By Jane Futcher, Director Clinical Services and  Laurie Doxtator, Public Health Nurse

On June 18, 2002, 45 health, emergency service and municipal staff from the tri-county area arrived at the Leeds, Grenville and Lanark District Health Unit in Brockville to participate in a table-top exercise intended to test the local 'Contingency Plan for Pandemic Influenza'. Representatives from area agencies came to "play" their roles in a mock community emergency caused by a large-scale influenza out-break. This was the opportunity to bring all the community partners together who would be required to respond in the event of a true pandemic. Laurie Doxtator, Public Health Nurse, coordinated the exercise in consultation with Phillipe Geoffrion and Dave Clarke from Emergency Measures Ontario.



Pandemic influenza occurs when the influenza virus under-goes major changes such that the population has no immunity.

Pandemics have occurred at irregular intervals throughout history. Experts agree that another pandemic is very likely, if not inevitable, although it is difficult to predict when the next one will occur. The Spanish Flu pandemic of 1918 was the most notable in history resulting in over 20 million deaths worldwide. It occurred around the time of WW I and infected over half the world's population.
Since 1918, there have been other, less severe, influenza pandemics in 1957 and 1968. It was felt that the "Chicken Flu" identified in Hong Kong in 1997 had the potential of causing a pandemic. However, increased surveillance allowed the virus to be identified early. In order to control further infection, millions of chickens believed to be harboring the virus were slaughtered.



Many consider the emergence of the new virus "Chicken Flu", to be one of the most worrisome medical events of the day. 

Since then, the World Health Organization (WHO), federal, provincial and local health agencies have been involved in preparation for the next pandemic. The Health Unit assembled a committee in March 2001 as a way to ensure a coordinated response throughout the tri-county area. The 'Contingency Plan for Pandemic Influenza' is intended to be the framework that connects all local emergency response plans. The major objective of the exercise was to test the plan through the use of a mock scenario in order to discover what works and what doesn't work well in a "real life situation". For this particular day, our situation covered a period of 4 - 6 weeks, from the initial appearance of a "new virus" in China to its arrival in Leeds, Grenville & Lanark. Initially no vaccine was available because it usually takes approximately 4-6 months to manufacture the vaccine for a new virus. As to be expected, the scenario included the absence of 25 % of police, fire and emergency responders due to illness, half the hospital staff and other health care workers were ill or home looking after family members in the mock scenario. The expanded use of long-term care facilities was identified as a way to ease the load felt by the hospitals. Mortuaries were feeling pressured, as their staff was also running at a minimum. In the exercise scenario, this virus infected 120,000 residents in the tri-county area, 27,200 people required outpatient care, 480 people required hospitalization and 176 people died.



The mock exercise was an excellent learning experience for all who attended the day. Several improvements and modifications were identified for the community plan.

 Individual agencies have also identified areas where their internal plans could be modified to complement the others. As the plan is a "living" document, exercises such as this one will be repeated regularly to ensure that changes in the community are reflected in the plan. Having a well functioning pandemic influenza plan will help us to be prepared to respond well to an actual pandemic.

Pandemic influenza occurs when the influenza virus under-goes major changes such that the population has no immunity.