Pandemic Planning

By KEVIN MULROONEY

With concerns ranging from terrorism to coastal storms, many fire departments consider a pandemic a thing of the past. Although avian flu fears have yet to transpire, a considerable pandemic risk remains.

Pandemics occur naturally; some historians suggest they occur roughly every 100 years. The last major United States pandemic was the Spanish flu in 1917. Smaller outbreaks occurred in 1958 and 1968, affecting almost 30 percent of the world population. The year 2017 marks 100 years since the Spanish flu pandemic, so there is considerable urgency for us to prepare.

In 1917, we didn’t have connecting global airline flights, multiple passenger ship terminals dotting our coastlines, or anywhere near the mobility we have today. A disease that took three weeks to circle the world in 1917 may well travel in several hours today with predicted potential to affect some eight million people worldwide.

Of course, we currently are in the throes of a pandemic—just ask any bird. Millions of birds across Eurasia have died from avian flu, and many thousands more were killed in attempts to curb the outbreak.

Fortunately, there are very few instances of humans contracting avian flu. H5N1 is the flu virus strain infecting birds throughout Asia, Europe, and the Middle East. Human transmission seems to occur primarily in people who live in close proximity to birds, often within their homes. According to the Clearing House newsletter Pandemic Planning in the News, in 2007 there were 37 avian flu deaths, with 59 reported cases worldwide, yielding a 63-percent case fatality rate. Since 2003, the cumulative case fatality rate averages about 60 percent.

Controversy over how avian flu spreads among birds has focused on illegal trade of infected poultry vs. migratory patterns. The prevailing wisdom is that migratory patterns do not pose the risk originally suspected.

On January 28, 2008, Reuters News service reported the 100th human death in Indonesia from the H5N1 strain. According to U.S. Health and Human Services Secretary Michael Leavitt, “We are overdue and underprepared.” Leavitt, in his 2007 report Pandemic Influenza Impact on Communication Networks, noted: “A pandemic is a global disease. Pandemic influenza occurs when there is no immunity in the human population and it spreads from person to person.” Presently, the avian flu is a virulent bird disease that has not made a widespread jump to humans.

Despite today’s medical world technology, the best defense against illness remains good hygiene, which includes hand washing; decontaminating equipment; and, most importantly, not going to work sick. State governments must formulate plans if two unrelated laboratory flu cases are confirmed. Some plans call for canceling most, if not all, social events, including concerts, festivals, and sporting events. Most significant are school closings. Studies show that the cities which recovered the fastest from the 1917 outbreak closed their schools the earliest and kept them closed the longest. Those schools included elementary, middle, high, parochial, and technical schools and public and private colleges and universities.

Closing schools would have a ripple effect, as parents would have to provide child care and not report to work. Nutritional needs filled by school meal programs would, in many areas, result in less-than-ideal children’s meals.

Experts have pegged today’s standard absenteeism at about 40 percent during a pandemic. That number grows significantly in the fire service for two reasons: higher exposure to illness and communal living conditions. We train together, eat together, and share sleeping quarters.

The firehouse is a good environment for spreading disease. Limit social interaction during a pandemic to groups of six. During an outbreak, enforce social distancing, which means giving yourself 10 square feet between you and your coworkers. Since flu viruses are normally respiratory in nature, social distancing protects you from viruses carried in others’ exhaled air.

Unfortunately, flu viruses can survive for days on inanimate surfaces, such as countertops, pens, doorknobs, telephones, and radios. Disinfecting surfaces plays a major role in offices and homes during an outbreak. People will also deal with sick family members, friends, and relatives; the sick may need up to three weeks of recovery time. We will plan funerals. Expect up to 40 percent of the workforce to stay home.

We will need to convince our families and ourselves of the need to work during a pandemic, risking illness and potentially death. You may face large crowds looking for medicine, hospital care, or simple answers. Critical infrastructure, including utilities, government, transportation, and retail stores, are certain to be affected by diminished workforces.

The potential for a pandemic is real, not imaginary. Although we seem to have dodged the pandemic bullet for now, numerous public health and infectious disease experts are convinced we will see a pandemic in the near future.

A 2007 U.S. Department of Treasury pandemic exercise conducted with 90 percent of the nation’s top 50 financial firms found that seven percent had no pandemic plan at all; 50 percent plan to increase conference calls and telecommuting; and 73 percent began cross-training employees in anticipation of absenteeism.

According to Gary Amato, director of the U.S. Department of Homeland Security (DHS), Office of Technology, the government should be alarmed about the nation’s telecommuting infrastructure’s ability to withstand the rigors of an increased workload from people working from home during the pandemic. The National Security Telecommuting Advisory Council was recently formed to address this situation.

Current collective bandwidth can handle 25 percent of all workers staying home. Problematically, if schools close during a pandemic, more kids will be home and on their computers. Not only will they receive and submit their assignments and do research, but they will also play video games and watch videos, creating more bandwidth strain.

Fire departments must designate a pandemic subject matter expert (SME). Now is the time to study the potential diseases, origins, your area’s history, and national trends. Of particular interest are private sector community umbrella groups that are already studying and making pandemic human resource recommendations. We must engage our mutual-aid neighbors and update everyone on the scope of the threat and what we can do to work together during the outbreak. Pandemic illness is expected to come in waves lasting two to three months and then temporarily subside. It is hoped that during this time vaccines will be developed, manufactured, and distributed.

During this time, pandemic diseases tend to mutate and reemerge in a slightly varying form. That will necessitate more study and changes in vaccines. It is believed that this cycle will occur three to four times. Nationally, many health departments have established points of distribution (POD) at fire and EMS stations to provide medications and vaccinations to firefighters and their families. The POD program ensures that firefighters and their families are as safe as possible using available resources.

Do the following to avoid spreading disease in the firehouse:

• Institute strident facility cleaning programs, designating one member of each shift to cleaning duty.
• Do not eat together.
• Stop conventional training together.
• Do not allow sick members to return to work; they should stay home if they are sick.
• Designate a pandemic SME.
• Create union/management working groups.
• Cross train to deal with absenteeism.
• Review EMS protocols.
• Prohibit exercise room use.
• Adopt policies for attending the funerals of fellow firefighters and their families.
• Use conference calls.

The volunteer fire service faces additional issues. Leaders may have to do the following:

• Cancel monthly meetings: group cleanups; weekly training; academy training or events where members are in contact with other firefighters (including graduation ceremonies); fraternal, firematic, or association meetings; and community events held in quarters.
• Institute duty crews to prevent all members from responding to every call.
• Avoid lingering at the station or at alarms.
• Avoid direct contact with mutual-aid companies.
• Consider a complete shutdown of quarters for all but emergency responses.
• Suspend fire prevention programs and outside training.

In addition, some added measures that both services can adopt are the following:

• Stockpile antiviral medications and over-the-counter cold and flu remedies. Although there is concern over storage space and shelf life, the overall benefits outweigh the negatives.
• Revisit EMS response protocols. Limit personnel entering hospitals at patient drop-off, limit patient contact, stress rigorous personal protective equipment use, reduce the number of personnel in the ambulance, and dispatch protocols for situations when all hospitals are full.
• Make annual flu shots available to members.
• Prepare families and members through outreach and education.
• Prepare on-line training programs, such as National Incident Management Systems online training and other home-based computer training, offered through the Center for Domestic Preparedness, the Texas Engineering Extension Service, the Department of Homeland Security, the Federal Emergency Management Agency, and the National Fire Academy. Designate one member to receive and track e-mailed certificates of completion. Not training together doesn’t mean no training—it means different training for a period of time.
• Establish syndromic surveillance. Learn about the usual patterns of illness in your community and develop mechanisms to flag unusual increases.
• Meet with your medical director, public health officials, and government liaisons to start working on revised standard operating procedures now, not when the outbreak occurs. Don’t expect your members to immediately shift gears in a pandemic—every step of your plans needs rehearsal.
• Install hand sanitizer dispensers throughout the workplace and routinely clean remote controls, telephones, doorknobs, steering wheels, and computer keyboards.
• Pay attention to your members’ health and fitness. Exercise, diet, and rest reduce the risk of illness during outbreaks.

We need to be risk amplifiers, discussing and communicating this hazard at community meetings and with city hall. At the national level, border control, quarantine plans, and disorder control updates will help us do our jobs.

It’s remarkable that with all of today’s medical technology, simple hygiene and hand washing remain our best defense against illness. Pandemics don’t discriminate. When preparing pandemic drills, eliminate some of your senior management from the roster. One method is to remove all names starting with a designated letter or perhaps every fourth person on the roster.

Social upheaval and disruption are very likely during a pandemic. The New York City Police Department disorder control unit recently held a tabletop exercise called Wounded Octopus for the Staten Island area. Civil unrest and response, including police escorts for medications, were part of the drill.

The fire service will bear the brunt of a pandemic response while simultaneously coping with our own losses over a number of months or even years. Today, we can prepare a true all-hazard approach for confronting a pandemic at the forefront. Our generation will be the first to prepare for a pandemic where previous responders could only respond.

KEVIN MULROONEY is a 22-year volunteer firefighter and an EMT and hazmat technician/NFPA, Firefighter I, with the East Williston (NY) Fire Department. He is a sergeant in the counterterrorism division of the New York City Police Department (NYPD) assigned to the Office of Emergency Management. He has a master’s degree in labor policy and is an associate business continuity professional (ABCP) in the Disaster Recovery Institute International. He is a certified emergency manager and is a member of the board of the Institute for Disaster Mental Health at SUNY New Paltz.