Two Manuscripts in Draft (Working Titles)

1. Two Manuscripts in Draft(Working Titles) 1. “Empowering Individuals and Families in The Event of a Flu Pandemic” (Possible Subtitle: “The Home Flu Kit”) Stan N. Finkelstein, M.D. Shiva Prakash Karima Nigmatulina Richard Larson, Ph.D. 2.“Pandemic Influenza Planning: How Ready are the Fifty States?” Richard Larson, Ph.D. Karima Nigmatulina Stan N. Finkelstein, M.D.

2. “Empowering Individuals and Families in The Event of a Flu Pandemic” Stan N. Finkelstein, M.D. Shiva Prakash Karima Nigmatulina Richard Larson, Ph.D.

3. Underlying Framework RoAverage number of new cases of illnesses generated by each infected person (Reproductive Ratio) Frequency of Social Contact Probability of contact with infected person P Ro = P

4. Why is this important? • Vaccines and medicines are likely to be unavailable or, at best, in scare supply • Individuals can choose to implement these measures for themselves • Our proposed interventions are relatively low cost

5. Why is this important? (continued) • Potentially more immediately effective than larger scale efforts • Our hypothesis: Multiple measures in the home, can significantly reduce transmission

6. Potential Modes of Transmission • Large droplet • Travel up to 3ft • Settle quickly • Indirect transmission through intermediate • Aerosols • Remain airborne • Long life in environment • Air handling • Droplet nuclei • Effect of evaporation and humidity • Inconclusive data regarding primary mode

7. Hand Washing • Studies in nursing homes and daycares • Reporting of numbers of ill • Studies with healthcare workers • Looked at bacteria and virus counts on hands • Overall showed correlation between hand washing and lowered risk of respiratory infection • Accounting for compliance and proper technique?

8. Hand Washing • Soap and warm water for 20-30 seconds minimum • Compliance issue • Alcohol rubs have advantages • Hands don’t remain wet • More compliance • Proper use more likely (at least 2mL for effectiveness) • Soap and water effective otherwise

9. Masks • Effectiveness is disputed, limited data • Relatively cheap • Easy to stockpile • Common surgical mask can be effective when used on ill person • Contain large droplets, but unlikely to contain small droplets or aerosols • Use in hospitals/close contact environment • Reduce air speed • N95 respirator useful for well person • No studies that can show isolated effect of masks • SARS

10. Air Filtration • High Efficiency Particulate Air filters (HEPA) effective for very small particles (including viruses) • Particularly important in places with less ventilation • Relationship between infiltration, filter efficiency, air circulation rate in room • Require maintenance, vital for effectiveness • Moderate costs

11. Negative Air Pressure • Created with exhaust fan placed in window facing outward • Creates pressure gradient between room and external environment • Prevents contaminated air leakage from within patient room to external environment • Effective in a patient care room and in home care setting • Protects well individuals caring for ill

12. Ultra Violet Light • Potential to disinfect air and surfaces • UV-C light filters • Air is filtered through device, exposed to concentrated UV light and circulated out • Ceiling fixtures--> relative air temperatures important • Lower humidity levels desirable • Most effective in areas without much movement (offices, school rooms)

13. Humidity and Temperature Control • Transmission dependent on environmental factors • Higher relative humidity levels and temperature lower transmission • Conflict with necessary conditions for UV light use

14. ~Next Steps~ • Can we model influenza transmission in the home environment? • Are there data regarding transmission rates from an ill family member to another? • Can use model to examine effects of specific measures, singly or in combination? • Recommendation of simple home care kit

15. “Pandemic Influenza Planning:How Ready are the Fifty States?” Richard Larson, Ph.D. Karima Nigmatulina Stan N. Finkelstein, M.D.

16. Review of Fifty States’ Pandemic Flu Plans • BACKGROUND • 2002: Congress provides funding to states for public health emergency planning and required states to develop pandemic plans as a condition of funding • 2005: PHS issues guidelines and offers assistance, but mandates each state to develop its own plan

17. Review of Fifty States’ Pandemic Flu Plans • OUR APPROACH • We reviewed all fifty state plans, in detail, accessing whatever information could be obtained from individual state “Pandemic Flu” or health department websites • “Point in Time” – Summer, 2007

18. Review of Fifty States’ Pandemic Flu Plans • FINDINGS • Great variation in effort expended • Tremendous strengths in some; gaping holes in others • Rarely able to identify names specific individuals who were main contributors to the plans • Generally inadequate attention to non-pharmaceutical interventions

19. Review of Fifty States’ Pandemic Flu Plans • “MODEL” Outline for State Pandemic Flu Plan • Medical Preparedness • Organization of Response • Surveillance • Communication • Non-Pharmaceutical Interventions • Hygiene • Social Distancing

20. Non-Pharmaceutical Interventions: Hygiene

21. Non-Pharmaceutical Interventions: Hygiene

22. Non-Pharmaceutical Interventions: Hygiene

23. Non-Pharmaceutical Interventions: Hygiene

24. Non-Pharmaceutical Interventions: Social Distancing

25. Non-Pharmaceutical Interventions: Social Distancing

26. Non-Pharmaceutical Interventions: Social Distancing

27. Review of Fifty States’ Pandemic Flu Plans • BOTTOM LINE: • NPI’s need to be taken more seriously!!!