Disease Containment

1. Disease Containment An Introduction to the Community Containment for Disease Tool Box

2. Disease Containment Primer Discussion of disease containment strategies Introduction to the Kansas Community Containment Isolation/Quarantine Tool Box Identification of steps necessary to prepare for an event involving multiple or community oriented strategies Opportunity to ask questions prior to the start of the exercise

3. What is Disease Containment?

4. Dictionary.com defines “Containment” • the act or condition of containing. • an act or policy of restricting the territorial growth or ideological influence of another, esp. a hostile nation. • (in a nuclear power plant) an enclosure completely surrounding a nuclear reactor, designed to prevent the release of radioactive material in the event of an accident.

5. Disease Containment Strategies • Strategies implemented to stop or slow (contain...) the spread of a contagious disease in a community • Websters alteration: an act of restricting the growth of a “hostile” disease • Can you name some examples?

6. Disease Containment Strategies • There are two general areas of containment strategies • Measures targeted at individuals • Measures targeted towards groups or the entire community

7. Disease Containment Strategies • Measures targeted at individuals include: • Isolation of symptomatic persons • Quarantine of exposed persons • Management of Contacts • These measures are the most commonly used (small or limited outbreaks)

8. Individual Containment Strategies We usually think of: • “Quarantine” involves a situation where a group of persons is reasonably believed to have been exposed to a dangerous communicable disease and is kept apart from others to prevent disease transmission. • “Isolation” is used when a person who is reasonably believed to have contracted a dangerous communicable disease is kept separate from others to prevent disease transmission. p. 24 of 71

9. Management of Contacts = Challenge! Household Contacts Hospital Incidental Contacts Potential Contacts

10. Individual Interventions • Passive Monitoring • Contact is asked to perform self-assessment periodically and to contact authorities immediately if symptoms occur. • Active Monitoring without explicit activity restrictions • A healthcare or public health worker evaluates the contact on a regular (at least daily) basis by phone and/or in person for signs and symptoms p. 15 of 71

11. Individual Interventions • Active monitoring with Activity Restrictions (quarantine) • The contact remains separated from others for a specified period, during which she is assessed on a regular basis (in person at least once daily) for signs and symptoms of disease. Persons with disease specific symptoms will require immediate evaluation by a trained healthcare provider. Restrictions may be voluntary or legally mandated: confinement may be at home or in appropriate facility. - - No specific precautions are required for those sharing the household with a person in quarantine as long as the person remains asymptomatic. p. 16 of 71

12. Individual Interventions • Working quarantine • Employees are permitted to work but must observe activity restrictions while off duty. Monitoring for illness before reporting to work is usually required. This may change based on the clinical presentation of disease. Use of appropriate infection control procedures while at work is required. p. 17 of 71

13. Disease Containment Strategies • Measures targeted at groups include: • Measures that affect groups of exposed or at-risk persons • Measures that affect entire communities

14. Group Interventions Community strategies • Snow days and self-shielding (voluntary) • Asking everyone to stay home • May be instituted for periods that might encompass the incubation period of a particular disease (SARS – Canada) • Closure of office buildings, shopping malls, and public transportation • May be feasible in some circumstances • Consequences must be carefully considered

15. Group Interventions • When to implement measures that affect groups • There is limited disease transmission in the area • Most cases can be traced to contact with an earlier case or exposure to a known transmission setting (e.g. a school or workplace where a person has fallen ill) • The intervention is likely to either significantly slow the spread of infection or to decrease the overall magnitude of an outbreak in the community Page 12 of 71

16. Groups that may be quarantined include: • Persons who might have been exposed: • Via family members • At a public gathering • On an airplane or cruise ship or other closed conveyance • At their school or workplace • Healthcare providers who work at a facility where disease cases receive care

17. Measures that apply to specific sites or buildings • Cancellation of public events • Concerts • Sports events • Movies or Plays • Closure of recreational facilities • Community swimming pools • Youth clubs • Gymnasiums

18. Individual vs. Community Quarantine Measures • Key Considerations • Do Public health and medical analysis warrant the imposition of a large-scale quarantine? • Are implementation and maintenance feasible? • Is there a plausible way to determine who should be quarantined? • Are resources available to enforce confinement? • Can the quarantined group be confined for the duration during which they could transmit disease? • Do the potential benefits outweigh the possible adverse consequences? p. 11 of 71

19. Other Disease Containment Strategies Mass Prophylaxis is a containment strategy! (Also known as Pharmaceutical Interventions) • Chemo-prophylaxis is providing antibiotics or antivirals as preventative treatment (ie. Anthrax, Plague or Influenza Exposure) • Immuno-prophylaxis is providing an immunization to prevent disease transmission (smallpox, mumps, measles, influenza)

20. Disease Containment Strategies Public Education • Stressing the importance of hand washing • Encouraging people to stay home when sick • Encouraging people to avoid public gatherings • Stressing the importance of good disease control measures: • Using tissues to contain respiratory secretions (cough etiquette) • Disposing of tissues in the nearest waste receptacle after use • Wash hands after contact with respiratory secretions and contaminated objects or materials • Disinfecting inanimate surfaces Page 13 of 71

21. Effect of Increasing Social Distance on Epidemic Dynamics Suppression Exponentiation Ro = 2.0, Progression = 1:2:4:8:16 Ro = 0.67, Progression = 1:2:4:3:2 Source: Shaw, UAlbany CPHP broadcast, 11/10/05

22. Preparedness Checklist for Community Containment Measures General • Establish and Incident Command Structure • Establish a legal preparedness plan • Establish relationships with partners, such as law enforcement, first responders, healthcare facilities, mental health professionals, local businesses, and the legal community p. 21 of 71

23. Preparedness Checklist for Community Containment Measures • Plan to monitor and assess factors that will determine the types and levels of response, including the epidemiological profile of the outbreak, available local resources, and level of public acceptance and participation • Develop communication strategies for the public, government decision-makers, healthcare and emergency response workers, mental health professionals, and the law enforcement community. p. 21 of 71

24. Preparedness Checklist for Community Containment Measures • Invite key partners to participate in containment exercises and drills • Utilize actual events as an opportunity to practice and improve processes • Writing After Action Reports and improvement plans will document process improvements p. 21 of 71

25. Preparedness Checklist for Community Containment Measures Facilities • Identify appropriate community-based facilities for isolation of patients who have no substantial healthcare requirements. • Identify facilities for persons for whom home isolation is indicated but who do not have access to an appropriate home setting, such as travelers and homeless populations. • Develop tools and mechanisms to prevent significant stigmatization and provide mental health services to persons in isolation or quarantine p. 22 of 71

26. Preparedness Checklist for Community Containment Measures Facilities • Identify potential quarantine facilities and prepare contingency plans for staffing and equipping them. • Identify potential sites for clinics and prepare for staffing and equipping them, including the ability to dispense antiviral drugs to identified cases in the priority groups. p. 22 of 71

27. Preparedness Checklist for Community Containment Measures Community Containment Measures • Ensure that legal authorities and procedures are in place to implement the various levels of movement restrictions as necessary. • Establish procedures for medical evaluation and isolation of quarantined persons who exhibit signs of illness • Develop tools and mechanisms to prevent stigmatization and provide mental health services to persons in isolation and quarantine. p. 22 of 71

28. Preparedness Checklist for Community Containment Measures Community Containment Measures • Identify key partners and personnel for the implementation of movement restrictions, including quarantine, and the provision of essential services and supplies: • Law enforcement • First responders • Other government service workers • Utilities • Transportation industry • Local businesses • Schools and school boards p. 22 of 71

29. Preparedness Checklist for Community Containment Measures Delivery of essentials to individuals in iso/quar • Essentials include: • medical care • food • services • Training for responders and health care workers, as necessary, in use of personal protective equipment • Plans for the mobilization and deployment of public health and other community-service personnel p. 22 of 71

30. Tool Box Orientation • What else is in the tool box? • Decision Trees and Flowcharts (p. 5 – 8 of 71) • Guidelines and recommendations (throughout) • Sample Legal orders (p. 32 –36 of 71) • Forms for medical monitoring (p. 43 - 46 of 71) • Copies of the applicable statutes and regulations • KAC Guide for Implementing KSA 65-129 (p. 60 of 71)

31. Tool Box and SOG • Today we will use a scenario to familiarize you with the contents of the tool box and our local Standard Operating Guide • The SOG describes how we will use the tool box and how we will make decisions • The tool box is the key attachment to the SOG • Other attachments are notification flow charts and a description of our Incident Command Structure.

32. Quarantine Pop Quiz: True or False? FALSE 1) Requires 100% compliance to be effective 2) Always means using a legal order to restrict someone’s activity FALSE 3) Must be mandatory to be effective FALSE 4) Increases a person’s risk for acquiring the disease FALSE • 5) Not necessary if everyone who develops symptoms is rapidly placed in isolation FALSE 6) Public will not accept it FALSE Source: Shaw, UAlbany CPHP broadcast, 11/10/05

33. Questions?

34. X Minute Break!!