A ‘pandemic’ is the worldwide spread of a disease, with outbreaks or epidemics occurring in many countries and in most regions of the world. An influenza pandemic is likely to occur when the influenza virus undergoes major change (‘antigenic shift’), and a new influenza virus emerges, which is markedly different to recently circulating strain and to which humans are not immune.
A pandemic will occur if the new virus:
Infects people (rather than, or in addition to, animals or birds);
Spreads from person to person;
Causes illness in a high proportion of the people infected;
Spreads widely, (most people will have little or no immunity to the new virus and will be susceptible to infection).
The effectiveness of medical countermeasures such as immunisation and antiviral drugs in reducing the impact of a new pandemic are uncertain. But what is clear is that the annual influenza vaccine will not protect against a pandemic strain, and a specific vaccine will need to be developed.
b. Surely this is just an over-reaction? Pandemic flu won’t affect us. This is a common response. Public research shows there is little if any, awareness or understanding of pandemic flu and there is little desire to engage with the issue. Avian flu is often confused with pandemic flu, which means information about pandemic flu is also open to misinterpretation.
But the threat is very real with experts saying we are long overdue a flu pandemic.
This is because it generally expected that there will be four ‘antigenic shifts’ in the flu strain leading to mass infection every 100 years. In the last century there were three instances of pandemic flu, with the last outbreak nearly 40 years ago (in 1968/9). Experts are not only predicting a pandemic because typical patterns suggest one is imminent but also because it is so long since the last one. In other words, its not a question of ‘if’, but ‘when’.
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c. OK so flu is coming. But we can handle a few coughs and sneezes? Put simply pandemic flu is likely to be deadly.
Pandemic flu will spread rapidly around the world and is likely to consist of one or more waves, several months apart, with each wave lasting two or three months. It will not necessarily occur during the winter, nor will it necessarily be traditional “at risk” groups who will be most affected – the 1918 Spanish flu pandemic affected mainly people of working age, whilst the 1957 pandemic mainly affected the ‘traditional’ at risk groups.
Up to 50% of the general population will be affected by the pandemic flu strain.
Mid Essex PCT has done some modelling around the potential impact on its population. This works serves to illustrate the scale and seriousness of the challenge:
There are approximately 370,000 people living within the Mid Essex PCT geographical area, based on the planning assumptions of an attack rate of up to 50%, 185,000 people in Min Essex will be infected.
It is anticipated that 28.5% of the 185,000 people infected will require GP care, this means that in addition to the normal workloads GP’s in Mid Essex locality can anticipate an extra 52,725 patients requiring additional care.
Approximately 22% of influenza cases can be expected to occur in peak week of the pandemic waves, this would equate to approximately 40,700 cases within this time period.
Previous pandemics have resulted in a mortality rate of between 1% and 5% of all those affected. The following calculations provide a sense of what this means in terms of actual numbers of people:
1% mortality = 1850 persons
1.5% mortality = 2775 persons
2.5% mortality = 4630 persons
5% mortality = 9250 persons
A mortality attack rate of 2.5%+ would require all services and functions to be suspended and staff redeployed to maintain critical functions.
A pandemic will therefore disrupt the daily life of many people and cause intense pressure on health and other services (e.g. public transport, schools etc).
Although the absenteeism rate would not be uniform, modelling suggests it would be sensible to plan for absenteeism as a direct result of flu at 10-15%. Public health advice will be that if you feel unwell you should stay at home, with people taking on average five and eight working days sick leave.
Staff who don’t get flu may still need to take time off work to care for ill children or relatives or may even find themselves stranded if public transport is temporarily suspended.
It is possible in this context that staff with limited communications experience will be required to help meet the demand for information from colleagues, the media and the public for information.
3. A communications plan for Essex health services
Whilst pandemic flu will be viewed as a health issue it will clearly have an impact on all organisations in Essex, whether private or public. The ERF’s Warn and Inform Group have developed a pandemic flu communications strategy outlining the roles and responsibilities of all organisations responding to the pandemic.
This communications plan aims to set out what might be required of health communicators. It is designed to complement – not replace – the ERF and Department of Health’s communications strategies. This plan should not therefore be read in isolation of these strategies.
a. Key objectives The purpose of health communications during a pandemic will be to
Provide accurate, timely and consistent information and advice to staff, the public and partner organisations;
Promote understanding of pandemic flu amongst staff and explain their role in helping to reduce pressure on services, whilst responding to public need;
Explain the ability of the health community to respond to, and reduce the impact of a pandemic, within the constraints that they will face.
b. The WHO alert phases The World Health Organization (WHO) has divided the evolution of a pandemic into several phases to support and anticipate planning and service needs. These phases are being used by governments as trigger points for intensifying or scaling down activity. The phases fall into six broad areas: Interpandemic Period
Phase 1: Not in humans, present in animals;
Phase 2: Not in humans, substantial risk from animals;
Pandemic Alert Period
Phase 3: Human infection(s), but rare and no or rare human-to-human transmission;
Phase 4: Small cluster(s), with limited human-to-human spread;
Phase 5: Larger cluster(s), but localised.
Phase 6: Pandemic phase – increased and sustained transmission in population.
The current alert period is phase 3 and has been for some time. It should also be noted that further waves are likely three to nine months after the first end of Phase 6, meaning we may have to move between phases 3 – 6 several times after the pandemic first hits.
c. The Communications moodIn an effort to capture the communications challenges in each of these phases the Department of Health conducted research into how people might react as a pandemic unfolds. The insights from this research give us an indication of how we might meet the communications challenges:
Phases 1-3 = “Vague Worry”
Little knowledge but much confusion regarding types of flu.
Vocal ‘experts’ inform opinion
Provide basic information
Use opinion formers to explain plans / rationale
Phase 4 = “Alarm Bells”
Many will remain unconcerned if the outbreak of flu occurs in Asia
Active information seeking from concerned panickers
Exaggeration and misrepresentation of threat and how to control it
Information about what a pandemic is, how it is different
The key messages we need to send to staff and the public will be developed by the Department of Health (DH) and the Health Protection Agency. These will be issued to communications leads directly or via the Strategic Health Authority at the appropriate point during the outbreak (see ‘planned national activity’ below).
NHS communications teams must support the DH programme of awareness raising by using their usual communications channels to distribute information.
In essence this means using the national materials (adapted for local circumstances if required) for:
Explaining what pandemic flu is and how it compares with ordinary flu and bird flu;
Demonstrating how the NHS locally is planning to respond to a flu pandemic;
Explaining the difference between vaccines and anti-virals and when and how they would be available;
Tell people what they can do to prevent the spread of infection.
a. Planned national activity The national activity has been planned around the WHO alert phases as follows:
Guidance for health professionals on a range of issues including antivirals and infection control available at the Department of Health website - www.dh.gov.uk/pandemicflu.
Publications - Explaining pandemic flu (CMO Guide), FAQs, Key Facts, and public information leaflet, Pandemic flu, important information for you and your familyavailable on the DH website and mailed to primary care, Oct 2005]
Media relations – strategy designed to promote understanding, particularly of the differences – and linkages – between avian and pandemic flu
Phase 4 / 5
Public information film - marketed to BBC and ITV for free to air broadcasting if public demand for more information. Could also be aired on NHS Direct Interactive or used for training purposes.
National door drop (all households) – flyer with key facts and self-help advice. Distribution also through primary care [DH to alert SHAs asap in advance]
Advertising campaign –print and broadcast. Alerts public to heightened risk and to look out for flyer through door (see above). [DH to buy media and alert SHAs asap in advance]
Automated action line - Setting up of single number action line which will direct callers through to NHS Direct or leaflet ordering service
NHS Direct – helpline services, online and interactive digital TV service
Antivirals leaflet – information for health professionals and public on how to use. Available through primary care [DH produce and distribute for use in Phase 6]
Treatment advice - self treatment advice for the public. Wide distribution. [DH produce and distribute for use in Phase 6]
Travel advice –as before
Media handling strategy to include live Chief Medical Officer broadcasts and twice daily press briefings
Advertising – messages will be adjusted to reflect advice now that pandemic has started TV, national and regional press, local radio [DH to buy media]
Public information film and radio – updated version of phase 5
Teletext page - key facts and sources of further information
NHS Direct – as Phase 5
Antivirals leaflet – (Distributed in phase 5) info for health professionals and public on how to use. Available through primary care [DH produce and distribute]
Treatment advice – (Distributed in phase 5) public info leaflet. Wide distribution. [DH produce and distribute]
Vaccination leaflet (Distributed in phase 5)
Media handling strategy to include live Chief Medical Officer broadcasts and twice daily press briefings
b. Action Cards The next section describes some more action communicators working in the NHS need to take pre, during and post pandemic. By carrying out the actions described below you will be supporting the over-arching multi-agency communications strategies and contributing to the effective management of the outbreak.
The section can be detached from the rest of the document to be used as action cards.
Action for Primary Care Trusts (PCTs)
Mid Essex PCT will be the lead health organisation locally in responding to a flu pandemic. The other PCTs in Essex will take direction from the lead PCT or the Strategic Co-ordinating Group Media Cell as appropriate.
It is the responsibility of each PCT to ensure staff are aware of the actions outlined below and of the communications strategy developed by the ERF Warn & Inform Group for multi-agency working.