Respond to New Federal Guidelines on Pandemic Flu Planning

Armen Hareyan's picture

The Centers for Disease Control and Prevention and the Department of Health and Human Services released guidelines on nonpharmaceutical interventions, outlining a series of strategies to slow the spread of pandemic influenza. Nonpharmaceutical interventions refer to community actions that may have to be taken in the absence of a well-matched influenza vaccine and insufficient quantities of influenza antiviral medications. The guidelines are a result of research and community input, spearheaded by the Centers for Disease Control and Prevention.

The influenza guidelines are based largely on historical studies of the effectiveness of similar measures used in the 1918 influenza pandemic, and modern computer simulation methods.

According to some of the historical records available, in 1918, some communities that employed measures early in the pandemic were able to delay disease transmission, reduce the overall outbreak peak, and as a result, reduce the death rate. St. Louis, for example, closed schools, theaters, billiard halls, Sunday schools, lodges, public funerals, open air meetings, dance halls and conventions. These actions appeared to reduce St. Louis' death rate when compared to other communities that took later or less aggressive action. Findings from looking to 1918 suggest that early, targeted, and layered actions can have a meaningful effect on the spread of disease.


These measures are intended to separate infected or exposed persons by use of restrictions on movement and activities, such as canceling K-12 classes for a period of time, keeping children out of school from congregating elsewhere in the community, and canceling large group meetings or events. "Social distancing" decreases the amount of contact that people have with each other in the community. A person with influenza spreads infection to other people within six feet when virus particles are released into the air through coughing and sneezing. Crowded conditions in enclosed spaces provide ideal conditions for the spread of influenza. Social distancing puts more distance between people, thus decreases the likelihood of spreading the disease.

Because these measures would be disruptive, and there clearly is a need to balance possible benefits with negative effects, a pandemic severity index has also been introduced in the guidance. Similar to a hurricane rating system, this will help communities plan and match the severity of a pandemic to the actions needed. Measures such as canceling K-12 classes would be reserved for a severe-1918 like scenario.

For the past two years, Multnomah County Health Department has planned for a public health response to pandemic influenza; the measures outlined today are part of a menu of approaches public health officials would consider to slow the spread of a severe influenza outbreak and manage its impact on an overwhelmed health care system.

The Health Department has provided more than 50 briefings to various groups to help the community prepare for a pandemic. In addition, the Health Department conducted focus groups with a variety of businesses to better understand businesses