*Pandemic Phases, Triggers, and Response*
Defining Triggers to Initiate a Timely Response During a Pandemic
By: Fairplay
September/December 2006

1. Introduction

This document was created to capture thoughts and research that define a set of triggers used to initiate appropriate and timely responses during a pandemic. If you want to jump directly to the conclusions, go directly to section 1.5 Recommended Response.

1. How to Use This Document

This document will be the most benefit if used as a workbook. Use it to help assess your pandemic preparedness.

2. Organization

1. How To Use The Worksheets

1. Pandemic Phase Definitions
1. Goals

Understand the definition of the phases used to communicate the status of a pandemic.

2. Recommendations

Review the Pandemic Phase Definitions table.

3. Rationale

In order to communicate effectively it is essential that everyone is using the same terminology when discussing the status of a pandemic. You should know something about the various phases of a pandemic and be alert when there is a change being discussed. Remember you don’t have to memorize all of this information; you just need to know where to find it when a question arises. When you get a Rubicon Alert on your cell phone that the pandemic is at Phase 5 you will know what that means and what to do.

4. Pandemic Phase Definitions

Phase	WHO Definition
One	Low risk of human cases.
Two	Higher risk of human cases.
Three	No or very little limited human to human transmission.
Four	Evidence of increased human to human transmission.
Five	Evidence of significant human to human transmission.
Six	Efficient and sustained human transmission.

2. How Fast Will It Spread
1. Goals

Understand the rapid speed at which a pandemic may spread, what the experts are saying, and what computer simulations are projecting. Understand that the infection will come in waves and there may be brief times between waves that may be safer than other times during a pandemic.

2. Recommendations

http://www.lanl.gov/news/index.php?fuseaction=home.story&story_id=8171

1. Rationale

It is important to fully realize how fast an evolved influenza virus could spread. . This is particularly noteworthy if you have family members that are remote and plan to return home during a pandemic or if you plan to bug out or relocate to weather a pandemic. Governments have stated the possibility that travel restrictions and quarantines may be used to slow the spread of infection. It is unclear how and when travel restrictions may be implemented. Avoiding getting caught in route with limited supplies would suggest that an early response is desirable if your plans include relocation.







 

2. Phase Worksheet

1. Triggers and Responses
1. Goals

1. Recommendations

Plan the timing of a response based that can be realistically supported by existing capabilities.

2. Rationale

A trigger is an observable event. A response is your reaction to that trigger. All triggers are the same for everyone. All responses are the same for everyone. What is different is the timing of when you respond. This is an important concept that will simplify your planning. It also establishes a common language and terminology for the Rubicon membership that will help us communicate our status effectively with one another in different geographic areas.

There may be little time to respond when sustained human transmission occurs. It is POSSIBLE that sustained human transmission evolves initially at a location much closer than the other side of the globe, in which case there may only be days or hours to respond. This is a guide, individual and families should make their own decisions about how to respond. These decisions will be difficult and should be discussed and decided in advance. Waiting for as long as possible without endangering members will help us keep jobs, insurance, stay in touch with loved ones, and care for our homes for as long as is safe to do so.

It is therefore very important to have a well defined plan of response based on a set of observable triggers. These triggers initiate a response in order to react in time to reduce the opportunity of infection. The triggers are well defined. Each response should be discussed and agreed to as appropriate by your family before the pandemic begins. Without such a detailed plan, valuable time will be lost deciding what to do instead of responding.

The primary objective is to avoid infection. This plan contains many aspects on how to prepare and how to develop habits that are not only desirable during a pandemic but many are healthy habits that should be practiced as standard operating procedures all the time. Many responses are also applicable to other threats such as biological, nuclear, or natural. The time that you spend discussing triggers and responses with your family will be time well spent in improving your preparedness efforts. Knowing when to respond is as important as knowing how to respond. Each member of your family should know what is expected of them so everyone can work together more effectively.

If infection has occurred it is important to avoid spreading the infection. Those not infected will be required to care for those that are ill. Home care may be necessary and/or desirable if hospitals and clinics are at capacity. Prevention and survival will be dependant on rapid response to quickly changing conditions.

The triggers are the same for everyone. The responses are the same for everyone. When a response is executed determines your level of risk. Each Rubie has different conditions that affect capabilities. For example: your family, where they are physically located, your health, your job, and your financial priorities all may affect the timing of a response. The timing of a response for a couple that is retired, well prepared, with no mortgage may be different than the timing of a response for a family with children, only partially prepared, paying a mortgage, with children living at home, and other children attending a university in another city. The responses are the same but the timing may be different based on individual capabilities.

You have invested time and money in material preparations that will be of little value if you do not have a plan and the capability to respond with timing reflecting your risk tolerance. Timing will be critical to use these preparations during what will likely be a rapidly changing environment as a pandemic develops.

3. Trigger Simplification

1. Recommended Response
1. Goal

Minimize infection risk by timely response.

2. Recommendations

Trigger	Response
NOW	Hygiene Monitor Response plan defined Preparations complete
Human sustained, remote	Alert Family
Human cases, national	Assemble Family Limit travel
Human cases, regional	Operate Positive Pressure (FIAC) Quarantine Decontaminate Wear Mask Outside
Animal cases, regional	Animal controls
Human cases, local	Lock down
Human cases, in house	Isolate Use antiviral

 

1. Rationale

A response initiated too early will waste valuable resources that may be in short supply. A response too late increases the risk of infection.

Attention now should be on evaluating and completing your preparations including reviewing plans to identify and improve weak areas.

2. Evaluate Your Capabilities
1. EVALUATE YOUR INFORMATION SOURCES
1. Goals

Develop your information sources so you will know when to pull the trigger.

2. Recommendations

Use the worksheet to improve your awareness and improve your sources of reliable information.

3. Rationale

Early detection is dependant upon the quality and availability of information from many sources including: news reporting, government agencies, internet blogs, and certainly the Rubicon. Keep in mind that once a pandemic starts events will happen rapidly. Reliable information will likely become increasingly suspect, containing a chaotic mix of rumors and facts. Government agencies may even attempt to suppress information to reduce panic and may not have reliable information depending on how broken the "system" becomes because of the pandemic’s disruption.

Think about the people that you know that work in various places and jobs that can be sources of reliable first hand information. It is likely that EMTs, LEOs, and hospital workers are going to be aware of a pandemic’s effects before it becomes common knowledge. The homeless, people in long term care facilities, and inmates are likely going to show signs of a pandemic’s impact first because of their proximity and exposure to other people. Also school children, college students, and people living on military installations or on campus type grounds are at higher risk for infection.

Make use of your available sources of information and share what you know with the Rubicon. You will think of other people to cultivate as sources of information. Now before a pandemic starts is the time to develop your information gathering capabilities and develop habits to help you monitor a pandemic when it occurs.

4. Information Sources Worksheet

Information Sources	Yes	No
I read the newspaper every day.
I watch the news on TV or radio every day.
I get my news from the Rubicon.
I work or have friends that are health care professionals.
I work or have friends that are first responders (EMTs, LEOs).
I work or have friends that work in a long term care facility or nursing home.
I visit NBII wildlife disease maps. http://wildlifedisease.nbii.gov/diseaseresource.jsp?disease=Avian%20Influenza&section=Maps&pagemode=submit
I visit CIDRAP. http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/index.html
I visit WHO. http://www.who.int/csr/disease/avian_influenza/en/
I visit CDC. http://www.cdc.gov/flu/avian/outbreaks/current.htm
I visit H5N1 News and Resources for timely information about Avian Flu. http://crofsblogs.typepad.com/h5n1/
I rely on FluWiki news aggregators and blogs. http://www.fluwikie.com/pmwiki.php?n=Resources.Resources
I visit The Microbiology Information portal for my news. http://www.microbes.info/news/bird_flu.php
Total score

 

3. Evaluate your Capability to Reduce Exposure
1. Goals

Identify ways to reduce exposure.

2. Recommendations

Use the worksheet to identify areas for improvement. For example: now is the time to try working from home (if that is a possibility).

3. Rationale

Until an effective vaccine is available; hygiene, social distancing, and quarantine are the best tactics to reduce chances of exposure and infection. Each trip beyond the confines of your positive pressure protection represents increased risk of exposure and infection.

4. Job, Health, and Finance Worksheet

Health, Job, and Finance Questions	Yes	No
Do you have the option of receiving your supply of required medication via the mail instead of visiting the pharmacy? Your spouse? Your children?
Do you have a relationship with your Doctor that would allow you to conduct your business on the telephone and reduce or avoid office visits? Your spouse? Your children?
If you rely on employer-provided health insurance for a health condition or medication, do you have a plan for coverage if you lose your job?
Does your employer have a disaster or pandemic plan?
Do you know how your employer will manage absenteeism during a disaster or pandemic?
Can you work from home?
Have you tried working from home?
Do you have accrued vacation or paid time off?
Does your employer have a temporary leave of absence program?
Do you have any disability insurance? Short-term or long-term?
Do you have unemployment insurance?
Do you have a short-term emergency cash reserve? Enough to operate your household for 6 to 12 months?
Do you have barter-able goods and services? Do you have a barter network? Are you a successful barter or a newbie?
Do you bank on-line? Can you conduct your financial affairs without leaving your home? Can you pay common bills on-line? Can you wire transfer on-line? Can you access your account and make payments by telephone?
Totals

 

5. Evaluate Your Preparations
1. Goals

Determine level of preparedness and prioritize needed improvements.

2. Recommendations

Use the worksheet to evaluate your preparedness and identify areas that need improvement.

There are many good articles in the Rubicon and an abundance of Rubicon experts available on the boards to help answer these questions. Avoid becoming overwhelmed. Instead take each row in the worksheet and evaluate an answer based on your circumstances. If you really don’t know the answer, take the time to determine an informed response based on FNV. For example: you may have bought a few N100 masks. Do you have enough? How did you determine that number? How long will they last? This worksheet is intended to break things down into "bite sized" manageable pieces.

3. Rationale

You can’t fix what you don’t know is broken.

4. Preparations Worksheet

Preparations Questions	Yes	No
Do you have adequate food storage for a wave that may last 2-3 months?
Do you have adequate food storage for a pandemic that may last 18-24 months?
Do you have adequate supplies of PPE (including masks, tyvek suits, etc.)?
Do you have the means to isolate a family member that becomes ill?
Do you have adequate supplies to care for a family member that becomes ill?
Do you have adequate over the counter medications?
Do you have adequate cleaning and disinfectant supplies?
Do you have the means to quarantine arrivals that may be infected?
Do you have the means to decontaminate mail? Money?
Do you have an alternative source of electricity?
Do you have an alternative source for heat?
Do you have an alternative way to cool?
Do you have a security system?
Do you have a water supply?
Do you have a positive pressure system (FIAC, etc)?
Do you have the means to decontaminate when reentering the confines of your positive pressure protection?
Do you have alternative communication capabilities (HAM, CB, etc.)?
Do you have "things to do" for entertainment to avoid cabin fever?
Do you have a plan to deal with the bodies of dead family members?
Totals

4. Definitions
1. Terminology

• Remote - geographic location that is remote to your location.
• National - geographic location within your country i.e. CONUS.
• Regional - geographic location in surrounding states.
• Local - geographic location in your state or adjacent counties.
• Hygiene - Diligent hand washing, cough etiquette
• Monitor - Increased attention to events.
• Stay home - Work from home, eliminate unnecessary trips
• Lock down - No admittance unless going through quarantine procedures.
• Quarantine - The compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas.
• Isolation - The separation and confinement of individuals known or suspected (via signs, symptoms, or laboratory criteria) to be infected with a contagious disease to prevent them from transmitting disease to others.
• Decontaminate - Procedure to eliminate contagions.
• Isolate - Procedure to separate people that are infected from those uninfected.
• Wear mask outside - Wear N100 mask if outside of positive pressure system.
• Animal control - Bring pets indoors, restrict access to fowl, take preventive measures to prevent poultry and livestock becoming infected.
• Use antiviral (illness treatment) - Family member is ill and receiving antiviral.
• Assemble family - Gather your family to weather the pandemic.
• Operate positive pressure system - FIAC providing positive pressure to reduce intrusion of contaminants.
• Bug out - Moving to an alternate location or retreat.
• All Clear - Occurs when risk of infection is past. This may also occur as a result of having been inoculated by an effective vaccine when one becomes available.

1. Trigger Definitions

The initial list of triggers was identified:

1. Animal cases, remote.
2. Human cases, remote.
3. Human clusters, remote.
4. Human sustained, remote.
5. Animal cases, national.
6. Human cases national.
7. Human clusters, national.
8. Human sustained, national.
9. Animal cases, regional.
10. Human cases, regional.
11. Human sustained, regional.
12. Human cases, regional.
13. Animal cases, local.
14. Human cases, local
15. Human clusters, local.
16. Human sustained, local.

1 - 3, 5 were eliminated because they have already occurred. 6, 7, 8 were collapsed into a single trigger; Human cases, national to simplify. 10, 11, 12 were collapsed into a single trigger; Human cases, regional to simplify. 13 was eliminated because it was felt to represent a delayed response with unacceptable risk. 14, 15, 16 were collapsed into a single trigger; Human cases, local.

1. Response Definitions

The initial following responses were identified:

1. Hygiene
2. Monitor
3. Alert Family
4. Wear mask outside
5. Animal Control
6. Stay home
7. Use antiviral (post exposure or preventive)
8. Bug Out
9. Assemble Family
10. Quarantine
11. Operate positive pressure system (FIAC)
12. Decontaminate
13. Isolate infection
14. Use antiviral (illness treatment)

7 was eliminated based on conversation with medical professionals and high cost that was better spent on other preparations.

Pandemic Reference Guides

http://www.pandemicreferenceguides.com/

http://www.lanl.gov/news/images/avianflu.shtml

http://www.lanl.gov/news/index.php?fuseaction=home.story&story_id=8171

http://www.umd.edu/emergencypreparedness/pandemic_flu/pdfs/AvianFlu_S.pdf

www.alpharubicon.com
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