Explaining

Courtesy of Your Pinal County Board of Supervisors

FOREWORD

As members of the Pinal County Board of Supervisors, we ask each citizen to review this booklet as a first step towards pandemic influenza preparedness. This booklet contains the information needed to understand how to help prevent this disease and how to create a preparedness plan for your home and business.

Recently it has been difficult to read a newspaper or watch a newscast without some mention of the avian influenza (flu) or influenza (flu) pandemic. Throughout history, flu pandemics have proven to have devastating effects on the health of our communities and economy. In 1918, the world was devastated by the Spanish Flu Pandemic. The Spanish flu killed around 675,000 Americans and tens of millions worldwide.

Today, we are the first generation in history to anticipate a flu pandemic. Your federal, state, and local governments have been working for the past two years on plans to minimize the potentially devastating effects of a flu pandemic. Scientific experts throughout the world agree that it is simply a matter of time before the world sees its next flu pandemic. The avian flu is a potential, and some say likely, source of the next flu pandemic and as such its effects and transmission throughout flocks of poultry and wild birds is being closely monitored worldwide. The concern that health officials have regarding avian flu is that the effects closely mimic that of the devastating Spanish Flu Pandemic of 1918. At this point avian flu is only easily transmissible between birds. However, a mutation could take place at any time that would allow transmission between humans to occur as easily as it does each year for seasonal flu.

The Division of Public Health has been working to prepare for a flu pandemic. As part of their work, they have examined statistical data using the Spanish Flu Pandemic as a model for an impending pandemic. Based upon that data, 30% - 40% of the residents of Pinal County will contract the flu. This will have a devastating effect on the ability for us to continue to run our businesses, schools, essential and government services. Given that every community in the nation and world will have similar effects, normal supply chains will likely be interrupted. If the impending flu pandemic follows the pattern of the 1918 pandemic, Pinal County could face 1,700 deaths and 8,500 hospitalizations over the course of the pandemic. Unlike seasonal flu that generally has its most devastating effects on the very young and elderly, the Spanish Flu mainly affected young healthy adults. In fact, nearly half of those who died in that pandemic were young healthy adults.

Pinal County has been and will continue to work with federal, state, and other local officials on pandemic flu planning. Given that the flu pandemic is by definition a worldwide event it is clear that the state and federal resources that local governments would normally use to assist in disaster will likely not be available. As a result, our efforts focus on using local resources to manage this event.

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The most important resource we have in Pinal County is our citizens. The personal preparedness of each citizen is the key to our successful mitigation of the flu pandemic. The prevention of the spread of disease must be the number one goal of every citizen, business owner, and government official. The likelihood of an effective vaccine being developed in time and in the volume needed is not promising so we need to concentrate our efforts on prevention methods. As covered in this booklet, these methods are simple and effective. Examples of some of the measures are simply keeping sick workers and school children home and regular washing of hands. We encourage you to take a few minutes to review this material. If you have a group that would like to have a presentation, please contact the Division of Public Health at (520) 866-7319.

Sincerely,

PINAL COUNTY BOARD OF SUPERVISORS

Lionel D. Ruiz Sandie Smith David Snider District 1 Supervisor District 2 Supervisor District 3 Supervisor

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This document may be reproduced without formal permission or charge for personal or in-house use.

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Table of Contents

QUESTIONS AND ANSWERS ABOUT THE FLU 6

The Pinal County Division of Public Health 6 What is Influenza (Flu)? 7 What are the Symptoms of the Flu? 7 How Does the Flu Spread? 7 How Soon Will I Get Sick if I am Exposed to the Flu? 7 How Do I Find Out If I Have the Flu? 7

INFLUENZA PANDEMICS 8

What is an Influenza Pandemic? 8 Recent Influenza Pandemics 8 The Potential for an Avian Influenza (Bird Flu) Pandemic 8 Does the Flu Have Complications? 9 How Long is a Person With the Flu Virus Contagious? 9

PLANNING 10

What to Expect During an Influenza Pandemic 10 Vaccines 11 Anti-Viral Medications 11 Your Part in the Planning Process 11

BUSINESS PANDEMIC INFLUENZA PLANNING 12 CHECKLIST FAMILY EMERGENCY HEALTH INFORMATION SHEET 14 PANDEMIC FLU PLANNING CHECKLIST FOR 16 INDIVIDUALS AND FAMILIES EMERGENCY CONTACTS FORM 17

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QUESTIONS AND ANSWERS ABOUT THE FLU

The Pinal County Division of Public Health

Please contact the Pinal County Division of Public Health, Emergency Preparedness and Response Section at (520) 866-7319 if you would like more information about the Flu. The Pinal County Division of Public Health can provide additional guidance and recommendations to assist in preparing for the threat of an Influenza pandemic.

Prevention is the Key to Controlling the Spread of the Flu

The Two Most Common Ways Flu is Prevention Strategies Spread Person-to-Person • Avoid close proximity to people who are sick.

• Wear a cloth mask if close proximity is unavoidable.

• Cover your mouth and nose when coughing or sneezing.

• Wash your hands if you sneeze or cough into them. Contact With Sick People • Disinfect surfaces such as phones, keyboards, doorknobs, and faucets.

• If you are sick, stay home to prevent others from becoming ill.

• Frequent hand washing is key.

Proper Hand Washing Technique

Contaminated Surfaces • Wash hands with soap and warm running water for at least 15 seconds (Children can be instructed to sing the ABCs at least once to ensure 15 seconds).

• Rub hands together vigorously to cover all surfaces of your hands (including under fingernails).

• Use single use paper towels to dry hands. Do not use a common use cloth towel.

• If soap and water are not available, use a 60% alcohol-based hand rub (hand sanitizer).

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What is Influenza (Flu)?

Influenza, commonly called “the Flu”, is caused by the Influenza virus, which infects the respiratory tract (nose, throat, and lungs). Unlike many other viral respiratory infections, such as the common cold, the Flu causes severe illness and may cause life-threatening complications for some people.

What are the Symptoms of the Flu?

Influenza is a respiratory illness. Symptoms of the Flu include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Children can have additional symptoms, such as nausea, vomiting, and diarrhea, but these symptoms are uncommon in adults. Although the term “Stomach Flu” is sometimes used to describe vomiting, nausea, or diarrhea, these illnesses are usually caused by other viruses, bacteria, or possibly parasites, and are rarely related to Influenza.

KEY POINTS How Does the Flu Spread?

• Flu is caused by a virus which The main way that Influenza viruses are spread is infects the nose, throat and lungs. person-to-person in respiratory droplets of coughs and sneezes called “droplet spread”. This happens • The main way Flu virus is spread is person-to-person when droplets from a cough or a sneeze of an infected person are propelled (generally up to 3 feet) through the air and deposited on the mouth, • A person exposed to the Flu will nose, or eyes of people nearby. Though much less begin to have symptoms in about frequent, the Flu virus can also be spread when a one to four days. person touches respiratory droplets on another person or an object and then touches their own • Prevention is the key to mouth, nose, or eyes (or someone else’s) before controlling the spread of the Flu. washing their hands.

How Soon Will I Get Sick if I am Exposed to the Flu?

From when a person is exposed to the Flu virus to when symptoms begin is about one to four days, with an average of about two days.

How Do I Find Out if I Have the Flu?

It is very difficult to tell the Flu from other viral or bacterial causes of respiratory illnesses on the basis of symptoms alone. A test can confirm that an illness is Influenza if the patient is tested within the first two or three days after symptoms begin. In addition, a doctor’s examination may be needed to determine whether a person has another infection that is a complication of Influenza.

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INFLUENZA PANDEMICS

What is an Influenza Pandemic?

When an Influenza pandemic is discussed, health experts are referring to an outbreak of Influenza (Flu) that spreads worldwide. Unknown to many people, there have been several significant Influenza pandemics in recent history.

Recent Influenza Pandemics

The Asian and Hong Kong Influenza Pandemics of 1958 and 1968 are both considered to have been “moderate” Influenza pandemics. Most victims of the Asian and Hong Kong Influenza Pandemics were elderly. KEY POINTS

However, the pandemic most often cited by the • An Influenza pandemic is a world- U.S. Centers for Disease Control and Prevention wide outbreak of the Flu. (CDC) when estimating the potential impact of

Avian Influenza or “Bird Flu” is based upon the • There have been several Influenza Spanish Influenza Pandemic of 1918. This pandemics in the past. “severe” Influenza pandemic:

• The Spanish Influenza Pandemic • Was more deadly than the Hong Kong Influenza Pandemic of 1958 and the Asian of 1918 was considered one of the Influenza Pandemic of 1968 combined. most severe.

• The current Avian Influenza (Bird • Killed mostly healthy young adults. Flu) virus is similar to the virus that caused the Spanish Influenza • Came in “waves” that affected communities for six to eight weeks at a time. Pandemic of 1918.

• Caused 30% of the American population to become ill.

The Potential for an Avian Influenza (Bird Flu) Pandemic

The Spanish Influenza Pandemic of 1918 killed 50 to 100 million people worldwide. It was one of the deadliest Influenza pandemics in history. Its cause was an Influenza virus that is similar to the Avian Influenza (Bird Flu) virus found today among infected birds and chickens in Asia.

So far, cases of people being infected with Avian Influenza (Bird Flu) in Asia have been extremely rare because Avian Influenza (Bird Flu) is known only as a “bird disease.” Although in some rare cases people have been infected with Avian Influenza (Bird Flu), these cases have been the result of people having been in very close contact with infected birds or chickens. However, medical researchers believe that the Avian Influenza (Bird Flu) virus seen today in Asia has the potential to change and become a “human disease” rather than a “bird disease.” Such a change could create an Influenza pandemic that would affect people of every nation. 8

Does the Flu Have Complications?

Yes. Some of the complications caused by the Flu include pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

How Long is a Person With Flu Virus Contagious?

The period when an infected person is contagious depends on the age and health of the person. Studies show that most healthy adults may be able to infect others from 1 day prior to becoming sick and for 5 days after they first develop symptoms.

Do I Have a Cold or the Flu?

SYMPTOM COLD FLU

Fever NO YES (Rarely Occurs) (High 103 - 104ºF, Lasting 3 - 4 Days) Headache NO YES (Rarely Occurs) (Very Common) Aches and Pains YES YES (Mild) (Severe) Exhaustion YES YES (Mild) (Extreme) Stuffy Nose YES NO (Very Common) (Can Occur Sometimes) Sneezing YES NO (Very Common) (Can Occur Sometimes) Sore Throat YES NO (Very Common) (Can Occur Sometimes) Chest Discomfort and Cough YES YES (Mild to Moderate Hacking Cough) (Very Common - Can Become Extreme)

What Can I Do?

COLD FLU

COMPLICATIONS Sinus Congestion or Earache Bronchitis, Pneumonia (Complications Can be Life Threatening for Some) PREVENTION No Shot Available Annual Flu Shot (Frequent Hand Washing) (Frequent Hand Washing)

TREATMENT None Antiviral Medications (Rest and Drink Plenty of Liquids—See Your (Antiviral Medications May Reduce Doctor if Symptoms Worsen) Symptoms of the Flu — Speak to Your Doctor)

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PLANNING What to Expect During an Influenza Pandemic

While no one can predict how severe the effects of an Influenza pandemic may be, the U.S. Centers for Disease Control (CDC) uses assumptions based on the Spanish Flu Pandemic of 1918 as a basis for planning.

In Pinal County, it is estimated that:

• 30% of the overall population may become ill, including 40% of all school-aged children and 20% of working adults.

• Of those who become ill, 50% will seek medical care, placing an overwhelming strain on the health care system.

• The amount of time that a person will be infectious prior to having any symptoms will be one-half day to one day.

• People will be most infectious during the first two days of illness.

• Each outbreak (or pandemic wave) will affect a community for approximately six to eight weeks.

• There will be at least three pandemic waves.

• Many areas will be affected simultaneously.

• There may be a disruption of national and community infrastructures: -Commerce -Transportation -Utilities -Health and Public Safety

• There will be shortages in the availability of vaccines and antiviral drugs.

• There will be more than five times the usual deaths from Influenza.

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Vaccines

In the event of an Influenza pandemic, it is unlikely there will be any vaccine available for many months. The process currently used to produce Influenza vaccine requires a minimum of six months to produce enough vaccine to meet the need of a “normal” Flu season. In the case of an Influenza pandemic, demand for vaccine would dramatically increase and it is unlikely that the current Influenza vaccine production method would meet the demand of a pandemic.

Anti-Viral Medications

Certain antiviral medications may be effective. However, using antiviral medications on a large scale during a pandemic would not be feasible. There will simply not be enough antiviral medications available.

Your Part in the Planning Process

In the event of an Influenza pandemic, people, businesses, health care providers, schools, community organizations and government agencies will play key roles in protecting the health and safety of our community. Preparing for an Influenza pandemic is everyone’s responsibility.

Planning for an Influenza pandemic is critical. To assist you, the U.S. Centers for Disease Control and Prevention (CDC) has developed a checklist that identifies specific activities you can do now as part of your planning efforts, many of which can also help you in other emergencies. (A copy of the CDC Checklists are provided at the end of this booklet.)

KEY POINTS

• An Influenza pandemic will significantly impact Pinal County.

• Flu vaccine and anti-viral medications probably will not be available for months during an

Influenza pandemic.

• Planning is critical to protecting the health and safety of our community

• Everyone in Pinal County must plan.

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Additional Web Resources

Official U.S. Government Website for information on flu and Avian Influenza http://www.pandemicflu.gov/

U.S. Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/

CDC’s Business Information Homepage http://www.cdc.gov/business/

Pandemic Influenza: Worldwide Preparedness http://www.cdc.gov/flu/pandemic/

U.S. Department of Health and Human Services, Pandemic Influenza Plan http://www.hhs.gov/pandemicflu/plan/

National Institute on Aging 31 Center Drive, MSC 2292 Bethesda, MD 20892 (301) 496-1752 http://www.nih.gov/nia

National Library of Medicine Medline Plus 8600 Rockville Pike Bethesda, MD 20894 1-888-FIND-NLM (1-888-346-3656) or (301) 594-5983 http://www.medlineplus.gov

U.S. Centers for Disease Control and Prevention (CDC) National Immunization Information Program 1600 Clifton Road, NE, Mailstop E-05 Atlanta, GA 30333 1-800-232-2522 (English) 1-800-232-0233 (Spanish) http://www.cdc.gov/nip

U.S. Food and Drug Administration (FDA) 5600 Fishers Lane Rockville, MD 20857-0001 1-888-INFO-FDA (1-888-463-6332) http://www.fda.gov

National Coalition for Adult Immunization 4733 Bethesda Ave., Suite 750 Bethesda, MD 20814-52787 (301)-655-0003 http://www.nfid.org/ncai

Arizona Department of Health Services http://www.azdhs.gov

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