Pain and Fever Reducer

Tabitha Zehms “Team T” Virology Dr. Shors 5/08/06

1. a. Flu Care kit

 Pain and Fever Reducer  Decongestant (Pseudoephedrine)  Cough medicine  Thermometer  Tea or juice  Chicken soup and a non-electric can opener  Throat lozenges (adults and older children only)  Tissues  Blankets  Nitrile gloves  Respirator masks (ex. 3M’s N95) b. Food Stockpile

• Manual can opener • Canned/jarred baby food and formula • Canned juices • Dried fruit • Dry, crisp crackers • Potatoes • Canned meat, fruits, and vegetables • Read-to-eat cereals • Peanut butter • Jelly • Hard candy, chocolate bars, and canned nuts • Energy bars c. How much water should be stockpiled? 1 gal/person/day, for two weeks. Use two drops of chlorine/quart of water, or boil for fifteen minutes or purchase chlorine purification tablets. One can get tablets at camping/sporting goods stores. d. Other miscellaneous items:

 Medical supplies and First Aid manual  Hygiene supplies  Portable radio, flashlights and extra batteries  Shovel and other useful tools  Money and matches in a waterproof container  Fire extinguisher  Blanket and extra clothing  Infant and small children’s needs (if appropriate)  Pet food and supplies  Disinfectants  Cash and credit cards  Sturdy shoes or work boots  Candles  Fluids with electrolytes  Alcohol-based hand sterilizer e. Recommended masks

Respiration masks are meant to protect the wearer. These are better than surgical masks, which allow air in and are meant to protect the environment from your breath. If exposed to the flu virus, the outside surface of masks can become contaminated. This would require having a stockpile so one could discard masks after a few uses. A box of 20 costs anywhere from $7.00 - $30.00 Shelf lives of masks range from five years to 20 years to indefinite, if properly stored. Masks can be conveniently purchased online or at home medical supply stores.

2. Emergency Workforce Team

Oshkosh Emergency Serves as the main hub of all planning and Operations Center executing of emergency response to the city’s Situation in the event of a pandemic.

Fire Chief Timothy Franz Will call for the EOC (Oshkosh’s Emergency Center) to come together. Will also maintain normal operations of the Fire Dept and Emergency Response teams.

Health Director Paul Spiegel Will serve as the coordinator for maintaining Hospitals and clinics in working order. Will Be responsible for making information on how To stay healthy (i.e., preventing spread of flu And water purification, etc.) available to our Citizens. Will also establish efficient methods Of placing the deceased in proper containment And burial. Police Chief David Erickson Will assure safety is established and Maintained at hospitals, clinics, nursing homes, And other places where medical treatment may Be available. May also be required to protect Food/water/medicinal supplies brought into the City.

Transportation Director Will coordinate with Police Chief to ensure that Mark Huddleston the maximal levels of supplies can be Transported safely into the city. May call upon Public works crews and park crew to keep the The city free of garbage, waste, and deceased.

City Manager A governmental leader of the city. Will be Richard A Wollangk expected to execute key decisions with the Mayor and other members of the EOC.

Mayor William Castle Jr. Will coordinate with the state and Federal agents so the city can Receive whatever instructions And aid it’s entitled to. Will also Work with local businesses and Schools to monitor closings.

Deputy Mayor Frank Tower Will assist in executing the Mayor’s responsibilities.

City Council: May serve on the EOC and lead Bryan Bain,Meredith Scheuermann efforts of city quarantine as Burk Tower, Paul J. Esslinger designated by the EOC. Shirley Brabender Mattox

Hospital Directors: Will work with the Health Director Mercy Medical Center in order to provide aid to the sick. Aurora Medical Center St. Elizabeth Hospital Clinic Directors

City Clerk Pamela R. Ubrig Both City Clerk and Deputy City Deputy City Clerk Angela G. Koch Clerk will be essential in keeping Accurate records of the sick and Dead, in cooperation with the Hospital directors. 3. Role of the Media (educating the community)

As long as electrical power is received, information should reach the community via TV. National news broadcasts, if running, would provide information on the state of the nation. Local news stations, such as FOX 11, ABC, etc., would also be expected to provide information on what local cities/counties are doing during the pandemic. Undoubtedly, OCAT (Oshkosh Community Access Television), would be an immediate source of information for Oshkosh citizens. Any decisions that need to be explained to the public by the Oshkosh Emergency Operations Center will be relayed on this station. Radio will also provide a consistent medium for updates on the pandemic. As long as national and local stations run, the Emergency Broadcast System will convey information. Should those stations be quarantined and shut down, Oshkosh citizens will know at least about their own communities through WOCT 101.9FM. Information to be provided should include but is not limited to  Death tolls  Number of cases  Decisions made by the EOC  Fire dept./Police dept./Health Services mandates to the citizens  Notices of food/water/supply shipments into the city, school closings, public event closings, etc.  Information on what to do when you get the flu, how to prevent coming in contact with it/spreading it, how to keep water clean, etc.

A “What to do about the Flu” website should be ran and maintained by the EOC, possibly with the help of local volunteers. The website would contain important information about how to prevent spreading the sickness and how to treat the sick, etc. A Flu Hotline could also be put into place, but would have to be ran by volunteers so that health care workers and other emergency personnel could tend to the sick. Examples are science professors and science students from UWO.

4. Community Communication (e.g. moving goods and services).

Army National Guard will be solicited to guard hospitals, pharmacies, and supply storage facilities. Transportation Director Mark Huddleston may utilize the Reserves and possibly public works crews to bring in necessary supplies, as long as the governor mandates their use.

US Army Reserve (920) 231-2354 221 N Sawyer St Oshkosh, WI 54902 Army National Guard (920) 424-2439 1415 Armory pl Oshkosh, WI 54902

Critical Supplies:

 Food and chlorinated water  Pharmaceuticals  First-Aid supplies  Flu vaccines  Hospital supplies (gloves, masks, blankets, medicine, etc.)  Personal hygiene products (soap, shampoo, deodorant, etc.)  Cleaning products (to keep quarantined houses clean!)  Body bags

5. Quarantine measures/Prevention/Travel/Crime Prevention

The only way to prevent the spread of Bird Flu is to quarantine Oshkosh and Winnebago County. A quarantine must be issued by the city/county government and will be enforced with the aid of police and the Army National Guard monitoring all major routes into and out of the city. The WHO recommends implementing a quarantine after six or more people become infected in the same neighborhood. Quarantined areas can start at the neighborhood level and increase to the entire city, as deemed appropriate by the Winnebago County Public Health Department. Other routes can be blocked. Large fines should accompany violation of the quarantine. Travel into and out of the city can only be done by those transporting food and other supplies such as medicine and hospital needs. If possible, widespread travel of citizens should be discouraged, even within Winnebago County. Establishing a curfew would ease the security demands of the city police; as long as the majority of citizens obey, there will (hopefully) be less nighttime activity, making it easier for policeman to notice any looting or other crimes going on at night. Police and/or the National Guard will have to pay special attention to local businesses and stores and maintain consistent street patrol to prevent the looting of unused businesses during the quarantine. Police and firefighters will be expected to maintain normal patrols and first response roles.

6. Public Gathering Policies

There should be a restriction on mass gatherings, for such occurrences allow the virus to be exposed to many individuals at once. Schools should be closed during the quarantine, as well as churches, public libraries, and theatres. Even venues like coffee shops, bars, and other areas of socializing should be quarantined. The best way to prevent spreading is to keep people (and their germs) away from each other. This would also include funerals and weddings.

7. Hospitals

Aurora Medical Center 84 beds 8 respirators Mercy Medical Center 157 beds, w/ special unit 172 8 respirators

Whether or not the hospitals in Oshkosh will be able to handle all of the flu patients depends largely on how well and how quickly the city responds to the presence of avian flu when it is first discovered. Based on the simple fact that no one has immunity to this virus, it is quite likely that we will overfill our hospitals and will require alternative "Isolation Hospitals." Locations for these "Isolation Hospitals" could include the Gruenhagen Conference Center, the Park Plaza Hotel and Conference Center, or gymnasiums in school facilities around the city, assuming that schools will be closed. Examples include the Kolf Sports Center at the University of Wisconsin—Oshkosh, or the gym at Oshkosh North or Oshkosh West, etc.

Below is a list of supplies necessary to equip these sites:

 cots/beds  medication to alleviate flu symptoms (cough suppressant, fever reducer, etc.) and antivirals (if at all available)  bed linens and pillows  meals  patient gowns and staff scrubs/masks/gloves  plenty of soap, hand sanitizers, and disinfectants  thermometers and medical charts  telephones  body bags  vehicles to run back and forth to the hospitals

Staffing of these "Isolation Hospitals" would have to consist of any available doctors/nurses/CNAs, etc., that could be spared from the local hospitals, clinics, and nursing homes. Nursing students here at UWO could also volunteer and work here in exchange for getting vaccinated, if there is an ample supply of an effective vaccine.

8. Pharmacies/Health Plans

In the event of a pandemic, pharmacies, which depend largely imported pharmaceuticals, will have to be protected by the police or members of the National Guard. They will prevent any looting or attempted robbery. If medicines are unavailable for an unknown amount of time, physicians should be stationed at each pharmacy and decide who should continue to receive drugs and who shouldn’t. Whatever antivirals are available should be reserved for health care workers and those who come in close contact with the extremely sick. If medicines are available in other countries for purchase, it is likely that health care plans will not cover the transactions. Cooperation of national health care plans would have to be mandated by the federal government. Agencies involved would include:  Food and Drug Administration  Department of Health and Human Services  Department of Homeland Security.

Many in the community have special needs and depend on the pharmacy for medicines that sustain daily living. These individuals should talk to their doctors about the shelf-lives of their drugs and possible stockpiling potential. These would include:  Diabetics  HIV/AIDS  Cancer patients  Fibromyalgia  Arthritis  Hypertension  Heart disease/high cholesterol  Anyone that depends on medicine to prevent organ failure/rejection.

Winnebago County should to stockpile its own supply of tamiflu® or other anti- influenza drugs. Stockpile extractions should be authorized by a health professional and physician. This would allow the county to treat its health care workers in a prophylactic manner and hopefully treat moderate to severe cases of flu and the close contacts of those patients, as suggested by the World Health Organization. It should be noted that the effectiveness of these drugs against H5N1 have not been confirmed.

9. Long-term care, including nursing home residents and elderly living alone.

The World Health Organization, in its report on the response and containment of a pandemic, suggested that antiviral drugs be used to treat moderate to severe cases of atypical respiratory disease and of the close contacts of those affected. Should it appear that the disease is spreading quickly or has infected a large number of people, it is implicated that it would be best to prophylactically treat an entire geographical area surrounding the severely infected outbreak. It is cautioned that if it is not deemed feasible by local experts to successfully stop the spread of the influenza that this type of treatment not be used; this would save valuable medications that are in scarce supply. In order to prevent such an uncontrolled outbreak, it is vital that health care workers receive vaccines or regular cycles of prophylactic treatment with antiviral drugs. It should be stated again that the effects and success of antiviral drugs against bird flu is uncertain at this time. Individuals in long-term care facilities and the elderly community have weaker immune systems and would be particularly vulnerable to becoming infected. Employees of these institutions should also be vaccinated and/or treated with antivirals to prevent bringing the disease into this environment. As far as the elderly living independently and alone are concerned, should they have any respiratory infection symptoms, they should report it to a public health official and their doctor immediately.

10.If a vaccine is available, the following people should receive it first. These citizens, listed here in a prioritized fashion, need to continue working during the pandemic and would risk coming in contact with the virus most often: Licensed healthcare workers including physicians, physician assistants, nurses, mental health professionals • State public health officials including the Chief Medical Officer and State Health Officer, members of the Clinical Management Team • First responders (Fire, Police, EMT’s) • Medical laboratory workers • Emergency management personnel • National Guard members that have been called into state service by the governor • Long term care facility staff • Utility field workers (gas, electric, water, sewer, etc.), • Communications personnel • Fuel suppliers • Food suppliers • Waste management workers (general and medical) • Public transportation drivers • Air travel personnel (pilots, air traffic controllers, etc.) • Corrections workers • Morticians/Coroners/Medical Examiners • Pharmacists • Red Cross field workers • U.S. Postal Service workers • Contracted persons involved in the transportation of vaccine • Staging: Category B Group • Day care providers • Teachers  Clergy 11.Employees critical to maintaining the city:

Mayor and City Manager Emergency First Response personnel (EMS, Fire, Police) Hospital and Clinic employees (everyone from Doctors to Janitors) Public Works employees Sanitation employees Power, Wasteweater Treatment, and Sewage Plants Pharmacy personnel Grocery Store personnel Funeral Home employees

In the event of a quarantine during a pandemic, only businesses that support the needs of the above employees should stay open. Schools, coffee shops, museums, etc. are not needed to provide food, supplies, and medical care to the community. The temporary shut down of non-essential business will prevent the spread of the disease. Business that do remain open should implement an immediate sick leave policy that requires any employee with flu-like symptoms to remain home until deemed appropriate to return by a medical professional. Employees with sick relatives should not be allowed at work. The city should attempt to make infection-control supplies, such as masks, gloves, and sanitizers, available for its citizens. This may not be possible if these items aren't already being stockpiled. The sewage treatment plant can maintain water supplies for a maximum of 45 days with the current amounts of chlorine. Bill Sturm, the Cemetery Supervisor for Oshkosh, said that there is significant space in the city's Riverside Cemetery and more room in privately-owned cemeteries. According to Sturm, " Mass graves are unlikely although we would potentially open a large area for multiple installations, but each would have a separate plot." Local funeral homes can store bodies, and the city also owns an old storage facility for bodies that was used before the city performed winter burials that could house 100 bodies. More should be purchased by the city. There are six funeral homes and mortuaries in Oshkosh and 13 in Winnebago County. Cremation or mass burial should be a decision made by the closest relative.

The Oshkosh Board of Health is currently working on a Pandemic Preparedness Plan. Oshkosh will follow any orders given by the Winnebago County Public Health Department. According to Douglas Gieryn, Winnebago County's Director and Health Officer, a Public Health Preparedness Constortia, consisting of six counties of 10 local health departments, is establishing a plan. The project is funded by the CDC through the State's Health Department. Board of Health Members--City of Oshkosh

Dr. Barbara Strand – Chair, Affinity Medical Group Jamie Bonell, CFNP, APNP, Aurora Medical Group Burk Tower - Council Representative Christine Kniep, UW-Extension Susan Panek, United Way Stan Kline- Alternate Mardell Sowers – Alternate

Winnebago County Board of Health

Nancy Barker James Koziczkowski Forrest E. Weber Thomas W. Widener Bill Wingren Alfred Jacobson Joanne Sievert Steven Arne Sources: http://www.toronto.ca/health/pandemicflu/pdf/toronto_pandemic_influenza_plan.p df

American Red Cross -- National website www.redcross.org

Local Chapter website www.vbe.com/~redcross/

Federal Emergency Management Agency – website www.fema.gov http://www.health.state.mn.us/divs/idepc/diseases/flu/avian/preparing.html

Pandemic Influenza: What Can You Do?, MN Dept. of Public Health items http://www.fema.gov/library/emfdwtr.shtm

FEMA: Emergency Food and Water Supplies http://www.ci.oshkosh.wi.us/emergency_government_report.pdf https://www.globalprotectionllc.com/birdflukits/order.html http://emergencymanagement.wi.gov/category.asp? linkcatid=81&linkid=32&locid=18 http://www.co.winnebago.wi.us/sheriff/index.htm http://www.aurorahealthcare.org/ http://www.affinityhealth.org/object/mmchospital.html http://www.toronto.ca/health/pandemicflu/pdf/toronto_pandemic_influenza_plan.p dfAmerican Red Cross -- National website www.redcross.org Local Chapter website www.vbe.com/~redcross/

Federal Emergency Management Agency – website www.fema.gov http://www.health.state.mn.us/divs/idepc/diseases/flu/avian/preparing.html

Pandemic Influenza: What Can You Do?, MN Dept. of Public Health items http://www.fema.gov/library/emfdwtr.shtm

FEMA: Emergency Food and Water Supplies http://www.ci.oshkosh.wi.us/emergency_government_report.pdf https://www.globalprotectionllc.com/birdflukits/order.html

.World Health Organization. Advice on Use of Oseltamivir. 17 March 2006 http://www.who.int/csr/disease/avian_influenza/guidelines/useofoseltamivir2006_ 03_17A.pdf WHO Pandemic influenza draft protocol for rapid response and containment http://www.who.int/csr/disease/avian_influenza/guidelines/pandemicfluprotocol_1 7.03a.pdf