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Pandemic Flu PANDEMIC FLU A Scottish framework for responding to an influenza pandemic October 2007 PANDEMIC FLU A Scottish framework for responding to an influenza pandemic October 2007 © Crown copyright 2007 ISBN: 978-0-7559-5502-2 The Scottish Government Victoria Quay Edinburgh EH6 6QQ Produced for the Scottish Government by RR Donnelley B52783 10/07 Published by the Scottish Government, October, 2007 Further copies are available from Blackwell’s Bookshop 53 South Bridge Edinburgh EH1 1YS The text pages of this document are printed on recycled paper and are 100% recyclable FOREWORD The possibility of a worldwide influenza pandemic presents us with unique and difficult challenges if we are to save lives and keep our society running. Planning and preparing now is vital to lessen the impact. We will all have a part to play in dealing with a pandemic. An outbreak will place considerable pressures on a range of sectors and will require people in the public, private and voluntary sectors to work across boundaries. The wider public will also need to be made aware of how they can prepare themselves and their communities. The Scottish Government has been working very hard to meet these challenges both across Scotland and as part of the wider UK planning. To assist and support organisations in their planning, this document sets out the Scottish Government’s strategic approach to dealing with an influenza pandemic, provides information on the potential impact, sets out key planning assumptions and proposes a planning framework. It updates the UK Health Departments’ UK Influenza Pandemic Contingency Plan, published in October 2005, expanding it to illustrate the breadth of planning across many different sectors. A draft version of this document was issued for comment in March 2007 and we would like to thank all those who responded. The comments were considered carefully as part of the revision process. We recognise the uncertainties associated with pandemic influenza are a considerable challenge to planners and require response arrangements to be flexible. We will continue to develop our understanding of the threat and will review and update the framework as further information becomes available. Pam Whittle Bridget Campbell Director Director Public Health & Wellbeing Directorate Police & Community Safety Directorate Scottish Government Scottish Government CONTENTS 1 INTRODUCTION................................................................................................. 4 1.1 WHY DO WE NEED A FRAMEWORK? .................................................................... 4 1.2 WHO IS THIS FRAMEWORK FOR? ........................................................................ 4 1.3 THE UK APPROACH ........................................................................................... 5 1.4 THE SCOTTISH FRAMEWORK ............................................................................. 6 2 STRATEGIC APPROACH.................................................................................. 8 2.1 AIM................................................................................................................... 8 2.2 STRATEGIC OBJECTIVES .................................................................................... 8 2.3 SCIENTIFIC ADVICE TO UNDERPIN POLICY AND OPERATIONAL PLANS .................. 10 2.4 LEGAL FRAMEWORK ........................................................................................ 10 2.5 ETHICAL CONSIDERATIONS .............................................................................. 12 3 BACKGROUND TO PANDEMIC INFLUENZA ................................................ 13 3.1 SEASONAL INFLUENZA..................................................................................... 13 3.2 HOW INFLUENZA SPREADS............................................................................... 13 3.3 AN INFLUENZA PANDEMIC ................................................................................ 14 3.4 AVIAN INFLUENZA ............................................................................................ 15 3.5 WHAT AN INFLUENZA PANDEMIC MIGHT LOOK LIKE ............................................ 16 3.6 PREDICTING THE HEALTH AND WIDER IMPACT ................................................... 17 4 STRUCTURES FOR PLANNING AND RESPONSE........................................ 19 4.1 INTERNATIONAL............................................................................................... 19 4.2 UK PLANNING STRUCTURES............................................................................. 19 4.3 SCOTTISH PLANNING STRUCTURES .................................................................. 20 4.4 UK RESPONSE STRUCTURES ........................................................................... 21 4.5 SCOTTISH RESPONSE STRUCTURES ................................................................. 23 5 PLANNING OUR RESPONSE.......................................................................... 25 5.1 INTRODUCTION................................................................................................ 25 5.2 THE WHO INTERNATIONAL PHASES AND UK ALERT LEVELS.............................. 25 5.3 KEY PLANNING ASSUMPTIONS .......................................................................... 26 5.4 UK PLANNING PRESUMPTIONS ......................................................................... 30 5.5 RESEARCH AND DEVELOPMENT ....................................................................... 39 6 INTER-PANDEMIC AND PANDEMIC ALERT PERIODS: THE NEED FOR EARLY DETECTION AND ALERT .......................................................................... 41 6.1 INTERNATIONAL COLLABORATION TO GIVE EARLY WARNING............................... 41 6.2 NATIONAL ARRANGEMENTS FOR EARLY DETECTION AND ALERT ......................... 42 6.3 INTER-PANDEMIC ALERT PERIOD - WHO PHASES 1 AND 2 ............................... 43 6.4 PANDEMIC ALERT PERIOD - WHO PHASES 3-5 ................................................ 44 6.5 PREVENTING A PANDEMIC’S INITIAL DEVELOPMENT ........................................... 45 7 PANDEMIC AND POST-PANDEMIC PERIOD ................................................ 47 7.1 DECLARING A PANDEMIC.................................................................................. 47 7.2 INTERNATIONAL PHASE 6 - UK ALERT LEVELS 1 TO 4 ........................................ 47 7.3 POST-PANDEMIC PERIOD ................................................................................. 52 8 MITIGATING THE IMPACT .............................................................................. 54 8.1 INTERNATIONAL TRAVEL RESTRICTIONS AND SCREENING .................................. 54 8.2 PRE-PANDEMIC VACCINATION .......................................................................... 55 8.3 ISOLATION, VOLUNTARY QUARANTINE AND SOCIAL DISTANCING ......................... 56 2 8.4 ANTIVIRAL MEDICINES...................................................................................... 57 8.5 INFECTION CONTROL AND PERSONAL HYGIENE ................................................. 58 8.6 THE USE OF FACE MASKS AND RESPIRATORS.................................................... 59 8.7 NATIONAL TRAVEL .......................................................................................... 60 8.8 PUBLIC GATHERINGS ....................................................................................... 60 8.9 POSSIBLE CLOSURE OF SCHOOLS, NURSERIES AND GROUP CHILDCARE SETTINGS 61 8.10 PANDEMIC SPECIFIC VACCINATION ................................................................... 63 9 THE HEALTH AND COMMUNITY CARE RESPONSE ................................... 64 9.1 AIMS............................................................................................................... 64 9.2 KEY PRINCIPLES UNDERLYING PLANNING AND RESPONSE.................................. 65 9.3 KEY PLANNING ASSUMPTIONS FOR HEALTH AND COMMUNITY CARE PLANNING.... 66 9.4 GENERAL PRINCIPLES OF CONTAINMENT AND INFECTION CONTROL ................... 68 9.5 PRIORITISATION OF SERVICES ......................................................................... 70 9.6 NHS PERFORMANCE TARGETS........................................................................ 71 9.7 WORKFORCE ARRANGEMENTS AND PERSONNEL POLICIES ................................ 72 9.8 ACCESS TO CARE ........................................................................................... 73 9.9 COPING WITH STRESS AND BEREAVEMENT ....................................................... 84 10 MAINTAINING BUSINESS CONTINUITY – THE SCOTLAND WIDE RESPONSE .............................................................................................................. 85 10.1 AIMS............................................................................................................... 85 10.2 KEY ASSUMPTIONS.......................................................................................... 85 10.3 DEALING WITH STAFF ABSENCES...................................................................... 86 10.4 DEALING WITH A LARGE NUMBER OF DEATHS.................................................... 87 10.5 BUSINESS CONTINUITY/MAINTENANCE OF UK’S ESSENTIAL SERVICES................ 90 11 COMMUNICATION AND PUBLIC ENGAGEMENT ......................................... 96 11.1 CURRENT PERCEPTIONS AND UNDERSTANDINGS .............................................. 96 11.2 AIMS AND OBJECTIVES....................................................................................
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