Saint Lucia’s Response to the current H1N1 Pandemic Influenza Presentation to the Sub-regional Meeting on Pandemic Influenza Preparedness and Response: Caribbean Experience and Lessons Learned 9-11 September 2009 Barbados Presented by Dr Gemma Chery Deputy Epidemiologist and Focal Point Pandemic Influenza. Saint Lucia NATIONAL INFLUENZA COMMITTEE MEMBERSHIP 1. NEMO Secretariat 2. Ministry of Health 3. Ministry of Agriculture 4. Ministry of Education 5. Ministry of Tourism 6. Ministry of Finance 7. Saint Lucia Fire Service 8. St. John’s Ambulance Brigade 9. Saint Lucia Red Cross 10.Saint Lucia Police Force 11.SlASPA 12. Attorney General Chambers 13.GIS INSTRUMENTS OF AUTHORITY Disaster Management Act No. 30 of 2006 International Health Regulations 2005 Education Act No. 41 of 1999 Emergency Powers [Disaster] Act No. 5 of 1995 Animal Disease Importation Act 1994 [amended] Public Health Act No. 8 of 1975 [Rev. December 31, 2001] Employees [Occupational Health and Safety] Act No. 10 of 1985 Police Ordinance No. 30 of 1965 Quarantine Act No. 13 of 1945 [Rev. December 31, 2001] Local pandemic impacts over a six week period Estimated numbers of illness, hospitalization, and deaths for a severe pandemic scenario in Saint Lucia based on CDC Models Characteristic Severe pandemic (1918 – like) Total Saint Lucia Population 153,889 High Risk 20,279 Outpatient Care [i.e. Health Ctrs] 40,328 Hospitalization 700 Deaths 200 NATIONAL INFLUENZA PLAN To guide policy and strategic framework response to influenza Objectives of the plan To serve as an important instrument for resource management To guarantee efficient and effective use of limited resources To intensify public awareness on pandemic influenza, surveillance, prevention and control in wild birds and domestic poultry. NATIONAL INFLUENZA PLAN Volume 1. Policy 2. Concept of Operations 3. Strategic Plan 4. Communications Strategy 5. Ministry of Health Plan 6. Ministry of Agriculture Plan 7. Ministry of Education Plan 8. Law Enforcement, Public Safety, and Security 9. Essential Services [Water, Power, Telecoms, Transport, Security and Port] NATIONAL INFLUENZA PLANNING TIME LINE 2005 - 2007 • 2005 - 2006 Series of meetings chaired by Ministry of Health • July 2006 Regional Meeting of Agriculture, Health and Disaster Offices in Barbados • January 2007 NEMO Secretariat assumed Chairmanship • May 2007 - Planning meeting held with PAHO • July 2007 -Table Top Exercise with PAHO/FAO Support • Sept 2007 - Full Scale Exercise with PAHO/FAO/USAID/IICA • NIC Review Plans with PAHO based on Exercise • September 2007 - Regional Meeting in Curaço with SouthCOM • November 2007 - Regional Meeting in Miami USG • Updates via email NATIONAL INFLUENZA PLAN SUPPORTING DOCUMENTS National Plan Approved by Cabinet - August 2, 2007 • SOPs: for a National Shutdown • Ministry of External Affairs - Guidelines in case of Disasters • Medical Waste &Other Bio-Hazardous Wastes Management Plan • Mass Fatalities Policy Work in progress • Emergency Action Plan for Agricultural Pests and Diseases • Disaster Victim Identification Plan • Wellbeing Emergency Management Support Plan • Epidemic Response Plan Other • Media Kit for the Caribbean • Emergency Response Plan for the Homeless NATIONAL INFLUENZA PLANNING TIME LINE - 2008 Meeting with Utility Companies Letters to HR Managers on the AI Threat and preparing for it Newsmaker Live [TV Talk show] TV stations broadcast: WHO: From Farm to Fork NatGeo: Race against the Killer Flu Oprah Winfrey: AI UNICEF: Jackie Chang PSA Briefing of Government Liaison Officers National Wellbeing Committee National Supplies Management Committee NATIONAL INFLUENZA PLANNING TIME LINE - 2008 Meeting between Ministry of Health and Ministry of Tourism on the strengthening of the surveillance SOPs on communicable diseases Strengthening of surveillance system from disease surveillance to syndromic surveillance Dissemination of Communicable Surveillance Manual Strengthening of Port Health Surveillance Program NATIONAL INFLUENZA PLANNING TIME LINE - 2008 Race against the Killer Flu DVD circulated to: All Members of Parliament [17 members] All Members of the Senate [11 members] Posters and flyers distributed nationally Regional Meeting: Panama MP became an ex officio member of NIC Inquiry to OECS Secretariat on an OECS Policy on AI/PI Completed first draft of National Communications Strategy Updates via email NATIONAL INFLUENZA PLANNING TIME LINE - 2009 Regional Meeting: Jamaica [NorthCom] Regional Meeting: Barbados with NorthCOM/SouthCOM/PAHO/CDEMA Regional Meeting with PAHO Miami Complete National Communications Strategy Meetings with: National Transport Committee [done] National Telecoms Committee [done] Teachers and Principals [done] Undertakers Private Vets and Vet Techs [done] NATIONAL INFLUENZA PLANNING TIME LINE - 2009 Simulations: FA HUM 2009 Region Rap 2009 Information flyer for Health Workers NATIONAL INFLUENZA PLANNING TIME LINE - 2009 GIS host Government Influenza Page http://stlucia.gov.lc/flu [includes the cartoon] National Influenza Plan [NIP] - www.tiny.cc/nip National Emergency Management Plan – http://stlucia.gov.lc/nemp NATIONAL INFLUENZA PLANNING TIME LINE - 2009 May 7 - National Influenza Plan approved by Cabinet [available at www.tiny.cc/nip] May 13 - A(H1N1) Cruise Ship Crisis May 26 - Presentation to Ecuador Committee August 31 - Pandemic flu (H1N1) presentations and DVD Updates via email from newsletters such as: Big Medicine Around the World Today Asian Disaster Preparedness Centre ReliefWeb Ministry of Health – National Influenza Plan What is in the MOH NIP? Explaining it to me World Health Organisation Saint Lucia Alert Levels Alert Levels Phase 3 No or very limited human-to-human YELLOW ALERT transmission Evidence of human to human transmission, Phase 4 but spread is highly localized Evidence of increased human-to-human transmission ORANGE ALERT Not fully transmitted but human to human is s Phase 5 till localized Evidence of significant human-to-human transmission RED ALERT Large cluster but human to human spread is still localized BLACK ALERT Phase 6 High severe diseases and death rates. Efficient and sustained human-to-human Situation beyond control. Healthcare system transmission overwhelmed ,panic sweeps through Community/Country Categorization of MOH Response Planning and coordination Situation monitoring and assessment Public health measures Health systems response Communication A(H1N1) Crisis of 2009 April 23 Mexico notifies of new Influenza virus causing cases and deaths April 24 – CAREC notified MoH of new influenza strain April 24 – CDERA notified NDC of new influenza strain April 25 – Meeting of the Health Surveillance Committee April 25 – Port of Entry, School and Animal surveillance increased April 29 – Meeting of National Influenza Committee April 30 – Press Briefing April 30 – Joint session of Cabinet and NEMAC A(H1N1) Crisis of 2009 May 1 – NIP, Action Plan and Budget completed May 4 – NIP, Action Plan and Budget presented to Prime Minister May 5, 6 & 7 – Committee briefings [District Committees, Homeless, Information, Transport & Supplies Mgn’t] May 7 – NIP approved May 11, 18 & 25 – Press Briefing May 13 – Barbados/Saint Lucia Scare Continuous SitRep to Cabinet, NEMAC & CDERA CU Reporting to WebEOC A(H1N1) Crisis of 2009 May 13 A female member of Cruise Ship arrived in Barbados with ILI Rapid test confirmed Type A influenza - sample sent to CAREC Next stops: Saint Lucia, Antigua and St. Kitts Saint Lucia convenes meeting of NIC with Cruise Rep. Ship held in Barbados till CAREC results in Saint Lucia hold decision pending CAREC results Pandemic Preparedness – Communication… Public Pandemic Preparedness – Communication… Press Pandemic Preparedness – May 13… CMO/Barbados CMO/Saint Lucia Cabinet Prime Director - NEMO Secretary Minister Part 1: Situation unfolding NIC eMail NIC Meeting *Health, Port Health, Port Authority, Immigration, DA - Press Release on ISPS, Tourism, actions Fire Service, NEMO Sec Cruise Ship Agent Crisis Communications Pandemic Preparedness – May 13… Prime Minister Cabinet Secretary CAREC Report: Director - CMO GIS NEGATIVE NEMO Part 2: Situation Resolved Press Release Weekly Press on Results Brief Crisis Communications Challenges Financial: the unexpected nature of disasters and the unfolding financial crisis has challenged budgetary allocations. Legal: engaging the legal Justice system. Human resources remain a challenge in areas such as: Epi Department, Port Health, Laboratory More training is needed to address areas such as the fear of the unknown and the of PPEs and Handling of Cases. Challenges Responding to a second emergency during an influenza pandemic September 9, 2009 [1:00am] – Saint Lucia Fire Service respond to a Fire at St Judes Hospital. Challenges Responding to a second emergency during an influenza pandemic 90% of hospital lost [Pediatrics and A&E alone standing but not functioning] 3 dead [2 in fire & 1 in transit to VH] All services located to alternate sites [e.g. Sports Stadium and Health Centres] Challenges Responding to a second emergency during an influenza pandemic Role of Hospital National Influenza Plan: Once hospitalisation starts: • Victoria Hospital becomes main “Flu” hospital • St Judes Hospital becomes main non flu hospital • Patients are relocated to St Judes This is no longer possible Pandemic preparedness – Next Steps… Ministry of Health: Reconstruction of main hospital of the South Review of Legislation [Colonial] Establishment of EOC [IHR requirement] Mental Health Response Ministry of Agriculture: Passing of CARICOM Legislation Source an incinerator SOPs for using Vets in Crisis Pandemic preparedness – Next Steps… NEMO Secretariat: Complete Publication of the NIP COOP for businesses, and government agencies National Influenza Plan [NIP] www.tiny.cc/nip National Emergency Management Plan [NEMP] www.stlucia.gov.lc/nemp.