DISCUSSION: Pandemic Scenarios: What Would be the Story of Pandemic Influenza in “Ourtown”?

COMMENT THREAD

• Legal Compliance - My Opinion
  

  Submitted by Benjamin Krakauer on 12/4/07 06:42 AM

  I think Margaret makes an excellent point, it's relatively easy in a planning document to state, "If you are ill, don't go to school/work/entertainment" but actual compliance at the individual level may differ vastly than what is requested/expected based on plans. In my opinion, public education is the first step both now, at the beginning of a pandemic, and throughout the pandemic's duration about how important it is for those who are ill or those who have been exposed to ill people stay home. That said, and although it may sound rather draconian, screening individuals before they leave for work/school (or as they arrive) and turning away the ones who are potentially infected may be another means to combat this.
  
  I expect schools (at all levels of education) will shut down completely once a Pandemic reaches our country. While this should help, students will likely find other places to congregate. Public venues of mass gathering need to be closed in order to prevent this from occurring. As far as places of employment, all sectors need to be prepared to alter operations during a Pandemic whether it's complete shut down, staggered shifts, or increased distance between employees (e.g. manufacturing plants).
  
  I truly believe that issues such as compliance with self-isolation are going to need to be handled on a macro, society-wide level. Given the forecasted staffing reductions plus the risk of virus transmission the regular Isolation & Quarantine laws/protocols will likely not work.
  
  Looking forward to other's comments on this.
  
  --BJK--
  

  • Education and screening
    

    Submitted by Joel Palmer on 12/4/07 06:51 AM

    Benjamin hit some of the points I was trying to get at. Mainly the need for quality education about the measures that might be taken and why.
    
    As for screening - many of the hospital emergency planners I have met with plan to do some basic screening of staff on their way into work. A few questions and a disposable thermometer is my understanding of the plan.

    • education measures
      

      Submitted by Holly Reischman on 12/4/07 09:36 AM

      As U probably know most American's have turned a deaf ear on anything bird flu or pandemic news related - they are numb 2 this. Education is best, but it is still falling on deaf ears.

      • Who is turning the deaf ear.
        

        Submitted by Mona Wenger on 12/4/07 10:21 AM

        Most Americans or most public health americans.

        • deaf ears
          

          Submitted by Holly Reischman on 12/5/07 09:42 AM

          Both

    • Training of Community Access Point Healthcare professionals
      

      Submitted by Mitchel Rothholz on 12/4/07 02:12 PM

      We need to keep in mind that many of these individuals will be seeking symptomatic relief from their community pharmacy. In 46 states pharmacists are authorized to provide immunizations. In addition, many of these pharmacists can help patients select products to help with symptomatic relief and be sentinal monitoring sites for public health. The system needs to take into account the common places patients will go and ensure that they are prepared to assist the community.
      
      I will discuss more tomorrow on the importance of ensuring that essential, non influenza medical services are maintained.

  • asymptomatic carriers
    

    Submitted by Catherine Jackie Mitchell on 12/4/07 08:45 AM

    I have always thought that for the initial wave a blanket containment of the effected area would work best. At least until we figure out what we are dealing with. No work. No school. No nothing. We won't have vaccine available and probably few NPIs...preparedness of the general public is crucial so that they can withstand a blanket containment.

    • Blanket containment dangerous
      

      Submitted by Greg Ewert on 12/5/07 01:43 AM

      Blanket containment in some demographic regions will spark anarchy from many different levels and perspectives. The idea needs to be considered carefully, with a great deal of thought and discussion. To date the public has been addressed in controlled conditions around tables. You get out there in the "public" and the you will hear; "they will not heard us up like they did in Katrina" There are preparations being made, but not like anything that is going to be planned for or discussed here.
      

      • blanket containment vs isolation and quarantine
        

        Submitted by Brant Goode   on 12/5/07 04:48 AM

        Let's define the terminology in use a bit further. Quarantine is an archaic term most people recognize but often attribute incorrectly: it's restricting some activities or mobility of a person who has been exposed but is not yet ill. Isolation also may limit activities or mobility, but for a person who is already ill. Both may be effective when used well, and they are used for a variety of infections, e.g. not letting a person ill with diarrhea handle food in a restaurant is a form of isolation. Public health authorities use these tools when necessary but in ways that also protect other civil liberties: we would not require a person ill with Salmonella to stay in their residence, but we would restrict their ability to work in a job that required contact with foods others eat.
        
        Another way to think about "blanket containment" is to "quench" an outbreak if we can identify a discreet area or group of people in an infection is present. If we can identify such a discreet area or group, then we can try to provide treatment and preventive medications to all persons in the area and effective stop spread. This quenching approach is planned for use where initial pandemic flu infections have occurred, but the expected spread is likely to overwhelm abilities to use this approach once increased numbers of cases occur. "Quenching" isolated outbreaks may however buy some needed time to implement other measures before widespread illness occurs, such as encouraging voluntary isolation and quarantine, and social disancing among children and adults who are neither exposed or ill.
        

  • Start Changing the Culture Around Flu Now
    

    Submitted by Heather Jensen on 12/4/07 10:48 AM

    Legal compliance may be necessary in an actual pandemic but it seems like the wisest thing we could do to get compliance in a true emergency is to begin to influence how our culture currently behaves around seasonal flu.
    
    Today companies educated about a pandemic flu, could encourage behaviors like working from home when one is sick. Pediatricians could talk to parents about keeping their kids out of school and encouraging them to find a way to work from home when caring for a sick child.
    

    • Health Care Culture needs change
      

      Submitted by Nick Kelley on 12/4/07 11:44 AM

      The health care culture around influenza needs to change too. Less than 50% of the people we depend on for health care get vaccinated for seasonal influenza, causing high numbers of excess death. People have been trying to change that culture for years but not much has happened.
      
      How can we expect the communities in America to just dramatically change their culture to deal with a pandemic?

      • absolute necessity
        

        Submitted by Catherine Jackie Mitchell on 12/5/07 05:55 AM

        Sometimes we can afford to be completely considerate of culture and then there are times, in my humble opinion, that we are faced with such an event scenario that all we can do is inform and educate and allow a particular culture to rise to the occasion, or not. The problem seems to be that we are at the point in time when theorizing about what will and won't work is not as important as actually getting out there with feet on the ground and doing the work of informing and educating. That needs to come from within the culture groups that we need to reach. The role of people from all walks who regard the issue of "the public health" is crucial in this. Take mothers against drunk driving as an example. Their mission, if you will, crossed cultures BUT people dedicated to that mission worked within their own cultures to demand attention to the issue. They did it effectively and they did it without rancor.
        
        I am not placing a value judgment on any particular culture because I have no specific culture in mind. Sometimes cultural pressure to change can be influenced when culture groups begin to adapt...almost like peer pressure on a much larger scale.
        

    • Will local government pick up where companies leave off?
      

      Submitted by Debra Mattas on 12/4/07 12:01 PM

      Unless legal compliance is enforced...an absolute paradigm shift will be necessary. Local, State and Federal governments may need to devise a way to pay workers to stay home if their employers either refuse or are unable to do so.
      
      We see the problem everyday in public health --- the high percentage of the population who constitute the working poor...most of them-- single moms---parents who take sick children to school or daycare ---or go to work horribly ill themselves---because they have no choice with no work/no pay.

      • Will the populatoin be confined to their homes for 90 days per wave?
        

        Submitted by Caroline Bridgers on 12/4/07 01:19 PM

        Do you think this planning assumption, as seen in this planning guide, will come to pass?
        
        "The population may be directed to remain in their homes under self-quarantine for up to 90 days per wave of the outbreak to support social distancing practices."
        
        It seems like requiring people to stay in their houses would take care of the need to screen people every day, and the need to educate people as to WANTING to use social distancing measures. I suppose it would only be used in a severe pandemic, though. And it might be awfully hard to enforce.
        
        Pandemic Influenza
        Best Practices and Model Protocols
        April 2007
        
        http://www.usfa.dhs.gov/download...
        

        • isolation and quarantine
          

          Submitted by Brant Goode   on 12/4/07 01:31 PM

          Hi Caroline,
          Isolation of ill persons away from others and quarantine of those who've been exposed are two of the four components of CDC pan flu planning guidance released last February--see: http://www.pandemicflu.gov/plan/...
          
          The other two recommendations include dismissal of children from schools and childcare and social distancing of adults, e.g. cancel mass gatherings like church or other meetings. Of course there are many consequences to such recommendations--they raise many more questions that are hard to answer--but the idea of social distance is based on experiences in the 1918-19 pandemic that showed reduced impacts in cities that implemented these strategies early and for long-enough duration. Isolation, quarantine, and social distance can make a real difference.
          
          If such recommendations are made then enforcement becomes a challenge: we know that absenteeism in many sectors will be high, including those personnel who might enforce any recommendations that were made into rules or laws. Your idea of encouraging people to want to use social distance and other measures--voluntarily--is more likely to work if the communication is planned well. While this is outside the vaccine prioritization focus of the web-dialogue, it's still very interesting and clearly pertinent to pan flu planning overall.
          
          Brant

    • times have changed
      

      Submitted by Terry Laura on 12/4/07 03:08 PM

      Historically, as with the 1918 outbreak, children would stay home from school because mothers were there to take care of them. Today, this is a more difficult issue as both parents contribute to the financial stability of the children and are not there to care for a child that needs to stay home. I would like to believe that employers would be understanding but they are only understanding up to a point. health care professionals are not looked on with favor when they have to stay home from the hospital to take care of a sick child.

• resistance will be futile
  

  Submitted by Roy Kamen on 12/4/07 06:43 AM

  There are plans in place to close the schools so i believe that will be a non issue. And in a severe pandemic i doubt most parents will let their kids out.
  
  There are also plans in place for quarantines of infected areas.
  
  People will be asked not to go to work if there is illness in their home. I would suppose penalties for going to work ill could be enforced but the virus is spread 1-3 days before you even show symptoms.

  • Asymptomatic
    

    Submitted by Joel Palmer on 12/4/07 06:53 AM

    That last point, the 1-3 days of infectiousness before symptoms, is the most worrying. No matter what measures are implemented to try and keep essential service agencies "clean" there is no way to catch every potentially infected individual before they start to show, and at that point it's probably too late.

    • Asymptomatic transmissability
      

      Submitted by Kelly Cruse on 12/4/07 07:06 AM

      Looking through the literature on this subject, there is actually very little evidence that much transmission occurs before individuals are symptomatic. What is evident is that the viral shedding is greatest when people are coughing, sneezing and producing fluids. Asymptomatic transmission definitely occurs, but it seems that it is fairly rare, and I'd hate to see us get wrapped up in issues that we truly will have no control over. Instead, I think our efforts should be focused on symptomatic individuals and the development of policies addressing work/school, because it's a big enough challenge to determine how we'll handle that issue.
      

      • We DO have some control
        

        Submitted by Ellen Rice on 12/4/07 07:16 AM

        I respectfully disagree. The time to act is when a pandemic is clearly underway in the world but has not yet arrived in "Ourtown". One characteristic of flu is that it hits like a train. A kid or worker might be perfectly fine at 8 a.m and sick as a dog at 10 a.m. You don't want that six year old coughing on classmates from 10 a.m. until a parent gets called and gets to the school to pick the kid up.
        
        We CAN control symptomatic and asymptomatic spread -- by informing the public now that such a thing could happen AND by closing schools BEFORE there is a case in the community. That is a hard thing to do, but it is the right step.

        • Agreed
          

          Submitted by Kelly Cruse on 12/4/07 07:37 AM

          I certainly was not trying to say that we have no control, and education NOW is definitely key. We are thinking along the same lines; I am only suggesting we concentrate our efforts on how we will handle symptomatic individuals, as opposed to worrying about asymptomatic cases, which will be extremely hard to identify and control.
          
          That said, I believe that education about the WHY people are being asked to not congregate (as mentioned in an earlier post)is critical. I think that we in the US need to be very proactive in our messaging about some of the basic things that we know will need to happen in a pandemic, and we needed to start yesterday. I think we need to be very conscious of the "crying wolf" syndrome, and structure our messaging in ways that don't overwhelm or scare, but that truly help people prepare.

          • naysayers and those crying wolf
            

            Submitted by Catherine Jackie Mitchell on 12/4/07 08:48 AM

            Those not speaking an accurate message also draw attention to the subject and force people to decide what to believe.

        • close schools early
          

          Submitted by larry wright on 12/5/07 01:44 PM

          I absolutely agree, with all my heart.

    • Informing the public NOW is important
      

      Submitted by Ellen Rice on 12/4/07 07:12 AM

      This is one of the reasons why it is important to better education of the public NOW. I know more than a few workers who take "sick" days as fast as they accumulate. They aren't really "sick" -- more like "sick of it" and will take a sick day to shop, rest, hang out.
      
      It would be helpful to let them know that at the first sign of a pandemic in their area that they should get the kids out of school and stay home so they don't get infected. The only way a worker will even contemplate pre-emptive staying at home is if they have a stack of sick days to draw upon.

      • Socio-Economic Problem as well?
        

        Submitted by Allison Merrick on 12/4/07 09:15 AM

        The point of workers only taking sick days if they have them is interesting, and leads me to wonder about the millions of workers who do not accrue sick time at all with their employer in hourly paid positions, which are typically filled by those who have less education and income. If they cannot afford to take time off of work, then they will be forced to go in, taking a "risk."
        
        We saw a similar socio-economic issue when people could not financially afford to evacuate due to a recent major hurricane. This group of citizens were the same ones to bear the highest death toll.
        
        I'm not sure what the best solution is... should we prioritize those who do not receive sick time from their employer?
        

        • Sick leave
          

          Submitted by Mona Wenger on 12/4/07 10:26 AM

          Might be beneficial to address this issue with the businesses employing the workers. What is their plan when workers are or are not showing up and will they get paid (big question asked by teachers in our state).

          • Work-related strategies
            

            Submitted by Sharon Hutchins on 12/4/07 04:54 PM

            Similar to the point made about many lower-wage workers not having any sick leave is the fact that many of the same individuals are in jobs where telecomuting (another option recommended by many pandemic plans) is not possible. An investment banker may be able to work from home via computer/phone but a janitor cannot.
            
            However, there are other ways to increase social distancing at work!

      • Sick Day Policies for Work
        

        Submitted by Glenda Ford-Lee on 12/5/07 07:24 AM

        Which is more of a reason why businesses must develop sick day policies for an pandemic. Workers need to know that they will get paid when taking off.
        Glenda
        

  • Work from home
    

    Submitted by Willie Hearns on 12/4/07 08:51 AM

    I agree with the idea that most people will automatically pull their children from school in case of a pandemic. The suggestion of imposing penalties for those going to work might be a bit extreme. I may be wrong to assume this, but I believe that for the most part of society an individual would not willing transmit the virus to others.
    
    For each business I address, I suggest they set up a system where their workers can still do their jobs, but from home. Of course this does not apply to industries and key public works. For those I suggest only have the bare minimum amount of workers on site to perform their tasks.

    • Food for the people
      

      Submitted by Roy Kamen on 12/4/07 09:00 AM

      Good points Willie,
      
      But for us to work from home means we need to be able to eat. It means that the power must stay on. It means that the internet and communications systems stay up ...
      
      Take a look at this thread about the JIT and see what I mean...
      
      https://www.singtomeohmuse.com/vi...
      

    • Working from home
      

      Submitted by Kerry Kimble on 12/4/07 09:11 AM

      Yes, working from home is an option, but the cascading effect would be can the internet providers support the increased usage from home computers. There are probably only a minority number of people who have a faster system at home than they do at work.
      
      There is also the issue of accessing files from a remote location. There are software packages and systems available to make this access possible. But the cyber security folks may balk at this type of access because it allows people from the "outside" through their firewalls.
      

      • Work from home? What about the customers?
        

        Submitted by Katharine Fisher on 12/4/07 10:35 AM

        Even if working from home was feasible and we had a robust internet, many jobs won't transfer there easily.
        
        Also important, for those white collar folks who are able to transition to a work-from-home option, will they have customers to do work for during a pandemic? Will architects still be sought out to design, importers still be able to sell items for interior decoration, travel professionals be able to advise on their client's upcoming vacation? Such jobs can make the transition to an online remote enviroment, but they may have no customers to support the continuance of those jobs for the duration of much of the pandemic. Without clients and customers, they'll be just another unemployed person with virtual ability sitting unproductive in their living room.
        
        My town has many people who could work remotely during a pandemic not just theoretically, because many here already do. Without clients, though, it will all come to a screeching halt. The prospect of many unemployed and idle breadwinners throughout my community who work remotely now, but will not be able to maintain that later due to simple lack of buinsess, is one that I think is very realistic.
        

        • Impact on service/retail and tourism sector
          

          Submitted by John Carney on 12/4/07 01:56 PM

          And what of those whose livelihoods depend on people congregating - retail, sports, entertainment, resaurant, tourism, travel, service sector, human transportation (plane, taxi) I remember the days after 9/11 in DC, it was a like a ghost town for awhile...and those service industry folks don't usually have health insurance, paid leave. They are gonna show up for work if at all possible - social distancing is an anathema to them.

        • Idle workers due to lack of customers
          

          Submitted by Sharon Hutchins on 12/4/07 04:57 PM

          Maybe it's this group of likely-to-be idle telecomuters that we can recruit to be part of citizen's brigades to help in the response. How we might be able to give them an incentive (money?), I'm not sure.

    • Working from Home
      

      Submitted by Glenda Ford-Lee on 12/5/07 07:26 AM

      
      The question here is do we have enough lines for everyone that wants to work from to do so?? Many internet companies and communication companies will tell you NO. The government will have control of the limited amount of lines that will be used for communication.
      Glenda

• Non-compliance
  

  Submitted by Joel Palmer on 12/4/07 06:47 AM

  Margaret - I can think of two different answers to your question.
  
  First - many cities (including the one I am writing plans for) are preparing to shut down many services including the schools to limit non-compliance. The problem is that once those options are closed there is every likelihood that people will continue to congregate on their own. The only way to resolve that is through education, doing everything possible to make sure people understand WHY they are being asked to stay away from each other.
  
  Second - most health officers/commissioners/insert title here have the power to issue isolation (keeping ill people separated) and quarantine (keeping potentially exposed people separated) orders. I know the state Attorney General here has been polishing the statutes to make sure everyone in the state and local public health realms understand what those powers include. In a case of a single or few individuals who are clearly ill yet insist on being "out and about" that might be the only solution.
  
  Again, the best tool we have is community buy-in, and the only way we'll get that is by making sure the community understands the risks and the reasons behind the policies.

  • Community Buy-in and Education
    

    Submitted by Alice Weingartner on 12/4/07 07:17 AM

    Community buy-in and education will be two of the most important (if not THE most important) tools in our kits.
    
    Government leaders at all levels must be informed and understand the significance of a pandemic and we as planners must be able to convey this message while they are also dealing with immediate budget issues, re-election, zoning, etc.
    
    Another important aspect is education and working with the media. In order for the public to understand why they must 'buy-in' to the plans, the media must be able to understand and convey effectively. We are currently trying to get media partners to attend meetings so we can explain the importance of educating the public now vs. waiting until a pandemic is identified. Not an easy sell when they are looking for excitement, hot button issues and we aren't able to provide a date, time and location for a pandemic.
    
    Community partners involved in planning efforts, must continue to speak up and provide clear, consistent messages for the public and govt. leaders. We cannot have one city responding one way and a neighboring city doing something else.
    

    • agreed
      

      Submitted by Roy Kamen on 12/4/07 07:30 AM

      The media is key. I can't tell you haw many times i talk about Panflu with someone and they say they haven't seen it on TV.
      
      We need top officials on the same page demanding TV time.

      • Caution with Media
        

        Submitted by Tammy Brown on 12/4/07 07:42 AM

        While I agree that media is key the general population does not always respond the way we would think. If media begins to broadcast Panflu information the first response from the general public could be panic. Which could cause a flood in the health industry. If we educate the businesses, schools, churches and all government entities we may have a better opportunity to educated those who could control congration areas.

        • Panic or complacency
          

          Submitted by Catherine Jackie Mitchell on 12/4/07 08:53 AM

          Which is the greater enemy? I would choose self limiting panic over complacency any day.

          • And when better to panic? Now or later?
            

            Submitted by Katharine Fisher on 12/4/07 10:47 AM

            I'd also choose panic before the disaster, rather than during it, if one truly belives that panic is going to be the ulitmate response of at least a portion of the public. That only makes sense.
            
            (Although really, I reject the premise that our public will panic if given information that is clear and complete ahead of a pandemic. It's a red herring argument, and one meant to justify not preparing the public).
            

            • the word panic
              

              Submitted by Holly Reischman on 12/6/07 07:37 AM

              The word panic derived from the word pandemic...I believe it is ok 4 the people 2 panic in a pandemic. Once they get over the initial scare, I believe they will calm down and do what they have 2do.
              

        • Panic from media coverage?
          

          Submitted by Sharon Hutchins on 12/4/07 05:08 PM

          Tammy,
          
          I'm not sure I fully agree with your point. I've seen a lot of pandemic influenza news in the media over the past 2-3 years and not a lot of panic. For example: Michael Osterholm was on Oprah, there was a made for TV movie about pan flu, discussions have been on major news shows and networks (CNN etc.), articles in local and major papers, etc. In fact, many public health folks are tearing their hair out to get any response from the public. Maybe we just haven't hit the saturation point yet, though.
          
          -Sharon

    • Different Responses
      

      Submitted by Catherine Jackie Mitchell on 12/4/07 08:51 AM

      Differing responses may allow us to hone in on what is working and not working in different communities. I think the key is great communication.

    • Synchronization Challenges-Example: School Closures!
      

      Submitted by Scott Hiipakka on 12/4/07 10:37 AM

      How do we ensure that plans are synchronized? As an example, one city or county implements school closures and the adjacent waits. Or worse, one state implements school closures and the neighboring states do not. The ripple affects will be significant.
      
      How are others ensuring that their plans (and triggers) are similar?
      

      • Response to "Synchronization Challenges"
        

        Submitted by Susan Webb on 12/4/07 12:08 PM

        If attack rate/case fatality rate differ among different jurisdictions, can you foresee allowing "rolling" school closures, or other forms of social distancing? Can we anticipate some non-synchronous application of the guidance?
        
        I work for a company with locations throughout the state. I expect some areas to hit sooner or harder, but business viability may depend upon relocation of some critical functions. I hope the "flexibility" mentioned in the guidance allows for variances.
        

      • Taking a State and Regional Approach to Planning and Response
        

        Submitted by Debra Mattas on 12/4/07 12:57 PM

        Speaking for Florida, representatives from all of our 67 counties have been participating in Rapid Response Training, Pandemic Influenza and Avian Influenza Exercises led by our State Bureau of Epidemiology, Environmental Health, Department of Agriculture, our State Veterinarians and Regional Epidemiologists. This way we are planning to have a more unified response no matter what county we represent.
        
        We also have established Regional Epidemiology and Environmental Health Strike Teams...with Team Leaders assigned from each county. We have perfomred asset typing, trained and equipped ourselves in order to have a uniform all-hazards approach to any type of event.

      • Coordinating across jurisdictions
        

        Submitted by Sharon Hutchins on 12/4/07 05:11 PM

        Boy is this hard! It's a challenge just to get plans and policies in place for a single jurisdiction, let alone to coordinate with others. Our 13-county mutual aid region is trying to coordinate our policies, but it is a long slog. State and federal guidance is helpful. For example, having a state-wide policy from the Department of Education about school closures means that each county/city does not have to work with each school district to draw up separate agreements and plans. The work can be done just once.
        

    • Being Prepared
      

      Submitted by Alison Lee on 12/4/07 04:25 PM

      I agree the more we are prepared and realize that people are willing if not given the information to where they feel as if they are putting out fires.
      

  • Non-compliance (continued)
    

    Submitted by Susan Webb on 12/4/07 12:31 PM

    To Margaret and Joel:
    
    Education IS the key. We currently don't have enough of it provided though public service announcements, flyers at hospitals and medical offices, programs to school age children, etc.
    
    Review and revision of statute also mandates education to those affected AND to those who enforce it. I believe that our law enforcement community is overlooked when it comes to providing education and guidance on how to explain public health statute and how to enforce it.
    
    Are there any good models out there for incorporating law enforcemenet partners?

• In response to non-compliance with Guidance
  

  Submitted by Tammy Brown on 12/4/07 06:55 AM

  In developing a Guidance plan from the state and government levels there should alse be levels of response to non-compliance to react to that non-compliance. There will be individuals that will show up to work and/or school that will be sick. Their intent, in most cases, will not be bad, but will in any event cause a spread of the virus. For business purposes our Pandemic Plans include such cases happening. There should be an awareness plan and a reaction plan. So that when this occurs the appropriate individuals within a facility and their occupants understand the process of notification and how to remove the individual from the building and then a decontamination or building closure process (even if this is a temporary step). There is no way to prevent non-compliance, but you must prepare to address it when it happens.

  • compliance
    

    Submitted by Tanya Cassingham on 12/4/07 10:26 AM

    As a parent, I find it's common for some parents to send their kids to school sick. My experience has shown two primary groups of parents who do this: hourly or temp workers who will not get paid if they don't go to work; self-employed workers; and professionals who perceive an exceptional need to be on site. I think that ALL children would prefer to stay home from school when sick!
    
    However, I have the luxury of paid sick days and easily working from home (as I am today with a sick child). I know single mothers for whom it is out of the question.
    
    How will we assure workers that they will not be allowed to go bankrupt, lose their homes, etc., if they stay home from work -- with or without children? In the case of a pandemic, most US workers are going to think about the mortgage payment before taking the "luxury" of sick time.

    • Mortgage payments
      

      Submitted by Roy Kamen on 12/4/07 12:49 PM

      so Tanya - are you suggesting we move all mortgage collectors to the end of the vax priority line?

• What if people don't comply with the guidance
  

  Submitted by Kerry Kernen on 12/4/07 07:34 AM

  I think initially people will comply with social distancing and mitigation guidance. Probably more so when the first wave of a pandemic hits. It's when the second or third wave comes through or during the first wave when we have institued community mitigation measures for 4-6 weeks that citizens will become intervention fatigued, that we may see non-compliance.

  • social distancing measure
    

    Submitted by Miriam Reynolds on 12/4/07 08:13 AM

    When we begin to close schools and daycare centers, we need to also plan for what to do with the children. If we want to ensure minimal interruption of the workforce, then we need to also provide an alternative to schools and daycare centers. If left up to families to do their own planning, is it feasible that no planning will take place and at least one worker will stay home to care for the out-of-school or daycare children.
    

    • "Social Distancing" - Public Health Needs Partners
      

      Submitted by Doug Fredericks on 12/4/07 09:32 AM

      Public Health Planners really need to gain the support and partnership of Civic Offices of Emergency Management on this issue. Public Health should provide surveillance, reporting and make recommendations or even issue orders (If applicable to a jurisdiction) to close schools. Once schools close, responsibility to implement and enforce "social distancing" measures and restrictions needs to be transferred to OEM types. Public Health has enough to do, without developing plans to police public gathering places and enforce issued directives to the populace. This is a trap that is very easy to fall into. Exercise caution or you'll be "sucked" in.

    • Education
      

      Submitted by Mona Wenger on 12/4/07 10:33 AM

      Although there may be families that may not do anything, there are families will be on top of things and will comply. I can almost guarantee no compliance initially by those outside of public health if no one is informing them of how to stay healthy and alive.

  • compliance concerns
    

    Submitted by Susan Webb on 12/4/07 12:20 PM

    I agree wtih Kerry - I think compliance may come easy for the initial wave and then economic and/or emotional hardship will set in. Non-compliance will be based upon the need to go to work, to be with or comfort faith partners, to obtain goods and services to maintain a household and/or business.
    
    Are we planning for second and third wave public service announcements? Will the tone of the messages be different than the initial messages?

• What if people don't comply with the Guidance?
  

  Submitted by Eleanor Peters   on 12/4/07 09:00 AM

  Margaret -
  
  This is a big problem! And a tough one to solve. The best answer for how to control this is good old fashioned peer pressure. In a pandemic if someone shows up to work sick then we in public health are counting on the company, the employers and the employees to send that person home. Same in schools.
  

• guidance
  

  Submitted by Tanya Silva on 12/4/07 09:01 AM

  In a scenario like this. School should be closed as part of the safety measures of population based containment. This is also part of basic education, communication. Plays a critical role in preventing influenza and reducing the chances of an outbreak. Is clear that we don't know when this is going to happend for that we all have to work together even the department of education to signal mandatory orders to follow guidance.