A. An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks of influenza. Seasonal outbreaks are caused by subtypes of influenza viruses that are already in existence among people, whereas pandemic outbreaks are caused by new subtypes that have never circulated among people before or that have not circulated among people for a long time. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss.
B. The University of Baltimore's Influenza Pandemic plan has been incorporated as an additional situational protocol in conjunction with the University's Emergency Preparedness Plan. The command, control, communications procedures, and the coordination/cooperation measures between state and local agencies already established in the university-wide emergency preparedness plan shall provide sufficient guidelines in which to operate.
Influenza Pandemic emergencies according to the University of Baltimore Emergency Preparedness Plan are classified as Level 3 incidents. However, depending on the severity of the pandemic in Maryland, a Level 4 and Level 5 response may be required.
SITUATION AND ASSUMPTIONS
A. Many public health officials believe it is only a matter of time until the next influenza pandemic occurs. The impact of the next pandemic cannot be predicted; however, some simulations suggest that, in the absence of an effective vaccine, a "medium–level" pandemic could cause approximately 10,000 deaths, 44,500 hospitalizations, and over one million people becoming ill in Maryland alone. A more severe pandemic could infect an additional 700,000 Maryland residents (up to 35 percent of Maryland's population). The recent outbreaks of avian influenza among poultry in Asia and Europe, and associated human cases, heighten the need for pandemic planning now.
- A pandemic will likely last for months – much longer than most other community-wide emergencies. Also, a pandemic may include "waves" of influenza activity separated by months (in 20th century pandemics, a second wave of influenza activity occurred three to 12 months after the first wave).
- A pandemic will affect all of us – including people responding to the pandemic. For example, health-care workers and other responders may be disproportionately affected. They will be at high risk of illness through exposure in the community and in health-care settings, and some may have to miss work to care for ill family members.
- A pandemic will be widespread, with outbreaks expected to occur simultaneously throughout much of the U.S. – and the rest of the world, thereby making it impossible to move human and material resources from place to place as would normally occur with other natural disasters.
- Some preventive and treatment measures – like vaccines and antiviral agents – will likely be unavailable or in short supply initially.
- A pandemic will pose significant threats to human infrastructure responsible for critical community services (in health and non-health sectors) due to widespread absenteeism.
- Assuming that prior influenza vaccination(s) may offer some protection (even against a novel influenza variant) the annual influenza vaccination program, supplemented by pneumococcal vaccination when indicated, will remain a cornerstone of prevention.
- Surveillance of influenza disease and virus will provide information critical to an effective response.
- An effective response to influenza will require the coordinated efforts of a wide variety of organizations – private as well as public, and health as well as non-health related.
- An outbreak could interrupt normal University functioning for a period of two to four weeks up to several months.
- The University will implement social distancing measures and many of its students and employees sent home, but it may need to maintain some systems to support continued operations.
- Essential employees may need to function from either remote or campus locations to maintain services. Options for limiting exposure of essential employees to the virus might be beneficial. Staff may be requested to work multiple shifts and critical staff may need to be on campus to service critical campus systems.
- Some level of loss of essential employees to illness or care for a family member will require back up options for essential functions. Absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40 percent with lower but still significant absenteeism both before and after the peak. Also, absenteeism may be affected by the closing of public schools, quarantines, and other measures taken in the community.
- Those associated with the University, (vendors, etc.), will require information on the University's plans and implementation during the crisis. Parents and families, the surrounding community, governing bodies and elected officials will all require periodic updates.
B. The state agencies that are considered the "lead" agencies that will disseminate information relative to a flu pandemic, specifically determine the need to declare a public health emergency and the subsequent "command and control" of the emergency are:
C. The first line of defense is early detection. The DHMH is working closely with federal, state, and local health and emergency preparedness agencies to monitor the early spread of the disease.
D. The best defense against influenza is vaccination. Unfortunately, the fully effective vaccine cannot be developed until the virus strain has evolved and been identified. Once developed, there must be enough production capacity to manufacture vaccine for the entire population.
E. There are currently two FDA-approved antivirals that have shown effectiveness against the H5N1 virus – Tamiflu and Relenza. Both must be administered within 48 hours of the onset of symptoms.
SIX PHASES OF INFLUENZA PANDEMIC
A. An influenza pandemic will evolve through the following series of phases:
1. Novel Virus Alert: novel virus detected in one or more humans; little or no immunity in the general population; potential, but not inevitable precursor to a pandemic
2. Pandemic Alert: novel virus demonstrates sustained person-to-person transmission and causes multiple cases in the same geographic area
3. Pandemic Imminent: novel virus causes unusually high rates of morbidity in multiple, widespread geographic areas
4. Pandemic: further spread with involvement of multiple continents
5. "Second Wave": recrudescence of epidemic activity within several months following the initial wave of infection
6. Pandemic Over: cessation of successive pandemic "waves," accompanied by the return (in the U.S.) of the more typical wintertime "epidemic" cycle.
DECLARATION OF PUBLIC HEALTH EMERGENCY
A. A very real possibility during a pandemic is an executive order from the Governor that all citizens should limit their outside exposure. Therefore, many people will be staying away from work and school. As a result, policies and procedures should be in place to address the critical areas of employee relations, technology, and teaching/learning capabilities during such a public health emergency.
B. Under the Catastrophic Health Emergency Act (CHEA), Md Ann. Code, Public Safety, Section 14-3A-01 to 14-3A-08 and the Md. Ann. Code, Health-General, Section 18-901 to 18-908, the Governor of the State of Maryland and the Secretary of Maryland Department of Health and Mental Hygiene have extensive statutory powers to declare a "public health" emergency, and mandate citizen compliance. The order may include travel restrictions, isolation, quarantine, cancellation of public events, and closure of facilities or requiring individuals to submit to medical examinations or treatment. The Governor's decision will be based upon many criteria, but specifically upon the recommendations of the Maryland Department of Health and Mental Hygiene, and federal public health agencies.
C. Upon learning of such an emergency, on-duty police supervisors or commanders will ensure University departments and organizations are notified as appropriate for Level 3 or above incidents.
1. Those notifications may include, but are not limited to:
a. university president;
c. senior vice president for Administration and Finance;
d. vice president of Planning and External Affairs;
e. chief information officer; and
f. chief of police
D. The activation of the Executive Emergency Center and/or the Emergency Operations Center will require that decisions be made and communicated to the University community concerning (this list is not all inclusive):
1. compliance with mandated governmental orders
2. class cancellations and/or campus closing procedures
3. revision of class and examination schedules
4. liberal leave or special administrative leave protocols
5. working from home protocols
6. anticipated return to work or class resumption dates
7. flexible or staggered work hours
8. social distancing measures
10. when students, parents, faculty and staff are notified of cases of the flu detected on campus
UB POLICE DEPARTMENT, PHYSICAL PLANT (Essential Personnel)
A. The UB Police Department and Physical Plant personnel are currently designated by University policy as "essential personnel."
B. During a declared public health emergency, the UB Police Department and Plant personnel will be required to report to work as scheduled.
1. It is recommended that essential employees call in to their respective supervisors by a certain time each day to determine if they are required to report.
2. Create "call center" at the Police Communications Center to provide current information on the campus situation and be the point of contact for all inquires. Staffing of call center should come from ALL university departments. The call center, while physically located at the Police Communications Center, shall be separate and apart relative to assigned duties from the police functions that normally take place. UB Police Department staffing shall be dedicated to police activities only.
C. Personal Protection Equipment (PPE), face masks (N95 or higher), rubber gloves, goggles, etc. will be issued and the wearing of such PPE shall be mandatory while on duty.
D. Physical Plant shall provide sufficient and accessible infection control supplies, i.e. personal HAZMAT clean-up kit, hand-hygiene products, tissues and receptacles for their disposal.
E. Appropriate training and fit tests must be conducted prior to issuance of any PPE gear.
F. Physical Plant personnel shall receive specific training in reference to collection and disposal of contaminated infection control supplies.
G. Plant personnel shall use EPA-registered detergent-disinfectant; follow standard facility procedures for cleaning and disinfection of environment surfaces; emphasize cleaning/disinfection of frequently touched surface, e.g., phones, lavatory surfaces, public access doors, etc.
1. inventory cleaning supplies
2. procure, store and provide sufficient and accessible soap, alcohol-based hand hygiene products (e.g., Purell), tissues and receptacle for their disposal
H. Develop protocol of what is the best method to assist in minimizing transmission of flu by potentially using building environmental systems where possible.
A. Human Resources shall work towards developing specific departmental plans related to (this list is not all inclusive):
1. compensation for essential personnel who must report to work
2. sick leave absences unique to a pandemic, i.e. non-punitive, liberal or special administrative leave
3. when a previously ill person is no longer infectious and can return to work after illness
4. flexible work hours
5. work from home procedures
6. immediate mandatory sick leave, i.e. employee suspected to be ill
7. continuity of payroll – implement emergency paycheck distribution plan
8. health benefits (work with health care providers)
9. develop employee's family emergency contact list
10. ensure the University is in compliance with any existing Memoranda of Understanding (Health and Safety – general duty clause)
11. notification of the Baltimore City Health Department if any faculty, staff or student is ill as a result of a suspected case of certain types of flu
12. assist in determining when faculty and staff are notified of avian flu cases detected on campus
OFFICE OF TECHNOLOGY SERVICES (CIO)
A. Develop and establish policies and procedures to enhance communications and information technology infrastructures:
1. publish information about telecommuting from home or remote location
2. publish information concerning remote access to UB e-mail, etc.
3. develop platforms, i.e., hotlines, dedicated Web sites, to communicate pandemic status to University community
4. establish redundancies for all emergency contact media utilized by the University
5. e-mail alerts will be sent to students, faculty and staff informing them of current status and encouraging them to refer to the Emergency Preparedness Web site.
6. campus-wide voice mail will be sent to students, faculty, and staff
A. The provost shall work towards developing specific planning strategies for each school/college using the list (not all inclusive) below. Moreover, an Academic Recovery Plan shall be crucial in this process.
1. distance instruction
2. telephone conference calls between professors and students
3. mailed (U.S. Post Office, Fed Ex, UPS, etc.) lessons and assignments
4. instruction via radio and/or television
5. e-mail lessons and assignments, i.e., expansion of current Web-based online courses
6. address issues of student absenteeism
7. determine if the University were required to close during the spring or fall semester(s) for one to two weeks, could we do so without significantly altering the semester calendar/structure
8. for any closure extending beyond two weeks, establish that the University may consider extending any semester during which the pandemic fell
9. assist in determining when parents and students are notified of certain types of flu cases detected on campus.
10. each school/college will be asked to designate an emergency point person(s)
B. Each semester, deans will ask each faculty member to discuss class activities/actions (5-10 minutes in class) to be implemented in case the campus is closed due to an outbreak of certain types of influenza and bring to their attention the Emergency Preparedness Web site. Faculty members will be asked to set up e-mail listservs for their classes and to consider how online teaching platforms and other technologies could be used in their courses.
A. Work with students with identified needs to ensure those needs are communicated to those university departments that can best assist them.
B. Assistance with student planning issues may include, but are not limited to:
1. education concerning proper hand washing and personal hygiene, and the University's response to a pandemic
2. international student issues relative to notification of family members
3. assess any risks to students who may be traveling or studying abroad
4. serve in aiding other administrative and academic units with communications to students
UNIVERSITY RELATIONS (Public Information Officer)
A. Duties and responsibilities of Manager of Public Information include, but are not limited to:
1. Creation and maintenance of an Emergency Preparedness Web site that is marketed to members of the University community and updated as needed. This resource will be used to communicate with students, faculty, staff, families, surrounding communities, local officials, state officials, and vendors.
2. administering the institution's public information program in response to incidents
3. collaborating with senior staff and chief of University Police in order to prepare information releases for the media and UB community
4. ensuring messages are prepared to reach the primary public information contact
5. ensuring all media inquiries, requests for interviews, etc. are referred or responded to as appropriate
6. implement procedures for dealing with increased media presence on campus; and
7. in consultation with senior administrators, communicate, through established channels, to students, parents, faculty and staff when cases of certain types of flu are detected on campus
1. communication will be maintained via the protocols established in the Communications Plan
2. communication will be needed for various audiences at different stages of the pandemic
3. draft communications should be developed in advance for each of the five relevant stages
A. Implement emergency cash flow as needed.
B. Increase purchasing card transaction limits to facilitate procurements.
C. Implement manual billing process if necessary.
D. Utilize paper purchase orders.
E. Prepare any required notifications to vendors.
F. Coordinate funding and procurements for emergency supplies and services.
ALL DEPARTMENTSA. All University departments shall work towards developing specific departmental plans related to (this list is not all inclusive):
1. all units will consider reassignments of staff within the department to meet temporary service needs
2. all units will identify vendors and allocate funding in conjunction with the comptroller for potential financial impacts, including emergency supplies and contracted human services
3. all units maintain staff phone trees
4. all units will publicize protocols for hand washing, respiratory hygiene and cough etiquette
5. all units monitor staffing levels, health, morale, and absenteeism
6. all units reassign staff if necessary
7. all units monitor impacts/revised service expectations related to liberal leave
8. all units will identify essential staff to maintain operations, and inform individual staff of their status in writing
9. all units will confirm communication protocols for all staff levels (e-mail, meetings, conference calls, etc.)
10. all units will be ready to communicate how they will function/provide services with fewer staff; noting restrictions of hours and service levels and alternative means of getting services as appropriate
11. all units will provide information to staff about departmental issues and the care and safety of their families
12. all units will follow campus protocols for updating the Web site and other communication tools
A. During a pandemic flu outbreak, transportation services may be interrupted. Therefore, you should rely less on public transportation.
1. make arrangements to have available reliable transportation
a. personal vehicle is mechanically sound
b. borrow a friend's or family member's vehicle
c. prearrange carpool with co-workers
2. Listed below are Web sites that should be monitored to ascertain the viability of public transportation during a flu pandemic:
A. The reported symptoms of influenza in humans have ranged from typical influenza-like symptoms, e.g., fever, cough, sore throat, and muscle aches, to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia and other severe and life-threatening complications. A person is infectious for a minimum of five days after onset of symptoms.
B. Stock a supply of water and food. During a pandemic you may not be able to get to a store. Even if you can get to a store, it may be out of supplies. Public water supplies and other utilities may also be interrupted. Stocking supplies can be useful in other types of emergencies, such as power outages and disasters. Store foods that:
- are nonperishable (will keep for a long time) and don't require refrigeration
- are easy to prepare in case you are unable to cook
- require little or no water, so you can conserve water for drinking
C. Take common-sense steps to limit the spread of germs. Make good hygiene a habit.
- wash hands frequently with soap and water – for at least 10 to 20 seconds
- cover your mouth and nose with a tissue when you cough or sneeze; cough and sneeze into the crook of your elbow, not into your hand
- Put used tissues in a waste basket
- clean your hands after coughing or sneezing; use soap and water or an alcohol-based hand cleaner
- routinely clean and disinfect surfaces – especially desks, kitchen, bathroom and common areas
- keep up with any immunizations
- avoid close contact with those who are ill
- stay at home if you are sick
D. It is always a good idea to practice good health habits.
- Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat dairy products, lean meats, poultry, fish and beans. Drink lots of water and go easy on salt, sugar, alcohol, and saturated fats.
- Exercise on a regular basis and get plenty of rest.
E. Items to have on hand for an extended stay at home:
Examples of food and non-perishables:
- ready-to-eat canned meats, fruits, vegetables, and soups
- protein or fruit bars
- dry cereal or granola
- peanut butter or nuts
- dried fruit
- canned juices
- bottled water
- canned or jarred baby food and formula
- pet food
Examples of medical, health and emergency supplies:
- prescribed medical supplies, such as glucose and blood-pressure monitoring equipment
- soap and water, or alcohol-based hand wash
- medicines for fever, such as acetaminophen or ibuprofen
- anti-diarrhea medication
- fluids with electrolytes
- cleansing agent/soap
- flashlight (hand-cranked and battery-powered)
- portable radio (hand-cranked and battery-powered)
- manual can opener
- garbage bags
- tissues, toilet paper, disposable diapers
CRITICAL INFORMATION SITES
A. Knowing the facts is the best preparation. If a pandemic occurs, having accurate and reliable information is critical to you and your family's health. Many of the Web sites below were used in the preparation of this plan:
- U.S. Department of Health and Human Services (http://www.hhs.gov/pandemicflu/plan)
- Pandemic Flu (http://www.pandemicflu.gov)
- Maryland Emergency Management Agency (http://www.mema.state.md.us/MEMA/index.jsp)
- Maryland Department of Health and Mental Hygiene (http://www.dhmh.state.md.us)
- State of Maryland (http://www.flu.maryland.gov)
- University of Maryland (http://www.umd.edu/emergencypreparedness)
- Centers for Disease Control and Prevention: Influenza (http://www.cdc.gov/flu)
- CDC via telephone: toll free, 800.232.4636 or TTY 888.232.6348
- Centers for Disease Control and Prevention: Avian Influenza (http://www.cdc.gov/flu/avian/index.htm)
- Fight Flu and Pneumonia (http://www.medicare.gov/health/fludetails.asp)
- Epidemic and Pandemic Alert and Response (www.who.int/csr/en)
- Avian Influenza Information (www.mda.state.md.us/animal_health/diseases/ai.php)
- The Flu and Infectious Diseases (www.mdhospitals.org/mha/Community_Health_Resources/Flu_index.shtml)
B. Nongovernmental organizations
- Association of State and Territorial Health Officials (http://www.astho.org)
- Infectious Disease Society of America (http://www.idsociety.org)
- National Foundation for Infectious Diseases (http://www.nfid.org)
- Institute of Medicine (http://www.iom.edu)
- World Health Organization (WHO) (http://www.who.int/en/)