©InfoPandemic influenza is one of the severest natural disaster challenges facing the UK.
Here are some questions to consider which help illustrate why:
- If pandemic flu closes hospitals, what happens to patients?
- What if space runs out to store the bodies of those who die?
- Will the government impose travel restrictions, limiting the movement of people as they did livestock during foot and mouth disease?
Flu is a health issue – obviously. Very large numbers of individuals will be ill. Some will not recover. However, a pandemic outbreak is more than a health problem. Daily life for virtually everyone, including those who are not ill, and don't know anyone who is, will be different.
This briefing does not offer health advice. There are plenty of government websites and other sources for that. It explains some of the planning designed to reduce the suffering caused by a pandemic.
Read the health protection agency's advice
Download the lesson plan for secondary
Download the assembly kit for primary
Why is there so much concern about pandemic flu?
The numbers of people involved make it a major health concern. There is an impact on individuals who contract the virus, their families and friends. Added together, that is a widespread problem.
The knock-on effects are also a major concern. People will have to change what they do, either because they are ill, or looking after someone who is ill. Or they may adapt their normal behaviour through fear or anxiety, or even panic. There cannot be "business as usual", if schools and hospitals are closed, transport systems are shut down, supermarkets run out of food, and there are no large public gatherings such as concerts or sporting events.
The strain that those changes will put on the normal running of the country is a real threat. This is a definition of an emergency – when the systems you have to cope with a problem are overloaded and you need to find special measures to help.
What form will the emergency take?
That partly depends on the nature of the epidemic, how it spreads, and also on how people react. The government expects "social and economic disruption". Services may not be provided, or only in a very limited way. Even essential services could be threatened. There could be widespread shortages of particular foods or other everyday goods. Even goods that are not in short supply may be unavailable because of distribution or delivery problems.
There will be knock-on effects, some of which are impossible to predict. For instance, if one organisation cannot get fuel, another one elsewhere in the chain could run short of a key component, and be unable to operate.
A helpful way to imagine it is to think of other disruptive times – perhaps when snow and ice brought the country to a skidding halt, or during a fuel shortage or a strike of key workers. Imagine it like all those things, rolled into one, and more besides, and going on for many weeks. That may sound depressing. The cheering news is that a lot of people have been preparing for it. And, of course, the worst-case would only happen in a serious epidemic.
What planning is going on?
An enormous amount. For instance, in the winter of 2007, the health department ran a dummy exercise to test the procedures in place for the disruption caused by a flu pandemic. Over 5,000 people from government, industry and the voluntary sector took part in Exercise Winter Willow. The exercise lasted several days.
What lessons have been learned?
One point revealed in the exercise stems, unsurprisingly, from the increased demand for medical supplies. Masks and antibiotics are normally purchased as they are need – a "just in time" purchasing policy. In normal times this cuts down waste and is efficient. But pandemic flu could create high demand. Following the exercise, planners agreed to build up stocks in case of high demand. They also looked at ways to prioritise groups who need them most if they are in short supply.
Dealing with high death rates was another concern. Though it should be stressed that a lot of people die in seasonal flu, and a flu virus that causes pandemic may be not particularly virulent, just easy to spread. But if there are many deaths, existing mortuary spaces may not be enough. Buildings will have to be adapted temporarily to store bodies. The cultural practices following death of different faith groups need to be more widely known and respected, said the report.
What will happen during an outbreak?
Large numbers of staff are likely to be absent from work at any one time. Organisations may operate a skeleton service, concentrating on essentials, and implementing their emergency procedure – if they have one.
The government will attempt the tricky balance of getting people to change their behaviour, but without panic. They have developed communication strategies geared to this. It is known from past events that panic buying for instance, can cause shortages even if the supply of the goods would have been adequate if everyone behaved normally.
The public will be given updated health advice, and asked to consider how to prepare for such socially disruptive effects as possible school closures, shortages and travel problems. There will be an emphasis on self-help measures. People will be advised to get support from family and friends who don't live with them and to consider how they might help others. That will be called being a "flu friend".
Will there be travel restrictions?
This is unlikely. Logically, you might guess that the government would want to reduce the spread of infection by stopping people moving around. But experts say it is not worth it – the reduction of infection is small and the disruption enormous.
Patients with symptoms will be asked to stay at home or in their place of residence while they are ill. There may also be general advice for everyone to minimise non-essential travel as a personal precautionary measure.
Will schools be closed?
In the early stages of an outbreak, the emphasis is likely to be on containing the spread of the disease. The early-stage policy would be to close a school where someone was thought to be infected.
This is because it is thought that children have low immunity, and could be "super spreaders". In a pandemic in 1957, up to 50 per cent of schoolchildren developed influenza. In some residential schools, attack rates reached up to 90 per cent, often affecting the whole school within a fortnight. So it makes sense for schools to close to help reduce the spread.
However, once the number of cases increases, policies will change from containment to management. Closing a large number of schools would create difficulties for working parents and cause problems in keeping essential services and businesses running.
Other places where flu is likely to spread rapidly include university residences. Prisons and residential homes also have distinctive problems. Such places are likely to have high levels of staff absence, and to experience supply disruption or transport difficulties. They all will have developed emergency resilience arrangements well in advance of an outbreak.
Who is responsible for planning?
The core planning team includes representatives from the Department of Health, Cabinet Office and the Health Protection Agency as well as local and regional governments. Less obvious key participants come from key industries –manufacturers, retailers, producers and wholesalers in the food industry, water companies, fuel refiners and retailers, and transport operators covering buses, trains, air travel and shipping.
Has everything been covered?
No. It is recognised that some problems which no one particularly expected could well break out. Likewise, some threats that planners have been very concerned about may turn out not to be a major issue. The planning process has to cope with this – by monitoring closely what is happening, and by having capacity to respond when an unexpected problem emerges.
Discussion and activities
- The emergency planning exercise for pandemic flu pointed out that communities would have to take more responsibility for vulnerable people. It says better ways to communicate this message are needed. Talk to students about what this might mean where they live. Talk about who and where the vulnerable groups are – such as elderly or disabled people. Who in the community would likely to check on them locally? How can authorities remind people to make sure they are not in need? Invite students to write the messages that might be used in a government publicity campaign. What mechanisms would they use to get the messages across? Do they think social media networking sties such as facebook or twitter could be used?
- Working in pairs or small groups, ask students to list what they personally would want to stock up on ahead of a possible pandemic flu outbreak. What would they most miss if it was unavailable? Ask them to move on to the needs of people they live with. Can they say what the essentials are for different people in their lives? Share the results and compare and contrast. Move on to discuss non-material goods too – such as events they attend, or venues they frequent. What would they most miss, and what might they do instead?
- For an out-of-class action project, ask students to research as much as they can about local planning arrangements for pandemic flu. Councils should have set up local resilience forums whose job is to ensure adequate planning for all kinds of emergencies. Ask students to find out who is on the forum. What else can they discover – about which buildings are to be used as temporary mortuaries, or who is responsible for communicating key information to the public? Set a target of unearthing three not-very-well-known facts about emergency planning.
Credits
This resource was written by PJ White and produced in August 2009.
This resource and other free educational materials are available at redcross.org.uk/education