10.3.1.

2 Pandemic Influenza Plan

Published 12/10/2018 15:21 by

MADISON COUNTY HEALTH DEPARTMENT’S

PANDEMIC INFLUENZA APPENDICES

DATE: March 26, 2008

RECORD OF CHANGES

MADISON County Health Department Pandemic Influenza Plan

 Change Date of
Affected Section Summary of Changes
Number Change
Updated FDA's approved drugs,
Madison County's population and
1 12/10/18 Introduction
projected cases, and influenza A viruses
H5N1 and H7N9

MADISON HEALTH DEPARMENT PANDEMIC INFLUENZA PLAN

INTRODUCTION:

Pandemic: A Worldwide Outbreak of Influenza

An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population,
causes serious illness, and then spreads easily from person to person worldwide.  Pandemics are different from seasonal outbreaks or “epidemics”
of influenza.

Seasonal outbreaks are caused by subtypes of influenza viruses already in existence among people.

Pandemic outbreaks are caused by new subtypes or by subtypes that have never circulated among people or 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.

Influenza viruses that have the potential to cause a pandemic are referred to as "influenza viruses with pandemic potential." Examples of influenza viruses with pandemic
potential include influenza A, H5N1, and influenza A, H7N9. These are two different types of avian (bird) influenza viruses. These non-human viruses are novel among humans
and circulate in birds in parts of the world. There is little to no immunity against these viruses among people. Human infections with these viruses have occurred rarely. If either
virus changes in such a way to allow for efficient infections in humans and sustained person-to person transmission of the virus, an influenza pandemic could result.

Influenza pandemics are different from many of the threats for which public health and the health-care system are currently planning:

A pandemic will last much longer than most other emergency events and may include “waves” of influenza activity separated by months  (as seen with 20th Century
Pandemics, a second wave of influenza activity occurred 3 to 12 months after first wave).
The numbers of health-care workers and first responders available to work can be expected to be reduced; they will be at high risk of illness through exposure, and
some may have to miss work to care for ill family members.
Resources in many locations could be limited because of how widespread pandemic influenza would be.

Vaccines to Protect Against Pandemic Influenza Viruses

A vaccine would probably not be available in the early stages of a pandemic. Once a potential pandemic strain of influenza is identified, it takes six to eight months before a
vaccine will be widely available. If a pandemic occurs, it is expected that the State government will work with many partner groups to make recommendations to guide the early
use of vaccine.

Antiviral Medications to Prevent and Treat Pandemic Influenza

Three different influenza medications (peramivir, zanamivir, oseltamivir) are approved by the U.S. Food and Drug Administration for the treatment and/or prevention of influenza*.
Sometimes influenza virus strains can become resistant to one or more of these drugs; therefore, monitoring of avian viruses for resistance to antiviral medications is ongoing. If a
pandemic occurs, it is expected that the State government will work with many partner groups to make recommendations to guide the use of antivirals.

*Per the U.S. Food and Drug Administration, two older drugs, amantadine & rimantadine historically have been approved for treatment and prevention of influenza A. But many strains of influenza, including the
2009 H1N1 influenza, are now resistant to these drugs.

Preparing for the Next Pandemic

The occurrence and severity of the next influenza pandemic cannot be predicted, but modeling studies suggest that its effect in the United States
could be severe. In the absence of any control measures (vaccination or drugs), it is estimated that in the United States, a “medium­level pandemic
could cause in between 15% and 35% of the U.S. population to be affected by pandemic influenza.

Potential Pandemic Influenza Cases, Deaths and Hospitalizations in MADISON

County from a Pandemic Flu ( assuming a 15% - 35% attack rate)*
Madison County Projected Projected
Projected Cases Projected Dead
Population Outpatient Visits Hospitalized
b. (calculate a c. (calculate a d. (calculate a e. (calculate a
range of 15%- range of 37.5% - range of .6% - range of .2% of
a. 35% of a) 45% of b)* .85% of b)* b)*

Phases of a Pandemic

The World Health Organization (WHO) has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national
preparedness and response plans. Phase 1-3 correlate with preparedness, including capacity development and response planning activities, while Phases 4-6 clearly signal the
need for response and mitigation efforts.

Phase Definition

No new influenza virus subtypes have been detected in humans.

Phase 1 However, a circulating animal influenza virus subtype poses a substantial
risk of human disease.

No new influenza virus subtypes have been detected in humans. An

influenza virus subtype that has caused human infection may be present in
Phase 2
animals. If present in animals, the risk of human infection or disease is
considered to be low.

Human infection(s) with a new subtype, but no human-to-human spread, or

Phase 3
at most, rare instances of spread to a close contact.

Small cluster(s) with limited human-to-human transmission but spread is

Phase 4
highly localized, suggesting that the virus is not well adapted to humans.

Larger cluster(s) but human-to-human spread still localized, suggesting

Phase 5 that the virus is becoming increasingly better adapted to humans but may
not yet be fully transmissible (substantial pandemic risk).

Phase 6 Pandemic: increased and sustained transmission in general population.

Because of these differences and the expected size of an influenza pandemic, it is important to complete planning and preparedness activities in order to respond promptly and
adequately. The Pandemic Influenza Preparedness and Response Plan should be read and understood prior to influenza pandemic. It is a dynamic plan that will be updated to
reflect new developments in the understanding of the pandemic influenza virus, its spread, treatment, and prevention. The plan will also incorporate changes in response roles and
improvements in response capability development through ongoing planning efforts.

MADISON COUNTY HEALTH DEPARTMENT BASIC PLAN

I. PURPOSE

The Madison County Health Department’s Pandemic Influenza Plan has been developed to assist the local health department in protecting the health
and safety of its citizens should there be a pandemic influenza outbreak. The plan describes the incident management activities, concepts and
structure under which the local health department (LHD) will operate during a pandemic influenza outbreak and the roles and responsibilities and
activities that apply to command and control staff. Other goals and objectives of this plan include:

To define preparedness activities that should be undertaken before a pandemic that will enhance the effectiveness of the local pandemic
response.

To describe state coordination and collaboration with the local health departments during the response.

To describe interventions that should be implemented as components of an effective influenza pandemic response.

II. PLANNING ASSUMPTIONS AND CONSIDERATIONS

Certain conditions must be present for a pandemic to exist. These include:

A susceptible population with little or no immunity,

A virus transmitted efficiently from person-to-person, and
A virulent virus with the capacity to cause serious illness and death.

Command and Control Assumptions

In the event of a pandemic influenza, Madison County Health Department could receive state and/or federal assistance. These agencies have
additional manpower and sophisticated systems to detect and monitor events. It would not take a very large event to tax the local public health system
requiring assistance from outside sources.

All agencies involved are operating under or encouraged to understand the Incident Command System which follows the principles contained in the
National Incident Management System (NIMS).

Local government officials have first line of responsibility for emergency planning and response in their jurisdiction per the County Emergency
Operation Plan (EOP).

Many elements of local, state, federal, private and non-profit agencies are integrated into a coherent response plan; involvement is dependent upon
nature and severity of the event.

Local Government and Health Care System

Influenza pandemic will place a substantial burden on inpatient and outpatient health care services. Due to the infectious nature of this
outbreak, illness and absenteeism among health care workers may increase, creating a further strain on the ability to provide quality care.
In addition to a limited number of hospital beds and staff shortages, equipment and supplies may be in short supply.
Not all ill persons will require hospital care but many may need other support services such as home health care, delivery of prescription drugs,
and meals.
 Various public services may be disrupted due to a decline in staffing capabilities over the course of a pandemic from increasing numbers of ill
persons.
Local planning is needed to address the delivery of essential health care and community services.

Vaccine and Antiviral Supply Levels and Availability Assumptions

When a pandemic first strikes, vaccine will likely not be available for distribution. Vaccine may need to be targeted to priority groups that will be
defined based upon guidance from the State. Factors may include: the risk of occupational infection/transmission (e.g. health care workers); the
responsibilities of certain occupations in providing essential public health safety services; impact of the circulating pandemic virus on various
age groups; and heightened risks for persons with specific conditions.
Antiviral drug therapy and preventive use in those not infected (prophylaxis), quality medical care, and interventions to decrease exposure
and/or transmission of infection will be important approaches to decrease the disease burden and potentially the spread of the pandemic until
vaccine becomes available.
Antivirals will likely be distributed to local health departments (LHD) via a public means (utilizing the Strategic National Stockpile (SNS)
mechanism). Vaccine distribution may follow a public (SNS mechanism) or private means, such as distributing vaccines to be stored in private
facilities, such as meat packaging plants, etc., to be distributed to the LHDs later.
Developing guidelines and educating physicians, nurses, and other health care workers before and during the pandemic will be important to
promote effective use of these agents in the private sector.
Guidance on the priority groups is expected from the state and the CDC.

Infection Control and Disease Containment Assumptions

Infection control in hospitals and long-term care facilities prevents the spread of infection among high-risk populations and health care workers.
If a novel influenza strain causes outbreaks in other countries or in the U.S., measures such as educating the public on disease transmission
and how to minimize transmission risk, screening travelers from affected areas, limiting public gatherings, closing schools, and isolation and/or
quarantine of infected/exposed persons could slow the spread of the disease.
Decisions regarding use of these measures will be made at the local level with State guidance and based upon their effectiveness and the
epidemiology of the pandemic.

Emergency and Risk Communication Assumptions

Informing health care providers and the public about influenza disease and the course of the pandemic, the ability to treat mild illness at home,
the availability and distribution of vaccine and/or antivirals, and priority groups for earlier vaccination will be important to ensure appropriate use
of medical resources and to avoid possible panic or overwhelming of vaccine delivery sites.
Effective communication with community leaders and the media also is important to maintain public awareness, avoid social disruption, and
provide information on evolving pandemic response activities.

III. CONCEPT OF OPERATIONS

A. General Information

1. It is the responsibility of the local health department to provide for a local public health emergency. When the local public
health emergency exceeds the ability of the local health department, the MADISON County Health Department will coordinate
with the Illinois Department of Public Health via their local EMA and through the State Emergency Operations Center (SEOC) to
address the needs of the community.

2. Staff and any group included in the plan will be briefed on the entire plan. Training will be provided to staff and others to
assist them in their emergency response responsibilities.
 3. The ability to maintain day to day operations will be dependent on the size and scope of the incident. It will not take very
much to exceed the local capabilities and state assistance will be requested via the EOC. The public health administrator or
his/her designee will be responsible to assess which operations are not critical to the immediate health and safety of the
community and temporarily suspend them as needed to provide the most critical services.

4. The LHD will operate out of a command center at the LHD or at the County Emergency Operations Center dependent on
the situation at the time and the length of time the incident remains acute.

B. Preparedness

The Madison County Health Department is responsible for community-wide influenza preparedness activities in the county jurisdiction.
Specific activities of LHD staff include:

Promotion of vaccinations to prevent diseases

Distribution of vaccine to public and private providers
Surveillance/outbreak control of preventable adult and childhood diseases
Outbreak investigation
Provision of educational and motivational resources through community partnerships
Assessment of vaccine coverage levels
Quality assurance reviews of federally purchased vaccine

Multiple stakeholders have important roles in pandemic influenza preparedness and response. Local stakeholders include public service
agencies, public health organizations, and laboratories; private health care organizations; elected officials; first responders; emergency
management; and appropriate non-governmental and private sector organizations.

The County Health Department and county Emergency Management Agency (EMA) will establish a multi-jurisdictional, multi-agency committee
responsible for developing recommendations for improving pandemic influenza preparedness and response in the County. The purpose of the
group is:

To bring together representatives of groups that are likely to be adversely affected by an influenza pandemic, and/or which, due to legal
responsibilities, the fulfillment of their respective missions, or the reasonable expectations of the public, are obligated to take part in preparation
for and response to such an event.
To foster open discussion among these representatives in an effort to address difficult and as-yet unresolved issues; develop clear, feasible,
and consensus-based recommendations on these issues whenever possible; and, deliver such recommendations to the Administrator of
Madison County Health Department for consideration.
To provide a forum for the LHD and the local EMA to update group members on the steps that state and local government is taking to prepare
for a flu pandemic.
To provide the LHD and the local EMA, as well as other local government and non-governmental entities, with insight into the needs and
capabilities of stakeholder groups throughout the county, thereby, eliminating or reducing disparities in the delivery of critical services during a
pandemic.
Planning efforts will not only include the development of the Pandemic Influenza Committee but reports will be made to the Madison County
Disaster Committee and the LEPC.

Sample Planning Guide

Performance Responsible Target

Activity
Measure Agency Completion Date
Establish a Pandemic
Influenza Preparedness
Coordinating Committee
to oversee preparedness
planning that represents all
relevant stakeholders in
the jurisdiction, including,
at minimum:

-Governmental

-Public health
-Healthcare agencies
-Emergency response
-Agriculture
MADISON County
Specified designee
Health Department
from each of the sectors Sept 2006
and MADISON
to sit on the Committee
County EMA

-Education

-Business

-Communication

-Community-based sector

-Faith-based sector

-Private citizens
Development:
Utilize the Committee to Committee designees
Listing of
delineate accountability
responsibilities, etc.
and responsibility, October 2006
included in an Executive
capabilities, and resources Approval: MADISON
Summary.
of key stakeholders County Chief Elected
Official
MADISON County
Health Department January 2007
Neighboring and MADISON
jurisdictions are County EMA
included in the planning
process

Various agreements MADISON County

Integrate response plans addressing Health Department
communication, mutual January 2007
across jurisdictions and and MADISON
with overall state and local aid, and other needs County EMA
response plans are developed

The Pandemic
Influenza
Preparedness and
Response Plan is MADISON County
NIMS-compliant Health Department
and MADISON January 2007
County EMA
Ensure demographic
Special Needs MADISON County
profile and planning
component to plan is Health Department March 2007
incorporates special
developed and Human Services
needs populations
Psychosocial Support
Address psychosocial MADISON County
Service Needs
support service needs of Health Department March 2007
component to plan
community in plan and Human Services
developed
 MADISON County
EMA
Channels of March 2007
communication
identified

Network of
Address communication MADISON County
communication
resources and needs in EMA March 2007
personnel established
plan

Identify legal authorities to reviewed and
review state and local
statutory provisions and
various response elements
Designated lead
spokespersons trained
in emergency risk
communication MADISON County March 2007
Health Department
and EMA
Ordinances and laws
that provide authority
and pertaining to
closure of schools and
businesses,
suspending public
meetings; healthcare MADISON County
and volunteer licensure, Legal Designee March 2007
liability, and
compensation;
quarantine and
isolation; and
reimbursement for
workers placed in MADISON County
isolation or quarantine Legal Designee March 2007
referenced in plan

Authority responsible
for declaring a public
health emergency and
activating the local plan MADISON County
identified EMA
March 2007

Local law enforcement

personnel responsible
for maintaining public
order and implementing
control measures
identified and educated
Public health Incident
Create and exercise a
Command System for MADISON County
NIMS-based Incident
Pandemic Influenza Health Department July 2006
Command System for the
established and and EMA
Pandemic Plan
exercised
Conduct jurisdiction-level
MADISON County
Pandemic Flu Tabletop
Tabletop conducted Health Department July 2006
exercises to test response
and EMA
capabilities.

C. Response

1. Command, Control, and Management Procedures

Phases 1 & 2 – Inter­pandemic phase

a. Conduct meetings of your local Pandemic Influenza planning

Committee

b. Regularly review the local operational capacity for each priority

c. Revise the Pandemic Influenza Preparedness and Response Plan

on an annual basis

d. Revise lists, including contact information of partners,

resources, and facilities

e. Conduct conference calls with bordering counties to coordinate pandemic influenza preparedness activities

f. Review, exercise, and modify the plan as needed on a periodic basis

g. Recruit and train volunteers to supplement health department staff.

Phase 3 – Novel influenza virus identified; no human­to­human spread

a. Conduct meetings of your local Pandemic Influenza planning

committee

b. Modify the plan as needed on an urgent basis

c. Coordinate with the State, federal agencies, and bordering

jurisdictions

e. Document expenses of pandemic response

Phases 4 & 5 – Some level of human­to­human transmission confirmed but not widespread

a. Convene the local Pandemic Influenza Planning committee and

meet with partners and stakeholders to review the plan

b. Activate enhanced surveillance and communications procedures

c. Prepare the clinic sites for vaccine and antiviral distribution however supply will be limited thus could most likely be handled
with current staff and building. MOUs exist for other sites if needed.

d. Notify key government officials of the need for additional

monetary resources (if not already available)

e. Activate enhanced plans for operational priorities

f. Arrange for appropriate facilities use

g. Document expenses for pandemic response

Phase 6 – Confirmation of onset of a pandemic

a. Activate the county Emergency Operation Center (EOC) and

meet with partners and stakeholders and review and fully

activate plan

b. Monitor staffing needs

c. Coordinate activities with neighboring jurisdictions

 d. Interface with appropriate counterparts at the State level

e. Document expenses of the pandemic response

2. Surveillance System and Laboratory Analysis

Phases 1 & 2 – Inter­pandemic phase

Phase 3 – Novel Influenza virus identified; no human­to­human spread

Phases 4 & 5 – Some level of human­to­human transmission confirmed but not widespread

Phase 6 – Confirmation of onset of a pandemic

3. Vaccine Delivery and Targeted High-Risk Populations

Use existing SNS Plan

4. Antiviral Prophylaxis and Drug Distribution

Use existing SNS Plan

5. Emergency and Risk Communications

Use public Information Plan

6. Emergency Response Plans and Procedures

See Madison Emergency Operations Plan

7. Interruption of Disease Transmission/Increasing Social Distance

Research has indicated that social distancing is the preferred method to slow the spread of the disease. That means
suspending public gatherings, encouraging people to work from home, etc.

The health department will be taking into their consideration whatever advice is given from IDPH and/or the Center of Disease
Control, also consider is the epidemiology of the pandemic, before a decision will be made. Quarantine and Isolation will be
considered as well.

8. Public and Private Sector Collaboration

Collaborations with these sectors will be ongoing as the situation demands.

 D. Recovery

Recovery is the development, coordination, and execution of service- and site-restoration plans and the reconstitution of local
operations and services through individual, private-sector, nongovernmental, and public assistance programs. Recovery involves
actions needed to help individuals and communities return to normal when feasible.

This section will be expanded on as more guidance is given and planning evolves.

For Surveillance and Detection Portion of this plan see – Epi Plan

ANTIVIRAL AND VACCINE PURCHASE AND DISTRIBUTION

I. Purpose

The purpose of the Antiviral and Vaccine Purchase and Distribution is to outline a plan to distribute and dispense antiviral prophylaxis and
therapy and vaccine during an influenza pandemic. The primary goals of antiviral and vaccine use and therapy would be to decrease adverse
health impact (morbidity and mortality), maintain a functioning healthcare system, and reduce social and economic disruption, supporting
overall pandemic response goals.

II. Strategies for Antiviral Drug Use

IDPH guidelines on antiviral drug use will be provided at a later date.

III. Pandemic Vaccine Supply

Detail what your LHD’s plan is for vaccine use:   1) if there is no vaccine available and 2) if there is an adequate supply of vaccine.

IV. Pandemic Vaccine Priorities

IDPH guidelines on vaccine priorities will be provided at a later date.

 RESTRICTION OF MOVEMENT OR ACTIVITIES TO CONTROL DISEASE SPREAD

I. Purpose

To establish a capability to implement isolation and quarantine orders or conduct other activities to control disease spread in the event of a
dangerous infectious disease outbreak.

II. Definition of Key Terms

Isolation: Isolation is the separation of a person or a group of persons infected or believed to be infected with a contagious disease to prevent
the spread of infection. Ill persons are usually isolated in a hospital, but they may be isolated at home or in a designated community-based
facility, depending on their medical needs.

Quarantine: Quarantine is the separation and restriction of movement or activities of persons who are not ill but who are believed to have been
exposed to infection, for the purpose of preventing transmission of diseases.

III. Concept of Operation

A. The restriction of movement and/or activities involves the ability of state and local jurisdictions to be prepared legally, procedurally, and
materially to contain and monitor: exposed individuals or those suspected of being exposed (term: quarantine); infected individuals (term:
isolation); defined groups or locations, such as individual schools, workplaces, malls, and public transit systems, as determined on a case by
case basis (term: focused measures to increase social distance); and entire communities, ranging from voluntary widespread cancellation of
most activities (term: snow days), eliminating large gatherings of people such as sporting events, shutting down other places where people
congregate such as schools and places of employment, or enforced restriction of movement into and out of defined areas.

B. Planning considerations for implementing such approaches include developing legal statutory authorities, procedural protocols, and
logistical/material provisions for carrying out such orders. Section D includes local legal authorities that allow for the execution of movement
restriction orders.

Procedural protocols include the means by which these legal authorities will be observed and applied, such as drafts of written orders,
notices, letters, etc., protocols for working among various neighboring jurisdictions (MOUs), procedures for providing the medical care,
food needs, and other services for those affected by movement restriction measures. Procedural protocols should also include pre-
scripted messages explaining the criteria, purpose, justification, methods, and expected duration of all movement restriction methods
listed in the plan. These procedural protocols are detailed in section E.

The logistical/material provisions for applying movement restriction include the physical supply that will be used to support, service, and
monitor those affected by these containment measures in healthcare facilities, other residential facilities, homes, community facilities, and
other settings. These logistical/material provisions are detailed in section F.

C. The following state legal authorities exist for taking containment and monitoring action:
i. Track and contain disease through case investigation and implementation of control measures. Section 2 of the Illinois
Department of Public Health Act (20 ILCS 2305/2 (West 2002)) provides that IDPH is required to investigate the causes of and take
means to restrict and suppress dangerously contagious or infectious diseases, especially when existing in epidemic form. (20 ILCS
2305/2(a) (West 2002).)

ii. Gain access to and utilize facilities and property. Upon the declaration of a disaster pursuant to section 7 of the IEMA Act (20 ILCS
3305/7 (West 2002)), the Governor may exercise, among other things, the following emergency powers: recommend the evacuation of all
 or part of the population from any stricken or threatened area within the State if the Governor deems this action necessary (20 ILCS
3305/7(a)(6) (West 2002)); prescribe routes, modes of transportation, and destinations in connection with evacuation (20 ILCS 3305/7(a)
(7) (West 2002)); and control ingress and egress to and from a disaster area, the movement of persons within the area, and the
occupancy of premises therein (20 ILCS 3305/7(a)(8) (West 2002)).

iii. Appropriate private property for public use. Upon the declaration of a disaster pursuant to section 7 of the IEMA Act (20 ILCS
3305/7 (West 2002)), the Governor may, on behalf of the State take possession of, and to acquire full title or a lesser specified interest in,
any personal property as may be necessary to accomplish the objectives set forth in section 2 of the Act, including: airplanes,
automobiles, trucks, trailers, buses, and other vehicles; coal, oils, gasoline, and other fuels and means of propulsion; explosives,
materials, equipment, and supplies; animals and livestock; feed and seed; food and provisions for humans and animals; clothing and
bedding; and medicines and medical and surgical supplies; and to take possession of and for a limited period of time occupy and use
any real estate necessary to accomplish those objectives; but only upon the undertaking by the State to pay just compensation as
provided in the Act. (20 ILCS 3305/7(a)(4) (West 2002).) Subsection 7(a)(4) sets forth a procedure for providing for just compensation.

Additionally, IDPH is authorized to order a person to be quarantined or isolated or a place to be closed and made off limits to the public to
prevent the probable spread of a dangerously contagious or infectious disease until such time as the condition may be corrected or the
danger to the public health eliminated or reduced in such a manner that no substantial danger to the public’s health any longer exists.  (20
ILCS 2305/2(b) (West 2002).)

iv. Impose isolation and quarantine. IDPH has supreme authority in matters of quarantine, and may declare and enforce quarantine when
none exists, and may modify or relax quarantine when it has been established. (20 ILCS 2305/2 (West 2002).) IDPH can issue
immediate orders, without prior consent or court order, for isolation, quarantine and closure of facilities when necessary to protect the
public from a dangerously contagious or infectious disease. Within 48 hours, IDPH must gain consent of the person or owner of the place
or request a court order.

IDPH is authorized to order a person to be quarantined or isolated or a place to be closed and made off limits to the public to prevent the
probable spread of a dangerously contagious or infectious disease until such time as the condition may be corrected or the danger to the
public health eliminated or reduced in such a manner that no substantial danger to the public’s health any longer exists.  (20 ILCS
2305/2(b) (West 2002).) No person may be ordered to be quarantined or isolated and no place may be ordered to be closed and made
off limits to the public, however, except with the consent of the person or the owner of the place or upon the order of a court of competent
jurisdiction. (20 ILCS 2305/2(c) (West 2002).) In order to obtain a court order, IDPH must prove, by clear and convincing evidence, that
the public’s health and welfare are significantly endangered and that all other reasonable means of correcting the problem have been
exhausted and no less restrictive alternative exists. (20 ILCS 2305/2(c) (West 2002).)

As previously noted, with regard to local public health agencies, the authority to control communicable diseases is stated broadly in their
respective enabling statutes. (See 55 ILCS 5/5-20001 et seq.; 55 ILCS 5/5-25001 et seq.; 65 ILCS 5/11-20-5; 65 ILCS 5/11-16-1; 65
ILCS 5/11-17-1 et seq.; 70 ILCS 905/0.01 et seq. (West 2002).) The following statutes specifically reference quarantine at the local level:
65 ILCS 5/7-4-1; 55 ILCS 5/5-20001 (West 2002)).

v. Use other means to restrict movement or activities. Upon the declaration of a disaster pursuant to section 7 of the IEMA Act (20 ILCS
3305/7 (West 2002)), the Governor may, among other things: recommend the evacuation of all or part of the population from any stricken or
threatened area within the State if the Governor deems this action necessary (20 ILCS 3305/7(a)(6) (West 2002)); prescribe routes, modes of
transportation, and destinations in connection with evacuation (20 ILCS 3305/7(a)(7) (West 2002)); and control ingress and egress to and from
a disaster area, the movement of persons within the area, and the occupancy of premises therein. (20 ILCS 3305/7(a)(8) (West 2002)).

D. The following local legal authorities exist for imposing containment and monitoring measures:
i. With regard to local public health agencies, the authority to control communicable diseases is stated broadly in their respective enabling
statutes. (See 55 ILCS 5/5-20001 et seq.; 55 ILCS 5/5-25001 et seq.; 65 ILCS 5/11-20-5; 65 ILCS 5/11-16-1; 65 ILCS 5/11-17-1 et
seq.; 70 ILCS 905/0.01 et seq. (West 2002).). Please work with your partners to establish and/or refine further legislation as necessary.

E. The following procedures have been prepared to provide for the execution of the legal authority to restrict movement:
IDPH guidelines with respect to various public movement restriction will be provided at a later date

F. The following logistical/material provisions to support the procedures involved in restricting movement have been identified (IDPH guidelines
with respect to the following will be provided at a later date):

i. Isolation and Quarantine Facilities (Planning Cmte to Consider)

 Point of
Name of facility Location 24/7 Number
Contact

ii. Sources for food and other basic necessities: Local Grocery Stores

iii. Sources for medical supplies: Same as used to run clinics, health department admin can assist

iv. Sources for protective equipment and communications equipment for use by those quarantined and those enforcing the quarantine: To be
determined
v. Sources for case and contact management tools, communication strategies, logistical elements, and the determination of thresholds for
implementation of different containment measures. See the appendices

G. Note: the above does not go into detail for other types of activities indicated to control disease spread, such as some of the techniques listed
in III. A, including eliminating the gathering of large groups, voluntary quarantine (snow days), or quarantining affected locations. IDPH will
provide further guidance for this information at a later date.

PUBLIC INFORMATION

(The first step in effective risk communications preparedness is to conduct an assessment of communications strengths and
challenges.)

I. Purpose

To provide timely, accurate, consistent and appropriate information to the general public, news media, health care providers and other key
partners during a pandemic influenza outbreak. Effective emergency and risk communications is essential to supporting the public health
response and to help build public trust, confidence and cooperation.

II. Organization and Responsibilities

A. The Public Information Officer(s) for the health department are:

Primary PIO:

Secondary PIO:

Tertiary PIO:
 The PIO's have attended the following training(s) on risk communications:

Date: Various Training: See the Learning Management System thus this information is available on request but all have gone
through training on Crisis Communication and General Media training.

B. Radio and television stations, websites, computer aided dispatch, indoor/outdoor warning systems, Emergency Alert System,
cable interrupt, etc. will be utilized by the local health department to disseminate information to the public. A list of these resources,
including contact information, is included as an appendix of the All Hazard Plan.

C. The special needs populations within the county needs to be addressed at the state level. In the event of any form of public health
emergency that exceeds day to day operations a request to the state will be made to handle the special needs population for the health
department and its volunteer system can not handle that. We can handle language issues with our contracted translation service.

D. If an influenza pandemic begins in the United States or another country, the following public health communications will take
place:

Coordination of emergency communications with private industry, education and nonprofit partners (e.g. Red Cross)

Media briefings will be conducted as necessary at the county emergency operation center or at the health department.

Tailor communications services and key messages to specific local audiences-see Public Information Annex that is current being developed by
a PIO working group.

Use the information from the daily tracking on numbers and locations of newly hospitalized cases, newly quarantined persons and hospitals with
pandemic influenza to determine priorities among community outreach and education efforts. The information will also be used to prepare for
updates to media organizations in coordination with state and federal partners.

E. Public information messages for pandemic alert and pandemic periods are in Attachment X. (Messages should include
working with mental health experts to assess the effect of message content on public anxiety, anticipate other possible stressful
situations, and plan appropriate countermeasures). PIO planning group still is working on.

FATALITY MANAGEMENT

I. Purpose
 A mass fatalities incident is any situation in which there are more fatalities than can be handled in a timely and professional fashion using
regularly available local resources to address a single incident or multiple incidents.

II. Organization and Responsibilities

A. The local health department will work with the county to assist with management of mass fatalities during and after a pandemic
influenza outbreak as able and applicable but the coroner will retain responsibility. See County Emergency Operation Plan-Fatality
Management Annex.

Initially, in the event of an influenza outbreak, the responsibility of fatality management will reside at the local level. Planning and
response may require the participation and cooperation of local agencies, such as, but not limited to the following groups, who have
been identified and included in the planning process:

a. County coroners
b. Municipal officials
c. Emergency Management Agencies
d. Fire departments
e. Emergency Medical Services
f. Rescue Services
g. Hospitals
h. Municipal, county and state law enforcement agencies

i) Ancillary volunteer agencies (i.e. American Red Cross)

B. The local health department will provide precautionary information to the public who may be handling a deceased person in their
home.

C. See Appendix X for a listing of medical examiners, coroners, morticians, and funeral homes within the county. (TO
DO)

E. The following are who are responsible for tracking the deceased:
In a disaster situation, identification of the dead is a critical issue. The ultimate responsibility for the collection, identification, storage and
release of deceased victims will lie with the coroner (or medical examiner), as per the regulations and rules of the state of Illinois.

Background information on once capacity is exceeded:

Once local capabilities are exceeded, the State of Illinois will assist local government in securing resources and assist with the
establishment of temporary morgues.

A temporary morgue should be established after determining that the expected number of cases will exceed the capacity of normal
operations. Upon assessment by IEMA and with consultation with D-MORT will determine the possible need for a temporary morgue, a
recommendation will be made to the coroner or medical examiner to seek approval for receiving federal assistance in the identification
and mortuary service effort, including site location for a temporary morgue.

The temporary morgue should be located close to the area where large numbers of deceased are located and should have:

a. Showers
b. Hot and cold water
c. Heat or air conditioning (depending on climate)
d. Electricity - adequate outlets for computers, faxes, printers, etc.
e. Floor drainage
f. Ventilation
g. Restrooms
 h. Parking areas
i. Communication capabilities
j. Rest areas

The morgue site should be guarded during use and fenced in or locked for security of remains and personal property. It should be
removed from public view, not be a school or other sites of local potential for long-term sensitivity and have sufficient space for body
identification procedures. It should also be capable of being partitioned for separation of functions such as body handling, property
inspection, X-ray, autopsy, records maintenance, interviewing, etc. Access to multiple telephones is a vital consideration for permitting
temporary morgue personnel to acquire victim information.

Potential temporary morgue sites can be in existing mortuaries, hangers, large garages, National Guard armories or other areas
without wooden floors. After a morgue site is established, coordinators should obtain refrigerated trailers, as necessary. The trailers
can be moved to whatever location is directed by the coroner. If refrigerated trailers are not available, the coroner should arrange for
railroad refrigeration cars, vans or other cold storage to aid in the preservation of bodies. The functions carried out at each morgue site
will be determined by the circumstance. (In the planning process, it should be understood whether the coroner or the county is
responsible to obtain this type of equipment.) Careful consideration should be given to the selection of a morgue site. The quality of
the facility is more important than having it located in close proximity to the incident site.

Consideration should be given to assigning a person to each body or body part. This person will become the tracker for that body,
accompanying the body through the identification process and being accountable for all appropriate paperwork. This technique has
been successfully used in several recent mass fatality incidents. However, exceptional care should be exercised in selecting those to
perform this task. Relatively few people have been exposed to dramatically mutilated bodies (e.g., at an airplane crash) and many will
be unable to handle the psychological aspect of the problem. Funeral directors who have expertise in handling family members or
others who would not be overly stressed by this task should be considered. No one person should have a prolonged assignment at this
task.

INFECTION CONTROL AND PERSONAL PROTECTIVE EQUIPMENT (PPE)

I. Purpose

To provide guidance on infection control measures (e.g., isolation precautions, PPE) to be implemented in order to limit the spread of
pandemic influenza. The infection control guidance is based on current knowledge of routes of influenza transmission. Given some
uncertainty about the characteristics of a new pandemic strain, all aspects of preparedness planning for pandemic influenza
must allow for flexibility. Any new guidance from CDC and IDPH will be implemented as needed.

II. Organization and Responsibilities

A. Respiratory hygiene/cough etiquette program will include:

Education of staff and clients on the importance of containing respiratory secretions to help prevent the transmission of influenza and other
respiratory viruses
Post signs in languages appropriate to the populations served with instructions to immediately report symptoms of a respiratory infection
Implement source control measures such as covering the mouth/nose with a tissue when coughing. During periods of increased respiratory
infection in the community, persons who are coughing will be offered a surgical mask to contain respiratory secretions.
Promote hand hygiene after contact with respiratory secretions
Coughing persons will be encouraged to sit as far away as possible (at least 3 feet) from others in common waiting areas.

B. Personal Protective equipment (PPE) will be used to prevent direct contact with the pandemic influenza virus. PPE for standard
and droplet precautions for healthcare personnel will be followed in clinics treating the ill and for those investigating cases related to the
ill. Investigations may need to be done by phone and hospital records.
 C. Hand Hygiene program will be promoted to staff and the public to include:
If hands are visibly soiled or contaminated with respiratory secretions, wash hands with soap (either non-antimicrobial or antimicrobial)
and water.
In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain
soap and water because of their superior microbicidal activity, reduced drying of the skin and convenience.

D. Recommendations for infection control for hospitals, nursing homes, prehospital care, outpatient medical offices, care of pandemic influenza
patients in the home and alternative sites is in Attachment A.

Non-Pharmaceutical Interventions for Influenza

Purpose:

The purpose of non-pharmaceutical intervention is to accomplish the following:

delay a rapid increase in cases and buy time for the implementation of possible medical interventions that address the multiple consequences
of a communicable outbreak such as influenza.
decrease the number of cases at any one time to ovoid overtaxing public health.
reduce the total number of cases thus reducing morbidity and mortality in the community,

Methods:

A. Respiratory Hygiene/Cough Etiquette in Healthcare Settings

To prevent the transmission of all respiratory infections in healthcare settings, including influenza, the following infection control measures should be
implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as one
component of Standard Precautions.

1. Visual Alerts

Post visual alerts (in appropriate languages) at the entrance to outpatient facilities (e.g., emergency departments, physician offices, outpatient clinics)
instructing patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of symptoms of a respiratory infection
when they first register for care and to practice Respiratory Hygiene/Cough Etiquette.

Notice to Patients to Report Flu Symptoms [76 KB, 1 page]

Emphasizes covering coughs and sneezes and the cleaning of hands
Cover Your Cough
Tips to prevent the spread of germs from coughing
Information about Personal Protective Equipment
Demonstrates the sequences for donning and removing personal protective equipment

2. Respiratory Hygiene/Cough Etiquette

The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.

Cover your mouth and nose with a tissue when coughing or sneezing;
Use in the nearest waste receptacle to dispose of the tissue after use;
Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after having
contact with respiratory secretions and contaminated objects/materials.

Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and
visitors.

Provide tissues and no-touch receptacles for used tissue disposal.

Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e.,
soap, disposable towels) are consistently available.

3. Masking and Separation of Persons with Respiratory Symptoms

During periods of increased respiratory infection activity in the community (e.g., when there is increased absenteeism in schools and work settings
and increased medical office visits by persons complaining of respiratory illness), offer masks to persons who are coughing. Either procedure masks
(i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not
necessary for this purpose). When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in
common waiting areas. Some facilities may find it logistically easier to institute this recommendation year-round.

4. Droplet Precautions

Advise healthcare personnel to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard
Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be
maintained until it is determined that the cause of symptoms is not an infectious agent that requires Droplet Precautions.
NOTE: These recommendations are based on the Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Recommendations of the
Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC.

B. Human surveillance and case reporting:

See Madison Epidemiological Plan

C. Rapid viral or bacterial diagnosis:

Provider and patient of masks and other personnel protective equipment:

Isolation of the sick:

Voluntary home isolation of contacts of confirmed cases:

Volunteer Social Distancing: