How to Manage the Risk?

Preventing a pandemic respiratory virus from establishing itself within the City is impossible. Actions will prioritize limiting the impact and slowing the spread of disease. The City will work with the healthcare system, state and federal partners, including the CDC, and private and non-profit sectors to manage the response and lessen its impact on New York City.

While the occurrence of a pandemic may be unpredictable, well-understood strategies can be employed to manage its risks. The City, including the Department Of Health and Mental Hygiene (DOHMH), relies on protocols, communications tools, public education efforts, and the promotion of community mitigation efforts in order to reduce and lessen the potential impacts from a pandemic.

Goals of community mitigation for pandemic influenza

Disease Surveillance and Epidemiology

DOHMH will assess epidemiological, clinical, and behavioral characteristics of the pandemic strain and recommend containment measures to limit the spread of the disease while minimizing social disruption and cost.

DOHMH has a state-of-the-art 24/7 system for monitoring disease patterns. The syndromic surveillance system involves routinely monitoring emergency room visits, ambulance calls, and pharmacy sales to detect early warning signs of a possible outbreak.

In the event of a pandemic, DOHMH will increase surveillance activities and monitor illness within the City to detect further pandemic waves and guide clinical and public health decisions about how to best use limited medical resources.

Social Distancing as a Selectively Applied Containment Strategy

In the early stages of an influenza pandemic, before a vaccine is available (usually 4 to 6 months but possibly longer), community measures are essential to limiting the spread of disease. As droplets can reach from 3 to 6 feet after they are expelled into the environment by a cough or sneeze, increasing the spacing between individuals can reduce exposure.

New York City’s dense concentration of living and working space and its heavy dependence on public transportation make social distancing particularly challenging. Closing schools and canceling public events during a severe pandemic can have far reaching social and economic impacts on New Yorkers. These closures will only be recommended if the benefits are considered greater than the impacts.

Mobilizing Resources for a Multi-Pronged Response

During a pandemic, healthcare facilities will face a massive increase in patients seeking care. Planning for this demand focuses on developing surge capacity in acute critical care facilities and on further strengthening communication between DOHMH and healthcare providers. DOHMH will work with the New York State Department of Health to monitor and address staffing, supply, and resource needs.

Ensuring Access to Medication

Before a vaccine is available, antiviral medications can be prescribed by a doctor within 48 hours of the appearance of symptoms to shorten the time a person is ill. When the pharmaceutical supply chain is strained by high national demand, DOHMH will work with  hospitals, clinics, nursing homes, and other healthcare facilities to ensure medication is available across the City.

Meanwhile, officials at the Centers for Disease Control and Prevention (CDC) will work with research partners as well as state and local health authorities to produce a vaccine for the virus that is causing a pandemic. Once a vaccine becomes available, the City will work to promote vaccination and open temporary vaccination sites if needed.

Risk Communication

Communicating clear accurate information to the public throughout an influenza outbreak is critical to limiting exposure. The City prepares for pandemic influenza by testing communication protocols, developing communication tools, training agency staff, and coordinating with agency stakeholders and community groups to build strong partnerships. In the event of an influenza pandemic, the government at the federal, state, and local levels will issue prompt alerts. As the outbreak progresses the City will keep the public informed using television, radio, websites, and social media platforms.

Promoting Workplace Controls

Respiratory viruses can easily spread in the workplace. Both employers and employees can exercise environmental controls to limit its spread. Employers can:

  • Maintain standard workplace cleaning routines.
  • Encourage employees to stay home if they are sick and to not return to work until they have been fever-free for 24 hours without the use of fever-reducing medications.
  • Ensure access to hand-washing facilities or to alcohol-based hand sanitizer if soap and water are not available.
  • Promote vaccination.
  • Promote respiratory etiquette, which includes encouraging covering coughs and sneezes, keeping hands clean and away from your face, and discouraging hand shaking.

The City created an Influenza Citywide Health and Safety Program aimed at reducing the occupational exposure of non-medical City employees. It is designed to help City agencies develop their own agency-specific plans for limiting the spread of viruses. The program includes a Job Risk Assessment that entails careful examination of a workplace and the tasks each worker performs. The objective is to identify workplace hazards and determine whether existing precautions are sufficient, or if further controls should be put in place.

The approach can be adapted to differing agency conditions and can be used for multiple-scale influenza scenarios. The City’s Awareness Level Training program helps City agencies promote staff awareness through employee training that covers influenza health effects, modes of transmission, preventative measures, and job risk assessments. Control measures include safe work practices, administrative controls, engineering controls, and the use of personal protective equipment.

To learn more about pandemics see https://www.cdc.gov/flu/pandemic-resources/index.htm

Link: Respiratory Virus with Pandemic Potential – Bibliography