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Ref: Episcopal Church releases flu pandemic response and preparedness plan

Episcopal Church

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Planning for a pandemic: Resources for the Church in case of Avian flu



Friday, February 16, 2007
[Episcopal News Service] Editor's note: The Rev. Phillip Cato, a retired priest long associated with the National Institutes of Health and National Institute of Child Health and Development, last year took up the task of pandemic preparedness. Cato, of Potomac, Maryland, wanted the Episcopal Church to have a plan in place in case of an Avian Flu pandemic.
From his own parish, St. John's in Olney, Maryland, he gathered Jay Lozier, MD, PhD, an epidemiologist/hematologist; Anne Dolbier, a professional in disaster planning with a master's degree in public health; and Dawn Hohl, a registered nurse at Johns Hopkins who is in charge of care for discharged patients. Together they prepared a comprehensive plan for use by parishes and dioceses, as well as individual families.

"Pandemic Influenza Planning," a 28-page report including a PowerPoint presentation and a list of resources and appendices, is available from Cato (phillipcato@yahoo.com) or Richard Olsen, disaster planner with Episcopal Relief and Development (rohlsen@episcopalchurch.org).

What follows are excerpts from the pandemic planning report and a partial list of additional resources.

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Until recently, the world had not heard of Jones Ginting. Ginting, a father of two young boys, lives with his wife and extended family in a tiny Indonesian village on the island of Sumatra. The family enjoys a close-knit existence – working, living, and playing together. They share another commonality – a tragic bout with the H5N1 virus, commonly known as "bird flu," an episode that has garnered international attention.

Ginting's story was reported in a news article last summer, and is just the sort of incident to spark concern within the global public health community. Eight members of Ginting's family were infected with H5N1; seven perished. Ginting was the lone survivor of the most significant reported incident to date of documented human-to-human transmission of avian flu. The gravity of this family's experience reverberates worldwide as communities locally and globally grapple with preparing for and mitigating the effects of a bird flu pandemic.

H5N1's inability thus far to transmit effectively from person to person has been the crucial barrier to a global pandemic. However, flu viruses' notorious capacity to easily and quickly mutate has given rise to the notion that the possibility of large-scale devastation reminiscent of the 1918 influenza pandemic is not far-fetched. Against this backdrop, governmental officials and community leaders are working to prepare for the worst, while hoping for the best. As a visible and influential pillar of the community, the church is ethically bound to spearhead avian flu preparation and mitigation efforts at the parish level. Episcopal parishes need a starting point and basic framework from which to initiate bird flu preparedness plans.

Understanding epidemics

An epidemic is the unexpected outbreak of a new infection in people in a limited geographic region (e.g., Maryland, the United States, North America). When an epidemic spreads worldwide, the term to describe it is pandemic.

In the age of widespread air travel, an epidemic in Asia or Europe can be here in hours. Further, migratory fowl (geese, ducks, swans) can carry bird flu from other countries/continents, despite being asymptomatic from the virus.

Efforts are underway to develop a bird flu vaccine . . . however, since the virus mutates rapidly, it is not clear whether this strategy will be successful in the event of an epidemic.

An unusually virulent influenza strain began to be seen in Asia in about 1997 that was designated H5N1. This is the avian influenza strain that has come to be known popularly as "bird flu." This virus can "jump" from birds to man, especially where people live in close proximity to domesticated fowl (e.g., Hong Kong, Vietnam). One feature of the bird-flu strain that is remarkable is that it seems to infect middle-aged people to a greater extent than do other influenza strains. Further, the illness seems to be quite severe.

There is no specific treatment for bird flu. Medical care focuses on symptom management. The measures to be taken to prevent or stop the spread of an epidemic include slaughter of infected or suspect bird flocks, vaccination, quarantine of infected individuals, early treatment of exposed individuals with antiviral drugs, and general quarantine of communities where influenza is present or suspected.

Parish planning

If a pandemic influenza event occurs, it will require an immediate, highly coordinated parish response. The communication plan and chain of command will need to be established and disseminated prior to an outbreak.

It is important to have redundant modes of communication, as phone and email systems may initially be over-taxed in the event of an emergency. Prior to a flu outbreak, a thorough system of communication with each communicant should be established with special consideration given to the needs of homebound parishioners who have limited communication and support systems. In the event of a full pandemic flu, the nation’s infrastructure may be jeopardized. Homebound individuals are at risk of not receiving basic services (e.g., electricity, groceries), and may have particular need for support and communication.

The vestry will need to recruit a cadre of volunteers to perform identified functions for these individuals (e.g., shopping, delivery, and other defined tasks).

The focus of educational efforts should be on open, honest communication with staff and parishioners, emphasizing the importance of preparedness. Education and training activities should be as low-key and reassuring as is practical.

Education should focus on respiratory and hand hygiene, "social distancing" (maintain a three-foot distance from others), signs/symptoms of avian flu, coping strategies, home readiness, end-of-life issues, potential for large-scale loss of life and mass burials.

The community at large should be invited to participate in any available education, with consideration given to possible cultural and linguistic differences. Sample educational materials are included in appendices.

When flu is active within the community, the focus of education must shift to communication of practical issues such as what services are available through the church and community, how to access these services, re-prioritization of resources, how to physically care for flu patients at home and death/dying support.

Families will need their own communication plans and stockpiles of water, non-perishable food, prescription medicines, first aid supplies, pet food, personal protective equipment.

For a concise disaster preparedness family checklist titled, "Be Ready for Anything: Suggested Family Emergency Preparedness," visit the Episcopal Diocese of Arizona’s website.

Ethical concerns

In the midst of a pandemic, ethical concerns abound. Most immediately, these will appear around the issues of allocation of scarce resources. Consider the following questions:

* Who will receive scarce vaccines and medications? At least initially, these will be in limited supply.

* Who will have access to medical facilities, respiratory support, nursing care, physician assistance, and in what order? For example, the local hospital may have ten intensive care unit beds available, but 100 patients needing full ventilator support along with the attendant medical care. How will the decision be made as to who gets the beds and care?

* Who will receive ministry from the church, and who from the church will be willing to minister?

* Will financial resources and political power confer unfair advantages?

* How can personal rights be rightly exercised in a situation of quarantine?

* What impact will isolation and quarantine (and even social-distancing) measures have on families and communities?

* Does the church have a moral or spiritual obligation to allow its facilities to be used for overflow health care and/or morgue use?

* What is the parish's obligation to nearby but unaffiliated neighbors?

There are no definitive answers to these questions. The questions, however, will present themselves repeatedly during the course of a pandemic.

It is important for congregations to embark on this ethical discussion now. When the emergency occurs, it will be too late to begin sorting out these vexing issues. Parishioners need to learn how to think about and talk about pandemic-related matters of morality now. Your parish may want to seek out persons with expertise in ethical and moral issues to help direct the discussion. Also view "Responding Faithfully to Pandemic Flu" for an overview discussion of ethical issues relating to bird flu.

Pandemic preparedness resource list

* U.S. government Avian Flu

* Centers for Disease Control Prevention

* Evangelical Lutheran Church in America (ELCA)

* Johns Hopkins University

* World Health Organization

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