Full text of "Pandemic Flu: Lessons From the Frontlines"

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Health 



WWW.HEALTHVAMEHlCANi.OHG 



ISSUE BRIEF 



Pandemic Flu Preparedness: 

LESSONS FROM THE FRONTLINES 




IUNE3GD9 

PrUVEHTHE ErDEHca. 

Ppu3tecthe Pedi-le. 



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Robm Wood Johii^oii Fomiditioii Ceuter lor Bioseainty o( UPMC 





SUMMARY Of TEN EARLY LESSONS LEARNED fftOM 
THE 2009 HINr OUTBREAK 

I, Invescments In pandemic pbnnhng ard stcc kpilhng artiviPH] med^atlQriF pard alT; 
1. Public he^kh departiriEnts dti ret have enoi^h rcscufCBS tn carry out pbns; 

3. nesponse plans m List be adaptable and sc iBncs-d rivefi; 

4. Pravldlns cl?ar, stralg hcfn rwanJ Inforntattan to thE^ublic waseeEntal^f albylng fears 
and ^ulkJing trusty 

5. Sc hoc I c kislngs hav? ma^r ram IHcatlo ns ^ r students, parents, and emplayer^ 
d. Sick lea^ ard pnlicfes fcr limitlr^ maa jaEherJngs ^etc also p ratslematk: 

7. Even with a mild outbreak, the health care delivery s^^ue m was overwhelmed^ 

E CammunlcatiDfi betw^n che p ubiE health ^stem ard heatth pfovifef? was not v^ coo fd Ira tEd; 

9. WHO pandemic alert p has^s c aused conf usv n, and 

10. Internat^nal coardina tks n wbe more campUcatcd than eppec tEd. 



I 



SUMMARYOFTEN RECOMMENDATIONS FOR ADDRESSING CORE 

VULNERABILITIES IN U S PANDEMIC FLU PREPAREDNESS 



■nadbDnm lIe Less cue ^n^ Fm m H I N I , dere hie a nn mbercls^EEm c ^ps n tie rBtnn's abditr 
b rspa rd tn a pantviE Ik ou tbreak. ~b lurtlErf CTEr^jtlEn U S prepaiedr^Q, the blbw]ng core 
ai^ nuFt beikidmsied 

Strategic N atlonal Stoc kplle and ^tclne Devebpment Recommendattens: 

1 1 Hab^tahn^ng tiie Strateg Ic Natural StDckpIt — malurf; s u re enough antiviral medcatcm, vac- 

C4fetiars^ ard equppmentafc avajbbb m pnniect AmencarE , wIeH irclu^ icpleni hing the itocJi- 

pt wlien msdcstciTE ard sipp)^ are Esed, 

1. ^Eclne development and ^sntduEtlon — enlHicirg lIe bDmedEsI icsssruh ard claffilDpEnEfit 
abilitiQ dT the Unrted^tstB m rapdlyckwIapardpradDiiea VKCirs, ard 

3. S^cirratlng all Americans — eie unrg der all Am enzirc vcukl leabb to bemxibtBd inashDrt f^- 
ncdal^ 



Adaptable, 5c le nce-B ased PlaT^nlng andCcordEnat^n n e^n mi^entbtlons: 

4i Pbnning ai^ CDord4natk>n — im proving ccc rrEiretun ama ng leckfal jQte, and bcalgo^m- 
EFienb ard tl^ pnvste lecran piepar^dneii and pbnning a^trvicES on an orbing bofs, imbdirg 
bking intD accoim bow the mnie of Flu chrmti clenge own time, 

5, Sc hoal cleslngs. sk k leaiffi, and comm unity m Itrgatlon strateff les — im provirg itmtE^ief to 
faiH the E pread qI dse^e en u nng all w] rkng ^neman lnve 3 ch ^ve bcrslrti and tlat com- 
munrt^ are piejiafed to limlc pubk gathenr^ ard cbse Ecbzck ai neceoary, ard 

6, Cloba] coondinatlan — buiUing trust, technobg^ , and pa Ic^ ntenottuBlly Id encaii^re jch 
m ence-based, CO m scent dec A»n waking ain:^ bonitrs du nng an d u tbreak 

Core Public HeaJth EnrraEtruc eu ne Improvement Recammendatlons: 

7, Resourres— provding errsug h fu ndirg Ion die on-the-gjo u nd res porae, whc h e cu nrently u rxbn- 
Furr^ ard o^Ke^terrtd, ard 

Q . Wd nkfn rce ~ Ecoppng bjcit at s tas and IdcbI l^aldi deparmencs ard recnit]rg the nexE ^nara- 
EiDnDlpublE h^lth protsE Dmfc 

Sur^e C a pac Ity and C afe ReE d m mefida tlons: 

?n Surge capac It^ — im pmvir^ [Is abilny bn l^[h pf^i^deis d mon^ a m;^rw inllux oI potenG , Hid 

10. Caflr^f br the uninsured and undeni nsuned ~ ensinng det all AmenorE will recef^ecare 
du nrg an eEtergeoE^ whiih limits cl^ s prezd ol [he ccmiEgDui dsesre to others^ ard itakjng 
siie hoE piEat ard l^ldic^re prmvtn are com pensated b n pn^vdirg car^ 



I 



g 



TEN EARLY LESSONS LEARNED FROM THE 2009 
MINI OUTBREAK. 



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SECTION 




ttCOMMUNHIffrHDH W^ KEY, INCLUDING THE NEED FT>PI LiS TO I E CWIEFUL TO SAV 
WHAT WE DID MOT KNOW, FOR BHADOV^NG POSSO LE C HANGED IN POUCV. AND BEING CLEAR 
AT TME OIJT3ET THAT WHAT V^ LEARNED ^QLT BOTH SE^HFTY jVJD THANSMEIE lUTT 
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iiEuki Jii TfIcz^ij^ ih^TcurentiEcrl 



I 



TEN RECOMMENDATIONS FOR ADDRESSING CORE 
VULNERABILITIES IN U.S. PANDEMIC FLU PREPAREDNESS 

The tiiVcsTmciilTcL pjiidrmlc Hu prcpartdii cm helped [he coUaalrV rcsjjcujd Tolhc 
fLr^C rc^Luid oflhe HLNI oulbre^ much more elTecU^cK [hjii could hj^c beeci 
LochJcyed 3 few vear^sgo. Ho^c^rr, ihe ]lmHs oFlhc rc^poine ij]]denc4)recl CHiji^lJiR 
gipshiLhc lalioLj ^ core cupihn LlI ra ^ id die ciecd Lc^bLiLld up ^id [n4>der[LLrc llic pub- 
lic hczJlh I ufnuLrij cLure^ uhldi Ii=h beeih u]]derrLiELdcd ^hd uihder resourced for 
decider Uiklealhe3C|i^ip^Larcuddresk:d^our jblllly Torespo^idla em ci^^c tcies ^ILI re- 
m^ih li LjdequL^Le. 

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RECOMMENDATIONS 



The ticLl^l llie couiLlf r Liod ^Ic^Jifiitd a luppti 
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bsicd ciij JM iTilCED LhaE r^lizi an iLnIa In pui- 

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pnrLk^ii Lh[ Lhr ^Liilminil nL^jrkpiJr |^Jn]- The 
[L~dn3L ^1 hid [LcriLiJl a.hi>ukl ie|htijiili LLi a.h;i[c 
zzl Ihe miCivii^l n[nrkpj]e L5epli>^ecl bi nL^Lezr 
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ffTOCK PILE Purr hasing an hvlraP nwrf IcntlD ns 
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reLr.^hL:e LhnI ivlut Hime nl:3len , Euiic alrczxh 
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E>r ajilivb-al nK-cGLcaliUJis ;iT L>f Dcluhtr KjOSl 



SECTION 



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pL^iiLih luppLic^ dft IhcT iif^ kBCEL 



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rriiur%c3 Ici hFizKirci bi Lirlfi tinp Ehc^prmd uFlh^ 
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Ap rlJ !21 h>» Ui:i] i[ w>u]r1 pian ti^uc =u i .Mkf I Llrhci^ 

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hjYc puTch3ic-d !2] rrullhciii ruurwzi [il ncLLhtr^dir 
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iLd^. ^Tbir pi^ \^ ti>r *LaLE9 Ln purrbins^ ll nnjt 
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3. Vi^CINE DEVELOPMENT AND PRODUCTION I AvTscclne fc the most Effectfrc way tn 
piDcecc thEpublE Frnm afi InrEC tlous dsease Dutbrsiik, buE current vbce Ins devepopment 
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abJIIlT n] KhB In jncri Ib/oc ^i-ik ** 

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lLiic Atl <i rdicL^ 1l7 n 1.TDC c-^LtiTCiEc. lL mziT riHE 

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pace vnLLh nrw [c-chfEtlnfrlrr. 
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raiaizi 3ihd zicvt Irr hiaraki^^lf^ , jjid Jjnpnnc^ 





MEDICAL ADVANCED RESEARCH AND DEVEiaPMENT 
ALTTHORJTYfBARDA) 

Th^ Bd rnedcal ^d^med Ref^mh and Devebprnent Au thofity{ B AliD^ wss ^bbh f^ tD eicDu f 
^eand IscAtBte mf^ixch3iidde^ek]prnerit{I^D]DFiEwbDrnBidiialcDuntEnnEeGi]ms, dogncstEs, 
Hnd r^tEd iBchnobg^, ho^e^r, theintentDiKof [lieCDrf;f^afil tlEBdrninEtr3lDnricicat]r^ 
BARD A am larFmm bsr^reabed The ^ mall aEnQuntDrFundirf; provEbdioBAJIDAmcblEGnly 1^ 
bIIo^ecI HhlS £d ef cablE h an inFr^trucnre CO f u pport a Y^f-m-be-ieen robust odhaniEd R&D pirtb- 
lo h r [TiBfH Lfmnot]^ bcmedEal pmduciE ~Ei ac hew tic goak ctntifEd in Hlfi Pubic h-lEokli 
Emer^nr^ Meckel Ca«n[£fTn££E u r^s Enefpfve Im pbmentuDa n Pbn, Q AADA ^ u td need £] ?9 bil- 
lon in FT 2C09 tD 1^^ a 90 peruent dams dI de wb pirg I uciess Til mcdcal Eou ncE/msss u r^ br 
^h bixtbrEE roqu iremefit sbL Id nh in tls phn 



CangiBs 5 bDLild imxease tl^ le^ ol B APDA Fu ndir^ macl^E^^Q millnnaf advccd by 14 
ton wSd s^rsd a bder tEi thE Apprnpnatora CammittEeDndu Esuenn May 7, 2C09 arid ee ie- 
quatedntetymr's P res den tiki FY 7 C09 Amenbd Q udf;ec request ei 




FLU VA::CINE CAPAZFTY world wide is LlMriED 

^ridvpvt [>e Trw e^bmed Ih ^accire manu la^tu r^n mcluda d^ blkuwirY 

■ G&L Lmited (AiHtralB) whiJi male AHufh, 

■ GbxcSm itHKhre B okr^csh (Be^iumt whth males Ruanx, 

■ ID BE]nedcHl(CarBji3j. whuh maka FluLa^. 

■ Ncnarts Vaccirs ( UK), wHe h mal^ Fhvinn, and 

■ SaraB l^teir ( PenmyluinB, USA| which malEs Fhione. 

In sddftzsn, Medlmmure ma!i^ FhMEt, whch e a Ir^ attEnuasd noaliprBy hocEii^. 

OnMay£,7CW iIeU£ RiodafilDnjgMmmEtra[i]n(FDA)a|ipm^darswE^bas€dinFlue^Ea 
wccirE Iscilrty in ^ ^FtwitET, F^fUEyKsna, whch will prexhcE ICOmillcnckfesci'FkzDrEMhen 
□F^ratirg at FullcaiBiiiy ThE brr^i the tntikldDmEstr prexEtctDn bom 5an]li I^CBir^ two-approhod 
^ilit^ tn 150 m illon ctecs GSK e b«ili^ a manubctu nng bcility in tic Lhried Stats, buLit e rct^t 
□per^tDml or appna^ by the FDA ThebclcDFU^ manulactijnrpca|Bc4r mcom tlscaur^^be 
dapenbnc on un partEd vixvES , whch will becc [ne unre difEculL tn cbtajn in d^ e^rv oFa pidem c 




3. V«;CENAriNC ALL AMERICANS -Che rauncry ha 
[hac will ensujc cPbc ahl AmerlcarE w^uid be atrie la 

H A TLhtjLiT[ putj]E ni^lcoi b iH-LLh-d tn be^it bi 
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IhrLJt^ti Llirir drjL [un lpf prriTilr cJiclLtt If Lbic 

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lilM rapjdfi EELl]9irtiJ]iiirEZf^r¥^3pub]klT-c£i- 



s not deve^jped m r adeciLntely tested a syrtem 
be hrocuiaL^ in :i s'un perbc^ ai i^n^. 

i^irc bulki I Li ^k1 C4xirdtii.i1r rk~lj\'cr^ lhn>Li^b 

□ r4>mbti Liliihi I ufpulilij ^iirJ pTh^[^ ^cLLtii^ 

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bdvrnzii Sl!j ^3^d ^X\ per pcnoii mn he 
lillJlU fnr ^ImbahLr^UrhCL 3ihf I fnlE'^H up 



I 



r 



THE CASE FOR A PUBLIC SECTOR APPF10«:H TO DETRI aUTION Of A 

PANDEMIC VACCINE 



« 



Tl^l-ll-tS l^rpibmic InfluenQ Pbnstaies tim aft£r ^ parcbm c xoccine hexms ai^ibbb. sate and 
kxal liEakh deparrmefiti Mid be expEclEd to 

■ Vitark wilH hB3l[^- c^m |:3rtr^rEafidcitlsrstBlsfT]kdE^ in [lEcrJ>utE, d^fwi; aid ahifnEter pan- 
cbmc \3ZL\r^£ ld p^ eh riy [;rDU p?, 

■ nonrtcr ^Qccine iipples , dstnbu bo n srri ce, 

■ Manrtmr and inh^t^atE 3d^e<ie eventi'. 

■ PhEe-in XQCcvBtcin oF the r^£T ol tl^ pa pu btDn altBf pmntv j ^ " r^ Kive been Mac ciiBtsd, 

■ PiT]VEle uptitEd inibnn3[»n tD ds pu btc va tie ne^ mcdo. ard 

■ ^rk ^Tth tcbral prn^n ed evaluate VTXclr^-rekbl ies pone a^cr^rt^ wl~en tic pani^E e cner'^ 

Wbila actual delr^ry ol ^^xiref may cccu r in bcch pu bk and pnnatE rntir^, it e viIilI lor the pu bk 
£ectDr to be In clnrge oF die overall sv^em oF {bkhcry to ssEire tl^t ley pubk l^ih clalLar^ia 
■iic|ue tD a FQntmE ^c ir^ are adcbBsed Thae e l^lbr^es inElvcb: 

■ A pandemt vaccine musl tie delivered to indivkJ Lials a^ rapidly a^ possible. AfienzarG rn- 
cene il^ir sssonal inFluer^a ^iiccire o ^r a penod ol mai^ no nthe nnd on^ a Fncton nf the U^, 
popubcon recEfhCS^Flu ^3:cir^ annually Health ctrGrtmenti will r^ed Id on[an[ze (olsn incon- 
cafT with ds pnratE jeccor) waEf im m u nEzamn clinH3 tint can f peed ctlivefy — po9Ed>ly a nar^ 
aE I CX]- 1 ^0 m ilk>n ctses inamoiKh's ame 

■ A pandemic vaccine vril] be rationed at the beginning of che p roductio n cytte, targesdac 
cntKial inlrastTuctiie WDrken and hgh-mk indnvduab UnlildaGorHl inFluenziL ^acc ir^, ^ch 

■ afe manu bccu red over a bng penid ol Time bu e SEentslly dEtnbiEed ac one time, a [endemc 
"iBECirs ^ill he dff [nb«Ted af it cones off tl^pvoductienlme TTie will reqive targenr^ oF Inrtsl 
dns \D tlnse key personnel (ivch eg l^akh care VfO rken ) win will be central to a puxtmc re- 
fpon^ bfc^sd by those aE hgliB t rHfulDrinlluenzacomplKatcra TTie kind of racnnirg re- 
quire cirefil o^^raf hL Dunrg the 2D0? SES^onJ llu \3EcinesbEinageit becimecl^tl^E the 
prr^Ee dQ tnbu tx>n and delr^ry sV^cen ¥/s£ n^c abb ed 3yi Emaccally fn Ibw reco mnenbtxiiiE Inr 
prvMity pcpibtu r¥ and h^th ctpanmentE WEfebrredm VKer^re 

■ A pandemt vaEclne may require two doses. ^ u nrg tl^E all indrvKluah who recer^afnt 
dasE r^urn br a jeco nd dose vhJI requ ir^ a cenoally organEzed i^tem ol mnnrtom^ and le- 
nncbn It may VFell be iIde prp.atE leccor entrtES (eg , plarrvac^) I^^EfstemE in pbce tmad- 
nnEtEr jk h call- toEb , bu E they m ust all be oiganEed and structu red in a I im ibr nanrer whch 
can only be Ecc rrhmtsd by a pubk liEEihh ^remy m erv u re co rvEtency with fefbril g u ii^llnES 

■ A inndemk vacc Ine wdlJ requ Ire Eiareru] monltorlr^and reporting DFad^rae r^actians. 
Bc£3Die the pandemc ^^iccn^ Mill be one widi whch the^e s br Iqs eirperEniE tl^n as^oml 
HccirE, rt wil be cntizil to Kine tl^E all ad^rse e^nts aie in^t^atEd Ths e a pubic l^elth 
rsporvibihy ard tlEs^sfen □[ wcc irs dstnfautcin and cbli wcy m uit be da fjicd tc ass u re rapd 
CDETim u nHatnn □! drc inbrmatnnta l^lth cbpartments and dien to the FDA. 

■ A pandemic ncctne m us^ i>e d IsirAuted equJtab V. ^nd shn ukJ not be a va I lab ha based nn 
ablilEy d] pay. Withr^orly SdmillDn^nercarE u nir^i^, and with broad-scab hacnmoon cntcsl 
to pn^tEct^ mt jusE indrvtduab biE tie ent]re popu btnn fn^m apandemc, iL e essenokl [fmc tic ^ac- 
c ire cbhsry ard dstnbu tnn Extern rot depend on prrh^te ifeu rame and reim bu rsemeA E^steav k 
^utd be oagc fsaxT^ we/b nore Irlcly Id be ara^b Issedon ir¥u nnze Etatis oc ability tn goy 

■ A pandemic vaEclne distributnn pn^j^m will require communication and nutiE^h £□ 
the publJc. Thfi e tradjconJIy apubic hBildilanctcn pubk l^di^ercES lo^ iTuque bvek 
of trust with tiE pibic, a Eezally vu Irerabt |X]p u btn re TImt Entst will lereecbd tcemure 
(snplBrcE widi a Eonplcsled Extern oF ^^ceife dEtnbitKn J 



I 



B ADAPTABLE. SCIENCE-DRIVEN PLAN>JING RECOMMENDATlO>JS 



DurUriif Llbc ] ^ 1 \ ] <iiJLlPiC3k. L[ m?u r t?u LEciL L>p 

IjiJi-criijncihL ijFTImh hctc hj]lih^^iJd|^ llir l^I[3- 
^ar^ ai publr fuzTiLch riLpcrLi jIiuI vk'iirir i.ult 
drJvaihjf pnCUricn. C#uieT[Lrru~i i L <i [[r Lifa pruTidnl 
rhzar nud ccj i iit^Lcair^ IfULctiiirc L> badJi IduaLi 

^hCJuL 1 |ic bc^L 1ATIVT [ch pruLcc L ClKTmrtLin. liinJ- 

dJlichii, Lfic nii^pLiin^ fLJiilJiiiirri InnpprLiprEziCdi 
ai±ip L lo L'lLiihj^cL)^ niT uim L^i \ct^ m itiljtl~ 1 1 1 Fljt- 

iTciCkiJ] bciTirrur tibrnAii Libfiul Lhc iirLB zazzl huiv 
ll u?u nLjJilii|^ ^^K\^ lLA [lhc Lmclr ckrnaL^itT 

:iIhii]I ^^hcii \i\ rhm^ H. ficjafa <it LljniC l^iLIil'i \ii\^- 

'Tf]c auihim^ik uciric-nrLPCcx] LJil~ ihrvd Erjr rjihj^ji[L|^ 
pbuicLli^^vC rixinJIiELliiiih ^uimjcLi^ ^1 tick nf ^jv- 
EiriimcTLL L jkL bdiidzi i l]>c c^h^n utt^iI ^Jii prcmL" 
■cckir. ]E li1«> niiiilbrLEid Lhc dinVijCLici ijTiilIli- 
iJ3 AiiEiJ nxhnJIiciIkpi I 3Jid ptuhcucu^ %^'jLJ ii>ul rl.TU~ 
LLic;^ nf L~rjnimLJ3ik^hLkhi I l jkL c;h[c-fuL ptujihuif^ lL li 

dl{T1rulL [n rmJcLLiiii ^uz cilcrLnc cc^pchi uciLr^ilc^. 



riCrVl zib/n ^hniMiEl [Eic r]]al[cii|^?3 lJia1 rnrnmu- 
iiIlIlz^ face ruLPU[L<[ dcLhH>iii 1c j cIcmc KbicHifa LPr 
^M>rt plTKd KM IJjiaiE pulhLlL" i^iLficricu^ Thcic 
nre [LLimm>Lci iTLJ7ai[»rLil il>ilt [i>r M 4 if Llhunc ;ir- 
LLjju Uinl Mbci I families aiKl Lbic ciniium^. IL La 

c^k~iiLclJ Ilj [|]Ju[[JrT Lhr tmp^u:! of Uicfec Li pc^i>r 
rLimmujilLT miLL|^Lkiii nLr^Lc^Li^. ncLcL pbiii Erhc 

yavrt Un iiELkr LficmczHlrT L> trripknur]] L, iwz iii- 
■Lsairc, bi ciihuncLg «Lck lcTiTr~ bndL~f]Li Li> iKJfk- 
cn, H> 1|ic^ dL> asLJl Isk^o Lhr iLTt^h dcuuLCJii i>r 

[rirc^hLcu^ a p^T^hcL k ^u^icuE «L3i bj|^ lirrm^ In 

rsr^Inr Ubcir rhikiicii clLirb]^ oii uuIIhec^ 

TIk~ bilL>nii i|^^ii^ rcminmciKtilkjin Tar ci liutul^ 
LtLiI jptujjji[L|^ ^]d 1 i-H] idb Liliiij] ace L-ih^phlih^ jIt- 
Lh-]lk3 ncuJ lJ]3[ t LjiTunLii 1JL7 mlljj^LkpcL nb^Lci^kciA 
mc upr^lccC niicl rmLLiLk' 



4. PLANNING ANDCCORDINATION: FefferaP. ^tate. k»:3P, aFKf prrvBte plaF>nlng and 
EODrdlnaEKsn miiEC becDnalscBnc ^nd an^ofcng— reftectlng che ld nst^ nit^ changlr^ 
RBtufeof thE Influenza threat. 



iTL'drr^ slalfi IdcdI and p^kT3lI^ irrlchr paj> 

dL^njL IjiCIuc n 13 pLanrriii] utd be fTXIenaCkaDv 
^rvLcHI^d bi Ll[r3i[ uf [he L-nperJcocc ivJlh Lli= 
DulbjvaLc zuid rti^icin^ l£> EEINIl II krriUc^ lu 
L~auLifL~ LlLhC Lhc pLicLJi bujtd jcl [IcxIlhlJiE^ Lii rc- 
^piJiHc, K^^" ^33L Ubc E [L\] 1 b~iii did jictE bir- 
Ie3^c :n iTLicL^ pbuhibcn Ii3d ^ielLL tpoictJ — iLdkE 
aiLiE ur^iEiEc urmcru njid cPLir c{|L>tr;3l mar^^l- 
Iticltc srilcoi did ikhL \^\^c ui Ubc Icic5 <if u^r]]- 
J]]L| dcnanicl. Il n jiEhi JmpijrLsiiL lu rcrLcLV 
iTiTPiiu i^Lrtii iLc^ , i[L p^Lfbrubir Lhc»rhi-ol rLj- 
Aurc f^idaikc r. bd Ll|^]l thF Ilic ccliJ h^orLd EZ>Lp^ 
i-icTLrciJTTT Uic buE I1AU mpcLLbi. 

l~FtkL^ fcdenJ c^jirmriLL^nl iluLikl l:3lu Lhe LedcL Ln 

IjiEreaKli^ and be l\ew ruurdbclii^ fi."^"!^ i&lIl^ 
Igl"^ ajid p^HTlb^ plannbi^ and p n^p^ixc-dnt^B^ 
anJ nU juf LmUt Uchis ittzpuU murk LzfrcllKr let crc- 
oLi.^ puLLclcv LinL TcilhivH bcft IfiTcrlinii-cnnLrLfL 
pcocLlccKj tJ[[c~ii Lhrrr n^h [lurri ljI ptuLnli^sL"- 
Jmljcn ih^KTL :l p^JlETLbaL ]ic::hllli Ltin^iE a Il3cii1J- 
lE-d ^jrl nNTinnui ik^LuN] nlxnaC pi^ysr^ilrjn nivL 
irmpHJLLAC k nLjLincf ] Jlp^hc^^t, cp^ct LJjtic, ivIlJt 
llbc Lhni:iL icn-cunn ckirni3ri1_ prtmE^-pubHc CLim- 
jnujiknEkpcL rrcn rlcxLjihc TMltc n}ii>uk[ tio nii- 
^pb|L| a£L<[ L~^c3^cdL L~<hniinuihk-alkiJi ;iJTXhii|j 
publlL njid prL\^[^ parbbcn ;vi In Enhin nnd r^- 
ApcTELiibJIIlJcn durb]}^ a imjiir hcnJlh rmk, ikhL 



jLUI h^iicih mar bcrcuTxn imjnbacihL FurLbcr- 
iivirc briLJ^ihi^ h^^Lhcr lhc 1 rizLJ[hr~ idciu njxl 
rriillcrLvr rrvj^rrEnr -^l di^c-nc lr=vk~Ti ^uidl ^it- 
^inLfhlH iJiT ivill IbcJp biidbi ^ I ammiinJl^ rc^lltnc'c 
lr> n puhiji iHi^iJLh rj7x-T|;|nu h Tl k lOhh linpitr- 
l^uhl lor ^ofzil rriunnnuniliii] JiuL bizolLh rJrpLiTl- 
inoab iTh nx>ndbulc Itucd oih LhcruuunnLu leizi 
lJic-\ kicc ^iurbi^^ I ciudhEciiL^Ld inucs Uh^Lnic 
ipn Jk \ci iJirLr ri 4>nimiJELllJC3. 

I Gcl^^TnI■[^^l aJ oE ItidrxhnuJd H^orL Edi f i^igc 

lhc primEc b<^^lh csrc nmlcra und raoiEaujilLieT 
in llitb~ pbimaiid tuf iri^^VL SuJIj: ciil lEiKiiirrizi 
iiiLEiE br ftrv^iTTl \ci pirp^nih^ Eeu p<raiblc da- 
izzic Ihnisli aihfl U^c |^i\'ctiiit^i 1I ihr>uLd be 
li^hcafiLifcnL abihul Jlisi Lif>[u oikfl bcLfl^^ ^^uiih 
j|>4r Eiir pn^ErrELiig LJic pubJk ][lIIliJ [ibuLiiica^ 
b^ HHSncbd nLhcr rcxtnii a^ihrn Eitlcrl laad- 

CT|LjaEcJ^ lih\'4 J\'c 4L1I11] ^xJ Lx^LLic3 lih ]iaLk>niil 

jhicpikr.iliiiiu Jr>r ^ pujirtjnLr cvm Lhi>u|^9 Ukc 
ausLriiixiJ jhbu] iclca tn] iJiiiic rlTnrb '^^ T~1J IS 
jitfl Lbr ^Y]]iEc E [eiuic ibniild cnj^iiHr parLctcri 
iih ijpd^iliL>^ Uhr \l1IL>iij] Sb~LilE^ Jikri Impln- 
jncnLiLJr^n PLiiL The fndcTsI KrivcniiTEaaL, in 

r4iliab:inLLhiih MLh UkciLilCTi ^bihiikl ^lixirr4LiE£~i 

jEux^jTiLL pErp^urdjin^ j^tuu jUxI pre Ee 11 iiuni'c 
gI3i±:^ inLh lhc pubUr Eci libric^ac Inu Lipnici 11 \ 
aihct buLlfIri i>niinuihLLi EC3Lli=iiJ~t.^i 



I 



CUYAHOGA COUNTY OHIO COMMUNICATION KEY TO EFFECTIVE MINI RESPONSE 



Tl^ Cu^ln^ Cqu nty hmkhdepartmenc via Ibrmzil^abnBd 
BbDuiThfl-IINI outbreak b[E on Fnday AfrdJ4. J!j09 TKe 
r^^ccby, tic Q] u nty EcdifiitBcl iG NortlsEQLOhD h-^JiAiert 
NstmnH^ Id [xmnu niziEE wiJi Dther kxisl energeniy pre- 
jiaredrYESE pfi?iEn BySurcby ApnlJbth, the state dI Oho 
Ind ID Jini Eonlirmed cse ol H I N I inasubirtaofClevebrrl 
Tl^t mme [by tls US ga^mmeftfckcbrBdapiblc Ivalth 
EmefgErcy srid C u^bJe^CgiiA^ folded fu Ebice aid I nib r- 
maixin un be d^semratad to t|v pibic 

On norcbv, Apnl ? 7th, the kxi^l pfEpar«liiBE yn^rkirg gmip 
mEt ard die 24^7 City dI CbhchniVC u^Jioga Coivny com- 
binod EmErger^r Opeidxin Censr%%3 ip and ru nnirg tc 
begn BEiirg c«r and inilBcr mesf^ing on the H I N I cut- 
brEBkandm OHckch^pm^msi nlarxl rEsparve to theouL- 
brEBlL TliecciiTKy pubic inTormBtnnDlfEEn [t^bped Isct 
s l^eft and u pctited dE EZ] u r^ ^bs iee widi linlc b d^CDC 
Tl^ Eou ntv l^^b com m ^oner^ ~&r^ Afan, ^nd Connr- 
scr^rcilthaCb^efandDeisrtsHFTtDEPiiblH: H^th. Malt 
GarTDll, began Intiir^ ewce iibj^ QjniErcrr e iialh wrthgrart- 
r^f^fran hapicah nur^ir^ IcmES ^alEt^ Ic r^s , ecIcc k and 
u4v^en4tiQ , da^nares , and busire&is ■ iTey ako a t3i>lE hed a 



1 



r^ubrenail bfEfirg Inr IdoI ekc^ oUhzok. 

AJthouph C u^ho^ Cou niiy Ieh on^ lod twc confrmcd i 
dF H I hJL SQ mE k]cal ic Im b bEfirknunihtEmll^closir^ be- 
iiatse nl Fs3n abou t ill f ncbfHi Dr ^u Ity Tli^cciiTHy heklth 
ckjiamnent mqs abb tn canEct the fabE inlbrmaDQn tlat ttaz 
cireiht]r^ and yn^rk ^ithschoob so ttei d~^ %%ErE lolkn^ing 
CIX] bc IugI clos u r? gLiHbniE The pibic Loon came to trust 
tl^E local pu blic Icahh nlTEBb , whE h Ind tlE im porbnt eF- 
bct ol reducirg pani: and anxety in tie com m u nrt^ 

C u^nhoga Coinr^ hkaldi Com m es oner AJbn atinbi^ tl^ 
rapd rEsporveand mobikzaDon, the abilicy to caTfdnuE mnnal 
diik oHratn ra^ Brd die atabl^hment oFa link tn tic mcda 
and putilc, to tl^ bet tIbL ~pubk health lad kmnally inte- 
grnied tb an eaEntol jzortner m g ur ccmmntfy enefgeniy 
repareeH^tEm ''^ 

Mr Alh/^ w^ned Car^i^ n E i^3i± I^Hs^, tl^£ c uts tn 
stasand bc^l prcparsbss cblbir (^Dbkf lamui ly albcc die 
abibty oF kjcd hailch dapartmenn \d rEspondeHectTHElytoli- 

tlJrE pubic l^lth EltE^IEES 



i 




5. BCHOOLCLOSING:, SICK LEAVE. AND COMMUNITY Mine ATFOTJ STRATEGIES: 
StrDteg4escD mFtl^atEa majo r ^n lect Id lis disease g uctrrea I [ I nc ItHJe ensu ring that all vrtadclrrg 
Americans have sick Eea'^ beneDts available and that CDmjnunJtlES are prepared cd 4lmkt 
public gatherings and Llose s^hoa Is as necessa ry. 



l-b-^u^ itijualrjil^ i ullumlh-^- ■inpciciil t i>mj7iu- 
ihiLaliiiii tnilli [he [lublLr ii c^kcihljsl ^luT^iht^ j dl^ 
czB^ [lulLni^, ir> Ih^l Jiciilllh rJr|L:krEiTicj i Li ^ad 
pmikJrn rnui Icl pci>pL^ hjhi>hi jbt>ul tiles L df- 
Ycii>pmra9li^ hom In bc^E pn>bn E iJiciraf l^c:^, 
h^iina lhc> ihciuld ILintJ LhclT jiubliL ^irlh l1JlI^ ^ id 
^LYtLiJ ^^iL>^ \i\ ht^tL tvr irhtir>l, zuirl ivhcci ^ad 
h^^irrr Lhci ^hr^ukJ ^1 Rir mcf JLl^Lhi i u tvr ^^irri- 
luLi/^m J^ Thh Includes IcFLiug pnipic LiHtiv Ihr 
p[|i>rllu3LJi>[L ptica Jnr vzKt JicLLlihiii ^^]]nh iLmllnJ 
^mrhui I Li <tr ^^icc bar 17131 br u\^LLilit i^r ^Ihrci il b 
niL^i^ impr>rtuil b> ^^icr ti Lsir □ Ioq^ fir>[i utilkju 
i[i jrh^uiccDf IhrnziE DrarrimmiiihLL^- 

H CnnChnurd vmrLc is Jirrdrd \it cfiniraunmcE 
iirciund Lhe 4.ouniTT bi dticlnp 3nd [ed erftc- 

lavc pci]iclcT lur rir>ivlii{r ihe sprtiid uf Lnftc- 
l5on lhn[ ills] nljahmhzf \hit ksxi^fn evi^LdS and 
e^oaciniJr ccfEEqiK nccf ^hkic blr d wiLh Lbc-ir 
neaxuTEfj Stii la JiTcmurn aicuri Eci be IeuceEciu 
AC[aJlik~:i£ui pr^ullr^l p<i1irlizi LhLi1 zuc iii I bar 
Tvllh Lihc kclraacr j\~LiiLLblc Jl Jiii ^^'nl [imr nf 
jui [lulbni^ nalhrr IIucl rnpLnidjih^ Ech jmikic 
4>r ri>nipUacnhr^ CurrrcLC iI^lIc LiiirJ Irdrml 
roles iih bavciLdL>^ quanuilaqa^ sikJ uuLiLlcau 



jbTttlrk^ ihriukl h^ rEcuincrl Tiar Ec-rlrr^l ^^^'- 

rrcLcrtrcLE- iih ccm rcEl 1 1 j L±tiJ] ^iLh Ihr iLibcs, 

iiatBl csEsbb^b ricar Ir^] ^ulhnrilY :uui i^LeI- 
aaarr Entr Lhc luc f'J suth itvuuutiz] Id rflrr- 
Ihrh llmJl Lihr i|hreivl i af rJj»eiac.t^ 

I Doe r>r lhc nnsi dUTLrLJE r halU^i^cw cJurlii^ ^el 

currcjillv 4H peirtnl of AiacrLrajir ho^v tx> pnhd 
■tkcbij^L ] tLiI jTxiLiJiT ^lurli 1^ Liih iiilci ElruBfla- 
cuac tiiallircil^ lib^ j F^aiKlrmir, Lhn imr br 
IbirccL Inrhrhcnf bcln^eih^ ps^',\ hci k^iid Ihrtr 

01^11 hizLiilh Durbai^llhc ccrmL] 3 IN I ■^ullhEciik, 
:utfrdchLkl ilrhrhzi rmcrgcrJ chf ihTirkcTT Ihrest- 

eikoJ ihlLh EerrrucL^I L hi I J Lbcr ^l^iyerl luunc, d^- 
spJlr briih^slrk- EtiT^ baj^ iLi L pcupLr In jfu In 
hhTirk 4>r irhrhn] duduj; jm gi^sdcnnlc iinl oiiJr 
llhiE-^riu Lhrir 411Y11 ^^€~l]-brJih^ 1auL Ihr hcsllh 
rtrc^iHi^rLrn, itBlr>mcn^ Jiui sr hf h hljni1cs ^cbd 
ucidci micHU izUrirli lj> UmlJ Lhr ipemd r>Fclb- 
cuac. The "HcalLhi pTimjIln Arl" 'ivm baljij- 
duccrJ ail C-i^ct^^rcsi ba rusjKhiiic In Lhf ] 3 1 X3 
oUlbn=Lk bj E^LUbt lhc nbillJi uriwrkm ki 
sUh hitmc ^^Ibcii Lhr\ avt iJarir Ejj7iI]y mrjnbcn 
zun Ul, buE JE hsB cteiL bcuLsrlcrJ upupi, 



6. GLOBAL COORDINATION - Eftrts muse be mads ro Increase coo^Sf natb n at ros bo nfe^^ 
Q] bultd crus^, impn?VE Eurvei Itance tec hnoFog ss 3 nd tr^acment capabilities, and encoorBge 
sclencB-based pn 1 1 les a nd dectslon making l^tE^1at»nall)^ 



ITIk UnllEd Sla Lcf kJxi uJd ^inrk c]r7Klv ivLch 

r 

IhL- ^^iirid lltalUa Dre^uiri zaUon [o rcidE [lv 

pzLndEMvlL pIcuE f^^li^riL [31111 lo c ci^cj uxa^ 
ruanLrlEf aruund lh[? VDrkJ In boiF pnlklcE 
Tor cCc Lrc Lion and ronLrul on mtund irttiEEx 



ITIk LljihCcd ^LiLiTE sJiciukJ ahTj tiitr LhL- Jtrul hiji 
InipniTJi^ ^kibiiL dLocaBir suridlLniEtr l Tbie 
PicPiL^icTLL J !J. ■ ^J p-Ti iri^mir [lu cnicci^'iiLi [uihcf- 
iih^ irrqiKi^E an lixki^^ZLI^I miDLjii bif CTLhnikciicl 
c{|L>tr3l dzKizvT^ [icicc[lL>ii zazd duH^an nlanukl 
prcnUc llHii^luudi. 



C. CORE PUBLIC HEALTH INFRASTRUCTURE IMPROVEMENT 
RECOMME N DATI ON S 



The E~ElN I 4ii][hrc^hL IhP^h lij^kkr I rrcuii ^iJ Eh^uu- 
^iljigiu]ibcr.ibiJLlJc^ uj iJir iixiLif^cL 1 pubLu hizLilLh 
LiiIniLrucliirc. The »ii1un b^u bcxii uudrr-ie- 
■jurrcrl Uvr rkrsr Jm^ ^uu I cinm VhiLh Lbcnr^ii^^mk 
iTTC-x^ii>[L k-^vlLii^ \i\ hLirJt|c~l I u\3 Jih nti]]\ itilci. 
rmnL jiuh]iL hizLilLh ^k~pni Ij7x~[lLi jrc biiba^ nlT 
vrf-rtcn ThnrsulLB Uh^l liCjilllh < k-fin ibnnib l1[i~ 
.ilrc3cJ^ iLrrkhcri Irxi Lhiii li^ rrulihtilih Lhnrd^Tv-b^ 
ch» ^T:^p4HulbJLIln ^^ buna oil ininhC Ukir Lbir KLN 1 



nuEbrmL nr r>Elirr nvijcir dh^abcr rrrrLrn. Ihr 
LiciilLh r^pEkrLmcihb riv I zir>\ liixvc Uhc mK>Lirm Lhr 
pcTMJuaaci icL pLare Ici vlcquslcb |in>ICEL Lhr 
Lic^lLh t^EhciT crh^^mI3llLlJlI^- 

Thr r^]LiivLii|j^r^ rcrninmciarbiEfai 1 11 r~>r pn>i hd- 

lijg Ihc rc»iumzi aiad cLApjhllJLln iircdccl hi 
maJiiUiJ]] jiulhLt hc^iJlh p rrpnxcd uizu :ukrl Ectr 
bublrraia^ the giublLr bic^llh mnrUnicEz: 



7. RESOURCES ^equa^e funding must ire prov"rd«f fe r o n-the-g ra u nrf reapranse. Rf^ht rcw. 
SQce anc^ ticaJ hejltt> deparcmenu [lo not currendy have enough fesaurces \o respQnd ts a 
se^recucbre^k. 



I Cci^TEBriluLikl aauiv ^ nibibk fuiiJLi^jtJvaji] 
fnjr zkJI cfin? publbr liraLU] arCkilJL"^ ai; pari uf 
hoaLlh Jirfnjrn —bulh Lo pj^^i?nl 3nd addiv^llK 
on-^DLitg pubClr hKLllh rt^Hinxlb JLlii^s fif s£n[e 
Tuid LocTi] ^iivrjinL^nl 3nd In risurr LurL LLpc;^- 
|kieIIv kr amLLihle In ivcpiuid Lo ^ niajur public 
l1I^3]lhf niirj^ncv.^iPiL'uckiiTj Fuiidii i|^ lj> nnunrn 
fulh upci^l j; iJijhl .hii[3 TLLlti TLLfkrL pulaLr ihciJlh 
M^Ccjn \a LrlbL"^ [cjcmcr^^iri icipLjCLic [)Lcri[t|f 
ui\ Ezmizr}fciLcy ^nc U 31 ^ flu pncLricmL'. liIL piiUCk 
IktJlIi iiHFrkL~n idU be [KTxk-d [lj mpuihCaL LIk~ rc- 
j^unc. rin[mril Ipurk^ fuLi lj> [LLJ[L-pi^p3£?zJ- 
iKim pni^num uiidciruE LiiircspznLi nCitiimiicl 
Lx~jL hcTkJilh Lk~pnj LiTvnrih Lnj^if up Jcl [c^pi^Lue 

luEliirIl]MuLJEbi^ii^ 

iTliF rc-ckrai ^irmniEnE sbaukl updaL.^ db 
fEL^drdt fuJii fund, ajxl pjompy v carrv cuE lli= 
IV.'«ld[^^L^E V[rJpinfli .^ulrfp /\r Pasrdvuni In- 
fhsmzjT furpSdMnrfuUtn rXun," llzu ^LilkujsE 
SlJTilc^ njjii ] mj7k~rTK~ihLiLLj[L I*tu] ihi>uki i»^ 
c^c~qficT~[L [JihcuinciJ La, iipcl.alnl :u Eihc ni Lciice 
c^<h]^c3 njjd llbc V^'tiLlLT 1 Iljloc j'vneuc:^ Ehrcllcc- 
ItiTiKixTLhE [inpkzrnziiLiLkni orj ;ul nchi^ibai^ hnn. 

Al pnnei il, pubJk hcriJlli dcpnj Lmcihli ^fljuclcC 
1|i^ ccjuiJlri jIec ujidcT-] uaidcd ziwzl cjtcc-ct^- 
liTj idcd lL> iTEUdai^ l|ic d^jTEuiLk of l]>cir <hi i|^j- 
aih}{ nzs^pucuubUiLiiin. In Ihecurrcail cxciaiLiirdr 
ritiTciEc, pLrbiu: b^JlJ] ricparUTKriLi hec larErjf^ 
Ac^^r^ cijllEuiki ZLruupifi Ltic CLPLOitiT- AccdhI- 



|]]|^ lr> lhr ^~£[LEcr \hu Lludi^l oihri P^^Uci PrkiT- 

iLln {r_ lU-ri , j[ Ic-^i -jfiiLUizi lac-irihr>rEbiLii in 

[heir 'JiH\^ zuui r^r ^UU burL^Ei C.BE'E' nrl- 
mnbc^ llQLrumbbaiicI bud^cL t^pi RinlJlc^ icL 

Lhf rrrTLhLiirJizror^'«]¥»_-fiEit^cu9d^}U nhuki 
IE1I.1J rm trc- lluiL Sir^l bi[|ji>ii ^ 

I To ndcqLnEchL sjppnri pubLc healLh pivpaiEd- 

noK nI^E-dl^ Congn^fhaiild z 

L CoQipblE \}tc fLindLi^ Ifi imp bine nl lilt .Virh'LiTrTr 

iSirTTtfnftr Pant^isdr XnfJvenza^ fibc PmkiccLl 
■ ■n^ijhlb rcT]LK^I[Tl 57 I hiJihuj En c^ur^ rjul tc- 
■miubi 3£ud dc^nkipmo il Ecir iTirr LiEilkiLu, ph:kr- 
iTctrcLi Iji xiLi, LicirJ jtxtJi^ dci Icci [tccriciJ Ira 
n^p^iikd Ira jL pujxirjTiu SHTl^ cnilikMJjri Lhn ictt 
iir^fT bc^cL rmidcd- Thn inricKT Li crrJcd Ira 
mihUcLL^ p^irkmk f!AJV Thb lui ir J Jhi^i^^n 4>jt|^ 
liciLh uarlurk-d in Lhr pEr^fKj^rd 1^^^^ ^llmuiiu 
btU, buE Llvcu rrjaumjJ bcitr^ Ihc hill 4 pjom^- 
Sillwr<EU-i I Ih. ill Ajarl] \3'*'^^ Vsrsiklziii C^hjrru 
fitbhallBrrJ .1 icrjursE IrarSL -"i hLUrici J[Li.LLkLf^Lir~t 
luudiij^ kir packricmLr pirjEu^Lbiiiii L jiih|$Trai 
ihiiuki ^ppiu^'c Lhb iu pplcm^i 1 tiJ lucirJii i|^ 

L Frnvidr rE-vaurrew fci r slalt^ zund l~H~aL h[^ikJlhdr- 
p^rLmr Jib Uz Jidr-cfiEilEly pivparr frj r [hulbrenLx. 
StLlr :kEud Lr>cal r^tGcub m^ Lhr Tiuul Ebir rr- 
ifHJudrn In riuEbrc3b."i , vci Lhcr Kivr iHtL Tr- 
rciicd Jizn z^cv^ ^czicrzil Juiuilih^ lor pacidnnU 
Du picpsTrdcKu ^bicr 3X16 ^I^T miUiiiu b 



I 



iHmb^ tttmiEkih b> nlcqicUir]Y iTEiki ttlih Mnir 
:ukiiL JtHH^ piLjJiik-nilr pTr|L:LrrTJiu~ni ^irLhLLJr^ 
The Pirskirihl'i ETLi^W [mitfic-jiik- Hu cji^c- 
^^it\ iu|^[itini~]]LiL Jik^Judc^ 53^'^ milJlf^cL [^u 
^LjIt ^kJ Lr>L^L p^iirirmE prr|amliicaA, whirii 
^r>ukl bccuDTlcrL 

I ^faJ^LlJ^ LnTKlmcjibf in flule aj^ Li-cbI pic- 
^r^unT such 3T Lbt PubUr Htii]lli Eiacq^nci 



n^lQU-rdnrar rnopcTQlhr ofiT-tnitnL^ ^rhlch 

JniT hrenruC 25 ptMrcnCciirr Lhr Lul Hii^ ir^u^ 

. Tbit fedrml gch^rrniaEMi] ilvhijld nndrrraif aiEJ 

pruiirlt Eisliuncd mjppnrl nl dliFXit koindl- 
kul^[^ in^il^jni^ fiuhllr }K3l[h LnbchCTSlnTii:^ mm- 
ni uhIl^iIli nr mvtcnu^ 3nd C1lh[^^ Lcinr puhlk 
lEalLh cDpabUdLJEi jKcded Tchr mpLd cl= Lcr Lkha 
and napfin^ [ci puhLc hcaLlh IhrtiiLrL 



ENTSTATLGOF 

AGnQfmHi:MsiLn&liAy CMTfE 4G>^) r^F^rt p u blslaf 
FnSBpCBilH-TOOB. faiidtfBt t^ Hht-bd ^^wafFtzte 
pr^mc inlkenQ rspa rBB pbrE bund ' many mapr^p ' in 
BTal=n3rcfemc aannirp in Ifiout dI22 pn^miy njsas ^ The 
tiO Lurc jHEsd di3[ "^>fe tie fecbral goremme^ hn pra- 
viled io me s u ppcrt tD sb£B£ in [hsir phnnir^ bTId m stalBf 
andbczL^n^ Id^ lid kt^ "^l^m^nL'nr^tnr^lpbnnir^ br 
anvdluenu pzindenihi E^n lxi u[;h ihe NatoTHl l^mdem c 
Im plemEntati] n Pbn reles Dn tl^se stakehok^ BflDni '^ 

Ajamary JOW 'AsssmentDlSta^' Operatvg Pbr? Id 
Com bai Pirc^m c InfluEnza" report [ran Hlfi Id lSe WhitE 
l-lave hbmebnc Secu nty Coimil bind t^ nanyfQta 
SLQr^ ^11 inar^iuchs pn^sctir^ citnerE and [kdm inEtEr- 
irf; mEfis ^]p:cim[vr¥ ^ ut ^ . ~v: ma[D r ^ap nsuchar^siDi- 
tBMW^ i caie a per^tK^ , de^bpi-~f com m u nity m m^Don 
pbiE, aid maffdnjnmg hey mfiii^U ■. Lu fr^ 




STATE PREPARED M 

flccDnDrp ro feztol g^ptlirES bgs pbr¥ ore "h™ irad ttj t^mn- 
SLnaif i^ e oia e zjilrr^ ed 3::d "" pis h a r^nga at & |£^aLEirB, bit 
soB Ih^c rot l^en ai^uately 'unikd Id m^ theecbmamt^ 

■ ErEurB pubk hsklth [Z]ndnurtynFDp€rat]Dnr dunrg suh 
pf^enla ponctmE, 

■ ErE u rB 1 u neilb-xe and bbaratory [spabilrty dnnng ^ich 
pliEeDla pjndemc, 

■ Implement comna ntri nrt^tnn mtEnentim , Bg , scli»l cks- ' 
■p crcaniebtnnol bxge pu bic ehenti, I 

■ Az|u ue und dfitrbulE meckialcDuivErmmfurB, ble lainrlb^ 
nrl^bfoh 

■ ErEurBmEQS ^cc imtnn capabllFty chrii^ ^ich pl^5 cl a 
IHTvlenc and 

■ ErE u re CQm m u ncstcn QfBbilitf dn mg each pices gI a 
prvlenc 




SEATTLE mOlWreoUNTy WASHINGTON RESPONSETOSW1NE FLU 

AMID BUDGET CUTS AND EVOLVIP^G POLICIES 

EbycarB ^r? sbtBcl, 3 a r^ult of prBVWK b de^L t^uc- 



AnnnthiniEi cheDutbrcak Sa3[ib5LKjrgCt]unty IndnQre 
tlun IbOcaiB dIHINI ardse^nklschncib ^w^scbzed tm 
pr?\Ent die lu rtlsr s prB:^ d' ds nDvel Itt ^rus ThebcslrB- 
spome Id tl^ H h ^1 1 cutbreaky^BZ u nzbrtaken am cbL con- 
cEns aboit it^] cits in local pubk Isalth 'u ndirg In bet, 
d^ bs r cby o- "_he ?Cro We hirgio n z ti^E k^E bn-^-ezss co- 
in ^hchSeacEe ft KjrgCaumyz p^b^t ■ea-xhTuncirg «b cut 
bySM4millDnfrDm120l6mill«niD$l97Jmill»n- V.QS 
d^ sam^ ciy 3 csB ^er^ lir^t den c^ed n tl^ UfVEed ^ tats 
ftcondirg ud ihe liart tie IbiC I'nC^i'ujiffMflr. tlKKJngCounl:^Clp- 
E^lt]^^ buc^Lcblcrtrbr20IOcciiUbe150mill»nanddie 
2C0? b*[^et may Ih^ ra te'urtl^rrBVEeddown^anl.^ 

A napr ca niem E dot i:«: programs whch'"^lp^ inL'"e ra- 
csntTBp^nse liiie an Lincemitf^ TituTe witic: ^dccml l^nd- 
ir^ [|^Ehibcar?lEalthpf^rim, whichalb^ednurseE Id 
MCf k ^ilH sc luoh ^ sceen br poa ibb EEE5 anJ thecDm- 
muncubtdEsue prrigram Ajz^rdrgm Dr Davd Fbm^r^, 
DirecEirnrPibkil-feBkhlcirSeatEkA KjrgCcunty. at the 
Isght oFcD rcBm tin p«bfe Ica^b nu r^ES wfu^sr^^crkirg 
□^eft]me cDndKtH^ EcTKatnn ^Q^imsv^b Id schook ! 




Tl^ buc^;etcuts ahnaie likelv In se wrely Jtrajn bcal and EtalE 
btcraro ry [=£:irp capibilmy ^condirg^n D^ Fbm-^. " Limia- 
tcr^ in cef tirg i-opab ilru/ " ou r b^al b^ r^iar^, aL ihe siate bb- 
oratory andat CDC kd m a r^tcrnl pctare qF tic citbi^ia 
rapD'iBd 'n tl^ nBLUi^l meda riat ^if a ^Eeh tD lO-c^p-cU 
ffom ^he front bie re^liiir V^ bd WK^p^cad cam m unft^ fl- 
r&s b^brcCDC jxiFtBdaiir^bcar^irmedQEemSeatib" 

Dr FbmLrpbEfe^QdEk^tD5sttb&KjrgCciur^'fiKCBst> 
cbie p EC n:ar^jrg de H I N I OLLbraikEannbutabbmcDmmiini- 
c]tnn and kucnj I'^ld'i c IFc ak beir^ oieli^l m say wlBt tl^ 
dcb't kmw, brBlocbwif poQiitclHrgQnpDty andlE*^ 
c\s^ ix re Du tee: i?Bc ^Fk d^ sir^ jbou t both H&errcr' and 
tTLn mELibilcri ^^u d c^nmfs di^ir r^^rae ' In tier cd meqc 
de comnu ncy rn^rk dct lod b^n [brecn |Biibmc fVEpoiod- 
rcss, wht 1^, MBS a liin~Er ' D^ ^mir^n^ Cli3r^irp jx^li- 
c^ tEi ratEhdnse idcaod bya ^l se^efeEcrajn ris drkult 
lEcaiBE titf s mt witf peopb lud l^en craiGd b ct ' 



i 



WORKFORCE- Thepublk health wo rkfciTT:E Is sep^ lis ^ strained, and budget c uts are r^ 
suiting in additional ^yoffe 



I F[?d[?r3lt K^li?h TiiKf IdcoJ ^QirrnniErnli nu:?! 
Likt DcLkjji In rc-cruLLt [mhiii 3iid nLshn Lbur 

jiL"i[ ^nrr^cLon of pulilLr hi^alLh profi.'si^DJi- 
ali Ln pubUr lie^iLctiL Fccijti fLn.! cc^ fiL>[LcLc~n Eu 
u InjlLib lAlHhcidn I njjd i-l-iiLucl dtHzim^, Uie 
ri^LUiii ^ pubEIr hc^lLh ihurLIcrL'^ b \l\^ Id 
fj ri ilcT Ll I |Cf Ihe [uiLkiii ��� ]]CTillEi Thcc^ n :l 
ihnrlni^ ui pllLjIJl hcTiCLtL ^Mhrkcn In ljie 
U^lICciJ SEsIeii. 39id JB Qnbr I^niijncn reLii^. 
LEicic b [KhL n ilciv ^dkcrallLiii lhE i^^rLcr^ 
bnirii^ LiTuiinJ [L> fUl Ehc vlpLcC c>[ izicpcrlJi 
Lr^liicxJ pu]i[lr hizzdlh ^wirLcr^ The cuuriLir 
h^ aih nlJiTEL[<T[ 31MH>] brwn- publr Ek^UiIi 
iMhfkcn iJaa]] ]L did 2i.^ vcisn ?i)^h, zaid nikc- 
Lfiird 4h[ Efie fiuliClr Eui:LJlh iwiTkliirLC In ^Eshi:^ 
li eL|L|1blc [n [dJTir ^^iLhlii [j^r ^c~jn, ncLiI l.^J 
pnTciiLcrchc [[JcaJ pubJE lie^di f^urUmc^a 
^liifilht lEP r^Ur^ t^Milii tw:' >^=3X]. 



I DcxpllE? bit^Ei c^nnDriLk lEnLi?^ 3l \k EmpartonC 

Lcj suxtnLn Uie puhlLr liKiJlh murhrorECf l£> piu- 
Lrcl Ainff rlL'Ts'f hKiJllij ]ii 1|iLr p^uL ^^i;u~, pulpCL. 
IictlJU] dcp^r LmLiJ Li nrLinihrl Ui^ rnuaalTT nic 
bcujy ]LiiniE[ [lj tii nil iznpcrh :ukI pn>[cHkj]i;kk 
n^ ^ ■ tj ■! In pnjlEirL C4>mniu i iilic^ rn>rn Ihn^iU 
IJk^ pncLcbrnx llu \ picltmiiLin survey 4>r 
Li>L^ iHzaLLti d^par LtticclE:^ by Lbie \nijuii^ .Aa- 
■ol-elLmuii (hf C^iuELty 3[L££ QLt I-Ic^lh OnLL-bik 
(N^Tl-IGI ]l-vi TljuikC bndi Irudffrl L-uLn aiKl 
^Kif kJncL'^ [cdiElinju [n ]]iza[Lh L^cp^Lf liTV^] Li A 
■ur^^v nl [Z,-IE^ kx^l h^.iJlh dcp^irEirv^i i Li ii^ 
LLjjioIEi ail Nnvcoibrr-TX i l Jiiber ^^A FljuikI 
LJclL marc Lb^ui Eciif nf [cjc^l hcnJlJi dcparV- 
ninaib li^T^ cLlEicr 1;il<[ i>LT cmphjTC^=i ur iLtrl 
Lfi^TTi llicciix^i jII LrllJi>i I E^crninc ihrJh^cuncTLl 
buc^jd IJnu LiUljilt, hmJlJa dcTTjirLmccLti tcii^ 
bccii uiEible In [cpLarc Lhc hut ihurlcr^, oikJ 
[Eiei ^alk-ljure mnic ruEn Jii 'J kH ^kJ !XI lih." 
Thcn^ cuLliLirti hziT^kcrkatn ^lpelmiciuizuceii iar 
rizipLaiKlb]^ liJJM iHzziJLh cttuit^ikt. 



(^ 



TO COUNTY HlNt CRTSlS RESPOWSE IN THE FACEOF BUDGET 
CUTS AND LAYOFFS 



DnFrEkr. Af]nl24. 2(t9 DrClenrnhTrochet ^arramenlD County's di^pgtalh: hstdiaFcEE-as- 
s^bbl her sblF Id [tlr^r scvtE had rs^ pbcuts v^ereBr^rcertavtyduebEewcBliH^etEn- 
SE liiiLf^ Calrb me ikrd the ^^ak mcDml €£Z] rDmy 

Tl^t mme [by l^ldi nFcok ^re ^^rTod abau t B ro^ inriuer^z vrus d^t^os blling n therms e 
hsld^ ^D rg Bckh nriEucD When the Tir^ccsE h^^Tif dogrcsed in^E^rimEi^iDCDuntyDn Apnl 
7£, a loniilcy pubic ^ncd tebplmie lir^ wnh c^uesLCirfi nju '^orred ^V nks^erckd d n bcsl 
l^aldi care facilrt^ whit hb lechnEGm kborod £d dogiuse and drFlerentQlE H I N I nncaes [ran 
sESDmllk 

Dr licLhet sDflfibd the abr^ and her bnl pubk bE£]ldiv^rldcirce|umpedintEi acton Asqiad^r 
50 ^3c ramenta Cqd nty lEskh v^rkefs oe^n putuff n 1 2-lio u r s hifts aid lo^lged mored^n I^^CQ 
Sdu rs o^r dE fnt fr^ cb^ af the ou tbr^k. 

TiBt kind DfckdkiBtDn in the bee ol bcnir^ buc^;ec CD tr and b^Dpt EembbmaticDl thsUS pubBc 
hsidi ^ rL:bruE ^mu ds country theacrumc r^cs^nnQ badir^ [D^ei^r^ruts in pubtc 
hsidi buckets ln20[Q. bcaH^dickpam^enisacTCEs tl^ country bsci^JCC nslbn and 70DD 
staHen Ed iHc^tcut^ and coikl lose an eqal mnlErDl ^rken dis ^ikr [^zcnnding \d N^ChlO 

In ^Dcninenti] Cointy, assr ths pest tv^ ^r^ tic D rvcn n cl Pu btc hbelth l^si^nis bu^et 
s bs 1^ n l^tf-dm ppir^ Fmm 1^ Q nJIcin in 1^ I miircn Ths ctpartment Iie been Id rred Id bt ^ 
more dnn a qHarfcr nf ID STaK ^c^j^ndirf; tn the SacroTTEinCci fl ee inZCHSl, 57 4 'u II- time pas rtcns 
b^re s led, an achdEtoml J I dmn r? co u td be b^c in IQO), bnngLng stafEirg bebw 123 [uH-tM^B-equrv- 
abncpDsrDDm ' I ha pe ^he pu bk 'eo^es ho ^' t^ve h ^3rli e ga«f anm ^£ep them sale and ^ ^sp 
d~£m ^^11, sa^Dr TmcheL '\is anly when ^i« bi dat ds pu b(c ra txies iliiL ther^ e a p«bb: 
hsQldidEEEtEr'' 



I 



D SURGE CAPACITY AND CARE RECOMMENDATfONS 



V^'tilt Iff I-I] h'l LJLil1inz:ik i-.^! i^biCn L-b JiiLirL .hcuJ 
lljiiLlL~d icL <hji^LlL>[L b] Lhc UihLlLr] .SLst^ Jih c^r]v 
1^ ^M, bunpiLhLTncuJfJuriirncLii^ nm Ihc l ljuiiItt le- 
p^jrCcxJ JTii^Jc mar^^c^ bz psil\cii\^, icurluf ll]»^ iLidn Ld- 
icih ^^iLh %lvr I1u, [lu-Lib~ pn m|h[LJiTii <\j [h^c ^whrricTJ 
HcU.~ i\^ Iiii:lJl1l pEUhidcn pieLixinr Eur u pukJiixil 



nrtuni iif HIN ] In Uk- tiJI iu id 'nr Ibc puLoalml wiT 
LPLhc3 LJLcLlinzTilA, LTU~lihj{ iitr n iTciphr Hurii^ fif fin- 
iKiib [CJ7EUCL1 LPi iL~ Ljf llhc iwwkA idil FV uIi fJLkJhziagi] 
Jbr UiirpLitjEk hcsJlh oiid hc^Jlfi C3ie n^^AcoBL 

rbi^ lih[[LJihlJd|4nre [cx[JiTirnL~]]dji[p]Ju far varm [c 



9, 5 U flO E CAPACITY. The 3 bil icy far h&zlih providers to manHjCE masElve influx oF patients 
during En emerge ncy remains e malar challenge for emBr^eiK|r public heakh preparedness. 



[>urLi|C{ J iTLipr l jjh. r|^i il~v [±m jmicJnnIc ultC- 
brc^L- Ubc ]Hza[Lh rnn~ j^^lrjn milL he Ms^iiUi-^w^l'f 
TUirLLbiL~d lh^LJ[L<[ I iLirrrusI i^^jLilhlJiUizi In Lhr 1k3L 
4>rLii7Hii. mMl CTTii=r}^K-L [con~B ^EC»Jy Ibc^ljcd 
ihurl^iLfc^ jMzui hLlJTicl^ n^tKi;! DuTHhj^ dusuCcn, 
Ik^lIiIi |h[i->Mricr« t[^nc~ liJjiibjpC Llh^u ic^^bif prLii- 
licd [cj Lnia[ n tirt^ jjumbrr zzl paliciiU ^cry 
f|U]Lkh. Mruir ^jf Lhr lun^ nipjirJli pn>blcini 
lEii^bceii rJnilJrkrJ — liil Lu[3ii|k( ]livli i|^ cih hLQfJ] 
tLuU, nloIT, ^k1 ^(jrirc lii lic^L palK-EiLi — bu[ k>|u- 
Ifaiau li> 1]]C3C~ pcoblnm ^uiriillni LirkJ]i|^ 

Thel'IhE l^iiricmLc liifLunhJ^h Pbuj pn>jiirLi lJ]3l 
JM pni idcoilr fLJuCd rciuLL Lii -LO jtiLIJkjj] .uIcLILilicl^I 
i>LrLtjn[irihL ^l^th. ivJ tb 36 [>.4 110-4.91X1 .DCU Eiidi- 
i, klLcdi i^T|uJriihjf lacu pJLsIilt^lELjj]. dcp^ id bi|^ ljji 
Llir nci^rlli i?I Llbc pnjridcmiL. SiEh n irLiiur dli- 
inCcr iMhLcId rniu iLiI^ ILcl?:^ ^iikI quirbly ljice- 
md9L~]jn ]][-3]lli rsic n^ilrjin 

HTbiL" TcdfinS ^>i7 rnjuf nt ntud L^i3i« n lezLd In 
pjTPridlng ^LrleEljKC Lo stnLirE rnn mr^ c^porEtr 
planning. CurTndlJy, dctficLLLHJiD Df^ppccjpii- 
jMlc ~^JLjbHln HLicidairh ■ jf [-3[c~ iire tirtLi|L|, zk- 
cuEcJjcu^ bj Uic \fiir ^~s]^fisnj^ jTMiTTinS ni ^JhTpj-pji^^ 
\JlIiui]}^] TTUiLiui Il-Ul j jI JojoiKvzn h^svc puli- 
Ikbic-rl nur^ ^arJaibTC- Uicic hn^^ hzcDi [^-wiib- 
c^JllKc^ <iT uihiClrd dirrrlkuir [n ei Liblc ^bLci 
In JiTiplnncihl lur^^ plnjjjjiih^ [^uricu^ msu 
i_iLkL J 1^ jbT Ic^, nv^LnuTC-^ mini L^ fjul iih pL^rL" Flj 
c?uc hhr a pcjlnilEi] i^urj^ i hf fj^ilKi i La. bir Iu Llihjf 
crc^Tbi|^ n[[criCTLih^ l'^uc ^eCezh mid rcurijilJihjf 
iKkdi[u.jiE;i[ hiisCLfi L~7i[r prrvjihihcC Sur^ pLicb- 
ihLii|f iihr]uJii:^ fjbuiJiicu^ Fur .hi ImicL hthi icL'krcli ijf 
f-^ifCiiEid ackJTLip.i[i|.^ Lcipl jIi id cllhLL~;hL LtniL cTCLi 
bcCiJic jIcl ^TTunu^xw tii.~run ITinpiLsti jnLnl 
iitHh ri>itTidcr bi>m Li> pccj^lde nuiLbiucil cz\T\r 
hhr rioib crrcTwihCic:^ zaui rlinpcLk c^u^ fvliLi] 
llbc^ :ljc :Lhih ] r^pLTCLfUih^ Fl] ^ rrajrjr uuLbnizLk 

H SlulTc Xidj'n 1 hmpiLik 3ibfl hcTiLlh rsic iz\i Ut- 
iim ippc-rjCc uhicL^n ""Jm I-ijj-Lij7k~ nup ph rh^cL,' 
udairh ITHZ71CUI irrv Jirrulc^ Tupplk::^ ^u-c^khrcd 
i>ii-»LT^ ^id Uulcsd iicc icpLci i Liltcrl i>ii mi :li 
ih-L-lH-lG b;BB-K>jmi|T ]9i=:kJL]i piuvuitzn ivlU ruai 



CTUl [ir^uppEki:^ i^T? quh-klr Iflhci h^s^^lo Eninl 
3 napr :^UT]fL~4hF p^iliccih []j :v[[J]Ip]J]. hi^rpi- 

4:3hji[c~ IjtcE^ ILJ TUih jliL>r[tiJinjUtLLi>n jillLcJ^- 

cnj]LirruiE3[LLJii uiiib h^rr tiueM? 

I 5Cn[F[ V^^hrUl>r[ ^^brTrL^^ pbi^^iir hiviplLkk oiid 
iKLUlb C3ie tiril][c3 c-^T~[L bj iJic bc^[ n] Umc^. 
\£Li>rdii|L| bj Lijuiir Ul ^ IH [c-]HhTl rcum Eh^ Cil- 
ler Iijr SLudyiih^ ITcnJLli Snlr-m fllELJii^, '^h^ 
ctii-Qj-cbiT ^bu^rLi^^cn i>rkL~h hchlU] pcmiihibcl — 
mih :li iiurKm, plnrikbuiT, plxiriTLirBLi Libura- 
lury [CT~fii If ^n , ^kI rc^pirslur^ CJiL~i3pHb— or- 
jirciKilr Ebe chnJ[ci|L|c tif Iltidji^ auITIc icial 
iiLuntEn Ljf hc^Lh ^^jrk^n Jih oil crrurr^ckr^.'^ 
DiL^u^T Ecj L iL nzTBeunrhiijic^cTipDrLlT zi lupEO- 
vric □iLCDiInc^ [n iTicdk~^ pjiFiLcl.~n ^urh m pn- 
chdLy ^tiLLEi hhr rcicn bjjf j7irdirLiUi>i u <hr 
^^m JiEilirjiiT r\iHilJicr Li Eci EcrruM lic^Eh CTun 
pcahidcTi rruliLdc <if L]]c CTruirycTLfv hiIcitk [cj 
AJ^i^ 3^ h^luELk-^nh durb»f [JnarLcn. LiibiElLT 
pru[ci~li]ii cuiircTiH Erjr nhbaiiLcun miiTL Iht^ieI- 
dronvd :li p:iTl i>r Lhr pbujihiiikf pnKf^u \ji 
njLih?.n lEil^^n EejuluJ Ui.aEchi^il itiii^ t\zv,c tifv 

ticfa i>r pnriCE Ll4>LLA Ecjr bui^CJi r^un ^ThluiiEcESi 

dunihg Eimc-T ihF ^mc-qfinhi Ir^, nvr^ihicuf Ui^ 
ftLilc^ li^h^tnjh 4.kxxJ SuTLhnLhi I urzilmLtu Ltaa 
under ^u-ti h^ltiiilrm jteti be prLPvbicri with 
mi ^JllrmilAV rk~fLiHL~, EiuE elljI iKxi^nrllv Lm- 
iTTuihLli limm IcalhjIlLy In ^iridl Lirjjj. ^J> iLiEc^ did 

mL Ii3^ AlsliiEc^ IIeiL dEEZiidcd vanwo tidn] 13- 

nbULlT immiacLjE^ [LJ^LJupn .hiic]^ ur nqpiii/ZLlfiiD 
pruvkdii i|^ rliTinLibt, dncij^Ln or -^"^n'^^ r^~ 
Itficrvrra-" 

I SpiiE^] ] JiKipjLah mi[J LJlJiLi EhcJILlKii ^il] b^rc 
Lj Liddnini bjiaiLcd ihumbcn i>r lamp] Li] bccfa 
njrid «p;icL~ El J LTii^ fur ^Kk iLKEIiidinh Tlhcr 
ivlEI Imi'e In iiEiEETif^ iuuc3 Uke mpLd dli- 
L lijhii^lj]^ ihf pallniLn, rsair^icL^ cEerlbi^ ^ur- 

L^[LC-n .hill I pTL>rcdLIEC9 , ICcIlLT bl|^ ^\^C M%C izf 

li3li mi[J aibrl|Liri kcrvkEH. ci>[L^^rlJiiff aI i |c^c 
TLKhcni iLJ :l£ 1 (unimdnlc rru>i^ pnppEc, Lnu^g 
ri>L:^ ^[kE pfijLib]r bcch, ^iicJ FlekELli^ uihurod 
Ap.iLi_ Ecj In^iLnr Ijix^i- p^ljraili. 



I 




i 



MEDICAL RESERVE CORPS VOLUNTEER HEALTHCARE PROFESSIO^J 
RESPOND TO MINI OUTBREAK 



"R^HecIksI l^fer^eCoriB ( MJIC) e 3 mtnrHl r^r^rliQlQjrnrnfnft^l^Ed^slur^Er die t^tsup|Drt 
bol pibtc h^th nnd pro^rk h r an aitqctsu pp^ gF hcLntEEfi n tlciiae c'a pabk l^chernBr- 
gercy Dunrg dEHINI nutbr^k, MRC urHacron tlcTdian^rcactrhH^tDzifftin tlEmspor^e. 

ArtZDRB 

■ TIe Nav3p Cquicy MRC K^lu r^£ra dfi|HKlBd bu r mem ben t] fdpclsNTflpCDDitt Pul^ h^kh 
DeiHTtwrrt m tl^ recsrvirf;, vrFentDr^wf;, and icirt]rf nf ^tra^E r^iDDnsI Stoc hpib (^NS ) plnnnazeati- 

K ok Sn MRC hclun^ra from th&urut btersEE^mclsdEtT^utDnor^r^suppr^En bcilliEprtHb 

Florida 
- ■ TIs Sarsotz Cou nty M RC sent three M RC nur^s [DztslTal-llNl tj^^ pfnne In^ O^iKcbjs 
H tl^ m^Hied a tEital dI 7 7 hoin at tF^o com m u nity l^alth [Apartment z rt€s Tl^se w] hirers ^bte 

abn tmirEd m |EfFaFBl piDfectr^ equ ipvtent | PPE) p^tccob \d cxmclKt pl^Kal afenmeftfx dF 
_ ^kmpatenti wId pcss ibly ^ere ill with H I hJ I flu 

■LautsbiQ 

■ CBkaEulbnhMI!Clcl|^tlEl^E]f^OFFksoFPubkl-^lthmblsCl^r^.l£«EB^ 

Id hifi prtab , dDctnr^' qITkxe arri otiier l^alth caie ^ilitES to clieik an ther nock aid cuncnt a^d- 
abilfiy d'j u pplEE Tl^ abo del ne red te^L lens in heakh C3re ^ilitKs AppFcmi^e^ 22 ^chn^si 
abc wer? iM)!^ m com minity mit^tcn eftDrlE EfichirQ pmper Isrd %%a Ivf ac bcBJ schoak. 

New york 

■ NewVorkCFtyMRC phy^can wlunt^rr ass; r^ £d tl^ NYC DfipHMttrfJ-^Uifiidnpfd 
_ hl^ierE helped m s tafF [he Pro vckr ^cesE Line call censr Id am^cTEpstzHT refafed b MINI 

^Jlah 

DnvE County M RC carducted a pomt-ofde peiE w^ (PCO) tiajnir^ coLirie in antE^Htnn oF litij re ma^ 

WCEirBtCFF 



ft WCEirBtCFF 



I WtH^nm Coiif^ MRC w^luniEer^ ^cre inwrl^ fn respvalDr Frt ^t]n£ br tic bcal Iyh piol TYey 
■ ran bu r Ert tE^ itatsTE D hcr ore ^^efd Thejr^^al we tn perfarm fit testxig o n l,{KK}pE£3pk 

□^erJOcti^ TIe^ abo stilbd a tEleplnne trc^ cbU lina \^4Blnon Cdu nty M RC abo n^xebpEd a 
_ pQ^ntnl ^JiefTiitE Care F^LiJrty br iiige op^ny in e^H^cl Kisp rtal Dwrlbw ^A'lsJLom Connty 
H M RC stalJEd a pIcrdHnk n conprcton w\\h F^cel-talthSLlmeph'i hlcspnl 

V^boRsln 

■ Snutl^EEt Weco r^in M RC wluntEer^itaFednallEentEn ikrd dincE wlcre tfsy peHbrmed dog- 
nxtE [Bt]rg o n i^tsntE 

^Sbuitb. ^ m|finmtJDn pra^ii^ [a Tl^H by iI]b Ojfri^ of tlw Cpidun VaFL^rtfer Atodk^ J^enrve Car^ 



I 



10. C^ING FOR THE UNINSURED AND UNDERPNSURED A "St^tG ol EmEr^enE^"^ health 
ben^rt ^houkJ be created m ensure ttiac al I Amertca ns wIM be tared Tor during emergen- 
ce. Pmrldlns care b not on I)! ImportBnE bribe IndlvidialpaE^nt, but srnce tndlvKJuah 
afecDnt^glDus, it a^w helps Jlinit the spread nf dlsense cd Diher^ 



V^'jlJ] JTXhre Ihjtzv 13 pcn-ciiE al Amcrlc^uLi Lark- 
i[L^ hLmllh UoDF^uiJi^ ci>LT~F?i^c~, Che fliioibr biJ Lj7> 
p-iiTl L?ih iJac CEHiqlry'^ fJubUr iHzaLLti ^id hcriJlJ] 
f-^vrc .TVA[rm cculd be <[biai[TLPtn if liHMpiEnh, 
1 Ljj7imuj]]LT fK^illh I L~a]lL~n. ii[L<[ prcircin c-^vrc E.i- 
i~IJiLkji Irejl Lsr}^ Jiumlicn lj] ujjiinuirxl " Likr- 
wUe^ if ucLLELAur^ cf uiidcrEmuECT[ piilic^dli 
Iwz^tEnlc In »crk I rcnLmt'i i E bcrsmc lhE Eizan ai 
itul-€yi-piic\r\ctat*, [icaCicLg zazd ri>[LLi[iil]]L| Ihc 
furlli^T npTL^id i?I ^ pniridcmu: ^Kju]d be aiizzifly 
imj7[mitj]c -Af rLiic[|]i|^ Ilj LlacCZ^CLCcr Echr Ru_iic- 
cutiLt, L' ^ fujiptL^i TLTLild [cue za murh in SI ^ 
bilULPii Lel ULirumpeELmCExI nuin hikJ c^uIi Ikpw 
ktuc3 til JM wcvuin pmidcjTiLc.^ 

Hc3]l|i refchrm uJIcn dir nppcirtucLLEy tn FlaicJ 
v,ixT\ kh ccuuie jmU Am^TlL~n[ui ii.^iak[ be ruiercd 
durbi|^ ^1 li|I^ iIlilh dK^uc i>uLbrL=iL aiKl Uioi 
hc^illh primEtm H^uCd be rnjnpci ieiEttC kir pTih- 
MflLiic^rnce 

H Elimr vcrh Lr unJi^cEiJ IvaJlh liKiirsiirc rciiAjr- 
jMg^ b nol 3cblmc[| thr Tcdr r^ gu^A^rnnrnL 
should zLfC jiDw [4] civalE? «n]cr£iMir? hrE9]lh 

ccji.^M^i£c ajid rrbub uncnc hLl I[ ^^Fuld lz3\n 
IL] ^icimiiCce pm^Jdm ^ume Ee^^ qF cum- 
pcEmalkin bif lliLrfeCTiLm:^ Efir^ pc^ ii xir tluriihjf 

JM pncHitmE, ivlil3c rainiuinjpEL^ Jihi 111 L^Juhb. Ilj 
r<ijne Inr^i.aTd [<it dbi|^LiLAb m [icaEinei i L 

n>r Lh^ hcJUi cue v^Q^n, Uie 4_i i Lrj^ikcy t»eLL- 
eTb ^Kiukl mJC^^Ec LhL~ n riiHunk. bnpn~l lhE pn^ 
I, kc3bji^nu. ti J ti^b k~Lel l^I LiriLifj^ici c^re. jhutJ] 
(hT^hkh n^ lie uihrLPrnpciiuEcrJ. i.^tLlk~ ^ibch Flje- 
}fiiEL^ nr^cTLLJC v/r\ irr^ljcu^ Lirln Llicn, xur h m cEct- 
Ih^ lur^cTia. ^bH h LEJukJ ptsre lunplLib AJid 
<hl]icr Ihi^eJi c^iie piuvklen lih njJTUiitLJ fcrijEmfp, 

Tbe beELe[iL ^Mruld abn e[L^^JU^^;e Ihe uelill- 
i^LLrerl lpf uiaderbdnurcd ^.^lirp till lLL Il> ^meu 
priiTEiiT E^ife Aervlca Ecjr prcimpL diajpiLPAii 



aiKJ liYZTilmecLE ii[L<[ elcjL be decayed due Eucaii- 

LeriLT :i1piii]l \2zuiw icL^biCLL^ In pstw Eur ^ei~L icei. 
l^L^ieil tiEuqhLMli JTiny ri>nip ljL~jiEe public 
hejidi ijfTlrEUi' ^biEllle^ In r<h[LLn>l dteipcead 
i>r ijiRtLllju SImibirh i^cl'med [Jjai^i iL-in 
jnL^^fiE leiKler inelczn piJleijUjI InzshCmeLLE ivlL|i 
aihUvimti, nbire ^urh InzziiJiicELE a mcnL e[Tbu- 
Iiie i^Li] bei^ii earlv ^[er JiircrEinii 

iThe PuhlLr Health FJaL-r|PiME^ R^^ni^ Mt 
inHR-Vh L>3n If xarapk rjf icfrU^kHitt^ vfDcU 
nddcEVf Lhtr cairtmj Tbe zclcrJli Iljf bcih^cr- 
ii|L( jjiiIjILt liL^hLlJ] p[ep3iTTJ[Leu m p^ul i>r^ i^- 
h>rrru:cl b^Jlli iLilcin IL ^^JuhL ndcCrew 
p^Tn^i il ^^^=:iini bir hiKpJLkk zukI b^^Eb cru-e 
pnhmc5crh cluTiii|^ cuirrj^nii ic^ , :ljxJ lL iupp->rEi 
imj^mpjLjTmecLl up^frarkm acuJ m Ji i Leci: jk r nf 
csp^iclL? khrhiMpjLib :jkL lii^hlUicsie tu IIlLp^.' 

Cur]e]Jll>. biJipibl piep^vrecEueL^ 1^ fiiQELCcd 

IhrLJUj^h 1lie E ki^piEaC f repnTeiSibeu TTiH^hEn 
^[rrr^, whlrb Eljcluc^lju lmpEE]Llii|^ LhecEbii- 
L~nl 3T::^pL>[LTe Ilj 3 bvr^e-iic^e hi^iEUi erner^^iLr. 
][LiELilE^ ruj] b\ IIil~ IJenEEli Rca^jutlc:^ :Liid 
ber^JLCi \rJi7ii[Ln Ir^i lJi>[L ^EEKSA^, MIT b iiuw 
ruai bv iJae D ETr e ljF the Aunlzuil S^ielsn k>r 
Pi^imEcrEueH^ ilLLd RcijxhLLAe { VSTR^ m mr^ii- 
Li-iEerJ bT Ihe ^iS f :li icJeinLr .ilh L .\lt-l I jj^kIi 
Prepnfcdjjeu .AcL ASTR nm^Lirb cjjje-ye^^ 
]ua][3i[L^ I^FlLjjLi Ilj hiyrplLiU mid LJlhe: heLilLh 
L~n[e izM iElLLc^ liY impTLJ^e nuTC^ mp^ lE^ mid 
L~]]]9njriLe ri>mmuihiLT ;uirl EuiipiLsl pinpjMwcd- 
J9LZU E4>r nLE-li.ij:iT[3«. liiL~]iaili[L^ bkiEerjLjrirm 
aiKl pmideiTiLr ]ihl]u^[L/3 Tlae LuiidJih^^mLem 
1^ vieih^d 7W% tiCLp leclLr Lnb]e ^ncJ EinuJFi- 
L"kztLL" '^■' hEHTfipiETib. rhiili rcLeih^ zu\ mem|^ 
uF V^Z,^^} zi 'iCiu pm bEJiptLiI 

AppL"iKlli: C c uirariiKE up Lknnr For fundii^iUL 
L"n]fTgfnL~i bI^alEh br riE ril. 



i 




LOSANGELECOUNTT DEPARTMENT OF PUQUC HEALTH: 



HEEPING MESSAGES 

Ehcn thiLf^h tliecher^ are idll u nbblif tl^sfinrTcsriLstBiE tint 
tl^lris Aj^^ G«i^De|BrtiTKntaFPubta: l-bJihlUV:DPI-l) 
aoc^ in tlsremEJ^iiy ispomB proycb B^partart ^iora 
ten^ nnd f uckms br Future Altera and fqIcee — m juf t Eh~ 
MINI cr lb (BfikrncF, bu t br vKst pu bk l^th ewf^ 

Se quick eq respord, but keep me^oges measured. 
U|X]n In tconMmatnn ol F^rrcm-tD-per^on ipi^Hl in fleKtci, 
L^ DPH's emer^nry connand openiDD r£ verB actnated 
Thfi cccu rred vseic belDrBtlelinccoirfirmHlareinLcG An- 
^\e£ and vfill b^ie chetfe %%ere arrv mtabtcl^fi^ incur 
i^HDfallu [ieease 1 LirffiilbfCB Actnatirf; tlsemer^rcy 
EsniQid ws mt mEknt as a [kcbratE] n oF abrm bvcrBDi^ 
niton tl^L an el^tiffi fB pame ^ u td ^u ire inirBCfied insr- 
acton nmn rg tl^ m u Idpb urns wthm Pubk hlekhhai ^ell s 
ackxecDlbbaratDn with marYQlnurcommunrtKS apeniES 
in theB9citE£ in Lcff Argeks Lou niiV l^u^ik hleikhDliiab 
Vicrea^^ore they ^ciU read m jerveaf che pnmary ener- 
ganif respa ne BfHny: Bnrgir^ key VKEn^ arxl EHsrr^l 
grr^upi together From the \ery be^mnrrg of tls lespome 
Iwlfed^-^m desebp col^£ r\^ '-^iz^ il^iecgDjb ardphn 
cao rr-roErd :t[K:i^ ro'^ i[^:i 5^[ |-iIc;on. LeiiLise die in- 
cdent conmafid itnctij ro E mta meshed af opera txniE nost 
aiB fam iIht with, and b certainly ode h^w P-:'c '-^ilthTCH- 
tjrriy EQiihiitE busirea, the eaily eeuyiltc n :^lb'^^ la r cbnfi- 
Qtun qI tie Fbw dF inbnnatnn ard tic pnicBS c'^s^nirg 
iBils te^reterGDre imrecGEd arxl in iKhsnce oFai^ c ivp 

Simibrly, wry early into their ra jxuve, LM] DPH erected 
teveral Qtl^r s tepi — Ece^ thiE nypKially only occ ur aFter an 
emefgercy 1^ lad bial inpacL but iher early iniLELton 
greadr impmx^ ou rpfe|urat»iE arri Eet tic it^e br oir 
□rgoirf; opefalDra Ttiq vcludEd lustir^ an ^irly |Dvt pi^ 
cciderercE with Pubk l^ldiand le^ral nlDflrLorecDEn- 
rnsnty parmefE, the Isljied m saldrly t^EEnlbbarHtunand 
firtlErefftplBS EZfid tls nats, manages, and bosE reconnen- 
cbtDrv Very early intn the res FCTce they abn initcited tic 
pnKea to ckcbre a kxsl emer^my and to proent tey inbr- 
matn n Q> o u r Boaid oFS u F^rvsorE , thn albwed branargir^ 
s uppcrtrne TecsI and lunc tn ml optx>rG in ante ipati>n ol tl^ 
cl^lkrgQ they Viou kl lace in die re? pa ne The prsenQtnn 
to tl^ Boand fu rtl^r cbniEd Pibk hlBshhs rr^binchs nype 
□Fewnt aid helped to ampbly p«blc edunatiDml messa^ 

Keep ttie messaBe siniple: bcus nn ^ts ard pmmote 

proEeccrve acCiorES. 

BeczEe l/CDPH leUa pr^matr ^ewoI [ankmc pbnnir^, 
an aF^ wlcfo cl^ ^^celbd W3S in d^ireducano ~d t^^eek:^ 
Tlocnre nESEagB Vi^re ai valie ^lafe H I N I e'^nc cce urred, 
applcabb du nrg, anditi nrg truetocby For irrtans, dieyal- 
^aV^stTQEed doEH E ^vtoiq toaaime tlot binl aie cl^sob 
BD«rue ol a nDvel vinjs — aKfc^ tl^t imxnieztly us^d tl^iE^m 
' bud Hu ' s a^^nym br pmbmcHu' in tin educate rol 
matefob and pbnre^ ctacuTnentE h^^re C2un k ii Hn^ejiarBd ^^n 
tl^s^Te-li3seG H I N I ^ruiev^r^ed The-rpDrtarcaoldiE 
dEt]nit]Dn ViS tn emplBS Ee tint [h^ Qknoc prslct tie OEe 



SIMPLE AND FOCUSED 

□I the reMt pu bk loithcfEE, and tint imE^d ownll rBpfe- 
torydE^eandemer^niy pregoiedrBi s Ii3u td be tie core 
bcus lA:DPHabaccint]nuedla h^blaSabn:^! ^ewnFtlE 
rotclaitnTab dunrg a inmbm c rat promQt]rf; a stiatE^ tlet 
antivir^ CEf> be usad lar m mnu nny-wiile pro plykcE Irrt^dcE 
EEEumEEj tl^ cciu kl aileiE :^ plnnnaceutJiaJ ref F^rBe ta pre^en- 
tnn du nrg a jzon^bnE tlcy itrsfad a bele^r^ral rm p^rce 
(vfslvig lnrct, i^yi|| Icme ^vhen s ck, etc } AbKun^rred 
In^m tl^ cu nenE H I N I sicuatE^n e tl^ nncltyand oannBEibd- 
rtydcia n^t rscessanly ec^aie eo Ee^fir^ Tlsccne pubc ms- 
B^ MEE \D o^mmuni^E lIe prxc ulu~3e^fity pfort aldiE 
pnibnc n tic Unrtsd Sbls (lilessEaiBl Hu j, Bud Irame die 
prewnton msss^ n t^renie tn ^^schbI Hu Flu Eal^c^a 
SBTD UE dEEEe ard e^ry s^on e tie npportinjtyanl the fhb- 
zan to prejiQxe And naw thit HI N I 1^ marpled rr^ i^oml 
circubuHL thcempleEE e SEpeiGlly lebvant 

Wh^tl^ m^Q^ bcui y^fi ^reraP^ Euc^ailuE anaiaa vnl^re 
oKsfc ^ tl^cou kl be better prejiafed br vhie ihe jjish cb- 
mand briBjbred ird^nnatunardguKkmeo mafydlbfeft 
gro«|E anr 30 ^u t^D ~^ Tl^y npdk c^v^bped mry gL^kbn:^^ 
com p^d pici nnacu^ 2s\i [tcu rrn^niL in n i ulopb brgu^^ and 
pEK led out irfbmatnn tlrouf h thejr ^^ srt and cclErclHmd. 
h-b'^e^e^ rtcoittn^a t be ^n or^ir^ clDFer^ ^a eTbclT^ly 
reaih and relr^ne tlc^cbrce or v^ ^r^EiEdii^rE^Ty ol cle pcpt- 
btnti tl^E o^mpne tl^ 10 mdlon penor^ n Iie Ai^^ County 

Every cnsls Ea polsntbl opponunJtf. 
Ibfitm t ad emer^niy pbmen camat n^cffbok tin many 
'liier linii^' tDU~aee\enQ OHkok bel tFiey kete been bnu- 
mte tint ac ^El lo cbte, &Ei o wfall Bevency oF thE cfaaxe la 
been refair^^ miM and ^ c leff hephteffBd aweref^si in tic 
gereral pu bih: oF tl^ mEd Eo preperelbra paidem c and ii^D 
btucd someqiiJiL resolu ten to some polEiy esub? tlotreecbd 
atler^iia but MererscLed intil tic emer^niy arme For n- 
st3ic^ Edioa I Betnrfp lehcaK^E been razognced 3 an en^ 
ronmenc br che pDEental spr^d nFdEmse but cbi irg scloob 
lis tn be con EEfed xery cirefuly a an approaih El present dB- 
ase [ranm BEon, and thr prstJie can l^e Eemn u ninenzbd 
impact on die rinctEinolovrcomm u n^ ft a iBilt af the ar- 
BSEmen? du mg tic bcal rspcrae ilieyft-eb|Ed a c^e on 
Iramew^rk br ich»}l cbsvf and dd nDtc b^ ai^ schcok 
L^DPH liE l^en cbhebpir^ mni^^trie mcxblir^ pm^fr cb- 
sqned to provit a rar^ ol l^p^thetKzl icemnK ani ahene- 
tiKBalutDTE dur¥^ a pnitmc TIe HI Nl ewnti provibd a 
heluabb oppartijnjiiy tD [^ thejr mocy and tn emic ard relrs 
anactol CBparae to ^^lot ^s pre^n v a l^potletiniliob tnn. 

TIcexenG ako alb^od nRkek ta putiherpni^cllu pbnvtD 
aitnn to hi^trly m Etiof^th and b^n to cnn Ekr mpro^efneitfi 
vnlEfecs bckfg TlKe^ntE5Pnfcv"r|yiirergc''ereda<Earg 
panTEnhips and pro ^[^ a ^oluabb oppcr^nrty ED ct^bp r^w 
prnEnhiJE tint red b^nn^^bol^ Pbnrvf; e ^Bentsl b eF- 
b:[^e emefje^^cv 'sporte and c ITcEib sinHd tlst tic mar^ 
lourE spencon pnibmc Hu eie::cts :Ld covim untycolbb^ra- 
ton cnird he 5 unzajlilly tranb^T^ im] a rsil-lt appkston. 



I 



APPENDIX 



i 



PANDEMIC FLU PLANNING BACKGROUND 



1 



^ HOW IS PANDEMIC FLU DIFFERENTTHAN SEASONAL FLLF? 

McHt Anencan aic bjniler wrth seaEor^l Ih a ra pirate ry ilrca cl^ticrricES annually 

S^oiellu kjk appraKMUtely 36,000 pempb in t Is Unrted Stat€£ Ehery )car arxl hp^plcalEES nor? 
d^nTOO.Om, bit QipenE gefEfal^ con der E z pradctibb pubk bekh prr^bbn uncB mai^ pEc- 
pt ha^ ions Ld m oF Hinu nicy ID rt ard a yearly vaccine e zvubb^ * 

A jiarxtm c (fn^m Gree4(, meanirp'Qlalldiepeapb')influefnaGarew3tT^lncilllBlklltf kcapabt 
qI suEtair^ nam m Q on arnorg Inmnn and s a rE£u II causa a gbbal ou [br^Bk BoiAibfrdcfeB 
bib rBtu ral im m u nrty jzondemc irf uenza \^^ll alleci j E;nrf cuncly more jie^pb tion e^uoibI Ih and like 
E^BorHlfu, s SGiy 3 pread fnun peraon o pEnoik Tl^fe 1^^ b^en aL bf e IDmcDnibdIh parrtmcs 
ckrlmtlEpaLUXJ^ra.^ 



PANDEMIC FLU IS EVERYONE'S PROBLEM 

If aie^eie pfickm p: occu rr, it ■ llke^ Id be a probr^Bd Hid wdEspfad oidHSik tlntcDU td reqiire 
■oprcl^r^s in mar^ sstor^ ol ux ecy, f uch aE ichcok, Mcrk, daic ponaton, busir^a , h^th car^ and 
^jnenaiEnL Tie pu bit can grB^ily reducB tier rnkcknrg a pnibmc by hevig inkmned and prepared 
bebre cheefnefj^ficy ~lci he prepjod fn r an oilbi^^ HtE epiiau riga indp/rduak^ bui ipqes , lyd 
com minrtES to 

■ ~&lk with ^ir bcal pubic IssldiolltiBkand healchcHie prDntn, viliacanEipply inbmatnn 
atcu c tl^ Ef m nnd lynptDmi cil a spEcrfc dsese ou [i}f^k and recommend pre^enton and co n- 
ciel^ctjarE 

■ Mapc bin Ir^si/icliDol pr3:TKXs tlet eficou rage i ck empb^s/itur^nti to sby Vome ard airtcH 
patE how tD lunc tn n Vrrth B I If nrfcanc Foni] n cil il^ ^^orklDrr^Echocil pa pu bton alsefic d«e Id iII- 
1^1 ci r cafTf k]r ill bndy menben , 



I PmitJCE fH>xl V^th l^rti. imludlr^ ^Ak|ra bhrced der exe^Eir^ctu^, ardgetiir^fuPcencr^t 
In 3HiuDn, tale com mon-BEfvefito^ b ibp tIb I prcEd dI ^nns iniludirg frequem lend y^Tif hirg, 
co^enrg cougle and sre^^£ and Eoyirg a%%3y Irrim ocherr aE mKhsG p^sEibls when ^du are ick. and 

I Stay inti nned abo ut pamtm c influeniaand hepiepoied to respond ^ 




STATE PURCHASES OF ANTIVfRAL MEDICATIONS 

JiA nfjuihc 1, [ZU09, 37 iL^Ccn ^id D C IekI pun ]93ktJ Z<I pcrrcciE lpf iDurc nf liicLr EeeIctsIIt-au tiib- 

dij^d ^ilLrLrsb In iIek kp L3e In r ur^ durliiEi n paiKlcmIc liinuciijs. 



pu rY huut 50 pciTCBE c r [luf^ af tkur 
far uiEE duf^Bgaji inifucnxa pandcmu 


J] itaCEG kavc purctaiEd J.E5S i±Ba 

fl pcnic nt bF diBrshuc cf 

fcdc r3llf^3uhD<kzEd antiviral drvfi In 

9caclf4iiL= far ec duTiTij an haHucvza pandcmc 




St3EE 


AJI Ajidnrah 
Punhunf l>r 

aa^ii.-iwH 


AJk>Lat]<]r> 
Pun: failed' 


Siarc 


All AnbHfnlf 
PuiY4iaicd by 
Eabtf ai [>f P 

D&5] 1 ^OCS 


Percent dF 

AltidtsDn 

LirckaiEd' ' 




Pisturra 


5] 1.553 


1 123^ 


^iiziXB 


67.717 


1 1 b<^i 




PixLVsi 


7T03D 


1 15 2^ 


C[J[]~i[ici 


215 


D[^ 




^rk^rmc 


H: JC.& 


IJ5J°. 


Ccniectiizit 


22 92° 


629. 




Cahtmii** 


2.773.*>12 


105 2°E 


n^ndi 


177 596 


15 69. 




Ddi^wE 


121.16^ 


MI^Q. 


U^D 


6^7 


AE^ 




DC 


9D.92& 


I55J^ 


HuiM±IU3Eta 


50^62 


75*^1 




Gkt^i 


^7^^:: 


52^°E 


Hntiru 


9.174 


Hi^j 




hljiA^ii 


171-^7 


IJI^^E 


ridnda 


71.952 


39-*^ 




llEnai** 


5lbOIE 


50 3Qd 


Hcwr^uacQ 


77.«r9 


59 J9. 




hdaru 


[>5D^I2 


100 \rj^m 


C4lah£fTi] 


^3.765 


25.59. 




b^H 


511^31 


IDI 2°. 


Ocpn 


2^.525 


7 19. 




fbnnc 


^tD^-l 


|[»^°. 


nKdehdmd 


1 1 900 


IDJ9. 




Ka>[LJiJi:^ 


:l^l:^ 


50JQd 


Utih 


52.035 


21 19. 




LxLuaisriJ 


^7B 73^ 


IDIJ^D 










r^nc 


I6^«? 


1 I9fl^ 










Mar^d 


-HI B5t 


65 3-^ 










r-ldTgan 


1 079-^0 


102^^.^ 










Mrri^sc^ 


540 900 


b-l Pd 










r~1^a::5:ppi 


j3BMe 


1 IIS^ 










P^Miniri 


[1O0-F77 


1000^ 










Nnub 


135.3 M 


57^9d 










New hburpd-TE 


6B1100 


50 3^ 










Ncw^"=r 


030 293 


97fl^ 










Ncw^itrt*** 


2 444fl3& 


121 2^ 










Ncrth CordLTEi 


677^2 


?6 7<^ 










No-th D^on 


57noo 


65 7^D 










ct» 


1 36 956 


1 I5 7^D 










f^nxffinrEi 


1 2^6 ": 


lOOOc-D 










Siudn Cardiru 


459 9^0 


l05i'^D 










Siudn D:Aoa 


30 310 


lODOc-D 










TmnsMC 


olJTUt 


lODO^D 










Te=kz 


1 U2.24I 


7tA^ 










lb iiEiiL 


71 [r3o 


109 3^.^ 










HvA 


B26.445 


107 Pd 










VfriJB^tm 


^3B253 


E4 1^ 










VfertMr^rut 


246 -»52 


1506^ 










Vrtscoian 


565 729 


&5 3aD 










Wpcfnng 


7^fl2^ 


MI^^D 











MtfE *T}r [KrunC /r|lK£i C^Cnl dolt iir^. kid I iijTC^BExaiiyiTnf iict^ majtsi^iH] diilE ^Midvma, w^kiV ^ vrl^ »7t ddH c^m^ 



APPENDIX 



I 



APPENDIX 



I 



FINANCING OPTIONS FOR CREATING SURGE CAPACrTY 

Evcih l]] 3 siTlc m 1^ I [h u]]l>crsjl IicjJlIi lEQur^uict^ coverage, [hr cqsIa Dfcrc^iiiikg 
AU]^^ c^ipjcil^ lij [he mcdlcul czirc^^Crni ^ill be ^o>c :ij]d bcvaud \hc lkujI 
ti\'!Ucni orrcLmbLirscmcLkL Lo prcnidci^. Therefore^ 31 h addJuoihal s^^cm Lc ItihaiLcc 
Lhc crcjLLoLj of sur^f onpjdL^ yn][ be hi needed 31 hd cuj] be ^d dressed durhig Lhe 
bc^di reform dcbaLc. 

OPTION I : Establish a Preparedness Program under Medkare and Medicard. 



\ E' rcji^cdi icu E'n>t^nim liur^u^h Mc^Lii-jjc jLiilI 
MccLir^lii r'lukJ h^t fT^jhrl li^ IhcLp h^j^plljbsLiicJ 
tv^Lhh jhnn \r5cn up^^rsrJrrqu ipmc-aal iimitiirur 
ciivc^^i iric^. Liihd Lj> jhrLn ltIc n liLLII]]^ Jim bui- 
ihbjTi fciT care durbiji 4_iiB_LifL ibr l^n. 

Medkare 

TliriL" Li p rc-LTxIc-ELCc fur injihjf Mc^lltiec f^jL A 

I liii^ihlLsl ]iniaiajiLcJ [lj mmfidiELC^ ]KKplLiEi bif 

hH^tKT UpCF7lll]]L| LCllb ihci llbT UT ICL fllTh^ L^JjIhJf 

i^~r\ H d In [Dfv-ti i[~i>rnc p^Lmili. ^id c^^ii uiaihjf 
^ ]>.~L I iL~;vrc PnrL A [ri pccnuT^^ nnem lr> euro [fix 
Mc-dcsnrncuJ hjiv-likri>rnc pi^putJpiin.l^ TFicDtt- 
pic]jKhrLujiE3[c SJinie HmpithL ^Ll^'Jj PinnvriiLi 
jizc ufecri [ri jniLl^LUr Lbic [liinjriLEiiJ dbilJT^K Uinl 
i^jcn^ iKapjLih cxpcrLiziiLe iu hcrilih^ ^^^'W clujt^ 
hen chF iLPW-liiTunvr, ucLLiuLim] i>r ujjdcrLi ULimJ 
p^lJciLti njjil MciIxlJC 3£l<L %[rdLLTiid jiirlpLci]li 

Mn3Lrm^ FhirE A Ieb nlbu Ikxdi u>^J Iu rnmjK-EECil^ 
lc=u tiling IbUTpiETili Jnr |Jil~ hEi^irr nnh auL^bilLiJ 
ivilh ruihCLUdi^ LfFLKlLrilr JnrdirLil ciIutlIIIj}! 1 pm- 
j^iajin nmL LTlIii uih^ iTmlkL~^ icnkicihti Tl ilt IhLi^i'L 
r^Tvl u 3 le Medical RcEuiTilichi I fChTAEF.) pEUTida 
p^ mcTLh [ri EunpJLiti fur iJac ciHb <h[ nppicJTCzJ 
^fia£jiEilE~ irvLTJE-^ crJuL'^licnj pccj^p^mi ^^ %[c^iib- 
H^iilr. EficIiKllniul Xlcrik-^ txlucUiiii {I^EF.^ prih- 
\rJ[-n :lj] n-b3iLkhi lsI pa^rruniE kh buTiptLifa iJaL Einic 
i??.kL^i I La ci]iii]Lcil 111 ChMF. picjjp^jm. Li> rrfkxL |Jil~ 
lhi|i^hrT r[nL4>r p^EkziiL cnf^ fCKb uE tru Eiiihjf hiit- 
pllsh i^tilh^ [n I icTEb-bmc huLCf iKupritilr 

\ [Lc^h rnriTV^ Trcpar^iK-u TrcTifrnjTi iiapuCcJ 
jiLhhm IbinpLLil^ \£s jjh.i_L ^id jiciliiLsiii ^iilioiKcd 
pc^paicdcHini ncLECiJjLilfaiaa iLukcbiml^ ^icJ 
MciILl'^jc CLjdcn i>r parbr IjviiLiJiJ. TIbc pTLtfT^xn 
HDuLd ILiiL px^in^iiL \i7 jm ptlmizh iELv<hLTbd}{ Ihr 
HHS Scr rc^nr^ rlcficLti |Cf Ube Acupc <h[ nEln^^Tiblc 
pr^piimJiHiin nnh O^^-r^ll, iJari nppiTRirh ^a^juEeJ 
be^LjnlkiT k> UicHc^LJUi rr ( E EETJ binmilh^ jtwx^I 
iLLr]ui[cd lEL Llh^ \jiirrLc3EL Rnrjici ^ ^iekE RciEb- 
\c:nLj7ir[LL \l~I Ljf EZf^^ Tbic I IIT pitti^mn n iilpE zi 
line J ] 111] J LI [ ^^uhl pccjifcim i^hc3L~ ]»HpLl:Lh Lipp]\ 
hhr iiEiiicy lu do L~cTtilii Uhcuip mid cumjTcL^ kir 
dnJbui. ck IL La, bubc^id^ like si luL nf EEi[ii|^ 
fuELcicd cj]9 Llic JiELJjd:3liir> ^LeIc. rnrmutk-lKiuiEE 



] Lir ] l\'i ]i]iuII]H^ litrriLiiLi n Il^u-^J i>[l h>jijhiL.Lb 
Mcilk.ifr iMlIic lIeicJ MrrJiv^irr bcrJrLih^ The frir- 
jhuLa i liIi utilki]] jhctiduEci j dii]bij jitv^lliiE [hs\l 
jih iikriii Li hixil luiipLLiJ Li jblr Lj> ^m lcsa it lL t^j 
jhctnr LJuE iL mcrb cctEdIi] iJirdhr^Lrlr Tciw imzLiii- 
iit^uJ cicrlfciiht hc^lh rcucird tac The Ifursh- 
ulcb hK>uU EicdciiEurd by Lbe KhE^cE nHof 1. 

][L Lhr pn>p['rKTL McrlLi^iEC PTrpanrl [Li~:u Pjn- 
LpiicTL, p]r|LajrTJ[L£7i jcz ircIlLilki]] 9 Lxiikrturli ^cbd 
MccElcorc'i btf 'ripJtiL riHJca nf |Eu~LJrtpaLki]] vrtiuLd 
be rc^ Inh^ii ^uuJ up^tjlrrl hh Lhr HH*^ ScurcEikrr 
In ^LrcEtj^kTih Ihr prcpu rci Ijjc^i rrquLrcmcihli. 
FLnlT^iir ruixJbi^ ihT -u Lf I tic^i^LiLilLt Uv lixJhvLLciI 
hinpLL.ib ihCL u E4>rmuLi-l]JiD if Lbcr pnidu: rd au 
ai Eli>[L ptiih Tc'W Lhrdi j^i^pufcf li icu [i LxUhCLuaK, \hc 
■ropecirivtili bi iM luLJ lif ddichzd hi Lh^HI-ISScu- 
i^tiTh E]] iulncT]Liciil I'c^ui fr^rjuuLk-lLiKT I fLnid- 
ict^ihTiuLiJ lie Ln^diAbLr lT iikrlnorJuiiJ JiinpLLilr mcl 
pi^pomljjizu ilmrLurc oihfl pmcizii LjcitrhntiTL 
iiETE^urci rtrLiicd Ei^ Ihc HHS 5ct rrlari Tbic Rir- 
inuL:3 hiT>uJd be based rua binplL^di" Mcdu^irc 
iharc 3iul Mrdiczur tic-d d;ii^. The HH*^ Scure- 
lun hm>ulr9 }^c rcr[uurd Iei rrpi>rL lf> Ctnat^c^i 311- 
jaiuLh ihCL Ihr idc 4>r prrjiucdcHiu pTr^^r^ua 
dcilbn, ^ifud Li inir Ilh^ nul^ rizr^jnunciirbAl L acu 
fnr unp iM\'c-rTK~]9li lii Lhc j^ntgram barbxJLiLi^ Lid- 
dm^iicL^ jELi ibccci E^ir i~.iTuLki]u Lii Lhf fiicidbis 
rnrmuti bavid nji gcr^^rajhlh^ mk-aucairmiL, ezIt- 

HedE3jd 

][L nrdcT Eu rczich chiEdrni ^ hrapJLiEi imiE Ectrp- 
liLcrMid by McdiL'axc- EujiplLii] p rL~pn[CTEi lau jviy- 
incELLa iJiOLEld CLCcd in iibrhifir lI p:ir;9lLc~l fucirEbiEi 
aLectltti b] VEcLJjr^Lxl 

MdElrnuJ Li ii jiiJiilly fuaxirri, r^rml-AL^Ec buiaJLh 
am UI71EH L~ pitiifmjTi Inr b->iv-ti i[~i>it^ rEilklcccL, Lhc 
3}^l, IpEbrid. oiKJ/ur dLmblcrl, ncicE nElbcr pLiapt 
i^bu aic rlL^iblc in nzr^lr^ RlIlj jiEi. iUEilcd Jii- 

cnm^ iTLiuj IniTij iLC pnTJTKi I Li. VErdiLTikd n a aLjiEc 
nimiELkErcnJ pirii^nim :ljkI caL'ii aLziIcacLs ]h cjwii 
L^LJrlLiiL^ [L~^Ljdb]L| cd^Ll>LliC^ ncuJ ACTiirc^, hnw- 
c^ct; Ihcl^dcrsi j^hicrihETiciJ I nrLi a juli 1 Ijhu m ui- 
3}{ibaitli nrx>r CI ihurud|f n Lcrtibj Ic^in] cth^^r^gc 
In kcfcirl pupLEL:3lxhiii. 



tti Ihc psiE, ^tcTlkLi»rl tun iKTih mcrl If h i^ijnhiinc 

Fiiuhirlcn ti] jtxtIuxiI jtvinLjiKr. ux liKLjh^^ hnfij- 
Lnfa^ far balnuLf u~[LHT~ uj^f^.irks. Fr^r rxsmpLc- L i 

Lh[3[ [1 mi, ]r^i ]rhr n L^ ^ pcicccLL ErdcmJ { ] 1^ jx~FUd i L 
itiJr^ [buiircil porCLrLpaCuhii frir Lh-rdc^it^h dc^'cJ- 
apinciiL, tir Lu[^tiliiiih 4>J iJic MctJu^vI ^Li[L^t|^^ 
men I IikfLirj7i;iliii]] Sh^Ecm OiMJ^h-=^ rnrr Ji^uiIjvtI 
cbjLm prT:rcuJih|d; lUvL iiht^rnciLir^i i i^EtLc^^ i\^lnTn 
^ppni\'CELh^ lU'L^ The Lima^h fin^vlcrJ.i Tr^pcT- 
rciiJ fLili-E-U {'—^ pcruciLl itiEc^ ILluu clI p^uU: Ip^t- 
[kHi law lbe4>pci^Lliou [il IheMMIS. 



ih4Uld lUlbbr n H;^^ prrrcihl Ecrlri^l rrulrbi i\i 

LbicTC mrhtild be ]» hzzbuel lr>r^Lnlizi \n npl uuLof 
Ibc pEr^fTLim The Ir^^Liliitii rihuld ,jh^i Jih hsrlc 
rrT=j|ii>ih i^r J MrdL^mi Tclmbu ncmrcLL ]r^j Lti^ 
iLsIc hizzitLh drjizkrlincj I L 1 nilc Eil admLi i LaC^i icL^ 
^]r9c^>i>rLljih^lLJ]K Ibic li[~lv pr^^t^iiirrL, :h9 dc^rnbcfJ 
LiJrr icL Lhc t^i^iltl IJJi li^r Hcimliuii^m^iiL siid 
Ebbiidzifcfa ri>r Sui j^ C_apari[Y icrlirnh. 



OPTION 1: Un Direct and Indirect PaymcTits to Reimbum H«pltal5 for 
Surge Costs. 



The dfnduEilc McrJtL^ ]Ldi]i^LlLriih t C\W1l) prr^ 
gruin rurrcihLh toc^ bctLh^lLm I .uid icuLjcil [uy- 
iTtciili lu rrdmbune lizsclhica^ htnpLLiLi ri>r Lhc 
nnE rhrcrJti^Llb]^ mrrlH jU iIikIoiIi HJcc^l Lrsd- 
Li:3lc Mcrlb^il t'j Lur^Lif ^]] ^^t^Mt'^ [im\klc] pjv~ 
mciili \£v Lir'riplLil^ Jhr tbc rcnli chf nfijircnfil 
|d^.ir9ii3[^ rncrlK jI rdiKLiTlr>[L |i9r»f^T^m. hrciiib- 
ivtitlr^ IiicIjtttC Mcdlr^L Ljlur^Lkui |[Mt~^ prr^ 
ikkmui dcLUItiiclI p^^ jt^ciiI In hLnpatLli lKiI hoie 
n^Ldnili cihntllcfJ icL tiMh jhnii^jJTU, 1r^ rclln I 

Lhr hj^^KT cml \>Z pulLcihl cjj^ crj^Li ctf Ec^u IhLiig 

hmjiitLii i^bllvc Ici cK^ii-lnx hzu^ LirnpitiLi ^ 

The cni^l^u ofn DLmr.! l^rcfinr^ihuu Pjmnn]!! 
(DPI'h J[iLl][irJin=i [ E'fr|hLin:cbii:-Li E'-lImihtjiIi (] Pr ^ 

muLr] Ihrlj^ r^lmhunc hii^piLili Elit Ubc ^lircrC e i^nli 
cif [iTY-pnnirJcHiai, 4Ljrh za Lhc puit JLh:^ ^^r^^Li^ sup- 
plier ^irS L>ecb, .uxJ prT^\i:ir hii^piLili iMllh l1 itukJ- 
crLmlh^ij rinr39[ ^zw ikuznz\^>ai^i\xi^r>\ builrJiiJi^ 



■j-iirtw^ ^arl n-rrni I liwr ^i lUT^ ViT irLTr^rfC 

C.raalcTT fnr Medicaid ^jd Medicaid ^r\iLr3 
(CMS> fcitikJ fed uji a iK>i MrrlL^ur- bdlliu^ mrt 
[ir u ] It^irn b f!f Lilrrl 4 j i hiip U'4C C r> ^ir^^ ^ih l]ul 
nMibi be lacd hi irinhbLmclunpiLjh Eiir d^piLiI cv- 
pcitfUliinzi ^kJ itiTTuTi^ lor bcnpltiL pEcparcdctcsi 
Thti Lippnia h vrtiuLrS Lst r utmc^ li^LLruj^ Ir^ im- 
pLcmciLl ]>cruiuc~ MctIh^uc CLirmhlh rkra ck^I rn- 
iji]biir>r Lhn>u|^9 Dlltr uihc^Lilcd IrhcElmrl^LiccLl 
rii[i~ Liibrl I tic pnxm vrtiul~J ]ci|uirr nu^nihi^ jij- 
diUihy <iJ lunpiLih ■~_\f S ri ^iiLf I L^kcr muir \blbcLJirr 
lixJ\iiiK prcpoiudihcsi LtjL laih^rurrLr u]um icL phirc 
L^hiikl lie irtinbiincri ^uid pciicipi \ilK~LhcT bcnpl- 
Liii i i>LrlrL illljl^^cl jrLdiUr^i mI p^imciil lf> rL~ivcr 
Lhr hL^icr nnEi HjflJ^baii i^ lUdfJcL cjncrKciu.^ pe^ 
pEuniihramiif 1 4ui^ cjjEir LJi EcuIi[lLc|lhi]. 



Eligibility brReliT^bursement and S tnndafds Fctr 5 ur^e Capacity 



C_M^. az C4 ti ijui iclku] ivlLh Lhc AudLiiiI Sc< irLiri 

fur I^rcjizkfcdihcr^ jjad Kcspuiks^ ( VSriLj ^cui 
ciUicT ^ijmtpTi:3lc~ porli icn. cciiiici dc^cLip il^ua- 
d^rcfa zuad ^pjiricl bacr Ei>r delrrmbaaih^ buLbi lF^ 
hoiplLiI ihr>uki be cUpblr Rir ^^ikI a t ,i^iah\n 
cif} dd'ckipJii^ ruEyc acid vrtuiE lur^c r^pncali 
c?9l^i]i9 ^lJ]i>ia^h C MS mint I pctn Idc Ihr rcLm- 
buncjTicihl mrj liLiJiimL, V^fll, hdlh nipuL Irr^m 
CrKtrdLiia[LL>^ Omr^ far Tcrnhrhm Frcjiafnd- 
imi jjad t'mcc^^ac y Eldpnivrf fCUTPtJt). 
ihould i^\mfc Ihr pTi~>|^Jin ^cici pruh liic r>\rT- 
i^hl ^ad Icuhaau ^ ai^LiLiiirc Ej> ^LlIc ^cici Ih»- 
pitiLi ^(•^ ciaurc ciT\nii.\ A iiujnbrr r^l luun l±uiL 
vrtmkJ JicT-d \£v he LvJrJrc^tccL Jibcturlc 



I TKjih^^ Lhr nikrmkj]^ pniccB , a rcrliQj^Lk>i i 
piucim vAiuhd creed In be ^trelnpcd kh itilc 
lar^Jllh ' lc~|ELrlJ7ici 111 t i>Eilf I ^^clcrmJibc J a hmpJ- 
Lkl Lid^Mc~1r> puflripaEc Lii Lhr jhcr^i^i^rn The 
iLilc hhThulri Lni^ L ilTh amiuul Ihc rcHu^aiai lacuri 
frhr lurjd^ Jivl Lhr cjjEicili nl icu Ij^ tdiiTiJ iunpJ- 
ia£i In [mfl^ipEsEc, lEucd nii 3 rLnic-i^vi^ p^L, 



I ISTR imjukl ijciid In dcrrlup i^Cd^irc In 
9L1L13 [<iT fLKhrdJiCTlkiii ur^iLiI^ prujjmin, Iji- 
cludiihjf rLimmuaaiLTillDCL bc[v.c^EL hcMplLik 
[rp^j^ncL^ i>r TUTL^ prLJlLhciah, dcp Il>7J7k-el[ i>r 
^DcEr, :u|d ciLtu=r iuiic:^ 

Md onitr Tq lU-L-ifL. i^mbiiTvzn^ciiL, huiplLiLi 

^iouLd aicnd On n^cd prcpiinitJcHiiu ^LicLcbird^ 
m rlcCcr miiK~d br E]9l~ [ctIttsI ru LcmzilLl i |Cf 
prucciu tj:iLmp[iz:h icicludc tciiLii|^ :l hixiplLiI 
p rcparc^cHini runccCI 1 Lilnr. a hm p I LJ-ipcr lJIl 

pbii LtciL n iippTi>h^^ 1'^ LEic TtiLc, mi iciEcKhfj- 

CFublc rnmrriuiikaEKJiu xyiLcz^, ajjcl a ca]jU~ 

ILUllT LI I CpCT^lKJ 111 piail. 

I Df ii|4Ji.iJ[L|^ Ich jEulL'Lj^nic, EunplLkb ij.t>uLc3 biv{e 
lui^fTU^ Li> parltlpnic ][L a nti^r nurj^ piEK^Liin. 
Ii> ]pcrLhJEdii nUicI by lJicnti4c bit~hlltL ricpor Lincihl 
miLh c^b±uLcciB*d liich]iL~jL:tuLit;uA^ Eirjm HI~K 

I PiTjr b>rTc.ilbhg Lhr ]iiMpLL'kJ picT^nrnJcuzn blUlihi^ 
fLxIc, {JVtS ^4,cnakJ hn^c 1l> ifrEcTJTibic ]L>r ivJ^hL 
iEizin iL^^ukJ be ^^dilbdj^lu iizipibuEic L4rKpjtiii. 



I 



Endnotes 



Pc-evibjI rh3rrcvpi3HE^iiEr hIAi 

D bcT biT 11 r ^V^ lllr JL klH][t~HI 



] itU Fk-m b||, M D 
ily ruli]b]ln1Ai Dc- 



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Imp irvif J aH J ■■■ SlNld ICEUTII 11^ [U ■□■- 

£]i<*TTviiTi Vxibiii^kiii, Dll TinlUii ^JDciiji » 
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rL S ltrpiT[mfHliiM}nj1l1 
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1illp wl■wl11l■^■^ Dc-PT^ p n 



Dft lEl 



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l£ SIHHI 



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pJ^*-l 

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]3IN I [dDuc-h.-u ^mi lur LJc-wbi^Hc-ij I Vr^l^LrpH 
^DC-nlHb^ aor] -^niTwn^ !^lnttu]C ibDiiLri infsi^iiac-h^ih 
^\l^t- wwir nnlk^ViaHLifc-rvkCMa in ^11 ^ KlILIhl ^3 
{ \l r^iilhi unhLrpq^iiT (■iinKTJ^IuxlHJ.LXHKq. 

kkL . 



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Iriv li ^n , [Lan Ldi J 
■ 4 ruDOLiJIn- biiin 
mi ai-v^ri! uppaiip 
-k 



i:^ I rlLi-j li HruHbiE hiuDir Clin 
riu3v^ L HhED ID lELj-r Mmi5 'TK-mmUi r I 
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h I 1 J> hriiu Uivk aihuH jliag Eij3 mi arvi 
^iaivi khE Llr BliinniH^I U^smr-J Dc-K-khpinnl 
tEsnai L Ku \haw Ih , PiEir 7, i^>IL> 

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Hpe^l»V^m»ry 

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iHihc-EiimrHl lirbiim [ -S. I Ieih- eiJ E^-f ie-iw-hIil 
ibhTu ^^ukiii^kiii, IK 4~uu^i>^ tjavHLy KiuieI e3J 
lli-a][^ XEix IM SH>'I 



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f^ ^rrrT^vxtmSW, ?.[yi T IMXILJ 

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liElp. lEWH J K% h bfl jpjq ^vLrla^HlK-iitJiP^ lIIT_^ 





I 



ACKNOWLEDGEMENTS 

Trust fci r AiTiErkB 's Health e3 mn-pfcfr^ ncn-partEan Dr^nEzztn n dedczicBd tozavirg lihca bypm- 
tBcnrg tie bEsihli ol E^iy conm u nitr arri ^w^rkirg to makedEEdEE pr^^ntc n a r^cn r^l prDnty 



The Center tor BfasecurFty s an irefeperitnt. rrs'^reilic cjancatKin of the Ujwerai^nf PstsburgFi 
Madc:^! CencEr TheCEotErviCifiG cm al^cFCrcv^'viprTt^tcE in^^ay^ tine Isszen ths illr^sE [feath, and 
civil dErupton tl^c mc u kl bkw bige-Ecsbepdemct, wittier they occur natu rally or nd u Ic fio m [lie 
use oF a bu bgKzl y^apcn 

The flabert V^nd fohnsan foundadofi E)ci5E3 nnrhe pr^ssn^ h^th and baa^h care gz us faci^ d u r 
coiitfry ^ thf niconz brgsx pij^nthmpy [fev^sd excluziwly b npicving me qual^ ol lSe health and 
hsich c^r? of all ^oencar^ , tl^ Fo u rcbtn n y^rks mkH a dr^ne ^n^u p of organEzatunt and irxlivduah to 
dsntily solu tiort and ac he^e com p'el^rG ne. meanirgfil and ^imeh^ cIb^^ For mo rt tlran 35 ^ra tfe 
Foundaton hcG aroughcexjienEnce commicvtEnc andarigon^uz tabnied appfoach to tl^ pfo bbms tl^ 
aBECt tl^ l^th and h^th care o' tfnze re zervEf When re comes to l^lpir^ /ijnEmarG IbkI lather 
lrvE± and ^ tl^ care diey need, die Fou ncktnn expecti m na^E a diFLErenie in ^ u r li^ime 



FiEPOHT AUTHOFIS 

f z mj J PIT rj I rrHf r 

TroiiL li>T ^J^^ rr^'i HcnJCh zukfl 

TIe Cjcuc^ UoihluglJiih L [LJ^T~ntli 
&h-fj[MrP«1>JLL E[i-.illJ]njft]1cTiJUi&rvh.n 

Hmjinw V. [B^tHbTs MD 

Mrdi-.il Cririrr 

DrriT^^ i J /^A/jr L/jfans 
Troiil li>T ^J^^^^^~l Hc3]Lh 

SciFEEL AIbIl'e; MH? 
TiuL Flm ^mrrr.ih llc^kJcbi 

CONTPIEUTOFIS 

-LUPTH^ 

Mrdi-.il tririrr 
KiMitKrt^EEki[l«U.-V 

Troiil [br ^mr rcs'i HizzilCh 

Ontn] FroflLD 

\ Trd H .il Cridcr 

Gl[FlKHibC7rDj]T7iIl| PfaD 
^ujpr Lupmirj 

fFfcilk^QridJir 



Abd NDnnod, MDh COL, L^A«MCcRr[| 

■SnrjBr Lui^rvidf 

Cknhlrc Fur l^-WTTHTLlT erf Lif UjiIkhiLt erf rilhbn n^ 

^Fnlr^JCf jairr 

Jcjui \I*ir Nnzu+ fM 

-Lui^ruidf 

C^hlTE iLjr IWiKTHril^ rd He Unh^E^f c^rilbbsT^ 

Vrili:^ CciaLTJ 

Snrjdr Lui^rui^ 

C^hLrr iLjr l^-wr^HTLlr utl Iff UjalKHiLr utl rilhbn ik^J] 

Mrilral Lriairr 

Snrinr LuiTPn^ 

Cknhlrc Fur r*.«rrHTLlr nTllE UnKcnKr nrrilhbD n^ 

Vrilrsl t rialrr 

PEER REVIEWERS 

iDJ|fAer ^Th pJrruriPLU fr^jrairrV ru thrnfM'fJw ttai 
vrfjisn'r^ rrYp.'aj7jj i^ ir^nci tf i^ unlp^ir^ii^iA pr ^r 
HT^irrcrjpii lurJ^ ~^rrJJ J^h urr r^upcmiVdL 

OnU Fk-[iiJa[^ MQ 

^"^JlLr iHii^tfl imiiFv, \^ dtuc^LLJCL 

Rjihertluidbi^MQ 

/>rinr' ^iVraiiJ. Lun/rir/ Jp ^lir J^b irf/ir/ |tr ^fDrrwJrnjif 
SrirrrNj 4mi4 "HJirDiriTti ^ A^r ArdAr^^r^ f ^^^lu j /^fui 

^^d njnri a rvfiJM/ffit if o^^ntfnt^tfAr^armWaart 

^rf dJnur d^^Ar iJ^fAp[T ^di^ Jp ^flt ufra^ttr-^ ^flfcA ifw 




' TTU'rU;vsT[c;ilth 



www 14 E ALTM Ti^±1 E L| Ci^Nf QAE 

l730USlr«l, Wl^. Sultr9l)l»"WiL-JibiLgTr.[L.DC ?(l09fi 



TFAH BOARD OF 
DIRECTORS 

Lj>VE[]K^tltE[,Jr 

FrivT J-iirmi' ^ \rH]i^r 
cru^ Ljdr^fl-Nir i/ 

£ PJJJJiTlTcTjJ 

OHlhbM Hurrkn 
PblXDAHT 

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^rij^pr 

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Rdrkb OinnuBi US,JD 

TrriiTU rrr 

Anjjkuuj ^PDnr^NPD 
Cafl Cbrlf Unptu^j; DN 

^'K ^^A^^ ^vn ni^lJLin 
Jahe Mf. Ennk 

^libnr Ceieh] eii Jrg 
hlEX MPK 

E^jcTTfiiw ^ pj r {^^a^rtfJiX 
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nf/ietiU/^i Srmitr fiuii 

Elubtrn T tlnrrK NtD 
J^rriVT I Ar^r ■liA^frc^ 
Offitrrftwl ^^vp■^ 

Aijhnjh PhuEK UA, 
MP]i, FID 

iJjnr^r, Liut^i^o 
PiriKrrpHfrrcu uwrt 

TkuEL4j FE Spcjifcr 

^^uln rrrJilapji rrfi 
f^rjWur fZpr^Eui/ 



I