Pandemic Planning in Ottawa

What has Ottawa Public Health done to prepare for an influenza pandemic?

With avian influenza causing sporadic cases of human illness and death in South East Asia, we are at risk of an influenza pandemic. The World Health Organization has urged countries to step up their preparations to address this risk. Ottawa Public Health is proud to note that it has been working diligently in pandemic preparedness for over a year. Here is a brief summary of what we have done to date and the plans for next steps.

1. Engaging professionals in pandemic planning
2. Co-founding the Pandemic Coalition
3. Promoting best practices in respiratory infection control in physicians’ offices
4. Promoting best practices in respiratory infection control in schools
5. Organizing three case studies with multiple agencies on pandemic preparedness, response and recovery
6. Establishing a Pandemic web portal
7. Drafting Ottawa’s first interagency pandemic plan
8. Engaging the community in pandemic preparedness activities
9. Informing revisions to the Ontario Health Pandemic Influenza Plan
10. Staying abreast of changes in national and international pandemic plans

Next Steps

Engaging professionals in pandemic planning

Within weeks of the release of the Canada Pandemic Influenza Plan in February 2004, Ottawa Public Health hosted an interagency workshop on pandemic planning. We had federal, provincial and local representatives give overviews, which was followed by local discussions on how to proceed with pandemic planning in Ottawa. All agreed this would be a complex process. One reason for this is that health care is highly specialized, and there are many health care providers who have separate and parallel mandates. For pandemic planning this includes infectious disease specialists, emergency physicians, intensive care physicians, family physicians, paramedics, home care nurses, pharmacists, and community health and public health professionals. Others, such as emergency managers, social workers and funeral directors are also implicated and were invited to the workshop.

Co-founding the Pandemic Coalition

At the conclusion of the February workshop, there was widespread support for proceeding with the formation of a Pandemic Coalition to address pandemic planning in Ottawa. The three co-founders of the Coalition were Ottawa Public Health, the City’s Emergency Measures Unit, and the Capital Health Alliance – a voluntary consortium representing Ottawa Hospitals and other health organizations. Two priorities identified during the Conference were the need for a web portal to assist in interagency communication and the need for some case studies or “table top exercises” to work out an interagency plan. Ottawa Public Health hosted a follow-up planning workshop for the Coalition in May 2004.

Promoting best practices in respiratory infection control in physicians’ offices

Colds and flus can be spread in the waiting rooms of physicians’ offices. From January to March 2004 Ottawa Public Health partnered with the Family Medicine Department at the University of Ottawa and, with one-time funding from the province, conducted research to assess the effectiveness of nurse facilitators to assist physicians incorporate best practices in respiratory infection control. All family physicians in Ottawa were invited to participate. Public Health nurses were trained by the University of Ottawa in facilitation skills. The research showed physicians appreciated the work of the public health nurse facilitators. Of those who participated, there was over an 80 per cent uptake of best practice recommendations. A Continuing Education event was held for physicians in the fall of 2004 to again promote best practices to prevent the spread of respiratory infections.

Promoting best practices in respiratory infection control in schools

Ottawa Public Health has been preparing a curriculum for elementary schools to improve best practices to prevent the spread of colds and flu. This included an extensive review of the literature, and consultations with the provincial Ministry of Health and Long-Term Care re: new recommendations from the Centres for Disease Control (CDC) in the United States regarding alcohol-based hand sanitizers. Previously, alcohol-based hand sanitizers were used mainly in health care institutions. Based on recent studies and a new program developed by the CDC, we have become one of the first health units in the province to promote the use of alcohol-based hand sanitizers in the schools. This new program is being piloted in a small number of schools in Spring 2005 and will be launched in more elementary schools in Fall 2005. Alcohol-based hand sanitizers have been shown to be over 99 per cent effective in killing viruses, including influenza viruses. It is an important infection control habit to promote now.

Organizing three case studies with multiple agencies on pandemic preparedness, response and recovery

In the fall of 2004, Ottawa Public Health established the interagency Pandemic Steering Committee to help inform the development of three case studies and the web portal. The case studies addressed all phases of a pandemic from planning to outbreaks elsewhere in the world, to outbreaks in Vancouver, Toronto, and finally Ottawa. The case studies were held between November 2004 and January 2005. The final case study included a second wave of influenza and the recovery phase. Almost 100 people attended the January case study, including Coalition members and representatives from neighbouring health units, and the province. This was very well received. Again, the complexity of the planning process was noted, when the implications were explored of being at a provincial border, being a major referral centre for complex hospital care, and being the nation’s capital with extensive numbers of federal employees, diplomatic corps, etc.

Establishing a Pandemic web portal

In the spring of 2004, Ottawa Public Health received provincial funding to develop a web portal for the Ottawa Pandemic Coalition and to pilot a “Secure e-mail for Health” project for the province. The web portal was launched in December 2004. It includes a registration system for health professionals who can then receive e-mail updates on pandemic planning related issues. There is also some basic information on pandemics and pandemic preparedness for the public. More information will be posted on it with time.

Drafting Ottawa’s first interagency pandemic plan

Based on the three case studies, the deliberations of the Pandemic Steering Committee, input from emergency planning experts, and the City’s Comprehensive Emergency Management Plan, a draft of Ottawa’s first interagency pandemic plan was completed in March 2005. The plan has already been approved and released in September. It is consistent with the national and provincial pandemic plans, the City’s emergency plan and all relevant legislation. It is an “umbrella plan” that identifies the roles and responsibilities of all the key players in a pandemic response.

Engaging the community in pandemic preparedness activities

The case studies highlighted the importance of public preparedness. In February 2005, Ottawa Public Health established the Community Engagement Steering Committee. This includes staff from the City’s Communications Department, Emergency and Social Services, as well as volunteer organizations, such as the Red Cross. The mandate of this Committee is to develop an overall communication strategy for the public, to launch an education campaign, best practices in business continuity planning, and a volunteer strategy to assist with the pandemic response.

Informing revisions to the Ontario Health Pandemic Influenza Plan

Pandemic preparedness includes coordination with provincial public health authorities. Ottawa Public Health has several representatives, including its Associate Medical Officer of Health, Senior Epidemiologist and Program Manager in Communicable Disease sitting on provincial committees to help update the provincial pandemic influenza plan and optimize the interface between provincial and local plans.

Staying abreast of changes in national and international pandemic plans

At a provincial meeting in March 2005, Ottawa Public Health learned that the World Health Organization is about to announce a change in its pandemic classification system. Currently it has an inter-pandemic phase and several phases of a pandemic. It will soon add a “Pandemic Alert” with 3 levels. We are currently in the Pandemic Alert, level 1, with sporadic cases of avian influenza, but no sustained human-to-human spread.

Next steps

Although much has been done in pandemic planning, there is still much to do. Ottawa Public Health is preparing a public education campaign and coordinating with the province to ensure consistency in messaging. Ottawa Public Health recently completed branch-wide service continuity planning for an influenza pandemic. This work will ensure that all critical public health services will continue during an influenza pandemic. In addition we are promoting influenza pandemic preparedness with businesses through the creation and dissemination of an emergency preparedness checklist 

This is a time of great difficulty for the health care sector, as hospitals face cutbacks, family physicians work in overcrowded practices, and many people do not even have a family physician. Nonetheless, during the case studies, there was a commitment that all the different health care providers would work together to plan the clinical care of pandemic patients.

Pandemic preparedness is well underway in Ottawa. If a pandemic hit tomorrow, we would be better prepared than most cities in Canada. If a pandemic never hits, we will still be better off. This is because we are using this opportunity to promote a “new normal” in preventing the spread of colds and flu, and to further develop Ottawa’s emergency preparedness skills. This “win-win” approach to pandemic planning is due in part to the collaborative culture here, where people are willing and able to work together to face the challenges ahead.