Pandemic Influenza Table Top Exercise

On Thursday and Friday (I'm only a couple of days behind, go me), I participated in a table top exercise about pandemic influenza preparedness. It had a tendency to drag on and get into the weeds at time, but was overall fairly educational.

One thing I didn't know before going into this is that we have definitions of pandemic severity, based on the case fatality ratio (below). In terms of pandemic influenza, the H1N1 (or swine flu) from 2009 was a category 1 pandemic (I feel like I need to back-up for a second and define 'pandemic'. It doesn't mean 'bad disease'; it means a disease outbreak that is spread around the world. An epidemic, on the other hand, is an outbreak that is in one area or part of the world. So H1N1 is a pandemic, because it's found everywhere, but obesity is an epidemic, because it isn't). Anyway, back to what I was saying: H1N1 is a category 1, because while there were a lot of cases, there weren't a lot of deaths. The 1918 flu, on the other hand, was a category 5 pandemic, and was the only category 5 influenza pandemic in history.

For the table top exercise, we were using a pandemic influenza modeling tool developed by the Innova Group, where you can enter in the severity of the pandemic (from 1-5), duration (typically 6-12 weeks for influenza, depending on the size of the geographic area you're talking about), the population size and age distributions, and expected attack rate by age (for example, children tend to have higher attack rates for influenza than adults). You enter in all that stuff, and then it spits out a bunch of reports about how many healthcare workers you need, how many gloves, the amount of storage space required for everything you're going to need, etc, etc. 

For this exercise, they modeled the Northern Region Medical Command, which is all the Army treatment facilities from the Canadian border through North Carolina, and a category 3 pandemic. The people running the table top were logisticians, not epidemiologists, so they didn't know all the right terminology of influenza surveillance or epidemiology and some of the things just didn't make sense. For example, based on the scenario, we knew there was a pandemic coming before the first cases hit the United States, which isn't the situation. With H1N1, it had been going on in Mexico for a couple of months before anybody typed the virus in San Diego and realized that it was a new influenza. So a little unrealistic, at least at the beginning of the outbreak, but it still generated a lot of good discussion about what we can do to prepare and how individual treatment facilities have to respond.

Overall, I don't know how much it taught me about policy (which is what I'm supposed to be learning on this rotation), but still educational overall.