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CIO Council Pandemic Preparedness Committee

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Title: CIO Council Pandemic Preparedness Committee


1
CIO Council Pandemic Preparedness Committee
Loma Linda University, California, April 2009
  • July 27, 2009

2
Global Update, July 27, 2009
3
What a difference two months makes
April 2009
June 2009
4
(No Transcript)
5
Distribution of US Cases, July 4, 2009
6
Florida, H1N1v by age
7
World cases, 23 June 2009
8
Australia, H1N1v by age
9
Consultations made to UK General Practitioners
Source Peter Osborn and Dr. Tony Yardley-Jones ,
UK
10
Global H1N1v fatalities, April-July 2009
Source Peter Osborn and Dr. Tony Yardley-Jones ,
UK
11
Source Peter Osborn and Dr. Tony Yardley-Jones ,
UK
12
The second wave in 1918 was the killer.
Second wave, Fall 1918
First wave, Spring-Summer 1918
Third wave, Winter-Spring 1919
Between 50 and 100 million people died worldwide
in a 20-week period in 1918-19.
13
The Argentina cautionary tale
  • Case fatality rate higher than global average
  • Absenteeism in some sectors exceeding 40
  • Connected to Florida, US via Miami, Orlando, NY
    gateways

People stand in line to vote in Argentinas
national election. The ruling party (Peronist
Party) lost badly, due in part to the
governments perceived mishandling of the swine
flu situation, and the Health Minister resigned
after the election.
14
Swine H1 Morbidity and Mortality
  • More Americans died of swine influenza (17) this
    month (July - 136),than in the entire months of
    April, May and June combined (127).
  • In early July, worldwide, there were more than
    60,000 confirmed infections, with roughly 230
    deaths.
  • Today, worldwide, there are over 140,000 cases
    with over 700 deaths. That explosive growth
    occurred in less than three weeks.
  • That is a case fatality rate of .5, placing it
    in the moderate Category 2 pandemic category.
  • Any shift toward greater lethality could move the
    virus to Category 3 status.
  • Sources CDC, CBS News
  • Source Associated Press

15
What might this virus do?
  • It might become resistant to Tamiflu.
  • It might reassort with other flus and become even
    easier to catch.
  • It might reassort with H5N1 in the Middle East
    (Egypt, Turkey, Pakistan), Africa (Nigeria), Asia
    (Indonesia, China, Vietnam, Cambodia) and acquire
    extreme lethality.
  • Or it could be overpowered by seasonal flu.
  • Nearly 100 percent of the influenza viruses
    being detected now (US) are novel H1N1 viruses.
    CDC, July 17, 2009

16
H1N1v has won King of the Mountain in the US.
17
Official UK estimates for planning purposes,
H1N1v (Source and graphic BBC)
18
Official UK planning estimates of mortality,
compared with 1957 and 1968 pandemic deaths.
(Source and graphic BBC)
19
Britain is one-fifth the population of the United
States.
  • Note

20
The Southern Hemisphere holds the key.
  • It is their flu season now. It started in April
    and stretches to October, when ours begins.
  • If swine H1 gains a strong foothold and becomes
    the dominant flu strain in the Southern
    Hemisphere, it will also do so here. DONE.
  • If the pandemic virus does not defeat seasonal
    H1N1 and H3N2 in influenzas game of king of the
    mountain Down Under, it could still emerge
    triumphant here.
  • UPDATE Over 90 of all typed Southern
    Hemisphere flu cases are the pandemic strain.

21
Worldview, April-July 2009
22
Tallahassee, FL
23
California
24
Texas
25
New York
Bad mask wearing!
26
Camp Modin, Maine, July 22, 2009
27
Mexico City
28
Mexico City
29
Cancun, Mexico
30
El Salvador
31
Buenos Aires, Argentina
32
Buenos Aires, Argentina
33
Scotland
34
Kuwait City
35
Cairo, Egypt
36
Mecca, Saudi Arabia
Umrah
37
Natanya, Israel
38
Bangkok, Thailand
39
Incheon, South Korea
40
Hong Kong
41
Chengdu, China
42
Auckland, New Zealand
43
Australia
44
Shanghai, China
45
Pandemic Planning for Agencies
46
BIG rule of thumb
  • If your agency or organization has not formulated
    a pandemic planning team, that organization is
    NOT PREPARED FOR A PANDEMIC.
  • If your agency or organization has not exercised
    its pandemic plan via a tabletop exercise or
    stronger simulation, that organization is NOT
    PREPARED FOR A PANDEMIC.

47
What would Ike do?
  • The plan is useless its the planning thats
    important.
  • Ike's point is that events will never go
    according to The Plan -- but a mature planning
    process will help you prevail. 
  • Believe me, no one in State government is smarter
    than Ike on this matter. No one.

48
Add context What will happen all around us?
49
The pandemic plan for organizations
  • PLAN ONE CATEGORY HIGHER
  • Create corporate/agency pandemic planning team
  • Prepare agency succession plan
  • Ensure retail business/government ops continue
  • Acquire protective equipment
  • Monitor employee absenteeism
  • Cross-train your staff
  • Design, implement and support Work at Home plans
  • Prepare for supply chain failures
  • Prepare Communications Plan
  • Teach protective actions
  • Gain an understanding of influenza and how it
    works
  • Leverage this planning for similar scenarios
  • Update DR and COOP plans NOW, as existing COOP
    plans without pandemic modifications will NOT
    WORK in a pandemic.

50
There should be already in place, a pandemic
planning team
  • Legal
  • Human Resources
  • Training Development
  • Information Technology
  • Procurement/Purchasing
  • Communications/Press Secretary
  • Facilities/Maintenance/janitorial
  • And at the top.. The CEO, agency head, or second
    in command.
  • If there isnt one theyre not ready for a
    pandemic.

51
Have they created a realistic pandemic annex to
their DR AND COOP plans NOW?
  • Armed with your information and in conjunction
    with all agency peers, urge creation of a
    Pandemic Annex to your organizations COOP and
    Disaster recovery plans now.
  • Additional questions to answer
  • Does agency COOP Plan have an event horizon
    beyond 30 days?
  • Within a 30 day to 120 day context, does it
    have a new definition of essential and
    nonessential personnel?
  • Does it contain a well-defined succession plan
    for agency leadership?
  • Just for grins, imagine if you had to support
    agency operations AND a hurricane or terrorist
    event came during a wave of the pandemic. Recall
    that 75 of all pandemics occur during hurricane
    season.
  • What plans would you engage?

52
Audit to ensure retail ops continue
  • Is an organization prepared to engage in core
    activities even if the following is true
  • Loss of raw materials/finished goods due to
    failures in JIT supply chain.
  • Everyday drop in workforce from 10 to 40 during
    a pandemic wave
  • Loss of customers due to pandemic
  • Forced closure of certain industries
    (restaurants, public gatherings such as football
    games, dry cleaners, boutiques).

53
Ensure retail government ops continue
  • Retail government service delivery offices in the
    social, medical and law enforcement safety net
    domains will have to remain open, and certain
    employees will have to remain exposed to citizens
    while at work.
  • Keeping offices open will be essential to
    preserve the integrity of government and to care
    for its customers.
  • Can you imagine what will happen if government
    fails its citizens when they need it the most?
  • Katrina times 400 in Florida alone.

54
Ensure retail government ops continue
  • What is an agencys plan to remain open in a
    pandemic?
  • Have they done or even considered doing -- the
    following
  • Focus on data center integrity first.
  • Focus on your agency public Website a close
    second.
  • Inventory business processes with intent to move
    them to eGov operations
  • Work with business partners to ensure they are
    on top of pandemic planning (weak link Y2K
    example)
  • Pay more to have priority restoration if networks
    fail
  • Have redundant communications plan (cellphones,
    aircards, broadband wireless, satellite, etc.) if
    network or Internet fails.

55
Acquired protective equipment?
  • N-95 masks or surgical masks
  • 3 per employee per workday for 6-12 weeks (you do
    the math)
  • Alcohol-based hand sanitizer
  • Enough for 6 12 weeks
  • Gloves (vinyl some are allergic to latex)
  • Same ratio as masks 3 pairs per workday for the
    duration of a wave of a pandemic

56
Have you/they decided who gets protective
equipment?
  • Front-line workers with constant exposure to the
    general public
  • The social and public safety safety net workers
    (AWI, DCF, HSMV, local equivalents, etc.)
  • Data center employees The checks gotta roll.

57
Working with Procurement
  • Do they know what to buy?
  • Do they know the quantities?
  • Do they know the context?
  • Everyone and their brother will want the same
    items and be willing to pay more for them.
  • Does your agency have the money to increase
    expenditures on staples?

58
Have you prepared for supply chain failures?
  • In a pandemic of any severity, the supply chain
    will falter.
  • In a 1918-type (or worse) pandemic, the supply
    chain will fail.
  • If possible, keep essential supplies/ parts
    stockpiled in advance (4-6 week supply).
  • Survey your suppliers. Resurrect the old Y2K
    adage If they cant articulate their plans for
    pandemic flu preparedness, be wary of their
    ability to survive.
  • In fact, go find your Y2K plans, turn to the tab
    marked Supply Chain Workarounds, update it and
    put it into your DR/COOP Pandemic Annex.

59
Has your agency prepared internal and external
communications plans?
  • How will key managers communicate among
    themselves?
  • How will information be conveyed to employees?
  • How will employees know who to call in specific
    situations?
  • How will information be conveyed to business
    partners?
  • How will the public know which safety net
    offices are open and which are closed?

60
Communicate with employees and teach preparedness
at work and at home
  • Conduct an awareness campaign within your
    organization.
  • Teach employees how to prepare themselves and
    their families FIRST. And do it now, instead of
    later when it is too late
  • Cover work and home issues
  • Teach protective actions and personal hygiene
  • Prepare them for moving from office to office
    even from agency to agency.

61
Teach protective actions NOW
  • Hand washing without recontamination
  • Covering cough, not using hands
  • Avoid putting hands to face, mouth, nose, eyes.
  • Staying home if any signs of illness
  • Proper use of protective equipment
  • Cleaning hard surfaces, wearing gloves, using
    hand sanitizer and wearing masks

62
Consider emergency notification services
  • Companies such as Dialogic Communications,
    TechRadium, Dell/MessageOne and others have
    affordable, hosted services that allow an agency
    to push information to employees via any type of
    device
  • Eliminates the old phone tree tedium
  • Includes voice synthesis and fax
  • Can allow agencies to poll their workforce to see
    who can work and who is too sick to report
  • Will be critical when trying to open offices or
    trying to tell people which office to report for
    work

63
Janitorial
  • Stop vacuuming during weekdays as soon as the
    virus is detected in your community.
  • Vacuum on weekends only, preferably on Saturdays.
  • Repurpose those vacuumers to the constant
    cleaning of all solid surfaces that are touched
    routinely, such as doorknobs, elevator buttons
    and elevator rails, staircase rails, and customer
    countertops.

64
Federal checklists (by sector)
65
Telecommuting and Work at Home Plans
66
Lets define work
  • Government still runs largely on paper
  • Forms have to be inputted into computer systems
  • The business process must be taken apart in order
    to be streamlined
  • Tremendous opportunity to further digitize
    government and we cannot afford to lose this
    chance to streamline government ops!
  • Inventory business processes with intent to
    Webify them as eGov operations

67
Potential failures in work at home plans
  • Paper must be quarantined, lest employers
    inadvertently sicken otherwise healthy homes
  • CDC and St. Jude say virus becomes inert after 12
    to 24 hours on paper and porous surfaces
  • Each stage in the paper handling process requires
    a day quarantine to prevent infection (learn from
    the death of Inuits (Eskimos) in 1918).
  • How will paper get home?
  • USPS? Irregular deliveries
  • UPS? FedEx? DHL? They too may suffer loss of
    dependable service.
  • Will agencies put together their own delivery
    routes?

68
SSL VPNs and you
  • Time for an SSL VPN solution with rigid,
    unforgiving policy enforcement.
  • Implement an SSL VPN service and be prepared to
    scale it radically upward
  • Be prepared to lose the Internet, as network
    service providers will also experience high
    absenteeism and be forced to scale back SLAs
    (Booz Allen)
  • That is one compelling reason to upgrade to
    priority restoration.

69
Conclusion, W_at_H plans
  • Government cannot afford to implement perfect
    work at home plans in the current financial and
    political climate.
  • W_at_H plans can be successful, if the process does
    not involve the moving of paper or constant
    online access to legacy systems if applied
    properly if created with enough advance
    planning and if exercised frequently.

70
IT Issues to Consider
71
IT Issues to consider
  • Do you have a succession plan in place?
  • Which services do you turn off or allow to fail?
  • Data Center operations (lights out operation,
    automated patching)
  • Public Website for emergency notices such as
    openings and closures, if necessary posted by IT
    staff at home, or even by non-IT staff as needed
  • Remote Access (Citrix, RAS, Terminal Services) as
    alternatives to SSL VPN
  • Dont forget field staff!!
  • Maintaining agency cybersecurity in the midst of
    all this
  • Do you enable or eliminate Help Desk operations?
  • PC support for employee personal computers? NO
  • Ensuring security of access and data while
    dealing with employee personal computers POLICY
    ENFORCEMENT via SSL VPN
  • Videoconferencing as alternative to face-to-face
    meetings how will you support it if it
    malfunctions?
  • Recovering from cascading emergencies (swine flu
    on top of hurricanes, terrorism, etc.)

72
IT Services
  • It is just not practicable to expect to support
    100 of all your applications/services.
  • Now is the time to sit down with leadership and
    ask which IT services may be turned off in a
    pandemic, and which can be allowed to fail
    without restarting.
  • Doing this now sets the expectation bar,
    reinforces the urgency of the coming second wave,
    and allows you to cross-train more efficiently
    and effectively.

73
Monitor your employee absenteeism, even if no one
else does.
  • Do not rely solely on actual totals coming from
    WHO and CDC. If you see a spike in employee
    absenteeism, it is probable that the virus has
    gained a foothold in your workforce.
  • This can be done without HIPAA violations, and
    should be performed agency-wide, statewide, and
    dont forget field staff.
  • Encourage an enterprise-wide or agency-wide
    initiative to monitor for absenteeism which will
    be critical to track both the spread of the virus
    (reporting daily roll-ups to DoH) and to
    determine operational readiness statewide.

74
Have you cross-trained your staff?
  • Create written instructions/ procedures for
    critical processes that can be carried out by
    others
  • Cross-train your staff, ideally three-deep
  • Anticipate 30 morbidity (illness) within staff
  • Assume absenteeism due to closure of other
    schools, day care centers
  • Train by TASK, not by what somebody does
  • Maintain a matrix of staff training and widely
    distribute and post in disaster recovery books
    and agency COOP plan
  • Cross-train inside and outside of Data Center in
    other words, cross-train non-data center people
    in simpler technical tasks such as tape rotation.
  • Dont cross-train on services you will disconnect
    or allow to fail!

75
(No Transcript)
76
The High Points
  • All you can do is all you can do.
  • COOP and disaster recovery plans must be
    realigned within an extended event horizon of 8
    to 12 weeks per pandemic wave.
  • Work at home plans require the exact expectation
    of WORK.
  • Business processes must be broken down and
    redefined by task, not by person.

77
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