New criteria for categorizing and responding to a future pandemic are identified in interim guidance issued recently by the Centers for Disease Control and Prevention (CDC). An appendix to the report specifically addresses mitigation strategies for colleges and universities. The Occupational Safety and Health Administration (OSHA) has also released additional guidance on workplace preparedness.
The CDC report, Interim Pre-pandemic Planning Guidance, focuses on steps that states and communities can take to mitigate the impact of a pandemic. Several new concepts are introduced that together provide a framework for pre-pandemic planning.
The Pandemic Severity Index uses the potential mortality rate as the basis for categorizing a pandemic, focusing on its potential human impact. The index classifies pandemics from Category 1--with a case fatality ratio of less than 0.1 percent (translating to fewer than 90,000 deaths in the United States)--to Category 5, with a case fatality ratio of 2.0 percent or higher (representing 1.8 million deaths or more).
Mitigation interventions provide a hierarchy of measures recommended for communities to take in the event of a pandemic. The CDC recommends an "early, targeted, layered application of multiple, partially effective, nonpharmaceutical measures" as follows:
- Isolation and treatment of all persons with confirmed or probable pandemic influenza, either in the home or in a health care setting.
- Voluntary home quarantine of members of households with confirmed or suspected cases.
- Dismissal of students from school, including colleges and universities, and protecting children and teenagers through social distancing measures.
- Use of social distancing measures to reduce contact between adults in the community and the workplace.
A matrix summarizes the CDC recommendations for these strategies depending on the Pandemic Severity Index. For a Category 1 event, only the first tactic--isolation and treatment of victims--is recommended. For a Category 2 or 3 pandemic, communities are urged to consider instituting the other three measures, with schools closing for four weeks or less. In a Category 5 pandemic, however, CDC recommends adoption of all measures, with schools closing for up to 12 weeks.
Triggers for initiating use of interventions are also delineated, since timing of these measures will influence their effectiveness. The primary trigger is the arrival and transmission of pandemic virus, i.e., a laboratory-confirmed cluster of a novel influenza virus with evidence of transmission between people. The suggested geopolitical trigger is a cluster of cases within a state or metropolitan region.
Three steps are identified between recognition of a pandemic threat and an active response.
- Alert: includes notification of personnel and related critical systems of their impending activation.
- Standby: includes initiation of decisionmaking processes for imminent activation, including mobilization of personnel and resources.
- Activate: refers to implementation of specific measures.
Advance planning aims to lessen the transition time necessary between these stages. The severity of a pandemic, coupled with a previously-designed system for staging world-wide incidence of a disease, would determine the progression of these steps.
The CDC guidance was the result of a collaborative process involving numerous government agencies, private industry, researchers, and education and civic organizations. It will be revised as needed.
A new OSHA report, Guidance on Preparing Workplaces for an Influenza Pandemic, addresses steps that employers can take to protect their employees and customers from exposure to a pandemic at the workplace and provides advice on maintaining operations during a pandemic. Topics covered include work practice and engineering controls, policies, and practices that minimize exposure, and personal protective equipment.
A number of other resources are available to assist those preparing pandemic response plans for colleges and universities.
NACUBO Contact: Anne C. Gross, vice president, regulatory affairs, 202.861.2544.