The Canadian Pandemic Influenza Plan for the Health Sector

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Annex A
Planning Checklists

Table of Contents

1.0 Introduction
1.1 Surveillance Checklist
1.2 Vaccine Programs Checklist
1.3 Antivirals Checklist
1.4 Health Services Emergency Planning and Response Checklist
1.5 Public Health Measures Checklist
1.6 Communications Checklist-
2.0 Emergency Response and Coordination Activities: Checklist for Provinces and Territories

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1.0 Introduction

Planning for a pandemic involves the consideration of what activities are necessary for optimal management of each stage of the pandemic. This annex provides a preliminary list of planning activities developed to facilitate planning at provincial and territorial (P/T) and local levels. These checklists will need to be reviewed on a regular basis and updated as they are completed. These planning activities should take place during the Interpandemic Period (i.e. WHO Phases 1 and 2) with the recognition that, when novel strains are detected or pandemic alerts are issued, they will need to be reviewed and adapted as necessary.

Activities have been listed and grouped in this annex according to the following components of the Plan:

• Surveillance
• Vaccine Programs
• Antivirals
• Health Services Emergency Planning and Response
• Public Health Measures
• Communications

The list for the former "Emergency Services" component of the Plan has been retained for reference purposes and appears following the Communications component in this annex.

Many of these activities and corresponding federal activities and responsibilities have been discussed and addressed by the various pandemic planning working groups. Refer to the Introduction and Background sections of the Plan for further information on these roles and responsibilities.

1.1 Surveillance Checklist

• Improve disease-based surveillance, in collaboration with the Centre for Infectious Disease Prevention and Control (CIDPC), Public Health Agency of Canada PHAC); includes improvements to the current system and consideration of enhancements (e.g. emergency room surveillance and real-time influenza mortality surveillance).
• Improve virologic surveillance capability by ensuring that at least one laboratory in the P/Ts has the capability to isolate and subtype influenza virus.
• Establish links with avian and swine influenza surveillance contacts within P/Ts.
• Develop and/or disseminate protocols and guidelines for the prioritization of laboratory services during times of high-service demand and staff and supply shortages.
• Develop and improve communication mechanisms for the rapid and timely exchange of surveillance information between P/Ts, CIDPC and local stakeholders.
• Consider how special studies, identified in collaboration with CIDPC, may be activated in your jurisdiction.
• Determine what information needs to be collected and how this will be done (to facilitate the evaluation of surveillance activities in the Post-pandemic Period, including socio-economic evaluations).

1.2 Vaccine Programs Checklist

• Enhance annual influenza vaccination coverage rates in NACI-recommended high-risk groups, particularly groups with low coverage levels.
• Increase annual influenza vaccination coverage rates among health care and essential services workers.
• Increase pneumococcal vaccination coverage levels in NACI-recommended high-risk groups (to reduce the incidence and severity of secondary bacterial pneumonia).
• Consider P/T modifications or refinements of nationally defined priority target groups, depending on local circumstances. For example, there may be specific groups of people in selected P/Ts whose absence due to influenza illness could pose serious consequences in terms of public safety or disruption of essential community services (e.g. nuclear power-plant operators, air-traffic controllers at major airports, workers who operate major telecommunications or electrical grids)
• Develop contingency plans for storage, distribution and administration of influenza vaccine through public health and other providers to nationally defined high-priority target groups, including:
  • mass immunization clinic capability in P/Ts,
  • locations of clinics (e.g. central sites, pharmacies, work place),
  • vaccine storage capability (i.e. identify current and potential contingency depots),
  • numbers of staff needed to run immunization clinics,
  • plans to deploy staff from other areas from within and outside public health organizations to assist in immunization,
  • advance discussions with professional organizations and unions regarding tasks outside routine job descriptions during a pandemic,
  • training plans for deployed staff, and
  • how to identify and target individuals belonging to priority groups (recognizing that the strategy will involve immunizing the whole population as soon as possible but that prioritization may be necessary for the first batches of vaccine that become available).
• Explore stockpiling syringes and other immunization clinic supplies
• Determine how receipt of vaccine will be recorded and how a two-dose immunization program will be implemented in terms of necessary recall and record-keeping procedures.
• Determine the number of people in P/Ts who fall within each of the priority groups for vaccination (e.g. high-risk groups, health care workers, emergency service workers, specific age groups).
• Verify the capacity of suppliers for direct shipping to health districts.
• Develop plans for vaccine security:
  • during transport,
  • during storage, and
  • at clinics
• Ensure that appropriate legal authorities are in place to allow for the implementation of major elements of a proposed distribution plan. (For example, will P/T laws allow for non-licensed volunteers to administer influenza vaccine? Do P/T laws allow for “mandatory” vaccination of certain groups if vaccination of such groups is viewed by the P/T public health officials as essential to public service?)
• Coordinate proposed vaccine distribution plans with bordering jurisdictions.
• Enhance the surveillance for adverse events following immunization in collaboration with CIDPC.
• Determine what information needs to be collected and how this will be done (to facilitate the evaluation of pandemic vaccine program activities in the post-pandemic period, including socio-economic evaluations).
• Review and modify plans as needed on a periodic basis.

1.3 Antivirals Checklist

• Estimate the quantity of antiviral drugs that would be required to implement national antiviral strategy in your jurisdiction.
• Inform stakeholders of antiviral strategy implementation plans, (including expected supply and use).
• Modify and refine the guidance provided by the Antivirals Working Group, as needed for P/T and local application (e.g. plan how to distribute available antivirals).
• Determine how stockpiled drugs will be stored, monitored (e.g. stability testing) and distributed.
• Monitor national antiviral stockpile storage conditions and shelf-life status on an ongoing basis.
• Determine what information needs to be collected and how this will be done (to facilitate evaluation of an antiviral response in the post-pandemic period, including socio-economic evaluations).

1.4 Health Services Emergency Planning and Response Checklist

• Develop P/T guidelines (modify federal guidelines) for prioritizing health care needs and service delivery, accessing resources and implementing infection control measures during a pandemic.
• Ensure that liability, insurance and temporary licensing issues for active and retired health care workers (HCWs) and volunteers are addressed with P/T licensing bodies. Define the extent of care that health care workers and volunteers can perform according to P/T laws and union agreements.
• Purchase in bulk and stockpile extra medical supplies. Explore the options for stockpiling extra medical supplies and identify sources for additional supplies.
• Develop mechanisms for coordinating patient transport and tracking and managing beds (e.g. central bed registries, call centre, centralized ambulance dispatch).
• Develop detailed regional and facility-level plans for providing health services during a pandemic, including the type of care to be delivered at different health care settings and the triage across sites. Identify human resource, material and financial resource needs and consider priorities for patient care.
• Assess health care personnel capacity: estimate number of HCWs by type (e.g. physician, nurses, respiratory therapists, radiology technicians, etc), and by work setting (e.g. hospital, community, long-term care facility, paramedical); estimate number of non-active HCWs (retired)
• Determine sources from which additional HCWs and volunteers could be acquired, include Emergency Measures Organizations and NGOs (Red Cross, St. John Ambulance) in pandemic planning.
• Determine the number and type of health care facilities, and estimate their capacity (e.g. hospital beds, intensive care unit beds, swing beds, emergency department, ventilatory capacity, oxygen supply, antibiotic supply).
• Determine potential non-traditional sites and corresponding "parent" organiziations for medical care provided they meet the criteria in Annex F, Infection Control and Occupational Health. Possible sites could include shelters, schools, gymnasiums, nursing homes and daycare centres.
• Identify sources of extra supplies needed to provide medical care in these non-traditional sites.
• Determine the capacity of mortuary and burial services as well as social and psychological services for families of victims.
• Coordinate clinical care and health services plans with bordering jurisdictions to avoid migration to centres of perceived enhanced services.
• Develop aftercare and recovery plans and guidelines.
• Ensure that guidelines are distributed to regional and local jurisdictions.
• Determine what information needs to be collected and how this will be done (to facilitate evaluation of the impact of the pandemic on health services in the post-pandemic period, including socio-economic evaluations).
• Review and modify plans as needed on a periodic basis.

1.5 Public Health Measures Checklist

• Coordinate professional and public education strategy for each phase. Identify staffing needs and resource requirements for the management of cases and contacts occurring in your jurisdictions during the Pandemic Alert Period and Pandemic Period.
• Train staff that may need to be re-assigned to work on the pandemic response, and identify what and how other essential and non-deferrable public health programs could be maintained during a pandemic.
• Develop protocols for case and contact management, including the implementation of antiviral strategy, quarantine and community-based measures.
• Develop protocols for school closures and cancelling or restricting public gatherings.
• Determine how changes in case and contact management and community-based control measures will be implemented and communicated to the public and pandemic responders.
• Engage community stakeholders (e.g. school boards, businesses) in the planning process for community-based control measures.
• Assess how border measures may impact your jurisdiction and inform and plan with stakeholders (e.g. airports) how these measures can be coordinated.
• Consider how measures to limit the spread of a novel virus emerging in a community, including "exit screening" (if required) might be implemented at various levels (e.g. town, urban centre, region, P/T) within your jurisdiction.

1.6 Communications Checklist

(Refer to matrix in Annex K, Communications)

2.0 Emergency Response and Coordination Activities: Checklist for Provinces and Territories

• Identify the advantages of declaring a P/T emergency during a pandemic.
• Develop contingency plans to provide food, medical and other essential life-support needs for persons confined to their homes by choice or by direction from P/T and local health officials.
• Ensure communication among P/T Ministries of Health and emergency responders organizations as well as among other P/T ministries or departments that would be impacted by a pandemic.
• Within P/Ts, estimate numbers of emergency services workers including police, fire, correctional, military, funeral services, utilities, telecommunications and F/P/T and local leaders (e.g. political leaders, managers of response teams) essential to pandemic response.
• Identify military personnel and voluntary organizations that would assist during a pandemic.
• Develop a list of essential community services (and corresponding personnel) whose absence would pose a serious threat to public safety or would significantly interfere with ongoing response to the pandemic.
• Develop contingency plans for emergency backup of such services and/or provision of replacement personnel.
  • Replacement personnel could come from lists of retired personnel and/or government or private-sector employees with relevant expertise.
• Conduct environmental assessments of surge capacity of hospitals, non-traditional sites and other facilities including ventilation, water sources, etc.
• Develop aftercare and recovery plans and guidelines.
• Determine what information needs to be collected and how this will be done (to facilitate the evaluation of the emergency response in the post-pandemic period, including socio-economic evaluations).
• Conduct simulation exercise(s)

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