Welcome to the City of Toronto website

What you should be thinking and doing

Based on material…

1. Toronto Public Health Reports and Pamphlets
2. Ontario Health Plan for an Influenza Pandemic
3. Various Governmental Web sites
4. Various International Websites
5. Toronto Long-Term Care Homes and Services educational materials

What is a Pandemic?

• A pandemic is a global outbreak of disease that occurs when a new virus appears or “emerges” in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks or “epidemics” of influenza.

Influenza Symptoms

The signs and symptoms are the same as seasonal flu.  However the symptoms can be much more severe, i.e.:

Fever	Headache	Sneezing	Sore Throat
Runny nose	Aches & pains	Cough

Symptoms may affect people who normally do not suffer from seasonal flu i.e. younger, healthy adults.

The History of Pandemic Influenza

Spanish Flu 1918
20 million died in 2 years
50-60 thousand deaths in Canada
half the deaths were young adults

Asian Flu 1957

spread from China to North America within 4 months
7000 deaths in Canada

Hong Kong Flu 1968

spread to North America later that year
3000 deaths in Canada

What is a Pandemic?

• Seasonal outbreaks are caused by subtypes of influenza viruses that already circulate among people, whereas pandemic outbreaks are caused by new subtypes, by subtypes that have never circulated among people, or by subtypes that have not circulated among people for a long time.
• The appearance of a new influenza A virus subtype is the first step toward a pandemic; however, to cause a pandemic, the new virus subtype also must have the capacity to spread easily from person to person.
• Pandemic viruses emerge as a result of a process called "antigenic shift,” which causes an abrupt or sudden, major change in influenza A viruses. These changes are caused by new combinations of the HA and/or NA proteins on the surface of the virus. Changes results in a new influenza A virus subtype.
• A form of bird flu known as H5N1 is currently spreading in bird populations globally. As of November 17, 2005 it has been associated with 130 human cases and 67 deaths (a mortality rate of more than 50%). To date there is no evidence that this virus has the ability to spread efficiently person-to-person. Significant mutation of this virus or any other influenza virus would be required to cause a pandemic

Another thought…

• Influenza pandemics occur in waves over a period of months to a year. An effective vaccine would likely take four to six months to be available. Initial control measures will focus on personal hygiene, isolation of cases (minimal quarantine of contacts only in the initial stage).

Is there a Pandemic Now?

• When a pandemic starts, everyone around the world could be at risk of serious illness. Canada has been working closely with other countries and the World Health Organization (WHO) to strengthen systems to detect outbreaks of influenza that might cause a pandemic.
• Currently there is no pandemic flu.

Why Plan?

• Usual services may be disrupted. These could include services provided by hospitals, banks, stores, government offices and public services such as water, power, and transportation.
• One out of every three health care workers could become ill and unable to provide services
• Schools may be closed for an extended period of time
• Consider childcare needs
• Transportation services may be disrupted
• The effects of a pandemic can be lessened if you prepare ahead of time. The Federal, Provincial  and Municipal governments have been actively working developing plans and strategies to ensue that essential services can continue during a pandemic influenza or any other infectious disease outbreak.
• An important component of the plan is ensuring that staff is prepared and have the ability to care for themselves and for their families.

Be Prepared

• Your 3 day Emergency Supplies Checklist
• Prepared by Toronto Public Health
• Items asterisked are per person

Some specifics

• Meats and alternatives: baked beaks, kidney beans, black beans, chick peas, meat, fish, poultry, etc
• Fruit: peaches, pears, applesauce, fruit cocktail, fruit juice, etc.
• Vegetables: peas, corns, carrots, green beans, etc
• Combination foods: pasta in tomato sauce, soups, stews
• Canned Milk and milk products: 2% evaporated milk,or UHT, fortified soya beverage, baby  formula if needed
• Packaged foods: cookies, crackers, instant breakfast, ready to eat breakfast cereals, granola bars, health bars, assorted nuts, skim milk powder, trail mix, instant noodles and minute rice, prepared pudding cups
• Jarred foods: peanut butter, jam, honey, other nut spreads
• Dried foods: prunes, apricots, dates, figs, raisins, assorted dehydrated foods
• Store canned, ready to eat food, dry goods, and water in a clean plastic bin or on a kitchen shelf. Check the canned and packaged food every six months for best before dates and damaged containers.
• Rotate and replace cereals, granola bars and water every six months
• Rotate and replace canned products at least once a year and discard damaged containers 

What You Can Do Personally

• Be informed
• Stay healthy:
  • Hand washingrespiratory etiquette:  cover mouth and nose; dispose of tissues; wash hands
  • Avoid large crowds when possible
• Reach out:
  
  • Support of neighbours, friends and family who may have difficulty managing in a pandemic
• Make your own contingency plans!

Shopping Week 1
Grocery Store (*per person)

• 6 litres water*
• 2 cans food containing meat and alternatives*
• 2 cans juice (individual or family size)*
• 2 cans fruit*
• 1 small jar peanut butter*
• 1 can combination foods (soups, pasta , etc)*
• 2 cans vegetables*
• Crackers, cookies and ready to eat breakfast cereals)
• Baby food or formula (ready to serve, in small tins) diapers and bottles with disposable plastic liners if needed
• Food for people on special diets
• 6 litres water per pet, if needed
• Pet food if needed
• Hand-operated can opener
• Large heavy duty plastic bags
• Paper towels
• Candles and waterproof matches

Shopping Week 2

Hardware store

• Leash or carrier for pet, if needed
• Portable am/fm radio with batteries or powerless wind-up radio
• 2 flashlights with batteries
• Waterproof portable plastic container with lid, for important papers
• Whistles
• Extra batteries for radio and flashlights
• Camping or utility knife
• Permanent marking pen

Shopping Week 3

Grocery  Store (*per person)

• 6 litres water*
• 2 cans food containing meat and alternatives*
• 2 cans juice* (individual or family size)
• 2 cans fruit*
• Quick emergency snacks (raisins, granola bars, nuts)*/li>
• 1 can combination foods (soups, pasta , etc)*
• 2 cans vegetables*
• Crackers, cookies and ready to eat breakfast cereals)
• Baby food or formula (ready to serve, in small tins) diapers and bottles with disposable plastic liners if needed
• Food for people on special diets
• 6 litres water per pet, if needed
• Pet food if needed

Shopping Week 4

Drug store - first aid supplies

• ASA and or acetaminophen – check expiry date
• 20 gauze pads
• 20 assorted rolls of gauze or bandages
• 1 roll first aid tape
• Scissors
• Tweezers
• Antiseptic skin cleaner
• 12 safety pins
• Disposable examination gloves
• 2 triangular bandages
• Multiple face mask per person
• You may buy a basic first aid kit in place of some of the items listed above

Shopping Week 5

Grocery Store (*per person)

• 6 litres water*
• 2 cans food containing meat and alternatives*
• 2 cans juice* (individual or family size)
• 2 cans fruit*
• Quick energey snacks (raisins, granola bars,nuts)*
• 1 can combination foods (soups, pasta , etc)*
• 2 cans vegetables*
• Crackers, cookies and ready to eat breakfast cereals)
• Baby food or formula (ready to serve, in small tins) diapers and bottles with disposable plastic liners if needed
• Food for people on special diets
• 6 litres water per pet, if needed
• Pet food if needed

Shopping Week 6

Drug Store first aid supplies

• Prescription medications
• Disposable hand wipes or alcohol hand sanitizer
• Sewing kit
• Saline solution and contact lens case or extra eyeglasses, if needed
• Extra hearing aid batteries if needed
• Denture care items, if needed

Shopping Week 7 

Household items (*per person)

• A change of clothing, rain gear and sturdy shoes
• Blanket or sleeping bag
• Extra clothing for babies or infants
• Knives, forks, spoons (plastic or metal)
• Disposable cups and plates
• Toilet paper
• Toothbrush, tooth paste and floss*
• Facial tissue
• Feminine hygiene products
• Assorted plastic containers with lids
• Plastic wrap
• Aluminium foil
• Paper, pens and pencils
• Credit card, small amounts of cash
• Extra set of house and car keys
• Roll of quarters for emergency phone calls
• Extra cell phone batteries

What we don’t know

• Characteristics of the virus
• When the pandemic will occur
• Which public health measures will be used & when
• Travel restrictions
• Closure of boarders
• Restrictions of public gatherings
• School/daycare closures

What else can we do?

• Help us prevent the spread of infection
• Hand washing…Hand washing… Hand washing
• Let your JHSC Pandemic Planning Committee representative know if you have questions you would like answered.

Preparation of a Pandemic Response Tool Kit

(University of Waterloo)

• You should consider compiling the following materials to prepare for a pandemic. In addition to the food, water and supply needs indicated above, you should consider purchasing the following set of materials which give basic protection from exposure to the influenza virus.
• Although the use of these items may appear excessive for typical flu or colds, the avian flu strain is highly likely to be a much more dangerous strain than the common flu bugs that circulate in the community. The precautions being recommended are warranted in the event of a pandemic influenza outbreak.!

Hand Sanitizer/Wipes

• Hand Sanitizer: Travel size for use when proper hand washing facilities are not available. The sanitizer, containing at least 60% alcohol, has been selected for its effectiveness against a broad range of viruses including influenza, Hepatitis A, B and C and other viruses and bacteria.
• Disinfecting Wipes: Used to cleanse surfaces you may touch when gloves are not being worn(pens, handrails, telephone handsets, etc.).

Masks

• Surgical masks may be sufficient however the most appropriate mask will not be determined until the specific characteristics of the virus causing the pandemic are known. The N95 should be used when caring for someone who is ill with flu.

Protect yourself and your family

The following health and safety measures are recommended:

• Give serious consideration to immunization with the most up-to-date influenza vaccine
• Maintain good health habits at all times
• Stay home when you are sick
• Follow safe practices at home or in public when you are sick
• Maintain good hand hygiene
• Clean/disinfect surfaces in your environment
• Educate family members, especially children, in personal hygiene
• Use protective personal equipment when providing direct care to a sick person, or in public once the pandemic has been declared
• Avoid close contact with people who are sick. Don’t sit near someone who is sneezing or coughing. Maintain at least one metre distance.
• Avoid touching your face, especially eyes, nose or mouth, unless you have just washed your hands. Use alcohol based hand sanitizers if soap and water is not available
• If you are sick, stay at home. Stay at home from work until you have no fever for 24 hours or Telehealth says you are no longer contagious. Do not allow ill children to attend school or daycare.

Safe practices at home and in public when you are sick:

• Stay in a separate room or, if this is not possible, keep the sick person at least one metre away from others, especially children.
• Cover your mouth and nose with a tissue when you cough and sneeze. Dispose of these tissues safely, as they are contaminated and then wash your hands (or use a hand sanitizer if soap and water are not available). Alternatively, if you don’t have tissues, cough or sneeze into your upper sleeve, NOT your hands.

Safe practices at home and in public when you are sick

• Make sure tissues are available in common areas. Avoid touching common surfaces and objects unless your hands have been washed or sanitized. Change toothbrush often or at least after cold or flu to prevent possible re-infection.
• Consider the use of a mask and gloves once a pandemic has been declared.

Differences Between Seasonal Flu and Pandemic Flu

Operational Preparedness

• You will be provided with Personal Protective equipment at work (PPE)
• The Long-Term Care Homes and Services division has stockpiled enough PPE to ensure that all staff will have access, for work, to gloves, gowns and masks for an 8 week period.
• If you become ill during the pandemic, you will be expected to return to work once you are feeling better and are asymptomatic ( have no symptoms )

During a Pandemic Outbreak

Consider eliminating all group activities including: daycare; sporting and entertainment activities; public transit.

• Do as much activity from home as possible including:
• Internet banking, Working from home
• Communication with friends and family should be by phone/email
• Outside travel into the community should be done by as few people as possible. Travel as a family should be minimized.
• Limit essential activities only to people you are very confident have not been in contact with infected people.

During a Pandemic Outbreak

• Minimize or eliminate all outside/in-public activities to those that are absolutely essential such as:
• Necessary doctors visits (delay routine health care until the pandemic passes if possible — use Telehealth to determine if visit to a doctor is necessary)
• Essential shopping, Phone first to confirm availability of required items if possible
• Do not leave your home without the Pandemic Response Tool Kit materials.
• Never touch your face without washing or sanitizing your hands first.
• When returning home, wash your hands before interacting with other family members.
• Disinfect reusable gloves with a household bleach solution. A lOOppm solution is an effective sanitizer or mix household bleach 1 tsp. in 1 litre of water
• Shower and wash clothing
• Do not wear shoes in the house that you have worn outside the home in potentially contaminated areas such as shopping centers.
• After handling money, packaging (such as a grocery box or bag) or any surface such as a grocery cart, public phone, gas pump handle, key pad etc, always wash or sanitize your hands.

Examples of day- to-day high risk behaviour and steps you can take to mitigate your risk of infection.

These activities are often overlooked as risk behaviour. Review these to improve your understanding of how, when and where to protect yourself.

• Going to the Library; Using Public Equipment Such as Debit/Credit Card Keypads, Phones, Computers, Video Games; Going to Restaurants & Grocery Stores
• In the time of pandemic outbreaks, eliminate or minimize use of these types of facilities as much as possible. If you must use them, use gloves and/or sanitizing wipes on all contact surfaces.
• Wash hands before eating in these environments at all times or stay home.
• Always have your own pen. If you handle a clipboard, consider using gloves. Wash hands before touching food or other people.
• Before you put your child in the cart, sanitize the surfaces with appropriate wipes or spray.
• Use of Shared Computers, Telephones etc.
• Decontaminate them with alcohol or chlorine bleach before each use. You may want to consider using gloves as well

The only thing tougher than planning for a disaster is explaining why you didn’t.

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