Scenario 1 - Pandemic Disease Recognised Overseas
It is a Friday before a holiday weekend, with fine weather forecast over the whole country.
For several weeks there have been many rumours and unconfirmed reports of large clusters of person-to-person spread of H5N1 in two south-east Asian countries - Sealand and Beeland. The situation in neighbouring countries is quiet, but in some regions the situation is unknown, with a total communications blackout from some provinces. The World Health Organisation (WHO) is intensively investigating, but has not yet confirmed person-to-person spread of H5N1 in any region, although the level of suspicion is high and increasing all the time. Nothing much else is happening in the world, so there has been intense and increasing interest in these developments from the world and New Zealand media.
Intensive surveillance in New Zealand has not found any evidence of H5N1 among the influenza-like illnesses that are normally present at low levels in the general population.
The Ministry of Health (MoH) has been monitoring the situation and has informed the health sector of the domestic and overseas situations through Code White (information) messages to District Health Boards (DHBs).
At 1200 on Friday, MoH receives information from the WHO in Manila that H5N1 influenza appears to have been responsible for a number of sudden deaths among Beeland citizens in the large capital city, Beeville. The people who died had no known exposure to infected poultry, or connection with the areas where H5N1 spread is suspected.
From Southern Beeland, there are unconfirmed reports of the sudden deaths of three German tourists who recently took a bus trip to the interior, and of influenza-like illnesses among other tourists. Some tourists are thought to have flown to Singapore or other regional destinations while unwell.
At 1230, while the MoH is attempting to verify the information received, CNN reports that "pandemic influenza has broken out in Beeland, and is causing many deaths in the slums of Beeville and the villages in the interior. Tourists have died, and many are ill". The report also says that the Beeland government has denied that pandemic influenza is present.
MoH assembles its crisis team and identifies people for Co-ordinated Incident Management System (CIMS) team roles. By 1430 a Code Yellow (standby/warning) message has gone out to the health sector informing them of the situation. Also by this time, the WHO in Manila has confirmed the information received earlier that 120 people are ill in hospital, a further 30 are thought to have died of a new form of influenza and an unknown but "large" number are thought to be affected. It adds that a pandemic declaration will be made at 1600 New Zealand time.
Advice from the Australian Health Disaster Management Committee states that Australia has closed borders to all incoming flights.
MoH issues a Code Red message (pandemic alert) to the health sector at 1615, following the WHO declaration.
At 1630 the MoH national controller issues the first pandemic advice to the government.
The advice is:
- To enable an effective response to be mounted, the Minister of Health should immediately unlock the special powers available to Medical Officers of Health, in the Health Act; and
- To immediately close the border, for an indefinite period, to all incoming flights.
At 1800, the Government's Ministerial-level Domestic and External Security Committee accepts all the Ministry of Health's recommendations and directs the appropriate agencies to action them immediately.
The Civil Aviation Authority issues a NOTAM17 advising the border closure to other civil aviation authorities, air traffic control centres and the airlines serving New Zealand. There are five aircraft carrying some 1,275 crew and passengers already enroute to Auckland, three Trans-Tasman, one from the Pacific, and one from Singapore. There are two aircrafts enroute to Christchurch from Brisbane, carrying 260 crew and passengers. For safety reasons, they will all be permitted to continue to New Zealand if the Captain determines that it is inappropriate to divert, or turn back. But generally, at the end of a 13-hour window from a NOTAM issue, there will be no more incoming flights.
Outline of Likely Health Sector Actions
After unlocking of powers, Medical Officers of Health (MOoHs) have a wide range of special powers available to detain, quarantine or isolate people who have, or may have, infectious diseases.
Health services will decide what to do with the passengers and aircrew held at the airport. Options include:
- Release them all after risk assessment, with tracking ensured in case of later developments;
- Medical assessment and review; with decision for release based on outcomes. Outcomes could embrace:
- Release all, with tracking ensured in case of later developments;
- Release some but quarantine others;
- Quarantine all for up to 8 days, or possibly longer.
- Immediately decide to quarantine all for a time to be decided, but possibly up to 8 days.
Planners should assume that it might take up to 24 hours, and possibly longer, to complete the processing of the people held at the airport, and/or make the necessary decisions.
Health services will also review the health declarations of all passengers arriving from South East Asian airports within the last 4-5 days to assess the risks to New Zealand. Passenger and contact tracing will be done if there are any grounds for suspicion.
Surveillance will be stepped up to the highest possible state, especially in communities close to airports and on the normal tourist pathways.
MoH will make supplies of anti-viral medication available to assist with border management operations. Health staff resources will be made available by the appropriate District Health Board(s).
MoH, through their Regional Coordinators, will direct relevant DHBs to prepare for the release of PPE to identified hospitals, primary health care centres and first responders.
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