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May 13, 2009 - Virginia Department of Health

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May 13, 2009 - Virginia Department of Health

Health and Medical Subpanel of the Secure Commonwealth Panel

    Meeting Minutes

    DATE: May 13, 2009

    TIME: 1 p.m. 5 p.m.

    PARTICIPATION

    AGENCY REPRESENTATIVE

    Black Nurses Association of Charlottesville, VA Deanna Simmons Central Region Hospital Coordinator Don Schindel County of Henrico, Va. George Drumwright Jr County of Henrico, Va. Anna McRay Dominion Virginia Power Kathi Schivley Eastern VA Medical School Serge Tankeu Fauquier Hospital Norris Royston, MD Federal Reserve Bank Yvonne Beaulieu Federal Reserve Bank Victor Brugh, MD Federal Reserve Bank of Richmond Donna Duerson government Penny Boyd Governor’s Office of VA Steve Mondul Hampton Roads Metropolitan Medical

    Response System William Ginnow Hanover Fire EMS Randy Abernathy Henrico Doctors’ Hospital Lewis Williams Inova Fairfax Hospital for Children Donald Knox, MD Martha Jefferson Hospital Mike Ashby MedResolve, Inc. Lonnie Byrd NiCe, LLC Cecilia Barbosa No. VA EMS Council Melinda Duncan Northern Virginia Hospital Association Zac Corrigan OCME William Gormley Office of Community Partnerships Jane Brown Office of the Attorney General Robin Kurz Rhodes Consulting Ed Rhodes Rockingham Memorial Hospital Dale Carroll, MD, MPH Southwest Region Hospital Coordinator Morris Reece Supreme Court of Virginia Pat Davis University of Richmond Lynne Deane, MD University of Richmond John Sheffield University of Virginia Ruth Bernheim VCU Health System Michael Gonzalez, MD VCU Health System Ruddy Rose, PharmD VDH Lisa Hague VDH/Southside Health District Charles Devine, MD VHHA Steve Ennis Virginia Association for Home Care and

    Hospice Debra Blom Virginia Association of Counties Larry Land Virginia Attorney General's Office Rob Bryden Virginia Community College System Mary Savage Virginia Department of Agriculture & Consumer

    Services Don Butts, MD Virginia Department of Education Tia Campbell Virginia Department of Emergency

    Management Randy Francis

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Health and Medical Subpanel of the Secure Commonwealth Panel

Virginia Department of Emergency

    Management Janet Clements Virginia Department of Emergency

    Management Michael Cline Virginia Department of General Services,

    Division of Consolidated Laboratory Services Jim Pearson, DRPH Virginia Department of General Services,

    Division of Consolidated Laboratory Services Denise Toney, Ph.D. Virginia Department of Health Kim Allan Virginia Department of Health Bill Berthrong Virginia Department of Health Gary Brown Virginia Department of Health Becky Bynum Virginia Department of Health Sidnee Dallas Virginia Department of Health Phil Giaramita Virginia Department of Health Diane Helentjaris, MD Virginia Department of Health Joe Hilbert Virginia Department of Health AJ Hostetler Virginia Department of Health Jeff Lake Virginia Department of Health Mark Levine, MD Virginia Department of Health Bob Mauskapf Virginia Department of Health Bill Nelson, MD Virginia Department of Health Jim Nogle Virginia Department of Health Rob Oldham, MD Virginia Department of Health Craig Parrish Virginia Department of Health Winnie Pennington Virginia Department of Health Karen Remley, MD Virginia Department of Health Suzi Silverstein Virginia Department of Health David Wilder, DO Virginia Department of Health Diane Woolard, Ph.D. Virginia Department of Health, OCME Leah Bush, MD Virginia Department of Health, OCME Anna Noller Virginia Department of Human Resource

    Management Sara Wilson Virginia Department of Labor & Industry Ron Graham Virginia Department of Mental Health, Mental

    Retardation & Substance Abuse Services Beth Nelson Virginia Health Quality Center Sallie Cook Virginia Healthcare Association Beverley Soble Virginia Hospital and Healthcare Association Betty Long Virginia House of Delegates John M. O’Bannon, III, MD Virginia Minority Health Advisory Committee David Simmons Virginia Nursing Home Association Dana Parsons Virginia Poverty Law Center Jill Hanken Virignia Department of Health Lisa Kaplowitz, MD Western Tidewater CSB Nora Butler York County Department of Fire & Life Safety Michael Player

    Purpose

    Speakers:

    ? Karen Remley, MD, MBA, FAAP, State Health Commissioner

    ? Mark Levine, MD, MPH, Deputy Commissioner for Emergency Preparedness &

    Response Programs, Virginia Department of Health

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Health and Medical Subpanel of the Secure Commonwealth Panel

? Denise Toney, PhD, Lead Scientist, Division of Consolidated Laboratories, Virginia

    Department of General Services

    ? Diane Woolard, PhD, MPH, Director, Division of Surveillance & Investigation, Office

    of Epidemiology, Virginia Department of Health

    ? Sara Redding Wilson, Director, Virginia Department of Human Resource

    Management

    ? Bob Mauskapf, Director, Emergency Operations, Logistics & Planning, Emergency

    Preparedness & Response Programs, Virginia Department of Health

    ? Jeff Lake, Deputy Commissioner for Community Health Services, Virginia

    Department of Health

    ? James L. Pearson, DRPH, BCLD, Deputy Director, Division of Consolidated

    Laboratories, Virginia Department of General Services

    ? Phillip Giaramita, Director, Communications, Virginia Department of Health

    Discussion

    Del. John O’Bannon, MD, opened the meeting welcoming and thanking everyone for

    their attendance and participation in planning efforts for Virginia. He then introduced Drs.

    Karen Remley and Mark Levine, who gave a status report on VDH’s efforts to identify

    and control the novel H1N1 flu strain. Dr. Denise Toney then provided information on

    new lab tests to detect human influenza and H1N1. Dr. Diane Woolard followed with an

    epidemiological update on H1N1 and a presentation on community containment

    activities during an influenza pandemic. Sara Wilson informed the group on Virginia’s workforce planning efforts relating to an influenza pandemic. Next, Bob Mauskapf

    provided details about the implementation of Virginia’s pandemic influenza plan in

    response to the H1N1 outbreak; as part of this presentation, Dr. Jim Pearson explained

    the process the lab used to test for H1N1, and Phil Giaramita noted that Virginia was a

    leader in the way we handled the outbreak, based on the number of media and public

    calls fielded from other states. Dr. Remley outlined VDH’s clinician outreach initiative

    and reviewed the process to communicate with clinicians during the outbreak. Lastly, Dr.

    Levine moderated a panel discussion, whose members included Drs. Remley, Woolard,

    Helentjaris and Pearson, along with Jeff Lake and Phil Giaramita, about VDH’s response

    to the outbreak, covering issues relating to epidemiological, laboratory, communications

    and local health district activities and involvement. Dr. Levine also updated the group

    about preparedness grant funding for the upcoming year.

The link for accessing presentations provided by the speakers is

    http://www.vdh.virginia.gov/EPR/SecureVaSubpanel.htm.

The following are questions and answers that were raised during the meeting:

    Question Did the lab have any issues with manpower? Answer The lab would have had major issues if the event had lasted much longer; as it was, technicians were working evenings, weekends and were very, very tired. There

    were hints of what could happen in an extended outbreak, and the lab was starting to

    cross-train staff.

Question/Comment Have you considered economic implications of workforce

    shortages?

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Health and Medical Subpanel of the Secure Commonwealth Panel

Answer State government is working with planning and budget, and this is a perfect

    time to think about things like this. If there are staffing problems now, they could only

    get worse in an outbreak.

    Question/Comment Dr. Lisa Kaplowitz started to comment on HR director in Alexandria City, but there was so much static that the comment was cut off. Sara

    Wilson’s response was: Answer Once any part of policy is activated, we are asking for feedback and that

    organizations revisit and refine their continuity of operations plans (COOP) and when

    you use and apply the HR policy. This has been a good chance for us to test it, and

    we’re continuing to learn more about this and other policies.

    Comment VDH’s former Northern Virginia Regional Planner who now works in Maryland called Dr. Kaplowitz to ask how Virginia was getting the message to its

    clinicians because some of Maryland’s clinicians, who are also licensed in Virginia, were

    receiving what we sent out. She explained what had been done in the Virginia

    legislature to bring into law the requirement for physicians/clinicians to provide their

    contact information to be used in public health emergencies.

    Answer Starting in July, we’ll be able to use that contact information for other communications, not just in public health emergencies such as the flu outbreak.

    Question It’s very impressive how far Virginia has come and how knowledgeable hospitals have become. However, during this outbreak, there was conflicting information

    coming from VDH and infectious disease experts so we were confused as to what we

    were supposed to do. Is it possible to look at what is already in place with RHCC’s and a way to communicate between VDH and what’s going on at the clinical level?

    Answer We are working on a statewide model for communicating with clinicians,

    which will also be used at the local level. Infection control nurses are the ones who

    contact the local health departments each day. Local health directors have a tighter

    relationship with the hospitals in their areas. We are working to coordinate and to do a

    better job of exchanging information and establishing expectations and consistency.

    Managing information and communication is a lesson learned for us. Communicating

    directly with the emergency rooms is a great way to do this. We held calls with the

    Virginia Hospital & Healthcare Association, which involved representatives from the

    hospitals. Everyone did a great job of planning for the worst, but we can do a lot better

    at getting the preliminary information out to the hospitals and clinicians; the CDC

    distributed information to us that we weren’t supposed to share with anyone else, but it’s something we hope to work out with them going forward. The Alexandria Health

    Department involved hospitals in their daily conference calls and as part of the incident

    command structure.

Question What are we going to do about people who have no access to health care,

    to keep from overwhelming the hospitals? LHDs don’t have the staff.

    Answer The hope is that we will have health care reform long before we have an

    actual pandemic.

Question EMS providers were calling hospitals asking what they should do.

    Answer Hospitals advised them to contact their Operational Medical Director (OMD),

    but all information needs to be focused and bring it to the level where clinicians are. The

    only credible information we had was from the CDC, so we would direct people to their

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Health and Medical Subpanel of the Secure Commonwealth Panel

    web site. It’s again about setting expectations about where people will get information and to come up with answers where there were none.

    Question Is there some mechanism or place where we can take the individual concerns and issues relating to EMS providers’ response to discuss them? Fortunately,

    Virginia has a great structure, but there is a lot of negativity regarding how the CDC

    responding.

    Answer We are clearly hearing everything everyone here is saying, and we want to go from being B+ to A+. EMS providers should go to their OMD, and another great

    resource is their local health districts. The CDC also held free conference calls each day

    for clinicians with excellent information provided that could be used as given or modeled

    to suit a locality’s needs. We will also turn to people like Dr. Charles Devine, one of our

    health district directors who spent many years as an EMT, to develop procedures in the

    future. Another venue is the EMS Advisory Group meeting coming up at the end of this

    week. We realized very early that consistent messaging is critical, but our normal

    communication process didn’t work in this case because the situation evolved very

    quickly and changed constantly. We also need to make sure we have a robust

    Emergency Services Function (ESF)-8 group in each locality.

    Comment It’s a good time to reacquaint local governments with continuity of operations plans that have been developed over the last few years to determine whether

    they need to be modified. It’s also important to provide them with information about

    workforce issues. VACO can play a part in communicating with local governments,

    utilizing their public information officers (PIOs), about these issues.

    Response The local health directors/districts would be very willing to work with the local governments on this issue. Henrico County’s policy group will be meeting in the

    next few weeks and can begin to do a better job of building communications methods so

    that they will be in place for the upcoming flu season in September, especially if this

    outbreak worsens over the next few months. Alexandria’s city manager took this as an

    opportunity to set up a unified command for influenza that can be used for other

    emergencies. This is an opportunity for everyone to take charge in their organizations to

    move forward with planning efforts.

    Question One area we need to look at is the rural areas; most of the conversation today has been the larger cities. Smaller areas may only have one ambulance. A

    concern is that staff may be exposed and not realize it; information needs to be given to

    these areas and treat them as equals to the larger cities.

    Answer That’s an excellent point, and we found early in the process that we need to use the communication vehicles that are already in place for EMS, but we need

    something more stable because the local squads’ officers change frequently. There are

    also important planning issues that need to be addressed, such as fit testing for masks,

    etc. We now have a window of opportunity because this shook up a lot of people, and

    we need to reassess where the holes are to be able to capture the knowledge while we

    can and collaborate together. Unfortunately, there will be some things we won’t be able

    to fix because there are no funds or because the system won’t be there to fix it.

    Question -- Would you please give your thoughts on syndromic surveillance? Answer We receive emergency room/urgent care chief complaint data files from 77 different facilities every night; we have good coverage in North, Central and Eastern

    regions but need to add capacity in Northwest and Southwest regions. The problem is

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Health and Medical Subpanel of the Secure Commonwealth Panel

that it’s “chief complaint” data, so we don’t know whether that’s what they really have or

    not.

Question -- Would you please explain what we do with our sentinel physicians and what

    we do with influenza-like illness (ILI) around the state?

    Answer Each district has been asked to identify one or more sentinel provider who

    collect specimens for us and report to us every week on patients who present on ILI

    symptoms. We are basing our flu activity on chief complaint data that come in every

    evening from the 77 facilities as described above. We are trying to test with physicians

    in finding out what information they need.

Comment Thought needs to be given to setting up a system so that other patients

    aren’t exposed.

    Answer The best way is through the local health departments; some directors have

    arrangements in which staff go to collect specimens.

Question -- What has the federal government done to energize the process that a

    vaccine can be produced?

    Answer They have been collecting a seed virus to use in producing a vaccine; as thearly as yesterday (Tuesday the 12), there was a discussion of the severity of this illness. Initial reports were extremely alarming, but there hasn’t been good scientific data yet on what is the actual risk. The federal Office of the Assistant Secretary for

    Preparedness & Response (ASPR) has been working for years on different methods for

    producing vaccines more quickly, but a better method has not yet been found.

VDH has set up an e-mail address for its situational unit (situnit@vdh.virginia.gov) and

    would be interested in your feedback, lessons learned and other concerns and issues as

    we’re compiling our information.

    Next Steps

The next meeting of the Health and Medical Subpanel most likely be held in August.

    Comments from today’s meeting will be used in the state’s planning efforts for its

    programs. These minutes and the electronic presentations received from the speakers

    will be posted to http://www.vdh.virginia.gov/EPR/SecureVaSubpanel.html.

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