Yes, Virginia Does Have a Plan to Fight the Pandemic

by James C. Sherlock

I have reviewed the Commonwealth of Virginia Emergency Operations Plan, HAZARD-SPECIFIC ANNEX #4 PANDEMIC INFLUENZA RESPONSE^[1], August 2012. Such plans are required by FEMA as a predicate for federal funding, so every state and territory has one. Virginia’s operations plan, which follows the FEMA template, is excellent. The lead agency for execution is the Virginia Department of Emergency Management (VDEM).

 The question, as always in emergency response, is pre-emergency training and exercises. FEMA offers every level of both training and exercises and pays the bills, but the states must opt to use them, make sure that the right people participate and correct any readiness deficiencies exposed. Assessments of how and how often Virginia exercised, who participated, the level of rigor and post-exercise corrective actions will wait for post-operation analyses Here follows highlights of that plan. (Text in italics are my editorial insertions.)

Purpose

The Commonwealth of Virginia Pandemic Influenza Response Annex …has been developed to provide a sound basis for pandemic influenza preparedness and to establish the organizational framework and operational concepts and procedures designed to minimize the loss of life and property and to expedite the restoration of essential services following an influenza pandemic.

This non-clinical Commonwealth of Virginia Emergency Operations Plan (COVEOP) annex is designed to be used in concert with [the Virginia Department of Health’s] clinical Pandemic Influenza Plan Together, these documents represent the Commonwealth’s approach to respond to and recover from pandemic influenza.

Planning Assumptions

These are generally spot on.

Policies

“All agencies assigned responsibilities within this annex will develop and maintain the necessary plans, standard operating procedures, mutual aid agreements, and model contracts to successfully accomplish their tasks.”

Organizational Structure

The Virginia Emergency Response Team (VERT) and associated Emergency Support Functions (ESFs) will coordinate response operations via the Virginia Emergency Operations Center (VEOC)….

Concept of Operations

Measures to Procure and Stockpile Additional Supplies

“Existing measures to provide for needed medical and non-medical stockpiles include Virginia’s purchase of an antiviral stockpile (maintained by a contract vendor responsible for storage and emergency distribution), Metropolitan Medical Response System (MMRS) caches in Virginia’s three (3) MMRS areas (Northern Virginia, Richmond and Hampton Roads), hospital supplies provided through Health Resources and Services Administration/Assistant Secretary for Preparedness and Response (HRSA/ASPR) grants, supplies purchased by the Health Districts and stored onsite for immediate response purposes, and the Commonwealth of Virginia Strategic National Stockpile (SNS) Plan for federal stockpile assets. Virginia may also request federal assets through the use of the FEMA Action Request Form process as described in the SNS Plan.”

(Author’s note, a MMRS defines, trains and exercises an enhanced local health and medical response to victims of terrorist incidents and other public health emergencies.  The characteristics of MMRS are expected to include:

• Integrated medical response system
• Detailed system response & operations plans
• Specially trained responders at all levels
• Specialized response equipment
• Specialized medical equipment and pharmaceutical cache
• Enhanced medical transport and treatment capabilities)

Points of Distribution

“The response structure will include provisions … to provide assistance for acquiring equipment and materials as requested .… Emergency Support Function (ESF) #7, in accord with procurement policy, will track resource requests, make provisions for service and emergency material delivery (e.g., site access, ingress routes, etc.), make sure vendors and suppliers are made aware of site access requirements, and provide for remote staging areas. Just-in-time purchasing arrangements exist through VDH’s pre-approved vendor list as well as pre-scripted VEOC equipment and supply lists, available for activation in the event of a declared emergency. Virginia’s primary SNS Receive, Store, and Stage (RSS) site, a state-owned facility, will be made available for storage and redistribution of received just-in-time supplies, among other warehousing options.”

3. Points of Distribution (PODs)

“The Commonwealth has also developed a database of Points of Distribution (PODs) in local jurisdictions throughout the Commonwealth. These PODs follow the typing recommended by the United States Army Corps of Engineers (USACE). The database facilitates the identification of gaps to support the POD at the local level, which allows the Commonwealth to address the gaps identified, in coordination with their local partners, before an event occurs, thereby ensuring an efficient operation….”

Appendix A AGENCY ACTION MATRIX

Stage 1 – Suspected Human Outbreak Overseas

ALL Virginia Emergency Response Team (VERT) AGENCIES:

1. Exercise, train, and refine continuity plans with an emphasis on pandemic influenza.
2. Provide pandemic influenza related education and training.
3. Review agency communications plan.
4. Review resource inventories and sustainability of supply chains.

Virginia Department of Emergency Management:

1. Review, exercise, and refine the COVEOP pandemic influenza annex.
2. Review resource needs/inventory/vendors.
3. Prepare to support implementation of travel restrictions.
4. Emphasize preparedness at all levels and sectors.
5. Promote and provide public education.
6. Provide technical assistance and support to agencies regarding continuity planning.

Virginia Department of Health:

1. Review and exercise the VDH pandemic influenza plan.
2. Continue surveillance.
3. Coordinate with partners.
4. Initiate education campaign.
5. Prepare pre-scripted messages.
6. Review and adjust inventories of selected resources.
7. Coordinate with suppliers.
8. Review and update the fatality management plan.

Stage 2 – Confirmed Human Outbreak Overseas

All Vert Agencies:

1. Continue to brief agency staff, as needed.
2. Review plans, as needed.
3. Reinforce contact and transmission strategies.
4. Review resource inventories.
5. Pre-deploy assets, as appropriate.

Virginia Department of Health:

1. Declare a “public health emergency.”
2. Review and activate appropriate plans.
3. Maintain dialogue with partners.
4. Maintain heightened hospital and community-based surveillance.
5. Continue education/guidance to the public.
6. Support isolation and quarantine initiatives at ports of entry.
7. Monitor health sector.
8. Review and implement anti-viral distribution plans.

Stage 3 – Widespread Outbreaks Overseas

All Vert Agencies:

1. Place essential staff on recall.
2. Reach out to critical infrastructure providers to ensure pandemic influenza and continuity plans are in place.
3. Review resource inventories.
4. Reinforce protective measures.

Virginia Department of Emergency Management:

1. Consider declaring a “state of emergency.”
2. Advise public to plan to reduce non-essential domestic travel once epidemic hits U.S.
3. Augment the VEOC .
4. Implement protective measures.
5. Establish a Joint Information Center.
6. Establish a Joint Public Inquiry Center.
7. Review continuity plan.
8. Coordinate with supply chain providers
9. Maintain dialogue with local, state, federal, and private partners.

Virginia Department of Health:

1. Maintain heightened hospital and community surveillance.
2. Prepare to implement surge plans.
3. Review and implement anti-viral distribution plans.
4. Continue education and guidance to the public.

Stage 4 – First Human-to-Human Case in North America

All Vert Agencies:

1. Activate continuity plan across all levels
2. Limit non-essential domestic travel.
3. Maintain situational awareness.
4. Begin monitoring absenteeism.
5. Implement protective measures.

Virginia Department of Emergency Management:

1. Activate the COVEOP pandemic influenza annex.
2. Alert and brief staff.
3. Monitor state operations and absenteeism
4. Ensure adequate resources available to maintain critical services.
5. Continue to provide technical assistance and support to agencies and communities.
6. Continue to coordinate with local, state, and federal partners.
7. Limit non-essential travel in affected areas.
8. Disseminate preparedness and prevention information/guidance.
9. Implement protective measures/social distancing.
10. Provide guidance to public.
11. Continue to support VEOC, JFO, and JPIC.

Virginia Department of Health:

1. Maintain heightened hospital and community surveillance.
2. Prepare to implement surge plans.
3. Review and implement anti-viral distribution plans.
4. Continue providing education and guidance to the public.
5. Implement antiviral treatment/targeted prophylaxis.

^[1] https://www.vaemergency.gov/wp-content/uploads/drupal/COVEOP_2012_HSA_4_Pandemic_Influenza_Response.pdf