UK Response phases

The definitions and terms for the phases of pandemic response in the UK were re-written in 2012. They are described in the Health Protection Agency Pandemic Influenza Strategic Framework October 2012, which is 58 pages long. Obviously, communication in advance of a pandemic hasn’t been considered a priority, as there’s no short version!

The important section (pgs 7-9) is:

The new UK approach is not driven by the WHO phases. The rationale for this is described in detail the “UK Influenza Pandemic Preparedness Strategy 2011” and uses a series of phases: detection, assessment, treatment, escalation and recovery. It also incorporates indicators for moving from one phase to another.

The phases are not numbered as they are not linear, may not follow in strict order, and it is possible to move back and forth or jump phases. There will also be variation in the status of different parts of the country reflecting local attack rates, circumstances and resources.

Detection

Triggered by either the declaration of WHO Phase 4, on the basis of reliable intelligence or if an influenza related “Public Health Emergency of International Concern” (PHEIC) is declared by the WHO. The focus in this stage would be:

  • Intelligence gathering from countries already affected
  • Enhanced surveillance within the UK
  • The development of diagnostics specific to the new virus
  • Information and communications to the public and professional
  • The indicator for moving to the next stage would be the identification of the novel influenza virus in patients in the UK.

Assessment

The focus in this stage would be:

  • The collection and analysis of detailed clinical and epidemiological information on early cases on which to base early estimates of impact and severity in the UK.
  • Reducing the risk of transmission and infection with the virus within the local community by:
    • Actively finding cases
    • Voluntary self-isolation of cases and suspected cases
    • Treatment of cases/suspected cases and use of antiviral prophylaxis for close/vulnerable contacts, based on a risk assessment of the possible impact of the disease.

The indicator for moving from this stage would be evidence of sustained community transmission of the virus, i.e. cases not linked to any known or previously identified cases.
These two phases – Detection and Assessment – together form the initial response. This stage may be relatively short and the phases may be combined depending on the speed with which the virus spreads, or the severity with which individuals and communities are affected. It will not be possible to halt the spread of a new pandemic; to attempt to do so would waste scarce public health resources and capacity.

Treatment

The focus in this phase would be:

  • Treatment of individual cases and population treatment, if necessary, using the National Pandemic Flu Service (NPFS)
  • Enhancement of the health response to deal with increasing numbers of cases
  • To consider enhancing public health measures to disrupt local transmission of the virus as appropriate, such as localised school closures based on public health risk assessment.
  • Depending upon the development of the pandemic, to prepare for targeted vaccinations as the vaccine becomes available.

Arrangements will be activated to ensure that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths. When demands for services start to exceed the available capacity, additional measures will need to be taken. This decision is likely to be made at a regional or local level as not all parts of the UK will be affected at the same time or to the same degree of intensity.

Escalation

The focus in this phase would be:

  • Escalation of surge management arrangements in health and other sectors
  • Prioritisation and triage of service delivery with aim to maintain essential services
  • Resiliency measures, encompassing robust contingency plans
  • Consideration of de-escalation of response if the situation is judged to have improved sufficiently

These two phases – Treatment and Escalation – form the treatment component of the pandemic. Whilst escalation measures may not be needed in mild pandemics, it would be prudent to prepare for the implementation of the escalation phase at an early stage, if not before.

Recovery

The focus in this phase would be:

  • Normalisation of services, perhaps to a new definition of what constitutes normal service
  • Restoration of business as usual services, including an element of catching-up with activity that may have been scaled-down as part of the pandemic response e.g. reschedule routine operations
  • Post-incident review of response, and sharing information on what went well, what could be improved, and lessons learnt
  • Taking steps to address staff exhaustion
  • Planning and preparation for a resurgence of influenza, including activities carried out in the detection phase
  • Continuing to consider targeted vaccination, when available
  • Preparing for post-pandemic seasonal influenza

The indicator for this phase would be when influenza activity is either significantly reduced compared to the peak or when the activity is considered to be within acceptable parameters. An overview of how service capacities are able to meet demand will also inform this decision.
The uncertainties in any pandemic mean that the actual characteristics of the pandemic may be different from the planning assumptions, and that planned actions may need to be modified to take account of changing circumstances.

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