Interim Pre-pandemic Planning Guidance

Written as an interdepartmental United States (US) government effort on interim planning guidance for the public, this document presents a group of non-pharmaceutical (e.g., social distancing, quarantine, etc.) interventions focused on harm reduction in the event of an influenza pandemic.

From the executive summary:
"Communities, individuals and families, employers, schools, and other organisations will be asked to plan for the use of these interventions to help limit the spread of a pandemic, prevent disease and death, lessen the impact on the economy, and keep society functioning. This interim guidance introduces a Pandemic Severity Index to characterise the severity of a pandemic, provides planning recommendations for specific interventions that communities may use for a given level of pandemic severity, and suggests when these measures should be started and how long they should be used... This guidance will be updated as new information becomes available that better defines the epidemiology of influenza transmission, the effectiveness of control measures, and the social, ethical, economic, and logistical costs of mitigation strategies. Over time, exercises at the local, State, regional, and Federal level will help define the feasibility of these recommendations and ways to overcome barriers to successful implementation."
The document introduces a "Pandemic Severity Index" in which the case fatality ratio (the proportion of deaths among clinically ill persons) serves as the critical driver for categorising the severity of a pandemic. It then gives a pandemic mitigation framework that is "based upon an early, targeted, layered application of multiple partially effective nonpharmaceutical measures." These measures include:

• Isolation and treatment with influenza antiviral medications.
• Voluntary home quarantine of members of households with confirmed or probable influenza cases.
• Dismissal of students from school and social activities.
• Use of social distancing measures to reduce contact between adults in the community and workplace.

Chapters include:

1. Executive Summary
2. Introduction
3. Rationale for Proposed Nonpharmaceutical Interventions.
4. Pre-pandemic Planning: the Pandemic Severity Index.
5. Use of Nonpharmaceutical Interventions by Severity Category.
6. Triggers for Initiating Use of Nonpharmaceutical Interventions.
7. Duration of Implementation of Nonpharmaceutical Interventions.
8. Critical Issues for the Use of Nonpharmaceutical Interventions.
9. Assessment of the Public on Feasibility of Implementation and Adherence.
10. Planning to Minimize Consequences of Community Mitigation Strategy.
11. Testing and Exercising Community Mitigation Interventions.
12. Research Needs.
13. Conclusions.
14. References.
15. Appendices.