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Pandemic Flu and Natural Disease Planning

Planning for Pandemic Influenza Fatalities

Local authorities are currently planning how to manage an increase in natural deaths due to a pandemic influenza event in the Commonwealth of Virginia. It is an undeniable fact that if a pandemic were to arrive, citizens will succumb to the disease or related secondary causes. Local medical facilities, first responders, funeral directors and many others need to prepare for managing the possibly high numbers of additional deaths during a pandemic. The Managing Pandemic Influenza Fatality Events brochure contains an overview of what localities need to plan for during a pandemic event including signing and filing death certificates, handling human remains and storage considerations. Additionally, the OCME has prepared pandemic flu death estimates derived from VDH projections and CDC’s FluAid 2.0 software and presented by Planning Districts, Virginia Department of Emergency Management Regions, and by Virginia State Police Divisions. While these numbers are estimates, they provide local authorities with an idea of how many deaths they might see in their locality and encourage collaboration with other districts/regions to manage fatalities. While pandemic flu deaths would be natural deaths, the protocol for pronouncing the death, signing the death certificate and handling the remains would not differ from that of seasonal flu, except that there would be higher numbers. For a review of the protocol for managing pandemic flu deaths, please review the Flowchart for In-Hospital Pandemic Flu Deaths or the Flowchart for Out-of-Hospital Pandemic Flu Deaths.

Additional information on Pandemic Flu is available VDH’s Office of Emergency Preparedness and Response:

All of the below files are contained in the above summary but have been separated out for your reading convenience. These files require the free Adobe Acrobat Reader pdf document.

The following file is a PowerPoint presentation:

Estimations of Deaths in Virginia Caused by Pandemic Flu by Planning District

NOTE: The numbers contained in the following table are estimations of what could happen and are intended soley as a guide to help localities plan and prepare.

The attached table contains estimates of the number of deaths that could possibly occur if pandemic flu were to arrive in Virginia. These numbers are based on 2004 population data obtained from the Virginia Department of Health’s Division of Health Statistics ( Population counts and total deaths for 2004 (Columns 2 & 3, respectively) are broken down by planning district and city or county (Column 1).

The remaining six columns represent the estimated number of deaths that could occur in two waves due to pandemic flu during a 24-week period. The first three columns represent three mortality rates: 1) the first rate of 0.6 deaths/1000 people is an average mortality rate based on the estimated total number of deaths in a “medium level” pandemic as provided by the Virginia Department of Health (Column 4); 2) the second rate of 1.52 deaths/1000 people is based on a worst-case scenario using a 35 percent attack rate modeled after the 1958 and 1968 pandemics (Column 5)1; and 3) the last rate of 7.35 deaths/1000 people is based on the a 35 percent attack rate modeled after the 1918 pandemic, which was a highly virulent influenza strain where the death rate for 15 to 34-year-olds was 20 times higher in 1918 than in previous years (Column 6)1,2. The second set of projected deaths is modeled after the 1958 pandemic where 44 percent of deaths occurred in a four-week span. Columns 7-9 represent the estimated number of deaths at their previously established specific mortality rates during one week of the peak period. In the event of a future pandemic, there could be more or fewer waves than two, and it also could last longer or shorter than 24 weeks.

County A’s population was 282,913 people with 1,286 deaths due to all causes in 2004. The estimated total numbers of death for a medium-level, 1958-like, or 1918-like pandemic are 170, 430, or 2,079 deaths, respectively. These estimated totals include the normal number of flu deaths this county has in a normal season. The next set of data demonstrates the number of deaths that County A would see in 1 week during the peak period of the different pandemics. The one-week estimates for the medium-level, 1958-like, or 1918-like pandemics are 19, 47, or 229 deaths, respectively.

1 Calculated using FluAid 2.0 (
2 Taubenberger, Jeffery et al. 1997. Initial Genetic Characterization of the 1918 “Spanish” Influenza Virus. Science. 275:1793-96.

Planning for Natural Disease Fatalities

Naturally occurring disease deaths pose new challenges for local planners and responders. Normally handled by the primary care physician and the families’ funeral directors, both private entities, the possibility of large numbers of naturally occurring disease deaths requires local government resources to investigate all non-hospital deaths, and to support the private funeral service businesses as they struggle to keep up with the management of increased numbers of deaths.

The OCME has created this document to help localities prepare to manage the increased number of deaths due to a natural disease event.

Natural Disease Plan

Last Updated: 01-10-2012

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