3M Transcript for the following interview: Ep-21-Pandemic ......Episode 21- Pandemic Preparedness -...

Episode 21- Pandemic Preparedness - Part 2 1

3M Transcript for the following interview: Ep-21-Pandemic Preparedness

Part 2 Mark Reggers (R) Dr John Pournoor (P)

Introduction: The 3M Science of Safety podcast is a free publication. The

information presented in this podcast is general only, and you should always seek

the advice of a licensed or certified professional in relation to your specific work or

task.

Welcome to the 3M Science of Safety podcast presented by 3M Australia and

New Zealand Personal Safety Division. This is a podcast that is curious about the

signs and systems of all things work, health and safety, that keep workers safe and

protect their health. I am Mark Reggers, an occupational hygienist, who likes to

ask the questions Why, How, and Please Explain. Whether you are a safety

professional, occupational hygienist, or someone with any level of WHS

responsibility in the workplace, maybe you are a user of safety products or maybe

you are a bit of a safety nerd who finds this stuff really interesting, then this is a

podcast for you.

(R) Today we are talking pandemic preparedness again with Dr John Pournoor from

3M. Welcome John.

(P) Hello Mark, pleasure to be with you again.

(R) Well, this is actually our second episode with John, so if you have not heard our

first part about pandemic preparedness with John, I would say you pause it right

here, go back and listen to the other one, because that really will help sort of follow

on or build the information that we are going to be talking about today. So,

following on from our previous conversation, John, we’ve got all these healthcare

workers that when people get sick in a pandemic or epidemic that are going to be


on that frontline, what is required to protect those key people to... for those health

systems?

(P) Of course, in a pandemic outbreak, the frontlines of response and protecting

citizens of a country is really the healthcare system. Everybody from general

practitioners, nurses, all the way to emergency responders, ambulance, operators,

even firefighters, anybody who has had any paramedic training will be called upon

to participate and will be mobilised to act. Generally, in many of these cases, the

pandemic influenza plan requires that there is a certain flow of patients through the

system and there would be many points of interaction between potentially sick

individuals and their healthcare practitioners that are delivering some degree of

care to them. One of the fundamental ways in which healthcare practitioners need

to be protected during the course of a pandemic is to equip them with personal

protective equipment. If healthcare workers contract influenza from the patients

they are caring for, they will be actively taken out of the system and can no longer

provide care for the additional patients that will be coming into the system, so

protection of frontline healthcare workers, first responders and civil defence forces

that are participating is essential in making sure for the long run, for the many

weeks that the first wave of a pandemic is going to take place, people are able to

come to work, they are protected and they can return day after day, delivering care

and taking care of the citizens that are coming in sick, seeking care. So, one of the

fundamental pieces of information I am going to leave with you is that protecting

those personnel is essential to making sure a sustained response can be delivered

during an outbreak.

(R) So, you don’t know how long it’s going to last, what type of equipment are

these healthcare professionals actually using, wearing, going through to make sure

there is enough of a supply in that peak usage of a pandemic?


(P) This is really focused on the common method of transmission of influenza virus.

The influenza virus usually is transmitted by what is known as droplet transmission

– coughing, sneezing, etc basically transmits airborne droplets that will carry the

influenza virus either to another person that may breathe them in or they may

deposit on a surface, somebody touches that surface and then touches other

objects and eventually it can get into the human host. Because airborne transition

is the dominant method of transmission, any personal protective equipment that

can minimise transmission of droplet particles would be really appropriate and any

personal protective equipment that can neutralise this virus upon contact would be

also appropriate. Consequently, what that means is that usually respirators with a

certain minimum filtration efficiency are required, so that when healthcare

professionals are delivering care the air that they are breathing filters a very large

proportion of these droplets out, therefore minimising their chances of exposure,

plenty of other types of personal protective equipment like eye protection,

certainly hand antisepsis, gloves, etc, these are the types of things that are quite

often required to protective the healthcare workers, so they minimise their chances

of contracting the disease and therefore are able to deliver care over the long haul

during the waves of a pandemic.

(R) Where does a government start, federal or state, even begin to figure out how

much equipment they would need? Respirators and gloves and other equipment,

how do they ever begin to figure out how much they actually need, given the

complexity of what we’ve been speaking about?

(P) That is a very good question. Actually, what we see is that many pandemic

plans are excellent in profiling what the potential range of scenarios for the

outbreak profiles are, meaning what the infectivity of the virus may be, what the

range of durations may be, these are all expressed in ranges. These plans are very

good at clarifying roles and responsibilities, so when disaster strikes, people don’t

get in each other’s way and are able to deliver care in a very effective and well-


coordinated manner. What most plans are missing is really an appendix at the end

that says if this happens this is the logistics and supply chain that we need of a

variety of products that we need to stockpile so that within short notice we are

able to bring all of these products into the system and have an effective response.

The challenge here is that many ministries of health, their expertise is really in

medical science epidemiology. It is in sort of understanding the health statistics,

the resources that are available at the national level, but what are the core

competencies that many ministries do not have is they are not supply chain

experts, and therefore what we have done at 3M is we have created a set of tools

where a country can hold a mirror to their pandemic plan. Basically, the

parameters that are in the pandemic plan – populations, demographics, virulence

of the pandemic strain of the influenza strain that is appearing, potential ranges of

this virulence, sort of range of duration, what is the shortest to the longest duration

that the event can happen – many of these parameters can be taken from the

national plan, entered into tools that we have developed and they can make

projections, also in the form of ranges, as to what range of stocks and stockpiles

and logistics and supply chains are required to be able to have a robust and holistic

response to this kind of an event. As a manufacturing company, as a technology

company, we know, and we develop these types of products and we know how to

manufacture them. Logistics and supply chain is our expertise. What we are not

experts in is in the profiling of the infectious disease and its potential outbreak, but

that knowledge already resides in the pandemic influenza plan so what we’re doing

here is basically marrying our expertise, subject matter expertise in logistics and

supply chain, combining it with the knowledge and content that exists in the plan to

create and appendix to that plan that makes projections based on the assumptions

that are made in the plan, and give the range of potential stocks that would be

required to effectively protect those who are on the frontlines.

(R) So, what is stopping these government departments to go out and just get that

equipment at the time of the pandemic that hits?


(P) Well, I would have to say actually Australia over the years has developed their

own means of making some of these projections. This knowledge... I think the

Department of Health now is very knowledgeable about this type of content and

the next step after having developed this logistics and supply chain plan is really to

prioritise this against a very large set of needs that the population has. There is a

need for care, for a variety of types of diseases, that the government basically

takes responsibility and part of the public health system’s response. Australia has

an emerging baby boomer population. They will need aged care, chronic care, etc

and then in this mix you are also placing the need for personal protective

equipment for potential infectious disease outbreaks scenarios like pandemics, and

so in many of these cases pandemic funding is competing with many other needs

that the country has all at the same time, and the degree of stockpiles not only

partly is dependent on many of these calculations, but is also partly dependent on

the availability of budgets and the prioritisation of this type of planning versus all

the other demands and needs that are bearing down on the government, so by no

means is it a very simple process, but I think each country really tries to do the best

it can to find a meaningful way of figuring out what the middle ground is going to

be for them and then building on that year after year, making it more sophisticated,

making sure better stockpiles, better plans are put together.

(R) Talking about pandemics crossing over borders, I guess in these kinds of events,

borders may get shut down, so that’s going to stop the flow of supply of a whole

range of equipment and food and so forth. Does that have an impact on the

planning and response of a government?

(P) It certainly does. One of the ways in which all governments in their legal system

have developed provisions for public health events is that at the national level a

country can declare a public health emergency and that the country basically uses

its emanant domain powers and are able to sequester anything that it needs to use


for the care of its citizens from leaving the country, so public health emergencies

are a special case where in the legal frameworks of many, many countries create

and impart that power to the government to be able to shut down the border and

says none of these products will leave the country because we will need all of it,

and therefore this is one of the concerns that many countries have. Because of

that, most countries desire that their stockpiles are within their own borders. That’s

one of the requirements for stockpiling, it’s a matter of national security to really

have that stockpile within your borders rather than outside. The second issue is

that if you are just seeing as the Department of Health, as the Ministry of Health,

that there are hot spots of influenza outbreak globally, the frequency is increasing,

these front, forward-facing laboratories – as I mentioned to you in the past podcast

–the World Health Organisation has certain laboratories that they have set up

exclusively for detecting the emergence of new strains of influenza virus, so if

these laboratories are recording new strains, these are the kinds of signals that sort

of sensitise the governments to look very quickly to see if they have enough

stockpiles. The bad news here is that, globally, almost all ministries of health, all

national departments of health, are making this internal check simultaneously, and

then there is a simultaneous and rapid demand for these products from all corners

of the world. The supply of these products are limited, the elasticity of production

of these products are limited and suddenly there is a massive multi-fold demand on

the system, and so when the demand outstrips the supply, that is when a public

health situation arises from not being able to get what you need. The personal

protective equipment that you’re ordering, if it is at the 11th hour, there would be

no-one that would be able to fulfil that order, so the fact that governments have the

authority to write purchase orders is not adequate to guarantee them, that they

would have the supplies that they need, because globally the demand would be

outstripping supply by many, many fold, and this is the rationale behind many

countries creating national, state and sometimes even municipal stockpiles to make

sure that in times of disaster like this they have the ability to respond without


necessarily the need for external provisions of products and services being made

available to them on such short notice.

(R) I was hoping very quickly, could you run a scenario through for us. I’m

obviously conscious of the time, but like can you give us a couple of, I guess,

parameters that you would work through, with the government, to work out a

number of, respirators as an example.

(P) Yes, a very simple example here is... for instance, in many plans, the first node of

service delivery is really the general practitioner. When we have a headache, when

we are sneezing, we feel we have caught a cold or the influenza virus, one of the

first things we do is we go to our general practitioner and ask them to help us get

over the illness, and so GPs are seen as the frontlines of seeing patients. So,

general practitioners become a class of healthcare delivery personnel that need to

be protected because they respond to the population’s early needs. Some of the

people that they will see, they may diagnose as having such advanced form of

influenza that they need to go to other, more sophisticated clinics for care. This

process of creating a flow of patients into the proper nodes of service delivery in

the healthcare system is typically referred to as a triage process. So, the general

practitioners may send many people to what is known as fever clinics, large

gymnasiums with cots or beds in them, that basically house them. They do not

need a lot of care but separating them from everybody else slows down the spread

of the disease and therefore reduces the stress on the system. Those who may be

severely ill may be sent, let’s say, to an emergency room for a quick diagnosis and

maybe admission into the hospital, so you would now have scores of people

focusing on these fever clinics. Emergency rooms become a node of consumption.

However, if we are channelling the sickest of the sick to the emergency rooms,

then the risk of exposure for the personnel that are there become that much higher,

and therefore depending on risk, depending on the frequency of exposure, all of

these individuals that are delivering healthcare services will need a certain level of


personal protective equipment. The higher the risk, the more sophisticated that

personal protective equipment needs to be, the more frequently they need to be

changed, etc, and it’s those parameters that basically create an intensity of

consumption. That’s typically how a scenario is built and then for each node the

level of consumption for all of the service providers nationally can be projected.

You put consumption at all of these nodes, combine them altogether, and the grand

total is the national consumption of these types of personal protective equipment

and products.

(R) So, if I had to summarise what you said, you are essentially trying to work out

how many people – and most particularly GPs, nurses, who’s going to be exposed

– how often they are going to be exposed, which then results into how often they

are changing their mask, and then based on the parameters of if we are going to

work on a 3-week pandemic, a 60-day pandemic you work out those calculations

on those parameters?

(P) Exactly. Let me give you a very simple example. Let’s say you have ten people

operating an emergency room on a typical day in a hospital in a city in Australia. If

they work 12-hour shifts, you would need 10 people in the morning, 10 people in

the evening, to be able to cover a full 12-hour shift. If they process, let’s say, 10

patients per person, this 10-person crew would be processing 100 patients in one

shift, another 100 patients in the second shift, and so you are able to then on a per-

shift basis make an extrapolation as to how frequently they are going to be needing

personal protective equipment and then by making those projections you will be

able to predict in one day what level of stock they need. If the duration of the

pandemic is 50 days, you multiply their need in one day by 50, and that is the stock

they need in 50 days. This is for one emergency room. Multiple that by all the

emergency rooms in Australia, in New Zealand, and by the number of staff that are

working there, this is the grand national total for what the consumption by

emergency room personnel is going to be. You do this for general practitioners,


you do this for people that are in the general ward of the hospital, for some of the

patients who will be there, you do that for people in intensive care units, etc, and

these nodes of consumption, all of these consumptions can be then combined and

the grand total would be what you would need in the national stockpile.

(R) I would imagine the same, like other PPE selection, it has got to be suitable for

the person, when you look at the range of face shapes and types and other

different characteristics, when we’ve done some podcasts before around being

clean shaven, so all those kind of factors would come into it as well, This can be

quite a complex issue if you are not planned in the event of a pandemic.

(P) The best time to get ready for a pandemic is before it happens, so you were

right on the mark. When you have a stock of, let’s say, respiratory protection

devices. As we mentioned, the main vector for transmission of influenza are

droplets, and therefore inhalation and airborne droplets are a common vector for

transmission. Therefore, respirators play a very critical role in protecting

healthcare personnel, and at the 11th hour and 59 minutes, right before the

pandemic is happening, when you see all the spots on the map of the globe are

glowing brightly and more cases are being recorded, that is not the time to start fit-

testing these products on personnel in healthcare facility. Right now is the time

where, according to the national plan, state plans or local plans, certain personnel

need to be identified as having key, forward-facing frontline responsibilities, they

need to be tested for fit so that we can accommodate the different types of facial

features and morphology that their face has, so that the right product with the right

tight fit to their face can be chosen, it would be qualified and protected for wearing

that product, and getting training, getting fit-tested, and then they would have the

ability to protect themselves should the event happen. So, the time to do that is

really during the times of quiet when the disease has not emerged yet, but very

important to do fit-testing, because without fit-testing the respirator doesn’t really


perform its job adequately and does not stop the droplet transmission, which is the

vector for transmission.

(R) You’ve hit the point. It’s all about the planning before the actual event. is there

any sort of key point you really want to put out there to governments or those who

have the authority to actually get that planning and getting prepared right now

before that actual pandemic hits?

(P) Yes. We have learned a number of lessons over the last decade and a half,

starting with avian flu, SARS, certainly a couple of different strains of pandemic

influenza that threaten to be global outbreaks but turned out to be some milder

than others and did not challenge the healthcare systems as dramatically as they

would have otherwise. I can catalogue these lessons learned into a few sort of

high-level concepts that I would like to share with you.

(R) That would be great.

(P) One is that... one is that governments certainly must continue to manage

resources or personal protective equipment, hand hygiene products, amongst

many other things in stockpiles, and those stockpiles need to be within their

national borders. This is a matter of national security. The reason for that, the

rationale for that, is that at the 11th hour when you want to order this, there is a

global run on many of these products and there isn’t adequate supply to be able to

sequester and bring into the country, and therefore the time for preparedness and

stockpiling within the national borders is before the event has happened. The

second one is that the inventory that is created by the national stockpile must be fit

for the task at hand. Since these are influenza stockpiles, therefore what is

available needs to be of a filtration efficiency that is appropriate for stopping

droplet transmission. That would be high-efficiency respirators and because the

healthcare workforce in the country may come from different backgrounds,


different facial features, etc, therefore a mix of products may need to be available

that can fit the maximum number of people with different nose bridges or different

types of bone structure on their faces. For all of these, there are different types of

respirators that can be procured and maintained in the stockpile to be

representative of the healthcare population that needs to be protected.

(R) The filtration efficiency for Australia is that N95, which is based off the US, but I

know our healthcare system uses the N95 or P2, for those people listening, what is

that level.

(P) Yes, that’s correct. World Health Organisation, US Centres for Disease Control,

European Centres for Disease Control and many other subject matter experts in

this area all recommend the use of N95 or P2 respirators. My recommendation is

that the country needs to be open to procurement of N95s and P2 respirators and

they need to specify that as such so that there is that flexibility to be able to reach

out and procure products that are validated to perform at those levels of filtration

efficiency.

(R) I think you’re up to point number three

(P) Yes, exactly. Third point I would say is that the quantity to be stockpiled should

be estimated using modelling tools and taking into account different scenarios all

rooted into the national pandemic influenza plan or the state pandemic influenza

plans that have been created by experts in the country, so a connection between

modelling and projection and the national plan is really essential. 3M is certainly

available to conduct in a workshop format a gathering of experts so that their data

could be put into the tools and statistical simulations that our tools are able to make

projections of the stockpile levels. Because many parameters for pandemics are


defined in ranges, the projections we make also project a range of stock that would

be required, and then other provisions, other discussions determine where the

needle stops for the level of stockpile within the range that was estimated based on

the national plan parameters. I would say a next step in preparedness is

manufacturers that understand pandemic preparedness and response and have

global expertise in this area really are the ones that can benefit governments when

they are engaging with reliable suppliers for stockpiles. The reason for that is these

organisations, these companies have been tested in previous outbreaks and they

have designed and refined their internal systems and their logistics and supply

chains to be able to respond to the surges and demand that these kinds of

outbreaks create. Also, manufacturers that have a global footprint, meaning many,

many points of productions in various countries, in various geographies, these

multiple locations of productions create the ability to respond in a more elastic way

and therefore supply chain elasticity combined with local presence in the country

become a defining feature of engaging with manufacturers that can work best with

public health officials. the issue of borders shutting down becomes less of a

concern because they can alter their supply chains in a way that is compatible with

their global footprint and it gives them more flexibility to be able to respond to

need. And, finally, I would say you must continue to recognise that during an event

no amount of excess capacity in the system can compensate for the exponential

rise in global demand. If a lesson that has been learned in the past outbreaks I cited

to you just a minute ago for 3M, it has been that there is a sudden surge and a

dramatic rise in demand that global capacity will not be able to respond to. Add to

this the complexity that personal protective equipment quite often is being used by

industrial workers to protect them from occupational hazards and so there is only a

limited amount of the product that can be removed from occupational frontline

workers in industries and given to healthcare workers before you create a different

kind of public health problem, so, the key message at the end is that stockpiling is

really the only way to protect the healthcare workers that will go to work because

they are confident in the fact that they have the right personal protective


equipment protecting them against exposure. They can come back home to their

families every day. They will show up for work when they know they’re protected

and they’re not going to take back those infections to their families, so we see

many countries, the presence of personal protective equipment isn’t just a

necessity because epidemiology, medical science and healthcare demands that it

be done, but also because it gives the confidence for those who put their lives on

the frontlines and try to help the patients through these phases of the pandemics.

They are the ones who show up for work with confidence because they know

they’re protected.

(R) Really appreciate those points there, John. It is quite a big topic, I know we’ve

only just skimmed the surface ever-so-lightly, but really appreciate those points

and hopefully those takeaways that listeners can take with us. Really appreciate

your time, John.

(P) My pleasure. It’s an important topic. I hope your listeners sort of learn

something from this and look back at their own plans and see how they can

improve them.

(R) Fantastic. Well, thanks for listening everyone. If you have any questions,

comments or suggestions for future topics, for future guests you think we should

into the studio, you can shoot us an email at [email protected]. You

can also contact us via that email if you need any further information about

pandemic planning or any other sort of PPE topics that we’ve covered in past

podcasts. Also, if you want to get in contact with John directly, you can shoot us

an email and we are very happy to pass on his details through that way as well.

Please make sure that you do subscribe to the podcast wherever you get your

podcast from. We’d hate for you to miss any future episodes If you have enjoyed

the podcast or found it informative, we’d really appreciate if you could take a few

moments to leave us a review as it really does help others find the podcast as well.

mailto:[email protected]


And, as Og Mandino said, “Always do your best. What you plant now you will

harvest later.” Thanks for listening and have a safe day.

3M Transcript for the following interview: Ep-21-Pandemic ......Episode 21- Pandemic Preparedness -...

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