General

• The flu will infect over 30% of the US population causing 2 million deaths, 10 million hospitalizations, 45 million outpatient visits and 90 million cases.
• Preparations should be geared toward a 1918 level pandemic.  In Missouri this would extrapolate to (without effective interventions) approximately 1.8 million ill, 900,000 seeking outpatient care, 198,000 hospitalizations and 38160 deaths.
• An influenza pandemic of this magnitude will affect all segments of society and could overwhelm health care and mortuary systems, severely disrupt commerce and economic activity, break down normal societal patterns, and cause psychosocial trauma.
• Risk groups for severe and fatal infections cannot be predicted with certainty
• The pandemic will occur in waves, with at least two waves likely.
• In an affected community, a pandemic out break will last about 6 to 8 weeks.  At least 2 pandemic disease waves are likely.  Following the pandemic the new viral subtype is likely to continue circulating and to contribute to seasonal influenza.
• The seasonality of a pandemic cannot be predicted with certainty.
• Local public health agencies will not be able to rely on external resources beyond what they have already prepared
• Preparations should be made for outbreaks that will likely occur simultaneously across the state and nation, limiting the ability of any one jurisdiction to provide support and assistance to others.
• Vaccine for the novel influenza virus will not be available in Missouri before the virus reaches the state
• Effective antivirals will be in limited supply and must be prioritized to maximize effectiveness
• Education, public health interventions, basic public health measures and social controls must be relied upon initially to slow the spread of the disease within Missouri
• People who become ill may shed virus and can transmit infection for one-half to one day before the onset of illness.  Viral shedding and the risk for transmission will be greatest during the first 2 days of illness.  Children will shed the greatest amount of virus and therefore are likely to pose the greatest risk for transmission.

Specific

• Dallas County has no hospitals within the county boundaries.  Dallas County relies on hospitals located in the adjacent counties/cities of Bolivar, Springfield and Lebanon. 
• There is one hospital based ambulance service in Dallas County.  There are a large number of volunteer first responders throughout the county.  Many are affiliated with the local volunteer fire departments. 
• Medical services are limited to 3 hospital based physicians offices and 1 independent physician.
• Pharmacies in Dallas County number 3 in Buffalo.  They have very limited facilities and would not be ideal for storage of a large amount of antivirals or vaccine.
• There are 2 large long term care facilities in Buffalo with 4 smaller facilities in the county.  These facilities could be used for alternative care in mild acute cases of influenza or for those discharged from hospital that are still in need of a level of skilled care that couldn’t be performed in the home.   There are no facilities in Dallas County capable of caring for ventilator dependent patients.   
• The two funeral homes in Dallas County have 4 locations in the county but limited space for holding bodies.
• Dallas County R1 School has an estimated population of 1950 students.  This district covers the majority of the county.  Hickory County (Skyline) School has a population of 820 students with 60% (492) of those attending live in Dallas County.   There are two other private faith based schools in the county.  School events in these communities are primary social activities for many and draw large crowds.  In the event of a pandemic, it may be necessary to cancel events and possibly to close the schools. 
• If in the event of a pandemic, schools were forced to close, more than 52% of the students attending Dallas County R1 School received free or reduced cost meals.  Many of these students have breakfast and lunch at school and little else at home.  
• The social/economic loss for Dallas County would be devastating.  The median household income for Dallas County is approximately 28% below the median for Missouri household income.  If Dallas County families lose their primary source of income, the need for social services would jump up drastically.
• In 2005, according to the data from the Missouri Department of Social Services, 17% of the population in Dallas County received food stamps and 16% of the population receives some type of public assistance in the form of income.   Social services for those not able to work or those caring for others will be in high demand.  Limited staff and the time it takes to process paperwork for social programs could prove detrimental.