Article Figures & Data
Figures
- Figure 1
The Centers for Disease Control and Prevention interval framework for influenza pandemic—hypothetical cases as a function of pandemic interval.
CDC = Centers for Disease Control and Prevention.
Note: This is a hypothetical depiction of the number of infectious cases as a function of the Centers for Disease Control and Prevention’s pandemic intervals. Reprinted from Qualls et al.4
Tables
CDC-Defined Intervals CDC Indicators2 Primary Care Experience Primary Care Actions to Care for Patients and Communities Investigation (Interval 1) Investigation of infection Business as usual for primary care; be ready for a potential pandemic Continue usual acute, chronic, wellness, mental health, and social care
Participate in public health surveillance programs
Maintain readiness to address local or global spreads of infectionsRecognition (Interval 2) Recognition of increased potential for ongoing transmission Patients in sentinel communities begin to get infected; clinicians hear about pandemic possibility Rigorous hand washing
Separate patients with infectious symptoms and those who are well
Implement physical distancing measures for all
Minimize patients in waiting room
Have patients and staff wear masks
Disinfect rooms after every patient encounter
Switch to virtual visits and telephone-based care
Testing and contact tracingInitiation (Interval 3) Confirmation of human cases globally with human-to-human transmission Infections rapidly spread in and across communities; patients worry about their risk of infection Convert to complete virtual care for first contact
Only see patients in person after triaged as necessary
Implement proactive population care to identify and reach out to at-risk patients for infection and worsening chronic conditions, mental health, or social needs
Implement policies to protect patients, staff, and clinicians
Keep patients away from emergency departments and hospitals unless necessaryAcceleration (Interval 4) Consistently increasing rate of infection, indicating established transmission Infections spread; patients get infection complications and require hospitalization; patients defer care of non-infectious conditions Continue virtual care and proactive population care
Limit patient contact with emergency and hospital care to necessary care
Systematically implement testing protocols
Define criteria for hospitalization
Create care teams to check in daily/weekly with patients in need
Reinforce and support hospital care teams
Create home hospital care for sick patients not hospitalized
Expand home palliative care for patients who want less aggressive careDeceleration (Interval 5) Consistently decreasing rate of infection Patients get infected—but fewer patients; hospitalized patients improve and need rehabilitation; resume care for non-infectious conditions Support convalescing patients
Support home rehabilitation care services
Consider overflow recovery centers or new home care services
Develop a strategy to resume “normal” in person care
Monitor reopening strategies to ensure patients, clinicians, and staff remain safePreparation (Interval 6) Low infection activity but continued outbreaks possible in some areas Patients suffer from uncontrolled and missed conditions and risks; there is a high burden of mental and social needs; practices recover from financial and staffing burdens Attend to pent-up demand as a result of delayed care
Address adverse consequences of delayed or deferred care
Expand the provision of evidence-based care for unhealthy behaviors, mental health, and social needs
Expand the role of social workers and community health workers
Leverage the clinician-patient longitudinal relationship to address needs
Advocate for essential social and economic policies
Rebuild practiceCDC = Centers for Disease Control and Prevention.
Note: many tasks started in early intervals continue throughout subsequent pandemic intervals.
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