Pandemic Contagion�Tabletop Exercise (TTX)

Today’s Date

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Opening Remarks

Name

Position

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Name

Position

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Agenda

• Overview of today’s exercise
• Module 1 scenario briefing
• Module 1 facilitated discussion
• Module 2 scenario briefing
• Module 2 facilitated discussion
• Module 3 scenario briefing
• Module 3 facilitated discussion

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Operations Security Reminder

Due to the nature of the content, this exercise is classified as Business Sensitive. It contains information intended for limited use within the company that, if disclosed, could be expected to have a serious adverse effect on the operations, assets, or reputation of the company.

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Sensitive information, even if notional, should not be left in public view.

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Pandemic Contagion TTX Overview

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What is a Tabletop Exercise or “TTX”

A Tabletop Exercise (TTX) is a discussion-based exercise in response to a scenario, intended to generate a dialogue of various issues to facilitate a conceptual understanding, identify strengths and areas for improvement, and/or achieve changes in perceptions about plans, policies, or procedures.

-FEMA Homeland Security Exercise and Evaluation Guide, 2020

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A TTX simulates an emergency situation in an informal, stress-free environment.”

-WHO Exercise Manual, 2017

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Design and Purpose

Exercise Design

Based on guidance from the Centers from Disease Control (CDC), the Department of Homeland Security (DHS), and the Federal Emergency Management Agency (FEMA) and designed for private sector organizations, such as businesses, retail establishments, and nonprofit organizations.

Purpose

Through facilitated group discussion, the exercise aims to help, conduct a tabletop exercise about a novel infectious disease outbreak. This discussion will help organizations assess their business continuity plans, identify actions that can help them protect their employees and customers, and identify actions to minimize the impact of an outbreak on their business operations.

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Rules of the TTX

• No fault environment
• There are no wrong answers
• This is a discussion, not an evaluation
• Respect the views of others
• Reply to the scenario as you would in real life in your current position
• Do not fight the scenario
• Assume your jurisdiction has only the assets and capabilities it has today

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Scenario

• Due to the constantly changing situation with COVID-19, exercise designers have chosen to use a general pandemic as the basis for this exercise.
• This ensures:
• That the information provided in the scenario and throughout the exercise is current, and;
• People can not make assumptions about the disease spread used in the exercise
• Further scenario details are provided in each of the following three modules.

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Overarching Exercise Objectives

• Discuss the role of company leadership in considering and making decisions on potential community mitigation measures.
• Discuss and determine what measures our company can/should implement to ensure business continuity and maintain a viable workforce during an outbreak.
• Discuss and determine how we will develop and adapt our crisis communication strategy as the outbreak evolves.
• Discuss and determine what policy changes may be necessary to support the response to the spread of an infectious disease.
• Discuss risks to our company supply chains and the means to mitigate those risks.

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Module 1: Growing contagion within the U.S., but no widespread outbreak in the immediate area

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Module 1 Disclaimer

• This exercise is for educational and informational purposes.
• The events described in the video are fictional and intended only for the purpose of participating in this exercise.
• The exercise scenario uses a novel influenza virus, but this scenario can be applied to other Highly Infectious Diseases (HIDs).

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Module 1 Scenario Highlights

• 35 tourists from the U.S. and other countries become sick with fever and respiratory symptoms while on an eight-day “Gateways to Lhasa” group tours in China. This is a popular tour with visitors throughout the summer months, with new tour groups on similar itineraries arriving every day in Lhasa, Tibet, and other cities in China.
• In late June, tour group participants return home, including U.S. cities Chicago and New York. Clinics and hospitals in Tibet and Lhasa report an increase in patients with pneumonia-like symptoms.
• Soon after returning to the U.S., a Chicago male who went on the tour in China presents at a hospital with shortness of breath and difficulty breathing. He is hospitalized with pneumonia. Three of his five family members also have upper respiratory tract symptoms.

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Module 1 Scenario Highlights (Cont.)

• The Chicago patient’s specimen is sent to CDC for testing and yields positive results for the first H7N9 virus infection in the U.S.
• The CDC conducts an investigation of the flights the Chicago patient was on. Other individuals that live in New York and Philadelphia who also participated in the “Gateways to Lhasa” tour have reported similar pneumonia-like symptoms.

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Module 1 Policy and Planning: Key Questions

• What are your immediate plans/actions?
• What critical resources or supplies are you most concerned about being affected by a disruption in your supply chain?
• Does your organization have legal and/or regulatory requirements/obligations that you must comply with, even during a public health emergency?
• How would your organization financially sustain a significant reduction of business?
• What potential policy issues are you most concerned about and what immediate actions can you take, if any, to address them?

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Module 1 Incident Management: Key Questions

• Who is responsible for managing your organization’s response to a severe outbreak?
• What are the most significant challenges you anticipate with respect to managing your organization’s response to the incident and what immediate actions can you take, if any, to address them?
• How will you work with state and/or local government to designate your business as essential, allowing you to stay open through lockdowns, curfews, etc.?

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Module 1 Crisis Communication: Key Questions

• What critical messages will you need to communicate to the following groups?
• Staff
• Customers
• Vendors/suppliers

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Module 1 Healthcare System Surge: Key Questions

• (For health care organizations) What are your primary concerns with respect to accommodating a large increase in patient numbers or patients with highly specialized health care needs?
• (For health care organizations) Does your organization maintain a stockpile of medical supplies and resources (e.g., PPE, respirators)? Are the stockpiles ready for deployment?

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Module 2: Widespread illness in the immediate area

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Module 2 Disclaimer

• This exercise is for educational and informational purposes.
• The events described in the video are fictional and intended only for the purpose of participating in this exercise.
• The exercise scenario uses a novel influenza virus, but this scenario can be applied to other Highly Infectious Diseases (HIDs).

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Module 2 Scenario Highlights

• Human transmission has now occurred in 5 countries, including the U.S., China, Thailand, United Kingdom, and Australia. As a result, the World Health Organization (WHO) declared a pandemic alert.
• CDC has issued a Level 3 Travel Health Notice to the public to not travel to countries with confirmed H7N9 cases.
• On July 7, the U.S. Department of Health and Human Services declares a public health emergency.
• At the end of July, 20 countries have reported a total of 6,225 H7N9 cases [Americas (3,032), Europe (660), Eastern Mediterranean (152), South-East Asia (594) and Western Pacific (1,787)]. Many additional cases are suspected. WHO has now declared the 2019 H7N9 Pandemic.

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Module 2 Scenario Highlights (Cont.)

• By mid-August, there are 12,100 H7N9 cases in the U.S and 18,000 worldwide. The City of Chicago has the most confirmed H7N9 cases of 1,400 and the State of Illinois has 1,600 confirmed cases.
• There is mass fear among the public and people are practicing social distancing. Large events have been canceled, schools are closed, and employees are working from home to stay safe.
• Absenteeism is now causing extreme issues to critical infrastructure systems, including water, power, medical facilities, and supply chains.

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Module 2 Policy and Planning: Key Questions

• What key indicators or triggers are you relying on to decide when to implement your emergency plan and/or business continuity plan?
• What is your organization’s policy regarding employee absenteeism and sick leave?
• Does your organization have policies and procedures if employees or customers contract an infectious disease while working at or visiting your place of business?
• What actions can you take to protect your employees in the workplace?
• What actions can you take, if any, to adjust your operations in response to disruptions in your critical supply chains?
• Will your insurance provide financial support/relief if you suffer financial losses as a result of a severe outbreak?

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Module 2 Incident Management: Key Questions

• How has your incident management approach changed as the incident becomes more severe?
• What social distancing measures (e.g., staggering workstations, canceling social events, alternating work shifts) have you implemented at this point?
• How might you deal with absenteeism rates of 15 – 25%?
• Are you coordinating with other companies within your community and/or business sector?
• How are you coordinating with government entities to ensure your response is consistent with current government guidance, to support the government’s response, and to represent your interests and needs to elected officials and decision-makers?

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Module 2 Crisis Communication: Key Questions

• How has your approach to risk communication changed as the incident becomes more severe?
• How are you communicating the social distancing guidance you have put into place?

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Module 2 Healthcare System Surge: Key Questions

• (For health care organizations) What key indicators or triggers are you using to decide when to activate your surge plan?
• (For health care organizations) how will you implement a change from conventional to contingency or crisis standards of care?
• (For health care organizations) As health care supply chains are stressed and critical resource shortages arise, what essential information are you relying on to make decisions about resource prioritization and allocation?
• (For health care organizations) If you are a health care organization, how are you coordinating with public health authorities to request support?
• (For non-health care organizations) Are there any ways that your company can reduce the burden on the health care system?

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Module 3: New cases are slowing/stopped, but a second wave is anticipated

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Module 3 Disclaimer

• This exercise is for educational and informational purposes.
• The events described in the video are fictional and intended only for the purpose of participating in this exercise.
• The exercise scenario uses a novel influenza virus, but this scenario can be applied to other Highly Infectious Diseases (HIDs).

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Module 3 Scenario Highlights

• The overall impact of the pandemic on government and businesses in the U.S. have been unprecedented.
• Government agencies were forced to scale back services to their most essential functions and government employees worked from home or implementing flexible work schedules to minimize human contact.
• Limited travel has resulted in devastating impacts to the transportation sector and tourism.
• It will take time for factories and manufacturing companies to get back online and return to normal operations.
• Community businesses (i.e. restaurants, shops) have also been greatly impacted and experienced significant decline in business.
• There were widespread cancellations of meetings, conferences, large gatherings, and some private sector businesses have been forced to close.

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Module 3 Scenario Highlights (Cont.)

• There has now been a lift on the more severe protective measures. People are now going back to school, work, and entering public spaces like restaurants.
• Although there is a significant decline in cases, there is some anxiety among the public to return back to normal operations. However, people are excited to reconnect with family, peers, and coworkers.
• Overall, the nation and the world will need to deal with the consequences to businesses on a massive scale (i.e. offering mental health support, replacing staff who may no longer be available to work).
• A second wave of infections could arrive in the coming months, so everyone should be prepared to respond based on the lessons learned from the first wave of infections.

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Module 3 Policy and Planning: Key Questions

• What is your strategy for reconstituting mission essential functions?
• What key indicators or triggers will you use to decide when to reconstitute your mission essential functions?
• How will you identify and fill key staffing vacancies in the short-term?
• How will your organization coordinate with vendors and supplies to address critical resource and supply shortfalls?
• What changes will you implement to better prepare for shortfalls in anticipation of a second wave
• How would you fund recovery efforts?
• Do you have a mechanism in place to identify and document key lessons learned in order to help prepare for possible subsequent waves of a severe outbreak?

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Module 3 Incident Management: Key Questions

• How will your incident management structure change as you transition to return to normal operations?
• What role will your incident management team maintain in preparation for a second wave?

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Module 3 Crisis Communication: Key Questions

• How does your approach to risk communication change as you transition to return to normal operations?
• What messages will you develop in anticipation of a second wave?

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Hotwash

• Please provide 2-3 strengths that you observed during this exercise
• Please provide 2-3 areas for improvement you observed during this exercise
• Please document detailed recommendations to address these areas in your Participant Feedback Form

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Summary Report

• Please fill out your Participant Feedback Forms (PFFs) as thoroughly as possible
• These will support the develop of the Summary Report
• The exercise planning team will develop a Summary Report by this date
• The Summary Report will identify gaps/issues, as well as lay out corrective actions we can take to address them
• Please provide your PFFs and any other feedback by this time

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