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University of Iowa Pandemic Influenza Tabletop Exercise
April 19, 2007 – 10:00 AM – 2:00 PM Quality Inn and Suites, 2525 North Dodge Street Tabletop Exercise Initial Fictional Scenario
This is an entirely fictional scenario. The people and events in this scenario are entirely
fictional; any resemblance to real persons or events is entirely coincidental.

For the past fifteen months, outbreaks of avian influenza have decimated bird populations in
Russia, Vietnam, Laos, Cambodia, Turkey, Romania, Indonesia, and China. Eight weeks ago, a
bird farmer and his two year old child in Indonesia died from confirmed avian influenza (H5N1).
To the best of anyone’s knowledge, the child was not in direct contact with the family’s poultry.
To date, there have been over 1,500 suspected cases of avian influenza in humans in Cambodia
and Indonesia, with over 400 deaths attributed to that infection. More than 75% of these recent
cases of avian influenza in humans occurred in patients with no known contact with birds or
poultry farms.
The WHO and CDC have representatives in the affected nations and posted travel advisories on
their websites, recommending that people not travel to these areas. Preliminary studies of the
avian influenza virus recovered from some of the recently infected patients suggest that the avian
influenza genome mutated and is now transmissible from human to human. The WHO moves
the pandemic alert period to Phase 4, and the Federal Government Response Stage to Stage 2.
Because of extensive press coverage of the outbreak, both the public and medical community are
now acutely aware of avian influenza occurring in humans and are very suspicious of human-to-
human transmission.
Initial Fictional Scenario and Master Sequence of Events University of Iowa Pandemic Influenza Tabletop Exercise
April 19, 2007 – 10:00 AM – 2:00 PM Quality Inn and Suites, 2525 North Dodge Street Day One: WEDNESDAY As part of a two week “extended spring break”, 20 year old undergraduate sophomore English major Leah Whusserfaise and her only roommate, 21 year old undergraduate junior pre-medicine Jennifer Notreal, enrolled in a student aid relief project run by a non-profit organization to help underprivileged rural inhabitants in developing countries sanitize poultry farms. The students left the first day of spring break and returned one week after all students were back on campus. Kenneth Wentmissing, a second year student in the University of Iowa College of Law, picked up Leah and Jennifer at CID when their flight arrived this past Sunday afternoon. Leah and Jennifer visited Indonesia and Cambodia with a group of approximately ten other students, none of whom were from the University of Iowa, and returned at the start of the tenth week of the spring semester. The return flight flew from Indonesia to Los Angeles Airport (LAX) to Chicago-O’Hare (ORD) to Cedar Rapids (CID). At 11:30 PM on Wednesday, Jennifer drops Leah off at the emergency department (ED) of the University of Iowa Hospitals and Clinics (UIHC) in Iowa City. Leah has a fever, chills, malaise, cough and shortness of breath. Leah tells emergency personnel that she and her roommate Jennifer returned from their spring break trip the previous Sunday. Since returning from their trip, Leah attended four classes on Monday but stayed in her off-campus downtown Iowa City apartment from late Monday night until today. Leah attended a St. Patrick’s Day bar crawl on Monday, but Jennifer stayed home to catch up on coursework. Although Leah is conscious, she is frightened and not fully/logically responding to questions. Leah does not remember when she started to show symptoms of illness, “I felt kind of crummy the last few days. I started to get sick before we left Indonesia, so I must have been sick on the plane. One guy got sick and left the trip early. I think my roommate Jennifer might be sick, but maybe it is just a cold or something with her.” Leah provides her address and Jennifer’s cell phone number. When staff attempts to call Jennifer, her voicemail picks up after the first ring. Leah was evaluated in the ED, was found to have pneumonia on a chest x-ray, and was subsequently intubated and placed on a ventilator for severe respiratory distress. Leah is moved from the ED to the intensive care unit (ICU) early Thursday morning. Initial Fictional Scenario and Master Sequence of Events University of Iowa Pandemic Influenza Tabletop Exercise
April 19, 2007 – 10:00 AM – 2:00 PM Quality Inn and Suites, 2525 North Dodge Street Days Two, Three and Four: THURSDAY, FRIDAY and SATURDAY On Thursday at 9:00 AM, Jennifer wakes up and realizes that she does not feel well. At 10:00 AM, Jennifer gets on a Pentacrest Cambus, which she rides from downtown Iowa City to Student Health Services (SHS), located in the Westlawn building. Jennifer does not make an appointment, and it is a busy morning at SHS, so she waits forty five minutes until she is seen by a doctor. When seen by a medical professional, Jennifer does not mention that her roommate was ill or that she recently returned from Southeast Asia. She states she had a cold all week and that she needs a doctor’s note because she does not want to go to classes today. Jennifer spent the past few nights with her boyfriend, prodigal law student Kenneth Wentmissing, who also has a “cold.” Jennifer does not have a home phone line, but she provides her University of Iowa e-mail address and cell phone number. “Don’t bother calling my cell phone, though,” Jennifer says, “I can’t find the charger and the battery is dead.” She states that she will return to her apartment upon leaving SHS and provides the address. Leah’s parents arrive in Iowa City at 7:00 PM and go straight to UIHC. Friday Morning: The local television station just aired a report on a confirmed human case of avian influenza in Los Angeles, California. The station concludes the report with “breaking news” that there may be avian influenza cases in Iowa City. The University of Iowa Relations Office, UIHC, SHS, and JCPH are receiving calls from the media, the mayor’s office, local health clinics and health care providers. Jennifer did not return to her apartment Thursday, but stayed with her boyfriend Kenneth until Friday evening, when Kenneth takes Jennifer to a popular local restaurant to try to cheer her up. Afterwards, they go to the Coral Ridge Mall to watch a movie. Jennifer did not eat much at dinner, and asked Kenneth to take her home early from the movie because she wanted to go to bed. Kenneth started to feel slightly ill on Wednesday, but said nothing to Jennifer because he thinks he just caught a cold in the law school. On Saturday, Jennifer is very ill and spends the day in her apartment. Throughout Saturday: Fifteen patients (including ten UI students and one Professor within the College of Law) come to UIHC with severe influenza-like illnesses (ILI). The Law Professor has two elementary aged children, one which also presents with severe ILI, and one high school aged child. Seven patients (including three UI students and one Professor within the College of Arts and Sciences) present to Mercy Hospital with severe ILI. Two of the new patients were on the same flight as Leah and Jennifer, and live in Johnson County. Initial Fictional Scenario and Master Sequence of Events University of Iowa Pandemic Influenza Tabletop Exercise
April 19, 2007 – 10:00 AM – 2:00 PM Quality Inn and Suites, 2525 North Dodge Street Days Five and Six: SUNDAY and MONDAY Forty additional patients go to UIHC and Mercy Hospital with severe ILI. University of Iowa students and staff are among those presented at both hospitals. Leah dies at 11:00 a.m. Sunday. Leah’s parents are devastated and her mother screams in the ICU. Determined to educate the world about the perils of befriending poultry, Leah’s mom emails photographs and the following message from her hotel room at the Sheridan to several local radio stations and the University of Iowa Relations Office: “Attached please find ten photos that my beautiful daughter Leah sent to me from the airport in L.A. Leah and her roommate Jennifer visited poultry farms in Cambodia and Indonesia to help poor locals clean the farms and make them more sanitary. Please help me educate people of the danger that chickens pose – I will never eat any kind of poultry ever again! All chickens should be killed so more people don’t die!!!” At 4:00 pm Sunday the media reports that Leah was on flight 49X1, 49X2, and 49X3 and attended a large pub crawl in downtown Iowa City last Monday. An evening news program shows a recent picture of Leah and Jennifer working at a poultry farm in Indonesia. Shortly after the program airs, parents begin to arrive in Iowa City to take their children home. Monday morning: Local residents are flooding their primary care providers’ (PCP) phone lines and offices with concern for being exposed. Many of these PCPs are calling UIHC, SHS, Johnson County Public Health (JCPH) and the Iowa Department of Public Health (IDPH) for information and support. Many people are afraid that they were exposed. The University of Iowa receives a phone call from a Coach who is in Indiana with an athletic team. The team left Iowa City to attend a tournament. The entire tournament is now indefinitely postponed. The Coach heard on the news that Iowa City is in a state of emergency and there is a highly contagious influenza virus circulating. The Coach and all players except one are healthy. The Coach wants to know whether he should return with his players to Iowa City, and if they stay in Indiana who will pay for their extra hotel nights and food. The one ill player is in a hotel room by himself and has not been seen by a doctor. Several teammates stated they will not travel in a bus with the ill athlete. The Coach worries other players might already be sick. People with a child or relative at the University of Iowa began arriving Saturday. By Monday morning, local roadways are packed with parents with rented trucks and trailers as a mass exodus occurs. Several accidents take place. In a loud public display outside Burge Residence Hall, one mother yells at her son, “I am not going to let you stay here to die! If your friends’ parents don’t care enough about them to come get them, that is not my problem! Get in the car; we are going home right now!” Public Safety is called. Initial Fictional Scenario and Master Sequence of Events University of Iowa Pandemic Influenza Tabletop Exercise
April 19, 2007 – 10:00 AM – 2:00 PM Quality Inn and Suites, 2525 North Dodge Street Days Seven and Eight: TUESDAY and WEDNESDAY Cases of severe influenza in humans are reported in other states


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