Thread by @PublicHealthW

We’re running a live Outbreak Control exercise w reps from @RCTCouncil @swpolice @WelshGovernment @CV_UHB @CwmTaf @H_S_E & PHW! #WPHC17

This exercise is live and unscripted - a demonstration of the serious and immediate nature of high-risk public health scenarios. #WPHC17

The scenario: microbiology has confirmed 4 cases of an infectious disease within 1 week; 1 deceased, no clear link between cases. #WPHC17

1 more case confirmed, and information in public domain thanks to BBC News finding out #WPHC17

Local authority is stretched interviewing cases - team now discussing patient backgrounds and investigating where infection could be spread

One patient has attended a spa and a local hospital - potential sites for transmission of disease #WPHC17

#Microbiology colleague updates on timing of test results

Lots of potential risk factors and unclear patient histories - team has to find links to stop spread of disease #WPHC17

Incubation period is 2-10 days - one patient recently returned from Benidorm, so assumed travel-obtained infection #WPHC17

Despite infections occurring at same time, might be coincidence if no link is found #WPHC17

New case notified today is homeless individual found collapsed in city centre - up to 5 confirmed cases now #WPHC17

#Microbiology: clear clinical risk factors, but no reference report yet

Case 6 is a serving police officer - current diagnosis community-acquiring pneumonia #WPHC17

Case 7: man passed away - community-acquired pneumonia and asthma symptoms - not confirmed outbreak case yet #WPHC17

Cases being tracked on city map to identify potential overlap #WPHC17

Information needed from many sources to confirm diagnoses. 4 confirmed cases and 7 more possible - team making informed decisions #WPHC17

Tightly clustered onset indicates connection between cases - disease is usually rare in the UK #WPHC17

Looking at likely journeys taken by those infected - where did they cross paths? #WPHC17

REMINDER: this is a mock live exercise - not an actual outbreak! #WPHC17

Team discussing incubation periods and how easily infection is transmitted - important to keep an open mind until cases confirmed #WPHC17

Environmental investigations looking for potential clues - eg air conditioners circulating air on to walkways #WPHC17 #exercise

Health and safety executive highlight local premises inspected for diseases - some identified as risk areas #WPHC17 #exercise

Team now discuss risk areas and how to rule out possibilities - even wind direction a potential factor #WPHC17 #exercise

Core team members take cautious decision to officially declare an outbreak based on available evidence #WPHC17 #exercise

“This is both urgent and will require extensive investigation - reasonable to call it an outbreak.” #WPHC17 #exercise

“We are now officially an Outbreak Control Team - bound by the Communicable Disease Control Plan for Wales.” #WPHC17 #exercise

Now the tricky part: risk assessment. What’s going on? Is there ongoing risk? #WPHC17

Number of potential sources: food factory, plastics factory, brewery #WPHC17

There are also a train wash, a bus wash and a car wash - all potential sites for exposure #WPHC17 #exercise

Wet air conditioning systems another plausible source of existing cases. And we don’t know what we don’t know! #WPHC17

Reasonable to assume the greatest cluster of cases closest to the source - within the city centre #exercise

“We need to act quickly...systematic ruling out of premises.” Important to manage risk to members of the public #WPHC17 #exercise

Local knowledge just as important as expertise - wider circumstances are potential factors #WPHC17

As new information comes in, situation needs to be re-evaluated - now 11 confirmed cases, extremely unusual and serious #WPHC17

Organisations and individuals will have to work through the weekend - protecting the public is of utmost importance #WPHC17 #exercise

Also important to protect the colleagues investigating potentially hazardous premises - advice sought from external agencies #WPHC17

Social media is becoming increasingly busy with questions such as is it safe in the coty centre / to go to events #WPHC17 #exercise

We have to prepare the pressure on hospital capacity, so we can take patients in, moderate pressure at the moment #WPHC17 #exercise

'If we start seeing more cases its going to cause some major concern for us' about hospital pressure,support may be needed #WPHC17 #exercise

47 of 56 pupils are off sick from a school after performing in Seren city with flu like symptoms #WPHC17 #exercise

Concluding: there is a risk of further infections and deaths, have escalated to police and Welsh Gov to set up an SCG #WPHC17 #exercise

And that's it, this was just a taste of the kind of questions and decisions that would be considered in a serious outbreak #WPHC17 #exercise

Would you have done anything differently? #WPHC17 #exercise