Pandemic Influenza Preparedness and Response Plan (U.S.)

I came across this executive summary while doing some research on the Avian Influenza A (H5N1) Virus. This document available on the U.S. Department of Health and Human Services is a summary of the Pandemic Influenza Preparedness and Response Plan. The summary was intended to show the scope of the problem and the efforts being undertaken and considered to combat a wide spread outbreak. While the particulars will be different, looking at the summary, this could apply to just about any biological outbreak, intentional or not. The full text of the plan is available using the link at the bottom of the page.

Characteristics of an influenza pandemic that must be considered in preparedness and response planning include: 1) simultaneous impacts in communities across the U.S., limiting the ability of any jurisdiction to provide support and assistance to other areas; 2) an overwhelming burden of ill persons requiring hospitalization or outpatient medical care; 3) likely shortages and delays in the availability of vaccines and antiviral drugs; 4) disruption of national and community infrastructures including transportation, commerce, utilities and public safety; and 5) global spread of infection with outbreaks throughout the world.

This is pretty much as expected. The key is the inability of localities to deal with simultaneous mass casualty incidents. Without help, it becomes sort of a fortress mentality with each area looking out for themselves. The other area is the ability of a given health care system to deal with such an outbreak. At what point does the system stop working? When do I or any of my coworkers, simply stop going to work out of fear or the desire to protect our families from contamination, or worse, maybe they are sick and we need to stay to care for them. If the Doctors and the Nurses do not come, you can have all the hospital capacity in the world, but it will do you no good. The same for the ancillary staff which is just as vital. Take the supply people out of the mix or worse the housekeeping staff and things go bad really quickly.

Additional preparation is also ongoing in several critical areas. Vaccination is the primary strategy to reduce the impact of a pandemic but the time required currently to develop a vaccine and the limited U.S. influenza vaccine production capacity represent barriers to optimal prevention. Enhancing existing U.S. and global influenza surveillance networks can lead to earlier detection of a pandemic virus or one with pandemic potential. Virus identification and the generation of seed viruses for vaccine production is a critical first step for influenza vaccine development.

This passage highlights the problem with rapidly developing a vaccine to combat any potential outbreak. The yearly flu shot is a gamble of sorts. They do not know ahead of time which strain may show up so they try to inoculate with the ones they think will be more virulent. This also highlights why China needs to step up and be forthright with what is going on. If they wait for things to get out of control, we may all pay a price. I understand national pride, but at some point you have to think globally.

Early in a pandemic, especially before vaccine is available or during a period of limited supply, use of other interventions may have a significant effect. For example, antiviral drugs are effective as therapy against susceptible influenza virus strains when used early in infection and can also prevent infection (prophylaxis). In 2003, the antiviral drug oseltamivir was added to the SNS. Analysis is ongoing to define optimal antiviral use strategies, potential health impacts, and cost-effectiveness of antiviral drugs in the setting of a pandemic.

This highlights the treatment options they may be forced to use if a vaccine is not readily available at the time of an outbreak. Antiviral agents are not without their pitfalls however, and I suspect that they will only be given to sick patients. While the article discusses cost effectiveness, the real key will be available supplies. I checked with our pharmacy and based on current usage, they have about a one month supply. These agents are not used much and because they are expensive, they usually keep a token supply and order as needed. In an emergency like we are talking about, they would blow through those supplies pretty quickly and be at the mercy of the supply chain. One aspect of an outbreak is that the baseline usage of these drugs would not change so we would need a supply above and beyond that.

Pandemic Phase 1 occurs with confirmation that the novel influenza virus is causing outbreaks in one country, has spread to others, and disease patterns indicate that serious morbidity and mortality are likely to occur. In Phase 2, outbreaks and epidemics occur in multiple countries with global disease spread. Response activities during these phases depend, in part, on the extent of disease internationally and in the U.S. Community-level interventions and travel restrictions may decrease disease spread.

The travel ban would be the key in keeping the pandemic at Phase 1, but as in with the case of countries like China, they need to be honest instead of cloaking themselves in this Stalin/Kim like veil of secrecy. I for one am skeptical that they would be able to keep things at Phase 1.

Vaccine will require six to eight months to produce. Once the first lots of vaccine are available, there is likely to be much greater demand than supply. Vaccine will need to be first be targeted to priority groups that will be defined on the basis of several factors. These may include the risk of occupational infections/transmission (e.g., health care workers); the responsibilities of certain occupations in providing essential public health safety services; impact of the circulating pandemic virus on various age groups; and heightened risks for persons with specific conditions.

This is the bad news. The time needed to produce a vaccine is a long one. With the mortality rate we have seen, this could be a catastrophic delay. The importance of vaccinating the health care workers etc cannot be over emphasized. As I mentioned above, if they become sick themselves or simply refuse to go to work, the entire system will collapse.

All quoted material is from the Department of Health and Human Services
Pandemic Influenza Preparedness and Response Plan www.hhs.gov...

But, other than all of theabove mentioned, everything is a bed of roses, right?
A little ray of sunshine, you are!
Are you suspecting this year to be a bad year? Have you reason to believe that we are going to see something we haven't seen in a long, long time?

Originally posted by Thomas Crowne
But, other than all of theabove mentioned, everything is a bed of roses, right?

TC, the concerning thing is the scilence coming out of China, coupled with the potential H2H transmission of the virus. The cases for that are in Jakarta (pop. 9.5 million) and there are an untold number of flights out of the area that go world wide. So It is a bit concerning esp. from the healthcare end of things.

Thank you so much for this FredT! Very informative indeed. I so hope our governments are waking up to this very real threat.

Thanks FredT, this is informative and sadly, something I know all too well. In many respects to a pandemic, I'm not sure if living in the city or the countryside is worse in terms of preparation and planning. I live in a fairly rural commmunity but close to 3 intersecting highways and a regional airport with international flights.

Unfortunately, there's practically no planning for such an event occuring locally. While there are efforts in some cities within a 50 mile radius, we have a shortage of skilled medical professionals in the area and the same with our police and fire departments.

As a college town, we've also got an influx of traveler's both internationally and nationally. Given that, we just couldn't handle such an event, we don't have the manpower or resources for first responders. As an example, recently the local PD had to call in the state police to break up a crowd of 30 drunken college students wandering the streets because all their officers were on other calls. I don't want to magine what would happen, if only 5% of the town fell ill during a pandemic.

The lack of contingency planning for public utilities disturbs me as well. Quite frankly we're so dependent on them locally for electricity and water, should the public works employees become infected, that would impact upon health services dramatically. I know for a fact we don't have people with those skills readily available to take over in an emergency. It took nearly a year to find a qualified replacement for our municipal water plant director alone.

Unfortunately, local politicians don't consider the idea of a pandemic to be an issue, preferring to pander to problems that are in their face. They simply don't see the value in cross-training public employees even within the same divisions for an eventuality that "might" happen, much less any other type of unforeseen emergency.

Given the recent discussion about recent US congress moves towards a pandemic bill I think these are very relevant