For some reason information isn’t working it’s way down from the federal and sometimes state level to local planners.

There are still local planners who are saying that they don’t need to worry about pandemic flu because they don’t have large poultry farms in their areas. (The problem will be infected people not infected birds.)

There are city health departments saying that we don’t need to worry because people can only get infected by traveling to Asia and having close contact with infected birds. (again untrue.)

A state health department staff person told me that an influenza pandemic could only start in the fall or early winter – the time during which we see seasonal flu and that it would have to start on the west coast in the U.S. because that it what is closest to Asia. (Influenza pandemics can and have started in the spring and summer.)

Information

There are some things that could be done to mitigate the impact of a severe pandemic. Unfortunately, for the most part, that information is not getting to the people who need to hear it.

The federal government states that closing schools early in a pandemic will be important to attempt to reduce the spread of infection and spread the number of cases over a longer period of time which would produce less stress on the health care system.

Unfortunately that information isn’t getting to the families who need to know it.

They are also saying that individuals and families should have the nonperishable food, water, baby food, pet food, medication, over-the-counter medications, cleaning products, etc that they would need during a pandemic.

That information isn’t getting to families

Much of the preparation for influenza pandemic is also preparation for any other virus or other disease that would spring up.

Surge capacity, just-in-time delivery problems, inadequate numbers of health care workers, and spread of infection through international travel are problems that we would see with any pandemic. Individual and family preparedness efforts benefit us if we need to deal with any other disease outbreak in the future as well.

Even the effort to increase our capacity to produce large amounts of vaccine for H5N1 has expanded the capacity we have to produce large amounts of vaccine against any other disease.

We don’t have a vaccine and one can’t be produced until the pandemic strain emerges. It will take approx 6 months to have the first vaccine for the pandemic strain. The first batches produced will be given to healthcare workers, first responders, fire fighters, etc. so that they can protect the public.

Current vaccine production requires fertilized chicken eggs and there may be some trouble producing the vaccine because H5N1 is so lethal for chickens..

“Prepandemic Vaccines”

There are “prepandemic vaccines already produced. I don’t have the number of vaccine doses at hand, but I think the U.S. has around 30 million doses.

Most of the prepandemic vaccine stockpile is based on the H5N1 clade that was in Vietnam in 2004, but that isn’t the clade that is spreading now.

They are hoping that this vaccine will provide some coverage for a mutated virus, but our experience with seasonal flu vaccine is that a slight mutation is enough to keep the vaccine from being effective.

Antiviral Medication

Our antiviral stockpile will cover treatment for only approx 20% of our population. Government plans are based on an attack rate of 30%.

The stockpile doesn’t include prophylaxis for healthcare workers or first responders, and some health care workers will be reluctant to work without protection from a lethal strain of influenza.

Some strains of H5N1 have developed resistance to Tamiflu – most of our antiviral stockpile is Tamiflu.

Home Care for panflu

Most people who contract pandemic flu will not be admitted to the hospital because there won’t be available beds.

My community’s trauma center has a plan for an additional 20 beds for pandemic flu – this for an area that has over 500,000 people. Clearly this is enormously inadequate.

Most patients will be cared for at home by family members just because there will be nowhere to take them.

In 1918, people were accustomed to caring for a family member who was experiencing a medical problem, but I think that for the most part we have lost the skills needed to nurse someone through a serious illness — in the past two weeks, one of my local ambulance squads was called to transport to emergency rooms people who had: an infected finger, a splinter, an ear infection, and a sore throat. Unfortunately, that’s a common occurrence.

International Travel

In 1918 people traveled from one continent to another by boat. Now we’re traveling by air, and many more people travel than did in 1918. A pandemic will spread much more quickly – we could see panflu spread from point of origin in a matter of days or weeks.

We have made huge medical advances since 1918, but we won’t be able to provide that technology to the vast majority of our population.

Surge Capacity

Our healthcare system doesn’t have the surge capacity necessary to handle a pandemic.

Many hospitals are full or almost full most of the time. It’s not uncommon for ambulances to be diverted to other emergency rooms because of patient volume. Patients who are to be admitted are sometimes kept in emergency rooms for extended periods of time because there aren’t beds available for them.

Health Care personnel

Some panflu needs can be purchased – patient beds, antiviral drugs, ventilators, or the inflatable hospital tents that are becoming popular. But we have only so many health care workers, and their numbers can’t be expanded easily.

Some health care workers will not be able to work because they will need to be at home taking care of family members who have contracted panflu.

Medical Supplies

Many patients will need vents – we have approx 105,000 ventilators in the U.S. We’re using around 90,000 every day – some of the rest are in for maintenance. I believe there are 5,000 in the strategic national stockpile. We could stockpile more vents, but we don’t have more healthcare workers to run them.

We are not stockpiling respirators, iv sets, infections, control supplies, and other materials needed to care for massive numbers of patients.

Just-in-Time Delivery System

Our just-in-time delivery systems will most likely fail when large numbers of people are not working because they are either sick or taking care of family members. So we will probably have problems getting fuel for emergency vehicles, medication that is produced overseas, medical supplies, etc.

Most hospitals do not have stockpiles of medications or supplies – they have deliveries of medications several times a day. It isn’t likely that they will be receiving deliveries during a pandemic.

Meanwhile, do you think that 50 million from 1918 will scale up in proportion to current populations in a global flu epidemic?

It could also keep it’s current CFR, and we could see patients with multiple organ failure and brain abscesses.

I’d be thrilled if H5N1 faded away and we never saw another human case, but while it’s in birds in over 60 countries in Asia, Europe, the Middle East and Africa – especially where there is close bird/human interaction – there is serious potential for pandemic.

We are seeing human deaths from both bird-to-human and from human-to-human transmission. The human-to-human transmission does not appear to be sustained, but that may be because the Indonesians are passing out Tamiflu to every potential case.

The Indonesians are saying that at least 25% aren’t linked to poultry. That doesn’t necessarily mean human-to-human transmission. We know both cats and dogs have been infected with H5N1 in Indonesia – either could have been the source of human infection as well, but there aren’t reports of large numbers of dogs or cats dying.

Over the past few months the majority of cases in Indonesia have been in clusters, this is a big change over the past threee years.

There have been mutations that enable the virus to more easiy latch onto the cells in the human respiratory tract .

And there have been mutations that make the virus resistant to antiviral drugs – or at least Tamiflu. I don’t know if you can really say that this advances a pandemic because we do not have enough Tamiflu to prevent a pandemic to begin with, but it makes attempts to slow the spread more difficult and has obvious impact during a pandemic.

Our preparedness is pathetic as well.