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
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...