The paper of record has made this amazing discovery: US unprepared for pandemic flu . The article gives one the distinct impression the plan has been leaked; in fact the plan has been on the DHHS web site since late August; Go here for your very own copy. Without addressing why the paper of record breathless reports on a plan that had been available to the public for 6 weeks, it would be worth while to review the contents of the plan; the sad fact is there may not be much that can be done to reduce the impact of a pandemic flu. There are several reasons why:
(1) We have to have human to human transmission in order to develop a vaccine and our physical capacity to develop the vaccine is limited; there simply arent that many pharmaceutical companies out there. We could take some guesses about what vaccines MIGHT work, but that approach has very low odds of guessing right. The same issues apply to antivirals (tamiflu); although it may be a bit easier to do some crash production on those meds. Bottom line: it may take up to six months to field a vaccine in response to a pandemic.
(2) Given the projections of infection rate and mortality rate, the entire country is short of ICU beds and mechanical ventilators: these are not items that can be easily reproduced and distributed; moreover, the pandemic could be even worse that the dire projections--we simply dont know.
(3) One of the lessons NOT learned from Katrina was that the existing federal system makes it difficult to work around state and local governments. The constant MSM bashing of FEMA and the Bush administration is largely responsible for distributing the wrong message about emergency response. The feds do NOT ride in to save the day, and in fact, the plan specifically tells state and local governments they are on their own during the first wave of infection.
(4) Since public health is population based, what resources there are will most likely be deployed to the larger population centers most directly effected. This means that rural areas and smaller cities will never see any significant federal support.
(5) The kind of assets needed to deal with a pandemic are not easily produced (eg hospitals, ICUs, negative pressure rooms and the like) and cannot be stockpiled.This means that we deal with the flu with what we have on hand--at least for the first wave expected to last two months.
In short, these are signficant barriers and are not easily overcome.
So how about the basic strategy as put forward in the plan? The strategy includes increased surveillance, travel restriction, and containment of the infection once it arrives. There have been some trial balloons floated about quarantine and using the military to enforce quarantine; that approach is probably not feasible because of not enough military units, civil liberty concerns, and reduced effectiveness of quarantine as a measure (two car families, transport nets and the like).
Is this the best strategy to deal with pandemic flu? I am less persuaded and would suggest that a better strategy might be to put a significant set of resources in containing the pandemic in Asia (or where the first reported cases of H to H transmission occur); increased surveillance there, use of quarantine there which is a bit simpler, deployment of vaccines and antivirals, and travel restrictions FROM Asia. I do believe it makes more sense to deal with there than wait for it to arrive here; yes, we still have to plan for its arrival here and I am not sure how one divides the resource, but those are issues that can be analyzed.
The NYT article would lead one to believe that nothing has been done--NOT true; local health jurisdictions were required to develop pandemic flu plans and have them completed by Aug 30 of this year if they were to receive CDC money. Those have been done, and many have been exercised. The local jurisdictions are planning for and developing strategies. More on those strategies in subsequent posts.
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