The NYT discovers pandemic flu plan

Saturday, October 08, 2005
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.

16 comments:

terrye said...

RogerA:

My agency has a plan of sorts for several different kinds of emergencies. We run flue clinics and things like that. We make sure homebound people are cared for and are not stranded.

But people should realize that there is always a possibility of this kind of thing. Health care professionals have always known that.

I do agree that we need to keep this thing in Asia.

That would be easier than trying to quarantine a city or county.

the NYT always seems a bit late to the party.

Rick Ballard said...

Another solid post, Roger. It's nice to hear from someone who is actually dealing with the problem. I agree with blocking the flu from the outside - it may not be east Asia though. Turkey has an avian flu outbreak occuring right now.

Syl said...

Solid post, RogerA.

I heard it may have been found in Romania as well. Don't know if that's been confirmed yet.

David Thomson said...

“..there simply arent that many pharmaceutical companies out there.”

We also must never forget that the pharmaceutical companies are constantly worried about lawsuits. The radical left is literally endangering our very lives. These business entities hesitate to involve themselves in new projects. A bird flu vaccine will surely attract the trial lawyers.

RogerA said...

David---the president met with the CEOs of the major pharma companies to get them on board--I am sure we will need some kind of waiver from lawsuits before the sign up.

Syl said...

With the drug companies, it's also about waste. They don't get reimbursed for vaccines not used. I think part of the plan is to pick up the tab for any waste.

MeaninglessHotAir said...

This just in: Sun to Explode and Incinerate Earth! Bush administration admits to having no credible plan. Experts warn of death to millions. How long can my children wait?, asks suburban mother. Jesse Jackson decries racist approach

truepeers said...

Here's a sceptical look at our mounting fears:
link...

MeaninglessHotAir said...

truepeers,

That's an excellent article. Thanks.

I don't as a rule watch television and I never listen to the radio any more, nor do I read a newspaper. I get all the news I need in the reflected glow of the blogs.

When I see a whole spectrum of folks with their proverbial panties in a twist on some subject, any subject, I become suspicious that I'm seeing herd behavior in action once again.

I've seen it twice now this last week: first Miers, then avian flu. Avian flu is obviously the designated fear-of-the-month. Right here in Boulder we have an outbreak of Black Plague (!) among the prairie dogs. Where are the articles warning us of the dangers and castigating the Bush administration for lack of preparedness? It's just like the OKC bomber, nothing to see here folks move along. I'm tempted to posit an inverse relationship between press coverage and real threat.

Rick Ballard said...

MHA,

The probability of a Cat 5 hitting NO was .005% - once in 200 years. It still hasn't happened but the Cat 4 that missed NO seemed to do enough damage. A .025% probability (once in 40 years) for a regular flu pandemic is rather high. You wouldn't fly with an airline that had a crash rate of .00001% per trip.

The planning and coordination process concerning response to a flu pandemic is similiar to what would be used in a widespread bio attack. It doesn't hurt anything to go through the exercise with heightened attention.

I agree that the disaster of the year is an overworked theme but every once in a while the precautionary efforts undertaken are worth the effort.

Kind of like a satisfactory soil analysis having been done before the repairs were undertaken in '98 at the point of failure on the 17th St. canal might have been a wise investment.

MeaninglessHotAir said...

Rick,

The probability alone isn't the proper measurement here. Rather, we should be considering the expected value, which is the probability multiplied by the magnitude of the potential disaster. After all, if something is highly probable but entirely innocuous it is of little concern.

In the article linked by truepeers, the author makes the point that while a pandemic flu has a mean reemergence time of 40 years, most of the real world pandemics are relatively benign. The next flu pandemic is likely to be so. Therefore the expected value is low.

The point that RogerA seems to be making over and over is that we should attempt to use our limited public response resources wisely. I agree and believe that too much worrying about this particular issue may not be the best use of resources.

Like you, I'm all in favor of prudence. What bothers me is that the feedback loop seems to be turned a little too high all around. We're starting to hear that echo-chamber effect emanating from the speakers. In the Miers case, we have masses of people condemning the decision long before we've heard one word out of the poor woman's mouth. Masses of people who couldn't have spelled "Miers" a few short days ago. She's been accused, tried, and convicted by the proverbial mob without the merest semblance of a chance to have her day in court.

This case is different obviously, but the feedback loop bears many of the same disturbing hallmarks.

Knucklehead said...

Roger,

Thanks for giving us a sane look at the problem and the issues.

If and when a pandemic strikes a whole lot of Americans will be dazed and confused as to why the starship isn't running the replicators full bore and beaming stuff down instantaneously everywhere.

If we just look at one of the points you make:

...the entire country is short of ICU beds and mechanical ventilators: these are not items that can be easily reproduced and distributed;

A family member was describig for me the machinations of a recent "disaster response drill" that our local hospitals had participated in. It was primarily a "run the checklists" sort of exercise as far as I could see.

Her description included, paraphrasing, "SoAndSo does stuff like call the local drug reps and pretend to order a bunch more drugs, the ventilator companies and order more vents..."

"Whoa there a sec, Darlin. How many additional ventilators do they ask for?"

"I think for this drill they asked for an additional 24."

"How many do you normally have?"

"We have about a dozen, typically around six are in use, sometimes we have all twelve. I don't think we've ever had more than fifteen going."

This is just one of three hospitals within rougly 10 miles of one another. And the smallest of the three. I believe we may assume that in this drill scenario all three were running their checklists and calling the ventilator dude and asking for the rapid supply of and additional TWICE, or more, of their standard compliment or ventilators.

Does anyone really believe that the local ventilator supplier has a stock of DOUBLE as many he has in his entire insalled base just sitting around somewhere in a warehouse waiting for the pandemic to hit?

And this sort of issue just cascades. It's not just the machines, it's the parts and service organization to keep them running, the tubes, the oxygen tanks, the oxygen, the fittings...

But when if and when a pandemic hits people will be screaming to the rafters wondering why "the system" wasn't prepared to triple, at least, its normal operations virtually instantaneously.

The answer, of course, is that there wouldn't be any "system" at all if we placed that sort of requirement that it be prepared to deal with a once in a lifetime, or less frequent, level of demand at tall times. The "system" would have been backrupted ages ago if were required to be fully staffed and stocked to deal with such an "outlier" event.

Rick Ballard said...

MHA,

I agree - except that the 40 year occurence before the '57 event was known as the 'Spanish Flu Epidemic' and released some 60 million people from earthly concerns. I definitely don't think heroic measures are called for at this point but I do like the idea of public health officials airing the perceived bottlenecks and problems that may arise. I especially would like to see the government begin discussions of quarantine at source rather than at destination.

Anonymous said...

Hi Roger - arrived here via Maxed Out Mama with a question for you - wondering if you have heard anything about the NanoMask and it's efficacy as protection from the bird flu. Just a gimmick? Better than an N95 respirator?

I'll watch comments for an answer, if you're willing to provide one!

Thanks,

Anniebird

RogerA said...

Anniebird--thanks for stopping by. N95 masks (available at ace hardward, home depot etc) are what medical and first responders use--anything else is probably a rip off. And if you are genuinely concerned see if your doc will write you a prescription for tamiflu--its available now, and with adquate demand, producers might even start producing more. Other things: practice self isolation if any family members are sick, cover your cough and wash your hands. :)

Anonymous said...

Thanks, Roger! Appreciate the advice! Off to Ace!


Anniebird