Pandemic Flu Preparedness

Friday, February 02, 2007
The CDC has issued their latest
guidance yesterday. Based on my experience in pandemic flu planning this is an excellent piece of work. It considers the relative severity of different scenarios and provides responses that are tailored to the threat. The mitigation measures do seem to dwell primarily on the impact of closing schools. It is indeed imperative that schools be closed, and especially colleges, because if pandemic flu does strike along the lines of the 1918 pandemic, college-age students are most likely to be at risk. That said, it is the colleges that probably can most easily shut down as they have the information infrastructure in place and the student body capable of adapting to on-line instruction.

Not so the k-12 schools. There administrators will have to develop plans for different forms of instruction; eg, mail-out lessons or use of public TV channels. Moreover, closing those schools will undoubtedly increase the overall absentee rate among businesses as working parents will have to stay home to supervise children.

There is a bottom line to this: There is little any level of government can do; they will need to focus on continuity of government operations and make sure the infrastructure continues to work properly. Our federal system imposes significant restraints on the ability of government to react, all the breast beating over Katrina notwithstanding.

Another major focus of planning will be the need for cooperation between businesses, schools, and governments; and from my experience it is difficult to get these entities to focus until the crises is upon us.

The report also points out the importance of home care; indeed, this is probably the most effective way to deal with a pandemic. The bottom line in terms of acute care is this: There are not enough ventilators to meet the projected demand and vents are the only reason for putting someone in the hospital; It is possible to provide palliative care at home to about the same degree you would receive in ICU less intubation and vents. The downside of home care is that many people striken with pandemic flu may die at home. The Red Cross has an excellent brochure and training session out on home care; indeed, the LDS Churches where I used to work actively provided training to their congregations: something that all groups should do.

There will of course be quibbles with CDC guidance, but it is an excellent piece from my perspective.

3 comments:

Skookumchuk said...

Roger:

I also found it very well done. I agree there is little the government can do and that one of the largest challenges is getting businesses, schools, and local governments to plan and to exercise. Planning and exercising simply ties up too many of their resources for too long.

I have worked a bit on the logistics side of this with DMORT and other NDMS elements and the problems are tough, though we are making progress.

The crucial thing is that these studies, whether for flu pandemics or hurricane preparedness, so often come back to the individual and the family and what they can do. Time to stress that a bit more I think.

Bostonian said...

There are a couple of things about epidemics that do not get stressed enough, IMO:

The more people are immune, the less likely it is for the damned bug to spread. AND when host-to-host contact is lessened, that applies a selection pressure to favor the bugs that are less virulent. (Bugs that kill quickly get burned out.)

So if you are holding off on getting shots, don't be a fool. It could be my grandma you're saving.

Mark said...

While the medical response to pandemic flu will be important to controlling its spread and limiting its toll, there are considerable non-medical issues related to flu preparedness that are essential for ensuring the continued well-being of the nation's economy. Planning for Continuity of Operations (COOP) and Continuity of Government (COG) is critical to maintaining the overall viability of society. Thus, while we rightly prepare for the flu, we must be equally prepared to function during the flu.

The Center for Technology and National Security Policy of the DOD's National Defense University has prepared a number of freely-available items which can help civilians be prepared both before and during the flu. "Bird Flu and You" is a poster available in 9 languages with basic information about influenza preparedness. "Weathering the Storm" is a report with information about planning for COOP, including instructions for carrying out "tabletop excercises" with a COOP plan.

Electronic copies of the poster are available at http://www.ndu.edu/ctnsp/Bird_flu.htm. Electronic copies of the report are available at http://www.ndu.edu/ctnsp/Def_Tech/DTP%2038%20Weathering%20The%20Storm.pdf, and to request hard copies of the
report, contact the Life Sciences group at lifesciences@ndu.edu.

Robert E. Armstrong, Ph.D.
&
Mark D. Drapeau, Ph.D.

Center for Technology and National Security Policy
National Defense University
Washington, DC

This is the view of the authors and does not represent the official view of National Defense University, the U.S. Dept. of Defense, or the U.S government.