Government issues a pandemic flu checklist

Everyone, including physicians, should prepare to be self-sufficient in the event of an outbreak of pandemic flu, advises the HHS secretary.

By Susan J. Landers — Posted April 3, 2006

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Washington -- Health and Human Services Secretary Michael Leavitt is urging physicians to prepare for a pandemic flu outbreak and, to that end, would like to ask a few questions: Do you have a planning committee to address pandemic influenza preparedness for your office or clinic? Is there a plan to contact key public health department personnel? How would patients be cared for at the height of an epidemic?

These are also some of the items on an HHS pandemic planning checklist for office- and clinic-based physicians. The list is the latest in a series that targets the needs of state and local governments, schools, businesses, families and home health care organizations.

Leavitt unveiled the physician's version when he spoke March 13 at the AMA's National Advocacy Conference in Washington. AMA policy supports increased federal spending for pandemic flu preparation as well as the administration's strategy for preparing for a possible outbreak.

Now is the time to plan for staff shortages and stockpile supplies of masks and gloves in case normal delivery routes are disrupted. "How would you handle a surge of patients if 40% of your work force couldn't get to the office?" Leavitt asked.

And not only should a plan be drafted, but physicians should be ready to act on it, he said.

Leavitt has been delivering a similar message to states -- he's visited about half so far. Self-sufficiency should be the goal for everyone, he said. Because a pandemic likely would break out almost simultaneously in many parts of the country, the federal government could not be relied upon to send help to everyone in need. States and localities as well as physicians' offices and households will have to be prepared to fend for themselves. "It's a good idea for people to have a couple of weeks of food and water available, not just for a pandemic but for any community emergency," he said. "Personal preparedness is a very solid ethic that makes a community safer."

Diagnosis and a vaccine

Early identification of an outbreak also is crucial, and physicians might be the nation's best surveillance system, Leavitt said. "The sooner we can discover an outbreak, the sooner we can begin to protect our people."

The Food and Drug Administration OK'd a lab test in February that can diagnose H5N1 flu strains within four hours of getting a sample.

But no matter how fast an index case is identified, having an effective vaccine during the first wave of a pandemic is unlikely, Leavitt said. Traditional public health measures, including proper hand washing and social distancing, will be crucial at that stage. These measures have been underutilized in recent years as modern medicines have kept many infectious diseases in check.

The best defense against a pandemic remains an effective vaccine, and the federal government intends to have 300 million courses available within six months of the identification of an infectious strain. Because the virus is continually evolving, the vaccine will have to be effective against the proper strain -- a challenge because the strain has drifted from the one identified in 2004.

It is this second strain circulating among the birds of Europe, Africa and parts of Asia. But the Centers for Disease Control and Prevention has identified a seed virus for this recent strain from which a vaccine could be developed, Leavitt said.

The United States also has stockpiled 20 million courses of antivirals with the intention of having 81 million courses -- at 10 doses per course of Tamiflu, for example -- on hand by the end of 2008.

Some people might compare preparatory efforts as "Y2K all over again," Leavitt said. "But pandemics happen, and there is no reason to believe that the 21st century will be any different than centuries past. What may be different is that we may be the first generations that have an opportunity to do something to prepare."

Leavitt also released a report March 13 detailing what the federal government is doing to contend with the H5N1 virus. He acknowledged it is only a matter of time before the virus is found in birds in this country. Avian flu is confirmed in birds in 37 countries while four months ago, it was found in birds in 16 countries. The bird flu has infected 175 people, of whom 96 have died.

But the arrival of the first infected bird in this country should not be cause for panic, Leavitt cautioned. Instead, it should serve notice that pandemic preparedness should be reviewed at every level, he said.

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Federal plans

The Bush administration's priorities for preparing for a possible pandemic flu outbreak:

  • Monitoring disease spread to support rapid response
  • Developing vaccines and vaccine production capacity
  • Stockpiling antivirals and other countermeasures
  • Coordinating federal, state and local preparation
  • Enhancing outreach and community planning

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External links

Pandemic and avian flu information from the federal government (link)

Avian flu information from the World Health Organization (link)

The AMA's Center for Public Health Preparedness and Disaster Response (link)

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