Local planning key to readiness for pandemic flu

A national conference and a new federal report emphasize the role of community collaboration in preparedness for an outbreak.

By Susan J. Landers — Posted Aug. 6, 2007

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Although most roads to pandemic flu readiness remain riddled with potholes, some communities are making steady progress.

Those cities and towns that have made exemplary advances in planning for a surge of ill patients and ways to mitigate the flu's potential devastation were honored, and the lessons they learned were shared during the Second National Congress on Health System Readiness: Pandemic Influenza Community Preparedness Planning, held July 18 to 20 in Washington, D.C.

The congress, sponsored by the AMA and the Centers for Disease Control and Prevention, also provided hundreds of representatives of the medical and public health communities the latest research on topics such as hospital surge capacity and vaccine development.

Although the threat of a massive outbreak of a devastating influenza virus has faded from the headlines, it remains very real, said several speakers who cited CDC figures estimating that 90 million Americans would become ill if a 1918-like flu were to emerge. Such a number could quickly overwhelm all medical facilities.

"We are working in this flat world where we have global extremes -- extremes in poverty and climate, the kinds of things that drive the context for emerging infectious diseases, natural disasters, terrorism events and flu pandemics," said CDC Director Julie Gerberding, MD, MPH, who spoke at the congress.

With rapidly disappearing funding, the need to collaborate and innovate becomes even more important as does the ability to network. But often the public health and medical systems appear to be moving in opposite directions, said Dr. Gerberding. "This meeting is about strengthening some of these relationships."

Federal progress report

Even as participants were grappling with the particulars of preparing their communities for a pandemic outbreak, a federal report was released that reinforced the important role such mitigation efforts will play in checking the disease's spread.

The federal Homeland Security Council released July 17 a progress report for the year since a pandemic preparedness plan was unveiled. So far, protective equipment and enough antivirals to treat nearly 50 million people have been stockpiled abroad to try to contain an outbreak before it reaches this nation, according to the report. Measures also are planned to try to halt the entry of the virus at the borders, but those efforts stop short of border closings.

The report stresses the importance of community efforts to mitigate the effects of an outbreak. A severe pandemic would place a tremendous burden on the nation's health care system, noted the report. Plus, it could be years before there would be enough vaccine to protect everyone.

Meanwhile, the NE Minnesota Emergency Preparedness Coalition has taken measures to protect the 18,000 square miles under its watch. The coalition was among the communities honored by the AMA and the CDC for its efforts.

The coalition has tried to include all players: the governments of eight cities, seven counties, three Native American tribes, police and fire departments, the border patrol and several volunteer organizations, said Jim Gangl, emergency preparedness coordinator with St. Louis County (Minn.) Health and Human Services, and Cheryl Stephens, executive director of Community Health Information Collaborative, a health care network based in Duluth, Minn. Among the lessons they learned were to look for ways to work together, leave egos at the door and share ideas and funding.

Another group cited at the congress was the Northern Virginia Hospital Alliance, a collaboration of 12 acute-care hospitals. Its planning process was shaped in part by the 9/11 attack on the Pentagon in Arlington, Va., and the arrival, soon after, of several letters tainted with anthrax at local postal facilities, said Dan Hanfling, MD, director of emergency management and disaster medicine for Inova Health System in Falls Church, Va.

Mistakes were made during both disasters that signaled something was wrong, said Dr. Hanfling. "We saw the importance of coming together," he said. "We know this isn't over."

There were also some surprisingly optimistic research findings provided at the congress. Gabor Kelen, MD, chair of the medical board of the Johns Hopkins Hospital in Baltimore, studied hospital surge capacity in three Maryland facilities. "We sampled 50 units throughout the hospitals and gathered data on 4,000 patients," he said. To the researchers' amazement, it appeared possible to discharge as many as 70% of patients within 72 hours to make way for an influx of more needy patients.

"That's a stunning number," he noted. The ability to come up with so many empty beds on short notice seemed almost unbelievable to the researchers, causing them to check and recheck their data, he said.

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Improved disaster response

A report drafted by a coalition of 18 health care organizations led by the AMA and the American Public Health Assn. provides recommendations to better prepare the nation's health care system to respond effectively to catastrophic emergencies -- whether natural disasters, bioterrorist attacks or a pandemic flu outbreak.

Among the main recommendations:

  • Appropriate funding for public health and health care systems.
  • Full integration of public health and health care disaster preparedness response systems.
  • Adequate legal protections for public health and health care responders in a disaster.

Speed and efficiency are key to saving lives in emergencies, said AMA President Ron Davis, MD, at the report's July 18 release. "The only thing we can predict with any certainty about terrorism attacks and other mass casualty events is: We are not going to know the time, location and magnitude in advance, but we have no excuse if our responses aren't known in advance."

Work on the report began more than a year ago with a grant from the Centers for Disease Control and Prevention, said James James, MD, DrPH, director of the AMA's Center for Public Health Preparedness and Disaster Response, and the editor of Disaster Medicine and Public Health Preparedness. Dr. James noted the organizations that helped draft the report also pledged to provide leadership in disaster planning efforts, put disaster preparedness into practice, educate themselves and others about preparedness and response and advocate for solutions based on sound science.

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External links

"National Strategy for Pandemic Influenza: Implementation Plan One Year Summary," Homeland Security Council, July (link)

AMA/CDC Second National Congress on Health System Readiness: Pandemic Influenza Community Preparedness Planning (link)

AMA's Center for Public Health Preparedness and Disaster Response for AMA/American Public Health Assn. sponsored report, "Improving health system preparedness for terrorism and mass casualty events," July (link)

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