Tuesday, November 21, 2006

Pandemic Flu Updates

Two recent reports focus on the risk of pandemic flu, as well as the steps being taken to prevent and/or mitigate it.

The first, a report from the Financial Services Roundtable, addresses the risk and current vulnerabilities. It also makes a number of recommendations for the federal government to prepare for a pandemic. (Its recommendations are focused on the national level because of the national and international scope of a pandemic.) A lot of the information about the threat is widely known. Below are some salient points from this particular report.

First, the report discusses the nation's state of readiness and finds it lacking.

No one is ready if the pandemic occurs within the next several years.

[T]he U.S. federal government plans to be able inoculate all Americans within six months of an outbreak -- by 2011. In other words, not only will it take six months after the outbreak of a pandemic to produce sufficient vaccine, this isn’t scheduled to be possible for another five years. This is not a workable plan – a pandemic could occur at any time.

In particular, there is broad consensus that most local health care systems – hospitals in particular – do not have the excess capacity of beds, equipment, and trained personnel to handle a large influx of patients seeking medical care in a moderate to severe pandemic.

[W]hen asked as recently as this summer if their city was prepared to meet a crisis on its own without federal assistance, only 30 percent of 183 Mayors’ offices responded affirmatively.
The report also discusses some of the potential effects of a pandemic.
Unlike the seasonal flu, the avian flu has struck most heavily amongst prime-age individuals, or those between the ages of 20 and 40 ...

The mortality rate during the 1918 pandemic, which killed at least 500,000 in the United States and perhaps as many as 50-100 million worldwide, was 2 percent of those infected. The mortality rate for the small number of identified avian flu cases has been something on the order of 50 percent. There seems to be some consensus, however, that a variation of H5N1 or a similar virus that is easily transmissible among humans would not be nearly as lethal.

A significant fraction – perhaps as many as 40 percent of the working population – will stay at home for extended periods of time in the event of a future pandemic ...

Although some business would be transferred to the Internet, the magnitude of this offsetting impact could be muted by the impact of the pandemic on the Internet itself ... [T]he surge in Internet traffic that might result from an increase in telecommuting would slow upload and download times, perhaps to the point at which the network could not function effectively. This would dampen use of the Internet for commercial purposes.

The Congressional Budget Office has estimated that a pandemic similar in severity and scope to the 1918-19 pandemic would reduce Gross Domestic Product (GDP) by about 4.25 percent during the year of the pandemic.
A second report, this one released by the U.S. Department of Health and Human Services, has a generally more optimistic tone. This is, after all, a report from a government department that is summarizing its own activities. It's not surprising that it accentuates the positive:
Vaccines have been developed for the two known variants of H5N1 and we have already stockpiled enough vaccine to treat more than some 3 million people.
Although these vaccines are not "perfect match" vaccines that would best protect against a mutated future form of the virus that's easily transmissable among humans.
The goal is to have 26 million courses of antivirals on hand by the end of 2006 and a total of 50 million courses in the SNS by the end of 2008. The Federal stockpile, in addition to State purchases of 31 million courses of antivirals, will ensure that we have enough antivirals for 25 percent of the population. We are on target to meet those goals. Sixteen million courses of antivirals have already been warehoused, and we will have 36 million courses on hand by March 2007.
The antiviral medications, Tamiflu and Relenza, are effective at treating flu symptoms. It is unknown how effective they would be against a particularly virulent form of bird flu. Indications are that they would be helpful.
[E]very state, every county, every community will be affected, and they could be affected over a short period of time. There would be little opportunity to shift resources from one part of the country to another, highlighting the priority of preparedness at all levels and by all sectors of society.
This last line, I think, is the key for preparedness professionals everywhere. The Financial Services Roundtable even recommends "live tests" of vital systems that would likely be affected by the flu (and more directly by the enormous absences from work that the flu would necessitate). These include vital networks such as healthcare, electricity, water, telecommunications, financial networks, etc.

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