Pandemic Planning Essential
By Your Child’s Health LANCE CHILTON For the Journal
Q: What plans are being made for schools, businesses and government for pandemic flu, caused by a new virus like H5N1 or a virus related to that? — a concerned teacher
A: “Complacency is enemy number one when it comes to preparing for another influenza pandemic,” said Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, recently. The CDC is working to combat that complacency by helping states plan and also by constructing a Web site, pandemicflu.gov/storybook/, to tell the story of the most recent great flu pandemic to strike the world, 90 years ago.
Governments at all levels have taken an active role in determining how to limit the spread of diseases such as a feared pandemic flu. I suppose it’s a little like planning for the 100- year flood if you live along the Mississippi: you know the flood and the flu are going to come, but no one knows when.
State Epidemiologist C. Mack Sewell spoke with me about New Mexico’s planning regarding pandemic flu. Sewell cited a number of questions addressed in the state plan that are not immediately obvious: How, for example, would state government continue to function? How would hospitals cope with a flood of sick patients, especially when many staff members would be calling in sick? How would hospitals, used to being re-supplied by wholesalers every few days, get vital antibiotics when warehouse workers and truck drivers are sick at home?
These and other questions are addressed in New Mexico’s 1,200- page pandemic flu plan, available to all with long attention spans at www.health.state. nm.us/flu/pandemic.html.
What about drugs that kill the flu virus and vaccines? Sewell believes that neither will play a large role. Antiviral drugs like oseltamivir (Tamiflu) may provide some protection, so the state is stockpiling it. But flu viruses are smart little critters. Most are now unfazed by two drugs formerly very effective, amantidine and rimantidine, and a few have begun to show oseltamivir resistance. In addition, there is not enough of the medication available to treat the entire population.
From first appearance of a new highly potent flu virus to manufacture of an effective vaccine, at least four to six months is required. Testing and distribution would take additional time — the horse may be long out of the barn before the key is found to lock the door.
So perhaps it’s both bad news and good news that public health measures, such as those detailed in the Department of Health’s lengthy report, are likely to be the most important protections for all of us during a pandemic flu outbreak. That’s bad news, perhaps, in the sense that all of us hate for others to limit our liberty to move.
Quarantine and closure of schools and factories are likely to be unpopular, no matter how effective they are.
The good news is that public health measures are likely to be highly effective. One of the best examples of prompt and effective public health work was Toronto’s actions that nipped the budding Severe Acute Respiratory Syndrome (SARS) scare in 2003. The virus arrived from Asia in a patient, and spread rapidly among contacts of that first patient, and then among health care workers.
Harsh isolation and quarantine measures were taken, but the disease was controlled with only 44 deaths. North America should consider the tireless public health officials of Toronto to be heroes who may well have saved the continent from a deadly disease by their actions.
Sewell does not believe that pandemic flu will be as easily quelled as the SARS epidemic in Toronto. “It will be a disaster anyway,” he notes, no matter how adequate the public health approach.
Government is working hard to minimize the terrors of the next worldwide flu epidemic. Quiet heroes like the Torontonians and like Mack Sewell are providing the leads. Yes, they are government people — bureaucrats, dedicated people doing important work. The next time you hear politicians speak ill of bureaucrats or threaten to cut “discretionary spending,” realize that we are talking about essential functions like this, and essential people who would be cut.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with UNM. Questions at 272- 9242 or lancekathy@msn.com. CHART UPDATES
Pneumonia: Flu shots don’t seem to stave off lung infection.
THE QUESTION: Might getting a flu shot help prevent older people from contracting pneumonia, which is a frequent complication of the flu in this age group?
THIS STUDY: Analyzed data for three flu seasons on 1,173 people, 65 to 94 years old, who were diagnosed with pneumonia, comparing them with 2,346 people of similar age and sex who did not develop pneumonia. About three-fourths of both groups got flu shots in those three years. People who did and did not get a flu shot had virtually the same likelihood of developing pneumonia.
WHO MAY BE AFFECTED:
People older than 65, who are far more likely than younger people to develop serious complications, such as pneumonia, if they contract the flu. As a preventive, an annual flu shot is recommended for anyone older than 50.
CAVEATS: The flu vaccine varies from year to year, depending on the strain prevalent in a given year; whether testing in other years would have produced different results is unclear. One of the study’s six authors has received fees from companies that make flu vaccines.
FIND THIS STUDY: Aug. 2 issue of the Lancet.
LEARN MORE: lungusa.org (click on “Diseases A to Z”), cdc.gov/ flu.
— The Washington Post
(c) 2008 Albuquerque Journal. Provided by ProQuest LLC. All rights Reserved.