Edition: October 2006 - Vol 14 Number 10
Author: Laura Thill
It’s not a matter of whether an influenza pandemic will occur, but when it will occur, according to many experts.
Some believe the time to plan and prepare for a pandemic is now. But what type of virus will actually strike?
“People [talk about] the avian flu a lot, but this may not be the virus that causes a pandemic,” says Chris Ground, senior VP of national accounts at FFF Enterprises (Temecula, Calif.). Viruses constantly mutate, Ground says. So, someone sneezes into his hand and the germs are left on the table surface he touches. They are then easily transmitted to the next person who comes along, and so it goes. As the virus is transferred from one individual to the next, it can mutate.
Likewise, if avian and human flu simultaneously infect a person or animal, the two viruses may swap genes, according to the National Institute of Allergy and Infectious Diseases, National Institutes of Health. In the end, a new virus could mutate, which is transmissible between humans. Because people would have no natural immunity to the new strain, a worldwide pandemic could develop.
“A big fear is that the H5N1 [avian flu] virus will start mutating to many other strains, which may be resistant to [vaccines such as] Tamiflu,” adds Yossi Sheffi, professor of engineering and director of the Center for Transportation and Logistics at the Massachusetts Institute of Technology (Cambridge, Mass.).
Viruses mutate all of the time, including regular flu viruses, Sheffi continues. Even the flu vaccine cannot be 100 percent effective. “It’s not [a matter of] finding a target and hitting it,” he says. “Viruses are living, mutating organisms.”
Experts warn that we are overdue for influenza pandemic, notes Ground. And if federal, state and local governments do not start planning and preparing, the effects of a pandemic could be excruciatingly widespread and devastating.
Indeed, today’s situation differs from those preceding past pandemics in that the world has received advanced warning, according to the World Health Organization (WHO). While the timing and severity of the next pandemic cannot be predicted, it is apparent that the virus has become epidemic in bird populations, and that this will not be easily deterred.
While many countries have been preparing response plans, developing new vaccines and, to some degree, stockpiling supplies of antiviral drugs, this is an expensive undertaking and only the wealthiest countries will be best prepared, states WHO. Third world countries lag far behind in their preparedness, and this is where the pandemic virus likely will begin.
Even the best-laid plans will not be foolproof, however. Manufacturing capacity of antiviral drugs is limited, according to WHO. About 23 countries have ordered antiviral drugs for their national stockpiles, but the major manufacturer will not be able to fill so many orders for at least another year. And, less than 10 countries have their own manufacturers working on developing a pandemic vaccine. In effect, most developing countries would be without a vaccine during the first wave of a pandemic, if not throughout its duration, according to one 2004 WHO report.
Pandemics can affect all corners of the world, including the wealthiest and those with the highest standards of healthcare, hygiene and sanitation, states WHO. Only international collaboration can lessen the effects of a pandemic.
The spread of disease
Once a fully contagious virus develops, it will not be containable, according to WHO. Even quarantine measures and travel restrictions, which may delay the arrival of the virus, will not prevent its spread. With the amount and speed of international travel today, a viral pandemic can spread globally in less than three months, according to WHO.
In the United States alone, a pandemic could incapacitate a substantial part of the population. “If it is what the government deems a moderate pandemic, some 865,000 people could be hospitalized,” says Matt Rowan, president and CEO of Alexandria, Va.-based Health Industry Distributors Association. “In a severe event, an estimated 9.9 million people would need hospitalization, according to The Health and Human Services (HHS) pandemic influenza plan.” WHO estimates between 2 and 7.4 million people worldwide may die from a pandemic, although it acknowledges that these figures are conservative.
Influenza pandemic is expected to strike in waves, each one lasting between six and eight weeks, according to the Centers for Disease Control and Prevention (CDC). Not all parts of the same country would be infected at the same time. For instance, the virus may be contained on the West Coast, but an infected Easterner could travel to Los Angeles and introduce a mutated version. The virus could reoccur up to two or three times in the same area, notes Larry Dooley, VP of contract and program services at Novation, an Irving, Texas-based healthcare contracting services company.
In the end, a global pandemic could last as long as 12 to 18 months, says Ground.
The wave before the wave
What most people don’t realize, notes Sheffi, is that global panic will set in long before an influenza pandemic begins to spread. “The effect of the pandemic will hit long before the [actual] pandemic occurs,” he says.
If influenza pandemic develops in Indonesia, every television, newspaper, Internet blog and Web site will report on it, he warns. People around the world will panic. Air travel will slow down, adults will miss work to take their children out of school and businesses may have to close. “The first wave will be a fear pandemic,” he says.
“If schools close, we can lose up to 40 percent of the workforce to childcare,” adds Dooley. This means fewer people available to run grocery stores, transport products to stores, deliver money to ATM machines or fuel to gas stations. Each community should be planning for these types of situations, he emphasizes.
Then there is the matter of supply shortages. With so many medical and other supplies manufactured in China, countries such as the United States, which depend on these products, are expected to face grave shortages of masks, gloves, respirators and more when they are most needed.
“It is not only medical supplies that are brought from China,” Sheffi points out. The components of many U.S. made products and equipment often are manufactured in China as well.
Since Hurricane Katrina struck a little over a year ago, the American public’s faith and trust in its government has diminished, says Sheffi.
Indeed, some might consider the government’s role to be up for grabs in the event of an influenza pandemic. There are 12 to 18 strategic stockpiles of medical supplies across the United States, according to the CDC. Ideally, these would first be distributed to healthcare organizations, but they would be quickly diminished.
With or without federal assistance, however, a country can only prepare to a certain degree, Dooley points out. “Basically, we don’t have enough [medical] supplies, space or money to stockpile,” he says.” It is [an issue] of supply vs. demand. There just isn’t enough.”
In the event of influenza pandemic, Americans likely would experience the following, he says:
• Too few respirators to go around
• Substantially fewer medical supplies manufactured in China or elsewhere overseas
• Limited mobility. (Travel would be hindered by the fear that transporting products could cause the disease to circulate more rapidly.)
“Many people live from paycheck to paycheck,” he adds. “What will happen when they have to miss work? There are a lot of unanswered questions. It is very difficult to plan for a pandemic because of its magnitude.”
United we stand — or not
Experts generally agree that the best defense against influenza pandemic will be a united front among hospitals, healthcare facilities and clinics, locally and nationally. Not only may local hospitals have to share resources, but those in one region of the country may have to move supplies to other areas that have succumbed to the pandemic.
“I’ve encouraged hospitals to plan together,” says Dooley. “In the past, they have been good at sharing [resources]. But, they also have a tendency to deal with things [individually].”
Sheffi suspects that local, state or federal governments may force hospitals to work together. “We’ll have to put some traditional rules on hold,” he says, referring to nonprofit facilities that normally compete for business.
When medical supplies and human resources are few and far between, though, it is more realistic that hospitals will do what it takes to care for their own patients, experts believe. And, even if different regions of the country agree to help each other in preparation for a pandemic, will they really do so when mass illness strikes and the fear level is elevated?
Similarly, if a foreign government develops an antiviral drug to combat influenza pandemic, it will be available to that country’s people first. “It’s not a matter of being good or bad,” Sheffi says. “[The United States] would do the same. Everyone has to worry about its own people.”
The moral dilemma can become even more magnified when understaffed, supply-starved hospitals must decide which patients receive treatment, notes Sheffi. Will older patients be removed from respirators to free up equipment for 25-year-olds who potentially can live longer? “And what will we do with the mass number of uninsured [people] who won’t come to the hospital until their symptoms are overflowing?” he asks. The longer these patients delay getting treatment, the greater the opportunity for them to infect others.
“In truth, we will have to work together to succeed,” says Sheffi. “This is the only chance [for survival].”
“A pandemic will be a good test of leadership,” he adds. “Good leaders can get people to do a lot.”
Plan of Action
The time to prepare for flu pandemic is now.
There may not be enough medical supplies available when an influenza pandemic strikes. But, that doesn’t mean it’s useless to plan and prepare.
“The secret is in planning, not only at a hospital and institutional level, but also at a family level,” says Chris Ground, senior VP of national accounts at FFF Enterprises (Temecula, Calif.).
“If a pandemic happens, manufacturers will only have so much capacity [to produce adequate] medical supplies,” he points out. “But, we can ease into this over the next six to 12 months if families go to their local hardware stores and pick up gloves and masks.”
“I’m most concerned about [people’s] lack of awareness and concern over a pandemic,” he continues. “Families should start talking and [become] prepared with the right tools and knowledge.”
Not only should families create their own personal stockpiles of shelf food, bottled water, gloves, masks and medications, they also should devise plans for meeting or contacting one another in the event of a pandemic.
“The greatest obstacle comes from a [lack of] planning,” says Ground. He makes the following suggestions:
• Learn what products/supplies you should have available.
• Fill prescriptions and have a prescription for Tamiflu on hand.
• Learn when and when not to send children to school. Sick children should stay home. In the event of a pandemic, schools and local governments likely will issue guidelines for sending children to school or keeping them home.
Organizations such as The Centers for Disease Control and Prevention (www.cdc.gov) and The World Health Organization (www.who.int/en/) provide educational material on their Web sites, and local counties usually have disaster plans available.
In addition, some basic steps, such as washing hands, or avoiding crowds when possible, can help prevent the spread of disease. “There’s a psychological comfort you have when you do something to prepare [for disaster],” says Ground.