PresiChimpoleon Buckwheat's Failure - USA ill-equipped for a swine flu pandemic, experts fear
- From: Patriot Games <Patriot@xxxxxxxxxxx>
- Date: Thu, 14 May 2009 09:13:35 -0400
http://www.usatoday.com/news/health/2009-05-13-preparedflu_N.htm?csp=34
USA ill-equipped for a swine flu pandemic, experts fear
Though health officials say the swine flu outbreak appears relatively
mild, some medical experts say the USA is unprepared in many ways to
handle a severe pandemic.
States, cities and public health agencies have made enormous progress
in preparing for health crises such as bioterrorism and a flu pandemic
since the anthrax attacks in 2001, says Neal Cohen of Hunter College's
School of Urban Public Health, who was New York City's health
commissioner from 1998 to 2002.
More recent threats, such as SARS in 2003, have given doctors and
nurses a "dress rehearsal" for a pandemic, Cohen says, allowing them
to test strategies for dealing with dangerous new viruses.
The world is "better prepared for an influenza pandemic than at any
time in history," said Margaret Chan, director general of the World
Health Organization, last week.
Yet even before the flu outbreak, emergency rooms could barely handle
all the patients coming through their doors, says Katherine Heilpern,
chair of Emory University's Department of Emergency Medicine in
Atlanta. "Most emergency rooms are working at or above capacity," she
says.
Equipment in limited supply
Hundreds of ERs have shut down over the past 15 years, largely because
of financial pressures, including declining reimbursements from
insurance programs such as Medicare, Heilpern says.
But the number of emergency room patients grew 32% from 1996 to 2006,
according to the American College of Emergency Physicians. Emergency
rooms have little "surge capacity," the ability to gear up to treat
many more patients, Heilpern says.
Even hospital equipment could be in short supply. In a pandemic,
hospitals might not have enough mechanical ventilators ? used when
patients have severe trouble breathing, Heilpern says.
Up to 80,000 of the nation's 105,000 ventilators are being used for
everyday medical care, and nearly all of them are used during a normal
flu season, according to a 2007 editorial in The New England Journal
of Medicine.
Even if hospitals were able to order more machines, many hospitals
don't have enough critical care nurses, respiratory therapists or
intensive care doctors to open up more beds in their intensive care
units, Heilpern says.
In a pandemic, doctors could be forced to ration ventilators, using
them on patients who have the most to gain, such as those who ? though
severely ill in the short term ? are otherwise healthy enough to
recover, she says.
In a crisis, Heilpern says, hospital beds might be reserved for the
sickest patients; others would be treated at outpatient clinics.
Health workers also might have to set up triage centers in public
places, such as parking lots, to decide which patients are well enough
to recuperate at home and which need medical attention. At Emory,
Heilpern has even raised the idea of "drive-through" flu triage, with
health workers performing quick assessments of heart rate, breathing
and mental status through the window.
And pandemics can be like marathons, according to an article published
last week in The New England Journal of Medicine, which notes that
they can continue taking lives for two to five years.
Will vaccines, antivirals work?
Other experts say the world could have trouble manufacturing enough
vaccine.
Because viruses can change rapidly, a vaccine produced today might not
match the viral strain circulating next winter, Cohen says. The
Centers for Disease Control and Prevention has not yet decided whether
to make a vaccine for H1N1, a manufacturing process that could take
months.
The World Health Organization has said manufacturers could produce 1
billion to 2 billion doses. That's enough to protect 17% to 33% of the
population with one dose. If it takes two doses to produce that
immunity, only half as many would be protected.
"Clearly, we need a major initiative in the vaccine area," says
Michael Osterholm, director of the Center for Infectious Disease
Research and Policy at the University of Minnesota.
In the USA, health professionals, emergency workers and people at high
risk for complications, such as babies and pregnant women, would be
vaccinated first, according to the national vaccine plan.
Osterholm commends the federal government for building a robust
stockpile of antiviral drugs. Between national, state and military
supplies, the nation can treat 80 million people, or about 25% of the
population, with antivirals, which can lessen the flu's severity if
given within 48 hours of the appearance of symptoms and even prevent
the flu if given to household members of flu patients.
Considering that influenza often has an "attack rate" of 25% to 40%,
those supplies may be enough, Osterholm says. But in a very severe
outbreak, a person might need four times the usual amount of Tamiflu,
leaving enough drugs for about 6% of the population, says John
Bartlett, a professor in infectious diseases at Johns Hopkins
University School of Medicine.
Antiviral medications might not work at all if the flu virus becomes
resistant to it, Bartlett says. A strain of seasonal flu that caused
about 45% of the infections this past winter was resistant to Tamiflu,
he says. That resistance developed very quickly. Two years ago, only
1% of that flu virus strain was resistant. Now, 99% of that strain is
resistant, Bartlett says.
.
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