[Mb-civic] Preparing for pandemic - Manuel Cortazal - Boston Globe Op-Ed

[William Swiggard]

  Preparing for pandemic

By Manuel Cortazal  |  March 17, 2006  |  The Boston Globe

THE APPEARANCE last month of the avian flu virus in Nigeria and India is 
a troubling development for health officials tracking the spread of the 
H5N1 strain and eyeing its potential for igniting an influenza pandemic.

Both countries, each with a grossly inadequate public health system, are 
beset with endemic diseases that could mask the spread of a variant of 
the H5N1 from animals to humans. The director general of the World 
Health Organization noted, ''If the H5N1 virus changes to allow it to 
pass easily from person to person, and it goes unchecked, this could 
trigger an influenza pandemic."

In this country attention is now turning to implementation of the Bush 
administration's strategy for the potential emergence of a pandemic 
strain of the avian virus. Bush unveiled his plan, built upon three 
pillars, on Nov. 1 and urged the nation not to ''waste time in preparing."

Observers should view the president's plan against the backdrop of a 
recent natural disaster, Hurricane Katrina, to learn vital lessons that 
should shape our preparations for the arrival of another disastrous 
event on our shores.

Preparedness is the first pillar of the administration's blueprint. This 
element of the national strategy presupposes that the patchwork of 3,000 
local public health units is actively developing response plans. 
Likewise, prior to Katrina, every locality and state along the Gulf 
Coast had a disaster plan that dealt specifically with tropical storm 
readiness.

While the potentially calamitous consequences of the looming threat 
surely call for extensive planning at all levels of government and 
across all sectors of society, Katrina's aftermath taught us a salient 
lesson: There is no steadfast relation between disaster planning and 
effective response.

Surveillance is the second pillar of the president's proposal. The 
residents of the Gulf Coast were privy to an abundance of storm 
reconnaissance presaging a disaster, yet officials were unprepared for 
the storm's ferocity. Here, too, Katrina offers a lesson: Even the best 
surveillance confers limited advantage when the capacity for response is 
lacking.

The national strategy's third pillar is response and containment. The 
president's plan depends on the response capability of local health 
departments, which, as the chaos that followed Katrina demonstrated, is 
an approach fraught with risk. Again, last summer's hurricane provides a 
lesson: The federal government cannot assume that local authorities will 
be able to manage relief activities in response to a pandemic.

The president's plan pays scant attention to quarantine measures, which 
many experts believe were the key to the containment of SARS. Also, it 
is weighted heavily toward vaccines and antiviral medications. Yet, 
national stockpiles are woefully inadequate and won't reach desirable 
levels until 2008. Owing to the glaring lack of vaccines and antiviral 
medications, quarantine may be the most effective response to an outbreak.

Officials responding to a pandemic outbreak will have to deal not with 
mass evacuation but with keeping citizens in place. State and local 
authorities have no experience in coping with the complexity of 
restricting the movement of entire metropolitan areas, which, 
ironically, is the opposite challenge that Gulf Coast emergency managers 
had faced.

It may come as a surprise to many that the federal government does not 
have broad police power to impose quarantines, a responsibility 
constitutionally vested in the states. The disarray among local, state, 
and federal agencies in the wake of Katrina vividly demonstrated the 
constraints on cooperation and coordination following a catastrophic 
event. If a regional outbreak, for want of cooperation among government 
agencies, were to spiral out of control, the deadly virus could spread 
nationwide.

The Centers for Disease Control and Prevention estimate that an outbreak 
of pandemic influenza could result in 20 million to 47 million Americans 
requiring healthcare. By way of comparison, California experienced a 
moderate outbreak of typical seasonal influenza in December that flooded 
emergency rooms and forced hospitals to turn away ambulances.

Equally disturbing is the finding of a study concluding that as many as 
50 percent of healthcare workers may be unwilling to report to work 
during a pandemic. The effects of a pandemic will engulf our healthcare 
system and overwhelm our ability to respond to the millions who will 
need assistance.

The unnerving prospects that await us, should an outbreak occur, call 
for unified leadership that recognizes the limits of state and local 
preparedness and the need for employing quarantine measures. Rather than 
delegating planning and response to myriad local health departments, the 
nation's governors and the president must urgently agree on plans to 
quarantine affected areas and prepare for the multitude of people who 
will need healthcare.

Manuel Cortazal is managing editor of the American Journal of Infection 
Control. 

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/03/17/preparing_for_pandemic/
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