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Avian Flu..U.S. Update May 5, 2006

Posted by jaldenh in Miscellaneous.
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May 3, 2006  Center for Infectious Disease Research & Policy
Academic Health CenterUniversity of Minnesota
Copyright © 2006 Regents of the University of Minnesota
 

Protecting human health

The federal government predicts that without containment measures, the number of cases of pandemic flu would double every 3 days. That estimate underscores the importance of good surveillance and prompt response.

The best way to contain a pandemic is by vaccinating people, the plan says. The government is trying to develop sufficient amounts of existing, or pre-pandemic, H5N1 vaccine to immunize 20 million people, as well as to create a vaccine-manufacturing surge capacity to make enough pandemic vaccine for all Americans within 6 months of a pandemic's start. The government has only a few million doses of pre-pandemic vaccine now.

In addition, the government aims to stockpile 81 million treatment courses of antiviral drugs. That includes 75 million courses to be shared with the states and 6 million courses reserved for use in efforts to contain initial outbreaks.

Primary prevention of a pandemic will include vaccination, early detection and treatment with antivirals, and infection control measures. Case tracking and contact tracing in the early stages of a pandemic may be useful in order to isolate the sick and request voluntary quarantine of their contacts, the plan says. However, it adds that the usefulness of quarantining contacts to contain flu is "not fully defined."

The document lists several other methods to reduce the spread of the virus:

  • Social distancing measures, such as advising people to stay at least 3 feet apart
  • Using more telecommuting or teleconferencing for work
  • Closing schools
  • Canceling non-essential public gatherings
  • Restricting long-distance travel
  • "Snow-day restrictions"—suggestions or mandates by community authorities that everyone stay home for two incubation periods (about 4 days for typical flu viruses)

The plan says the likely effectiveness of school closures and snow-day restrictions is not yet known.

In addition, geographic quarantine, imposed by force, if necessary, may be used to stop or slow the spread of flu from an infected community to an uninfected community. "Even if such efforts prove unsuccessful, delaying the spread of the disease could provide the federal government with valuable time to activate the domestic response," the plan states.

The plan also emphasizes the importance of expanding healthcare surge capacity. Rationing of scarce supplies, including ventilators and intensive hospital care, is to be expected, it says. Effective home-based care could be an option to reduce demand for hospital rooms. Protecting human health also means planning for behavioral health and ways to support populations to reduce psychological distress.

Transportation and borders
The United States has 317 ports of entry, and about 1.1 million people pass through them on a typical day, according to the plan. Moreover, Americans are highly mobile, taking about 1.1 billion trips per day.

Although policies affecting the nation's ports of entry and transportation system will influence the spread of a pandemic flu virus, even the most extreme action—closing the borders—would not stop the virus or decrease the ultimate number of cases or deaths, says the plan. It would, however, have "significant negative social, economic, and foreign policy consequences."

Slowing the virus's spread while minimizing the social and economic consequences, then, is the goal. This would buy time to continue preparations and take preventive actions, such as transporting vaccines and antivirals to an outbreak area.

The transportation system's complexities and its importance for public safety, health, and the economy require "extraordinary cooperation between the varied and diverse elements of the sector," says the plan. Critical transportation services will need to be sustained to keep communities functioning and to allow delivery of emergency supplies and resources. For example, planning must be done for delivery of chlorine for water supplies, gasoline, food, and drugs and other medical supplies.

The plan points out that while individual travel will likely decrease as a pandemic spreads, a surge may occur early in an outbreak area as people try to return home, help others, or relocate.

The federal government will have a key role "to provide clear criteria to guide and inform State and local actions and to conduct outreach with State, community and tribal entities to communicate a cohesive national strategy for maintaining movement of essential critical goods and services, while encouraging limitation of non-essential transportation."

Federal support for emergency transportation will come through activation of the "National Response Plan and Emergency Support Function #1." Even so, the plan acknowledges that a pandemic will pose a greater challenge than natural disasters do in this regard, because multiple urban areas will be affected simultaneously and for a longer time.

Cargo entry into the United States, except for live animals and animal products, would pose little risk of spreading flu and could continue, the plan says. Protective measures for workers may be necessary, as may actions such as confining crews and using strict transmission prevention protocols to lower the risk of transmission to or by cargo workers.

Continental rather than national containment will be stressed in a pandemic, and treaty commitments and other agreements with Canada and Mexico will be respected, says the plan. It predicts that mass migration from Central America or Mexico could occur if the virus affects those areas first, likely leading to the need for the Department of Homeland Security to deal with a large increase in illegal aliens.

Protecting workers, ensuring continuity
The implementation plan recommends that government agencies and the private sector expect absenteeism of 40% for 2 weeks during a pandemic’s peak, with fewer employees missing work before and after that period. Some preparedness recommendations for employers and their employees:

  • Identify essential functions and personnel beforehand. Consider cross-training to ensure vital functions continue. Protect and ensure the ready availability of key electronic and hard copy documents.
  • Delegate authority beforehand for key decisions, and establish an order of succession in case leaders are incapacitated.
  • Consider alternate operating facilities and preparing personnel for an announced relocation of essential functions. Such relocation steps may include telecommuting components or other “social distancing” steps.
  • Implement measures to protect personnel, which include frequent hand-washing, limiting travel to affected areas, maintaining 3 feet of personal space, replacing face-to-face meetings with teleconferences, posting infection-control guidelines, cleaning frequently touched surfaces like keyboards daily, and, possibly, wearing face masks.
  • Emphasize communication measures that minimize person-to-person contact.
  • Establish plans to resume normal operations quickly once a pandemic subsides.

Preparedness checklists for state, local, and tribal governments; private businesses; schools and universities; faith- or community-based organizations; and individuals and families can be found at the federal Web site dedicated to flu pandemic information (see link below).

See also:

National Strategy for Pandemic Influenza: Implementation Plan
http://www.whitehouse.gov/homeland/nspi_implementation.pdf

Transcript of May 3 White House news briefing on the plan
http://www.whitehouse.gov/news/releases/2006/05/20060503-6.html

Federal site providing pandemic preparedness information
http://www.pandemicflu.gov/

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