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The first Pandemic Influenza Response and Preparedness plan was drafted in 1978, not long after the swine flu outbreak of 1976. In 1993, the U.S. Working Group on Influenza Pandemic Preparedness and Emergency Response was formed to draft an updated national plan. A draft was released in August and the public could comment for 60 days. Those comments are now being reviewed. The plan will be continually updated to reflect changes in public health, vaccine production, technology, and other developments.

“Our proposed strategy draws upon the wealth of experience and knowledge we have gained in responding to a number of recent public health threats, including SARS and avian influenza,” Tommy Thompson, the former secretary of the U.S. Department of Health and Human Services, said in a press release last year.

“This plan will serve as our road map on how we as a nation, and as a member of the global health community, respond to the next pandemic influenza outbreak, whenever that may be.”

The HHS plan calls for increased surveillance, vaccine development and production, antiviral stockpiling, research, and public health preparedness. The plan describes coordination and decision-making at the national level, gives an overview of key issues, and outlines steps that should be taken at the national, state, and local levels before and during a pandemic. The plan also provides information to health departments and private-sector organizations to help them develop local preparedness plans.

Mary Lopez, RN, MSN, director of critical care, telemetry and dialysis care at Community Regional Medical Center in Fresno, Calif., says many of the measures now being taken in the annual flu season would be implemented in a pandemic flu outbreak.

Those include asking anyone with a cough or runny nose to wear a mask, to make available facial tissues to those who are sick, and to provide bags for discarding used tissues. She says children would be prevented from visiting patients and signs would warn people to be wary of spreading the flu virus.

One issue facing the central part of the state is how to educate a public that speaks 100 different languages. Much of the population is poor and transient, traveling from Mexico to California each year to work in the fields.

Staffing is key

Steve Cantrill, MD, associate director of emergency medicine at Denver Health, says staffing is one of the biggest concerns he sees in handling a pandemic flu outbreak, especially because a vaccine would not be immediately available. Health care workers, therefore, would be exposed to the virus and some would become ill.

Staff morale and fatigue also would become an issue, he says. “Often, medical care providers like to think of themselves as bulletproof,” he says. “We’re not. We need rest periods, too.”

Shortages of equipment, such as ventilators, are likely to occur during a pandemic. Cantrill, however, believes that’s a secondary problem. The main problem will be finding enough respiratory therapists to run them.

“Ventilators don’t come with a respiratory therapist attached,” he says.

Cantrill says Denver Health’s pandemic flu planning has piggybacked on its SARS planning, which, in turn, piggybacked on the bioterrorism planning that took place after the anthrax scare in October 2001. This year’s shortage of flu vaccine has forced hospitals and public health providers to develop communication, rationing, and mass vaccine plans that should help in the event a pandemic flu occurs.

Glennah Trouchet, MD, health officer for Sacramento County in California, agrees, yet she warns that no one really knows how well prepared they are for something like this until it happens.

“We’re much better prepared than we were, say, three years ago, and we’re definitely thinking about it and working on it,” she says. “But if you were to ask me: ‘Are you totally prepared?’ We won’t know that until something hits and then we’ll find out.

“Certainly, we have exercised our communications skills and we have developed contacts with folks that could help us should it be necessary. … Everything that we have done since 2001 has helped us prepare for [pandemic flu].”

Trouchet formed the Northern California Partnership for Influenza Prevention last year that includes the four largest hospital systems in Sacramento County. They meet once a month to discuss issues that might impede the delivery of flu vaccine to the right people.

Alonzo Plough, MD, director and health officer for Seattle and King County Public Health, says pandemic influenza preparedness has become the focal point of all its preparedness planning activity.