Pandemic Planning; Healthcare and Public Health Aren’t Talking
There is a lack on communication in America regarding Pandemic Influenza planning and resourcing and it must stop immediately. The Federal leadership is putting out a loud and clear message that in a Pandemic, the States and Territories will be pretty much be going it alone. That sounds great since the CDC grant programs are pouring money into State Public Health Departments so they can do whatever they need to do to pretty much “Stand Alone” during a Pandemic. So what’s wrong with the plan? Plenty!
The major problem that nobody wants to talk about is that America is unwilling or unable to address where sick Americans will get care during a Pandemic that Federal Agencies are saying will occur.
The Public Health Community is taking a three-pronged approach to managing a Pandemic.
- Early Detection: The idea here is to provide Public Health Officials with an early warning that a new “person to person” strain of Influenza has mutated from the current H5N1 strain. It is thought the earlier we know that the Pandemic has begun, the better we can deal with it. Sounds good doesn’t it? Imagine the North American Aerospace Defense Command (NORAD) detecting inbound missiles coming in from an attacking country. Then imagine the President asking for options from the Commander in Chief NORAD, only to be told we didn’t have options until the new missile defense system came on line. Imagine the horror the President would feel if the NORAD folks said they had destroyed all offensive missiles because the new defense system would render all offensive weapons useless. Well folks that’s about where we are now in Public Health. We spent a lot of money on syndromic surveillance systems so that we know a novel Influenza virus when we see one. The problem is there is very little we can do about it when it arrives in the USA.
- Antiviral medications. The Centers for Disease Control and Prevention (CDC) has said “Four antiviral medications (amantadine, rimantadine, zanamavir and oseltamivir*) have been approved by the U.S. Food and Drug Administration (FDA) for treatment of influenza. However, you will need to begin taking the medication within 2 days after becoming sick.” What they don’t say is (a). Does the CDC have enough Antivirals on hand in the Strategic National Stockpile to cover the American people? (b.) How is Antiviral Medication going to be distributed…and when? (c). What is the Priority either by medical condition or occupational category that local Public Health departments going to use in administering the medications?
- Vaccines. If there is a magic cure for the new strain of Influenza, it will come by way of a vaccine. The problem with the whole idea of vaccination is t cannot be manufactured until the specific strain of the organism is present in the population. We hear that it may take 6-9 months for Vaccine manufacturers to ramp up production of vaccines and start moving vaccine through the supply chain.
The Issue: What we do know is according to Federal Officials is; about 45 Million Americans will need some form of professional medical care.
Problems:
Home Care. None of the above strategies discuss where the sick Americans can go to get the definitive care that Federal Officials are saying they will need. Even worse, the other 45 Million give or take a few million Americans are going to need to care for themselves or have family take care of them at home. Did anyone tell the makers of Robbitusin, NyQuil, VapoRub, Aspirin, Tylenol and the other manufacturers of over the counter (OTR) medications and other cold and flu home care supplies and equipment to expect a bit of a spike in demand for…let’s say a year or so? Do the drug store chains know anything about this? Do we think when the drug store chains and supermarkets run out of OTC medications the folks who may have been able to stay home will now have to go to the ER? Pretty good bet isn’t it.
Hospital Care. Every time we open a newspaper or a magazine, we read that the American Healthcare System is in a state of Crisis. With financial pressures from Managed Costs (opps! that’s Managed Care isn’t it), reduced Medicare and Medicaid funds and a increased Baby Boomer population, our hospitals and medical centers have been at near capacity for some time now. Emergency Room visits are up in many if not most areas of America. But as the saying goes; “You ain’t seen nothing yet.” In a Pandemic when the shelves of OTC and home care products are empty, every ER in the Country will be inundated. Or will they too run out of supplies?
Under the best of Healthcare Surge Plans, we might be able to take on 1 Million very sick patents that can be saved if they get immediate and aggressive intensive health care. Why only 1 Million additional patients if Hospitals cancel all elective procedures, go to 12 on 12 off staffing schedules? I have seen figures that up to 40% of the nurses in the Country will either be sick themselves or will be home taking care of loved ones who are sick. If America’s divorce rate is approaching 50% would the 40% call-out seem reasonable? The 1 Million additional patients is just my guess…but someone has to guess. While we are on the subject of Hospitals, with all the elective procedures and outpatient visits cancelled for about 9 Months, how are healthcare organizations going to be reimbursed so that they won’t go out of business during those 9 Months? We absolutely have to answer the really tough questions. Now would be an excellent time to get the details out to the Healthcare Industry.
Medical Facilities, Supplies and Equipment. Has anyone in the Federal Government met with manufacturers and distributors of medical supplies, pharmaceuticals and equipment? I like round figures so let’s for the sake of argument say that 100 Million folks will become infected with the new strain of Influenza. How long will manufacturers take to ramp up production of all OTC medications, home health supplies and hospital supplies? Can manufacturers expect to acquire raw materials on the Global Marketplace? Are the manufacturers planning to go to 12 hour shifts? Is there any excess capacity to surge manufacturing at all in 6 to 9 months? I asked that question to the X-ray film manufacturers that question as a part of wartime surge planning. The answer was “maybe in 12 months.”
Are those who are planning to open Alternative Care Centers (ACC) planning on developing a medical logistics support plan to support the ACC? Do Healthcare Materials Managers know anything at all about this ACC Concept of Operations? How about food, water (drinking, washing and chillers), back-up generators (and fuel), regulated medical waste (RMW) treatment units? Do RMW transporters and Off-Site treatment facilities know anything about a surge in RMW.
If quarantine is ordered, how will transporters get into the quarantined jurisdiction to pick up and transport the medical waste? The hospitals that treat RMW on-site will be very happy about their decision process. Are pre-established, anticipated demand contracts in place for all hospital services?
How about opening previously shutter hospitals? One would think that every Public Health Officer in the County would be submitting plans and budget requests for re-opening currently closed hospitals, or more likely, former hospitals that are currently being used as office buildings, county or state buildings. Well you would be wrong. We need to put plans and teams together across America to upgrade previously operational hospitals to be able to support at least an intermediate level of healthcare during a Pandemic.
How about mobile medical facilities? In the 1960s, America had about 1900 “Packaged Disaster Hospitals”, each with three operating rooms and each with 200 beds which were capable of attaching IV Poles and medical equipment devices. These were not cots; these were beds where nurses and physicians would not have to be on hands and knees to provide patient care. That was 380,000 additional beds and 5,700 operating rooms. Each one of these “Packaged Disaster Hospitals” came with enough equipment, pharmaceuticals and medical supplies to operate 30 days without re-supply.
Healthcare Staffing. With about a 40% reduction in health care providers, how will hospitals cope with “The Longest Year” in American healthcare? Are public health departments conducting training for healthcare augmentees? How about the Red Cross? Are their contracts for Per Diem nurses amended to accommodate the surge in demand for care givers? Are communities and hospitals involved with their state or local Medical Reserve Corps (MRC) Chapter? Is the MRC expanded to include home health providers? Are provisions to care for persons with disabilities in place at public Health departments, healthcare organizations and the state or local MRC? Are folks going to deliver back-up power units, food, water and assistants for Special Needs and At Risk persons on life support equipment in their homes? Are all Non-Government Organizations being fully integrated into the Public Health Department plan for Community Surge?
Let’s not forget that in 1918 America had a very large contingent of Faith Based care givers. How capable is America’s Faith Based organizations to provide various levels of patient care and end of life care?
And now for the $64,000 dollar question. Will Public Health Departments across America open emergency health care centers and provide “hands-on” patient Care? The answer is…They better! If the Public Health Officers across America are not planning to augment the Healthcare Industry which everyone knows is at or near capacity (and in many jurisdictions is over capacity), the next after-event Congressional Committee will be asking the question Why Not? Is it an “It’s not my job” type of thing?
What I believe wholeheartedly is that the time for plans, studies, research projects and countless articles on Pandemic is over. The anticipated Pandemic is undoubtedly the most studied Public Health Emergency in World History. Never before has a disease been so studied and researched while the society in which it was studied remains so utterly unprepared.
I have developed a “Battle Plan” type of chart and enclosed it in this paper. This is just one person’s best effort at trying to hold the line during a Pandemic. Every Public Health Officer in America will have her own or his own plan; at least I hope they will for their states and territories.
© JVR Health Readiness, Inc. 2008
