U.S. Flu Outbreak Plan Criticized

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U.S. Flu Outbreak Plan Criticized

It Does Not Anticipate Strain on Hospitals, Local Health Officials Say

By Lee, Washington Post Staff Writer

Saturday, February 2, 2008; A03

The federal government's voluminous plans for dealing with pandemic

flu do not adequately account for the overwhelming strain an outbreak

would place on hospitals and public health systems trying to cope with

millions of seriously ill Americans, some public health experts and

local health officials say.

The Bush administration's plans, which run more than 1,000 pages,

contemplate the nightmare medical scenarios that many experts fear,

but critics say federal officials have left too much of the

responsibility and the cost of preparing to a health-care system that

even in normal times is stretched to the breaking point and leaves

millions of people without adequate access to care.

" The amount going into actually being prepared at a community level is

not enough, " said Libbey, executive director of the National

Association of County and City Health Officials. " We are still talking

about rearranging with little additional resources the assets of a

system that are built on such a thin margin now that you have

significant amounts of people without access to care, and hospitals

that are periodically shutting down their ERs and the like. "

The Bush administration argues that it is doing a lot to help

communities as part of its three-pronged strategy for dealing with the

flu threat. It has doled out hundreds of millions of dollars in

preparedness grants for hospitals and public health systems every

year, subsidized the stockpiling of antiviral drugs, conferred with

governors and encouraged resource-sharing plans among hospitals.

Its larger strategy involves partnering with other countries to

quickly identify and contain potential outbreaks overseas, developing

vaccines and other medical measures to limit the virus's spread if it

reaches U.S. shores, and working with state and local officials to

keep the economy and society functioning as normally as possible. But

administration officials acknowledge that gaps remain.

" We're seeing substantial progress across the board in terms of

various aspects of preparedness for flu, " said Raub, science

adviser to Health and Human Services Secretary Mike Leavitt. " But I

won't sugarcoat this. In virtually every area, we have a good way to

go. . . . It would not take much of an unmitigated pandemic to

overwhelm the hospital system. "

A serious outbreak and its fallout would probably overwhelm medical

centers, cause lengthy delays in emergency and routine care, and

trigger shortages of beds, ventilators, drugs, masks, gloves and other

supplies, experts said. Unlike a hurricane or a terrorist bombing, the

crisis would drag on for months and affect communities nationwide at

the same time.

Doctors and nurses would be swamped at a time when many of them and

their family members would also be falling seriously ill, thinning

their ranks and forcing some to choose between helping loved ones or

patients. A vaccine, if one becomes available, could be difficult to

transport and distribute, and imperfect vaccines and antiviral drugs

used in the early stages of an outbreak probably could not forestall a

pandemic. The " just in time " economy on which many hospitals rely for

shipments of drugs and medical supplies, many of them from overseas

manufacturers, would quickly fall apart.

" If we have even a moderate-sized pandemic, these supply chains are

going down overnight, " said T. Osterholm, director of the

Center for Infectious Disease Research & amp; Policy at the University

of Minnesota.

Osterholm and others said that a serious flu outbreak would be nearly

impossible to contain and that building the medical capacity to treat

the surge of victims would require billions more in sustained federal

aid. Moreover, health experts say there should be greater attention

paid to who will control scarce resources and to how people will get

care at home and in other nonhospital settings.

" The priority focus within U.S. pandemic plans on controlling

contagion has unwittingly diverted attention from the problem of

caring for the sick, " said Schoch-Spana, a senior associate

with the Center for Biosecurity at the University of Pittsburgh

Medical Center and an assistant professor in the university's medical

school.

Greenberger, director of the Center for Health and Homeland

Security at the University of land, said the federal effort

amounts to a " classic " unfunded mandate.

" If you look at the plan, the basic message is, 'This is going to be

one hell of a problem, and you better get ready.' You better get

ready. You the cities, you the states, you the citizens, " Greenberger

said. " The pandemic flu preparations in the United States are a tragedy. "

Since late 2005, Congress and the president have devoted more than $6

billion to pandemic flu preparedness, although little has gone

directly to states and communities. The vast majority has been spent

on researching vaccines and building the capacity to manufacture and

distribute them, and on antiviral drugs and overseas disease

surveillance, analysts said.

Near the end of 2005, the government also allocated a separate $600

million, one-time pot of money for pandemic preparedness grants to

states and localities, as well as another $170 million to help states

buy antiviral drugs, but much of that money has been spent already.

Other grants for state and local bioterrorism preparedness and

hospital emergency preparedness total hundreds of millions of dollars

annually, but they have declined in recent years.

Raub, the HHS official, said the government's strategy and funding are

sound. Overseas surveillance could help delay a pandemic's arrival or

lessen its severity, he said. And domestically, the goal is not to

simply throw money around but to help states and communities develop

plans -- even low-tech ones such as encouraging sick people and family

members to stay home -- that could minimize the spread of flu while

stretching medical resources.

" A lot of leadership will come from the trenches, " Raub said. " None of

this is a panacea, and I don't mean to represent that we've got this

solved. But at least there are substantial public resources flowing

with a focus on what we think are the practical things that,

unglamorous as they are, can be done. "

Health and hospital officials around the country vary in the degree to

which they believe they are ready, but even those who say they have

made good progress want the federal government to do more.

" So far we don't have supplies and that sort of thing in large

quantities, " said Ron , president of Parkland Health & amp;

Hospital System, which runs the county hospital in Dallas. " We don't

know how we would treat all the people who would be coming in large

numbers. I'm afraid this country doesn't understand that there isn't

much surge capacity here, not only for pandemics but for any kind of

biological terrorism or something like that. "

In Northern Virginia, Inova Health System has focused much of its

planning on regional collaboration, said Dan Hanfling, director of

emergency management and disaster medicine. Inova has spearheaded a

regional hospital alliance that has examined how best to deploy

durable medical goods, drugs and other supplies, he said, and has

purchased a " modest " supply of extra ventilators to help victims whose

lungs have been devastated by flu.

Hanfling agrees that federal officials have provided leadership and

some important funding streams, but he, too, said more needs to be done.

" The amounts of funding still pale in comparison to the tremendous

need that exists, " he said. " It's a big, complex, daunting issue. . .

.. It makes our current state of readiness tenuous, at best. "

In Farmington, Maine, the lin Community Health Network, a

nonprofit system serving 50,000 people, has developed plans to

relocate existing patients and, if necessary, house its medical staff

for weeks, said Batt, the network's president.

lin Memorial Hospital, a 50-bed facility with $60 million in

annual revenue, spent $100,000 to stockpile a month's worth of gloves,

masks, drugs and other supplies at a warehouse, Batt said. Much of it

must be regularly rotated into the hospital's inventory and replaced

to keep it from deteriorating.

Batt, whose hospital has received about $10,000 in federal help, said

federal funders have favored police and fire departments over

hospitals and primary-care systems.

" In a pandemic, the action is going to be in the doctor's office and

in the hospital emergency room and the ICUs, " he said. " It isn't going

to be with the fire department intercept squad. . . . You'll find that

there are almost no resources going to this problem proportionate to

the real risk it presents. "

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