Flu Vaccine Delayed; ICU Crisis Looms

by Admin on August 26, 2009

White House Report Lays out Hard Numbers for the Flu Impact

White House Report Lays out Hard Numbers for the Flu Impact

In the most strongly worded statements to date, the administration is putting the public health system, and the American people on notice about this Fall’s flu impacts.

The most complete media recap that we’ve seen of the 86 Page report was written for the Washington Post, and is included in this posting. We are strongly advising our clients to review the entire document which can be found on the White House web site.

Some key points from the report bear noting:

The 30,000 to 90,000 deaths expected from the Swine Flu H1N1 virus are in addition to the annual 30,000 or so people who perish from the so-called “seasonal flu”. This means that flu deaths in the US could easily top 100,000 this year.

The strain on our health care system, particularly on ICU resources is perhaps the most alarming news from this report. Imagine a mass casualty incident in your community this Fall or Winter, where victims arrive at hospitals requiring critical care, only to find no beds available.

To help mitigate the situation, there are concrete steps that emergency managers and public service agencies can begin doing immediately:

  • Incorporate key points from this report into your public communications. Encourage common sense prevention steps such as staying home from work or school if ill, frequent hand-washing, etc.
  • Closely monitor the flu in your area. Emergency Managers and public service chiefs should consider getting daily updates from hospitals in their community on the number of beds available, especially those in ICU wards.
  • Review overflow procedures for your area hospitals, be sure to monitor secondary hospital case loads as well. Look for “choke points” in the system and have plans to work around them.
  • Work closely with your school systems, and begin the educational process now for parents. It looks like the Swine Flu H1N1 vaccine will require two injections because there is virtually no immunity to the virus at this point. That could mean a total of three flu vaccinations for some citizens this Fall. Convincing parents of the need for the vaccinations will be a tough sell. Start early. Handouts should go out the first day of school, followed by “town hall” type meetings, etc.

Swine Flu Could Infect Half of U.S.
Presidential Panel’s Estimate Is First To Gauge Possible Impact of Pandemic

By Rob Stein
Washington Post Staff Writer
Tuesday, August 25, 2009

Swine flu could infect half the U.S. population this fall and winter, hospitalizing up to 1.8 million people and causing as many as 90,000 deaths — more than double the number that occur in an average flu season, according to an estimate from a presidential panel released Monday.

The virus could cause symptoms in 60 million to 120 million people, more than half of whom might seek medical attention, the President’s Council of Advisors on Science and Technology estimated in an 86-page report to the White House assessing the government’s response to the first influenza pandemic in 41 years.

Although most of the cases probably would be mild, up to 300,000 people could require intensive care, which could tie up all those beds in some parts of the country at the peak of the outbreak, the council said.

“This is going to be fairly serious,” said Harold E. Varmus of Memorial Sloan-Kettering Cancer Center in New York, co-chair of the 21-member council. “It’s going to stress every aspect of our health system.”

The estimates mark the first time experts have released specific calculations about the possible U.S. impact of the pandemic. The “plausible scenario” is based on previous pandemics and how the swine flu behaved in the United States this spring and during the Southern Hemisphere’s winter over the past few months, said Marc Lipsitch of the Harvard School of Public Health, who helped prepare the estimate.

“They are not a prediction, but they are a possibility,” he said in a telephone interview, noting that the estimates are based on various assumptions, including that the virus will not mutate into a more dangerous form or infect more older people.

“If it turned out to affect a lot more adults, the severity would be a lot worse,” Lipsitch said.

While the seasonal flu is associated with 30,000 to 40,000 deaths and 200,000 hospitalizations each year, the lack of immunity to the swine flu virus probably will lead to many more people becoming infected, sick — and possibly to 30,000 to 90,000 deaths, the council said. And while most deaths during a typical flu season occur in the elderly, swine flu is more likely to kill children and young adults, the panel said.

Lipsitch stressed that the outbreak could turn out to be milder, too. The primary purpose of the estimates was to help guide planning to protect the public. For example, it was estimated that the outbreak could peak in mid-October, so the panel urged expediting the availability of a vaccine.

In addition, the panel recommended clarifying how antiviral drugs should be used to fight the pandemic, speeding a decision about whether to approve intravenous antivirals in case they are needed, designating someone at the White House to coordinate the nation’s response to the virus, and improving the system for tracking the spread of the new virus.

Swine flu virus, or H1N1, emerged last spring in Mexico and quickly spread to the United States and around the world. Although far less dangerous than initially feared, the virus has sickened children and young adults more frequently than the typical seasonal flu.

“This isn’t the flu that we’re used to,” said Health and Human Services Secretary Kathleen Sebelius. “The 2009 H1N1 virus will cause a more serious threat this fall. We won’t know until we’re in the middle of the flu season how serious the threat is, but because it’s a new strain, it’s likely to infect more people than usual.”

The pandemic has caused significant disruptions and economic damage in parts of the Southern Hemisphere, and has contributed to the deaths of more than 1,799 people in at least 168 countries, including at least 522 in the United States. A second wave of infection is expected to begin within weeks in the Northern Hemisphere as schools reopen and cooler weather returns.

Overall, the panel praised the federal government’s response, which has included signing contracts to spend nearly $2 billion to buy at least 159 million doses of vaccine from five companies that are rushing to produce it. But the first batch is not expected to be available until mid-October, when the outbreak could peak.

“This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk for serious disease,” the report states.

The report recommends that a portion of the vaccine be made available by mid-September for those at highest risk by asking the manufacturers to start filling vials with vaccine even though the studies to determine dosages and whether a booster will be necessary have not been completed.

Administration officials said they are already taking action on the panel’s recommendations. All five companies “have been asked to put their initially available vaccine in vials as soon as they are ready,” for example. “This will move forward, even while awaiting results of clinical studies to confirm expected dosing, to ensure the earliest possible availability of initial doses of vaccine.”

“This report is being read very carefully,” said John O. Brennan, White House deputy national security adviser for counterterrorism.

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