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Report Gives U.S. Good Grades for Swine Flu Response

THURSDAY June 4, 2009 --Although the U.S. response to the ongoing H1N1 swine flu outbreak that surfaced unexpectedly in April has been largely effective, there are shortcomings that must be addressed.

And those shortcomings could take on added urgency if the virus returns in a more virulent form in the fall, a new report found.

"It's clear that all of our pandemic planning and preparation have improved the nation's ability to respond to an outbreak, but H1N1 did not test the limits of our response," Jeffrey Levi, executive director of the Trust for America's Health, said at a news conference Thursday to announce the release of the report, Pandemic Flu: Lessons from the Frontlines.

"If, in the future, we face a situation with a large number of Americans becoming ill and flooding into hospitals and health-care facilities, our system could be overwhelmed," he added.

Chief among the strengths of the U.S. response was the investment the nation has made over the last decade or so in planning for a pandemic flu and stockpiling antiviral medications. Those were decisions that "really paid off," Levi said.

On the other hand, the H1N1 swine flu posed a very different challenge than the one that health officials had been planning for, said Dr. David Fleming, director of public health for Seattle and King County, Wash.

"Most of the planning was for a severe form of influenza [avian flu] for which we would have six weeks' notice because it emerges in the Far East," said Fleming, who spoke at the news conference. "We were wrong on two counts. The swine flu was of normal virulence and we had no warning. In the first couple of days, we were adhering to our plan with policies and procedures that did not match the severity of the strain."

That realization offered another lesson learned -- public health responses must be flexible, according to the report. Not only must they be able to adapt to different flu strains appearing, they also must be responsive to fluid circumstances as every outbreak is constantly changing and knowledge is always being updated.

Effective communication was another widely acknowledged strength of the response, largely because it helped alleviate public anxiety, the report stated.

"This was clearly the top priority in managing and controlling this outbreak -- I give them [public health officials] high marks," said Dr. Scott Lillibridge, assistant dean for the Texas A&M Health Science Center School of Rural Public Health in Houston, and executive director of the National Center for Emergency Medical Preparedness and Response, who was not at the conference but was geographically at the frontlines of the epidemic.

But communication wasn't perfect, Fleming said, with the national picture often lagging one to two weeks behind local happenings. Local health officials had a clearer picture of what was actually occurring: who was being infected, how severely, how the virus was being transmitted, and how resources were handling the strain.

Another shortcoming, according to the report: Public health departments are strapped in terms of resources -- including personnel -- and need to be replenished.

One expert who was not involved with the report agreed.

"Health departments and labs in hospitals were really marginally staffed. New technologies helped but the people were just not available," said Dr. Kenneth Bromberg, chairman of pediatrics and pediatric infectious diseases at the Brooklyn Hospital Center in New York City. "We don't have enough respirators in the U.S. for the worst-case scenario of a flu epidemic."

The report also said authorities need to think more carefully about the effects of school closings on parents, students and employers, as well as the reality that about half of all working Americans don't have sick leave.

The report made several recommendations, all based on the stated vulnerabilities. They include:

  • Making sure that the national stockpile of antiviral medications, vaccinations and equipment is maintained.
  • Improving coordination among federal, state and local governments and the private sector, including taking into account how the nature of flu threats change over time.
  • Enhancing the nation's biomedical research and development abilities to rapidly develop and produce a vaccine.
  • Making sure all Americans are vaccinated. Currently, more than 50 percent of Americans do not get their annual flu shots.

"The most difficult part of this list of vulnerabilities is vaccinating all Americans," said Dr. Len Horovitz, chief of pulmonary medicine at Lenox Hill Hospital in New York City. "It may be that with the tremendous scare this time about this particular virus, people may be more willing to be vaccinated. It remains to be seen but the message is vaccinate, vaccinate, vaccinate. Not just for H1N1 but for the seasonal flu as well."

Since it was first detected in April, the H1N1 swine flu has caused 19,273 cases of infection in 66 countries, but just 117 deaths, 97 of them in Mexico, the WHO reported Wednesday.

The U.S. Centers for Disease Control and Prevention reported Wednesday a total of 11,054 cases in all 50 states and the District of Columbia and Puerto Rico, including 17 deaths.

Health officials in the United States have said that infections have been mild for the most part, and most patients recover fairly quickly. Testing has found that the H1N1 virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza.

The report was prepared by the Trust for America's Health, the Center for Biosecurity at the University of Pittsburgh Medical Center, and the Robert Wood Johnson Foundation.

More information

View the full report at the Trust for America's Health.

Posted: June 2009


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