U.S. Flu Outbreak Plan Criticized

Preparing for a Pandemic
By Christopher Lee
Washington Post Staff Writer
Saturday, February 2, 2008

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 Patrick 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 William 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 Michael T. Osterholm, director of the Center for Infectious Disease Research & 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 Monica 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.

Michael Greenberger, director of the Center for Health and Homeland Security at the University of Maryland, said the federal effort amounts to a "classic" unfunded mandate.

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