Reports Criticize Pandemic Planning

Flu Readiness Check Finds Gaps In Care, Coverage

By Rob Stein
Washington Post Staff Writer
Monday, September 21, 2009

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/20/AR2009092002541_pf.html

Many state and local governments are not 
adequately prepared to deal with a surge of 
patients in a flu pandemic or quickly distribute 
vaccine and antiviral drugs, according to two 
reports by federal investigators being released 
on Monday.

An analysis of preparations by five states and 10 
municipalities around the country found that many 
had failed to take steps crucial during a 
pandemic, such as recruiting health-care workers 
to volunteer, creating systems to track hospital 
beds and medical equipment, and determining how 
to manage a patient load that exceeds what 
emergency rooms are able to handle.

"Our review found that although the selected 
states and localities are making progress within 
the five components of medical surge that we 
reviewed, more needs to be done to improve 
states' and localities' ability to respond to a 
pandemic," investigators from the Department of 
Health and Human Services' Office of Inspector 
General concluded in one report.

The findings come as federal, state and local 
officials are preparing for a second wave of 
swine flu infections. The H1N1 virus emerged in 
Mexico last spring and quickly spread to the 
United States and elsewhere. Although the virus 
appears no more dangerous than seasonal flu, many 
more people than usual are expected to become ill 
because most people have no immunity against it.

For the first report, investigators collected 
information last summer about pandemic planning 
in Portland and Lewiston, Maine; St. Louis and 
Rolla, Mo.; Sioux Falls and Mitchell, S.D.; 
Virginia Beach and Blacksburg; and Seattle and 
Longview, Wash.

In a 30-page report, investigators found:

-- Although all 10 communities had developed 
committees to help plan for a pandemic and 
health-care coalitions to coordinate care, "the 
degree to which coordination occurred varied" 
among them.

-- Fewer than half of the communities had started 
to recruit volunteer medical workers to help with 
a surge of patients, and none of the states had 
implemented an electronic system to manage such 
volunteers.

-- All 10 communities had acquired additional 
medical equipment to respond to a pandemic, but 
"many experienced difficulties with managing this 
equipment," and only three states had electronic 
systems to track beds and equipment.

-- Although nine of the 10 communities had either 
identified or were working to identify 
alternative sites for treatment of patients that 
hospitals could not accommodate, few had signed 
formal agreements for the use of those 
facilities, and "none of the localities that were 
planning to use alternate care sites had plans 
that included the scope of care and how these 
sites would be managed, staffed and supplied."

-- Nine of the 10 communities had not identified 
guidelines for adjusting their triage, admissions 
and care to handle a rush of patients in a 
crisis. Many cited liability concerns.

-- All of the communities had conducted exercises 
during the previous two years, but most of the 
exercises involved discussion only. None 
documented lessons learned from the exercises.

Although the investigation was conducted before 
H1N1 appeared and many communities began planning 
for the second wave, some experts said they 
thought that little had been done to improve the 
care administered when patient loads reach crisis 
levels.

"The ability to cope with a surge in patients is 
going to be very spotty," said Kim Elliott of the 
Trust for America's Health, a nonpartisan 
research and advocacy group. "Depending on the 
jurisdiction, preparations can range from 
probably mediocre to really bad."

The second report, which focused on vaccine and 
antiviral-drug distribution, similarly found that 
communities must do more to be able to respond 
adequately to a pandemic.

Centers for Disease Control and Prevention 
spokesman Von Roebuck said that "CDC agrees that 
while states, overall, are doing well with 
antiviral drug distribution and development of 
vaccination plans, local pandemic preparedness 
can and should be improved."

The CDC on Friday gave details of the vaccination 
distribution, which will originate at four 
regional warehouses next month. The deliveries 
will be distributed among 90,000 immunization 
providers, including health departments, 
hospitals, doctors' offices and pharmacies.

Federal guidelines call for the H1N1 vaccine to 
be given first to pregnant women; people who live 
with or care for children 6 months or younger; 
health-care workers; people 6 months to 24 years 
old; and people with chronic health problems or 
compromised immune systems.

Staff writer Ceci Connolly contributed to this report.


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