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November 29, 2005 > The Flying Flu

The Flying Flu

by Nitasha Sharma and Pushpa Warrier

With so much attention on avian (bird) influenza H5N1 outbreaks in Asia and Europe and the possibility of a worldwide (pandemic) human influenza, local health authorities are creating contingency plans should a local outbreak occur. TCV contacted the Alameda County Health Department to ask about these preparations.

To date, there has been no detection of the H5N1 virus found in Asia and Europe and no human or animal cases of avian flu in the United States. For a pandemic influenza to occur, three conditions must be met: (1) a new influenza virus subtype emerges to which no one will have immunity; (2) it infects humans, causing serious illness; and (3) it spreads easily and sustainable among humans. The H5N1 virus has met all of the conditions, except it does not have efficient human-to-human spread. The risk that the H5N1 virus will acquire this ability will persist as long as opportunities for human infections occur. To reduce this risk, the virus must be eradicated in birds, or this situation could endure for some years to come.

In a pandemic influenza, potentially hundreds of thousands of Bay Area residents could become sick and require medical attention putting a strain on our medical infrastructure and resources. The question then becomes: What resources does Alameda County have to deal with such a disaster?

If a vaccine and/or specific treatment for a pandemic influenza virus becomes available, Alameda County and its regional partners are planning to set-up mass vaccination and treatment centers to distribute these treatments to Bay Area residents as quickly as possible.

The Alameda County Public Health Department continues to work with both regional and state partners in the areas of local and regional preparedness, surveillance (detection), notification and risk communication. In addition to these areas, the U.S. Department of Health and Human Services (HHS) continues to support influenza vaccine research, development and production, strategic stockpiling of antiviral medications, and risk communications.

Each hospital has a disaster plan that includes early discharge and canceling elective surgeries, etc. The Hospital Census Alert System has been in use since 1998. Alert status (no alert, alert level 1 or alert level 2) triggers certain actions in the hospital. Alert status is reported daily via the ReddiNet and is available for all hospitals and Emergency Medical System (EMS).

Computer models suggest that a flu pandemic will create a significant need for surge capacity, especially for Intensive Care Unit (ICU) beds and ventilators; the county has used FluSurge and FluAid to project surge needs in the past. Last winter they convened multiple county healthcare providers and presented various scenarios related to the influenza vaccine shortage.

In a flu pandemic situation, Alameda County has a sufficient number of staffed hospital beds (approx. 3157) to handle admissions at the peak of an epidemic (weeks four and five of epidemic 8 weeks in duration). Local area hospitals also have a sufficient number of ventilators (approx 356). They do not, however, have a sufficient number of ICU beds (180) if the attack rate approaches 25 percent, but they would work with area hospitals as needed and have developed a contingency strategy that will allow them to accept low acuity patients into a county-owned and staffed facility in order to free up higher acuity beds in county hospitals. Additionally, recent Health Resources and Services Administration (HRSA) grant funding through the U.S. Department of Health and Human Services has provided cots, tents, and other equipment for surge capacity in all hospitals. Some hospitals do overspill into outpatient areas in the evenings.

Shortages of beds and equipment will depend upon the proportion of the population that becomes ill, the virulence of the virus and the duration of the epidemic. The Spanish Flu Pandemic of 1918 infected at least one-quarter of the U.S. population (25-28 percent).

Flu pandemic estimates used here are based on an epidemic of 8-week duration and three different attack rates of 15, 25, and 35 percent.

The county maintains a stockpile of antibiotics and other supplies plus substantial personal protective equipment including N-95 masks and other supplies for a 20-person "Go-Team" that would be sent in to evaluate and diagnose an unknown illness or event.

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