The Swine Flu Response

As the first swine flu cases were diagnosed in Mexico, health officials all over the United States leapt into action. This is the test that they are always preparing for.

As the disease spread, public health professionals have been actively tracking the cases, working to contain the disease by treating areas where the disease is most concentrated, dispensing antiviral medications from the Strategic National Stockpile, and letting the public know how to protect themselves and when to seek treatment.

The Administration has displayed strong, coordinated leadership, with the U.S. Centers for Disease Control, the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security, and the White House conveying guidance and strategies based on the best expert advice for how to respond. State and local health departments are monitoring and responding to cases as they emerge.

We are fortunate that the country has taken many measures to prepare for a potential pandemic flu outbreak. In November 2005, then President Bush issued a National Strategy for Pandemic Influenza that called for plan that spanned every department of the federal government, every state, and the private sector. Congress provided nearly $7 billion to help prepare. Most of this funding went to stockpile existing antiviral medications and give scientists resources to research and develop vaccines and other pharmaceutical interventions.

Since then, due to the tireless work of public health professionals, the country has made significant strides in improving surveillance, coordination, communications, treatment capabilities, and vaccine manufacturing capacity. In addition, all 50 states and the District of Columbia have developed pandemic plans.

Overall, our ability to respond to a pandemic is light years ahead of where we were just a few short years ago.

But, our public health system has been under-funded for decades and there are many existing gaps that leave us vulnerable, particularly if the swine flu becomes more severe and lethal.

If large numbers of Americans start getting very sick and start flooding into hospitals and health care facilities, our system will really be in for a test. Our health system could be overrun in a very short period of time.

Figuring out how to plan for a massive influx of patients is one of the hardest parts of preparing for health emergencies, and it has yet to be adequately dealt with. "Surge capacity" management is one of our biggest weaknesses, particularly at a time when we have shortages of emergency and public health workers. That problem is getting worse as state and local governments are cutting budgets. An estimated 11,000 public health workers have been laid off in just the past year.

The problem of managing massive numbers of patients is even more complicated under the current health care system, where there is serious concern that people who are uninsured or underinsured may not seek treatment or may not have trouble accessing care. If people who are contagious do not seek treatment during the limited time period when antiviral medications might be effective, they are at serious risk. And they also risk spreading the disease to others.

During an infectious disease outbreak, ensuring that care is in place for all Americans is more vital than ever. Not only is the patient at risk, they risk further spreading the disease unless they receive proper care.

The swine flu is a clear demonstration of how public health issues are an integral part of our overall health care system -- and the importance of considering these issues as part of the health reform debates.

Congress should incorporate preparedness planning support into health care reimbursement streams, so hospitals and health facilities can actually meet the needs of all patients when emergencies arise. In particular, a "State of Emergency" health benefit would ensure that the uninsured and underinsured receive the care they need on a temporary basis during crisis. Hospitals and health providers shouldn't have to worry whether they'll be compensated for providing care to individuals in need in an emergency. And more importantly, no patient should have to worry that they'll be turned away when the need care.

We also need to ensure that the right medications will be available to people when they need them. The investment the country has made in buying antiviral medications for the Strategic National Stockpile is now paying off. However, even now, some states have more antiviral medications available than others, leaving some Americans unnecessarily vulnerable.

We also need to make sure we continue to replenish the Strategic National Stockpile, so if there are additional cases and waves of swine flu -- or even another new strain of flu develops, we will be able to treat people.

Vaccine development and production is also imperative. We need to give scientists the resources they need to develop a vaccine for this new swine flu, and once a vaccine is ready we need to be able to produce enough vaccine to cover all Americans. At the same time, scientists must continue development of bird flu and other flu vaccines.

The swine flu outbreak is a very real reminder of why we need a strong and stable public health system in the United States. This requires an ongoing and sustained investment in our federal, state, and local health departments. Unfortunately, in the past, we have not provided sufficient resources to this system. As we look to reform the health system in coming months, we also have the opportunity to build a reliable funding stream for public health as part of that system. Until we do, we are leaving Americans unnecessarily vulnerable to potential health threats, and our hospitals and health care providers at risk for emergency situations they do not have the capacity to handle.

Comments

[Daniel D 68]

PANDEMIC!?!
Influenza has alway been in the top 10 list of leading causes of death in the USA, and in recent years moved out of the top 5.

Acording to the National Vital Statistics Reports, Vol. 56, No. 5, November 20, 2007, : Influenza and pneumonia Caused 59,664 USA deaths in 2004 and 65,163 USA deaths in 2003,

I am just trying to point out thousands have been dying due to the FLU for years without this whole "Sky is falling" reporting that is happening now. I also wonder even with this outbreak, if the increase in deaths due to all Flu strains will jump up any real percentage point when looking at the statistics years from now.

I do not know why the media feels they need to "SELL" panic, but it does seem to distract us from some of the worlds real problems while we hide from eachother behind masks, and stay indoors to watch the Media telling us "to stay indoors and watch, FOR THE LATEST OUTBREAK UPDATES"

[MistahCharleyPhD]

I agree that our public health system, while it has benefited from the efforts of many dedicated professionals, needs further strengthening. In the meantime, I'd like to mention a few things that people may be able to do for themselves, besides using common sense about not spreading the flu.

Accumulate food and water at home in case supplies are interrupted.

Download and print out the Centers for Disease Control and Prevention's home care advice (just as the stores might be empty if this hits hard, the hospitals will definitely be full) - it's at the CDC site, or search for the terms "swine influenza" "taking care of a sick person in your home"

www.cdc.gov/swineflu/guidance_homecare.htm

While antivirals and antibiotics require prescriptions, CDC says over-the-counter cold and flu medications will give symptomatic relief (but don't give them to children under the age of two; don't give aspirin-containing drugs to teenagers or younger). You might check that you have some of these on hand, just in case. Aches and fever can be helped with acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, Nuprin®), and naproxen (Aleve).

And finally, here's a doctor's advice about dealing with being sick without help - based on going through it herself:

http://www.fluwikie.com/index.php?n=Consequences.HomeAlone

[spivey02]

One time I faked the flu to get a note for a test. They gave me a blood test at the doctor and charged me over a hundred dollars. The doctor told me I had a rare case of influenza A and B. I was told to quarantine myself in my room for a week and take a bunch of pills. I did end up feeling really sick. I'm not sure what the moral of this story is. BUT IT SEEMS RELEVANT!