Parts of southeastern Washington are considering drive-through flu shots if a pandemic strikes – although a practice run this fall showed they’d better hire traffic cops.
In Idaho, health officials have asked state lawmakers to spend $50,000 to buy 3,500 courses of antiviral vaccine from the federal government, to be stored in-state to treat people until supplies arrive from the Strategic National Stockpile of flu shots.
States and communities are getting creative as they struggle to answer the Bush administration’s call to prepare for the next influenza pandemic.
The Associated Press took a closer look at those preparations and found wide differences in how far along states are – and little consensus on the best policies on such basic issues as who decides whether to close schools.
“How are states doing, and how do we know how states are doing?” asked Dr. Pascale Wortley of the Centers for Disease Control and Prevention. “There’s a lot of important things that are very hard to measure. It’s a real challenge.”
Indeed, when the government’s first official assessment of state readiness begins in a few weeks, officials expect few states will have tackled some of the toughest issues: How will you keep grocery stores stocked? Will you reserve enough anti-flu drugs for utility workers so the water and electricity stay on? If you close schools, will local businesses let parents stay home with their children, or fire them?
When the feds fly in your state’s share of vaccine and medicine, can you store it properly and get it to patients without being mobbed?
“Nothing, we think, is better than having 5,000 communities right now wrestle with this,” said Dr. William Raub, emergency planning chief at the Department of Health and Human Services.
Short on hospital beds
Idaho public health officials are trying to prepare for the worst.
Last summer, the health districts held another drill, this time handing out M&M candies in lieu of “medication.” Officials said that while the drills went fairly smooth, they did highlight some problems.
In one district, workers ran out of pens needed to fill out medical forms because mock “patients” kept them. In another, there weren’t enough bathrooms for people as they waited in medication lines.
But the most common problem was a need for more medical professionals.
“We do have a nursing shortage,” Carole Moehrle with North Central District Health said. “Depending on what the crisis is, most nurses would have to stay at the hospital and work, so we would not have enough workers. That’s a real problem.”
The state is likely to run short of hospital beds. Idaho has only 3,371 beds available in its 49 licensed hospitals, state Department of Health and Welfare spokesman Tom Shanahan said. The CDC estimates that 3,385 people would require hospitalization and 162,507 would likely require outpatient care if an outbreak were to hit.
Each of Idaho’s seven health districts has completed plans on how to deal with a surge of patients, Shanahan said, and each district will run a drill before September 2007.
Meanwhile, the state’s seven health districts are stockpiling gloves, gowns, masks, respirators, eye protection, booties, bio-disposal bags, sharps containers and hand sanitizer, Shanahan said.
Food supplies might also be scarce. Because there are no major food storage and distribution warehouses in Idaho, the state’s grocery stores only have a three-day supply of food, according to officials of the Red Cross of Greater Idaho.
For now, hospital overflow, purchases of the anti-flu drug Tamiflu, plans for school closures, and how states are practicing for an outbreak are emerging as initial indicators of readiness.
A new study by the Trust for America’s Health suggests half the states would run out of hospital beds within two weeks of a moderately severe pandemic outbreak.
In interviews conducted by the AP in every state, health chiefs repeatedly said they know their hospitals will be overrun – but that having enough beds isn’t the most critical issue.
“We don’t have the health care workers to take care of all the patients,” explained Alabama State Health Officer Don Williamson.
Indeed, nursing shortages and other issues mean that today, hospitals around the country may have staff available for just 60 percent or so of their beds. In a pandemic, some of those workers are going to be sick or caring for ill relatives, not at work.
Will funding last?
In Washington, $2 million in state money and $5 million from the federal government has paid for a stockpile of protective equipment for health care workers, a new TV commercial and brochures to educate the public, a new Web site, and meetings and drills around the state.
“This is all one-year, one-time money, which is part of the problem,” said John Erickson, who runs the state’s emergency preparedness program through the Department of Health.
He and Secretary of Health Mary C. Selecky aren’t complaining about the infusion of cash for emergency preparedness, but they wish they could expect yearly help.
Sixty percent of the money has gone to local and county health departments and to Washington’s 29 American Indian tribes.
A worldwide outbreak of influenza could cause more than 5,000 deaths in Washington out of more than a million sick people, the health department estimates. The state has 300,000 licensed health care workers, and 96 hospitals with approximately 14,000 beds – not enough to handle a flu pandemic, state officials said.
“They’re at capacity now,” Erickson said, adding that other ailments won’t stop and women won’t stop going into labor if a worldwide flu arrives. “The challenge in a pandemic would be to redirect people away from hospitals.”
The sickest would still be sent to hospitals, but the next level down will be treated in schools and fairgrounds and at home, he said.
The federal government has allocated 900,000 Tamiflu treatments – 10 pills to be used over five days – for Washington pandemic flu patients, and the state has ordered another 200,000 courses, Selecky said. If the Legislature allocates more money, the health department would like to buy 400,000 more treatments.
Tamiflu, which is expected to help with symptoms but doesn’t cure or prevent the flu, will be given to the people who get sick first and the health care workers who take care of them.
Selecky said this plan, modeled on the federal guidelines, will allow the first people who get sick and then recover to take over in the business world and in care centers when the next wave of people gets sick.
In the Tri-Cities area, Benton and Franklin counties held drive-through flu shots. They underestimated the demand, and the traffic.
Here’s the rub: CDC’s Wortley doesn’t think super-fast vaccination is the best to practice. The first scarce doses of vaccine to arrive in each state will be reserved for high-risk groups, such as health care workers and those most at risk of death. The federal government currently is debating if other people needed to keep key industries going, such as grocery truck drivers and power-company workers, should be added to that list. But it won’t be first-come, first-served.
“You’re potentially talking about a vaccination campaign that draws out over more than a year,” Wortley warned. “Really the issue isn’t how many people can you vaccinate in a day. The issue is how do you pull off this type of campaign where people are going to be wanting vaccine and there’s not enough?”
As for drive-thru flu shots, she jokes that it’s “the American way” but doubts it will work because of traffic jams.
An urgency in planning
Super-strains of the easy-to-mutate influenza virus cause worldwide outbreaks every few decades or so, three in the last century. Worst was the 1918 pandemic that killed about 50 million people worldwide, 500,000 in the U.S. alone. If a 1918-style pandemic struck today, up to a third of the population could fall ill, and 1.9 million Americans could die.
With another pandemic overdue, the CDC began telling states to prepare years ago. The plans have taken on greater urgency with the simmering H5N1 bird flu. In 2004, 29 states had pandemic plans of some sort. Today, all have at least a draft on paper.
Next spring, federal health officials will have their first report card on the quality of those preparations, based on a questionnaire that Raub hopes to ship to the states by month’s end. The questions will go beyond health care to ask how communities would keep the economy and society in general running.
The responses are key to helping less-prepared states catch up and identifying best practices that others can copy, Raub said.
It’s an assessment that public health advocates, worried at varying state investments, call long due.
“Where you live shouldn’t determine your level of preparedness,” said Jeff Levi, director of the Trust for America’s Health.