US readiness for a health emergency

I look at flu preparedness like I look at how the U.S. public responded in WWII. Everything in American life was changed so that people could be prepared--as a single unit--for the war effort. Everyone from the elderly to little kids saved aluminum from gum wrappers, scrap metal, etc. There were all kinds of drives for ripped silk stockings, tires, metal, etc. People planted victory gardens to make more farm-raised food available to the troops, and even the amount of fabric in women's dresses was lessened, with the intent of sending more for soldiers.
There is a huge difference between that and any nation's current preparedness for a possible pandemic. Most people have Teflon attitudes about this--nothing sticks, because nobody at the federal level has looked out at them from their TV sets to say, "You know, there is very likely a pandemic coming, and we're going to put information into your mailbox about preparing. And I'll be back in two weeks to tell you more about a specific aspect of this." Until that happens, nobody is prepared on even a village level. And other nations would follow the U.S. in this. AnnieRN

This is just a bunch of political posturing in an election year. "The CDC grades inself an A". What is that? We the medical community grade them an "F". They have spent Billions of dollars and 5 years and the best they can do is squawk about needing Epidemiologists! What about Doctors and Nurses who will actually be treating patient? Or nation will have a shortage of 30% below our normal level. We will not be able to keep our hospitals open with our current number of patients (this includes Federal hospitals, Army, VA, prison, Indian Reservations). What are we going to do with Epidemiologists? Count the dead? Their initial plan was to buy $3 Billion dollars of Tamiflu. That got scraped for lack of manpower to distribute. Then they worked at buying portable hospitals. That didn't work either. No man-power. So now we are instructed to find a cave and hide in it for the duration of the Pandemic. You call that a preparedness plan?
Has someone asked anyone from from the CDC or Public Health if any of them will be treating Avian Influenza patients? I think you will find that they will be as hands on as Mayor Ray Nagell and FEMA's director Michael Brown. Sitting in an air conditioned hotel discussing while the rest of us put our lives on the line. We are promised no assistance from the Federal Government (as per Michael Levitt of HHS).

In every disaster response there is a designated command and control. Homeland security has decided to take that role. However who will they be talking to? None of the Medical Professions (Doctors, Nurses, Medical Technicians) are part of their response plan. Same as in Katrina we are on our own.

gwmd,
I agree with your observations on CDC vs. the medical community for the most part. But I'd just like to add that it is a 2-way street. In my experience there is a huge lack of participation on the part of the medical community in public health planning. The ones who show up to the meetings I go to are nurses, public safety, emergency responders, etc... Medical doctors are invited, offered high ranks on directing boards and slobbered over when they do come, but most of the time you can't get a doctor to grace a public health planning meeting at all.

Meanwhile, the whole medical system seems to be changing in order to accomodate physician pay creating a confusing web of outpatient treatment organizations and healthcare satellites that makes planning for medical contingencies seem impossible.

regards,
-one of those lowBs that counts dead people

I agree with AnnieRN. I think that if the PTB actually made a bold, concerted effort to educate the populace to the potential impact of a moderate to severe pandemic, to strongly encourage and enable grass roots preparation (anyone tried to purchase 90 days of presription meds lately?) and volunteerism, we could actually hope to save lives during such an event.

As it is, people will be woefully unprepared and surprised by the harsh, unforeseen realities of a dysfunctional just-in-time-based society if a moderate to severe pandemic occurs.

It takes bold leadership willing to step up and risk ridicule if the pandemic is slow to occur or if it turns out to be a mild event. I haven't seen a leader like that for a long time.

In this case it takes four to tango. The federal government, the medical establishment, the local government and, the public. But the lead dancer must be the federal government. Without a strong and integrated message we are all trying to dance with two left feet and the wrong music. Instead of fado we are hearing the blues. As we count down to pandemic I fervently pray we get better a better band.

Everyone to comment so far have interesting and valuable points to be considered. I would dispute Shannon on the Feds role as being first. We, the people, must begin to take back what should have been our responsibility in the first place. That would be taking care of ourselves.
The Feds need to be down sized big time and State leadership needs to be upgraded big time.

AnnieRN, you shared great wisdom.

Shannon-WADR, thats what the NPFP states. It might take four to tango but not if dont go to the dance. They are NOT going to get involved in that. Its a states issue and as evidenced by Katrina and trailers, and sewage and all the other problems in that state we cant afford. Its tough and this is a nice big crap sandwich and we all get to take a bite. We would not be able to physically or financially to take over the problems by federalization of 50 states. Nor would it be legal to do so. The regulations are clearly stated now.

They can federalize any infrastructure problem not contained in the NPFP such as power production, transportation, etc but they are going to draw back a bloody stump if they havent prepared in their individual states medically or in relation to supplies. Thats really good as far as I am concerned because it puts responsibility back onto the people and off of the Feds for a change. Personal responsibility. All the Feds would do is throw money at it. E.g. you know how much ice was sent down the drains and at how much cost for Katrina? For what we spent on Katrina we could have simply bulldozed the houses down, brought ill in and brought it up to river grade plus six feet. Its almost laughable except for the human suffering. We are rebuilding for the next disaster... Still 16 feet below sea level. If you have your house below sea level and you build your levees out of sand, guess what happens.

The same thing is going to happen in every state in varying degrees. The levees and grade figuratively speaking are too low for pandemic flu or pandemic anything. The costs are simply too high to prepare beyond a certain level. You have seen me post about food, water, electricity, gas, fuel. Storage would be in the billions of dollars a year and just tossed away.

Without a total control of that particular set of issues by both the feds and states there are going to be a lot more than 5%, there will be more than 30%. A goodly portion of people will be going down the primrose path because we have gotten into this federal government does everything for everyone. You want to ensure defeat in this...put the federal government in charge of everything. I can guarantee that more people would die than if they simply did it themselves.

The Federal governments answer? Militarize it and then you have the martial law scenario that has been spoken of so often here and in other places. You'll do what you are told or you will be imprisoned or shot or maybe both. Revere posits that beefing up the healthcare infrastructure would help. Okay, which area? Takes about 10 years to train a doctor and if the sonuvabitch is smart, he wont even show up past the first week. Pezzulli's tabletop exercise along with others showed that. By polling those same docs said that if the supplies and equipment werent there neither would they. We have a little over a months worth of supplies for the US even after we have beefed it up to the point it is now...and thats the 5% number.

Why not more? Problem with this is that if you are sitting on inventory in the US on Jan 1, you pay taxes on it. That means FIFO and JIT and a long supply chain. In a pandemic its a war. Supply lines will be cut. Money might become worthless. How do you buy it? As for the inventory laws, change them in relation to the expected needs and we might see more warehousing, but even then it has an expiry date on it. How much and how long? Too many questions, not enough answers.

The UK just moved their status from 3.0 to 3.1 along with the Swedes, Netherlands, and I hear the Germans are going to. They did this without the WHO telling them too so they are going to get their asses cracking. Kind of pissed the WHO DG off from what I understand. Well Aunt Margaret better start figuring it out on her own too. Each state here is like one of them. They are big boys and they still think that Unkle Sugar is going to be there with masks, vax, food, water, medicines. Even the WHO thinks we are going to be there. I think they are all in for a BIG SURPRISE!

As for being there we could have done it in Katrina but that hesitation on the part of Blanco is what did a lot of those people in and not so much from primary cause hurricane, but from the old killers such as exposure, lack of water, meds. But this is where it turns into a circle jerk and in my experience if the circle ends around you on the first pass, you get shot.

Doctors only look at this from their angle. The Feds from another, the States and others from yet other angles. All are locked into a spiral when it comes. If its 5% then we can weather it all the way up to 8% if its a slowly creeping deal. If its a 10% initial, then 15, and then another 10-20 then we are screwed and screwed big. Electricity alone would require mass relocations. Why? Because we wont be able to maintain it for one thing and then there is that "died with the light switch on" meaning TV's, radios, dishwashers, furnaces etc are all on. We did a mini-run on that here.... It took one guy an afternoon just to go in and safety three houses from fire, gas, electric. Yeah, fire. You leave it on, something will happen and then it breaks out. A tree hits a wire. An old furnace kicks on. Cat lifts its leg on a electric socket. Zero lot line homes ensure that a firestorm will ensue in the big cities and then you get into the same spiral... Who is on first, what is on second, he is on third.

Taking it all into account we will have limited government in a whole new degree. Maybe not since the 1700's level. Laws will be dropped like rocks and to the detriment and betterment in some cases. All of the government supportees who survived would have to get jobs. At 8% we default on all debts the US government is owed and owes. Everyone restarts and thats going to be tough. we have to have state and personal responsibility because if not, Revere would have to submit in entirety to GWB if the federal government was put in charge in the next 10 months... He would have a stroke from the shock. Then what?

Take personal responsibility for yourself and then encourage others to do the same. Have a bailout position to go to in case your situation requires it. If you have to go mobile in the middle of winter, where are you going to go? Think of all the what ifs, write them down and then expand them by one or two levels in. If you get all that mitigated and it still whacks you, then your number was just up.

I agree about the need for Feds to take the lead. A central consistent, scientifically-based approach informed by social/behavioral specialists is needed for states and communities to refer to as an informed resource. States/communities vary greatly in public health infrastructure and capacity. Have you read the wide variations among local health department panflu factsheets and press releases?

There are essential federal activities that can enable and enhance the grass roots activities that IMO must occur:
- policies and procedures that allow local preparedness such as: mandating insurance reimbursement for multiple months of medications, coordination of regional bulk purchasing of stockpile items such as PPE and USDA surplus foods
- practice acts and legal protections that allow health care providers to offer consultation, remote supervision and support during a panflu event without actually seeing every patient themselves
- reparation and a family compensation structure for providers/responders who provide heroic community service and may give their lives during a pandemic
- guidance on scientifically sound approaches for prevention such as thresholds for school closure, NPI protocols
- etc.

AND most of all, a clear and consistent message directed to the public that the time to personally prepare is NOW.

The feds must take the lead or we lack coordination. Fifty states moving independently is a recipe for disaster. There are also some things only the feds can afford. I'm not talking about ice here but communication equipment, etc,.... When the pandemic actually arrives communications are key to lessening the morbidity. We will also be reduced to local governments running the show. If they don't know how, we are again facing disaster. States are doing what they can with the resources they have but, we are working in a vacuum. We need to do more actual disaster exercises NOT tabletop exercises. The feds also need to mandate just how the public needs to prepare. The whole point is to get the public to prepare for keeping kids out of school, treating there own sick, in a position to stand on their own for several weeks if necessary. But, the message needs to be repeated over and over by everyone from the top down both at the federal level and in your local church groups.

Should be their sick not there sick. Sheesh I need to proofread a little better.

The Federal Governement should show leadership or get out of the way! If the local physicians won't follow, won't get involved with the current planning is that a lack of leadership or a lack of follow-ship? The Federal Government has given itself blanket immunity from tort during a pandemic as well as any state employees but won't extent it to local health providers. The Federal government is granted immunity to COBRA, EMTALA, HIPPI and other regulations the local hospitals are not. The state government is allowed a waiver of all licensing regulations the local hospitals are not. The state government officials will all be paid their salary plus time and 1/2 half overtime. The local medical providers are being asked to work for free. The Federal and State employees planning this disaster are all covered by state medical insurance programs, disability programs, workers comp programs etc. many (most?) health care workers are not. FEMA, CDC, HHS and state health employees will have protective equiptment on before they arrive on site. Local health care workers will have protective equiptment only if the state and Feds bring it. Local health care workers are trying to establish OSHA standards to protect their workers. The Federal Government opposses it. Public health has access to the SNS of Tamiflu. They and the Feds will decide who gets it and when. The local MDs have simply got to stand there and take for as long as they can. If I get sick will someone from the government take care of my family? No?
The only thing the local MDs have been promised is "don't expect any help". Is it any wonder why there is a huge disconnect between the "planners" and the "doers". Most of my nurses will not come to work for fear of violence. The others are worried that when the ER closes they will not get paid. Seems like maybe someone should have aken some time to shore up the infrastructure before they spent $3 Billion dollars on Tamiflu.

Gregory, Shannon and Concerned-You really need to read the NPFP. It clearly states who is going to be responsible for what and the "50 states, moving independently" thing is exactly what they are going to do because infections will vary, and general operations will be conducted by the states differently.

They were all required to develop a plan to receive their federal money for panflu.Now here's a shocker. Most of the supplies they bought with the money? Its been used. Bag recusitators, gloves, the N-95's and M-95 masks all used. The government gave them the money to get ready and they bought all sorts of crap not relating to it.

Now why did they do it this way? Because some groups had to get to square one first rather than a New York where it would be just additional stuff. I again reiterate and this is the official position of the Federal Government and that of the US Congress...The states are on their own except for money being sent to them. They can send all the federalization requests for supplies and assistance they want. They might get some supplies but as far as anything beyond infrastructure and police services, hold your breath and let it out when the BF passes. I am a national incident manager level 800 and I have to tell you that the the statements while heard, will be ignored. The parameters of this were agreed upon by more than a 2/3rds majority of the house and senate. They'll do what they can when they can but general infrastructure will be the feds will be involved in.

Gregory... Tamiflu was about the only thing that was and still is working... some. My state didnt buy but just a little as they were getting pumped daily with an infusion of reality that Tamiflu and most anything else doesnt work. Keeping your guns at home is one thing, but when you bring them out... You use them. What purpose would it serve for you or your nurses to show up for work if there were no supplies or meds. I think everyone is going to learn how to push morphine if this comes.

In a pandemic flu, the biggest shortages will be hospitals (beds, rooms), and health care workers. The most important of those workers will actually be those who take care of the daily needs of the patients too sick to care for themselves.

And schools will be closed. Millions of teachers and assistants will have nothing to do but stay at home, and presumably will still be paid.

The current system will simply not be able to handle conventional treatments for all if a boatload of seriously ill people with pneumonia start showing up (blood tests, x-rays, respirators, etc), at a minimum the system should be expected to keep them clean, warm, fed (IV), and give them prophylactic antibiotics to prevent secondary infections, and keep the infectious patients separated from non-infectious patients.

These essentials are things doctors will not be needed, for the most part, and they can focus on people ill for other reasons which happen in every day life, accidents, heart disease, child birth, in a hospital environment, etc.

The objectives have to be scaled down to what is possible and provides maximum benefit, otherwise, the system would break down and everyone will suffer.

But even these minimum levels of scaled down expectations seem to be a challenge for the current system. So schools and educators (and most have health insurance), as well as volunteers, are the most likely solutions to fill these gaps to provide the minimal care. Training and legislation should be provided/enacted to make sure these resources can be utilized. I see no evidence the problem is being addressed at this basic level, but have no time to research it, so I may be wrong.

Keep you fingers crossed. There is no guarantee that the health system will manage in a pandemic, nor are there any guarantees that other infrastructures will cope.

I believe Randy is correct, it still comes down to individuals and their immediate communities. Preparation being the key.

Without a viable vaccine and even if we had every piece of equipment and the staff to use them in this, the outcomes would be minimal. If I were in charge, I would level 6 the doctors and nurses when the panflu supplies ran out. This would be a hard decision but a necessary one. Post flu we would need doctors for the remaining people. I wouldnt lose one doctor or nurse to panflu if I could help it and at some point in time I would order them out and send in the military or militia to provide the basic hospice care to people. Nothing that can be done for them at least for now and a PFC can hand out Tamiflu tablets or Flu Mist and inject morphine if necessary.

Lets hope that the doctors dont have to make that decision or that it be made for them. Its not what people like them and Revere are about. They wouldnt want to, but without their gizmos and equipment, meds what could they do except possibly get sick? Understand that at Pan Level 4 high side the state of emergency would be declared and we are inching towards that now.

Dont worry though...Supari has our backs and she has sent a total of 16 samples to Atlanta with the provision that if vax is made from it that they get, well I am not sure what they get. For my way of thinking, we have already paid them for it to the tune of pushing on a billion dollars.

Do I get a refund for 16 samples? A little change coming back?

Randolph I can assure you I have read the NPFP. I have read all 50 different plans and have made presentations to the Public Health officiial telling them that their plans are unworkable. That the plan adopted by most states to distribute Tamiflu in ERs was unworkable because the ERs run a 4 hour wait in non-flu periods, a 6+ hour wait during seasonal flu and a infinite wait for walking wounded during a pandemic. We the medical staff will be treating the dead and dying so will never be able to see the walking wounded. We asked for a waiver to allow non-MDs, non-Pharmacists to help distribute the Tamiflu but could not get a waiver of current regulations. I argued with Public Health and the told me I did not know what I was talking about. Now they have realized their error and have abandoned there plan. My state chose instead to set up a series of distribution points throughout the states staffed by public health to distribute the Tamiflu. No trucks, no buildings, no computers, no phones but they bragged that a handful of public health officials aided by an "army of volunteers" could do a better job of distributing the Tamiflu that the 14,000 pharmacist in the state in all of the Walgreens, Eckerts, Walmarts and Eckerts combined could not. I asked them why the pharmacist at Walmart couldn't use "an army of volunteers". Their reply was Public Health law only extends those rights to volunteers for public health. (Historical Note)- our state has also abandoned any effort to distribute the Tamiflu what-so-ever. No they still won't allow the local MDs to use non-licensed volunteers and no they will not release the Tamilu to the local pharmacies for distribution. So we have $3 Billion in Tamiflu in storage and there will be none for my staff or patients. Oh yeah, the shelf life is about 5 years so we had better have the pandemic soon because its only got another 2 1/2 years before it expires. So I now have all 50 of the early NPFP plans where they argues I was wrong and the new 50 plans where they gave up on the concept of Tamiflu distribution because they cant figure out how to distribute it. They are making it sound worthless because it is only 92% effective in a disease with a 58% mortlaity. Are you kidding me? I will take 92% every day of the week. Meanwhile I have lectured and published articles for the past few years showing how we can distribute the Tamiflu using computer driven screening over the Internet. We have a program that can FAX a prescription to the pharmacy of the patient's choice. This program, without the benefit of a physical exam or lab testing has 20 year track record of 92% acuracy. It will not require any health care workers. The patients can maintain isolation home in bed. Here is the kicker though it would require the State or Fed to allow Pandemic Flu to be added to the list of only 4 other diseases which we can legally treat by internet medicine. Both the state and the Feds have opposed this plan. Oh yeah, did I meantion the cost? It is projected to actually save the Federal government by recouping $1.5 Billion dollars. Ms Gerberging and Mr. Levitt are not interested.
As far a legal authority I have studied that too in depth as have our hospital authorities. The Public Health Codes and the Emergency Powers act do not extend any power or authority to the local health care providers. On the contrary. We are told that all are facilities, manpower, food, fuel, medicines and supplies can be legally confiscated if the state or Feds deem necessary. So we are forced to hoard supplies in secret. We are afraid of the Flu but just as much we are afraid of government troups that could take or property at gun-point or conscript us and put us in harms way. That is not a plan that I would be proud of and I certainly wouldn't rate it as an "A".

The samples were sent MRK because some head honcho over Supari was notified by some head honcho in the U.S. or another country over the comments in her book.
It's money, all money. Supari was told funds were going to be withheld if this type of behavior continued.
Prediction: News releases in the next few weeks will reveal money has been sent to them.

Gregory MD. Would you kindly put paragraph breaks in your postings? It's difficult to read.

No matter what anyone says the efforts to date have rated an A but it would take IMO about ten to fifteen years of those to get us to a moderate stance for panflu and that is at a less than 8% number. Putting the Federal government in charge of this would be a complete disaster. As you say a 58% would take this country apart like a two dollar watch. I have 1/2 dozen plans on file and they are all intricate to the nth degree. I REALLY liked California's which by far would have been the US plan if they had gotten into it. It also would/will ensure a disaster does happen. Its a PDF and its basically worthless because there is nothing to back it up. It assumes that supplies and money and medical will be there. It wont. Its okay, Tennessee's is the same 600 page document that makes me want to puke.

Once the bug whatever it is goes active, it would and will pick off the people in charge like a sniper. The plans are all too long and above all dont have any meat to go with the potato's. OTOH if anyone really looks at the numbers like I do and am constantly banging away at the people who would take the entire military budget and call it the cost of Iraq everyone should take note.

Here are some non Henry Waxman numbers. Katrina is pushing on now some 200 billion dollars. 40 billion is for the Corps of Engineers to rebuild most of the levee system, 20 billion for the housing give or take coupled with "assistance" payments to the people who were already getting "assistance" payments. The rest is red tape slop for trailers and continuing putting NO back together. So lets take NO only for costs and multiply it for 50 states.

Each city would have unique problems... fire being one of them. So lets say that a city burns down mostly in each state (just one per state please) which is the same as a Katrina and all of the trailers come out, all of the infrastructure is paid for by government for housing, and all of the Katrina type of noise is based on one big city in each states and its roughly 200 billion per city (not hard to believe). Some would be better and some worse and we multiply one city times 50 states- $10,000,000,000,000 give or take a hundred billion or two. Katrina taking the young and productive ensures we have no tax money coming in and no one to pay for the bills of the country and retiring debt and the seniors are going to be picking up cans on the side of the road for eating money.

Cant inflate an economy on dead people. Our GNP an GDP would be gone. Cant buy oil with dollars that might be worth 10 cents. Think about it. This one could finish us and you cant come up with enough tax money to come close to paying for this or whatever comes down the road. We would lie prostrate in front of it. Very simple math and very simple effects. Dead people.

The entire process behind Katrina caused government to rethink the FEMA and EMA roles in government. Does the federal government want the responsibility of 50 Katrina like problems with the multiples of the cities in those states? If that be the case then it would require that the the US government take total control. This means control of every fire department, police/sheriff, EMA, Hospitals, Doctors, nurses, states militias and blanket order by state of emergency the compliance of every man, woman and child in the country. It would be the complete take over of the states. Think it through. The bureaucracy associated with this would be the equivalent to the US military budget and more.

Doctors/nurses who dont show up to work could be arrested, confined, and later imprisoned. Same with the fire department or cops... Blue flu? You go to jail. It also puts the military in charge overall because they are the only ones with a command structure to do this. I shit you not.

Might end up with that anyway. We would be out of Iraq and back without a doubt, or we would take the place and ensure the wholesale theft of the oil. Lots to consider. Its tangential to the above of course. But really what could government do except to spend money and I mean all the money out there on pandemic preps. Their ability to control the people is thru the taxation system if there is no one to tax, no products to be had the entire system collapses either by consumption taxes, income taxes. What do they do if people just up and refuse to pay because they dont have it? Louisiana is leading the nation right now in that and we have pumped more money into there than any state in history. Thats by the number of unit dollars and not the inflationary ones. What did we get? A dead city that will see a hurricane again.

There is nothing unique in any of the pandemic plans. Some would assert that the militarization thing would impugn the rights of the people. No shit. But thats the ACLU and trying to apply the law to a situation that is gone the second it starts. The law will be what the state and federal governments say on each particular day because its a state of emergency or martial law. Cant file a lawsuit if there are no courts, cant scream my rights were violated if the government has suspended those rights by the rights established in each state constitution and the US constitution. Real fur ball shaping up. The states have been warned and I dont blame the Federal government one bit on this one. Its either do it for yourself or pay the price in the long run. It takes it down to the lowest common denominators. The people, the state government, the federal government. the latter two will control you during this time. Make sure your stuff is well hidden.

The Feds can't take the lead. That is why they are not taking it. H5N1 vaccine science is looking more promising. This makes me a little more hopeful.
Grattan Woodson, MD

Dr. Woodson, MD; Good to hear you are a little more hopeful however this fact remains: distribution and who gets it first and who will be forgotten in the panic.
Also it's my belief that citizens of any nation simply cannot handle the idea that a pandemic is looming before us, therefore the Feds know this and do nothing.