What's Your Pandemic Plan?

The World Health Organization (WHO) estimates that even in the best case, an avian flu pandemic would lead to somewhere between two million and 7.4 million deaths worldwide. No one is certain what the worst case would look like, but according to the WHO, the number of deaths would be "dramatically higher" than 7.4 million.

The H5N1 avian influenza virus hasn't yet mutated into a deadly form that can easily pass from person to person. The general consensus in the scientific community, however, is that it will. Government, healthcare providers, and businesses have, therefore, begun setting up contingency plans to deal with a pandemic.

Government Strategies

The US federal government's pandemic plan is outlined in its National Strategy for Pandemic Influenza. It provides for a coordinated response between federal, state, and local governments, and is based on three pillars: Preparedness and Communication, Surveillance and Detection, and Response and Containment. Measures that might be taken by the government include: limiting the movement of people, goods, and services in and out of an affected area; encouraging "social-distancing"; limiting public gatherings; and creating quarantine zones, which could be enforced by the military. During a pandemic, a website set up by the US Department of Health and Human Services will act as the authoritative site for government information.

The US government has also passed the Bio-defense and Pandemic Vaccine Drug Development Act of 2005, which limits the liability of pharmaceutical companies in case of adverse reactions to antiviral drugs.

Similarly, the Canadian Pandemic Influenza Plan outlines how different levels of government, emergency workers, public health officials, and healthcare workers would cooperate, and it lays out the steps the government would take from the moment the virus is detected in a person. These steps include:

…increasing surveillance of the virus; developing and purchasing vaccines; determining priority groups for treatment based on epidemiologic data and local circumstances; making sure that the vaccine is secure during storage, transportation, and at clinics; monitoring adverse drug reactions to antiviral drugs; coordinating patient transport and tracking; making sure that people to do not overcrowd facilities that they presume provide better care than others; making use of volunteers from non-governmental organizations such as the Red Cross and St. John's Ambulance; tracking those who show immunity to the disease; providing food and medical services to people confined to their homes; creating overflow facilities for victims who cannot be accommodated in hospitals; instituting travel advisories within Canada; enforcing mandatory isolation; banning public gatherings; closing schools; and launching multimedia campaigns to inform target groups in the public.

Canada's plan, which many consider to be the most comprehensive national plan to date, also includes detailed descriptions of topics such as planning considerations for its Native communities, laboratory procedures, vaccine use in a limited supply situation, the management of mass fatalities, etc.

Healthcare Facilities

Although the US and Canadian plans provide funding for disease surveillance and public health preparedness, it's clear that healthcare providers and hospitals will face major challenges during a pandemic.

The biggest challenge will be finding the resources to cope with the possible thousands of flu victims. Toronto, which was hit by the SARS epidemic in 2003, has established the Toronto Pandemic Influenza Plan. Initial estimates cited in Toronto's local press stated that hospitals could expect up to 14,000 cases in the first wave of the pandemic.

So in North America, hospitals, most of which are already stretched to their limits, will have to find the extra staff, beds, equipment, and money to deal with this sudden surge of patients. Infection control measures will have to be expanded and isolation rooms will have to be set up. Ventilators will have to be found, as will staff to operate them. Hospitals will have to communicate with one another, so that they know each other's levels of capacity and bed space. And they'll have to do this as their employees fall sick or choose not to come to work.

Hospitals will have to decide who receives drug treatment or even a bed, and who doesn't. Those who do not receive treatment might try to steal drugs, and members of their families might do the same, so hospital drug supplies will have to be protected.

Both the US and Canadian pandemic plans mention the creation of overflow facilities for victims and for stockpiling antiviral drugs.

Hospitals will also have to cope with the economic impact of under-utilization. Under normal circumstances, hospitals provide a range of services to patients, and they depend on these services for revenue. But many services (e.g., elective surgeries) will have to be cancelled during a pandemic, and this will be compounded by the fact that no one will want to go near a hospital, because they'll be afraid of catching the flu. A recent study of under-utilization during a pandemic suggests that in countries with large private healthcare systems, such as the United States, governments should consider reimbursing hospitals for losses that are directly related to the pandemic.

Because no one can predict the actual extent of a pandemic, experts suggest that the best preparatory measure for hospitals is to ensure that there are clear lines of communication between governments, healthcare facilities, and staff. Hospitals should also begin a dialogue with staff on expectations and mutually agreed upon responsibilities.

Businesses

According to estimates by the World Bank, an avian influenza pandemic would result in the loss of $800 billion to the global gross domestic product over the course of a year. Companies across all sectors of the economy would be affected. Employees would fall ill or choose not to go to work. Because most people would stay home and avoid stores, shopping malls, movie theaters, and restaurants, and would avoid travel, the demand for consumer products and services would fall. Those who went shopping would find empty store shelves, as supply chains fall apart. Critical services, such as the delivery of electricity and water, would also be affected.

The poultry industry has already been forced to respond to the current avian flu outbreak in Asia. KFC, one of the largest fast food chains in the world, has put together a consumer education plan. And in the United States, the National Chicken Council has set up a public relations website (Avian Influenza: Protecting Flocks, Protecting People) to ensure consumers that it is safe to eat poultry. Some European countries are forcing poultry farmers to keep their flocks indoors to avoid infection from wild birds.

The most common recommendations to businesses focus on the idea of allowing for social distancing between employees. If possible, during a pandemic, companies should find a way to allow employees to do their work from home or at least create shifts that limit the number of employees in the workplace at any given time. The US Center for Technology and National Security Policy recommends that only one-third of a company's employees be at work at any given time.

Businesses would also have to consider a number of legal questions. For example, how much liability does an employer have if an employee becomes sick on the job? Do employees have the right not to come to work for fear of becoming infected by coworkers or by commuters on public transit? Will companies have to comply with government imposed pandemic "snow days"?

What about you?

Is there anything that individuals should do?

Inform yourself about the avian flu. Familiarize yourself with your national and local governments' pandemic plans. Read the newspapers and/or watch news and documentary reports about the avian flu. Make use of the many resources available on the internet.

Some people have purchased the antiviral drug, Tamiflu (oseltamivir). To date, it is the only antiviral that seems to have worked against the avian flu. However, in the case of at least one Vietnamese girl, it didn't work, and it is feared that incorrect use could result in drug resistant strains of the virus. As was the case during the SARS epidemic, some people have also begun to stockpile facemasks.

The US Center for Technology and National Security Policy has set out its own guidelines for individual preparedness for a flu pandemic. It suggests storing three days worth of non-perishable food and three gallons (11 litres) of water (per day), per person.

Also recognize that the best way to prepare yourself for a possible pandemic is to take all of the precautions that you (should) normally take during the regular flu season. Wash your hands regularly, cover your mouth when you sneeze or cough, and stay at home when you are sick. Government and healthcare officials also recommend getting a flu shot to boost your overall immunity.

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