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CorrectCare
Pandemic Flu:
Planning for the ‘What If’
By Richard
Garden, MD, CCHP
In medicine
we must plan for the worst. We exhaustively question, examine
and test our patients, being certain to rule out the most
sinister of causes for their complaints. Furthermore, we never
begin a procedure without having the necessary “what if”
equipment at the bedside just in case things go bad. In short,
we are prepared.
Preparation
is incredibly soothing. It not only increases the likelihood of
a good outcome, but it also provides a dash of serenity in a
world in which nearly anything can happen. Katrina and 9/11 come
to mind.
A different
type of cataclysmic event may loom on the horizon in the form of
pandemic flu. A pandemic is a global outbreak of infectious
disease. Flu pandemic occurs when a new influenza virus emerges
for which people have little or no immunity and for which there
is no vaccine. The disease causes serious illness, spreads
easily person-to-person and can sweep across the country and
around the world in very short order.
It is
difficult to predict when the next influenza pandemic will occur
or how severe it will be. But wherever it starts, everyone
around the world will be at risk. Countries might, through
measures such as border closures and travel restrictions, delay
arrival of the virus, but they cannot stop it.
Cause for
Concern
Health professionals are concerned that the continued spread
of a highly pathogenic avian H5N1 virus across eastern Asia and
other countries represents a significant threat to human health.
The H5N1 virus has raised concerns about a potential human
pandemic because:
• It is
especially virulent.
• It is being spread by migratory birds.
• It can be transmitted from birds to mammals and in some
limited circumstances to humans.
• Like other influenza viruses, it continues to evolve.
Since 2003, a
growing number of human H5N1 cases have been reported in
Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand,
Turkey and Vietnam. More than half of the people infected with
the H5N1 virus have died. Exposure to infected poultry is
believed to have caused the infections. There has been no
sustained human-to-human transmission of the disease thus far.
However, if
H5N1 evolves into a virus capable of human-to-human
transmission, then our nation and the world may face widespread
illness and death. Should a pandemic occur, our correctional
facility staff and inmates are at high risk due to the close
quarters and groupings of large numbers of people. Furthermore,
risk of transmission is heightened as inmates are frequently
moved from one facility to another.
Considerations for Corrections
A
pandemic not only jeopardizes the health and lives of our staff
and inmates, it also may jeopardize our ability to maintain
public safety. Effective planning by correctional institutions
needs to address both of these issues. Additionally, the
pandemic will be dealt with by national, state and local public
health agencies, so any plan must fit optimally into the public
health response, local emergency medical systems and tertiary
health care providers.
Key
considerations when developing a plan include the following:
• Staff may
not report to work. Concerns over family, personal well-being or
illness may prevent up to 50% of the workforce from reporting to
duty. Proper personal protective equipment, available antivirals
and vaccine (which may not be available for three to eight
months following outbreak) will be key to ensure the development
of a workplace that is perceived as safe. If staff members feel
safe, then a greater number are more likely to report to work.
• Local
public health agencies and hospitals may not have considered
your facility in their planning. You must meet with them to
ensure they are aware of and prepared for the medical and public
safety issues that may arise.
• Contact
the homeland security representative in your agency. This person
may want to include pandemic planning in the overall disaster
preparation.
• Local
medical services may not have the surge capacity to accommodate
inmates when overwhelmed with community patients. Consider
establishing an on-site isolation ward for those infected. An
on-site morgue also may be necessary. Discuss this with the
local EMS planners and the medical examiner’s office.
• Health
care staff serve as resident experts and should anticipate
providing correctional administration with updates and technical
information to facilitate public safety. They also may serve as
a communication conduit between community services and
corrections.
• If
outbreaks occur simultaneously across the country, your state
department of corrections may not be able to obtain assistance
from other states.
• We may
have as much as a three-month warning of impending pandemic—or
no warning at all.
•
Depending on where the pandemic strikes first, vaccine may not
be available for up to eight months after onset. Also,
correctional facilities may not be given top priority if vaccine
suppies are limited.
• Once
formulated, the vaccine may not be available for widespread use
for another five months.
• The
initial wave of infections will be followed by a second wave
three to nine months afterward. Each wave is estimated to last
about 30 days.
• Movement
of clinically ill inmates should be minimized; they should not
be transferred to a facility where illness has not struck.
• It is
unlikely that limited resources will be allocated to corrections
while mainstream needs go unmet. So plan ahead!
Throughout
human history pandemics have struck with varying degrees of
catastrophe. Little question exists that another will occur; it
simply is a question of when. Knowing that such an event is
unavoidable and that our profession cares for a particularly
vulnerable population demands that health professionals be
prepared for the event. Proper planning will improve our
management, provide the satisfaction and peace of mind of being
ready for the task, and go a long way toward preventing the
unthinkable.
—
About the author:
Richard
Garden, MD, CCHP, is the clinical director for the Utah
Department of Corrections, Draper.
[This article first appeared in the
Fall 2006 issue of CorrectCare.]
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