Swine flu outbreak shows U.S. public health system not ready for a major influenza pandemic — report
Efforts in King County and elsewhere to prepare for a pandemic flu “paid off” during the current outbreak of the new H1N1 swine flu, says Dr. David Fleming, director of Public Health – Seattle & King County, but the outbreak also showed that local and national public health systems do not have the staff or infrastructure to handle a larger outbreak caused by a more virulent virus.
Lack of long-term investment in public health and recent budget cuts due to the recession are to blame for the system’s shortcomings, Dr. Fleming said.
“The bottom line is that health departments in order to respond to an epidemic need to have core capabilities in place—surveillance capabilities, analytic capabilities, capabilities to communicate effectively—and you cannot invent those or create those after the emergence of a pandemic strain,” Dr. Fleming said.
Dr. Fleming made his comments during a Thursday telephone conference call announcing a new report on the U.S. response to the H1N1 outbreak.
The lack of adequate laboratories to test for the virus meant public health officials had to make decisions on-the-fly without crucial information, Dr. Fleming said.
In Seattle, for example, health officials had identified probable cases, had identified schools that appeared to be involved in the outbreak, had decided to close those schools to contain the epidemic, and then, when it became apparent that the virus had already spread extensively out into the general community, had decided to reopen the schools—all before the U.S. Centers for Disease Control and Prevention (CDC) laboratories had confirmed that the illnesses being seen in Seattle were, in fact, due to H1N1 influenza, Dr. Fleming said.
In general, information about the spread of the virus, such as laboratory confirmation of cases, was coming out one to two weeks behind what was happening on the ground, Dr. Fleming said. “The virus was moving faster than the information available.”
Budget cuts due to the recession are further undermining the ability of public health departments to respond to outbreaks, Dr. Fleming said.
In King County, for example, public health nurses were despatched to schools and day-care centers to train staff on what measures they should take to stop the spread of the virus, Dr. Fleming said. “It’s ironic that many of those nurses were slated to receive their layoff notices two weeks after they were performing those tasks.”
The report “Pandemic Flu Preparedness: Lessons from the Frontlines” was prepared by the Trust for America’s Health, a non-partisan public health advocacy group and the Center for Biosecurity of the University of Pittsburgh Medical Center.
The report was funded by the Robert Wood Johnson Foundation.
Dr. Fleming served as a peer reviewer for the report.
The H1N1 flu outbreak is still ongoing. To date, more than 13,000 cases have been identified in the U.S., including 27 deaths. Cases have been found in all 50 states and Puerto Rico. Worldwide, the virus has spread to at least 62 countries.
The virus now appears to be moving into the Southern Hemisphere, where the flu season is beginning, but experts expect the virus will return to the Northern Hemisphere in the fall, possibly in a more virulent form.
There is also concern that another more dangerous virus, perhaps related to the H5N1 “bird” flu might appear.
The new report found that even though the H1N1 virus has turned out to be less virulent than originally thought, outbreak still stretched the U.S. public health system to the limit.
Among the report’s recommendations:
- That core public health infrastructure should be improved and efforts be undertaken to recruit, train and retain the next generation of public health professionals.
- That the federal government take responsibility for maintaining strategic stockpiles of drugs, vaccines and medical supplies, such as face masks and respirators, for use during a pandemic.
- That U.S. vaccine development and production capabilities be enhanced so that the entire population can be vaccinated within 6 months of onset of an influenza pandemic.
- That the government develop a system to distribute, deliver and administer pandemic vaccines to priority groups quickly.
- That strategies be developed to lessen the impact of school closings and sick leave.
- That the country create a “State of Emergency” health benefit that would provide insurance coverage to all Americans during emergencies so that sick individuals will not forgo health care because of concerns about cost.
To learn more:
- Read the full report: Pandemic Flu Preparedness: Lessons From the Frontlines.
Category: Influenza, Public Health
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