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Pandemic influenza preparations are seriously deficient warns medical journal

New influenza strains emerging in the world could cause a global pandemic comparable to the disastrous influenza pandemic of 1918, writes Steven J. Hatfill, M.D., in the spring issue of the Journal of American Physicians and Surgeons. Yet despite the expenditure of billions of federal dollars, "we are not much better prepared than in 1918. Most communities will be on their own."

Current stockpiles of vaccines and antiviral drugs are inadequate in quantity and variable in effectiveness, notes Dr. Hatfill. Moreover, contingency plans to distribute them are deficient. Federal planning is largely focused on continuity of government, with inadequate attention to workers vital to maintain essential urban infrastructure as well as to care for the sick. With just-in-time inventories, medical surge capacity is extremely limited.

Public health measures to prevent transmission of the virus would be critical, yet evidence concerning transmission by aerosol and the importance of protecting the surface of the eye has been ignored for decades says the article. Only in 2017 was the 2006 Pandemic Influenza Plan updated to recommend the use of high-efficiency particulate air (HEPA) filtered N95 masks (respirators) instead of surgical face masks. But the eyes are still exposed. For ease of use and safety, full protection ideally requires a sealed, full-face HEPA-filtered respirator, combined with alcohol-based wipe disinfection of both respirator and hands after use.

"Local communities will have to manage a pandemic themselves," Dr. Hatfill warns. Yet there has been little progress in local preparedness. Instead, there is increasing reliance on the federal government.

On the hopeful side, he reports that there is some progress toward more effective vaccines that can be produced more rapidly. Also, new classes of antiviral drugs show promise to supplement or replace oseltamivir (Tamiflu), which has been extremely disappointing.

If a major 1918-type pandemic occurs now, Dr. Hatfill predicts that at least 123 million Americans will not receive any antiviral medications or vaccines for weeks. "There will not be enough for all Americans, and we lack well-thought-out plans for prioritizing their use. Even if there were an adequate supply, many local authorities appear unable to distribute these essential items in time to make any difference to their communities."

His grim conclusion is that "local/regional hospitals would be quickly overwhelmed, and morgues would overflow."

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

https://aapsonline.org



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