The final report on Utah's readiness for a killer pandemic flu is 75 pages of measured urgency, laced with words like "inevitable," "triage" and "emergency powers."
The report, the result of six months of meetings, was presented Tuesday to Gov. Jon Huntsman Jr. by the Governor's Task Force for Pandemic Influenza Preparedness. The task force was co-chaired by Utah Department of Health Executive Director David Sundwall, who noted that no one knows when the pandemic will strike, but "we're not waiting for the 'what ifs."'
The task force offered seven areas of recommendations, with a timeline for the most crucial proposals. By July of this year, for example, Huntsman should establish a permanent Pandemic Advisory Committee that will determine whether current state and local emergency powers are adequate.
That list of emergency powers underscores how devastating a pandemic flu could be. The governor, under expanded powers, would be able to set "altered medical care standards" in cases where the health care system is too overwhelmed to adhere to usual standards. The governor would also be able to enforce cancellation of mass events, limit travel into and out of Utah, and require facilities be made available such as emergency hospitals, quarantine facilities or shelter for people unable to stay in their own homes because family members have the flu.
The task force is a response to an emerging avian influenza outbreak among birds and other animals in Asia, Europe and Africa. According to the federal Department of Health and Human Services and the Centers for Disease Control and Prevention, 285 human cases in 10 countries, resulting in 170 deaths, have been reported since 2003.
All of these cases, according to the "Avian (H5N1) & Pandemic Influenza Update" on the Health department's Web site (www.pandemicflu.utah.gov), have been the result of bird exposures, and "there is no evidence that the virus has mutated and become capable of efficient person-to-person transmission."
Influenza pandemics, the task force report notes, occur inevitably but at unpredictable intervals. When the next pandemic strikes the United States, the report says, an outbreak will last about six to eight weeks in each affected community, although multiple waves could occur. At least 30 percent of the population will become sick but there likely won't be enough health care professionals or support personnel such as hospital housekeeping staff, the report warns.
During a pandemic, nurses may need to care for five times the recommended number of patients, but because many health care workers will fear that they'll take the flu home to their families, "there is the potential for decrease in available work force to be even higher than in the nonhealth care workplace."
In addition, most medical facilities have no protocols in place to stockpile supplies such as the respirators, masks, gowns and gloves that will be needed. The lack of ventilators, for example, may result in "triage criteria" for who gets what. Utah hospitals trying to stockpile supplies "are having a difficult time purchasing these supplies ... due to high volume orders being placed all over the country," according to the report.
The Utah Legislature has appropriated $750,000 for a stockpile of anti-viral medications, and "we will strongly consider requesting more next year," Huntsman told the task force Tuesday.
In the first four to six months of a global epidemic, there will not be a vaccine available, since it can only be made after the newly mutated virus has been identified. And the vaccine would only be available in "limited supply" after that. By the end of this year, the task force recommends, the Health Department should have a plan that makes sure "priority groups" (health care workers, for example) get the vaccine first and figure out where vaccines would be administered ("gathering large numbers of people in a single setting would be undesirable," the report notes).
The report also tackles issues such as the potential for high employee absenteeism rates that could disrupt businesses and essential services such as police, fire, utilities, garbage pickup and food distribution.
Acknowledging that the press and the public may already have "flu fatigue," in September the department will begin a media campaign about pandemic preparedness."It's not just to scare them," Sundwall explained, then added "but, yeah, to scare them a little bit."