The birds and the beds: A week in the journey of pandemic preparedness

(CIDRAP Source Weekly Briefing) – The world of pandemic influenza preparedness this past week experienced another roller-coaster ride of public attention—and a lack thereof.

I’ve talked about the dilemma of pandemic planning fatigue before, and the events of this week have added to my profound sense that much of the world is slipping even further into such a state. As the menace of pandemic preparedness fatigue rises, fueled by news coverage that downplays concerns, the reports that actually should incite us to action go largely ignored.

Let me highlight two examples from the past week that trouble me.

The birds…

On Monday, the World Organization for Animal Health (OIE) issued a press release, proclaiming: “Today most countries overcome avian influenza outbreaks when they occur.” It generated quite the buzz, but frankly I’m not sure why the OIE issued such a statement because its bottom-line message is unclear.

Here’s what we do know:

  • Migratory birds infected with H5N1 avian flu can transmit the virus to domestic poultry, ducks, and geese when they share common areas.
  • Attempts to control the ongoing transmission among domestic birds require early H5N1 detection, containment of domestic bird movement, and slaughtering.
  • As long as migratory birds are infected with the virus, the disease will move back to domestic birds with subsequent contact. This is exactly what’s happening today in Vietnam, where poultry infections have reemerged in multiple provinces after almost 2 years of absence (and another outbreak in domestic birds is being reported as I write).
  • We can’t do much about wild bird infections.

The OIE release stated that in the first half of 2007, “Countries reported fewer deaths of wild and migratory birds, which could indicate the disease is coming closer to the end of a cycle.” It concluded that fewer bird infection and death reports mean less real infection in the bird population.

But what the OIE did not mention is that the fatigue experienced by local officials in reporting such cases for the past several years—a phenomenon commonly seen during outbreaks of other newly emerging infections in humans and animals—could have played a role in these lower numbers.

What’s more, we would expect to see lower wild bird infections several years after the first introduction of a new virus into the bird population, because one of two things happens: (1) the new virus infection kills the birds or (2) any birds that recover are now immune. In epidemiologic terms we call this “burning out all the susceptibles.”

But from a scientific perspective, it’s important to note that for several years birds born after such an event reestablish a relatively naive (unexposed) population, and the rapid and significant spread of the virus can start all over again. This also may be what’s happening today in Vietnam.

Within hours of the OIE release, a Bloomberg News story, “Avian flu virus may be nearing end as fewer birds die,” received major international attention. I was deluged with phone calls and e-mails over the next 24 hours from business preparedness and public health skeptics who had read the Bloomberg story, convinced they had evidence that the pandemic potential was indeed overblown. That conclusion is just plain wrong.

…and the beds

In contrast to the Bloomberg story, Novation, based in Irving, Tex., which is the healthcare contracting services company of both VHA Inc. and the University HealthSystem Consortium, announced the results of a survey of hospital materials managers on their pandemic preparedness status. Novation found that of the 68 managers who responded:

  • 79% reported they could continue operations without external resources for less than a week.
  • 54% said they could continue for only 1 to 3 days.

Christine Miller, a senior clinical manager at Novation, was quoted in the press release as saying, “Our survey provides some real insight into the supply crisis that hospitals would face during a global flu pandemic.”

Was this story picked up by any wire service or trade publication? Not that I could see.

Did anyone send it to me or call to discuss its implications? Not one.

Yet, I found myself rereading the release several times to take in the full implications of these important results.

Bottom line for business

We are mired in a world of pandemic preparedness fatigue. The voices of skeptics who doubt the eventuality of a pandemic and dismiss the need for preparedness are growing louder. Meanwhile, important studies like the one from Novation are going unnoticed or getting buried. No organization will help itself in the long run by buying into this mindset. There will be a next pandemic, whether it is tomorrow, next year, or even years from now. Like hurricanes, earthquakes, and tsunamis, pandemics happen. Nothing we do today to better prepare for the next pandemic will ever be wasted.

Our biggest risk lies in hoping that the Bloomberg headline is right, then one day being proven wrong—deadly wrong.

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