Hospital preparations

Stern: Hospital must prepare for pandemic

Health director advises doctors to plan now for the next pandemic flu
By JIM HALL


Date published: 5/27/2006


This week's headlines from Indonesia gave urgency to Dr. Donald R. Stern's message: Now is the time to begin preparations for a pandemic flu.

Stern, the director of the Rappahannock Area Health District, told doctors and nurses at Mary Washington Hospital yesterday that a severe and widespread flu outbreak is likely, though the timing is unknown.

Stern quoted another flu expert as saying: "The pandemic clock is ticking. We just don't know what time it is."

As Stern was speaking, several flu experts were in the Kubu Sembelang village of North Sumatra to investigate a cluster of six deaths from a single family there.

The family members died after contracting the H5N1 avian influenza virus, according to the World Health Organization. The latest death was a 32-year-old man who developed symptoms May 15 and died May 22.

All of the cases have been linked to close and prolonged exposure to a severely ill patient, according to the WHO. To date, the investigators have found no spread to the general community. They also have found no evidence that the virus has mutated to make it easier to spread from chickens to humans or from humans to humans.

"So far, the spread of H5N1 virus from person to person has been rare, inefficient and unsustained," according to the federal Centers for Disease Control and Prevention.

As of May 23, the WHO has recorded 218 cases of avian flu in humans, with 124 deaths. Stern refers to these as "incidental" cases, usually among people who have had contact with diseased chickens.

The disease occurs naturally in wild birds and can be deadly in domestic fowl. The disease was first identified in 1997 and continues to spread. Now it can be found in Asia, Europe and Africa.

But it is the possibility of a genetic shift in the virus and more efficient transmission from humans to other humans that concerns health officials, Stern said.

"There's a huge population that's being exposed to this virus," Stern said.

A "novel" virus for which the public has little immunity--like a mutated bird virus--could move swiftly around the globe and cause thousands of deaths, Stern said. Such pandemics occurred in 1918, 1936, 1957 and 1977.

"History tells us that we have these pandemics periodically," Stern said.

Stern spoke to hospital leaders recently about preparing for such an outbreak, and he speaks to elected officials next week.

His message: "How are we going to handle the demand for health support? We have some work to do."

Stern estimated that a "moderate" pandemic of the type that hit in 1958 would result in 78,000 illnesses in the Fredericksburg area. Over a three-month period, 700 people would need hospitalization, 100 would need intensive care and 50 would need the support of a ventilator.

"How many ventilators do we have in this hospital?" Stern asked the doctors.

When no one answered, he said, "Anybody know? Any pulmonary folks here? Anybody take a guess?"

Still there was silence.

"How can we plan for this if we don't even know how many ventilators we have on board?" he asked. "We need to know this."

http://fredericksburg.com/News/FLS/2006/052006/05272006/194552