Individuals need to plan: states can only do so much.

Planning for flu pandemic involves even Meals on Wheels

By Anne Saunders, Associated Press Writer | December 14, 2006

CONCORD, N.H. --Meals on Wheels delivers 850 meals a day in Rockingham County, relying on 35-40 drivers and hundreds of volunteers who package the food for delivery.

What happens if these folks get sick in a flu pandemic? Will elders go hungry?

The New Horizons shelter for men and Angie's Shelter for women in Manchester typically serve 95-120 people a night with a staff of 17, three of whom work overnight. If their staff is ill, where will the homeless go?

This is when statewide avian flu planning gets down to the nuts and bolts.

Like all states, New Hampshire has been involved in making plans should a new flu strain or other contagious disease strike large numbers of people.

The state's efforts led to a 99-page document on pandemic preparedness that talks about how state health officials, hospitals and the state Emergency Operations Center will work together.

Another fat document looks at the numbers of hospital beds and how to provide extra beds in an emergency. That report found the state has room to accommodate 2,149 patients in regular beds and 374 in intensive care units. The goal is to find room for up to 30 percent more.

"I believe strongly that New Hampshire is leading the way on pandemic planning. I'm not going to say that I'm satisfied with our efforts. We do have gaps that we need to fill," said Health Commissioner John Stephen.

The state already has tested its ability to deliver flu vaccine to large numbers of people when it ran a large-scale drill in three parts of the state last November. And a drill this fall used 50 volunteers at the field house at Dartmouth College to test the Hanover community's ability to turn that space into a makeshift hospital.

A strike force of medical providers from all over the state came together for the event and two new software systems were tested, including a new Internet-based program creating an electronic medical record for patients who might be forced to move around in a disaster.

"You can only plan so much on paper," said Dr. Robert Gougelet, who directs the Northern New England Metropolitan Medical Response System, a bioterrorism and pandemic planning agency involving Maine, New Hampshire and Vermont.

New Hampshire has divided the task of pandemic planning into 19 regions, each with at least one hospital. Hospital officials, public health leaders, social service providers, emergency medical providers, law enforcement and homeland security representatives are meeting regularly to talk about the specific needs of their communities.

They're identifying the buildings that could take patients if the hospitals run out of room and arranging ways to get additional beds, supplies and staff. They're looking at sites to securely store vaccines and ways to ensure everyone involved can communicate. They're identifying people like the homebound and homeless in their communities who may need special attention in a disaster.

Gougelet said the regions all are at different points in the process but after studying what went wrong following Hurricane Katrina on the Gulf Coast, he's convinced that localizing the planning will be key to a successful response in New Hampshire whatever the threat.

"You're not waiting for the state. You're not waiting for the feds. They can still go into action without anyone's permission," he said.

Several steps remain in the pandemic planning, including getting the state Legislature to appropriate $6 million for special vaccines being made available by the federal government, getting each region to complete and run a drill on its plan and making sure officials have the legal authority to ration medicine, commandeer buildings or take other steps that may be necessary in a health emergency. Gougelet said it's also unclear whether existing plans make adequate provisions for an extended emergency.

And what will Meals on Wheels do if its volunteers are laid low by the flu? The agency keeps a supply of frozen meals to deliver extras if bad weather or a shortage of delivery people makes daily delivery impossible. It also has a collection of meals that don't require refrigeration in case of a prolonged power outage.

"We see ourselves as having to keep going no matter what. So many people depend on us," said Executive Director Debra Perou-Hermans.

And at Angie's Shelter and New Horizons, officials said shelters have a broad base of volunteers to provide extra hands in an emergency, especially since New Horizons also houses the local health clinic.

"A lot of what is done is done by volunteers," said Tim Soucy who's vice president of the board and a Manchester public health administrator.

"It could be the saving grace. I'm sure people would still say: what needs to be done? I think we're very fortunate," he said.
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