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Delaware refining flu readiness

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  • Delaware refining flu readiness
    Delaware refining flu readiness
    By Randall Chase, Associated Press

    DOVER - State officials have stockpiled medicines, masks and other protective gear, ordered extra hospital beds and ventilators, set up a medical reserve corps, coordinated response plans with schools and corporations, and run emergency response drills.

    But while Delaware appears to be better prepared than most states to respond to a pandemic flu outbreak, authorities say there's always room for improvement.

    "I think Delaware is one of the leading states out there in public health preparedness and emergency response," said Timothy O'Hea, the state's principal public health planner. "We can always refine and do things better."

    Delaware is one of only 14 states to receive a "green" rating from the Centers for Disease Control for its ability to handle medicines and supplies from the nation's Strategic National Stockpile.

    Last year, Delaware shared the highest ranking, along with South Carolina and Virginia, in a report on emergency preparedness by the nonprofit Trust for America's Health. The three states each obtained passing marks in eight of 10 emergency preparedness indicators. In this year's rankings, using revised indicators, Delaware was one of 11 states to earn passing marks in seven of 10 categories. Fourteen other states scored higher.

    Delaware has budgeted $2.3 million for pandemic flu preparations, including $1.4 million appropriated in the current state budget for anti-viral medicine. But of three live drills for large-scale health emergencies in recent years, none dealt specifically with pandemic flu.

    Earlier this year, the state held a mass-vaccination drill in response to a simulated smallpox outbreak. A public health drill last year simulated a tularemia outbreak, while a 2004 drill tested the state's ability to respond to the release of a biological agent.

    Drills specifically involving pandemic flu, including one earlier this month, have been mostly tabletop exercises, O'Hea said.

    "We were thinking about doing a full-scale (flu) exercise in 2007, but we need more in-depth training in certain areas," he said.

    From tabletop drills and discussions with other agencies, public health officials determined that the state needs to address several issues surrounding pandemic flu. Those issues, to be addressed in four tabletop drills next year, include the role of the courts, essential services for disabled people, mass fatalities, and ethics and legal issues surrounding prioritization of medical resources and standards of care.

    "We didn't even think about bringing in the judges," O'Hea said, noting that courts may be involved in quarantine and isolation issues in the event of an outbreak.

    Officials also must figure out how to ensure that disabled people who rely on government and nonprofit agencies for help continue to have access to food, utilities and medicines.

    At the same time, the state would have to deal with the dead. Fatality estimates for a pandemic in Delaware range from several hundred to a few thousand.

    "Do funeral homes have the storage capacity? Do hospitals have the storage capacity until funeral homes catch up?" O'Hea asked, adding that burial regulations and identification of the dead also may pose problems.

    A key issue is prioritization of pharmaceuticals and vaccines.

    Delaware has bought 121,164 doses of anti-viral medicine, and the federal government will stockpile a similar amount, but that is enough for only about a third of the state's population.

    While previous flu pandemics have primarily affected young adults, federal guidelines say anti-virals should be given first to health care workers, decision makers and high-risk populations such as the elderly and people with chronic illnesses.

    "I think the emphasis will continue to be on the most vulnerable rather than the most highly affected," said Dr. Robert Rosenbaum, emergency preparedness chairman for Christiana Hospital in Newark.

    Christiana and Delaware's eight other hospitals have worked closely with one another and with state officials in preparing for pandemic flu, officials said.

    All nine hospitals can submit reports to the Delaware Electronic Reporting and Surveillance System, which health officials would use to help identify and analyze a flu outbreak, and which they hope to expand to doctor's offices and clinics.

    The hospitals also have their own dedicated group of channels on the state's 800 MHz emergency radio network.

    In the event of an outbreak, health care providers would coordinate "surge capacity" efforts to ensure that enough hospital beds are available for flu victims. Among the options for increasing bed space are eliminating elective surgeries and moving patients from hospitals to long-term care facilities such as nursing homes.

    Delaware has 2,300 licensed hospital beds, 2,000 of which are currently staffed. O'Hea said hospitals have identified 200 more beds that could be opened in the event of a pandemic, while the state could open up another 400 beds.

    "There's a fairly high rate of bed occupancy to begin with, so you're already pushing your limits," Rosenbaum said. " ... When we're talking about a true pandemic, ... then you're talking about stretching resources, making treatment decisions. You can have the plans in place and use them as your framework, but the decision-making will be an ongoing process."

    Officials believe a pandemic could deplete public-sector and private-sector work forces by 30 to 50 percent. The state is putting together 20,000 equipment kits to help keep essential workers stay on the job, and large private companies are taking similar measures.

    "The bigger the company, the more likely it is to be preparing or prepared," said Terry Stuchlik, business development director for DuPont Co., which is making personal biosecurity kits for its 66,000 employees worldwide.

    DuPont's medical staff would decide when to issue the kits, which include disinfectant cleaners, antiseptic hand spray and surgical masks, as well as when to deploy the doses of Tamiflu the company has stockpiled.

    In the event of an outbreak, DuPont would shift manpower and resources to essential tasks, such as production of Tyvek protective suits that likely would be in high demand for health care providers, Stuchlik said.

    "This whole area is so event-driven," he said. " ... If something happens it's going to change things very, very quickly."

    In the event of a pandemic resulting in a state of emergency, the Delaware Emergency Management Agency would lead the state's response. DEMA came under fire recently for emergency notification problems involving a chemical leak in Cheswold, but officials note that a flu outbreak would be different.

    "A pandemic is not going to happen overnight like Cheswold did," said DEMA spokeswoman Rosanne Pack. " ... We wouldn't have to get word out within a 24-hour period that people should stay in their homes."