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Pennsylvania pandemic flu planning a work in progress
MARTHA RAFFAELE
Associated Press
HARRISBURG, Pa. - Over the past year, state health officials have taken a number of steps to prepare Pennsylvania for a possible flu pandemic, including compiling a database of health care volunteers, helping hospitals plan for a surge in patients, and talking to businesses about how to keep workers healthy.
They are struggling with some key questions, however, such as how to ensure the state will have an adequate supply of flu vaccine.
The state has not bought any doses of the seasonal flu drug Tamiflu to supplement an allotment it can receive from a federal stockpile because of questions about the vaccine's effectiveness and concerns about how long it can be stored.
"There's concern that the longer the disease is around, the less effective (Tamiflu) will be," said Art Stephens, deputy chief of staff to Gov. Ed Rendell.
In its pandemic preparedness plan, the state estimates that a pandemic could strike an estimated 1.6 million Pennsylvanians - about 13 percent of the state's population - with 39,000 people needing hospitalization and 9,000 dying within 12 to 16 weeks.
Since March, Pennsylvania has received $12.5 million in federal money for pandemic planning, and it has allocated $500,000 to the Pennsylvania Emergency Management Agency to assist with planning efforts.
The federal government is in the process of buying enough anti-flu medication for 44 million people for its stockpile. More than 1.8 million courses of the vaccine - consisting of two pills a day for five days - will be available for Pennsylvania once the federal purchases are complete.
The state would also be able to buy about 1.3 million additional courses, with the federal government paying 25 percent of the cost, said Michael K. Huff, the state Department of Health's director of community health systems.
But before creating its own stockpile, the state needs to develop a storage and distribution strategy so that it can make the vaccine available during the regular flu season near the end of its three-to-five-year shelf life so it doesn't go to waste in the absence of a pandemic, Huff said.
"The challenge here is, we don't want to spend $20 million ... and then have to discard it," Huff said. "It's like buying milk from the grocery store. Every state is struggling with it."
The state is also developing plans outlining which groups of people should be vaccinated first, with top priority given to doctors, nurses and other health care workers, emergency-management officials, and law enforcement, Stephens said.
"Then, the strategy will depend a little bit on who is most impacted," Stephens said. "During the normal flu season, the very young and the elderly are most vulnerable; however, we know we've got to be flexible enough to react to changes."
While some counties and hospitals have conducted vaccination drills, the state's test of its response plan has been limited to "tabletop exercises" where state officials discuss how they would handle various scenarios.
"There's no way you can practice it, because a pandemic is huge," Stephens said.
At the same time, the state has had some recent real-life experience handling a mass health emergency, Huff said. The department administered immune globulin shots to 9,500 people after a hepatitis outbreak linked to green onions at a Chi-Chi's restaurant was publicized in November 2003.
Bucks County conducted its first pandemic flu vaccination drill in November at three different sites, including a drive-through clinic set up inside a firehouse. Health officials inoculated 3,325 people for the regular flu season, averaging 554 vaccinations per hour.
Overall, the drill was successful, and many people who participated in the drive-through clinic said they preferred waiting in their cars to standing in line for a flu shot, county epidemiologist Meredith Allen said.
"For people who have issues with movement, it's just easier for them to drive through, because they can remain seated while they're waiting," Allen said.
Another challenge a pandemic poses is an overflow of hospital patients, including those who are sick and the so-called "worried well" who are not sick but fear they may be, Huff said.
The state currently has more than 34,000 general acute-care hospital beds and more than 8,500 other beds in facilities such as children's hospitals, psychiatric hospitals, and Veterans' Administration hospitals.
Officials have not yet estimated what the increased need would be during a pandemic. But they are working on identifying alternative sites where people can receive medical care and developing mutual-aid agreements among hospitals in specific regions outlining how one facility would accommodate any patient overflow, Huff said.
Hospitals would have to take steps such as canceling elective surgeries and quickly discharging patients who are recovering from illness or surgery but no longer need acute care, said Melissa Speck, director of policy development for the Hospital and Healthsystem Association of Pennsylvania.
But having enough staff to take care of everyone is another critical part of the equation, given that hospitals are already suffering from a nursing shortage, Speck said.
According to a report released last week by The Trust for America's Health, Pennsylvania met five of 10 criteria for being adequately prepared for a flu pandemic or other health disaster. The health policy group cited the state's nursing shortage as one shortcoming.
"We can have all the beds in the world, but if we don't have the staff, there's not much we can do," Speck said. "One of the things that is a misnomer is that alternative-care sites will be the answer. It will be an important part of the plan, but to expect that the hospitals will be the ones staffing those, that's not realistic."
Toward that end, the Health Department is compiling a statewide database of doctors, nurses and other medical professionals who could volunteer in the event of a pandemic, department spokesman Richard McGarvey said.
The Pennsylvania State Nurses Association is taking its own inventory and has compiled a volunteer database of more than 760 registered nurses and licensed practical nurses, said Betsy Snook, the association's executive administrator.
"We do remain concerned that if a large-scale disaster occurs, there would not be sufficient numbers to meet the needs in our hospitals, nursing homes and other facilities," Snook said. "But we are fortunate to have a very large number of RN and LPN licenses."
ON THE NET
Pa. pandemic preparedness: http://www.pandemicflu.state.pa.us/