Pandemics present special challenges because the risk of serious illness or deaths on a large scale are unknown—-but are known to be much higher than in a regular flu season.

Will this be like the devastating 1918 epidemic? Or, will it roll along, sickening many people, circling the globe, around and around again, in a flu season which seems never to end?

No one can tell yet.

• Are the federal and state governments prepared to put into action the plans they have drawn up? (Having a plan is only the first step. Funding must be in place. People have to know what the plan is and be equipped to follow it. There have to be enough people on the ground, too, if the plan is to work. There have to be enough professionals to do vaccinations, testing or other tasks, with the goals of preventing or monitoring local infection rates by type. Right now, we have several influenza strains loose at the same time. Distinguishing among them is important.)

• Are these governments working in a coordinated way? (Influenza knows no boundaries).

• Is the supply of vaccine adequate and safe? (All of the ordered doses do not come at once. Vaccines can pass safety checks in tests only to show problems when used in large populations. It is a constant process, balancing ordering, inventory control and safety monitoring. Be aware: No one gets it all right. It is not possible. They are chasing a changing virus, one with a course no one can predict.)

• Who should be vaccinated first? (Some groups are more likely to spread the influenza faster than others—-such as schoolchildren.)

• Will the general population use prevention strategies as directed? (Your steady use of hand-washing and other steps can help you and help prevent the spread. Your role is important, too.)

• If there is a community-based quarantine ordered, will people cooperate and follow it? (Employers, schools and other community-based organizations have to sign on and mean it. People who are afraid of losing jobs, especially in this economy, will listen to the boss, not the boss of the quarantine.)

Last week, the president held a “summit” meeting with the secretaries of HHS, Homeland Security and Education last week at the same time HHS rolled out Flu.gov. (As noted elsewhere on this website, this is your single source for news about all forms of influenza active now. Seasonal. Avian. Pandemic/Swine/H1N1/Novel H1N1. Please bookmark it and use it before you need it.)

Other participants at the state level were connected by video-conference. The federal government committed to helping states get ready for their influenza programs, including essential funding.

The goal was to coordinate a fall plan, when the pandemic flu (also called swine, H1N1 and Novel H1N1) is expected to return and hit harder. That expectation comes from the pattern of these A-type strains of influenza. A mild first round is followed by a second round which hits people much harder. The officials at the summit emphasized that, as yet, there has been no evidence that the pandemic flu has become the more dangerous form.

Vaccines have to be made and tested for safety before shipping. Manufacturers are working now, with the intention of shipping the first doses in the fall.  A fall ship date depends on the vaccines passing the safety tests. In the meantime, the antiviral drug, Relenza, is the only one to which patients show no drug resistance. Tamiflu, long a stand-by for influenza patients, is not working as it has in the past nor have the older classes of anti-virals. For once, no drug company will have windfall profits from a drug; pharmaceutical companies sell these emergency drugs in epidemics at a discount.

Many governments, world-wide, stocked a mix of these anti-virals. What supplies of the best drug do governments world-wide have on hand? That is not clear.

At the moment, these federal agencies have to set priorities among populations.

Who needs the first shots the most?

The preliminary list of those who should get the vaccine first includes:

• Schoolchildren, the leaders in spreading infections of many kinds.
• Pregnant women.
• Health care workers.
• People with higher than usual high risks, such as asthma.

Last week, there was a report that patients who met the medical standard for clinically morbid obesity were at higher risk with this strain. It is possible other groups will be identified as having higher than usual risks due to one or more underlying medical conditions.

New York Times

“The Obama administration warned Americans on Thursday to be ready for an aggressive return of the swine flu virus in the fall, announcing plans to begin vaccinations in October and offering states and hospitals money to help them prepare.

“The potential for a significant outbreak in the fall is looming,” President Obama said by telephone link from Italy to the White House’s H1N1 Influenza Preparedness Summit, held at the National Institutes of Health.

“With good planning, “we may end up averting a crisis,” Mr. Obama said. “That’s our fervent hope.”

“The summit meeting was jointly led by the secretary of health and human services, Kathleen Sebelius; the secretary of homeland security, Janet Napolitano; and the secretary of education, Arne Duncan. It gathered health and school officials from across the country and took questions by video link from the governors of several states, most of whom wanted to know who would pay for preparations like the vaccination drive.

“Vaccinations will begin in October only if tests scheduled to begin in August prove that the vaccine is safe and effective. Even then, officials expect only tens of millions of doses to be ready, so they will have to decide who is vaccinated first. The most likely candidates, Ms. Sebelius said, are school children, health care workers, pregnant women and people with asthma or other conditions that make the flu riskier.

“While health officials were careful to warn that there was no evidence that the flu had mutated into a more dangerous form, they noted that it seriously disrupted some cities, including New York, in the late spring and could do worse as the fall flu season begins.”

Source: New York Times, July 9, 2009