Preparations for a Pandemic Flu Outbreak

We are all fearful of the pandemic flu. What kind of preparations are they taking at the state and local level? You are listening to ReachMD XM 233, the channel for medical professionals. Welcome to the clinician’s roundtable. I am your host, attorney and Dr. Bruce Bloom, President and Chief Science Officer of Partnership for Cures, a nonprofit that drives cures the patient to repurposinggeneric drugs for new uses and my guest is Dr. J. Patrick O'Neal, Director of Preparedness in the Georgia Division of Public Health. Dr. O’Neal and I are discussing pandemic flu preparations in public health.

DR. BLOOM:

Dr. O’Neal, welcome to ReachMD

DR. O’NEAL:

Thank you Dr. Bloom. It’s a pleasure to be with you.

DR. BLOOM:

So, tell us a little bit about The Office Of Preparedness In The Georgia Division Of Public Health. What you do; how big are you; and what is your role?

DR. O’NEAL:

The Office Of The Preparedness In The Georgia Division Of Public Health is a fairly small office, but I think a really critical office. Since in public health, one of our key priorities is protection and safety of the public, emergency preparedness falls within that priority area. So we do have a key role in public health, but we have a fairly small staff at the state level. Throughout the state, however, we reach into all districts in Georgia and we have personnel throughout public health at every level; local, regional, as well as the state that are involved in the emergency preparedness oversight planning and actually exercising.

DR. BLOOM:

And, how did you get into this public health area; were you always a public health physician?

DR. O’NEAL:

No, my primary career was in emergency medicine, which I practiced for 29 years, and during emergency medicine years, I was also functioning as a medical director for EMS. EMS in Georgia is part of public health. So that was my entry into public health, and upon retiring from clinical practice in 2002, I went to work full time with public health on the preparedness side.

DR. BLOOM:

Let’s talk a little bit about pandemic flu. First of all, can you describe what pandemic flu might be and why this is such a big public health issue?

DR. O’NEAL:

Pandemic flu, I think, is difficult to describe because it is not like anything that most of us living today had have ever experienced. There may still be some folks, who have recollections of the pandemic of 1918, but not too many of those folks are left. So, essentially it is a situation that is hard to describe because folks have for the most part not really experienced it. We talked about it definitely as a public health emergency or a health emergency, but I think that, that is an under statement. Pandemic influenza would be far more than a health emergency. It will be a true societal emergency, which will have an impact on every sector of society. Certainly on the healthcare side, it will be monumental. We expect that the demands on the healthcare system would be greater than perhaps anything that we have ever experienced. In The State of Georgia, we are thinking that if the attack rate is what it has been in the past with pandemics that we will be seeing perhaps in excess of three million folks, who will be sick with pandemic influenza, and of those, we are expecting that we will have close to 60,000, who will not actually survive the pandemic. So, from the health side, it is an overwhelming; almost unimaginable, requirement on the healthcare system for delivery of care with circumstances that basically defy most of what, any of us, have ever experienced in our lifetime. On the societal side, it is going to impact the economy tremendously because of the fact that every aspect will be affected. With perhaps up to 40% absentee rate, the impact on virtually every sector of our economy will be fairly monumental.

DR. BLOOM:

And as you plan for this three million potential people that would be sick, over what period of time do you expect this to play out and how quickly are you going to get up to maximum need?

DR. O’NEAL:

With a pandemic, we expect waves of illness to occur; bell shaped curves. We think that the first wave will probably be 8 to 10 weeks. You will see in the literature anywhere from 6 to 12 weeks, but we are basically saying somewhere around 8 to 10 weeks in which probably at least two-thirds of the folks, who are going to get sick will be sick during that first wave. Pandemic will be a novel virus essentially a brand new virus to which there is relatively no immunity, so we expect the entire segment of all age groups to be involved. We think that this will occur not just in the first wave, which I mentioned, we think probably two-thirds of the folks will see sickness, but at least in a second wave and possibly even a third wave. We do not know how much time will elapse between the waves, but we are expecting two to four months perhaps between waves. So altogether, we are thinking that we will be dealing with the pandemic to some degree for close to a year, perhaps even longer.

DR. BLOOM:

If you have just tuned in, you are listening to the clinician’s roundtable on ReachMD XM 233, the channel for medical professionals. I am your host, attorney and Dr. Bruce Bloom and with me is Dr. J. Patrick O’Neal, Director of Preparedness For The Georgia Division of Public Health.

How long have you been preparing for this pandemic flu outbreak?

DR. O’NEAL:

In some senses, we have been preparing for about seven or eight years. I can recall the first pandemic influenza plan that I saw in Georgia was written, I believe it was either 1999 or 2000, but it was a very a epidemiology focussed plan, it did not get a lot of attention in the general medical community, and I can tell you at that time I was still on my practice in emergency medicine, and I had a very archaic view of pandemic. I thought that it was something of interest to medical historians that was about anything that we would have to deal with in modern time. I had assumed that moderate medicine had evolved to the point that we would no longer be seeing pandemics, and I think that there are lot of physicians, who are under that assumption, essentially an erroneous assumption, in the past. And, it was until, I guess, maybe late 2005, that we began to start hearing about the need to prepare. There had been bits of information that had been coming out actually since the late 1990s, related to the strange bird flu that was occurring primarily in South East Asia, and we were getting some word that there was very limited impact on humans by this bird flu. Early on, I do not think that most of the medical profession pay that much attention to where there is anything of great risk to us, and it was not until roughly 2005, I think that we began to think a lot more, at least in Georgia, we began to think "Gosh! This is a real threat. There is certainly no way of knowing that this particular bird flu H5N1 virus is going to be one that becomes a pandemic virus," but it has a lot of disturbing similarities to the virus that was involved in the 1918 pandemic, and as we have watched a change over the last 10 years, I think there has been growing concern and a growing awareness of the need to prepare as well as we can internationally, as well as nationally, and certainly here in The States for a pandemic; whether it is H5N1 or not, we need to be preparing.

DR. BLOOM:

So, what are those preparations look like in The State of Georgia?

DR. O’NEAL:

I think the most important aspect of the preparations has been to try to present an educational piece to not only the public, but also particularly to the healthcare sector where we do have that primary responsibility of being prepared to respond and able to deliver care during a pandemic, but at the same time, they were carrying through this education with the healthcare sector of what a pandemic would looked like, numbers of folks that would be involved, how could they best be cared for. We have also been sharing that informational piece with our non-healthcare sector partners trying to make everyone aware that the impact on businesses, on the educational community, on the transportation community, the faith community, all of those communities; the impacts will be tremendous. So, the educational outrage has been not just to the health sector, but to the other sectors as well essentially trying to inform people of what a pandemic will look like, how extensive the impact will be, and also with that general awareness to convey the things that can be done to mitigate to some degree the overall impact of the pandemic. Preparation has also involved actually caching certain items. We think that some of the things that are mothers thought as children are going to become exceedingly important, covering your cough, for example, or your sneezes so that you are not spreading germs around, is going to be extremely important. Handwashing is going to be important. So caching flyers that basically describe proper techniques for minimizing transmission of disease has been part of our effort; caching N 95 masks has been part of our effort and identifying within the healthcare community what the search capacity realistically can be is also a very important part of what we have been doing.

DR. BLOOM:

Have you done any exercises and training with physicians in EMS personnel around pandemic flu?

DR. O’NEAL:

Yes we have. I guess the first real training that we did was a state wide thing, and this has happened in all states. The Secretary For Health And Human Services, Michael Levin, essentially initiated this effort back in December 2005, with a national summit in which he, along with assistants from secretary Tetrault from the Department Of Homeland Security, began the process of informing the nation of just how critical it was to prepare for pandemic. From that, each state was asked to develop their own summit and Georgia did so on January 13, 2006, and along with Georgia Governor, Perdue, presented a summit here in Georgia in which physicians, hospital workers, administrators, emergency managers, EMS personnel, as well as the non-healthcare sectors were invited to essentially participate in, and to hear from the federal level what the concerns were about a pandemic.

DR. BLOOM:

Eventually, there will be a pandemic flu in the United States. I want to thank our guest, Dr. J. Patrick O'Neal, Director of Preparedness of the Georgia Division of Public Health for giving us some insight into pandemic flu preparations at the state and local level.

I am attorney and Dr. Bruce Bloom, President and Chief Science Officer of Partnership For Cures, a nonprofit that drives cures the patient for repurposing drugs for new uses. You have been listening to the clinician's roundtable on ReachMD XM 233, the channel for medical professionals. For comments and questions, send your e-mails to www.xm@reachmd.com. Thank you for listening.