 Ever thought what pandemic flu might do to you, your family, your practice or community? Sure, who hasn’t? Nearly daily, reports of avian flu fly through the media like a highly anticipated and catastrophic event, yet there are things we all can do to make the effect less than doom and gloom. A little anticipatory guidance and planning can go a long way to making you and your practice better prepared.
Fortunately, the Colorado Department of Public Health and Environment has been thinking about family practitioners and how to get us involved in pandemic flu preparedness. Through a contract with the Colorado Medical Society, the Colorado Academy of Family Physicians Foundation has been awarded funds to promote family physician awareness and planning. Recently, a group of physicians from Denver Health were selected to lead the training effort for CAFP. Drs. Grace Alfonsi, Art Davidson, and Lauren DeAlleaume are working to prepare a curriculum to train physicians around the state in pandemic flu preparedness. The goal is to train 12 family physician trainers who in turn will work with additional practices to improve their readiness.
By the end of February 2007, there have been 275 human avian flu cases worldwide (13 countries total) with 167 (61%) case fatalities. The H5N1 is indeed a virulent strain but fortunately to date there has been little human-to-human transmission. Our ability to effectively respond to epidemics and pandemics is crucial. The impact is more than just increased morbidity and mortality – the disruption to economic activity, trade, travel and
Figure 2. In 1918, a Seattle street car conductor prevents passengers from boarding without a mask as a precaution against the spread of Spanish flu. (Wikipedia) |
general commerce can be significant. Influenza pandemics can rapidly infect nearly every country. If international spread begins, pandemics are considered inevitable because the virus spreads rapidly through coughing or sneezing. More importantly, infected people can shed virus before symptoms appear adding to the risk of international spread via asymptomatic air travelers. |
Normal seasonal influenza causes illness in 5-20% of the US population with some deaths (about 36,000 each year); the deaths caused by a pandemic virus will greatly exceed the seasonal numbers. During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people worldwide. In the US, the mortality rate during that pandemic was around 2.5% (more than 500,000). In Colorado, more than 150 people died in one week in Denver and nearly 10% of the entire population in Silverton died due to the 1918 pandemic.
Pandemics may cause large surges in the numbers of people seeking medical or hospital treatment which will overwhelm health care services. High rates of worker absenteeism can adversely affect your office staff as well as other essential services such as law enforcement, transportation, and communications. Given high susceptible to an H5N1-like virus, rates of illness are anticipated to peak fairly rapidly within most communities but a second wave of global spread should be anticipated within a year. While we expect emergency conditions to exist during a pandemic, there are opportunities for us to make plans to mitigate the impact. Some of these are disease or exposure containment to avoid ongoing transmission and reduce the likelihood of infection, especially among more vulnerable populations. In addition to pharmacologic interventions, we must think about prevention and protection during these pandemics.
With the funds from this CDPHE grant, we will work with physicians to build awareness and plans to improve our collective response capacity. If you are interested in becoming a trainer or learning more about this activity, contact Tina Goldstein at CAFP, tina@coloradoafp.org.
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