If H1N1 re-emerges this fall as many health officials anticipate, hospitals could lose essential portions of their workforce and supplies and support services could be held up as well, warns the American College of Emergency Physicians.
"If the virus follows the pandemic patterns of the 20th century, health care providers should prepare for the potential of higher level of virulence in the fall wave, which occurred in both 1918 and 1957," says the group's new report, which spells out a plan for managing the virus. Cases could occur in early fall, before the vaccine's availability in late October, and continue into the normal flu season.
"If this occurs, the population will not have had available vaccine, and similar patterns of infection are expected, with higher prevalence in children and young adults," the report says.
The College says no emergency department will be exempt from the risks of an H1N1 outbreak. And if transmission rates double from the events of this spring, "over 30,000 cases can be expected over the fall and early winter. Emergency departments could see 150% of normal volume of respiratory complaints."
"Without a vaccine, the best defense the nation will have in reducing transmission would be community mitigation strategies," such as school closures, social distancing, frequent hand washing and requiring people to stay home from work at the earliest signs of illness, the report says. "No area of the United States would be spared from the spread of H1N1."
For hospitals, the college says, "pharmacies may not be able to get additional supplies from distributors . . . supplies of personal protective equipment and other supplies may require stockpiling, and food services could encounter supply problems due to production and delivery. The workforce may be depleted due to infection."
Complicating the scenario is that even though prevalence of disease may be as low as 2%, public officials may discourage the use of public transportation, and adults and parents with sick children will seek care from primary care providers, who "will be overbooked and will be referring patients to the emergency department." The report said.
Among the report's 27 recommendations, most of which list three or more action items, the college advises hospitals to have predetermined lead officers to coordinate preparedness, plan for surge staffing for the entire institution, prepare for supplies of personal protective equipment, and augmented post-mortem and mortuary services.
As of July 2, there were 33,902 cases of influenza in the U.S. including Puerto Rico and the Virgin Islands, and 170 deaths, according to the Centers for Disease Control and Prevention. Wisconsin had the most cases, 5,861, but only four deaths. By contrast, New York state had less than half the cases of Wisconsin, 2,499, but 44 deaths, more than any other state.