Government Agencies Are Not Ready for Predicted H1N1 Outbreak

Cheryl Clark, for HealthLeaders Media , July 31, 2009

Nearly half of 24 recommendations from the General Accounting Office last year to prepare for a flu pandemic have not been implemented by the responsible agencies, the GAO said in a report yesterday.

"Much more needs to be done, and many gaps in planning and preparedness still remain," which have "become even more pressing in light of the very real possibility of the return of a more severe form of the H1N1 virus later this year," the GAO's report said. "As the current H1N1 outbreak underscores, an influenza pandemic remains a real threat to our nation."

Gaps exist in leadership, authority, and coordination, which cause issues with detecting threats and managing risks, planning proper training, and exercising possible responses. It also raises concerns about assuring capacity to respond and recover, and share information, according to the GAO.

Of particular concern, the report noted, is the lack of guidance sought by many state and local health agencies and hospitals on how to manage scarce resources in a way that saves the maximum number of lives. The difficulty of addressing ethical, legal, and medical issues involved had delayed drafting such proposals, and they looked to the federal government for help.

For example, among the most important concerns is the need for the U.S. to plan for assisting other countries, especially developing nations, with their surveillance and detection efforts so the U.S. can take relevant actions involving its transportation system and border crossings.

The Centers for Disease Control and Prevention has recorded 44,000 Novel H1N1 illnesses and 302 deaths as of this week, and more are anticipated this fall.

The report synthesizes recommendations in three prior reports in the last three years whose recommendations were based on experiences in prior disasters such as hurricanes Andrew and Katrina, 9/11, threats of bioterrorism, and emerging infections like Severe Acute Respiratory Syndrome (SARS).

"Unlike incidents that are discretely bounded in space or time (e.g., most natural or an-made disasters), an influenza pandemic is not a singular event, but is likely to come in waves, each lasting weeks or months, and pass through communities of all sizes across the nation and world simultaneously," the GAO said.

It added that while the current H1N1 pandemic seems relatively mild, it is widespread, and its history "suggests it could return in a second wave this fall or winter in a more virulent form."

While H1N1 won’t directly damage the nation’s physical infrastructure, such as power lines or computer systems, it could disable "the essential personnel needed to operate them" for weeks or months. Absences due to illness, fear, or the need to care for family members may reach 40% during peak weeks of an outbreak. Additionally, such a pandemic could result in 200,000 to 2 million deaths in the U.S., according to the report.

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