Friday, February 18, 2005

Influenza planning at the local level

We have been pretty critical here about the degree to which CDC is getting the ready for a possible influenza pandemic, so it is nice to report something good, although modest. The CDC's Cities Readiness Initiative hands out money to local health departments to figure out ways to get self-administered medicines (like antibiotics or antivirals) quickly to the population. Designed for "bioterrorism" it would work equally well for delivering antivirals like oseltamavir (tradename Tamiflu). Of course that assumes there is Tamiflu to deliver, which at the moment doesn't seem to be the case, so while CDC and the cities are working on a delivery system, if there isn't anything to deliver . . .

Anyway, a story in the Seattle Post Intelligencer has some interesting details on what Seattle is doing with its $830,000 grant (equivalent to how many minutes of Iraq War? Nevermind.) One aspect of the plan is to use lettercarriers to deliver medicine. They know the neighborhoods and the system itself is a distribution system for letters. But Seattle's Health Commissioner, Al Plough, is also considering other possibilities:
"Rather than having a postal worker going to each home, and no one being there, we might have a large number of small neighborhood sites" where people could go to pick up medications from health care providers who could teach them how to properly use them, said Plough.

Such protocols have grown out of local preparation for the possibility of an influenza pandemic, which Plough calls much more likely than a bioterror attack. "If you're ready for that (influenza pandemic), you're ready for anything."

Michael Loehr, Public Health's preparedness manager, said that rather than being completely reliant on the CDC strategic stockpile of medicine, the department would draw on local sources such as hospital pharmacies and regional drug wholesalers in King County.
A couple of things about this deserve mention. First, the recognition that in the event of a national/global influenza pandemic, it will be up to the local communities to deal with it. They will be pretty much on their own and they need to start getting their act together, as Seattle is doing. Second, Plough's statement that if you are ready for the (much more likely) event of an influenza pandemic, you are pretty much ready for anything (including a bioterrorist attack) is right on target. So why, then, does CDC have it backward: preparing for an influenza pandemic by preparing for a bioterrorist attack? They are not the same thing and the resources you use for one are not the same as for the other. In this case there is some overlap, but how much better prepared could we be if we actually set out to prepare for influenza rather than reap any benefits as a biproduct. Third, there is a great deal of ingenuity, resources and desire to help at the local level that could be tapped. Organizing "neighborhood sites" for distribution is one example. Hotels could be used as temporary hospital beds, retired nurses and doctors could be pressed into service, and Visiting Nurses could serve some patients in their houses.

But these things take some advance planning. There is too little of it being done and some of it is being done for the wrong objectives. The CDC public health commanders are still fighting the last war. Of course, consider who the General Staff is.