The Next Pandemic

Slide from Lisa Stone M.D., M.P.H.

 

 

 


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 Experts are predicting that the virus that will cause the pandemic will be a result of the human influenza virus merging with the avian flu virus such that the airborne virus can spread from human to human.  When a pandemic influenza virus emerges, most humans will not be immune to it because it's strain will be very different than other influenza viruses that has been passed around. As a result, more people  die than usually die from seasonal flu, and even more people become infected with the virus. It is expected that about 30% of the population will become infected with this virus, that 4% of those infected  with need hospital level care, that 46% of those infected will need care in a clinic, and that 50% of those infected will not need medical attention.

 

 It is unknown when the pandemic flu will hit, but it could be as soon as tomorrow, or in as many as many years away.

Above image: slide from Lisa Stone M.D., M.P.H

 

 

Predictions

Based on the data from the 1918 epidemic and assumptions from the pandemicflu.gov, if a pandemic were to strike in 2008, the numbers would look as follows:

Amherst:
Population from most recent census (2000): 34,874
Would be infected with influenza: 8,852 Deaths from influenza: 141
The infected needing hospital care: 354
The infected needing clinical care: 4,072

Hadley:
Population from most recent census (2000): 4,793
Would be infected with influenza: 1,067
Deaths from influenza: 17
The infected needing hospital care: 43
The infected needing clinical care: 491

Northampton:
Population from most recent census (2000): 28,978
Would be infected with influenza: 3,955
Deaths from influenza: 63
The infected needing hospital care: 158
The infected needing clinical care: 1,819

South Hadley:
Population from most recent census (2000): 17,196
Would be infected with influenza: 2,825
Deaths from influenza: 45 
The infected needing hospital care: 113
The infected needing clinical care: 1,300

Note: These numbers are assuming a severe form of influenza, like that of which occurred in 1918.

Assumptions from pandemicflu.gov: the hospitalization rate will be 4% of those infected, and the rate necessitating clinical care will be 46% of those infected.

 

Implications

What these numbers mean for the surrounding area is that there is a need for a plan of action when a pandemic of this nature strikes. Hospitals in the area already operate at capacity or near capacity, and could not handle the sudden influx of such a large number of patients.

 In Amherst, the UMass health center does not hospitalize people overnight, and only has one hospital bed used for observation.

At Cooley Dickinson Hospital in Northampton, there are 142 beds. If the influenza struck, then the hospital would be overrun. Even if just the sick from Northampton go to Cooley Dickinson, that's still 16 more people that need care than the hospital has room for. This is as well as the fact that most of the 142 beds would probably already be occupied with people sick with other ailments, leaving even less space for those infected with the flu. Since this is the nearest hospital, the sick from surrounding towns (Hadley, Amherst and parts of South Hadley) would also go to this hospital first for care. This would bring the number of sick looking for care at this one hospital to around 600, assuming some residents of South Hadley go to Holyoke Hospital.

 If the towns were quarantined individually, this would put less of a burden on Cooley Dickinson hospital, but also leave many without proper health care. Thus, the local towns would need to set up beds for the infected in their respective towns for both hospital and clinical care, and each town should have a plan for this possibility of quarantine and hospital overflow to care for their residents.

It should also be noted that doctors and nurses are also susceptible to the infection, and could also be inclined to stay at home and take care of their own family should a pandemic strike. Thus, the area should be prepared to handle not only an increase in sick, but a decrease in medical staff.

Recommendations

Towns should be prepared to handle a situation like this, and being prepared for such an event would not be regrettable.

Supplies:
Supplies should be stockpiled ahead of time. If there were a quarantine, and supplies could not get back and forth, the towns are left with what they already have. In either basements of town buildings, public schools or colleges, there should be:

General Supplies:
Enough beds for at least the number of those predicted to need hospital care, adhesive tape, Angio caths, bedpans, Biohazard bags, blankets, blood pressure cuffs, disposable thermometers, disinfectant cleaning agents, emesis basins, gauze bandages, gloves (latex and vinyl), hand washing solutions, IV administration kits, IV fluids, oral fluids (Gatorade, apple juice, bottled water, Coke), paper products: drapes, pillow cases, exam table paper, gowns, peak flow meters, pillows, pretzels/crackers, pulse Oximeters, surgical masks, thermometer probe covers, urinals.

Personal Protective equipment:
Respirators, face shields/visors/goggles, Non-sterile long-sleeved gowns (disposable and fluid resistant)

Medications:
Acetaminophen (suppositories and oral tabs), antibiotics, antiemetics (suppositories and injection), cough suppressants (liquid syrups, lozenges), decongestants, NSAIDs. 

(See www.who.int/csr/disease/avian_influenza/guidelines/infectioncontrol1/en)

Preventative Equipment:
Enough face masks to prevent the transmission of the respiratory disease. This would potentially help the spread of disease both in the town and at home.  

Medical Workers:
Since the amount of available medical staff will be decreased due to illness and those staying home, it will be necessary to find and train volunteers that will be willing to come in and help out regardless of the situation. The towns could send letters to all of its' residents asking for volunteers and setting up volunteer meeting and training times. Volunteers will be needed for non-medical tasks, such as organization of medical facilities and preparation. Volunteers could also be more highly trained to do things such as be a nurses' assistant in order to help the actual trained medical workers with such a large number of patients. Both medical and non-medical volunteers are needed in the Medical Reserve Corps Volunteer program.