The recent H1N1 flu pandemic sent many people scurrying for their disaster plans—although we don’t call them disaster plans anymore. We like to put a positive spin on unplanned events these days; now they are known as preparedness plans.
Nonetheless, for many private and public entities, the dust had collected on those binders full of information on phone chains, continuation of operations, and business recovery. The fear that predictions of a widespread illness—one that could paralyze the entire country—were coming true raised the anxiety level of many administrators and health care workers. The use of pandemic to describe the event caused many to wonder whether this was the outbreak of the century, in which millions of people could sicken and die.
Daily updates from the CDC were often met with mixed responses: relief or concern, depending on whether one’s own community was affected and/or whether medication would be available, coupled with anxiety about whether it was safe to go out in public. The goals of the CDC updates were to reduce transmission of the disease and to educate people about staying healthy. Yet near-panic persisted and daily questions about what to do, whom to test, and how to treat those who were ill seemed endless. And it made me wonder—at a personal level, how well prepared were we? On the larger societal level, would we ever be ready to face a disease outbreak that threatened the existence of every citizen?
So I started at the beginning—in my own circle of friends and family. Did they receive their annual flu vaccine? Most had. Was anyone traveling? Most were or planned to be. Was anyone exposed to someone with flu-like symptoms? And there was the rub—who knew? The person sitting next to them on the train (or bus or plane) had been sneezing; the person they shared office space with at work was out “with a cold”; the neighbors went to Mexico during the school break. Concerns flourished, but often common sense withered. At least I had credibility with them; at work, it was another story.
My next step was to look at my workplace. My main focus was my patient population: adolescents, the majority of whom live in secure residential settings. This, by default, places them at a higher risk for any communicable disease. While I do not provide direct care to them, my responsibility is to coordinate and monitor the health services provided to them. Annual vaccinations are a component of the services they receive; however, the data on how many had received the flu vaccine were nearly impossible to extract. That the opportunity to be exposed to the flu was constrained did little to quell the anxiety that we would have a full-blown outbreak in all of the residences.
To compound that, we had no information about the vaccination status of the employees—the greatest potential source of introduction of the flu to the residents. While the employees are not under my purview, their communicability is my concern. And so the daily phone consults—who had a child that was home because the school was closed due to the flu; which employees had the sniffles or a sore throat; should they all to be sent home for a week’s quarantine?—continued for weeks. My response to “follow the CDC guidelines” was not always the answer people wanted. The best I could do was assuage their concerns that while the number of people with the flu was rapidly increasing, most cases were mild.
All of this was made worse by the local news programs, which made the latest statistics appear as if, one by one, we would all be wiped out by the flu. When the World Health Organization (WHO) declared the pandemic, all hell broke loose. I spent days explaining what it meant that we had a pandemic (ie, it had crossed geographic borders) and what needed to be done. Thankfully, the WHO representatives reiterated the importance of getting vaccinated and reducing the risk for transmission as much as possible as the key methods of controlling the flu.
The recent declaration by the WHO that the H1N1 flu is “unstoppable” made me realize that the frenzy will recommence soon. As I write, the Advisory Committee on Immunization Practices (ACIP) has announced plans for an “emergency or off-cycle meeting” on swine flu to be held on July 29. The ongoing concerns about availability of vaccines and identification of priority populations for vaccination, on the part of both WHO and ACIP, suggest that during the next flu season we may have more questions to answer.