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BIRD FLU Fine tuning the plan for a pandemic outbreak
WORST CASE SCENARIO: METHODIST PREPARES FOR A PANDEMIC
BY SHESHE GIDDENS
Dr. Jeffrey Kalina
With the rise in the global spread of bird flu in wild and domesticated birds, and the ease in which people travel from one continent to another, the question is no longer if, but when will the next major flu pandemic strike.
Although no human infections of bird (avian) flu have been reported in the United States, hospitals and government agencies are preparing for the worst case scenario. The last catastrophic flu pandemic struck in 1918, affecting approximately onethird of the world’s population and killing approximately 50 to 100 million people worldwide.
The reason for the great concern is that bird flu is highly lethal. Of the cases reported to the World Health Organization since 2003, more than half have resulted in death because humans have little immunity to bird flu.
Bird flu is caused by avian influenza viruses (there are several subtypes) that occur naturally in wild birds, rarely making them sick. Infection can easily spread among birds and can make some domesticatedbirds, such as chickens and
turkeys, sick and die. In its current state, bird flu does not transfer easily from birds to humans. Human infection usually occurs as a result of a person coming into direct contact with infected birds or their secretions and excretions.
Human-to-human transfer is even rarer, though a few cases have been reported. So far, infection from human-to-human has not continued beyond one person — but like all viruses, bird flu can mutate, and it already has. Bird flu could change into a form that makes it highly contagious, spreading from person-toperson, creating a pandemic, which occurs when there is an outbreak of an infectious disease that spreads worldwide or across a large region.
Dr. Jeffrey Kalina, associate medical director of The Methodist Hospital Emergency Department, believes that we are due for another pandemic, and he has made it his mission to ensure that Methodist and the Texas Medical Center (TMC) are prepared. Kalina, who chairs the Texas Medical Center Disaster Response Committee, says the committee has developed a comprehensive pandemic flu preparedness response plan to address the logistics of dealing with a large-scale response to the looming pandemic.
Methodist and the TMC are taking this opportunity to implement a comprehensive plan that can be used during any natural or manmade disaster.
“The goal is to develop a coordinated response that can be used for any pandemic or disaster, not just for avian flu,” Kalina said. “Every time something happens — such as Sept. 11 and Hurricane Katrina — we find gaps in the system. For instance, Katrina raised the question of what do we do about medical staff who are the sole caregivers for children or elderly parents. With Katrina, we offered day care here at the hospital but we would have to find an alternative if a pandemic broke out.”
The plan is divided into six stages. The first three stages focus on planning and preparation all the way up to the point when there is a confirmed case of human infection in North America. The last three stages address specific measures that need to be taken by hospitals in the TMC from the time of the first human-tohuman transmission in the United States and/or the Houston area to the recovery period.
Issues such as managing security and restricting traffic in and around the TMC, providing public education about flu hygiene and prevention, and establishing triage facilities are all addressed in the plan. Patients too sick to go home, but not sick enough for hospitalization, will be sent to a large-scale ward facility in Houston and the sickest patients will be sent to the TMC.
“Unlike Katrina and Rita, we will not get thousands of patients coming in one day. It will be spread out over months and we will still have to care for patients with other ailments,” Kalina said. “Hospitals should be reserved for the sickest of the sick.”
Hopefully, we will not have to face a bird flu pandemic or any other disaster in the near future. But if we do — when we do — Methodist and the TMC have a plan.
BY THE NUMBERS
Affected areas with confirmed human cases of avian influenza since January 2006
Azerbaijan
Cases: 8 Deaths: 5
Egypt
Cases: 15 Deaths: 7
Turkey
Cases: 12 Deaths: 4
Cambodia
Cases: 2 Deaths: 2
Indonesia
Cases: 53 Deaths: 43
As of October 31, 2006 Source: World Health Organization
China
Cases: 12 Deaths: 8
Iraq
Cases: 3 Deaths: 2
Djibouti
Cases: 1 Deaths: 0
Thailand
Cases: 3 Deaths: 3
Map and statistical data courtesy of the World Health Organization.
