05/07/09

You rarely hear people mention the H1N1 virus and bioterrorism in the same sentence.  And yet, talk to Doug Owens, MD, MS and the similarities become obvious.  He says there’s commonality, in assessing the amount of disease in a community, how serious, what treatments can be offered, and whether there is surge capacity to deal with the large numbers of people potentially affected.

Owens, a professor in the Center for Primary Care and Outcomes Research is one of the authors of a report on bioterrorism response to be released later this year.  He is also involved in ongoing work on pandemic response. “What we’re learning is that the mortality and transmissibility are what help map out a reasonable public health response. A multilayered response is probably going to be most effective. Adult and child social distancing, school closures, done together are more effective than individual things other than vaccines. We’re also doing modeling work to look at both the health benefits on the population comparing the cost of non-pharmaceutical interventions and pharmaceutical interventions like Tamiflu and vaccines,” said Owens.

Underfunded, and Understaffed

A great deal has changed in the 5 years since the avian flu scare. There’s a coordinated global response to H1N1 from the Centers for Disease Control and World Health Organization. The government updates information online on an almost hourly basis. The CDC uses social networking tools like Facebook, Twitter, and blogs to counter misleading information.  And yet, in the event of an epidemic, the crux of pandemic response will fall squarely on the shoulders of underfunded local public health systems.

“This is a stark example of why we need to support our public health infrastructure,” adds Owens. “The response, the legal authority and the expertise come from your local health jurisdiction. They figure out how much disease there is, make recommendations on how and when to treat, when to close and when to reopen the schools. You need good leadership on the federal and state level, but if local public health agencies are underfunded and lack resources, there will be no foot soldiers on the ground to implement.”

Although, evidence suggests that mortality in H1N1 cases is not high, it’s extremely contagious and spreading rapidly across the US in a short period of time. “We don’t need the 1918 Spanish flu epidemic to have an incredibly big problem,” according to Harry Greenberg, MD. “If this is a routine pandemic, we will have emergency rooms overrun, and hospital intensive care units that don’t have enough ventilators. That’s what we should be thinking about at this point in time,” said Greenberg, professor of immunology and microbiology, at medical grand rounds.

Experts estimate vaccine development will take 4-6 months and its highly likely there won’t be enough available for all who want it. Because everyone is susceptible, Owens believes, “When you know little about a new influenza virus, you need to prepare for the worst case scenario and hope for it to be mild. It’s a big mistake to assume it’s mild before you have good evidence for that.”