States and Cities Lag in Bird Flu Readiness - New York Times

[ Originally published 2/6/06 -- How are we doing on this one?
To my knowledge, hospital surge capacity is less than it was 18 months ago. ]

States and Cities Lag in Bird Flu Readiness
February 6, 2006
New York Times

By DONALD G. McNEIL Jr.

High-points:

WASHINGTON, Feb. 2 — The nation's 5,000 state and local health departments are rushing to plan for an epidemic of avian flu, but they say they are hobbled by a lack of money and guidance from the federal government.

"It's a depressing situation," said Jeffrey Levi, a flu expert at the Trust for America's Health, a nonpartisan health policy group. "We are way, way behind."

"..That $350 million sounds like a lot, but divided among 5,000 health departments, it's only $70,000 each," ...

"If we prepare now," Dr. Gerberding said, "we may be able to decrease the death rate and keep society functioning."

Dr. Harvey V. Fineberg, president of the Institute of Medicine, the medical arm of the National Academy of Sciences, was more pessimistic. "We're completely unprepared," Dr. Fineberg said...

There are few local stockpiles of even the simplest precautionary items, like masks and hand sanitizers, and none of expensive equipment, like $30,000 ventilators.

And many states are chronically short of public health money.

But Dr. Isaac B. Weisfuse, the deputy city health commissioner in charge of flu planning, said he expected the first wave of any pandemic to swamp city hospitals; 67 percent of all intensive care beds, he said, would be filled with flu victims.

Officials interviewed from a dozen states named questions on which they want federal guidance so they do not set different policies, including these:

¶When should we urge citizens to wear masks?

¶When should we close schools?

¶If a vaccine arrives, who gets it first?

¶When should patients be taken off ventilators?

Dr. Levi, of Trust for America's Health, gave an example of a dilemma that could arise at George Washington University, where he teaches: If a dorm had one infected student, should everyone else be sent home for their own safety, or padlocked in to keep them from spreading the virus to their hometowns?

"Right now, that's up to individual schools to figure out," he said. "That's no policy."

Thomas W. Skinner, a spokesman for Dr. Gerberding, the C.D.C. director, said, "These are tough questions that will take time to answer, and we'll work with the states to help them come up with answers."

The agency also realizes that health districts need more money for preparedness, Mr. Skinner said.

But the biggest danger, public health officials said, is the one over which they have the least control: hospitals in their regions, most of which are privately owned, cannot handle big surges of patients.

Dr. Roger P. Baxter, head of flu preparedness for Kaiser Permanente, said his Northern California hospital network was "probably better off than 90 percent of the health systems out there, and we have no surge capacity."

"We're a business, and we operate on a thin margin," Dr. Baxter said. "We don't have extra ventilators."

"Even in normal flu seasons," he added, "we tend to divert patients to other hospitals. There's no way we can realistically plan for this."