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Pandemic Flu Not The Chief Worry?

August 7, 2008

Revere, of Effect Measure, points us today to an article published in the CDC’s Emerging Infectious Diseases online journal entitled, “Bacterial Pneumonia and Pandemic Influenza Planning.”

The article aims to make the point that our current pandemic preparations, which focus mostly on vaccine development and distribution, are wrong based upon a re-examination of medical records from the 1918 “Spanish Flu.” The authors conclude that most of the deaths associated with the pandemic were caused by opportunistic bacterial pneumonia that swept in as people were recovering from bouts of the novel, but apparently not very deadly, flu. Even Anthony Fauci, director of National Institute for Allergy and Infectious Disease, says “We agree completely that bacterial pneumonia played a major role in the mortality of the 1918 pandemic.”

Wow, so where has the disconnect been? Literally billions of dollars have been spent in pursuit of defending against an outcome that might not have an adverse effect?

I’m not so sure–and apparently, neither is Revere. Even if most of the deaths during the Spanish flu died from bacterial pneumonia acquired following an influenza infection, the fact remains that most of the people who died were infected with influenza. Decreasing the rate of flu attack would have teh benefit of reducing the number of pneumonia infections and thus, deaths. And assuming that penumonia was a chief cause of death isn’t exactly cut and dried:

For example, they consider the most cogent item the opinion of contemporary observers that most deaths were due to bacterial pneumonia, although these observations were made in an era prior to the discovery of the influenza virus. That a lot of smart people identified bacterial infection and isolated common respiratory tract bacteria from autopsy cases is neither surprising nor is it very informative.

So, what should we do about it? The authors call for more money to be spent on stockpiling anti-microbials and prophylaxing with pneumococcal vaccine. I wonder about the utility of that approach, though, as we should with all stockpiling strategies–the question needs to be asked, is there a better way to do this? And I would argue that there is. Our current pandemic preparations encourage non-pharmaceutical measures, especially social distancing strategies. Coupled with increased surge capacity (of which one part is stockpiling of medications and medical materiel), it becomes possible to effective respond to a pandemic. Decrease demand (read: susceptibility via infectiousness) and increase supply (read: amount of medical care that can be given) and the price (literally) of the disease will go down.

The authors may have hit on an important facet of influenza pandemics, that secondary infections may prove to be just as deadly as the primary infection. And that should be considered when planning a suite of pandemic response.

The primary way to plan for a pandemic situation should be to reduce the transmissability and infectiousness of the disease. By encouraging social distancing, hand washing and other non-pharmaceutical interventions, you can hopefully prevent the transmission of the diseaes. The secondary plan should be to lessen the burden of the disease to those afflicted through increasing surge capacity, developing means of vaccine and anti-viral and anti-microbial development and distribution. In the emergency management field, that’s called mitigation. In pandemic planning, it’s called the way it should be.

Photo credit: tinkernoonoo

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