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Lessons from the Frontlines

June 8, 2009

swineflu Last week, the Trust for America’s Health, the Center for Biosecurity, and the Robert Wood Johnson Foundation published a document reviewing the initial response to the swine flu called Pandemic Flu: Lessons from the Frontlines.

I think it’s a great document, and functions very well as a “while the iron is hot” identification of chronic problems in public health emergency response and preparedness. While that description might seem a bit self-serving and underhanded, the folks at Trust for America’s Health put out a huge report every year that raises most of these points. They’ve put in the time, pointed out the glaring problems, over and over, so I give the authors kudos for not calling the report, “Pandemic Flu: See? I Told You So!”

As always, I encourage you to download the report (pdf) and read for yourself, but in lieu of that here’s my take.

The report is divided into two sections: lessons learned (a set of ten), and recommendations (another set of ten, coincidentally). The lessons learned are among the better that I’ve seen this early, and while I totally expect future lessons learned documents to get more in depth, this is a great quick review (of the pandemic that is still going on, mind you). On to the lessons:

  1. Investments in pandemic planning and stockpiling antiviral medications paid off;
  2. Public health departments did not have enough resources to carry out plans;
  3. Response plans must be adaptable and science-driven;
  4. Providing clear, straightforward information to the public was essential for allaying fears and building trust;
  5. School closings have major ramifications for students, parents, and employers;
  6. Sick leave and policies for limiting mass gatherings were also problematic;
  7. Even with a mild outbreak, the health care delivery system was overwhelmed;
  8. Communication between the public health system and health providers was not well coordinated;
  9. WHO pandemic alert levels caused confusion; and
  10. International cooperation was more complicated than expected.

The quick and dirty? See? We told you so! A bit more in depth? It’s a good thing we’ve done some planning, because if this would’ve been any worse, we’d be up a creek with a paddle. From mounting a response, to providing care, to informing the public, to implementing those plans we have written–we reached the breaking point (and mind you, the outbreaks are still going on, and getting worse in many places). Obviously, the ones that I’m most interested in are #4 and #8, but understand that #2, #7 and #10 are probably the most important, followed by #3, #5 and #6, then mine. We’ve got a ton of work to do, and none of it will be easy.

So, where can we start? Well, here are ten good places:

  1. [Continue m]aintaining the Strategic National Stockpile;
  2. [Enhance v]accine development and production;
  3. [Plan for v]accinating all Americans;
  4. [Improve p]lanning and coordination [at all levels of public and private enterprise];
  5. [Improve the planning around s]chool closings, sick leave, and community mitigation strategies;
  6. [Encourage g]lobal coordination;
  7. [Provide r]esources;
  8. [Stabilize and expand the public health w]orkforce;
  9. [Improve the s]urge capacity [of health providers]; and
  10. [Ensure care] for the uninsured and underinsured.

Like I said, a tall order. Obviously, there’s a ton of work that needs to be done to improve our planning, at all levels, all the way from the international level down to the level of a single community health care provider. So, again, where should we start?

I would argue that the first thing that needs to be done is to bring everyone to the table–to all of the tables. Hospital emergency preparedness staff should bring everyone in for a hotwash. Public health departments should pull those pandemic plans off the shelf and point out where the the pinch-points were–where specifically did we run into problems and what do we need to do to make sure that everyone can do their jobs even with a proposed 30% absentee rate. Then the public health departments should pull together stakeholders from all of the industries and partners and government agencies and school districts and go through the same exercise. This should happen at both the state and local levels. The feds should conduct the same operation, but include the states on all of these meetings. And  they should reach out to the international community, including neighbors, places where we frequently get travelers from as well as WHO and start reviewing everything. In the Congress, there should be hearings. There should be funding approved and sent to the White House for disbursement. The Public Health Workforce Act should be voted on immediately and implemented in full force.

Holding your breath? Yeah, me neither. But since most of my readers live at some level of response organization/government agency/interested party there’s no reason that we can’t start with those internal meetings first. This is the scariest thing to come along in a long while, and as you see from my last post, it has the potential to get a WHOLE lot worse.

Image from the report

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