Monday, August 07, 2006

Are hospitals ready for a flu pandemic?

Are hospitals ready for a flu pandemic?
Editor's note: This is another in an occasional series exploring how the suburbs and state are preparing for the possibility of a deadly flu pandemic.

BY MARNI PYKE and DAVE ORRICK
Daily Herald Staff Writers
Posted Sunday, August 06, 2006

A Daily Herald survey of suburban hospitals shows many aren't fully prepared for a potentially deadly flu pandemic - a situation that reflects a national trend.

Seventeen medical centers were surveyed on their readiness for a global epidemic in the wake of concerns about avian flu. Another seven hospitals declined to take part in the study, which was based on recommendations by the federal government.

Results for the 17 medical centers that did participate, indicated that although some were well on the way to preparedness, others lagged behind.

The survey found shortfalls in critical areas.

• More than 40 percent of hospitals did not have complete plans for allocating life-saving medical resources to patients in the event of a pandemic.

Mark Welsh/ Daily Herald
The Alexian Brothers Medical Center ER prepares for a pandemic flu by staging a Code Three Drill.


• Nearly 60 percent hadn't conducted an avian-flu-specific drill.

• At total of 18 percent answered yes to all the survey questions.

"I think if anything, your survey shows we better hope there isn't a pandemic in the near future because the system isn't ready," said Jeffrey Levi, executive director of the Trust for America's Health, a nonprofit national organization that focuses on epidemic prevention.

However, other experts gave suburban hospitals higher grades, given the state of readiness nationwide and the exorbitant costs involved.

Right now, avian influenza is not a pandemic. But international scientists are cautiously tracking the spread of the H5N1 strain of bird flu.

More than 100 people, mostly in Asia and Africa, have died as a result of contact with infected birds, according to the World Health Organization. The virus has left an estimated 150 million birds dead.

Avian flu doesn't easily transmit between humans. The fear is if H5N1 mutates to a virus that spreads quickly from person to person, millions could die worldwide.

That's why health experts say it's essential hospitals be prepared for the worst.

"Pandemics have occurred many times in the past. They do occur and will occur in the future," said Dr. John Agwunobi, assistant secretary of health with the U.S. Department of Health and Human Services. "Therefore it is important that every part of the world prepare for and stay prepared for a pandemic."

Yet, "No matter how much preparation we do, it will be a very bad situation," Levi said.

No sense of urgency

Imagine a deadly disease spreading rapidly through the metropolitan area, infecting hundreds and killing 44 people, including two nurses and a doctor, within five months.

It sounds like a movie of the week, but it played out for real in early 2003 when severe acute respiratory syndrome, or SARS, made a deadly appearance in Toronto.

Brought to Canada by a woman returning from Hong Kong in February 2003, the virus wasn't identified for weeks. By that time, many medical workers had fallen sick after caring for SARS patients.

"I think SARS was a wake-up call for many," Agwunobi said.

"SARS was global, so like a pandemic it threatened more than one nation. The other thing that made it unique was that it really was a hospital-based infection. It prompted greater attention to infection control in hospitals."

Since 2003, 134 people have died as a result of coming in contact with the H5N1 virus, according to the WHO. The latest fatality occurred July 24 in Thailand, when a 17-year-old man died 14 days after burying chicken carcasses.

Despite the grim statistics, pandemic expert Dr. Eric Toner fears some hospitals are asleep at the switch.

"Most hospitals haven't taken avian flu seriously. Most have not really drilled on it," said Toner, a senior associate with the Center for Biosecurity. The center, based at the University of Pittsburgh Medical Center, focuses on societal effects of infections and diseases.

"Almost no hospitals have the necessary resources to prepare for a pandemic," he said.

By the numbers

The Daily Herald's one-page questionnaire was based on a lengthy checklist issued early this year by the federal government. The analysis of the survey was conducted using data collected in May, June and July.

Among the hospitals that participated in the study, only 41 percent had conducted an avian flu-specific drill.

About 47 percent reported carrying out a related exercise or indicated that they intended to do so in the future.

Agwunobi recommended every hospital conduct a drill.

"The reason we conduct exercises is not to show what works," he said. "Exercises should be geared to find out at what point the system breaks down."

Many medical centers - 88 percent - had created plans to prioritize workers and offer them medications to lessen the likelihood of infection.

The study also showed more than 90 percent of hospitals had named an influenza preparedness coordinator.

However, just 67 percent of medical centers had set a threshold for how many avian flu cases it would take to activate emergency plans.

And, only 56 percent had tackled tough ethical issues, such as how to ration resources if hospitals are swamped with influenza patients.

Northwest Community Hospital is at a high level of preparedness, but Emergency Response Coordinator Mary Casey-Lockyer noted the Arlington Heights-based facility is still fine-tuning issues such as rationing ventilators - a situation she said reflects what's happening nationwide.

"We don't have very many ventilators in the country," she said. "It's a question of how we disperse them and how we triage patients - who gets a ventilator and who doesn't."

One of the many challenges medical centers face as they prepare is the lack of health-care workers, said Darlene Gallagher, infection control manager at Adventist GlenOaks Hospital in Glendale Heights.

"There's a shortage of nurses, respiratory therapists, pharmacists, radiologists," she said. "What happens when they get sick? You can have the greatest plan on the books but you have to have the people."

The saving grace, Gallagher noted, is that agencies such as the Centers for Disease Control and the World Health Organization are closely monitoring the spread of H5N1.

"We will know when the virus changes to become a pandemic. It's not something where tomorrow it would be in the Northwest suburbs," she said.

Overall, the Center for Biosecurity's Toner was impressed by the survey results.

"I think the 41 percent who have done an avian-specific drill is higher than the national average," he said.

But Toner pointed out answering "yes" doesn't necessarily indicate how thorough is the planning.

"The devil's in the details," he said.

The Daily Herald consulted with experts familiar with pandemic planning to make sure the study was informed, fair and filled with questions the public should know.

Still, seven hospitals either refused to participate or submitted a generic statement.

Centegra Health System, which runs two hospitals in McHenry County, was one such organization.

"We just don't feel that the survey is a fair indicator of our level of preparedness," said Melissa Matusek, Centegra spokeswoman.

Health-care experts contend that the more information made public about a potential pandemic, the better.

"No matter how much preparation we do, this is going to be a very bad situation," Levi said. "A public that has been warned will be much more accepting."

Toner agreed. "The public needs to know this information," he said.

'Mass confusion'

Across the country, health-care leaders are worried about inadequate funding and insufficient guidance for hospitals in the event of an influenza-type pandemic.

"Hospitals have the biggest burden to address, and it's going to take far more resources than the government is willing to put on the table," Levi said.

The Center for Biosecurity estimates it will cost $5 billion to get hospitals across the country "minimally" prepared for a severe flu pandemic.

Being truly ready goes beyond drills and protocols, Toner said.

"A lot of being prepared involves stockpiling things such as masks, gowns and gloves," he said. "That's very expensive and few hospitals have resources to put away serious supplies. It also involves stockpiling medications."

Condell Medical Center in Libertyville is one hospital in the midst of ordering negative-pressure tents to deal with a surge in capacity. These high-tech tents equipped with ventilation systems could be draped over a patient's bed and filter out contaminants before air is released in the open.

"We have 11 negative-pressure rooms, but if you have 30 or 40 patients, we wouldn't have enough," said nurse Emily Bergman, Condell's Infection Prevention and Control Program coordinator. One tent alone could cost up to $6,000.

Another dilemma is a lack of detailed guidance from federal or state agencies, some experts contend.

"You will find once a hospital gets its teeth into this issue, then it starts churning out more questions," said Dr. Charles Baum, vice president for health affairs at Alexian Brothers Hospital Network.

As an example of the "mass confusion" being experienced by hospitals, Baum cites debate over flu vaccines. In the event of a pandemic where vaccines are mandatory, it's unclear who carries the insurance liability if someone falls sick as a result.

"Nationally, no one is stepping forward and saying, 'We'll relieve you of your liability for vaccination,'æ" Baum said.

Agwunobi said government agencies are issuing guidelines on a regular basis but pandemic readiness is a broad field and all the questions can't be answered at once.

Another uncertainty is paying for the uninsured.

"We have a large number of uninsured people, and we want them to come and get care," Levi said. "If hospitals take care of these individuals, the government needs to step forward and say costs will be covered. We want hospitals to be financially viable at the end of the pandemic."

Toner acknowledged that the federal government can't handle the financial burden alone. "It's (funding) got to come from a variety of sources, he said.

Agwunobi said Congress already has given out $325 million for hospital preparedness and another $250 million is on the way.

"States, local governments, the federal government - we should all be involved in a partnership to strengthen the system," he said.

Agwunobi avoided criticizing hospitals that refused to participate in the Daily Herald's study.

He said the checklist is voluntary and each hospital is unique. "The key is going to be having hospitals working closely with each other."

Overall, the state is in good shape, said Jay Bogdan, deputy director of the Illinois Department of Public Health's Office of Preparedness and Response.

"We are more prepared today than we were five years ago," he said, "and we continue to get more prepared."

Toner also saw signs for optimism. "Hospitals are beginning to get the message," he said. "Even if they're not doing what we think is necessary, they are drawing up plans and doing drills and that's at least a step in the right direction."

Daily Herald staff contributed to this report.
dailyherald.com

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