News + Events
Swine Flu: The Next Pandemic?
April 29, 2009
Steven "Steve" D. Gravely
Erin S. Whaley
As you have no doubt heard, seven countries have officially reported cases of “swine flu.” According to the
World Health Organization (WHO), “The United States has reported 64 laboratory confirmed human cases in New York, California, Kansas, Texas and Ohio. Mexico has reported 26 confirmed human cases of infection including seven deaths. The following countries have reported laboratory confirmed cases with no deaths – Canada (6), New Zealand (3), the United Kingdom (2), Israel (2) and Spain (2)." In response to these confirmed cases, the Acting Secretary of Health and Human Services (HHS) has declared a public health emergency to mobilize the federal government’s response to this epidemic. According to the HHS press release, this declaration will, among other things, “enable the FDA to review and issue emergency use authorizations for the use of certain laboratory tests to help detect the newly discovered strain of influenza and for the emergency use of certain antivirals.” Additionally, 25 percent of the nation’s stockpile of antiviral medication, approximately 12 million doses, has been released to the states from the Strategic National Stockpile.
On April 27, the World Health Organization (WHO) raised its Pandemic Alert Level from Level 3 to Level 4 in response to the fact that suspected cases have been reported from many countries. Level 4 indicates a significant increase in risk of a pandemic, but does not necessarily mean that a pandemic is a forgone conclusion.
The speed with which this swine flu has spread is impressive and has public health experts around the world very concerned. There is no way to predict if this swine flu event will become a pandemic or, if it does, whether it will be a relatively “mild” version or a more virulent strain. However, it is possible that the novel virus that has infected so many and spread so rapidly could become a pandemic. Healthcare providers are well advised to continue proactive planning and remain abreast of the rapidly evolving developments. On Sunday night, the Centers for Disease Control and Prevention (CDC), released interim guidance for non-pharmaceutical interventions for community mitigation of the swine flu (http://www.cdc.gov/swineflu/mitigation.htm). Specifically, the CDC recommends the following:
- Voluntary home quarantine for seven days after onset of illness or at least 24 hours after symptoms have resolved for individuals with influenza like illness.
- Individuals with influenza like illness should contact their healthcare provider via phone or other remote communication rather than going to the hospital or the doctor.
- Face masks are highly recommended for ill persons within 6 feet of others.
- School dismissal and closure of childcare facilities is strongly encouraged in communities with confirmed or suspected cases of swine flu. Some localities are already implementing this measure. New York City has closed schools for Monday (4/27) and Tuesday (4/28); 14 schools in Texas have been closed for at least the next week; and some schools in California, South Carolina and Ohio have also been closed.
These recommendations could have significant impacts on healthcare providers in terms of the call volume they experience and staff absenteeism if schools and childcare facilities are closed. To prepare to handle these impacts, healthcare providers should:
- Review, update and expand their existing pandemic influenza response plans, as needed; conduct rapid training for staff so that expectations are well understood; and prepare to mobilize the infrastructure needed to support the provider’s response.
- If planning has not already occurred, quickly consider how to respond to an influx of patients with influenza like illness and the “worried-well” who may be contacting healthcare providers in-person and by phone, as well as how it will alter standards of care if demand exceeds supply.
- Communicate with local and state health departments to understand the health department’s response to the current outbreaks, what the department expects of the healthcare provider currently (e.g. increased reporting of influenza like illness, more robust interviews with patients regarding travel history), and what the department is likely to expect of the healthcare provider if swine flu becomes a pandemic. Much of this information may be found in the department’s pandemic influenza response plan and updates issued by the department in response to the evolving situation.
There are numerous governmental resources that can help you with your pandemic planning and response to this swine flu outbreak.
Troutman Sanders has also developed comprehensive materials that address specific legal issues of importance to healthcare providers related to pandemic influenza:
- www.panfluplanning.com (This is a comprehensive guide to legal issues for healthcare providers that Troutman Sanders prepared on behalf of the New Jersey Hospital Association. It discusses a full range of legal issues that should be considered during a pandemic event.)
- Troutman Sanders’ legal whitepapers on compliance with EMTALA and HIPAA during a pandemic (available upon request)
- Troutman Sanders’ Critical Resource Shortages : A Planning Guide for Hospitals (available upon request)
Please contact Steve Gravely, Erin Whaley or Pat Elliott if you have any questions or would like to receive the materials referenced above.