State plans for pandemic influenza

Conventional wisdom in the public health realm is that it isnâÄôt a matter of IF a pandemic influenza is headed our way. ItâÄôs WHEN. Minnesota, like many other states, has begun to answer big picture questions such as, âÄúwho will get treated,âÄù and âÄúwho will have access to scarce resourcesâÄù during a pandemic. A pair of reports addressing those questions, prepared by the Minnesota Pandemic Ethics Project, is now being circulated for public comment until March 16. âÄúThese questions are too hard and too foreign to be asked and answered with any great comfort in a crisis,âÄù said Ellie Garrett , assistant director for health policy and public health at the Minnesota Center for Health Care Ethics âÄî one of the co-authors of the study. âÄúThatâÄôs why we should do it now.âÄù The state commissioned GarrettâÄôs group, along with the University of Minnesota Center for Bioethics to discuss how best to ethically ration scarce resources, such as vaccines and medications, during a pandemic influenza. Pandemic influenza occurs when a âÄúnovel virus,âÄù or strain of influenza that people donâÄôt have a pre-existing immunity to, develops and is spread easily from person-to-person, said Deb DeBruin, associate director at the Center for Bioethics. There have been three pandemics in the last century, she said, in 1918, 1957 and 1968, all ranging in severity. âÄúWe want to hear from anybody who wants to have input in the process,âÄù she said. âÄúThese are decisions that potentially affect everyone.âÄù Among the issues addressed by the group were questions about whether to treat illegal immigrants or people who were residents of other states. But, âÄúthe virus isnâÄôt going to make distinctions about whoâÄôs here and why,âÄù Garrett said. In the end the group worried too much about dividing society by those lines and, âÄústayed way the heck away from making those kinds of determinations,âÄù Garrett said. Age was another issue that arose in the discussion about rationing, one which they hope the community will weigh in on. The hope is at the end of the revision process, the state will have a pandemic flu plan that âÄúreflects common values among us as Minnesotans,âÄù Garrett said. ThereâÄôs no way to tell how severe the next pandemic will be, Dr. Ruth Lynfield , the stateâÄôs epidemiologist, said. But the state often uses the 1918 pandemic as a model. If the next pandemic is of similar severity, about a third of the population would fall ill, she said, or about 1.5 million Minnesotans. Just over 2 percent of the cases would be fatal, Lynfield said, resulting in just less than 33,000 deaths over a two-year period. And while college students may believe their young and healthy bodies will keep the virus at bay, Lynfield said that very quality could act against them. Regular seasonal influenza sees a very low fatality rate, mostly affecting the very old and the very young, resulting in a âÄúU-shapedâÄù death curve, she said. But in 1918, the death curve was âÄúW-shaped,âÄù indicating that death rates were higher among 15 to 40-year-olds. Lynfield said the robustness of their immune systems likely caused their bodies to overreact to the unknown virus. Thanks the UniversityâÄôs recent brush with fame for breaking the Guiness Book of World Records record for number of flu shots given in one day, they now know exactly what they are capable of in terms of mass dispensing , Dave Golden , director of public health and communications at Boynton Health Service, said. Boynton administered 11,810 flu shots (for seasonal influenza ) in one day and âÄúwe know we could have upped it further,âÄù Golden said. University students may be encouraged to limit their exposure to other people during the pandemic, Lynfield said âÄî which may be difficult, considering students live in tightly-packed dorms, ride over-crowded buses and attend classes with hundreds of other students each day. Some students may ultimately leave school in the event of a pandemic, Golden said. âÄúThey should take a look at (the draft recommendations) and do a little planning in advance,âÄù he said, meaning students should decide with their families in advance what should happen during a pandemic. Both reports, one on rationing and one on implementation, are available by clicking here. and the community can comment directly through the website.