The next pandemic will be unlike any other before because of the increased interdependence of the world, and “every country will be compromised by what they can do,” says a leading US public health expert.
Michael Osterholm, an expert in preparing for pandemic and bioterrorism incidents, was speaking to 350 of the world's flu experts attending an annual conference, Seasonal and Pandemic Influenza 2007, on 1-2 February, at a hotel near the Pentagon in Washington, DC.
“Today we are at the pinnacle of a global ‘just in time' economy. It is based completely upon efficiency, lack of redundancy, and it has virtually no surge capacity,” Dr Osterholm said. “It is this collateral damage that will magnify the impact of the pandemic many many times over.”
He offered several examples. “Over 80% of all pharmaceutical products used in the US [United States] are made off shore … many of these critical products will dry up, literally overnight.”
A petrochemical plant cannot operate safely if it loses 20-30% of its workforce. If that happened it would have to shut down. But oxygen is a byproduct of the petrochemical industry, and most hospitals have at best a few days supply.
As late as the 1960s, 70% of the food in the average US food shop was grown, processed, and tinned within 150 km. Today, a growing portion comes from overseas. “We will have major food shortages overnight.”
Because of this interdependence, Dr Osterholm urged attendees to take a global rather than a national approach in preparing for a possible pandemic. “It is not about being altruistic, it is about saving our own tails.”
The US Centers for Disease Control and Prevention released pandemic flu guidelines to states and cities. They stage pandemics into five categories depending on their level of severity, based upon a similar system used to alert the public to the severity of hurricanes.
John Bartlett, infectious disease specialist at Johns Hopkins University, called the US healthcare system “fragmented, competitive, disorganised, and broke. We are about the only country in the developed world that doesn't own its healthcare system, and therefore trying to organise this becomes almost impossible at a central level.”
He pointed to Toronto and Hong Kong as examples of good planning, based on their experience dealing with an outbreak of severe acute respiratory syndrome (SARS). Studies from the Canadian province of Ontario show how more rapid diagnoses of respiratory infection lead to better management of those infections.
Anthony Fauci touted progress made in developing biochip technology to identify specific respiratory infections in a few hours. The goal was to achieve point of care diagnosis within minutes. The work is being supported by Dr Fauci's National Institute of Allergy and Infectious Diseases.
Richard Whitley, co-chairman of the conference and a paediatrician at the University of Alabama at Birmingham, said that early use of drugs such as oseltamivir (Tamiflu) was crucial to efficacy.
“If you introduce therapy within 12 hours of the onset of disease, you accelerate the resolution of all clinical symptomatology by six days. In contrast, if you wait until 24-48 hours, you only decrease the duration of disease by 2-3 days.”
But that would need a change in clinicians' attitudes, a reporter with young children said: “Have you ever tried to get a small child with flu-like symptoms to a paediatrician within 12 hours? Do you know what they tell you to do? To wait three days.”
Dr Whitely acknowledged, “We are doing a horrible job of educating paediatricians regarding the potential value of oseltamivir. That is why the American Academy of Pediatrics is endorsing this meeting.”