Are we ready for a flu pandemic?
During a flu pandemic or other severe public health emergency, hospitals in the U.S. are likely to exceed their “surge capacity” – that is, the ability to effectively handle a large-scale, sudden influx of patients. Emergency departments may become flooded with sick patients as well as the “worried well,” or people who are not sick yet but fear they could get sick or are taking care of someone who is. As a result, high-risk patients in immediate need of medical attention will be delayed in accessing treatment.
The 2017-2018 flu season caused people to seek medical attention at levels near the peak of the 2009-2010 swine flu pandemic. By early March 2018, flu claimed the lives of 119 children and clinical laboratories had confirmed 178,241 positive influenza specimens. Nearly a decade ago, the novel 2009 influenza A (H1N1) virus caused an estimated 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths. Hospitals in the U.S. experienced an 18 percent increase in overall emergency department visits, and a doubling of pneumonia and influenza emergency department visits compared with prior years. In the 1918 flu pandemic, there were over 50 million deaths worldwide and over 675,000 deaths in the U.S. alone. Future pandemics are predicted to cause at least 3 million hospitalizations and tens of millions of people to seek care. These daunting numbers make clear that hospitals alone cannot handle the surge demands in a public health emergency.
What’s the solution?
Given the volume of patients that are anticipated to seek care, an integrated approach to leverage the U.S. healthcare system is needed to support overflow in hospitals and long-term care facilities, provide access to antivirals, and educate those who may not need emergency or critical care. Traditional preparedness planning for pandemics has focused on increasing hospital readiness. With less than 6,000 hospitals nationwide, and building upon expert recommendations of a “systems” approach to emergency planning and response and national recommendations for local health systems to collaborate on emergency preparedness efforts, community-based healthcare centers and clinics are needed to be part of the solution to increase available capacity of health care services. These centers and clinics, including Federally Qualified Health Centers (FQHCs), must maximize opportunities to integrate into local emergency response collaborations. FQHCs and other community health centers, which serve as a major source of primary care to vulnerable populations nationwide, are essential components of an effective response to a severe pandemic or disease outbreak.
Since 2012, NNPHI has partnered with the Research & Evaluation Group (R&E Group) at Public Health Management Corporation (PHMC), the National Nurse-Led Care Consortium (NNCC), a PHMC affiliate, and the Centers for Disease Control and Prevention (CDC) to explore ways to engage community health centers to effectively address large scale public health emergencies. PHMC, housed in Philadelphia, is one of the largest public health institutes in the country. NNCC is a non-profit organization that represents hundreds of nurse-managed health clinics around the country and provides its members with technical assistance and consultation services. Together with CDC, these organizations and other strategic partners are leveraging community-based health centers and clinics to improve national public health preparedness efforts.
How can health centers help?
To better understand how health centers can provide assistance during a flu pandemic or other disease outbreak, R&E Group, NNCC and CDC conducted a comprehensive needs assessment in 2017 that included a poll of health centers nationwide related to emergency preparedness. Of the 1,376 health centers that received the poll, 391 responded, with the majority indicating that they have a written emergency preparedness plan and provide emergency preparedness training to staff. Less than half of respondents, however, indicated that their centers provide training on pandemics and outbreaks, and another 7% reported that they are unsure if their trainings cover pandemics at all. Roughly one-quarter of respondents rated their health centers as “completely ready” or “almost ready” to respond to a pandemic or disease outbreak, while 32% reported that they are “not quite ready” or “not at all ready.”
R&E Group and NNCC are currently developing and delivering resources to health centers to address the needs identified by health centers in the assessment. In spring 2018, NNCC hosted a webinar training series about building a culture of preparedness in the health center setting. The trainings explored the requirements of the CMS Emergency Preparedness Final Rule; methods to bolster health center staff capacity and readiness for an outbreak; and ways to advance the health center role in local emergency response efforts. The team also recently released a series of Health Center Stories, chronicling the first-hand accounts of five health centers across the U.S. that handled outbreaks of influenza, HIV, and pertussis.