guthrie birkhead, md, mph - new york state department of health
TRANSCRIPT
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Allocation of Ventilators in an Influenza Pandemic
Statewide Videoconference
March 16, 2007
Pandemic Influenza Preparedness Planning
Guthrie Birkhead, MD, MPH
New York State Department of Health
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Source: MMWR 1999;48:621-29
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Influenza Pandemics:20th Century
Credit: US National Museum of Health and Medicine
A(H1N1) A(H2N2) A(H3N2)1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
50-100 m deaths675,000 US deaths
1-4 m deaths70,000 US deaths
1-4 m deaths34,000 US deaths
5Source: http://www.pandemicflu.gov/#map
Nations With Confirmed Cases of H5N1 Avian Influenza (March 2007)
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Influenza Pandemic Scenarios
• DHHS Plan – Moderate Scenario– 1957/1968 Influenza Outbreak– 35% Attack Rate
• DHHS Plan – Severe Scenario– 1918 Influenza Outbreak– 35% Attack Rate
NYS pop = 19.28 million
(2005 census estimates)
Moderate
(1957/68-like)
Severe
(1918-like)
Flu Illness (6 weeks)6.75 M
(35% of population)
6.75 M
(35% of population)
Flu Outpatient Visits
(6 weeks)
3.60 M
(53.3% of those ill)
3.22 M
(47.7% of those ill)
Flu Hospital Admissions
(6 weeks)
93,753
(0.5% of total pop, 1.4%
of those ill)
770,640
(4.0% of total pop, 11.4% of those ill)
Flu Hospitals Admissions
in peak week
19,688 (21% of total hospital
admissions)
161,834
(21% of total hospital admissions)
Flu Deaths* (6 weeks) 18,650 (0.28% of those ill) 153,301 (2.3% of those ill)
Estimated Impact of Pandemic Influenza (6-Week Period), NYS
*vs. 1400 flu deaths in an average season, vs. 17,500 total deaths in an average 6 week period
NYS pop = 19.28 million
(2005 census estimates)
Moderate
(1957/68-like)
Severe
(1918-like)
ICU care14,062
(15% of those hospitalized)
115,596
(15% of those hospitalized)
ICU beds in peak week4,342
(109% of available beds) *35,688
(896% of available beds) *
Mechanical ventilation7,031
(7.5% of those hospitalized)
57,798
(7.5% of those hospitalized)
Vents in peak week 2,171 (36% of all vents) ** 17,844 (293% of all vents) **
Vents: Projected Shortfall -1,256 ** - 16,929 **
Estimated Hospital Impact of Pandemic Influenza, NYS
*HERDS Critical Asset Survey = 3,981 staffed ICU beds.
**An estimated 85% of the 6,100 vents are routinely in use.
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Goal of Pandemic Flu Response
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Principles of New York’s Pandemic Influenza Response
• Early (prior to transmission in State)– Surveillance for illness in recent travelers– Rapid diagnostic laboratory testing– Isolation of ill persons and contacts– Health system and communities placed on alert
• Pandemic declared in State (person-to-person transmission)– Community containment or “social distancing” including school
closures, cancel mass gatherings, “work from home” and alternate work schedules
– Implement health care system surge capacity plan– Manage health care system assets– Mitigate societal and economic impacts
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Pan Flu Planning: AccomplishmentsState Health Department
• Helps develop and update the Pandemic Influenza Annex to the State’s “All Hazards” plan. Lead response with SEMO.– http://www.nyhealth.gov/diseases/communicable/influenza/pandemic
• Since 2003: 16 statewide, multi agency table tops and 18 full scale preparedness exercises
• Conducts human disease surveillance and lab testing.• Coordinates health care system response & EMS services• Maintains statewide electronic systems to issue health alerts (HAN) and
track health system resources (HERDS)• Maintains Medical Emergency Response Cache (MERC)
– 1 million antiviral treatment courses, 4 million surgical masks, 500,000 N95 masks, 850 ventilators, other medical supplies.
• Administers federal public health/hospital preparedness grants; liaison with federal emergency medical stockpile
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Pan Flu Planning: Accomplishments Health Care System
• Surge plan: stop elective admissions, discharge all stable patients from hospitals and nursing homes, expand number of staffed beds
• 8 Regional Resource Centers (RRCs) hospitals funded for regional planning. NYC hospitals funded separately
• Regional surge plan (500 beds per 1 million pop)• Develop lists of volunteer physicians and nurses• Alternate site care planning, including home care• Ventilator allocation protocol roll out• Drills & Exercises
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HospitalIncident Commander
Local EOC(Emergency Manager)
State EOC
DOH(Unified Health Command)
HERDS
Hospitals report ventilator data
DOH uses data for resource allocation decision making
Ventilator Requests in a Pandemic
Networks, MOU’s, and vendor sources have been exhausted
Ventilator resources: national stockpile, statestockpile, redistribution of assets
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Pan Flu Planning: Accomplishments “Live Fire Exercises” – i.e. Seasonal flu
• 2004 – managed flu vaccine shortage• Disease surveillance and outbreak control
– Lab reporting, HERDS reporting of hospital bed reporting, drug utilization
• Supply antivirals from MERC• Vaccination “point of dispensing” (POD) drills• Electronic health alert system utilized (HAN, HPN)• Ambulance diversion• Hospital bed management, cohorting
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Pan Flu Planning: Ongoing Challenges
• 1918-style pandemic would overwhelm current healthcare planning (500 surge beds per million)
• Pharmaceutical interventions: – Vaccine would not be available for 6 months:
and then only limited supply (e.g. 100K doses per week)– Antivirals would only be available for treatment, not prophylaxis
• Non-pharmaceutical interventions (community containment):– Social distancing/school closures/ban mass gatherings
• 35% illness rate and higher rates of absenteeism would strain infrastructure functioning at all levels
• High number of deaths would strain mortuary capacity as well as societal resolve.
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Pan Flu Planning: Ongoing ChallengesMedical Surge
• Locate, equip and staff surge beds• Volunteer/retired health care workers• Provide care in home/community settings• Protocols for ethical rationing of limited
resources– Ventilator Triage protocol
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Contact Information
NYSDOH email for comments:
Websites for more information:
State: www.nyhealth.govFederal www.pandemicflu.gov