Albany's Plan for Flu Epidemic Leaves Big Decisions to Localities
http://www.nytimes.com/2006/02/24/nyregion/24flu.html?_r=1&oref=slogin
By MARC SANTORA
Published: February 24, 2006
Each county in New York would be responsible for formulating its own response plan in the event of an outbreak of pandemic influenza in the state, according to the formal preparedness plan made public yesterday by the state's Department of Health.
While state health workers would offer guidance and help coordinate the response, the plan calls for critical decisions — like establishing quarantine measures and deciding whether to close schools and businesses — to be decided largely on a local level.
Almost immediately, the plan drew criticism from outside experts who contend that simply providing a template for localities without adequate resources in the form of equipment, money and expertise could prove disastrous.
"Someone at some point is actually going to have to step up to the plate and actually provide some actual resources to the localities," said Dr. Irwin Redlener of the National Center for Disaster Preparedness at Columbia University. "Every place in the state will be facing overwhelming challenges and need concrete support."
But Dr. Antonia Novello, the state health commissioner, dismissed criticism that the plan was lacking in detail and that too great a burden would be placed on the localities.
"All responses are local," she said. "We have a standardized template that everyone can build on and utilize."
It will be up to local communities to tailor the state plan to their own situations, she said, from issues as simple as communicating messages about the importance of basic hygiene to the distribution of medicines.
She noted that Gov. George E. Pataki's most recent budget asked for $29 million to be devoted to bolstering emergency supplies. She also said that the federal government had emergency stockpiles that could be used in the event of a pandemic outbreak.
At 400 pages, the state plan focuses on three main areas: early detection, prevention, and delivery of care. Dr. Novello acknowledged that the plan was evolving, and she said the goal was essentially to give the localities a framework so they could create their own plans. State officials, however, could not provide specific details on matters as basic as how many additional ventilators the state has or how much antiviral medication has been stockpiled.
The need to prepare for avian flu has taken on added urgency in recent months as a dangerous strain, H5N1, has spread from Asia to Europe. On Thursday, French health officials said that avian flu had possibly been found at a poultry farm. Millions of birds around the world have died, and about 170 humans have been infected, and more than half of them have died. The virus, however, has not been found to be easily transmissible from person to person.
Scientists are worried about the possibility that it could combine with a more common form of flu and become a rapidly spreading killer.
The federal response plan was unveiled in November, with President Bush calling for $7 billion to be devoted to preparation. Congress has since slashed that figure by about half, and about 90 percent of the federal money is being devoted to research on a possible vaccine and to buying Tamiflu, one of the only drugs now effective against avian flu.
The federal government said it was up to individual states to develop their own plans to receive financing, which is why New York State is making its plan public now.
New York City, which is developing its own plan apart from the state, receives money directly from the federal government for preparations to battle a potential pandemic flu.
Dr. Isaac B. Weisfuse, a deputy health commissioner who is leading the city's flu planning, said it would be very hard to develop one plan to cover the needs of wildly divergent departments across the state.
He said the city should be done with its plan within two months. "For New York City," he said, "clearly I feel we have to have ownership on the local level."
He said city officials were still wrestling with some of the difficult details painted over in broader strokes in the federal and state plans. One aspect the city is focusing on concerns voluntary isolation. "If you are ill, you should stay home — and we as government should provide guidance," he said.
Dr. Novello said that the state, in the event of a pandemic outbreak, wanted everyone to have at least a two-week supply of food, water and household goods ready.
While the city is developing its own plan, the quality of the health departments in New York's 62 counties varies wildly, so it is hard to know if they would be prepared in the event of pandemic flu.
The kinds of challenges the city and state may face were demonstrated in September, when the city ran a "tabletop" exercise involving more than a dozen city and state departments envisioning a situation similar to the outbreak of Spanish flu in 1918, which left at least 33,000 dead in the city alone. At least 20 million to 40 million people died worldwide.
The exercise was intended to test the emergency response system by challenging leaders to make quick decisions, and seeing if and where communication breaks down or resources run out. One major concern repeatedly expressed was that many health workers would simply fail to show up for work.
Dr. Redlener of the Columbia University center said that the state plan could more directly address staffing issues. For instance, he said that decisions should already have been made about whether day care centers would be set up in the hospitals. He also questioned whether it was really wise to move patients to hotels and dorms if hospitals got too full, a measure called for in the federal plan.
Susan Waltman, senior vice president and general counsel for the Greater New York Hospital Association, agreed that there were challenges, but she praised the state's efforts to develop a plan.
"I thought that the federal plan was a very good framework," she said, adding, "I think the state fleshes that out even further."
Others, however, criticized both plans for a lack of details. Dr. David Seaberg, a board member of the American College of Emergency Physicians, a national organization with 23,000 members, testified recently before Congress about what he said were shortcomings in the federal plan, and echoed those concerns about the state plan.
"With the majority of the nation's emergency departments already operating either at or over critical capacity, the strain of arriving avian flu patients would cripple America's 4,000 emergency departments," he said.
There is one really good thing about our MSM. They may be promoting agendas most of the time, but if there was a case of BF anywhere in the CONUS, they would be falling all over each other to be the first to report it. You got to love it!
