Challenges to Hospital Medical Preparedness and Response in a Flu Pandemic
By Richard Waldhorn, MD and Eric Toner, MD, October 13, 2005 

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An influenza pandemic has the potential to become a mass casualty event and quickly overwhelm the capacity of hospitals and the healthcare system to respond. HHS should include strategies for hospital preparedness in pandemic influenza planning, as improvements in hospital preparedness will be critical in caring for the sick and preventing the spread of the epidemic.

Caring for the Sick

• With few exceptions, hospitals are unprepared for a major flu pandemic and are not involved in national, state, or local planning efforts.
• Hospitals do not have sufficient supplies of masks and gowns to protect their staff or prevent the spread of flu between patients.
• Hospitals are chronically short of staff in normal times. In a pandemic, it is likely there will be a critical shortage of available healthcare workers due to illness, quarantine, fear, or caretaking of sick family members. Hospitals do not have realistic plans to augment staffing.
• Hospital surge capacity (the ability to cope with surging numbers of patients in excess of normal patient demands) is very limited, but not primarily because of space concerns. Hospitals will run out of staff long before they run out of beds. Sport arenas, hotels, or other nonmedical facilities would be of limited value given the likely staff shortages and the absence of key medical infrastructure (e.g., availability of medical gases, pharmacies, laboratories, medical supplies, etc).
• Medical care of pandemic flu patients should be carried out at home to the greatest extent possible so that hospitals can focus on the sickest patients.
• There will not be enough Tamiflu or vaccine to protect most healthcare workers.
• In response to the surge of flu patients, other necessary medical services will need to be deferred, delayed, or curtailed, with resulting negative consequences.

Preventing the Spread of Flu

• Hospitals will be a major source of transmission of pandemic flu, as they typically are in contagious disease outbreaks.
• Hospitals do not have enough isolation rooms for even a tiny fraction of the number of contagious flu patients anticipated in a pandemic.
• Most hospitals do not have plans to screen and isolate infectious patients on arrival.
• Quarantine—that is, cordoning off large areas (e.g., cities, regions) that contain infected individuals—will not work for an influenza pandemic. Because flu is contagious before symptoms start and can have an incubation period as short as one day, some people will be contagious before they know they have been exposed. Also, a significant percentage of people infected with (and transmitting) flu may have no symptoms; therefore, those who have been exposed to them cannot be identified.
• Social distancing is likely to be useful. In a community setting, flu is transmitted mostly by respiratory droplets that typically travel only 3 to 6 feet. It is likely that transmission can be significantly reduced by having people avoid crowded spaces, unnecessary meetings, and large gatherings.
• Routine use of masks and frequent hand-washing by the general public are proven ways to reduce the spread of influenza and should be strongly encouraged.

Prepared by the Center for Biosecurity of UPMC, for a briefing on Capitol Hill, October 12, 2005, co-sponsored by Trust for America's Health (TFAH), Senator Barack Obama (D-IL), Senator Olympia J. Snowe (R-ME), Congresswoman Nita M. Lowey (D-NY), the Infectious Diseases Society of America (IDSA), and the Center for Biosecurity of UPMC.