H1N1 Outbreak Shows Flaws in Pandemic Preparedness, Says Report

A new report from the Trust for America's Health gives U.S. public health officials high marks for communication, coordination and ability to adapt to a rapidly changing situation during the recent outbreak of novel H1N1 influenza, but the report (24-page PDF; About PDFs) also says the outbreak revealed that the nation's public health capacity would be overwhelmed by a more severe or widespread outbreak.

"H1N1 is a real-world test of our initial emergency response capabilities," said Jeff Levi, Ph.D., executive director of the Trust for America's Health, in a June 4 news release. "All of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago.

"However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."

The report, "Pandemic Flu Preparedness: Lessons from the Front Lines," says that investments in pandemic planning and stockpiling antiviral medications proved worthwhile, but public health departments lacked staffing and other resources needed to carry out plans. Specifically, state health departments lacked adequate ability to track, investigate and contain the disease outbreak.

According to the report, which was developed in conjunction with the Robert Wood Johnson Foundation and the Center for Biosecurity at University of Pittsburgh Medical Center, the nation has 50,000 fewer public health workers than it did 20 years ago, and it calls on federal, state and local governments to recruit, train and retain the next generation of workers.

The report also says that although the outbreak has been mild in the United States relative to what originally was feared, the health care delivery system still has been overwhelmed. Outpatient facilities had inadequate personal protective equipment and limited understanding of infection control measures.

In addition, although the "worried well" overburdened many emergency departments, concerns about health care costs were a barrier for some patients, especially the under- and uninsured, who did not seek early care.

Some physicians reported that they did not receive guidance documents in a timely fashion from the CDC, and others complained that the guidance they did receive lacked clinically relevant information and practical instructions.

Despite the criticisms, Anne Schuchat, M.D., interim deputy director for the CDC's Science and Public Health Program, said the extensive report was helpful because it identified what has worked and what did not.

"This is the kind of review that we really encourage organizations and communities to do to think about where the gaps are and what we need to do to strengthen those gaps," Schuchat said in a June 4 news conference. "As we've been saying, this is not over."

On June 5, the CDC reported that there were more than 13,000 confirmed and probable cases of novel H1N1 infection in the United States, including 27 deaths. The World Health Organization reported on June 8 that there were 25,288 laboratory-confirmed cases, including 139 deaths, in 73 countries.

Schuchat said the CDC is working with partners in the Southern Hemisphere to understand the course of illness there, while also making extensive preparations for the U.S. flu season this fall. Those preparations include consideration of potential vaccination, laboratory and epidemiologic needs.

In its report, the Trust for America's Health makes ten recommendations aimed at addressing core vulnerabilities in the nation's pandemic preparedness. Among those recommendations:

The report estimates that a pandemic could result in 45 million additional outpatient visits, with as many as 9.9 million patients needing hospitalization.