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As Sen. Mark Pryor said when chairing a U.S. Senate hearing in October, “Pandemic Influenza: State and Local Efforts to Prepare,” to most people the idea of a pandemic flu outbreak is somewhat abstract.

“Most of what we’ve seen in the media so far portrays bird flu as an animal disease, not a human one,” Pryor said. “It usually breaks out in countries on the other side of the world. Nonetheless, the disease is worrying. To date, 329 people have contracted avian flu. Two hundred and one of them have died. That’s a 61 percent death rate.”

Pryor said doctors and scientists across the world worry that if a disease with these characteristics mutated into a contagious human disease, it would quickly circle the globe and overwhelm public health systems.

“In the most severe estimates, the disease could kill up to two million Americans,’ Pryor said. “It could also cost our country hundreds of millions of dollars. We can all imagine overflowing hospitals, constant CNN updates, and a growing feeling of panic and desperation among citizens.”

Officials at the Arkansas Department of Health say it isn’t a matter of “if” the country experiences a flu pandemic, but “when”. That makes it critical that preparations be made to limit the spread of the flu and provide the best possible medical care to people who get sick.

Dr. Paul Halverson, director of the Arkansas Department of Health, who testified at the hearing in Washington, D.C., said physicians in the state can play a vital role while helping prepare for a flu pandemic.

“One of the most important things physician partners could do to is to continue to encourage patients and families to be vigilant around seasonal flu,” Halverson said. “Seasonal flu and pandemic flu are two different things, but we still have 36,000 people per year die from seasonal flu. If we can get people used to the idea of every year getting their flu shot, that provides a teachable moment for the physician when talking with patients to raise awareness about the flu.”

Physicians can also help by being cognizant of symptoms helpful in diagnosing a pandemic.

“We need good communication between practicing physicians and the health department,” Halverson said. “If physicians start to see a pattern in their practice, they need to get in touch with the health department so we can diagnose what might be a pandemic. If we move quickly during that period of time early in the pandemic to reduce public exposure by limiting public gatherings, we can have a profound impact on the spread of the disease.”

Hospitals, of course, will also play a critical role in a pandemic outbreak. Arkansas has 84 hospitals that have participated in the Hospital Preparedness Program since its inception in 2002. Many counties in the state have one facility serving all of the needs of that area.

“Because of the rural nature of Arkansas, access to care is a critical issue,” Halverson said. “If we were to experience a pandemic influenza, and assuming a 35 percent attack rate, approximately 500,233 of the state’s 2,800,000 citizens would become clinically ill, 11,167 would be hospitalized and 3,538 would die. We have 10,897 hospital beds and 2,000 physicians in active practice. This rate of illness would be extremely detrimental.”

Another issue is while most large companies have plans and supply lines in place to deal with emergencies, smaller companies often don’t. Small employers, which make up the bulk of businesses in Arkansas, will face major challenges if an estimated 40 to 60 percent of employees don’t come to work for various reasons.
“Small employers are going to have a real difficult time,” Halverson said. “We understand that creates a dilemma for them, but we need them to become more actively involved in planning. Small business owners need to think how to operate their business if there is an emergency. Now is the time to have this conversation. That is the whole value of preparedness.”

Halverson said one of the biggest challenges would be the ability to sustain basic needs such as electricity, food, water and other services during emergency events because the state’s smaller communities potentially lack the resources from a manpower perspective to support these services.

Dr. William Mason, chief of preparedness and emergency response for the Arkansas Department of Health, said the tight-knit rural nature of the state could also be an advantage in an emergency.

“Everyone knows everybody else,” Mason said. “We don’t need business cards to know people. We know them face to face or have talked to them in some fashion.”
Mason said it is important for physicians be very proactive with their hospitals and ask tough questions of the hospital CEOs and chiefs of staff regarding what is being done to insure there are resources such as respiratory equipment and oxygen supplies to accommodate a likely surge of patients during a pandemic.

“Physicians don’t want to face ethical dilemmas in the face of equipment shortages,” Mason said. “We don’t want that to occur because of lack of equipment and personnel. Hospitals must prepare for a potential pandemic that would bring with it a massive surge of patients. We want all hospitals to think about this. Physicians have to ask the hard question: ‘What would happen if we had such a massive surge? What is the hospital prepared to do?’ None of us want to be in the position of the physician in Louisiana after Katrina who had the sole responsibility for taking care of a large number of patients with no backup. Physicians need to be very proactive now. If not, we will face ethical dilemmas such as we have never experienced before.”

The state legislature has appropriated money to purchase emergency supplies of antiviral medications such as Tamiflu. The state has also purchased over $1 million worth of personal protective equipment to be used in case of emergency.
Plans have also been made to work on funding medical reserve corps training and equipment to be used in case of a flu pandemic or natural disaster. If hospitals are overloaded, the medical reserve corps could go out and take care of the sick. While the severity or mortality rate of a pandemic can’t be predicted, Mason is confident the state is well prepared to meet the challenges.

“I think Arkansas will do well,” Mason said. “We will get through this fine.”


December 2007

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