Academic journal article Homeland Security Affairs

Surviving the 'Storm': Expanding Public Health's Capabilities in Response to the Increasing Threats Posed by Novel, Pandemic Strain Viruses

Academic journal article Homeland Security Affairs

Surviving the 'Storm': Expanding Public Health's Capabilities in Response to the Increasing Threats Posed by Novel, Pandemic Strain Viruses

Article excerpt

Introduction

While the Ebola crisis in Africa has recently captured the media's attention, influenza and other pandemic strain viruses remain by far the largest killer viruses facing the U.S. Seasonal flu-associated deaths in the United States have ranged from about 3,000 per season to about 49,000 per season.1 Over the span of fifteen years public health has witnessed a series of pandemic viruses. In the late 1990s the world watched the emergence of the H5N1 avian influenza virus (that continues to smolder in Asia). In 2003 the SARS coronavirus erupted out of southeast China. And in 2009 the H1N1 influenza pandemic emanated out of Mexico. The recent emergence of two separate and concurrent outbreaks of two new viruses- the H7N9 type-A influenza emanating from southeastern China and, the Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) coming out of northeastern Saudi Arabia- has generated renewed interest in the threat of pandemics.2 Science tells us that these naturally occurring pandemics are both normal, and to some extent, cyclical: it is not ca matter of 'if' humanity will see some sort of pandemic strain viral pandemic, but 'when.'3

Although the 1918 Influenza and 2003 SARS Outbreak are separated by eighty-five years and decades of medical advances, the biological processes that take the lives of those who succumb to either of these illnesses are quite similar. Each of these infections is an invasion of a novel virus into the human body's respiratory system. For a significant portion of the total fatalities associated with each of these infections (some researchers have attributed as much as 50%), the cause of death was often described as 'viral pneumonia' as opposed to traditional bacterial pneumonia. In the intervening years since the 1918 event, physicians have developed a term for this pathological process that puts extreme stress on the lungs: Acute Respiratory Distress Syndrome (ARDS). Almost unique to each of these illnesses, this syndrome is an over-reaction of an infected body's immune system to contain and defeat an invading pathogen.4 For this reason, we will consider novel influenza and novel pandemic strain viruses together in this manuscript since they pose a similar treatment conundrum.

Since the SARS outbreak in 2003, there has been a vast amount of research devoted to developing treatment strategies to combat ARDS. The literature on the effectiveness of these emerging treatment strategies is mixed at best, but several of them may be useful for treating future novel viruses. Many states have existing stockpiles of medications originating from the CDC release in preparation for the 2009/2010 H1N1 epidemic.5 Stockpiles are a difficult question for states to tackle because they are often for illnesses that may not yet exist (e.g. a novel strain that has yet-to-mutate), they require a sizeable investment of resources upfront, and they require sizeable time/effort/resources to properly maintain over long periods. While we do not address all of these state-specific fundamental issues, we do examine potentially useful options for a state wishing to supplement its existing stockpile of medications to provide some capabilities when confronting ARDS. This research is the first attempt to plan policy for this type of scenario.

Pandemics are of particular concern because disease is truly widespread, typically global, and frequently associated with a more virulent strain of virus (with the ensuing increase in fatality rates). Even if one of these novel influenza or pandemic strain viruses is only affecting a single country or state, there is still concern because the treatments required may quickly overwhelm existing capabilities. Depending on the ability to obtain supplies rapidly in an epidemic, it may become necessary to consider developing stockpiles. While the private sector health care system provides medical treatments, it is not required to maintain a stockpile of prescription medications or personal protective equipment. …

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