H7N9 Virus: Planning For the Next Pandemic

By Christina Thielst via Multibriefs

Most public health officials agree that the next pandemic is not a matter of if, but when will it arrive in the United States. And they have been closely watching China and the H7N9 virus.

Since March 2013, China has reported human infections from an Asian-lineage avian influenza A virus — H7N9. Annual epidemics of sporadic human infections have occurred there each year, with the latest (the fifth) being the largest to date. Those infected suffer from severe respiratory illness.

Public health officials around the world are concerned because of H7N9's virulence: 88 percent of those infected developed pneumonia, 68 percent were admitted to an intensive care unit, and 41 percent died. Most identified cases resulted after exposure to poultry, but there has also been some limited person-to-person spread in China.

While the current risk of the H7N9 virus to the public's health is low, there is a real concern for its pandemic potential. After just a few mutations, the virus could evolve into one easily spread through communities until there is a global outbreak.

In fact, of the novel influenza A viruses that are of special concern to public health, Asian-lineage H7N9 virus is rated by the Influenza Risk Assessment Tool (IRAT) as having the greatest potential to cause a pandemic, as well as potentially posing the greatest risk to severely impact public health.

The CDC has interim guidance available, along with modeling tools to assist local health officials and health administrators in anticipating the scope and magnitude of any potential event. For example, FluSurge 2.0 estimates the surge in demand for hospital-based services during an influenza pandemic scenario, including number of hospitalizations and deaths.

It also compares the potential impact with a hospital's existing capacity for hospitalization, intensive care and ventilator support. Health professionals then have more realistic site-specific data and potential impacts to improve upon their planning and exercise activities.

The 2017-18 flu season is just a few short months away, so this summer is a great time for ambulatory, long-term and acute care facilities to revisit their surge plans and update or improve upon their preparedness, based upon an H7N9 scenario. Nine important areas to address for this type of a surge event are:

• Activation, operation and location of triage, holding, treatment and fatality areas
• Assessment of security vulnerabilities and limiting access to facilities
• Plans for maintaining critical and essential services
• Protocols for expanding patient capacity and tracking
• Estimates and sources of essential supplies, equipment, furnishings and pharmaceuticals
• Plans for large-scale prophylaxis and vaccination
• Protocols for long-term management and disposition of deceased patients
• Protocols for prioritization of resources when demand exceeds the resources available
• Establishment of standards of care during crisis, along with policies and procedures for the allocation of scarce resources

Even if the H7N9 virus doesn't begin spreading through communities or become a threat to the U.S., the investment of time and energy into planning for a surge of patients with influenza is productive. The review of existing plans with a specific event in mind can make gaps and weaknesses more apparent and contribute to processes running smoother during the next event — when it does arrive.

Christina Thielst, FACHE, is a skilled and innovative hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. Christina is also the author of "Applying Social Media Technologies in Healthcare Environments."