A Tale Of Two States
# 535
Dig through the various State Pandemic Influenza Plans, and three things are sure to strike you.
First, many states get good marks for their ability to generate large documents with lots of graphs, charts, and pretty pictures.
Second, there are significant variances between States as far as what they expect a pandemic could bring, and what they are preparing for.
And Third, there are a depressing number of dangerous assumptions contained in these documents.
To find your state's pandemic plan(s), go to the HHS's pandemic influenza website at pandemicflu.gov and select the STATE & LOCAL PLANNING tab at the top of the page. Be prepared to sit and read for awhile, some states have generated multiple pdf files with hundreds of pages in them.
I haven't begun to read all of the plans, but the discrepancies in the ones I have read are sobering. Apparently some states are preparing for a repeat of the mild 1957-1958 scenario, while others are gearing up for another 1918 Spanish Flu.
My home state of Florida is preparing for a `severe' pandemic, according to their pandemic plan. While their definition of `severe' and mine differ, they are at least looking at a 1918 style event.
The assumptions are that out of 18 million residents, 6.41 million will be stricken. That's 35%, and may be optimistic with a truly novel virus.
Of those, they expect 75% will seek treatment, and 10% will require hospitalization. Furthermore, they expect 2%, or 120,000 people to die.
Grim numbers, and in line with what we saw in 1918, but not necessarily the worst case scenario. The virulence of the H5N1 virus would have to attenuate considerably to produce these numbers.
Still, when you compare it to South Carolina, it is a far more realistic view.
The South Carolina Emergency Operations plan for Pandemic Influenza is a dead link on the pandemicflu.gov site and the South Carolina Pandemic flu page. Hopefully this means they are revising it. Given what information that is there, they need to.
The SCDHEC (South Carolina Department of Health and Environmental Control) webpage states, not too reassuringly, that:
A pandemic’s effect on South Carolina
It is impossible to accurately predict what effect a pandemic would have on South Carolina. Experts believe 15% to 40% of the state’s population could be infected in the first wave of the illness. Also, hospitals and physicians’ offices could expect to see many more patients than normal. There is no way to know how many of those cases would be severe or deadly. However, it is almost certain that more people would die during a pandemic than during an outbreak of a more common form of human influenza.
Thereby winning the wishy-washy award for informing the public.
A little digging on the net found the South Carolina Mass Casualty Panning pdf, dated December 2006. If there is a link on the SCDHEC website to this, it's well hidden. I had to Google to find it.
On page 5 of this document, they list a series of assumptions.
6. Based on a population attack rate of 15-35%, South Carolina could anticipate between 560,000 and 1.32 million cases of influenza during the peak transmission period.
7. Outpatient visits due to influenza are projected to reach almost 533,000 (range 320,000 – 750,000), which translate to over 25 extra patients per day during the peak transmission period for every primary care physician in South Carolina.
8. Hospitalizations due to influenza and influenza-related complications may reach 12,000 (range 7,200 – 16,800 persons) – the elderly and those with chronic medical conditions could account for most of these admissions.
9. South Carolina is expected to experience almost 3,600 deaths from pandemic influenza (range 2,200 – 5,000), or nearly double the regular number of state’s expected deaths, during the peak transmission period.
Now, granted, South Carolina's population is just a bit over 4.25 million people, or about a quarter of that of Florida, and the demographics are different. But still, their worst case scenario (5000 deaths) out of a population of 4.25 million appears low, when compared to the Federal estimates, and the State of Florida.
Judging by these figures, South Carolina is looking at an event roughly 1/6th as severe as Florida, or for that matter, the Federal government.
And that is a dangerous assumption.
Using federal guidelines, the South Carolina death rate would be nearer 30,000 people. The number requiring hospitalization (assumed by the Feds to be 10%) would be 140,000 . . . not the 12,000 projected in this document.
The SCDHEC website has a page on the differences between seasonal and pandemic influenza. The graphic below (click to enlarge) shows a similar downplaying of the effects of a pandemic. Instead of 40% absenteeism, the number normally stated, they expect up to 25%. And once again, the 3600 deaths are repeated.
More disturbing is this statement: Symptoms could be the same as seasonal flue but possibly more severe, including sore throat and shortness of breath
South Carolina isn't the only state with optimistic projections. And it may well turn out that the next pandemic doesn't rise to the 1918 level, in which case, they may dodge a bullet.
But if states prepare only for a mild pandemic, and a severe one strikes, they, and the people of their state, are in for a world of hurt.
