Wednesday, September 18, 2013

NPM13: Pandemic Planning Assumptions


Credit - HHS Interim Pre-Pandemic Planning Guidence: Community Strategy For Pandemic Influenza Mitigation In the United States.


Note: This is day 18 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NPM or #NPM13 hash tag.

This month, as part of NPM13, I’ll be rerunning some updated  preparedness essays (like this one) , along with some new ones.


# 7783



The declassification this week of a 2009 Northern Command Pandemic Plan (see SciAm story Pandemic Flu Plan Predicts 30% of U.S. Could Fall Ill) has caught the attention of a number of news organizations and websites with its estimates that during a moderately severe pandemic 30% of the population could fall ill, 3 million could require hospitalization, and 2 million Americans could die.


Although a certain amount of surprise is registered in these media reports, these are roughly the same numbers that were being openly discussed by local, state, and federal agencies during the pandemic planning phase of 2006-2008.

In fact, in 2008, the HHS outlined their vision of the likely impact in the United States of a severe and a moderate pandemic (see A Tale Of Two Scenarios).   As you’ll see, the numbers of hospitalizations anticipated during a severe pandemic is quite a bit higher than the Northcom plan.


The HHS defined a severe pandemic as:

    • An attack rate of 30% (90 million Americans sickened)
    • 50% (45 million) requiring outpatient medical care
    • 11% (9.9 million) requiring hospitalization
    • 745,000 requiring mechanical ventilation
    • 1.9 million deaths (2.1% fatality ratio)

A moderate (1958/68-like) pandemic is described as follows:

    • An attack rate of 30% (90 million Americans sickened)
    • 50% (45 million) requiring outpatient medical care
    • .9% (865,000) requiring hospitalization
    • 64,875 requiring mechanical ventilation
    • 209,200 deaths (.23% fatality ratio)


In other words, while the number of people affected doesn't change, a severe pandemic is envisioned to be about 10 times worse than a moderate one.


Pandemics, like hurricanes, are measured on a five point scale, with a CAT 5 pandemic – as bad or worse than 1918 – at the top of the scale.  While there are many similarities between the hurricane and pandemic scales, there is one aspect where they differ greatly.


With Hurricanes, there are physical limitations that keep the storms from growing much stronger than 200 mph winds. Category 5 storms start at 156 MPH, and these storms are only capable of intensifying about 35% above that wind speed.


There are no such restraints on a severe pandemic. While a 2% CFR indicates a Cat 5 pandemic, so does a 5% or 10% CFR. Yet, the difference between the impact of these three CFRs would be enormous. Although the 1918 pandemic is often used as a model for the next severe pandemic, doctors and scientists generally admit that the Spanish Flu isn't the worst that nature could throw at us.


The thing about pandemics is, even after one starts, you never know how bad it is going to be until it is over.   And even then it can take years to sort our just how bad it really was.  Experts continue to wrestle with the toll of the 2009 H1N1 pandemic. 


A pandemic can start out mild, and over time become more virulent – as did the 1918 H1N1 pandemic -  or it could look really serious at the start, but prove milder than expected (as we saw in 2009). 


While we can’t know when the next pandemic will arrive, or how bad it may be, we can prepare for a `reasonable-worst-case’ scenario – which  is probably somewhere on the order of the 1918 Spanish Flu.  To that end, the HHS has a number of pandemic planning toolkits available on their website.


Pandemic Flu 

The federal government cannot prepare for or respond to the challenge of a flu pandemic alone. Your community can develop strategies that reduce the impact and spread of pandemic flu.

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist (PDF – 68.91 KB)

Lista de Preparacion para una Pandemia de Gripe Tanto para Organizaciones Comunitarias como Religiosas (PDF – 268 KB)

Community Strategy for Pandemic Influenza Mitigation (PDF – 10.3 MB)

Plan Now to Be Ready for the Next Flu Pandemic (PDF – 213.55 KB)

The Next Flu Pandemic: What to Expect (PDF – 226.83 KB) (excerpts below)



Their advice (and this is for before a pandemic threat becomes imminent).



Over the past six months I’ve written a number of pandemic preparedness blogs, including what the United States government is doing to prepare for a possible pandemic.  You can revisit these at the following links:


The Pandemic Preparedness Messaging Dilemma
Pandemic Planning For Business
CDC: Pandemic Planning Tips For Public Health Officials
H7N9 Preparedness: What The CDC Is Doing


Admittedly, we may not see another severe pandemic for years, or even decades. But since it is impossible to predict when the next one will occur, it makes sense to incorporate pandemic planning into your family, community or business disaster plans. offers the following basic advice for families and individuals.



Inspire others to act by being an example yourself, Pledge to Prepare & tell others about it!

Pledge to Prepare

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

Plan for a Pandemic

  • Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
  • Periodically check your regular prescription drugs to ensure a continuous supply in your home.
  • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
  • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
  • Volunteer with local groups to prepare and assist with emergency response.
  • Get involved in your community as it works to prepare for an influenza pandemic.