Homeland Security Watch

News and analysis of critical issues in homeland security

August 30, 2006

Report cites confusion in state plans for pandemic influenza

Filed under: Biosecurity — by Kate Phillips on August 30, 2006

The September issue of the Emerging Infectious Diseases includes a policy review that assesses variability in state plans to contain pandemic influenza. The report reviewed 49 of 50 states’ pandemic influenza plans (Lousiana was the only state without one on the web), and focused on three key areas: vaccination, surveillance & detection, and containment measures. Although the report describes variability in the first two areas, containment strategies–such as legal and practical plans for quarantine–showed the most marked heterogeneity:

…confusion and lack of specificity exist in these posted state plans in proposing practical containment measures in the community.

The authors, all from the Research Triangle Institute International (RTII), make helpful recommendations to fill this gap:

Several practical nonpharmaceutical containment steps need to be considered. For example, only approximately one third of the state plans are explicitly considering recommending self-isolation of adults with influenzalike symptoms and keeping children with such symptoms home from school and daycare. Even in this increasingly computer-based economy, in which a considerable percentage of persons can work from home most of the time, this simple stratagem is not addressed in most state plans. Other simple recommendations for use in the community, such as avoiding mass gatherings; shopping on off hours; and household and workplace strategies such as frequent hand washing, avoiding handshaking, and keeping towels separate, are often neglected in state plans.

We should remember that health officials who fought against the spread of SARS in 2003 used extensive exposure control measures, including restrictions on mass gatherings and voluntary home quarantines. Many officials credited such measures as important to slowing disease spread, including CDC director Julie Gerberding. And a Harvard survey of Toronto citizens impacted by SARS demonstrates that the public is not as allergic to the idea as many think. Creative solutions, such as Singapore attention to workforce issues and Hong Kong’s guidance for business and special needs groups, should be thoughtfully considered.

The RTII researchers suggest lack of federal guidance and gaps in epidemiological knowledge as primary reasons for variable state plans, and recommend a revision of the national pandemic influenza plan. Such a revised plan should pay close attention to exposure controls like isolation, quarantine, community restrictions, and other practical containment measures.

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Comment by Andrew Brodie

August 30, 2006 @ 10:16 am

Singapore and Toronto, Canada are nanny states where the population is conditioned to respond to expensive government advertising campaigns to achieve centrally planned social goals.

In Canada, most provinces provide flu vaccine free as part of their socialized medicine packages. What might work in an American model is for employers to provide flu vaccinations free as an economic alternative to losing the service of absent, ill workers.

Comment by Brian

August 31, 2006 @ 2:14 pm

This is where experts in single track areas miss the larger scope of homeland security. Each of the states is sovereign, which means they are not controlled by a single bureaucracy, as is in the Peoples Republic of China (and we know too well how PRC protects its citizens).

I wonder if the RTII has given much thought about the constitutional issues. How are you going to deal with a son or daughter that is confined to a quarantined area when their parent is dying in an uninfected region? There are enormous questions of which little effort and thought has been given to. We need to have a citizen discussion before we let the academics and bureaucrats strip away our freedom.

One other point that should be made when criticizing the States: three quarters of the States had some type of plan before DHS and USG. How do you coordinate standards when the central bureaucracy fails to get a plan together?

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