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PANDEMIC FLU OUTBREAKS

What is the best way to prepare for a pandemic flu?

Welcome to clinicians roundtable.

Host is Susan Dolan.

Dave Gruber, Senior Assistant Commissioner for the Division of Health Infrastructure Preparedness and Emergency Response for the state of New Jersey.

SUSAN DOLAN:

Mr. Gruber, welcome to the clinicians roundtable.

DAVE GRUBER:

Glad to be here Susan.

SUSAN DOLAN:

How are states doing in terms of preparing for a pandemic influenza outbreaks?

DAVE GRUBER:

I think states are doing well. We have been preparing as a country for the pandemic for years right now. For a few years in a very, very intense way that said different states, different entities are at different levels of preparedness and the reason for that is that there are just so many areas that need to be addressed in preparing for pandemic that its probably impossible for everybody to address them all in the fashion that we would like to.

SUSAN DOLAN:

New Jersey has received very high marks for strategies and planning for a pandemic flu scenario. Tell us more.

DAVE GRUBER:

Well, I think I would like to sort of avoid the, we are doing very well reports. What we look at more is are we doing the best we can to prepare and what we are doing consistent (01:30) with our partners throughout the country is:

1. Recognizing that we have to prepare.

2. We are looking at the medical and public health responsibilities that we have and addressing those.

3. Which is just as important as we are engaged with our other partners across all sectors to include critical infrastructure, private enterprise, and our faith based groups, and all those in the philanthropic areas to make sure that the community as a whole is preparing. This truly will be a community effort.

SUSAN DOLAN:

Tell us more about how states are scored and ranked in this regard?

DAVE GRUBER:

Well, I think one of the biggest difficulties that all of us have experienced is there has never been a true measure of success for preparing for a pandemic. So, there are different groups that have tried to come up with ways to measure. For example, the Trust for America has come up with certain what they believe is ways to gauge whether a state is prepared. The Centers for Disease Control have given us in the health department’s measures of what we need to do. So, I do not really think there is a consistent measure for preparedness. When you are looking at a pandemic influenza, anyone who claims to be an expert right now is probably not telling you the whole truth because none of us have really experienced a pandemic and none of us have really seen whether or not the plans that we are putting into place right now are the best plans.

SUSAN DOLAN:

Tell us more about the preparedness indicators, for example, (03:00) the emergency preparedness growth.

DAVE GRUBER:

When you look at preparedness indicators, they span the gamut of various from stockpiles to preparedness drills, to having plans, and I think that all states and all entities in one form or another have varying degrees of completion of those indicators; however, I think that if you look at it, it is a moving target. So for example, if you look at the indicators of a group, they may be certain set 1 year, but a different data set another year. Emergency preparedness and response for the health community as we know it today is a new field. So, it is very, very difficult to come up with those measures of success, with those measures of preparedness.

SUSAN DOLAN:

Tell us more about the antiviral stockpiling.

DAVE GRUBER:

The antiviral stockpiling is a critical aspect in our preparedness efforts. There is a national effort to ensure that states have the ability to stockpile antiviral agents. Specifically, in 2006, the United States Department of Health and Human Services began stockpiling treatment courses, began allowing the states to purchase stockpiling treatment courses of the antiviral drugs – Relenza and Tamiflu, and they supported that effort by providing 25% of the cost. They subsequently subsidized 25% for state purchases and the recommendation was that the states have enough antivirals on hand to treat (04:30) approximately 10% of their population. Throughout the country, different states have elected to approach the stockpiling in different ways. In New Jersey, we have approximately 90 some percent of what was recommended to us in addition to what the feds may give us during an event.

SUSAN DOLAN:

What is the shelf life of stockpiled antivirals?

DAVE GRUBER:

The shelf life has just been increased and when we talk antivirals again, I want to define that we are talking the two, the Tamiflu and that is oseltamivir phosphate for the technical term and Relenza, which is Zanamivir. For the Tamiflu, the expiration date is 7 years right now, it is just been up within the last year or two to a 7-year shelf life.

SUSAN DOLAN:

How much federal funding is available for state preparedness?

DAVE GRUBER:

Well, if you ask me that question right now, the answer is zero for flu preparedness. We have gotten significant amounts of money in the past specifically for influenza preparedness and for pandemic influenza preparedness. We were zero at this year; however, we do get the funding for overarching preparedness, both in the form of Centers for Disease Control grant and also from the assistant secretary for preparedness and response in helping human services.

SUSAN DOLAN:

And how do the individual state efforts dovetail with other states and the federal government in terms of preparedness?

DAVE GRUBER:

I think that when you look at the process, the federal government has used in rolling out the (06:00) pandemic plan, their attempt was to come up with general guidelines that would be passed down to the state; however, a reliance on the states to be the heavy lifters for the preparedness in response effort. So, we have along with the other states have taken the guidance given to us by the federal government and apply them specifically to our individual states. We talked with the other states regarding preparedness efforts and how we might work together, but I think the critical thing to bring up for a pandemic is that unlike hurricane in which perhaps a state might be affected and others might be able to assist them, here in a true pandemic everybody is going to be affected, and the ability for states to help each no matter how much they want to may be significantly impeded.

SUSAN DOLAN:

Mr. Gruber, tell us more about what is happening at the public health laboratories?

DAVE GRUBER:

I think the public health laboratories much like everybody else that is preparing for a pandemic has to look at the surge capacity that they be able to bring to the table when asked to conduct a larger amount of sampling than they would normally do on a daily basis. This would be particularly important during the beginning stages when physicians, epidemiologists were trying to determine whether or not there was an outbreak and the actual strain and the extent of the outbreak. So, laboratories are looking at how they might handle that surge capacity. Additionally, (07:30) based on the possible effects of a pandemic on the population as a whole, the laboratories and others are looking how they are going to deal with the reduced workforce. Based on those who either may be sick, may be affected because their family members are sick or may be fearful to come to work.

SUSAN DOLAN:

Tell us more about biosurveillance efforts.

DAVE GRUBER:

I think that one of the positive things that we can bring up is that biosurveillance is occurring right now regardless of whether or not there is a threat of pandemic or not. So, our epidemiologists, our public health departments in New Jersey and throughout the country and CDC and the world health organization have a strong, strong surveillance effort that monitors the status of infectious disease, and I think if the people wanted to go onto the CDS web site or the WHO web site, they get a good feeling that everybody was looking at it right now.

SUSAN DOLAN:

Are the states increasing the rates for immunizing adults over 65?

DAVE GRUBER:

Oh I think we have to define what immunizations we are talking about. I think that what the states are doing is heavily promoting any of those over 65 to (09:00) get their annual flu shots and that is a critical aspect for maintaining good health which is one of the key aspects of preventing disease via pandemic or any other disease. So, there is an active effort each year to ensure that those who might most be affected by influenza get their immunizations or their flu shots.

SUSAN DOLAN:

Describe the effort in terms of recruiting volunteers if there were a pandemic outbreak.

DAVE GRUBER:

I think the effort for recruiting volunteers again is a good new story and that it is not specifically related to a pandemic. It is related to an overarching effort by health departments throughout the country to ensure they are capable of responding to any event that has health component to it. So, there are 2 main programs in the health arena that involved the recruitment of volunteers, one is the MRC or Medical Reserve Corps program that has been in effect for a while, but has significantly grown over the course of the past few years. Another program is the WHIP program, which is a federal program that focuses on ensuring that volunteers from one state have the ability credentialized and licenselized to act in another state should states look for a mutual support.

SUSAN DOLAN:

What is your best advice for preventing a pandemic flu outbreak?

DAVE GRUBER:

I think the best advice for presenting an outbreak is twofold. First of all for the medical community and the public health community, continue the preparedness efforts that we have engaged in and even though we are facing staffing and funding shortages throughout the county, we have to somehow overcome those and continue the strong preparedness efforts that have gone on in the past few years. As far as the individual, good hygiene is really the key to prevention of disease. That is (10:30) hand washing, it is covering your mouth when you cough or when you sneeze, and just having the common courtesy of making sure that the things stay clean and remain clean and you stay home if you get sick.

SUSAN DOLAN:

Are there efforts underway to secure more funding?

DAVE GRUBER:

Well, the states are always asking for more and I think that we would hope that the new <__10:54___>, which is a federal bill requiring health preparedness and response is the impetus for those at the federal and the federal legislative arena to fund what they are telling us we have to support. So, I think that I will refer to some federal people to help me out with this question, but obviously at the state level, we are not going to turn down any money that comes to us to help us with our support efforts.

SUSAN DOLAN:

What led to your interest in this area?

DAVE GRUBER:

Well, first of all my degree is in microbiology and that was a long, long time ago. So I have always been interested in infectious and communicable diseases, but more recently in my position at the Department of Health and Human Services and responsible for the preparation in response to any outbreak, it is imperative that I do stay interested.

SUSAN DOLAN:

What is your take-home message?

DAVE GRUBER:

I think the take-home message is to continue the effort that has already started in preparing up for a pandemic to ensure that a state health officials and others that we continue the effort, but not cry wolf and cause the country to get pandemic influenza burnout, but that the effort is maintained so that (12:00) should we be faced with this disastrous type of disease that were where we need to be.

SUSAN DOLAN:

Mr. Gruber, thank you for joining us to discuss pandemic flu outbreaks.

DAVE GRUBER:

It is my pleasure Susan. Thank you.