Here is the exact quote from the Centers for Disease Control:
"The reemergence of the H7N9 virus and transmission among people in the United States remains a possibility, and if that occurs in the fall of 2013, the U.S. health care system is likely to be overwhelmed"
That quote is from the justification for a H7N9 Pandemic Flu National Nurse Triage line contract just awarded by the Centers for Disease Control (CDC) to the United Way 2-1-1 phone system and the Poison Control Center. The nurses will diagnose the concerned callers' avian flu status, prescribe appropriate medicine, and electronically transfer those prescriptions to local pharmacies.
Solicitation Number: 2013-Q-15473 and Solicitation Number: 2013-Q-15472
The CDC's worst scenario is a Fall 2013 H7N9 outbreak, as the system is the least prepared for it. The initial planned massive antiviral dosing steps taken to halt and triage such an outbreak will likely put strong natural selection pressures on the existing virus to mutate into untreatable variant during the next flu season. That cycle could potentially be fast enough that the currently planned Spring 2014 H7N9 vaccinations will be ineffectual against the mutated version. Or just as likely, that antiviral gambit might not halt the outbreaks immediate progression to other cities.
That begs the question: How would the CDC triage a medical-system-overloading infection which is only symptomatically treatable, has a 66% death rate with hospitalization , and nearly a 100% death rate if advanced life support equipment is not available?
Based on the charts (see our video @6:48 for analysis) from this "Comparative epidemiology" study published in the Lancet, it would appear that delaying hospitalization of H7N9 infected persons by 1-2 days could significantly triage-out those individuals who would likely die anyways, thereby potentially freeing up valuable hospital space 30 days earlier than if they had received treatment more quickly; it is also significantly more cost effective. The most recent patient released spent 170 days hospitalized. Reducing this type of drain on the system, by delaying hospitalization, is exactly the type of "triage" a National Nurse triage line would be adept at performing once the medical system becomes overwhelmed.
Triage designed to delay, and meted out based on herd population statistics, instead of being based solely on individual health, amounts to nothing more than a "death panel". Maybe thats why a massive private employer (which engaged in significant Pandemic preparations in 2009) recently contracted out to CARENA to provide house-calls and telemedicine services.
But there is more:As indicated by the CDC's own statements, H7N9 Avian Influenza 'overwhelming the U.S. health care system' is the driving force behind a massive pandemic C4ISR mobilization. The most recent of which has been the CDC and FCC mobilizing the Emergency Alert System for "sustaining emergency television broadcasts vital health and life safety information to medical professionals,first responders, and the general public"
Obviously if the medical system is overwhelmed, more capability needs to be added. In that regard, FEMA is mobilizing to support 100,000 medical personnel at 1000 quazi-luxury mobile medical hoteling stations. To that end, FEMA is attempting to order 100,000 Dickies Medical "Scrubs" and 100,000 winter sweat shirts and pants, all to be delivered on 48 hours notice. Of course, they are also expecting the same delivery time frame with the associated mobile showers, restrooms, hot food, free clothing, and 6 million autoclavable white cotton blankets. And, that doesn't even count the requirement for "Surge Temp" delivery requirement for 12 hour rush delivery medical "push" packages and Federal Medical Stations from the Strategic National Stockpile to locations in the Pacific Rim (the direction from which human borne H7N9 is likely to propagate)
If you think this sounds logistically impossible for short notice private sector contracts, you may be too smart to work at FEMA (shades of Katrina). Here is what two contractor had say in the Q/A phase of some of these solisitations:
Notable contractor comments:Contractor A (Mobile showers and restrooms):
I think the Armageddon scenario is too large to provide the Federal Emergency Management Agency with several responsible parties....we could address and service the 20 camps in California, the 5 in Oregon and the 5 in Washington"Contractor B: (6,000,000 Pcs order for autoclabable blankets)
Question4. Would we be able to get a longer lead time for the initial order and then 30 days for the remainder of the contract? As the blankets will be manufactured in Pakistan? It will be hard to carry 100,000 Pcs in Inventory. We on a general basis stock no more than 25,000 - 30,000 Pcs in inventory locally in GA.
Answer4. No.Based on all the above information, its a little bit more clear what exactly they mean when expect the U.S. medical system to be "overwhelmed" by a Fall 2013 H7N9 Pandemic. The primary reason they specify Fall 2013 is because no safe vaccine against H7N9 will exists by Fall; by Spring they hope to have enough of the adjuvant laced experimental H7N9 vaccine available to give each U.S. citizen two shots. On the positive side, there does seem to be some hope for Alpha Interferon as a treatment.
Links:Solicitation Number: 2013-Q-15473
Solicitation Number: 2013-Q-15472
Solicitation Number: HSFE70-13-R-0062
Solicitation Number: HSFE70-13-R-0058
Solicitation Number: HSFE70-13-R-0070
Solicitation Number: HSFE90-13-I-0018
Solicitation Number: HSFE70-13-R-0061
Solicitation Number: HSFE70-12-R-0043
Solicitation Number: HSFE70-12-R-0097
Solicitation Number: HSFE70-13-R-0071
Solicitation Number: HSFE70-13-R-0049
Solicitation Number: HSFE70-13-R-0048
Solicitation Number: HSFE70-13-R-0046
Solicitation Number: HSFE10-13-P-5023
Solicitation Number: FEMAtransportationCarrierIndustryDay