Flu deaths raise fears of pandemic

DEFENSIVE APPROACH: Annie De Groot, CEO of EpiVax, leads a team that has develped new recipes for a vaccine to combat the H7N9 flu. / PBN FILE PHOTO/RUPERT WHITELEY
DEFENSIVE APPROACH: Annie De Groot, CEO of EpiVax, leads a team that has develped new recipes for a vaccine to combat the H7N9 flu. / PBN FILE PHOTO/RUPERT WHITELEY

The rapid spread of H7N9 flu throughout China and with it, fears of a potential global pandemic, has Rhode Island health officials examining protocols and plans, in case the deadly flu spreads to the U.S.
As of April 23, there were at least 108 confirmed cases of the H7N9 flu – and 22 deaths, according to Chinese health authorities. Taiwan last week also confirmed a case of the bird-flu infection.
“We met with the key operational groups last week to discuss some initial messaging and strategies we should be prepared to implement,” said Peter Hanney, spokesman for the R.I. Department of Health. “We have participated in numerous national conference calls to provide us with situational updates and what those at [U.S. Centers for Disease Control and Prevention] are doing.”
The health department maintains a “Pandemic Influenza Plan” to ensure an effective response if and when a pandemic occurs, according to Hanney. “We stockpile antivirals and medical supplies that may be used in a pandemic, test and refine plans so that we are prepared to distribute vaccines as they become available, and work with hospitals and health centers to plan for patient surge and alternate care sites,” he said.
The plan, Hanney continued, “kicks in when sustained human-to-human transmission of a novel flu strain occurs. We take our guidance from the [World Health Organization] and CDC when this happens, so it is not activated now.”
Chinese health authorities have claimed that there has not been any human-to-human transmission, despite the wide geographic range of flu cases. However, the World Health Organization is now saying that limited human-to-human transmission of H7N9 flu in China may be possible.
And, analysis by researchers at the University of Hong Kong has shown that twice as many adults may have been infected with milder infections, according to Benjamin Cowling, an associate professor at the university’s public health center. The researchers’ analysis suggests risk of illness from the H7N9 virus rises with age, with more than half of reported victims age 60 and older, Cowling told Bloomberg News on April 22. “We are dealing with an exceptionally unusual influenza virus,” Laurie Garrett, senior fellow for Global Health at the Council on Foreign Relations, told Providence Business News. “What I think we can definitely say is that the threat of a pandemic exists, and it would be folly to pretend otherwise. As the Boy Scouts say, ‘Be prepared.’ ”
The CDC, in a recent conference call with clinicians, officially asked hospitals and doctors to begin looking for signs of human infection with H7N9 flu. It has also advised organizations to review their pandemic plans.
Hospitals in Rhode Island “are not undergoing any special planning at this time,” Dawn Lewis, the hospital emergency-preparedness coordinator at the Hospital Association of Rhode Island, told Providence Business News.
In a flu pandemic, acute care hospitals in Rhode Island will play a critical role, serving as a regional center for care, coordinating the deployment of health care assets such as nursing homes, urgent-care centers, pharmacy services, community health centers, long-term and assisted-living facilities, according to the R.I. Department of Health.
For instance, Landmark Medical Center would be responsible for North Smithfield, Burrillville and Woonsocket, while South County Hospital would be responsible for Exeter, North Kingstown, Richmond, South Kingstown, and Narragansett.
Despite Landmark’s current financial troubles, with the hospital about to enter its fifth year in receivership, Edward Quinlan, president of HARI, said he saw “no difficulty” with Landmark having the resources and capability to assume such a role.
At Lifespan, an Emergency Office of Preparedness was created five years ago to respond to health challenges such as a pandemic, according to Peter Ginaitt, who directs that office. Lifespan’s Rhode Island Hospital, The Miriam Hospital and Newport Hospital are all designated regional centers to respond to a flu pandemic, according to state plans. Each Lifespan hospital, Ginaitt said, “had response plans and procedures in place,” along with a stock of emergency supplies. “The state is also very well-connected through hospital work groups and Internet-based management tools, providing for centralized communication,” Ginaitt said. At Care New England, President and CEO Dennis Keefe told PBN that he had not been contacted by the R.I. Department of Health regarding the potential pandemic. “We have a plan, we test it periodically, we run emergency response drills twice a year,” he said.
The hope is that training will kick in, as it did with health care professionals and hospitals in Boston after the bombs exploded at the marathon.
Blue Cross & Blue Shield of Rhode Island has business-continuity plans to address an array of disruptive situations, according to spokeswoman Stacy Paterno. The health insurer, she continued, is prepared to ensure continued access to care and services for its members if H7N9 flu spreads to the United States. “As a preventive service, flu vaccinations are covered at 100 percent,” Paterno said.
Bryant University, which recently signed partnership agreements with the Chinese educational authorities to set up its own campus in China and expand its resources for Chinese students to study environmental management at its Smithfield campus, did not immediately respond to questions about what protocols and procedures the university had in place should the H7N9 flu develop into a pandemic.
Hasbro Inc., with extensive manufacturing operations in China, also did not immediately respond to emails seeking comment.
The biggest problem should the flu spread is the lack of a preventive vaccine to administer to the public.
“H7N9 is a novel strain of the influenza virus for which no vaccine currently exists,” said Michael J. DeAngelis, director of public relations for CVS/Caremark Corp. “Manufacturers that have already begun making the upcoming seasonal flu vaccine have not included the H7N9 strain, but the CDC has reported that they are working through the early steps of developing a vaccine.” DeAngelis described the situation as similar to what happened in 2009 when the H1N1 strain was not included in the year’s seasonal flu vaccine.
Dr. Anne S. De Groot, chief science officer and CEO of EpiVax, a bioscience firm based in Providence’s Knowledge District, and her team have developed new recipes for a vaccine to combat the H7N9 flu. They put them into production in mid-April, in a collaboration between EpiVax and Aldevron in Fargo, N.D., and a researcher at Fort Detrick, Md., the home of the Army Medical Research Institute of Infectious Diseases.
“When something like a new pandemic is emerging, it’s time to think differently. The time to do that is now,” De Groot said. Because of the low immunogenicity factor of the H7N9 flu virus, she continued, “There will be no antibody response unless you make the vaccine the way we make them, with epitopes that will drive an immune response.”
So far, De Groot said she has had difficulty gaining the attention of the CDC.
When asked about the capability of the Rhode Island health care delivery system to cope with a major flu pandemic, De Groot said: “People are taking their information from the CDC, and that is like the blind leading the blind,” De Groot said. “If past pandemics are any indication, it may take the CDC six months to make enough flu vaccine.” And, she added, “It may not be effective.”
CDC recognizes the potential for a pandemic.
“This is a serious public health situation and it’s possible that a pandemic could start if this virus were to change [and] spread easily between people,” CDC said on its website. “CDC is preparing for that possibility.” •

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