Pandemic Preparedness (Influenza A)

Viral RNA replication errors constantly introduce changes in the influenza A genome. These changes increase the risk that a circulating non-human influenza viruses may gain the ability to be sustainably spread among humans, triggering a pandemic. An influenza pandemic can occur when a non-human (novel) influenza virus gains the ability for efficient and sustained human-to-human transmission and then spreads globally.•

Current examples of influenza viruses with pandemic potential include:

• Avian influenza A viruses H5N1 and H7N9 are circulating in birds in parts of the world. These influenza A viruses are novel among humans, so there is little to no immunity against these viruses among the general population. Human infections with these viruses have occurred rarely, but if either of these viruses were to change in ways that it was enable them to infect humans easily and spread easily from person to person, an influenza pandemic could result.
• H3N2 is an influenza A virus that normally circulates in pigs. In 2011, a H3N2 variant (H3N2v) containing genes from avian, pigs, humans and a matrix gene from the 2009 H1N1 virus was found to infect people who had close contact with pigs. In the United States, there were 12 cases in 2011, 309 cases in 2012 and 19 cases in 2013.
  
  Although human infection with H3N2v is rare, it is a concern because the matrix gene increases the ability to spread from pigs to humans. It is associated with severe disease even in healthy people. The CDC has found that children younger than 10 years old are likely to have little or no immunity.
  

When an influenza virus is identified as a pandemic risk, the World Health Organization and the CDC collaborate to determine the viral components necessary to produce an effective vaccine. Commercial production of a vaccine takes time. Meanwhile, the public may need to rely on nonpharmaceutical interventions including: isolation and quarantine, social distancing, use of masks, hand washing, and respiratory hygiene/cough etiquette to prevent transmission. Strict adherence to "Standard", "Droplet" and "Airborne" precautions will be key to limiting the the spread of the virus.

The Department of Health and Human Services has issued a Pandemic Flu Planning Checklist for Individuals and Families.
The HHS pandemic plan includes:

• storing water and food
• asking your doctor and insurance company if you can get an extra supply of prescription medications
• stocking health supplies including:
  • pain relievers
  • stomach remedies
  • cold and cough remedies
  • fluids with electrolytes
  • vitamins
• getting involved in your community as it prepares for the pandemic

The world economy has become very interconnected; many raw materials and products are only produced outside of the United States. A pandemic beginning in Asia and spreading to Europe is likey to produce shortages of medical supplies, drugs, clothing and nearly every other commodity we have come to rely on. Prudent preparation will be key to sustaining health and well being.

A pandemic will test the social fabric of the USA, many of our domestic services will be outstripped. All types of societal services including: police, fire, EMS, utilities, mail, communications, education etc., will all be seriously affected by loss of personnel.

It is assumed that the pandemic will involve sequential waves of infection. High initial death rates followed by ebbing due to social distancing and then additional waves of infection as the virus mutates and populations attempt to reconnect.

The nursing implications of an influenza pandemic are really beyond imagination, but our science is well founded, our profession is committed and well regarded. Nursing will make pivotal contributions to the health and safety of our nation, just as it has done in the past.

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