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The CDC has isolated the new influenza A H1N1 (swine) virus and modified the virus so that it can be used to make a vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines must be tested in clinical trials over the few months. When a new vaccine is produced commercially, the question remains, will the vaccine be a good match to the circulating virus. Even if it is a good match, the U.S. public health system may not be able to inoculate the entire population.

Effective antiviral medications for the prevention of influenza are in short supply. The U.S. federal government and states have stockpiled tens of millions of doses of antiviral flu medication. However, there are over 300 million Americans. Therefore, in a virulent epidemic, it is unlikely that all who need these medication would have timely access.

To insure effective use of limited supplies and to slow the emergence of resistance to antivirals, the CDC recommends chemoprophylaxis for those patients with the highest risk of complications, as follows:

People with more severe illness, such as those hospitalized with suspected or confirmed influenza
People with suspected or confirmed influenza who are at higher risk for complications
Children younger than 2 years old
Adults 65 years and older
Pregnant women
People with certain chronic medical or immunosuppressive conditions
People younger than 19 years of age who are receiving long-term aspirin therapy. They have

In the event of a pandemic, provided that a vaccine is effective and available, it is likely that vaccinating health care professionals will be a priority. Vaccination and strict adherence to "Standard", "Droplet" and "Airborne" precautions will be key to managing the virus within the nations medical facilities.

Meanwhile, the vast majority of Americans, including your family members, may need to rely on non-pharmaceutical interventions including: isolation and quarantine, social distancing, use of masks, hand washing, and respiratory hygiene/cough etiquette to prevent transmission.

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
- face masks
Getting involved in your community as it prepares for the emergencies.

Example List
Food and non-perishables	Health supplies
Ready-to-eat canned meats, vegetables, fruits and soup Protein & fruit bars Dry cereals Peanut butter & nuts Dried fruit Crackers Canned juices Bottled water Canned or jarred baby food & formula Pet food Salt	Prescribed medications & supplies: glucose and blood pressure monitoring equipment, colostomy devices, etc. Body soap and alcohol-based hand wash Wound care supplies: dressing, antiseptic ointment, peroxide, alcohol, gloves Analgesic/antipyretics: ibuprofen, acetaminophen Thermometer Anti-diarrhea meds Vitamins Fluids with electrolytes Cleaning agents: bleach, dish soap, laundry liquid Flashlight Batteries Portable radio Manual can opener Garbage Bags Toilet paper, paper towels, disposable diapers, feminine hygiene products Face masks Blankets, warm clothing, hats, sunglasses, sunblock

The world economy has become very interconnected; many raw materials and products are only produced outside of the United States. A virulent pandemic beginning in Asia and spreading to Europe could produce shortages of medical supplies, drugs, clothing and nearly every other commodity we have come to rely on. Prudent preparation would be key to sustaining health and well being. The social fabric of the USA could also be tested, as many of our domestic services may be outstripped. All segments of societal services including: police, fire, EMS, utilities, mail, communications, education etc., could be seriously affected by loss of personnel.

It is assumed that a virulent pandemic would involve sequential waves of infection. High initial death rates followed by ebbing due to social distancing and then another wave of infections as the virus mutates and populations attempt to reconnect.

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