It was my privilege to be part of a group advising the Centers for Disease Control and Prevention on how primary care providers (PCPs) can best be integrated into the national response to disasters, specifically focusing on the H1N1 flu pandemic.

It was my privilege to be part of a group advising the Centers for Disease Control and Prevention on how primary care providers (PCPs) can best be integrated into the national response to disasters, specifically focusing on the H1N1 flu pandemic.


PCPs are the unsung heroes of our health care system. Keeping their offices open and operational in a disaster is crucial, as is maximizing the impact they will have in a well-defined disaster response role. To do this, Public Health and Emergency Response officials will need to reach out to PCPs, and PCPs will need to develop and coordinate emergency response plans working with these officials.


It is always best to plan for the worst but hope for the best, so H1N1 response planning must assume that up to half our population may become infected. Even with a small percentage of these people getting very sick, the impact on our health care system could be overwhelming and up to 90,000 people could die.


The unique features of H1N1 mean that younger Americans have limited or no immunity to it; older people likely have some immunity from past H1N1 outbreaks. Hence, unlike the seasonal flu where older people are felt to be at highest risk, H1N1 has the potential to be more worrisome in the young.


In order to minimize the health consequences of H1N1, those that will benefit the most should be vaccinated first. This means pregnant women, children between 6 months and 4 years of age, caregivers for children less than 6 months of age and children 4 to 18 with certain medical conditions should be immunized first. Of course, health care providers and emergency responders will also need to be vaccinated in order to prevent them from spreading the flu to their patients and to keep them at work providing care to the population.


As more vaccine is available (195 million doses have been bought and more will be purchased as needed), everyone 6 months to 24 years old, and those with certain medical conditions up to age 65, should also be immunized. Eventually everyone wishing to be vaccinated will have the opportunity.


This only addresses H1N1; the usual flu season is approaching, and just as in previous years, people should be getting their regular flu shot as well.


Herein lies the amazing challenge ahead of us: The regular flu vaccine and the H1N1 vaccines (two doses will likely be required) will probably need to be given at different times. If up to 170 million Americans will be vaccinated for H1N1 (times 2 doses) and another 170 million Americans for the seasonal flu, this would mean up to 510 million shots must be given.


PCPs will be seeing a surge of patients (some for vaccines, some sick with the flu) in addition to their regular patients, so using innovative strategies to help vaccinate people (such as using a town's Election Day process but instead of having people vote, giving them shots) will be necessary.


There will also need to be a commitment from individuals to help minimize this pandemic:



Don't spread germs! Wash your hands frequently, cough/sneeze into your forearm (not your hand), and keep surfaces that are frequently touched (such as doorknobs) clean by using disinfectant.
Stay home if you are sick so you do not spread the illness. This will mean planning to work from home, including staying home to care for sick family members.
Reach out to friends and neighbors that may need assistance if they get sick - "it takes a village..."
Be sure your home has proper supplies. This includes canned goods (soups, vegetables, fish, meat, etc.), pasta, rice, liquids (to prevent dehydration), other staples (including baby supplies, pet supplies), over-the-counter medications (do NOT use aspirin to treat flu symptoms as certain uncommon complications can occur, but acetaminophen, anti-diarrhea medications, etc. can be useful) and disease transmission prevention supplies (disposable gloves, masks, disinfectant wipes, tissues, etc.).
As recommended for your age/medical conditions, get immunized. This includes all health care providers!
Know that Tamiflu and/or other prescription medications should only be used as recommended; do not pressure your health care provider to prescribe them.

The H1N1 pandemic will likely pose tremendous challenges for all of us, but if we work together we will get through this.


Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.