A month has passed since Homeland Security Secretary Janet Napolitano declared a national emergency in response to the growing number of swine flu cases in the United States. The human-to-human spread of swine flu from Mexico to the United States and 40 other countries was the first big test of pandemic flu preparedness plans instituted by President Bush in 2005. There are valuable lessons to be learned from the weaknesses exposed in this real-life disaster drill.
Napolitano told us recently that one issue that loomed large for her was the response of schools. Some districts closed their schools; New York City shuttered 23 more last week. This had a ripple effect on local areas and raises serious questions. How would future school closures affect parents who might lose their jobs if they stay home with their children? What would be the impact on day care? How should closures be decided on? Napolitano said that the decision should be based on guidance from the Centers for Disease Control and Prevention.
Though quarantining of the sick wasn't necessary, the current outbreak also reminded officials that clarity of authority, deemed a concern during avian flu pandemic planning in 2005, is still needed. The federal government has the power to quarantine at the border and between states. But state and local jurisdictions' laws determine what can happen within their own borders. Napolitano said that it is time to untangle this legal thicket.
Another weakness that must be addressed was the delay in making the connection between the swine flu cases in Mexico and those in southern California. According to regulations adopted in 2005, nations are supposed to report unusual and serious outbreaks and those that threaten to spread internationally to the World Health Organization within 24 hours. Mexican authorities notified the WHO eight days after they started investigating pneumonia cases on April 6. The CDC was notified four days later. While the effects of the H1N1 virus appear to be no worse than what people would experience from regular influenza, scientists are watching warily to see if this new strain of swine flu mutates into something more virulent in the Southern Hemisphere, where it is winter now.
In the meantime, the Food and Drug Administration is moving to develop swine flu seed lots that could be used to develop a vaccine. This is good planning, as it takes five months to make one. But the Obama administration, mindful of the debilitating effects and deaths attributed to the rushed 1976 swine flu vaccine, is wise to proceed cautiously to get a vaccine in place if it's needed for the coming winter flu season. The administration's ability to strike a delicate balance between preparing for the worst while keeping the public informed is a hallmark of the current response and should guide it if a more dangerous flu virus roars back this winter.
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