Tough Decisions: Preparing VA for the Ethical Challenges of Pandemic Influenza

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Tough Decisions Preparing VAfor the Ethical
Challenges of Pandemic Influenza

• A Forum for VA Staff Discussion

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Staff discussion forum on ethical challenges of
pandemic influenza

• Influenza basics
• How VA is preparing for pandemic influenza
• Possible impact of pandemic flu
• Ethical challenges, questions to consider

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Influenza Basics

• What it is
• A febrile (fever-causing) respiratory illness
  caused by an influenza virus
• Forms of influenza
• Seasonal influenza
• Avian influenza
• Pandemic influenza

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Influenza Basics (continued)

• Seasonal (or common) flu - usually occurs every
  fall, transmitted person to person. Most people
  have some immunity, and a vaccine is available
  (get your flu shot!).
• VA has an active annual
• program to promote flu
• vaccination of staff and patients.
• (Prevent seasonal flu - get your flu shot!)

Drive-through flu shot clinic Credit Albuquerque
VA
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Influenza Basics (continued)

• Avian (or bird) flu occurs in birds, current
  version (H5N1) can be transmitted from birds to
  humans. There is no human immunity vaccines are
  under development.
• Avian flu is being tracked carefully
• because it (or other animal flu) plus
• human flu virus could evolve to a
• pandemic (global outbreak) form.

Chicken with avian flu Credit US Department of
Agriculture
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Influenza Basics (continued)

• Pandemic flu would be a virulent new human flu
  that causes a global outbreak of serious
  illness. Because there is little natural
  immunity, the disease can spread easily from
  person to person.
• There is no pandemic flu at
• present, but because pandemics
• occur a few times per century
• (1918, 1957, 1968), the world is preparing.

Camp Funston, Kansas, 1918 or 1919. Credit US
National Museum of Health and Medicine, Armed
Forces Institute of Pathology
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How VA is preparing for pandemic influenza

• Use of effective existing emergency plans
• Development of pandemic flu-specific
• plans by facilities,
• VISNs, benefits offices,
• cemeteries,
• Central Office
• Creation of central stockpile
• of antiviral drug that may help

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How VA is preparing for pandemic influenza
(continued)

• Promotion of Infection Dont Pass It On
  campaign for hand washing,
• respiratory hygiene
• Testing of plans via tabletop exercises
• Education and communication of staff, veterans,
  partners in community, state, nation

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How VA is preparing for pandemic influenza
(continued)

• June 27, 2006 National Ethics Teleconference
• With DHHS, developing guidance that will provide
  criteria and processes for decision making on
  altered standards of care and allocation of
  scarce resources
• Dialogue and planning for ethical challenges
  posed by pandemic flu (staff discussion forums)

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Possible impact of pandemic influenza

• US government (and VA) assumptions
• All may be susceptible to the pandemic flu virus
• Infection may lead to symptoms in 2 days, but
  people will be contagious before they become sick
  
• 1/3 of population will be ill
• 1/2 of ill persons will seek health care
• Waves of illness will last 6 to 8 weeks in a
  community
• Several waves might occur across the country

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Possible impact of pandemic influenza (continued)

• Assumptions, continued
• Communities may close schools, prohibit
  gatherings, require quarantine (staying home) of
  people of household contacts of infected
  individuals
• Effectiveness of antiviral drugs not clear until
  strain known
• Vaccine production time will take months
• If severe (like 1918) could cause significant
  death, illness, societal disruption

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Possible impact of pandemic influenza (continued)

• Assumptions, continued
• Absenteeism may be 40 at peak due to illness,
  need to care for family members, or fear of
  infection
• There may be shortages of health care resources
• Staffed hospital beds
• Mechanical ventilators
• Medications
• Personal protective equipment
• Morgue capacity

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Possible impact of pandemic influenza (continued)

• Assumptions, continued
• Patient care may change
• Postponement of elective hospital admissions,
  appointments
• Discharge of patients who can receive home care
• Altering of standards of care to save the largest
  number of lives versus the traditional focus on
  individual care

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• Pandemic influenza plans are
• works in progress.
• They will change as
• -They are discussed, tested, and improved.
• -Pandemic influenza knowledge emerges and federal
  policies evolve.

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Ethical challenges of pandemic influenza

• Questions to consider
• What are my obligations to come to work?
• How much should I expose myself to risk as a
  member of the health care staff?
• How would I feel if I were subject to
  restrictions such as quarantine?

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Ethical challenges of pandemic influenza
(continued)

• Questions to consider
• Who should get a ventilator if they are in short
  supply?
• What ongoing services should be cancelled, which
  maintained, and how should these services be
  managed?
• How should difficult decisions about resource
  allocation be made?

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Ethical challenges of pandemic influenza
(continued)

• Staff discussion forums provide an opportunity
  for VA staff to share information and concerns
  and to build mutual understanding about the tough
  ethical decisions that will need to be made in a
  pandemic.

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Prepared by National Center for Ethics in
Health Carehttp//vaww1.va.gov/vhaethics/
Office of Public Health and Environmental
Hazardshttp//vaww.vhaco.va.gov/pubhealth/Veter
ans Health Administration Central OfficeFor
more information on - The VA and pandemic
influenza, visithttp//vaww.vhaco.va.gov/phshcg/F
lu/pandemicflu.htm- Pandemic influenza in
general, visit www.pandemicflu.gov2006