Preparing intensive care for the next pandemic influenza

Abstract

Few viruses have shaped the course of human history more than influenza viruses. A century since the 1918–1919 Spanish influenza pandemic—the largest and deadliest influenza pandemic in recorded history—we have learned much about pandemic influenza and the origins of antigenic drift among influenza A viruses. Despite this knowledge, we remain largely underprepared for when the next major pandemic occurs.While emergency departments are likely to care for the first cases of pandemic influenza, intensive care units (ICUs) will certainly see the sickest and will likely have the most complex issues regarding resource allocation. Intensivists must therefore be prepared for the next pandemic influenza virus. Preparation requires multiple steps, including careful surveillance for new pandemics, a scalable response system to respond to surge capacity, vaccine production mechanisms, coordinated communication strategies, and stream-lined research plans for timely initiation during a pandemic. Conservative models of a large-scale influenza pandemic predict more than 170% utilization of ICU-level resources. When faced with pandemic influenza, ICUs must have a strategy for resource allocation as strain increases on the system.There are several current threats, including avian influenza A(H5N1) and A(H7N9) viruses. As humans continue to live in closer proximity to each other, travel more extensively, and interact with greater numbers of birds and livestock, the risk of emergence of the next pandemic influenza virus mounts. Now is the time to prepare and coordinate local, national, and global efforts.

Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies

“…This may mean that high-flow nasal cannula (HFNC) therapy or non-invasive ventilation (NIV) is used to mitigate acute ventilator shortages, even though they do not constitute preferred management due to infection control concerns (aerosolisation of respiratory droplets). Triage of critically ill patients may become necessary to prioritise ICU resources, and ethical principles must be carefully considered to ensure just and equitable delivery of care for all patients [25][26][27]. Triaging protocols should not disadvantage patients without COVID-19 who need ICU care.…”

“…These criteria should ideally be objective, transparent, and publicly disclosed. Authorities should engage the community in this process so that public trust exists when it is most needed [25][26][27]29].…”

Safe patient transport for COVID-19

“…Patient numbers can surge, and hospitals should be ready not just with the infrastructure, but also staff to be familiar with workflows. Kain and Fowler [2] have eloquently detailed influenza pandemic preparations for hospitals and intensive care units, and we feel the principles described in the article are relevant to COVID-19. Staff must consider patient transfers in between wards, as COVID-19 patients are admitted in isolation facilities to contain infected cases and to avoid nosocomial spread [1].…”

Benefits of Exercise on Influenza or Pneumonia in Older Adults: A Systematic Review

“…Virus infection has had a profound effect on human history and mortality. One of the deadliest viruses documented in human history is pandemic influenza virus [1]. Although influenza is a common respiratory disease, several serious complications, such as pneumonia, could develop if the disease is not controlled rapidly and effectively [2].…”