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

1. Tough Decisions: Preparing VAfor the Ethical Challenges of Pandemic Influenza A Forum for VA Staff Discussion

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. How VA is preparing for pandemic influenza (continued) • Promotion of “Infection: Don’t 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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?

16. 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?

17. 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.

18. Prepared by:National Center for Ethics in Health CareInternet: www.ethics.va.gov Intranet: vaww.ethics.va.govVA Office of Public Health and Environmental Hazards Internet: www.vethealth.cio.med.va.gov/ Intranet: vaww.vhaco.va.gov/pubhealth/Veterans Health Administration – Central OfficeFor more information on:─ The VA and pandemic influenza, visithttp://vaww.vhaco.va.gov/phshcg/Flu/pandemicflu.htm─ Pandemic influenza in general, visit www.pandemicflu.gov2006