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Preparing intensive care for the next pandemic influenza

Authors
  • Kain, Taylor1
  • Fowler, Robert1, 2
  • 1 University of Toronto, Department of Critical Care, Toronto, ON, Canada , Toronto (Canada)
  • 2 Sunnybrook Health Sciences Centre, Room D478, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada , Toronto (Canada)
Type
Published Article
Journal
Critical Care
Publisher
BioMed Central
Publication Date
Oct 30, 2019
Volume
23
Issue
1
Identifiers
DOI: 10.1186/s13054-019-2616-1
Source
Springer Nature
Keywords
License
Green

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.

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