White House officials played down the dramatic-sounding language, saying the president's action was not prompted by a new assessment of the dangers posed to the public by the flu. Instead, officials said the action provides greater flexibility for hospitals which may suddenly find themselves confronted with a surge of new patients as the virus sweeps through their communities. "The H1N1 is moving rapidly, as expected. By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly," White House spokesman Reid Cherlin said Saturday.
The waivers authorized by the president's actions still require individual requests by the hospitals, Cherlin said. "Adding a potential delay while waiting for a National Emergency Declaration is not in the best interest of the public, particularly if this step can be done proactively as we are doing here," he said. If granted a waiver, hospitals would be freed from some regulations that guide their behavior during normal day-to-day operations. Cherlin provided the following example: "Requirements under the Emergency Medical Treatment and Active Labor Act would prohibit hospitals from certain rapid triage or sorting activities and prevent the establishment of off-site, alternate care facilities that could off-load emergency department demand," he said.
Public health experts praised the move, saying it was an important precautionary step that could help hospitals and other first responders care for large numbers of sick people as the outbreak continues. "We know a number of hospitals are already experiencing high but manageable loads. It's not a stretch to imagine that hospitals could be strained," said Jennifer Nuzzo of the University of Pittsburgh's Center for Biosecurity. "It's a just a precautionary move so if need be we can focus on the care of patients rather than focus on administrative hurdles. In disasters, you often don't have the time or luxury to keep the paperwork in order. You want hospitals focusing on patients." Others agreed, likening the move to getting snow plows and salt supplies ready before a large snow storm. "You get ready -- make sure everything is battened down," said Arthur Caplan, a University of Pennsylvania bioethicist. But Caplan was concerned that the dramatic language could create unnecessary anxiety, in the same way that the World Health Organization's progressive elevation of pandemic alerts last spring caused widespread concern. "From the point of the view of the public, I think it's, 'Holy cow,' " Caplan said. "It gets heard very differently."
The declaration could sharply increase demand for the vaccine, which is becoming available much more slowly than originally expected. "I've already gotten a couple of calls from people today asking, 'Where can I get the vaccine?' whereas yesterday it was, 'I don't want that vaccine,' " Caplan said. "I'm worried about people getting panicky and vaccine being diverted away from those who need it most." Said David P. Fidler, a professor of law at the University of Indiana, "The declaration has political implications in that it will intensify scrutiny of the federal government's preparedness and response for this kind of event (e.g., are we seeing a nationwide microbial Katrina unfolding, or are the CDC and DHHS, in fact, doin' a heck of a job). "I also wonder whether the increasing impact of H1N1, coupled with the presidential declaration, will make the U.S. move more slowly in sharing the H1N1 vaccine it promised to donate to developing countries . . . especially in light of all the problems being experienced with access to the vaccine in the U.S. now and for the foreseeable future," Fidler said in an e-mail.
The federal Centers for Disease Control and Prevention reported on Friday that the flu was spreading widely in at least 46 states and had already hospitalized at least 20,000 Americans. More than 1,000 confirmed deaths have occurred due to the virus and more than 2,400 additional deaths that were likely associated with it, officials said. Health authorities are especially concerned about pregnant women, young adults and children. At least 95 children have already died from the virus, far more than usually die during an entire typical flu season. Although officials had hoped at least 40 million doses of vaccine would be available by this time, production problems have delayed the federal government's massive inoculation campaign. Only about 16 million doses have become available so far.
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