Preparations to Pandemic Flu, 2006

Inglesby et al., Disease Mitigation Measures in the Control of Pandemic Influenza; Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science; 2006

It has been recognized that most actions taken to counter pandemic influenza will have to be undertaken by local governments, given that the epidemic response capacity of the federal government is limited.

This is reflected in HHS Secretary Michael Leavitt’s statement at a February 2006 State and Local Pandemic Preparedness Meeting: “Any community that fails to prepare [for an influenza pandemic] with the idea that somehow, in the end, the federal government will be able to rescue them will be tragically wrong.”

It cites a study reviewing pandemic influenza plans of 49 states and positively compares the New York City to them: “One of the better-developed plans is that of the New York City Department of Health and Mental Hygiene”. This was in 2006.

This article is interesting for many reasons. Some of the influenza pandemic mitigation measures described in this article are being applied now, including the social distancing. It discusses mitigation measures from multiple perspectives, including epidemiological, social, and political ones. It cites important references. It shows what CDC expected and prepared for, and explains some of the mistakes, made in response to the COVID-19 epidemic. From the Abstract:

The threat of an influenza pandemic has alarmed countries around the globe and given rise to an intense interest in disease mitigation measures. This article reviews what is known about the effectiveness and practical feasibility of a range of actions that might be taken in attempts to lessen the number of cases and deaths resulting from an influenza pandemic.

Weinstein et al., Transmission of Influenza: Implications for Control in Health Care Settings; Clinical Infectious Diseases, 2003

The coronavirus is not an influenza virus, but both are enveloped single-stranded RNA virus types and are expected to have similar behavior in the environment. COVID-19 is not influenza, but until COVID-19 specific research is available, the information about influenza can be used with appropriate corrections and acknowledgement of uncertainty.

The NYC should have known better than to send COVID-19 patients to the nursing homes:

Influenza can spread rapidly to patients and health care personnel in health care settings after influenza is introduced by visitors, staff, or patients.

Outbreaks of influenza among patients have been described in both long-term care and acute care facilities. During outbreaks in nursing homes, attack rates of >60% have been reported. 

Considering that COVID-19 is more contagious than influenza, the following suggests that airborne transmission might play role in COVID-19:

Although droplet transmission is thought to be the primary mode of influenza transmission, limited evidence is available to support the relative clinical importance of contact, droplet, and droplet nuclei (airborne) transmission of influenza.

More on the same subject:

The amount of virus required to induce infection is inversely related to the size of infectious particles administered, with particles <10 µm in diameter more likely to cause infection in the lower respiratory tract.

In human volunteer studies, intranasal droplet administration was associated with milder disease than was inhalation of smaller (i.e., <10-µm) particles and required a larger inoculum of virus. Sneezing, coughing, and even talking can produce droplets of a wide variety of particle sizes, which can facilitate either droplet or droplet nuclei spread.