Healthcare epidemiology: the current status of planning for pandemic influenza and implications for health care planning in the United States.

The United States needs to be better prepared for a large-scale medical catastrophe, be it a natural disaster, a bioterrorism act, or a pandemic. There are substantial planning efforts now devoted to responding to an influenza pandemic. Here, we review these efforts and identify some harsh realities: (1) the US health care system is private, competitive, broke, and at capacity, so that any demand for surge cannot be met with existing economic resources, hospital beds, manpower, or supplies; (2) the emphasis placed on the development and rapid production of an effective vaccine is excellent, but the effort is underfunded to meet global demand; (3) and the Centers for Disease Control and Prevention's community mitigation measures, such as the use nonpharmacological and social interventions (e.g., use of face masks or respirators, social distancing, and closure of schools), lack validation and could have substantial indirect and unintended consequences. Finally, international collaborations are essential for disease surveillance and to assure investigator access to influenza strains, equitable vaccine distribution, and availability of critical supplies from offshore sources.