California is stockpiling massive supplies of important medical supplies, including masks, gloves and life-saving medicines, in secret warehouses strategically positioned across the state, attempting to be higher prepared than it was through the Covid crisis.
Four years after the coronavirus turned our lives the other way up and a brand new viral threat looms, public health experts are asking: What else have we learned from the pandemic?
While California is a lot better prepared, a better look suggests that implementing well-thought-out plans would require more testing, more sustainable funding and stronger national leadership, health experts say.
“We've learned a lot. We're in a better position to deal with the next threat,” said Dr. Sarah Rudman, deputy health officer for Santa Clara County, where the country's first COVID-19 death was recorded.
But potential recent threats are emerging – whilst counties face budget cuts that might impact their future preparedness. As a public health emergency fades, so does the eye, Rudman said.
Until now, The risk to public health from H5N1 avian influenza is lowOf the 4 people infected with H5N1, three had contact with dairy cows and one with infected poultry. In the United States, all cases were mild, and there have been no cases in California.
But the virus is spreading in several mammal species. Last week, the German government 36 more cases of bird flu in house mice and 4 more cases in house catsSo far, 95 cattle herds in 12 states have been affected.
“This is a red flag,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley. “The risk is very small, but there is potential – and I don't think we are responding as vigorously as we should.”
The concern, said Dr. George W. Rutherford of UC Berkeley's School of Public Health, is that the virus is accumulating genetic mutations that will allow it to leap from animals to humans – after which spread.
Health experts see successes and failures:
California’s “SMARTER” planannounced in 2021, is A seven-part strategy that increases readiness. The “S” within the acronym stands for access to vaccines, M for masks, A for awareness, R for preparedness, T for testing, E for education and R for Rx or medical treatment.
In the early days of the pandemic, Bay Area hospitals and county health clinics were so desperately low for medical supplies that they asked the general public for donations of N95 masks, gowns and gloves. Under former Governor Arnold Schwarzenegger, the state had spent tons of of thousands and thousands of dollars buying and storing supplies. But when the 2008 recession hit the state budget hard, they got away to save lots of on storage costs.
Today, hospitals, nursing homes, dialysis clinics and doctor’s offices, that are part of a bigger health system,required to create a 45-day supply of non-public protective equipment equivalent to masks and gloves.
And the state, in partnership with the Strategic National Stockpile, has several “strategically placed” warehouses that store protective equipment, emergency medications and other supplies. The stockpile is repeatedly rotated and updated to avoid expiration, in line with the California Department of Public Health. For security reasons, the locations of the warehouses are secret. The department said the associated fee of replenishing the stockpile to exchange items past their shelf life “depends on supply chain readiness, community needs, available funds and the type and nature of specific events and incidents.”
“It's a very good, solid plan,” Swartzberg said. “The people who designed this thought about the big things.”
“But there is one big caveat: We are not an island,” he said. “If we are really well prepared – and the United States is not well prepared in general – then it will be difficult for us to implement this plan.”
That's because California has to follow the rules of the U.S. Centers for Disease Control, he said. And California doesn't have the manufacturing capability to supply every thing it needs.
The federal government has been working with flu vaccine manufacturers to develop and test batches of H5N1 vaccines that focus on different versions of the virus. in line with STAT, the digital medical news site. About 10 million doses are being stockpiled in bulk, in line with David Boucher, director of infectious disease preparedness and response on the federal government's Administration for Strategic Preparedness and Response.
However, since two doses are needed per person, this is able to not be very far-reaching. A bird flu vaccine, which uses eggs, takes longer to supply than the mRNA system developed for COVID. This could affect the production of the seasonal flu vaccine.
And experts like Rutherford worry about fighting bird flu with an egg-based vaccine since it could end in chicken losses.
And although the federal government has tried to extend supplies, “there hasn't been a lot of transparency. It's hard to judge whether supplies are sufficient,” says Jennifer B. Nuzzo, director of the pandemic center at Brown University School of Public Health.
California firms need more help to follow the recommendations or mandates of public health experts, Swartzberg said. At the peak of the pandemic, large firms could afford private consultants, but smaller firms couldn’t.
In particular, firms lack the expertise to optimize air exchange, take care of contagion, implement quarantine and isolation, and communicate the importance of vaccinations. They also need testing protocols for testing employees.
To speed up economic recovery, firms need easier access to capital or subsidies beyond government disaster loans and likewise need mentoring in creating recent sales channels, a report from the Regional Small Business Development Center Networks of California.
“Just as we prepare the state government to deal with the next pandemic, we should also prepare the state's businesses and industries for the next pandemic,” through higher communication from state and federal health officials, Swartzberg said.
“They really wanted to do the right thing to keep the businesses open,” he said.
Better monitoring and testing would warn us of the arrival of a deadly virus.
The CDC monitors the general concentration of influenza A in wastewater, but doesn’t test for specific subtypes equivalent to H5N1. Wastewater testing specifically for bird flu viruses can be expanded nationwide this summer. The philanthropically funded WastewaterSCAN, A wastewater surveillance network to trace infectious diseases, led by Stanford University and Emory University in collaboration with Verily Life Sciences, will monitor samples from 190 wastewater treatment plant sites in 36 states.
While samples of pasteurized milk from retail stores are tested, testing of animals for H5N1 is voluntary, except when the cows are transported across state borders.
And testing is scarce, partially because individuals who work on farms don't volunteer. And there's one other problem: The CDC is the one institution authorized to manage a sophisticated confirmatory test, called a PCR test, on people suspected of getting bird flu, Swartzberg said. This is harking back to the botched early days of the COVID pandemic, when a backlog of CDC testing led to delays in case counts.
Finally, the U.S. Department of Agriculture has released limited information in regards to the genome sequences of the H5N1 samples, limiting research.
Funding cuts could undermine the state's preparedness. Facing a $44.9 billion budget deficit, Governor Gavin Newsom has proposed Cut public health funding by $300 million.
This would downsize not only the California Department of Public Health but additionally local health agencies, putting over 1,200 jobs in danger. Santa Clara County, for instance, faces a $7 million to $10 million cut in flexible funding that supports pharmacists, lab employees, data scientists and public outreach experts. This coincides with the termination of a big federal grant that helped the county construct critical infrastructure equivalent to wastewater monitoring, data management and vaccine distribution.
“We have learned a number of lessons from the COVID pandemic that put us in a much better position to deal with the next threat,” Rudman said. “But our ability to do so is at risk.”
“The difficult thing about pandemic preparedness is that we don't know much about what will hit us next,” she said. “Except that it will be different from what hit us last.”
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