www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 15 |  PREPAREDNESS attempting to slow or stop the spread of the pandemic. According to the CDC, the 2009 H1N1 pandemic resulted in over 12,000 deaths in the United States, at least 90 percent of which occurred in persons ages 65 or older. But a larger scale pandemic, like those seen during the early 20th century, never materialized. Again, the emphasis was on making sure preparations remained in place for a potential larg- er-scale incident. “In the wake of this pandemic, the challenge in preparedness is to sustain the interest of private and public sectors in planning for a large- scale outbreak that may have a much more severe effect at a time that cannot be predicted,” read a CDC report at the time. When the Ebola scare occurred in 2014, taking it seriously was no longer a concern—if anything, authorities overreacted to a disease that, in total, resulted in only four cases observed within U.S. borders. As a prior ADVANCE article outlined, resources were taken away from smaller, rural hospitals to treat Ebola—hospitals that had an almost negligible chance of ever coming into contact with an Ebola patient. In that same CDC report, the authors outlined four essentials ele- ments of any response to a pandemic: • Material resources, such as vaccines, antiviral drugs, and personal protective equipment are essential • A commitment to planning, exercising, and refining plans is necessary • A sufficiently large and robustly trained workforce is the basis of any response • A commitment to improvement is crucial. This concept extends from continuously improving plans and training to ensuring that scientific advances are incorporated into procurement and planning If there’s any advice health care professionals—and Americans in general—should follow regarding the possibilities of pandemics, it would be ‘expect the unexpected.’ “Plans and training should be flexible and designed to respond to var- ious levels of disease severity or newly identified pathogens,” the CDC report concluded. “Benefits from pandemic preparedness will enhance our collective public health response to the next infectious disease crisis.” THE NEXT PANDEMIC? It’s impossible to predict when or where the next threat will emerge, but certain social and environmental factors are areas of concentration for professionals. For example, the opioid epidemic and injection drug usage are at least partially to blame for a rise in HIV, Hepatitis C, and skin and organ infections. Measles outbreaks, as well as hepatitis B and whooping cough cases, are in the news. These are believed to be the result of anti-vaccination misinformation campaigns. Finally, climate change bears watching for the future, according to Marik Moen, PhD, MPH, RN, assistant professor at the University of Maryland School of Nursing. “We are seeing an increase in vector-borne diseases from increase in conditions favorable to tick-borne diseases, such as Lyme disease, babesiosis, ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis, Southern tick-associated rash illness, tick-borne relapsing fever, and tularemia,” said Dr. Moen, the recent recipient of a National Excellence in Advancing Nursing Science Award. “In mosqui- to-borne illnesses, West Nile virus is most common, but there is a grow- ing risk of malaria, dengue, and chikungunya.” Many of the causes are directly tied to social determinants of health. Dr. Moen’s award-winning study focused on social factors within low-income populations, and these factors are present within risk behaviors as well, as it pertains to the potential for drug abuse. “Persons who are marginally housed often struggle with mental health conditions that may have preceded or resulted from housing struggles,” she explained, “and these struggles often coincide with substance use disorders. As injection substance use is stigmatized, access to clean, safe injecting materials to prevent infectious disease is limited or illegal in some states, and treatment for infections may be delayed because of shame, stigma, or competing priorities such as food, shelter, etc.” Similarly, poor housing conditions can also be an indicator of poor environmental hygiene measures, subjecting inhabitant to a greater number of vector-borne illnesses. Lastly, people who’ve had unfavorable experiences with the health care system due to discrimination or other factors, or even those with less access to education may be particularly susceptible to the aforemen- tioned anti-vaccination campaigns. n Rob has 15 years of experience writing and editing for healthcare. He pre- viously worked for ADVANCE from 2002 to 2012.