Pandemics and epidemics are inevitable. There is good historical information to support significant outbreaks of disease, in global proportions, for all of history. For example, the 1918-1919 influenza outbreak killed 21 million people, the majority over a 16-week period from September to December in 1918 (Barry, 2004). At that point in time, the world’s population was a little more than a quarter of what it is today. Likewise, global travel was not as rapid or readily accessible. Containing the spread of such a disease would be difficult if not impossible today. How would the numbers change in such an outbreak?

The World Health Organization defines a pandemic as a global epidemic that spreads to more than one continent (WHO, 2009).  One of the more recent pandemics that you might be familiar with is the H1N1 influenza outbreak of 2009. The H1N1 outbreak began in Mexico and was considered a swine flue, because the virus was similar to strains found in pig populations. That outbreak brought over 13,000 deaths globally (WHO, 2014). Consider the definitions below and then review the global news for any disease that might fight the definitions.


  • Pandemic—a global epidemic of disease that spreads to more than one continent (WHO, 2009)
  • Outbreak—the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, or time of year. An outbreak may only last for a matter of days or weeks, but may last for years (WHO, 2014).
  • Quarantine—the separation and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill (CDC, 2014).
  • Isolation-—the separation of sick people with a contagious disease from those who are not ill (CDC, 2014)
  • Disaster epidemiology—“Disaster epidemiology is defined as the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health, and behavioral health” (CDC, 2012).

What Causes New Strains and Outbreaks?

An understanding of genetics and genomics is important in understanding how new strains of viruses develop. Antigenic drift is a term describing the changes that occur within virus’s ribonucleic acid that changes the virus. Typically, these changes create seasonal changes or new strains of a virus (Macha & McDonough, 2012). These new strains are the reason for medical interventions such as seasonal influenza vaccines, and are also the cause of adaptation in the virus that can create jumps from one species to another. However, rapid genetic changes are some of the most challenging and deadly occurrences that epidemiologists and scientists must battle in monitoring and treating viruses

For example, the rapid changes and adaptations of human immunodeficiency virus to antiviral medications created the need for multidrug therapy and drug resistance among the disease. Even the recent ebola outbreak in West Africa has led to documented genetic changes. The original ebola virus had already undergone over 350 genetic mutations in less than 10 months after the original cases were noted (CITE).

Pandemic Preparedness

The larger population of both humans and animals, and the widespread connectivity of people throughout the globe, create an environment in which a pandemic outbreak can spread quickly. The U.S. government has programs for pandemic preparedness that move from federal to state and local levels. Gauging the impact of a pandemic is difficult, but researching past statistics about rates of infection and the numbers of people that seek medical care have assisted in preparation. In the last three major outbreaks of the 20th century, around one third of the population has developed illness, with half of those reaching out for medical services. Children and older adults are the hardest hit as far as both incidence and complications. Based on these statistics, the U.S. healthcare establishment could become overwhelmed with demand and lack space and personnel to care for patients. It should likewise be noted that to develop a vaccine for an outbreak such as influenza would take 4 to 6 months from identification of the strain to a vaccine (OSHA, 2009). Remember the time frame of the highest level of influenza devastation in 1918-1919?

Pandemic preparedness lies in the ability of healthcare workers to plan ahead, work together, and understand the importance of genetics, genomics, environment, risks, and spread of disease, as well as having a good understanding of biological sciences.

Pandemics Severity Index

  • Category 1—case fatality ratio of less than 0.1% and fewer than 90,000 U.S. deaths
  • Category 2—0.1%–0.5% case fatality ratio and 90,000–450,000 U.S. deaths
  • Category 3– 0.5%—1% case fatality ratio and 450,000–900,000 U.S. deaths
  • Category 4—1–2% case fatality ratio and 900,000–1.8 million U.S. deaths
  • Category 5—greater than 2% case fatality ratio and more than 1.8 million U.S. deaths (CDC, 2014).


Pandemic Actions

Based on the severity and type of outbreak, the CDC will more than likely request actions by the public and healthcare providers to decrease the spread of disease, including asking people who are ill to remain at home until they are no longer contagious, asking members who live with ill persons to remain home for the same period, closing schools, and asking people to distance themselves socially from other adults and children within the community.

In an event, preplanning is key and should involve the entire community and not just major health centers. The goals are to maximize the safety of healthcare workers and patients, ensure that the basics of care such as airway maintenance and minimizing trauma are considered, and have a plan and education in place for infection control.




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