# Stockpiling Supplies for the Next Influenza Pandemic

Lewis J. Radonovich , Paul D. Magalian, Mary Kay Hollingsworth, and Gio Baracco
Author affiliations: North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA (L.J. Radonovich); Miami, Florida, USA (P.D. Magalian); North Florida/South Georgia Veterans Health System, Lake City, Florida, USA (M.K. Hollingsworth); Miami Veterans Affairs Healthcare System, Miami (G. Baracco)

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## Table 5

Formulas, prioritization, and example calculations of supplies for a 1918-like influenza pandemic*

Assigned variable name†Item‡FormulaPriorityExample calculation (patient population = 500,000)Comments and explanation of calculation
Vital statistics
B1Fiscal year 2005 unique enrolleesB1500,000
B2IllnessB2 = B1 × 0.25125,000B2 = B1 × 25% attack rate
B3Seek healthcareB3 = B2 × 0.562,500B3 = B2 × 50% of ill seek healthcare
B4HospitalizedB4 = B3 × 0.2213,750B4 = B3 × 22% hospitalized
B5ICU careB5 = B4 × 0.152,063B5 = B4 × 15% treated in ICU
B6Mechanical ventilationB6 = B5 × 0.51,032B6 = B5 × 50% receive mechanical ventilation
B7DeathsB7 = B4 × 0.253,438B7 = B4 × 25% case-fatality rate among hospitalized
B8Outpatient visits, not hospitalizedB8 = B3 – B448,750B8 = those seeking healthcare not hospitalized
B9Hospitalized patient daysB9 = B4 × 568,750B9 = B4 × 5 d average length of stay
B10ICU patient-days (not receiving mechanical ventilation)B10 = B5 × 0.5 × 1010,315B10 = B5 × 50% no mechanical ventilation × 10 d average length of stay
B11ICU mechanical-ventilation daysB11 = B6 × 1010,315B11 = B6 × 10 d average length of stay
Contacts
C1PhysicianC1 = B8 + (B4 × 3) + (B9 × 2) + (B10 × 4) + (B11 × 4)310,020C1 = no. not hospitalized + 1 physician contact (from Table 4) + no. hospitalized × 3 physician contacts (from Table 4)
C2NurseC2 = (B8 × 2) + (B4 × 5) + (B9 × 6) + (B10 × 24) + (B11 × 24)1,073,870
C3Respiratory technicianC3 = (B4 × 3) + (B9 × 6) + (B10 × 12) + (B11 × 6)639,420
C4Radiology technicianC4 = B4 + B9 + (B10 × 2) + (B11 × 2)123,760
C5PhlebotomistC5 = B968,750
C6HousekeeperC6 = B9 + B10 + B11+ 1,00090,380
C7Other HCW (mental health, clergy)C7 = B8 + B9 + B10 + B11138,130
C8AdministrativeC8 = B9 + B4 × 296,250
C9EscortC9 = B413,750
Personal protective equipment
D1GlovesD1= (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 2 × 1.2A6,130,392D1 = (physician contacts + nursing contacts+ escort contacts) × 2 gloves per pair × 120% to account for unforeseen needs
D2GownsD2 = (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 1.2A3,065,196
D3N95 disposable respiratorsD3 = C8 + C9 +10,000 × B1/50,000A210,000D3 = administrative contacts + escort contacts + an extra 10,000 respirators per 50,000 patients to account for unexpected or unforeseen needs
D4GogglesD4 = 1,000 × B1/50,000A10,000D5 = 1,000 respirators per 50,000 patients
D5Reusable respiratorsD5 = 1, 000 × B1/50,000A10,000See D5
D6Reusable respirator filter cartridgesD6 = D5 × 3A30,000
D7Disposable mask (for patients)D7 = (B8 + B4) × 1.2A75,000
Essential supplies
E1Oxygen nasal cannulasE1 = B4A13,750
E2Oxygen masksE2 = B4 + B10B24,065
E4Circulaire nebulizersE4 = B4 + B5B15,813E3 = 1 nebulizer for each patient who is hospitalized and each patient who requires ICU care (each considered separately)
E5Circulaire masks/filtersE5 = B4 + B5B15,813
E6IV tubingE6 = B4 + (B9 × 2) + (B10 × 4) + (B11 × 4)A233,770
E7Heparin lock kitsE7 = B4 + (B9 × 0.33) + (B10 × 0.33) + (B11 × 0.33)A43,245
E8Central line kitsE8 = B5B2,063
E9Blood gas kitE9 = (B10 × 3) + (B11 × 3) + B9B130,640E9 = ICU without mechanical ventilation patient-days × 3 kits per ICU stay + ICU mechanical ventilation-days × 3 kits per stay × 1 kit per non-ICU stay
E10Suction kitE10 = B11A10,315
E11Ambulance bagsE11 = B6A1,032
E12Alcohol-based hand cleanersE12 = (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 0.01A25,543
E13Disposable ventilatorsE13 = 60 × B1/50,000C600E13 = 60 ventilators per 50,000 patients
E14Ventilator suppliesE14 = B6B1,032
E15Morgue packsE15 = B7B3,438
Medication
F1Home care kitsF1 = B8B48,750
F2IV fluids: D5NS (1-L bags)F2 = (B4 × 2) + (B9 × 3) + (B10 × 4) + (B11 × 4)A316,270
F3Antipyretics (in DDD)F3 = B4 + B9 + B10 + B11B103,130F3 = non-ICU patient days + ICU without mechanical ventilation patient-days + ICU mechanical ventilation patient-days in daily-dose equivalents
F4Ceftriaxone (in DDD)F4 = B4 + B9 × 0.75A65,313Arbitrarily assume that among those who are treated initially with ceftriaxone and azithromycin, 75% will continue on the same regimen and 25% will be switched to moxifloxacin
F5Azithromycin (in DDD)F5 = B4 + B9 × 0.75A65,313
F6Moxifloxacin (in DDD)F6 = B9 × 0.25B17,188
F7Vancomycin (in DDD)F7 = B10 + B11B20,630
F8Piperacillin/tazobactam (in DDD)F8 = B10 + B11B20,630
F9Albuterol unit dosesF9 = (B9 × 4) + (B10 × 6) + (B11 × 6)B398,780
F10Sedation (midazolam or propofol in DDD)F10 = B11B10,315
F11Norepinephrine (in DDD)F11 = B11C10,315
F12Proton pump inhibitors, IV, (in DDD)F12 = B11C10,315
F13Morphine (in DDD)F13 = B11B10,315

*ICU, intensive care unit; HCW; healthcare worker; IV, intravenous; D5NS, KCl in 5% dextrose and NaCl; DDD, daily defined dose.
†To understand this table and use the calculations for a selected population of patients, view the format like a table with the assigned variable name representing the name given to the figure (the variable) that is produced when calculating the figure in that row. For example, the figure that is produced from calculating B4 (13,750) is the number of patients who can be expected to be hospitalized among a patient population of 500,000. In turn, to arrive at the figure for B5 (the number who require ICU care) the figure that was produced for B4 (13,750) is multiplied by the 15% treated in the ICU. Thus, the definition of B5 (2,063) is the number of patients who require ICU care, which is calculated (and then assumed) to be 15% of the patients who are hospitalized.
‡Not necessarily an exhaustive list; additional items may be added in the same fashion.

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