Volume 15, Number 6—June 2009
Peer Reviewed Report Available Online Only
Stockpiling Supplies for the Next Influenza Pandemic
Lewis J. Radonovich
, Paul D. Magalian, Mary Kay Hollingsworth, and Gio Baracco
, Paul D. Magalian, Mary Kay Hollingsworth, and Gio Baracco
Table 5
Formulas, prioritization, and example calculations of supplies for a 1918-like influenza pandemic*
| Assigned variable name† | Item‡ | Formula | Priority | Example calculation (patient population = 500,000) | Comments and explanation of calculation |
|---|---|---|---|---|---|
| Vital statistics | |||||
| B1 | Fiscal year 2005 unique enrollees | B1 | 500,000 | ||
| B2 | Illness | B2 = B1 × 0.25 | 125,000 | B2 = B1 × 25% attack rate | |
| B3 | Seek healthcare | B3 = B2 × 0.5 | 62,500 | B3 = B2 × 50% of ill seek healthcare | |
| B4 | Hospitalized | B4 = B3 × 0.22 | 13,750 | B4 = B3 × 22% hospitalized | |
| B5 | ICU care | B5 = B4 × 0.15 | 2,063 | B5 = B4 × 15% treated in ICU | |
| B6 | Mechanical ventilation | B6 = B5 × 0.5 | 1,032 | B6 = B5 × 50% receive mechanical ventilation | |
| B7 | Deaths | B7 = B4 × 0.25 | 3,438 | B7 = B4 × 25% case-fatality rate among hospitalized | |
| B8 | Outpatient visits, not hospitalized | B8 = B3 – B4 | 48,750 | B8 = those seeking healthcare not hospitalized | |
| B9 | Hospitalized patient days | B9 = B4 × 5 | 68,750 | B9 = B4 × 5 d average length of stay | |
| B10 | ICU patient-days (not receiving mechanical ventilation) | B10 = B5 × 0.5 × 10 | 10,315 | B10 = B5 × 50% no mechanical ventilation × 10 d average length of stay | |
| B11 | ICU mechanical-ventilation days | B11 = B6 × 10 | 10,315 | B11 = B6 × 10 d average length of stay | |
| Contacts | |||||
| C1 | Physician | C1 = B8 + (B4 × 3) + (B9 × 2) + (B10 × 4) + (B11 × 4) | 310,020 | C1 = no. not hospitalized + 1 physician contact (from Table 4) + no. hospitalized × 3 physician contacts (from Table 4) | |
| C2 | Nurse | C2 = (B8 × 2) + (B4 × 5) + (B9 × 6) + (B10 × 24) + (B11 × 24) | 1,073,870 | ||
| C3 | Respiratory technician | C3 = (B4 × 3) + (B9 × 6) + (B10 × 12) + (B11 × 6) | 639,420 | ||
| C4 | Radiology technician | C4 = B4 + B9 + (B10 × 2) + (B11 × 2) | 123,760 | ||
| C5 | Phlebotomist | C5 = B9 | 68,750 | ||
| C6 | Housekeeper | C6 = B9 + B10 + B11+ 1,000 | 90,380 | ||
| C7 | Other HCW (mental health, clergy) | C7 = B8 + B9 + B10 + B11 | 138,130 | ||
| C8 | Administrative | C8 = B9 + B4 × 2 | 96,250 | ||
| C9 | Escort | C9 = B4 | 13,750 | ||
| Personal protective equipment | |||||
| D1 | Gloves | D1= (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 2 × 1.2 | A | 6,130,392 | D1 = (physician contacts + nursing contacts+ escort contacts) × 2 gloves per pair × 120% to account for unforeseen needs |
| D2 | Gowns | D2 = (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 1.2 | A | 3,065,196 | |
| D3 | N95 disposable respirators | D3 = C8 + C9 +10,000 × B1/50,000 | A | 210,000 | D3 = administrative contacts + escort contacts + an extra 10,000 respirators per 50,000 patients to account for unexpected or unforeseen needs |
| D4 | Goggles | D4 = 1,000 × B1/50,000 | A | 10,000 | D5 = 1,000 respirators per 50,000 patients |
| D5 | Reusable respirators | D5 = 1, 000 × B1/50,000 | A | 10,000 | See D5 |
| D6 | Reusable respirator filter cartridges | D6 = D5 × 3 | A | 30,000 | |
| D7 | Disposable mask (for patients) | D7 = (B8 + B4) × 1.2 | A | 75,000 | |
| Essential supplies | |||||
| E1 | Oxygen nasal cannulas | E1 = B4 | A | 13,750 | |
| E2 | Oxygen masks | E2 = B4 + B10 | B | 24,065 | |
| E3 | Nonrebreather masks | E3 = B10 | A | 10,315 | |
| E4 | Circulaire nebulizers | E4 = B4 + B5 | B | 15,813 | E3 = 1 nebulizer for each patient who is hospitalized and each patient who requires ICU care (each considered separately) |
| E5 | Circulaire masks/filters | E5 = B4 + B5 | B | 15,813 | |
| E6 | IV tubing | E6 = B4 + (B9 × 2) + (B10 × 4) + (B11 × 4) | A | 233,770 | |
| E7 | Heparin lock kits | E7 = B4 + (B9 × 0.33) + (B10 × 0.33) + (B11 × 0.33) | A | 43,245 | |
| E8 | Central line kits | E8 = B5 | B | 2,063 | |
| E9 | Blood gas kit | E9 = (B10 × 3) + (B11 × 3) + B9 | B | 130,640 | E9 = 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 |
| E10 | Suction kit | E10 = B11 | A | 10,315 | |
| E11 | Ambulance bags | E11 = B6 | A | 1,032 | |
| E12 | Alcohol-based hand cleaners | E12 = (C1 + C2 + C3 + C4 + C5 + C6 + C7 + C8 + C9) × 0.01 | A | 25,543 | |
| E13 | Disposable ventilators | E13 = 60 × B1/50,000 | C | 600 | E13 = 60 ventilators per 50,000 patients |
| E14 | Ventilator supplies | E14 = B6 | B | 1,032 | |
| E15 | Morgue packs | E15 = B7 | B | 3,438 | |
| Medication | |||||
| F1 | Home care kits | F1 = B8 | B | 48,750 | |
| F2 | IV fluids: D5NS (1-L bags) | F2 = (B4 × 2) + (B9 × 3) + (B10 × 4) + (B11 × 4) | A | 316,270 | |
| F3 | Antipyretics (in DDD) | F3 = B4 + B9 + B10 + B11 | B | 103,130 | F3 = non-ICU patient days + ICU without mechanical ventilation patient-days + ICU mechanical ventilation patient-days in daily-dose equivalents |
| F4 | Ceftriaxone (in DDD) | F4 = B4 + B9 × 0.75 | A | 65,313 | Arbitrarily 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 |
| F5 | Azithromycin (in DDD) | F5 = B4 + B9 × 0.75 | A | 65,313 | |
| F6 | Moxifloxacin (in DDD) | F6 = B9 × 0.25 | B | 17,188 | |
| F7 | Vancomycin (in DDD) | F7 = B10 + B11 | B | 20,630 | |
| F8 | Piperacillin/tazobactam (in DDD) | F8 = B10 + B11 | B | 20,630 | |
| F9 | Albuterol unit doses | F9 = (B9 × 4) + (B10 × 6) + (B11 × 6) | B | 398,780 | |
| F10 | Sedation (midazolam or propofol in DDD) | F10 = B11 | B | 10,315 | |
| F11 | Norepinephrine (in DDD) | F11 = B11 | C | 10,315 | |
| F12 | Proton pump inhibitors, IV, (in DDD) | F12 = B11 | C | 10,315 | |
| F13 | Morphine (in DDD) | F13 = B11 | B | 10,315 | |
*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.
Page created: July 19, 2010
Page updated: July 19, 2010
Page reviewed: July 19, 2010
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