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New York City Addresses Crucial Issues in Planning for Pandemic Flu

By Clarence Lam and Luciana Borio, M.D., August 22, 2006

The New York City Department of Health and Mental Hygiene Pandemic Influenza Preparedness and Response Plan, which was released on July 10, provides a model for other large urban areas working to formulate similar plans [1]. New York City’s plan concentrates on four primary goals: 1) Limit severe illness and death from influenza; 2) Work with health care partners to support appropriate influenza evaluation and care; 3) Maintain essential medical services; 4) Communicate rapidly, accurately, and frequently with the public, the medical community, and others using all available media. The plan addresses a number of crucial issues, such as the delivery of antiviral drugs and vaccine management, and is particularly useful because it lists upfront the planning assumptions used in its formulations, e.g., “infection will occur in up to 30% of the population. Infection rates will be highest in school-aged children (40%) and will decline with age. An average of 20% of working adults will become ill” [p. IV]. The rationales for most of the decisions are also included, which is helpful. Overall, this comprehensive planning document is very well done, and provides a realistic assessment of how public health priorities and capabilities will change at different stages of a pandemic.

Of note, the plan addresses some very difficult issues, such as the mandatory isolation of patients and the mandatory quarantine of contacts. Mandatory quarantine of potentially exposed, asymptomatic individuals will not be recommended after a pandemic arrives. Instead, individuals exposed to infected persons should remain alert for symptoms and seek medical care upon development of respiratory symptoms or fever [p. 104]. Clinicians may also be interested in the interim case definition and testing guidelines for suspected H5N1 cases in the United States [p. 35], proposed management of suspected patients [p. 37], and disease control measures in the community [p. 104].

In all, NYC’s plan is lucid, realistic, and comprehensive, and while tailored for New York City, it could be very useful to other localities.


New York City Department of Health and Mental Hygiene. NYC DOHMH Pandemic Influenza Preparedness and Response Plan. July 2006. Available at: Assessed on August 16, 2006.

Note: State pandemic plans can be accessed online: