If a severe influenza pandemic develops, like the one in 1918, the Health Department estimates that more than a million and a half people in Minnesota will get sick and nearly 33,000 people will die. That would put a huge strain on health care resources. A vaccine matched to the virus won't even be available for at least five to six months, Health Commissioner Sanne Magnan says.
"When we have that vaccine it will only be enough for about 25 percent of the population. We will not have enough antiviral drugs. We will not have enough protective masks. We will not have enough mechanical ventilators for people who are having difficulty breathing."
Nearly 13,000 flu patients are expected to need a ventilator at sometime during a severe pandemic. But there are only 1200 ventilators currently available in Minnesota hospitals and 85 percent of them are already in use.
So who should get these scarce resources when the time comes? The Health Department put that question to two ethics groups.
Ellie Garrett is with one of the groups - the Minnesota Center for Health Care Ethics. Her team thought it was important to start with the premise that Minnesotans should be treated as equally as possible, within limits, Garrett says.
"We recommend giving most of the resources to the general public but also carving out a portion of those resources for some key workers. We considered many factors to help prioritize among key workers and the general public."
Some of those factors looked at who is at the highest risk of death or complications. And who's most likely to be exposed to the virus. Garrett's group didn't actually determine who qualifies as a key worker - other state and federal agencies are working on that definition. Her team did offer a recommendation on the size of the category.
"Make the group as small as possible. The more resources that are diverted over to key workers, the fewer resources that are available for others who may be at even greater risk because of the way the virus is working."
The framework also acknowledges that there are groups that won't benefit as much from certain treatments. For example, the panel says it assumes that vaccines will be less effective among the elderly. So the vaccine part of the plan gives priority to other groups before the elderly.
The panel also looked at issues that might prevent people from getting the treatment they need.
A fair plan for distributing medical resources won't mean much if people encounter barriers to care, according to Debra DeBruin, with the University of Minnesota Center for Bioethics.
"How can we achieve that goal when lots of people have trouble getting care now because they don't have insurance or because they have insurance but their health care costs are still too high? Or because they don't have clinics nearby or they just aren't able to get to a place where they could get care?"
The authors say they shouldn't be considered hard-and-fast rules, because there's much about a pandemic that cannot be known in advance. They also want to hear feedback on the plan before they finalize it. Public comments will be taken through March 16th. The Health Department will also hold public meetings on the proposal in Owatonna and Duluth.
The avian influenza ethical framework recommendations are posted on the Minnesota Department of Health's Web site.
The health department released the report today.