Towns and Cities Prepare for Public Health Crisis as Pandemic Flu Could Kill Up to 1.9 Mill

With this dire warning from Dr. E Marcuse in mind, town officials and business leaders around the country are taking part in workshops addressing how town and cities plans to deal with a pandemic flu outbreak, which the medical profession agree is coming.

A pandemic flu has the potential to devastate the status quo around the globe. Should an outbreak happen, the U.S. Center for Disease Control estimates anywhere from 200,000 - 1.9 million deaths in the U.S. This data was assembled with projections of a 15 - 35 percent attack rate - the percentage of the population that would become infected. "The implications are frightening and mind boggling," said Glastonbury, Conn. Director of Health David Boone during a recent workshop, "but we really have to start to deal with these issues. We really have no choice."

The reason that the effects could be so devastating is the fact that if a pandemic were to strike, it is assumed that the entire population would be affected. Because everyone would be affected, there would not be any way for the town and state to be able to function as they would during a traditional emergency.

U.S. Health and Human Services Secretary Mike Leavitt has said "Any community that fails to prepare, with the expectation that the federal government will at the last moment be able to come to the rescue, will be tragically wrong . . . there is no way in which 5,000 different communities can be responded to simultaneously, which is a unique characteristic of a human pandemic."

Adding to the complexity of the issue is the fact that health officials simply don't know how a disease would act. A flu pandemic would be caused by the introduction of a new, or "novel," strain of a disease that nobody has immunity to, because it does not exist right now. Bodies build up immunities to sickness when they are exposed to them.

One of the first challenges facing the medical profession is educating the public. "There's a lot of terms involved with influenza, and they're all related" said Lucinda H. Hogarty, public health emergency response planner for the University of Connecticut. "It can be confusing."

Flu, or influenza, is the traditional sickness that comes around in winter. A pandemic flu is the scientific name for a global outbreak characterized by a novel virus, to which all or most of the population is susceptible. The disease would be transmissible from person to person, will feature a wide geographic spread, and may occur in two or three waves.

The third "flu term" being bounced around is the avian flu, scientifically referred to as "H5N1" or "H5." This is a disease that currently only affects birds, but there have been a few instances of transmission to humans from birds in developing countries to people that were "literally sleeping with their chickens," as Hogarty says.

Although the government had been trying to plan for a pandemic since the 1990s, the avian flu scare has heightened urgency because of a particular concern of the emergence of a "super virus." "The fear in the public health world is that if H5N1 combines with the genetic material in a person with seasonal [traditional] flu, it could become person-to-person transmissible," explains Hogarty. "H5 is always mutating, drifting, moving. So far, it hasn't been able to transmit from person to person. But seasonal flu is easily transmissible. The fear is that if the two get together, a new strain would be formed]. People have no natural immunity to H5N1 because it is new, novel, so there's no natural protection," she said.

Slowing the spread

Although the medical community is still working on it, there are some measures that if properly executed could curb the spread of the virus. The federal government has mandated towns in all 50 states to implement plans to deal with a potential outbreak, and has allocated funds for emergency planning. The actual dollar amounts have not been released.

Likely, the most effective method harkens back to at least the plague outbreak during the Middle Ages, the tried and true method of quarantine and isolation. During an outbreak, the fewer number of people who come into contact with infected persons, the less the disease will spread. Towns and cities across the nation are looking into measures that will help people work from home and other issues that will make it possible for them to stay at home and care for their families. "Theoretically, if a person hasn't been exposed and they don't go outside and they don't let anything inside, they should be fine," said Hogarty. She said that, realistically, people should plan on staying inside for a maximum of two weeks. There are not many germs that have an incubation period (the time it can survive without a host) of more than five days.

During the 2003 SARS outbreak in Toronto, quarantine and isolation were very effective in stopping the spread of the disease. It is hoped that people would volunteer to do this, but the government will have the authority to make it mandatory.

It is also important to note that it is likely the outbreak will come in waves. The more the spread can be curbed, the more time is bought so that a vaccine can be produced. Realistically, a true vaccine won't be available for, at the very least, four to five months, and even then there would be limited supplies.

The use of current vaccines and antivirals could also help people both fight off the disease if infected, and also boost the immune system so that it would be more difficult for a person to become infected in the first place.

The most important issues in an emergency will be educating the public beforehand, so that they are prepared and ready to deal with an emergency.

More question than answers

Because an outbreak in a world as "globally mobile" as today's hasn't happened, scientists have more questions than answers. Questions and issues being currently discussed include: how to keep the business infrastructure running with people being told to stay home, what to do with schools, supply chain concerns, cross-training and back up resources, how to make shut down decisions, how to deal with "mass mortuary" (a lot of dead bodies), how hospitals and other government functions deal with increased need. There are also questions regarding the civil rights involved with mandatory quarantine and isolation.

Another question is who should be given the existing anti-virals and vaccines that treat the traditional flu. One thought is that it should be given to emergency workers so that they will be better protected. But there's the other thought that if those infected become healthy, they would be more valuable because they would not be susceptible to the disease, as they have built up immunities.

Other containment issues include: "snow days" or "shelter in place," suspension or restriction on group assembly, cancellation of public events, closure of mass transit and public places and Cordon sanitaire- an ancient term for geographically isolating neighborhoods, possibly by force.

What can you do to prepare

Most likely, the most important thing you can do is to create an emergency kit for your family. Contact your town Health Department for tips on what to include in your kit. Water, canned foods, medications etc. is a good start. Healthier people will likely be better equipped to fight off the disease, so thats another incentive to get into shape. A flu shot might also help guard against the disease. Planning ahead to see if you can work from home is also important.

What can you do to help in your community

States and towns will also need volunteers to help deal with a crisis, and this can be as simple as answering calls from home. Up to 40 percent of the workforce might be unable or unwilling to work. "With a lot of jobs lost, volunteers will be crucial," said Hogarty.

Outbreak history and the 'Chicken Little effect'

A particular concern in the medical community is of a "Chicken little Effect." Because the population has recently been warned that smallpox and anthrax were coming and never did, it is feared the population might not take warnings seriously.

But there have been large outbreaks in recent history, most recently in 1969, and more lethally in 1918 - 1919. That outbreak killed more Americans than any war: "The social and medical importance of the 1918 - 1919 influenza pandemic cannot be overemphasized. It is generally believed that about half of the 2 billion people living on [E]arth in 1918 became infected. At least 20 million flu cases were counted and about half a million people died," wrote Alfred Crosby in "America's Forgotten Pandemic." These numbers would be worse today because of increased global mobility.

To learn more about how to prepare for a pandemic, or to volunteer, contact your town health department or visit www.PandemicFlu.gov. Managed by the U.S. Department of Health and Human Services, the site provides access to U.S. Government avian and pandemic flu information.