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Avian Strain Hasn't Been Found in North America, but Local Hospitals Face Big Challenges to Be Ready Just in Case

Posted on: Saturday, 15 April 2006, 09:00 CDT

By Ridgely Ochs, Newsday, Melville, N.Y.

Apr. 15--Several weeks ago, an East End farmer found 20 chickens dead. Within hours, county, state and federal health officials were alerted and the chickens were sent to a state lab in Albany and then to a federal lab at Cornell where the birds were tested for the deadly avian flu.

The lab's findings were negative: The chickens probably were killed by a small animal and not the lethal H5N1 avian flu, which has spread from Asia across Europe, killing 109 people and millions of birds.

But the swift attention given to the incident underscores public health officials' concern about a disease that's still evolving.

U.S. health officials say it is only a matter of time before such tests come back positive and this avian flu strain will be found in North America. But the real fear is that the virus will mutate so human-to-human transmission becomes easier, which could set off a flu pandemic.

"We are in a race," U.S. Health and Human Services Secretary Michael Leavitt has said. Last year, Congress appropriated $3.8 billion to help the country get ready for pandemic flu. But it is local hospitals and county health departments that are responsible for planning for a pandemic.

This is no small order: A pandemic would be likely to occur in many places simultaneously; initially it is likely there will be no vaccine and possibly hundreds of thousands of people could be infected, experts say.

The question, then, is how ready are local health workers? Right now, they say, they're better prepared than before 9/11 - but not prepared enough.

In February, the state Health Department issued a 400-page pandemic preparedness report, designed to serve as a template for the counties, which must submit their own plans to the state by the end of August. While the state would give guidance and some medications or equipment in an outbreak, the counties would decide whether to establish a quarantine, or to close schools, said Dennis Whalen, executive deputy commissioner in the state Department of Health.

Gov. George Pataki has set aside $29 million in the most recent state budget for buying antivirals, ventilators and protective gear. The state also has funded the counties and hospitals for emergency planning, including for pandemic flu: In 2005-06, Nassau received $1.33 million and Suffolk $1.42 million - about the same as they received in the previous year. New York City received a total of $40 million last year directly from the federal government for emergency preparedness.

In addition, hospitals statewide received a total of $23 million for emergency planning. Stony Brook University Hospital and facilities in the North Shore-Long Island Jewish Health System are among eight hospitals the state has designated as regional resource centers for epidemic or disaster preparedness. These eight hospitals, which received an additional $13.9 million, are, along with the health departments, primarily responsible for developing pandemic flu plans.

The city is probably better prepared than the counties, although it too faces problems, said state Sen. Michael Balboni (R-East Williston), head of the committee on Veterans, Homeland Security and Military Affairs. Dr. Isaac Weisfuse, deputy commissioner of New York City's health department, said that since 9/11 and the anthrax attacks, the city has beefed up its disease surveillance system.

Every city agency has also developed "continuity plans," Weisfuse said. But, he said, how hospitals would contend with huge numbers of patients over "prolonged periods" remains an issue.

Brian O'Neill, vice president for emergency services for North Shore-LIJ, said he believes emergency preparedness also has vastly improved on Long Island since 9/11 - especially in disease surveillance and communications. But he said hospital officials still have major issues to resolve. In testimony last month in Mineola before a panel on pandemic preparedness, convened by Balboni and state Sen. Kemp Hannon (R-Garden City), O'Neill said that Nassau's hospitals had identified room only for an additional 755 patients. He said there are 125 ventilators in the county; 218 isolation beds; 281 staffed intensive care unit beds; and 102 pediatric beds. The hospitals' morgues can only accommodate 194 bodies, he said. Of the 321 emergency room beds, 26 can provide isolation from an airborne virus such as flu.

Given predictions that a "moderate" pandemic would infect 30 percent of the population, O'Neill estimated about 390,000 people in Nassau alone could be infected with flu. Of those, 3,705 would need to be hospitalized, 556 would need ICU beds and 278 would need to be on a ventilator, he said.

Dr. William Greene, associate director for medical and regulatory affairs at Stony Brook, said Suffolk hospitals are grappling with the same problems. Suffolk has 274 ventilators; 108 isolation beds; 227 ICU beds; 124 pediatric beds; 94 emergency room isolation beds; and room for 144 bodies in hospital morgues, according to the state Department of Health.

"We still have significant challenges," Greene said.

While Stony Brook has stockpiled surgical masks, some antivirals and special respirators, Greene said many hospitals in the county don't have enough cots or stretchers. Staffing for an overflow of patients when many health workers are infected is a challenge.

Officials are trying to be creative. Nassau's health commissioner, Dr. David Ackman, said the county has met with churches to discuss using their facilities. North Shore-LIJ has purchased 100 portable isolation units, O'Neill said.

Greene said Stony Brook has identified where it could put another 200 beds, and Dr. David Graham, Suffolk's deputy health commissioner, said the county has discussed using closed Brunswick Hospital in Amityville.

But no one is resting easy. As Greene said: "Being more prepared is not the same as being completely prepared."

WHAT YOU NEED TO KNOW

What is a flu pandemic?

It is a worldwide disease outbreak that occurs when a new influenza A virus emerges that causes serious illness, spreads easily person-to-person and for which there is little or no immunity. Currently, there is no pandemic.

Why is there concern about H5N1 avian flu?

The H5N1 virus has spread among birds from Asia to Europe and Africa. The virus also has been transmitted from birds to mammals, including humans who have come in close contact with infected fowl. So far, 109 people have died. There's the possibility this strain will mutate so that easy human-to-human transmission is possible.

Is there a vaccine?

No. The yearly flu vaccines are designed to protect against specific viruses, so a vaccine can't be produced until a new pandemic influenza virus emerges. Even after a virus has been identified, it could take at least six months to develop and test a vaccine.

There are also only two vaccine manufacturers in this country. The federal government has allocated $1.75 billion to speeding up and increasing vaccine production.

Are there other drugs?

Tamiflu and Relenza are the most likely antivirals to be used in a pandemic. They can be given to help prevent viral infections such as the flu or to treat people who have been infected by a virus, limiting its impact.

How can I avoid getting sick?

Get the seasonal flu shot. This will protect you from seasonal flu and may offer some immunity to a pandemic flu.

Wash your hands frequently with soap and water.

Cover your mouth with tissue when you cough.

A surgical mask may help stop transmission of a virus.

For more information, go to www.pandemicflu.gov.

- RIDGELY OCHS

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Copyright (c) 2006, Newsday, Melville, N.Y.

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Source: Newsday, Melville, N.Y.

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