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A World of FLU: Health Officials Are Aware of the Possibility of an Avian Flu Pandemic and Are Taking Steps to Address the Problem

Posted on: Monday, 9 January 2006, 12:00 CST

By Angie Toole, Northwest Florida Daily News, Fort Walton Beach

Jan. 9--Imagine planning for a hurricane that knocks out power, halts gasoline supplies, shuts down grocery stores and kills or injures half the population of Northwest Florida

Hospitals, in recent decades designed for steady, manageable patterns of illness, are overwhelmed by the volume of people sick and dying. Emergency workers' ranks are as decimated as the population.

And afterward, there won't be help coming from another part of Florida, another state, or even another country, because that same storm hit everywhere else, too.

Welcome to the scenario for pandemic flu, as envisioned by public health officials.

And, unlike hurricane season, experts aren't saying "if" it happens, projecting a limited path of destruction.

They're saying "when."

The menace they see hovering on the horizon is H5N1, or bird flu, an avian virus that once was limited to wild and domestic birds but has infected at least 141 people and killed 73, all in Asian countries where the flu has become established.

"Right now, we're in a Phase 3 'alert' stage of pandemic," said Dr. Karen Chapman, director of the Okaloosa County Health Department. "That's a monitoring phase. Right now, we don't have a human virus, just a bird virus that has infected humans in close contact with birds."

But Chapman believes it's only a matter of time before this virulent strain, which human immune systems are expected to have little ability to combat, spreads beyond Asia to threaten the rest of the world.

Flu pandemics have happened throughout history, and experts believe that the next one is overdue.

"It's a force of nature," Chapman said. "Three pandemics have occurred in this country in the past 100 years: 1918, 1957 and 1968. The last two were relatively mild pandemics."

The pandemic in 1957 claimed 70,000 lives, the one in 1968 34,000 people in the United States. The pandemic of 1918, also called the Spanish flu at the time, killed 50 million people worldwide, many of them suddenly.

According to "The Great Influenza" by John M. Barry, medical experts at the time reported cases of people suddenly dropping dead, or symptoms progressing within a matter of hours. Those who died quickly most likely succumbed to an overwhelming and massive invasion of the virus itself. Medical experts believe the avian flu is similar to the 1918 strain of flu.

"For years now, since 1968, we've wondered in public health when another pandemic is going to happen. Not if," Chapman said. "Right now, we're monitoring the situation, and trying to contain and delay the flu as long as possible."

"I think influenza has the potential to be deadly if the bird flu virus mutates to be able to be transmitted from one human to another," said Dr. Nitin Bawa of Santa Rosa Beach. "Right now, it can only be acquired by people who are directly in contact with live chickens. So, for now, there is not much to worry about as most people in this country are not in contact with live chickens."

Locally, doctors fear the United States is woefully unprepared to deal with the consequences of a deadlier influenza virus.

"I do not think we have enough arrangements (for quarantine)," Bawa said. "There are not enough rooms for quarantining people in airports, away from home."

Having a plan of action for quarantine would also help in cases of other viruses, like Ebola.

"In my opinion, China has been quite innovative in finding ways to quarantine by checking temperatures of all people boarding flights and also vaccinating all their chickens," Bawa said. "I think we could learn from such measures."

One of the strategies public health officials are using is to try to form a ring of protection around anyone they believe has been infected by the virus. For the past two years, local hospitals and doctors' labs have had criteria, signs and symptoms of avian flu to look for in patients, particularly those who have traveled to this area from parts of the world affected by avian flu.

The Health Department is ramping up for a more intense education campaign. When travelers come to the immunization clinic for shots before going overseas, they'll be given brochures on avian flu describing symptoms and ways to avoid infection.

"People need to be aware, to avoid things like visiting big outdoor markets in Asia where live birds are sold, to avoid raw blood puddings or dishes with raw poultry that might be a delicacy in another culture," Chapman said.

Time is an important factor.

"The key is to delay the virus from transmitting so we have time to stockpile antiviral medication," she said.

Making a vaccine to fight a new virus is a process that could take six to nine months.

"Our vaccine technology is very dependent on eggs, a specific type of egg, and the supply of those eggs is very limited," Chapman said. "It's a slow process, so the more time we have to develop a vaccine, the better prepared we are against the virus."

Once the avian virus infects humans, though, there is only so much the medical community can do. They can try to manage symptoms, but people are going to die because the potential for a high mortality rate is greater, experts fear, than the 1918 virus.

The key, Chapman said, is the longer health officials can delay the spread of the disease, the better prepared they can be when the storm strikes.

"Every day, every month, every year we can delay this virus from becoming more efficient in transmitting among humans is a another day, another month and every another year we can get better prepared," Chapman said.

In the next couple of months, the Health Department will begin advocating for local governments, businesses, organizations and health care centers to begin planning for the worst.

"We can't do everything. The antiviral and vaccine supply is out of our hands," Chapman said. "What we can do is begin the educational process for leadership in planning throughout the community. We'll have a health care subcommittee. We need to plan for alternate triage sites and case reporting, (and) monitoring people in isolation."

Critical infrastructure, both government and private, will have to be protected in the event of a pandemic.

"We have to plan for the workforce to deal with a 25, 35 or 50 percent absenteeism rate," Chapman said. "There are certain critical businesses that are attuned to becoming affected by a natural disaster, especially here in a storm area, but we are looking at power, water systems being down, food shortages, and gas supply stoppages."

Hospitals would probably be overwhelmed as well.

"We live in a country with a health care system that's good at 'just in time.' We won't have that luxury if there's a surge of people getting sick on this scale. We have to address how we would handle that surge," Chapman said. "We need to take a serious look at how we would function."

Public health officials also plan to work with school officials on how soon schools would need to close when an infectious disease starts to spread in epidemic proportions. After all, in a regular flu season, schoolchildren become a vector for spreading flu.

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Copyright (c) 2006, Northwest Florida Daily News, Fort Walton Beach

Distributed by Knight Ridder/Tribune Business News.

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Source: Northwest Florida Daily News

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