More Questions Than Answers / U.S. Is Not Yet Ready for Bird-Flu Outbreak, Official Says at Summit

By TAMMIE SMITH; A.J. HOSTELER

Virginians – and everyone else – can expect life as they know it to be turned upside-down in a flu pandemic, officials warned yesterday.

Here’s the bottom line, the nation’s top health-policy official said during a state summit on preparing for a worldwide flu outbreak:

The United States is not prepared for a flu pandemic, which if history holds true, is almost certain to happen eventually.

“We are well-prepared for a natural disaster that is weather- related,” said Michael O. Leavitt, U.S. secretary of health and human services, at the Greater Richmond Convention Center. “We are not as well-prepared for a pandemic because of its unique characteristics.”

By definition, a pandemic occurs in many places at the same time. With many communities affected at once, communities would not be able to rely on outside help, Leavitt said.

In addition, a pandemic could last from a year to 18 months, during which time communities could face such issues as how to care for a large number of sick people, how to get food and medications to people who are isolated or asked to stay home, and how to keep cities, businesses, schools and hospitals running when many of their employees are sick.

There are fears worldwide that the deadly H5N1 bird-flu virus will mutate into a form that is easily passed from person to person and cause a pandemic.

As of March 21, the World Health Organization had confirmed 103 cases of humans infected with the H5N1 bird-flu virus. It is believed most of them had direct contact with birds.

“Pandemics happen,” Leavitt warned. “If it isn’t the H5N1 virus, at some point in the future it will be another. We are overdue and underprepared.”

“Everything you say in advance of a pandemic seems alarmist,” Leavitt said. But were a pandemic to hit, nothing anyone does will seem to be enough, he said.

He urged simple preparations, such as having at least a couple of weeks’ worth of food and water stashed away and extra doses of prescription medications.

Yesterday’s meeting drew more than 1,000 people. Other states are holding similar summits, and Leavitt is traveling to them urging preparedness.

Virginia has received a $2.29 million federal grant for pandemic- flu planning. Leavitt said the state is also getting 458,000 doses of the antiviral drug Tamiflu, which can be used to lessen flu symptoms.

The Virginia Department of Health’s plan for responding to a flu pandemic, first developed in 2002, has been revised to bring it in line with a federal plan.

The state’s plan estimates that during eight weeks of pandemic flu activity:

— as many as 1,137,850 people could be sick enough to require outpatient medical care;

— 24,090 could be sick enough to be hospitalized; and

— 5,380 could die.

The state’s population is estimated at more than 7.5 million.

Leavitt said he is particularly concerned about the ability of hospitals to handle an overload of patients. In addition, communities need to focus on how they will distribute antiviral drugs and vaccines in a pandemic.

Speakers emphasized over and over that communities have to be prepared at the local level.

“Any community that fails to prepare with the expectation that somehow the federal government will come to the rescue will be tragically wrong,” Leavitt said.

Gov. Timothy M. Kaine said current planning is taking into account the needs of all citizens, including those who are most vulnerable, such as the elderly, disabled, those who are geographically isolated and those who do not speak English.

“There are all these questions no one has thought to ask us,” Kaine said.

Smaller group sessions yesterday provided a chance to solicit some of those questions and ideas.

Lee McNutt, environmental health and safety team leader with Chesterfield County public schools, attended the K-12 school issues group. One concern: how to educate students if schools were forced to close.

“We have developed an online high school, and I’m sure that could be adapted for elementary and middle schools,” McNutt said. The online high school is used for homebound students.

Deborah Childs, a registered nurse at the University of Virginia, attended the health-care group. Her concern was educating the public to expect things to be different.

“I have been used to somebody licensed giving me my vaccine,” Childs said. “Now my next-door neighbor is going to have to do it…. We have to educate people in advance it may not be health care as they know it.”

WHAT’S NEXT

State health officials are integrating ideas and comments from yesterday’s meeting into the health department’s pandemic-flu preparedness plan.

People can comment on the plan, which is posted on the Virginia Department of Health Web site at vdh.virginia.gov/pandemicflu

— Go to Times Dispatch.com to see the state health department’s flu video.

Unanswered questions

Here are some questions asked at the converence break-out groups yesterday:

SCHOOLS, K-12

— At what point should schools close?

— Will there be adequate substitutes for sick staff and staff who stay home out of fear they will become ill?

— How will resources, including staffing, be allocated if some schools are affected more than others?

— How can we prepare for grief issues when the stricken die?

— How can we continue to educate our students, particularly if schools close?

— Who determines when a child has avian flu? Parent? School nurse? Doctor? Once a child is sick and at home, will a doctor need to sign off before the child is readmitted?

— If large numbers of children become sick while at school and are not immediately picked up by parents, should they be quarantined to a “holding room”? A sick bus?

— If schools close, can the buildings serve another purpose, perhaps as a public-health facility?

— If schools close, who will care for students with parents who work during school hours? What will happen to students who depend on the federal free lunch program?

— What will happen if students, especially high school seniors, miss such crucial tests as state Standards of Learning tests and the SAT?

— How will crucial information be communicated to parents and others in the community?

LOCAL GOVERNMENT

— What will be the role of local governments in distributing antiviral drugs and doing vaccinations?

— Who decides who’s first to get vaccine and antivirals?

— How will people in rural areas without health-care providers be cared for?

— Who will get the word out about what people need to do?

— How will communities sustain such vital services as providing drinking water, fire and police protection, if those workers are affected in large numbers?

— If there is an overwhelming number of deaths, how will the bodies be disposed of?

— Who will pay for all that needs to be done?

— Will college students be sent home?

— If the economy is disrupted and people lose their jobs, what sort of social services will be available?

— Who will decide if big events, such as county fairs, need to be canceled to prevent infections?

OTHER AREAS

— How will it be assured that vaccine is available to vulnerable residents, such as the elderly?

— What can be done to measure how groups and localities are complying with directives to get prepared?

— How are public-health messages going to be communicated to the public? How can it be assured that local, state and federal officials are telling people the same things?

— Because flu vaccine is made in chicken eggs, what is being done to protect poultry flocks?

– Compiled by Lindsay Kastner and Tammie Smith

Avian-flu symptoms

— In humans, the symptoms of the H5N1 avian virus initially look a lot like seasonal flu: cough, sore throat, fever, aches, fatigue and chills. However, these symptoms quickly become severe. Those infected can also develop eye infections, bleeding from the nose and gums, vomiting, diarrhea, high fever, viral pneumonia, acute respiratory distress syndrome and multi-organ failure.

— The symptoms begin a few days after infection and can last two weeks and sometimes longer. Most deaths occur within 9 or 10 days after the symptoms begin.

— Antivirals, antibiotics and corticosteroids can be used for treatment. Hospitalized patients can require mechanical help to breathe.

– Source: Virginia Department of Health

— Contact staff writer Tammie Smith at TLsmith@timesdispatch.com or (804) 649-6572.

— Contact staff writer A.J. Hostetler at ahostetler@timesdispatch.com or (804) 649-6355.

— Staff writer Lindsay Kastner contributed to this report.

ILLUSTRATION: PHOTO

MEMO: Virginia prepares for a flu pandemic; Who decides who’s first to get vaccine and antivirals?–Who will get the word out about what people need to do?– At what point should schools close?- – Who will pay for all that needs to be done?