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Posted on Thu, Jan. 19, 2006

Avian flu plan thinks 'the unthinkable'

By Sandy Kleffman
CONTRA COSTA TIMES

SACRAMENTO - If an avian flu pandemic sweeps through the state, health authorities would consider quarantines, school closures and encouraging people to avoid mass transit and public gatherings.
Should a pandemic develop, it could last as long as two years and kill 35,000 Californians, state health officials said Wednesday as they released the state's draft avian flu plan. The state proposes spending $2 million now to stockpile 270,000 treatments of Tamiflu, an antiviral drug that eases the disease's symptoms.
"The biggest challenge is getting people to think the unthinkable," said Sandra Shewry, director of the California Department of Health Services.
No one knows if the avian flu, which first infected humans in 1997 in Hong Kong, will reach the United States and if the virus will mutate enough so that it is easily transmitted among humans.
The H5N1 strain of avian flu has been detected in domestic and wild birds across Southeast Asia. Reports of isolated outbreaks have come from Romania, Russia and Turkey.
At least 60 people have died. Most victims became infected through close contact with birds.
Despite the small number of infections, health officials worry because the strain appears to be particularly virulent and since it is new, no one has developed immunity.
"It causes severe illness and high mortality rates," said Dr. Mark Horton, the state's public health officer.
If the virus mutates, health leaders say they fear it could lead to a pandemic or worldwide outbreak similar to the 1918 Spanish influenza, which killed 40 million people.
The state's influenza plan notes that as many as 35 percent of California residents could become ill during a pandemic and 35,000 might die. It assumes the epidemic would come in waves and could last 18 to 24 months.
"This level of disease activity would disrupt all aspects of society and severely affect the economy," the report states.
Gov. Arnold Schwarzenegger has proposed spending $60 million next year to enhance the state's readiness for avian influenza and a natural disaster.
The California plan dovetails with President Bush's $7.1 billion avian flu proposal unveiled in November. It calls for stockpiling antiviral medication and accelerating vaccine development.
Contra Costa County health leaders completed their first pandemic flu plan in September and are revising it, said public health director Dr. Wendel Brunner.
"The thing that is the biggest challenge is that if there is a flu pandemic, it will occur nationally, so resources from outside the county will not be available," Brunner said.
That makes planning for a pandemic much tougher than gearing up for an earthquake or outbreak of botulism, for example. In those cases, state and federal agencies could be counted on to rush in with resources.
Contra Costa has about 1,500 hospital beds available and that could be expanded by 10 percent to 20 percent, Brunner said, "but that wouldn't be adequate in a major flu pandemic."
Local leaders would probably set up emergency hospitals in school gymnasiums and other large buildings if health care facilities become overloaded, he said.
A shortage of health care workers would also be a major challenge. The state plan suggests expanding the permitted duties of paramedics, emergency medical technicians, nurses, dentists, veterinarians, podiatrists and pharmacists during such emergencies.
The best strategy, Brunner said, would be to quickly get vaccine to large numbers of people. Contra Costa could immunize all 1 million of its residents within a few weeks, he said.
Whether a vaccine will be available and in what quantities, remain big questions. Manufacturers are developing vaccines based on the existing virus. However, those vaccines may not be effective once the virus mutates. Because vaccine production is a lengthy, cumbersome process, Bush has proposed spending $2.8 billion to develop quicker technologies.
The state plan includes a strong surveillance system to quickly detect the virus, which has not arrived in California. In recent months, physicians have submitted specimens on a couple dozen cases, but testing in state laboratories revealed that the ill people had the standard seasonal flu or some other disease, Shewry said.
If the virus is detected, health leaders would consider containment strategies such as quarantines and administering vaccines or antiviral medications to people who have close contact with the infected person. The state implemented quarantines during the 1918 pandemic. "They would never be used lightly," Shewry said.
After the virus becomes more widespread, the plan suggests "social distancing" techniques such as closing schools, restricting public gatherings and encouraging people not to use public transportation.
It will take a team approach to make the plan work, state officials said, including having education, business and local health officials develop their own strategies.
Residents can do their part by maintaining a supply of food, water, prescription drugs and other health supplies in case they cannot get to a store or the stores run out of supplies.
"While we cannot absolutely prevent a pandemic, we can mitigate its impact," Shewry said.
Reach Sandy Kleffman at 925-943-8249 or skleffman@cctimes.com.

PREPARING FOR A PANDEMIC
ONLINE
� Plan for an extended stay at home by storing bottled water, canned juices and such nonperishable food items as ready-to-eat canned meats, fruits, vegetables, soups and protein bars.
� Ask your doctor and insurance company for an extra supply of prescription drugs.
� Have health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
� Other emergency supplies include a flashlight, batteries, a portable radio, a manual can opener, garbage bags, tissues, toilet paper and disposable diapers.

PREPARING FOR A PANDEMIC
ONLINE
To read the state's draft pandemic influenza plan, visit www.dhs.ca.gov. Residents can submit comments through Feb. 15. State officials say they hope to finalize the plan by spring.