Fortunately, preparations late last month to help the U.S. government prepare for the nation's largest-ever major flu pandemic was just part of a drill. Although the mock run-through went fairly smoothly, the results suggest that more needs to be done to prepare Americans if there occurs a real worldwide virus outbreak—which some experts say is overdue.
The U.S. Centers for Disease Control (CDC) planned a 24-hour drill which involved nearly 300 employees, mostly based out of their Atlanta headquarters. Only four media outlets were allowed to attend the drill: the New York Times , the Associated Press, the Washington Post , and the Canadian Press.
According to the New York Times and the Associated Press, the made-up scenario meant to simulate a sudden virus outbreak was conducted in real time, much like the TV show 24. In it, a Georgetown University student returns to the U.S. after a trip to Indonesia. He becomes seriously ill the following day and goes to a hospital in Washington, D.C., where tests indicate he has been infected with a new strain of the H5N1 avian influenza virus. Over the course of the day, evidence emerges that this new strain is transmissible between humans; cases pop up among his fellow dormitory residents, people who might have been on his flight from Jakarta, and elsewhere. By the end of the day, there are nine confirmed infections including three deaths.
Although the CDC cut the fake drill short because of a real emergency—a snow storm that swept through the Atlanta area—it successfully exposed challenges the CDC might face in the event of a true outbreak:
How do you get an accurate count of people who have been infected and killed? Is the outbreak serious enough to divert airline flights? Should the U.S. government start shipping its stockpile of antiviral medicine? If so, should it be distributed across the country or just to those regions that have confirmed cases? How do you avoid a public scare or severe economic ramifications? These are just a few of the questions that would need to be answered quickly—and probably based on incomplete information—in the event of a pandemic.
Planning for a Real Disaster
The U.S. government has already developed plans for terrorist attacks and hurricanes, but planning for a worldwide flu pandemic is somewhat new, at least for the U.S. Centers for Disease Control.
On February 1, the CDC issued two new initiatives to increase pandemic preparedness. The first is a series of public service announcements, including television commercials. The second is a set of guidelines for implementing public health measures in the event of an outbreak. (Comprehensive information is available at www.PandemicFlu.gov)
"The impact of pandemic influenza extends well beyond health and medical communities into many segments of society. Developing a pandemic influenza vaccine could take several months, and this guidance describes strategies that may lessen the impact of pandemic influenza through the use of public health measures that don't involve vaccines or medications," said the CDC in a recent media release.
Called "nonpharmaceutical interventions," the measures would be implemented according to a rating system intentionally similar to the familiar hurricane rating system, from Categories 1 through 5.
For a Category 1 outbreak, the CDC suggests that the sick voluntarily stay home, and that the general public pay more attention to hygiene. The average flu season is a Category 1, and causes about 36,000 deaths in the United States.
A Category 2 or 3 situation would be more serious, with the potential to kill several hundred thousand Americans. The CDC would call for quarantines and possibly short-term closing of schools. Major flu outbreaks in 1957 and 1968 both would have fallen under Category 2.
A Category 5 outbreak is an extreme disaster. The CDC would recommend closing all schools and childcare programs for up to three months, staying home from work wherever possible, and canceling large public gatherings.
There has only been one outbreak in recent history that would have resembled a Category 5: the avian flu of 1918. It killed more than 600,000 in the United States and an estimated 50 million people worldwide—more than died in World War I, which ended partly because more soldiers began dying from disease than bullets.
Challenges to Stopping a Potential Outbreak
Carrying out these measures is bound to carry it's own set of problems. For example, says the CDC report, "Dismissal of students from school may lead to the second-order effect of workplace absenteeism for child minding."
If measures to stop the spread of disease are taken too late, the consequences are obvious, but measures taken prematurely could not only cause unnecessary economic damage, but also wear down the public's confidence in and adherence to the government's recommendations—a phenomenon known as "intervention fatigue."
Financial needs would make it hard to withstand long-term quarantine, especially because the average American spends more than he or she earns. A public opinion poll conducted by the Harvard School of Public Health last year indicated that one in four adults couldn't afford to miss work for a week, and one in five said their supervisors would make them come to work even if they were sick. In addition, one in four said there would be no one to take care of them at home if they fell ill.
The Bird Flu Today
As of January 29, the World Health Organization has confirmed 270 human cases of the H5N1 avian flu virus, mostly in Asia. The data show a mortality rate of 60 percent. Luckily, there is no evidence that the virus has mutated into a form transmissible between humans, but experts fear this could happen anytime.
Last week, the Nigerian government reported the first human bird flu death in Sub-Saharan Africa, highlighting a problem many countries would face in the event of a large-scale outbreak: Most of those countries' people are too poor to stay home from work; in addition, AIDS, water-borne diseases and other problems seem to pose more pressing health issues.
Although the U.S. government has stockpiled over 21 million doses of the antiviral Tamiflu, it may not be effective enough or readily available enough. The CDC says it could take several months after an initial outbreak to develop and distribute an effective vaccine for a new disease.
The CDC is encouraging local regions to develop their own pandemic plans, and asking Americans to familiarize themselves with them.
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