Flu emergency plan is being fine-tuned



The next global influenza pandemic could sicken more than a quarter of Maryland's population, sending more than 44,000 to hospitals and nearly 10,000 to their deaths, public health authorities say.

Hospitals and morgues could fill to overflowing. Schools would likely close for weeks or months to curtail spread of the illness. And medical workers, as well as the supplies and equipment they need to care for a flood of patients, might be in short supply.

State and local health authorities say they're working hard to avoid such an appalling scenario, which assumes no government intervention. They're fine-tuning their emergency plans to cope with what otherwise could become the largest public health crisis any of them has ever witnessed.

"Pandemic influenza planning has come a long way, and we are more prepared today than we have been in the past," said Dr. Jean L. Taylor, Maryland's head of epidemiology and disease control.

But the plans are "a work in progress," she said. And in the end, their work might never be done "because some of the decisions need to be guided by the epidemiology of the pandemic" as it unfolds.

No one can forecast the precise nature or timing of the next pandemic. But "everyone would agree, based on past history, that a pandemic is going to occur again," said Dr. Michelle A. Gourdine, a deputy secretary at the Department of Health and Mental Hygiene.

The United States has been hit by three global flu pandemics in the past century. The "Spanish flu" in 1918 killed more than 500,000 people. The milder "Asian flu" in 1957 killed more than 70,000. And in 1968, the least-virulent pandemic "Hong Kong flu" took about 30,000 American lives.

World health officials are worried that the next pandemic will be caused by the H5N1 strain of bird flu virus. It has killed 50 percent of the roughly 120 people in Asia who have caught it from birds. If health officials are right, and the virus doesn't change much, the next pandemic would be more like 1918 than the milder outbreaks.

In 1918, Johns Hopkins Hospital had to close its doors to new patients. Hospitals across the region were filled with pneumonia patients, a deadly complication in an era before antibiotics.

Bodies and caskets piled up because Baltimore had too few workers to process death certificates. Coffins and gravediggers were in short supply. By November, 5,160 people had died statewide.

Estimates by the federal Centers for Disease Control and Prevention say that a "midlevel" flu pandemic - one three times as lethal as the 1968 strain but milder than the 1918 virus - could sicken 25 percent of the state's residents and kill about 9,950 of them. The estimates assume there would be no public health intervention.

CDC modeling suggests as many as 3,300 hospitalizations per week over 10 weeks, peaking at more than 500 a day. Flu patients could take up more than a third of hospital beds and a similar percentage of its ventilators.

While Maryland authorities await new guidelines from the federal government, they continue to shape their own "Pandemic Influenza Preparedness Plan," now in its fifth version.

It dovetails with more general state and local public health emergency plans, which have been undergoing continual development, revision and exercises at least since Sept. 11, 2001.

The plans require local health officials to address such issues as: Where could mass vaccination clinics be held? Who would staff them? Who would provide security? Is there sufficient access for the disabled and parking? Where would hospitals turn for overflow space when all their beds are full? Is there enough refrigerated storage for medicines and bodies?

These questions are still being addressed.

As an early warning, the state has set up a "syndromic surveillance" program. "Chief complaints" from patients are compiled daily by emergency room personnel and reported to the health department. State epidemiologists watch for "red flags."

"For example, if we found that on a particular day in mid-July, at a hospital in Queen Anne's County a large cluster of people presented to the ER with flu-like symptoms, that's a red flag," Gourdine said. Flu outbreaks are normally confined to the fall and winter.

In the current "pre-pandemic" period, health authorities, hospitals and other groups have held drills and "tabletop" simulations to test their plans.

The most recent was a simulation in August for public school officials, health authorities and PTA leaders from across the state.

Taylor said the implications of pandemic flu surprised many at the session. They're now addressing questions about how to deal with high absentee rates among school bus drivers and food service and delivery personnel, and how to respond to requests to use school facilities for emergency vaccine or treatment clinics.

Key questions for schools are when to close and reopen, and how to provide instruction during shutdowns.

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