Recent SARS and avian flu threats and last fall's failed response to Hurricane Katrina have sparked industry and government preparations for a potential health crisis, which has grown with the pace of global travel.
Stricter monitoring of borders, improving the system of finding travelers after they've entered the country, coordinating first responders and stockpiling the best available treatments are among the steps being taken or studied.
Handling some of the measures are 25 quarantine stations that are being opened or expanded at airports that are portals for nearly two-thirds of U.S. international travelers, or nearly 75 million people. At one such center at Washington's Dulles International Airport, two health officers working for the U.S. Centers for Disease Control and Prevention will monitor for avian flu, among other infectious diseases or bioterrorism threats.
The stations coordinate with local emergency authorities to blanket the nation's water, air and land borders. The Dulles station, for example, also covers Baltimore-Washington International Thurgood Marshall Airport.
Travelers are unlikely to come in contact with the new stations unless someone aboard a plane or ship shows suspicious symptoms. On a daily basis, the station keeps tabs on potentially infected refugees, immigrants and others, said Michael Doney, a physician and lieutenant in the U.S. Public Health Service. At Dulles, he and Jason Thomas are working on plans to uniformly respond to sick passengers on the airplanes and to find planeloads of people later.
"The nation has a long history with the quarantine system, but when smallpox was eradicated in the '70s, the perception was that infectious disease was not at a level of concern," Doney said.
"More recently, SARS and bioterrorism concerns had the CDC feeling like it should have a system to monitor the health of international travelers," Doney said.
Nearly a century ago, coming to America meant a voyage of days or weeks in a ship that could arrive at a handful of ports. Passengers who got the flu on the journey could, theoretically, be separated from the masses. But the relative ease of air travel now means infected people could be living and working in their communities for days, potentially spreading human and economic pain.
Before bird flu, the last major health scare, SARS, or severe acute respiratory syndrome, caused more than 8,000 people to become sick and about 10 percent to die, according to the World Health Organization. Most were reported in Asian countries, although 250 cases were reported in Canada and 27 suspected in the United States. Lost revenue for the travel and hospitality industry in affected countries was reported to be in the billions.
No one in the United States died of SARS, but the epidemic revealed shortcomings in the government's pandemic preparedness about two years ago. Preparation efforts got a public and monetary bump after the botched response to Hurricane Katrina in New Orleans last summer. President Bush called for an extra $7 billion for planning and response in a speech last month, although Congress approved a little over half that amount.
"You can get anywhere in the world in 72 hours," said Dr. Georges Benjamin, a former Maryland health secretary who headed up a committee that studied infectious disease and bioterrorism at the borders for the U.S. Centers for Disease Control and Prevention. "There are 474 official points of entry where people and things come into the United States, and only a few people to manage that. We needed to rethink the way we did our work."
The world health community says there will likely be another flu pandemic, though it may not be imminent.
Now that the current avian influenza outbreak, which began in 1997, is creeping from rural Asian chicken farms westward, other countries and world health officials are talking more publicly about preparedness.
Until recently, the response largely had been limited to destroying potentially infected birds - more than 150 million so far, according to the world body. Hundreds of thousands of chickens were destroyed on the Eastern Shore last year, but the flu strain there was not considered dangerous to humans. The U.S. chicken industry said last week that it plans to test for the deadly strains as a precaution.
The H5N1 flu strain is still infecting people mostly in Asia, though the latest two cases were reported last week in Turkey. About half of the total of 144 people infected since January 2004 have died, according to WHO. Officials there said most are believed to have contracted the flu directly from birds, or perhaps from close caregivers. Far more regular human-to-human transfers are needed for a pandemic.