U.S. offers plan to fight bird flu

Communities, firms would lead response


WASHINGTON -- Local governments and businesses will have to take the lead in fighting a flu pandemic, the Bush administration warned yesterday as it released its latest plan for responding to a feared outbreak of avian flu in the United States.

The 227-page document establishes such goals as stockpiling 75 million antiviral medications for humans and 110 million doses of vaccine for poultry. It outlines specific steps that federal officials should take, from beefing up surveillance efforts abroad to preparing to limit international flights and quarantine infected visitors.

In the event of an outbreak, up to 2 million Americans could die, 40 percent of the work force would stay home and schools would close, the plan says.

It assigns overall responsibility for coordinating the federal government's response to the Department of Health and Human Services. But it says local communities and private businesses would have to do much of the work, from preparing response plans to caring for the sick.

"The center of gravity of the pandemic response ... will be in communities," the plan says. The document says the private sector controls more than 85 percent of the "critical infrastructure" that would be called upon to respond to pandemic flu.

In the event of an outbreak, the plan says, doctors would be urged to wear facemasks and employers would be advised to arrange for teleconferencing and to give workers time off to care for sick relatives.

The Bush administration has requested $7.1 billion from Congress to prepare for an outbreak, but none of the money would go directly to local communities, said Kim Elliott, deputy director of the Trust for America's Health, an advocacy group in Washington.

State and local governments must buy beds, obtain ventilators and develop the capacity to handle a surge in infections, Elliott said, and a federal plan should arrange to help pay community hospitals to care for flu patients, including many who are uninsured.

"No state or locality has the capacity to completely foot the bill for responding, even though they are being told not to count on the federal government," Elliott said.

Avian flu first appeared in China in 1996, and infected birds have carried the disease to Africa and Europe. More than 200 people have been infected after coming in contact with the virus while handling poultry. Many scientists fear that a widespread outbreak is inevitable.

Frances Fragos Townsend, the president's homeland security adviser, emphasized that the virus has not mutated into a form that would quickly spread among humans and that the plan's estimates of casualties and other effects represents a worst-case scenario.

"We have taken an unprecedented level of activity to address this threat," Townsend said.

Officials at the Maryland Department of Health and Mental Hygiene had just received a copy of the plan and had not had a chance to review it, a spokesman said.

Critics in Congress and the public health community have said that the Bush administration has been slow to prepare for a flu pandemic and warned that the country might be as unready to deal with an outbreak as it was for Hurricane Katrina.

Sen. Edward M. Kennedy, a Massachusetts Democrat, called the Bush administration's latest effort inadequate, and said U.S. preparations are running behind those in other countries.

"A flu plan that doesn't say how to distribute vaccine is about as useful as a hurricane plan that doesn't say how to rescue people," Kennedy said.

The Senate passed a measure yesterday, sponsored by Kennedy, that would compensate emergency workers who fall ill after receiving experimental vaccines.


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