Pandemic Influenza Can Happen Here: Making A Case For Preparation
by Barbara Jean Briskey
A pandemic flu? How can we worry about one more thing with a bloody mess in Iraq, murder and mayhem on the home front, political shenanigans cluttering the airwaves, families to care and provide for, these all added to our daily struggles to eat well, exercise enough, keep up with good reading or at least the Sunday paper, and nurture our passions as well as our important relationships? Surely the case for preparing ourselves against such an attack has lost credibility before it's even presented — from weeks and months of orange and yellow terrorist alerts with serious advice from the Department of Homeland Security that all households should stock up on duct tape.
But numbers, left to untricky people, do not lie. Pandemic influenza really can happen here. Following are some reasons why it's a good idea for communities and households to take the first steps in preparing against a possible pandemic.
First, let's clarify what we mean by pandemic influenza. This kind of flu may begin with our winged friends — but it's not just for the birds. The media, when not otherwise distracted by celebrity drug overdoses and paternity contests, has been full of scary stories of avian flu. Multiple countries have been slaughtering millions of chickens, turkeys, and ducks to prevent its spread. Why such concern over this particular avian flu, the A(H5N1) virus? Primarily because of its virulence. Among domesticated poultry, it spreads rapidly and kills quickly. 291 people have definitely contracted the A(H5N1) virus since 2003 — almost all had direct contact with infected birds. According to the World Health Organzation, of those 291 confirmed cases, 172 people died within days to weeks of contracting the flu. That ads up to a 59% death rate in humans.
Pandemic flu would happen if the A(H5N1) virus shifted its game plan through mutation or re-assortment. The last thing left for this particular virus to do to achieve pandemic status is cause easy and sustainable transmission among humans. There are already, in fact, a few reports of person-to-person transmission of avian flu. Because the current population of the world has no immunity to H5N1 or any cousin to the virus, if this virus becomes easily transmissible among humans it would spread faster than rumors in middle school.
But how likely is it that a pandemic flu will occur in the near future? If the history of epidemics is any guide, quite likely. Birds have marked the beginnings of the last three pandemics of the 20th century, and for the past several years, a virulent flu has been brewing among them. Also, over the past 500 years, pandemics have occurred three to four times per century. The longest time between pandemics has been 42 years. This year, it will be 39 years since the last pandemic.
Influenza pandemics can be relatively mild or severe. In the twentieth century, the world suffered through:
• The Hong Kong Flu, A(H3N2), of 1968, with one to four million deaths worldwide and 34,000 deaths in the United States.
• The Asian Flu, A(H2N2), of 1957, which caused another one to four million deaths worldwide, and 70,000 deaths in the United States.
• The colossal Spanish Flu, A(H1N1), of 1918, which broke records with 50 to 100 million deaths worldwide and 675,000 flu-related deaths in the United States alone.
In an influenza pandemic, 25 to 45 percent of the population gets the flu. Infection and death rates can vary, depending on how lethal the strain of influenza has become and what mitigating factors communities have implemented. Those 675,000 American deaths represented 2.5 percent of the total population of the United States in 1918. And, while the annual flu that we see each year kills mostly the very old, the very young, or those with depressed immune systems, the Spanish Flu rapidly killed teens and young adults by inciting a cytokine storm in their healthy immune systems, which caused the lungs and other organs to become hopelessly inflamed and filled with fluid.
The Spanish flu was in 1918; in this new century we take comfort in our modern medicine, our wealth of vaccinations, medications, and excellent health care. But such comfort might prove treacherous. It takes about nine months for health officials to produce an accurate vaccine after identifying a strain of influenza. Don't expect a vaccine to be widely available until long after the beginning and middle of a pandemic — historic pandemics have run in approximately two-year cycles with illness traveling through communities in four- to twelve-week waves. Aren't there effective antiviral drugs that can be picked up at the pharmacy, you may ask? Don't count on it. While rumors of government stockpiling of antiviral drugs have circulated over the past couple years, the amount would not be nearly enough to treat everyone, nor is there a guarantee that the virus won't rapidly become resistant to antiviral medications. Plus, the federal government and state governments have announced that, however proactive they are willing to be in helping institutions and communities with planning efforts, in the event of an actual pandemic they will be of limited use (think Katrina). And remember: The A(H5N1) virus seems to be one of the most lethal yet (59% death rate so far).
Some folks are comforted by the fact that all recently documented human cases of A(H5N1) have occurred in foreign parts of the world such as Cambodia, Viet Nam, Thailand, Indonesia, Egypt, Djibouti China, etc. Don't be fooled. Through some Darwinian magic, migratory waterfowl happily harbor avian flu viruses but are immune to their ill effects. So, lissome swans preening in the neighbor's pond may, in the not-too-far future, be spreading avian flu virus to poultry flocks right here at home. And don't forget that, given the robust international business and air travel of our modern world economy, a pandemic flu could travel to several countries before it is even identified as such.
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How do we care for our own in the event of a pandemic flu scenario? Local communities and institutions should have plans in place to care for their own. Planning is extremely important. Dr. John Sabia, Director of Emergency Services at Northern Dutchess Hospital, reports that the hospital has developed local and regional protocols after working diligently with the Dutchess County Department of Health, local hospitals, and emergency response teams. "We take this pandemic planning very seriously," he said. Dr. Sabia's advice for the community in the event of an influenza pandemic: do not panic, and be prepared to take direction from the local health department and local hospital.
The Red Hook Central School District is also incorporating the possibility of pandemic flu into its safety plans. It has agreements with the Red Cross and the Dutchess County Health Department for a school building to be used as a community resource in the event of an area emergency — providing a space, for example, where preventative and low-level medical care could be dispensed.
Clearly, our local institutions are concerned about and planning for the possibility of an influenza pandemic. What about families? Here, it may be profitable to take a leaf out of the planning book for another kind of emergency situation — fire. The local fire department is prepared to respond rapidly to reports of a fire in your house . But since smoke can cause unconsciousness in just a few minutes, it is unrealistic to expect the fire department to be wholly responsible for a family's safety. It is up to adults in the home to check that smoke alarms are strategically placed and working, that small fire extinguishers hang in the kitchen, garage, and basement, and that all family members have rehearsed an escape plan for when they hear an alarm. Parents teach young children about fire safety from "hot" on the stove burner to the age-old admonition to not play with matches. So it ought to be with pandemic flu: planning can save lives.
The Dutchess County Department of Health has mailed a pandemic preparation informational booklet to every county resident. Many of the recommendations can also be used for other emergency plans. The booklet advises residents to plan for disruption in health services, banking, commerce, food supplies, transportation, government offices, water, and power. That means keeping a two to three weeks' supply of water, nonperishable foods, medical, health, and emergency equipment, some cash, pet supplies, an old-fashioned "wired" phone that does not need charging or an electrical outlet, medications, and essential household items. The booklet also advises discussing emergency planning with friends and family and to post emergency contact and important health information on a bulletin board in the home.
Families and individuals can develop good habits that will help protect them daily and in a pandemic. On an individual level, hand washing is the single most important means toward preventing the spread of infection. This includes influenza viruses. Practice proper hand washing. Teach children the importance of it and supervise their technique. Hands should be washed frequently, even when they don't look dirty, and especially after sneezing, coughing, before preparing food, eating or drinking, after using the bathroom, or after touching railings, doorknobs, publicly-used phones, etc. To wash hands properly, wet with warm water, lather up with soap, then scrub front, back between fingers and under nails for the time it takes to sing the "ABC song" slowly. Then dry hands and turn off the tap with a paper towel. If hands are not visibly dirty, alcohol-based antibacterial gels are an effective alternative to hand washing.
Another important habit to prevent the spread of germs is to sneeze or cough into tissues and then immediately dispose of them. If no tissues are available, sneeze or cough snugly into the crook of your elbow. After sneezing or coughing, wash your hands again. All of this sneezing and coughing may require a cultural shift in some workplaces — also, it is important that sick people stay home, whether from day care, school, or work.
In the event of an influenza pandemic, stay alert for further information from the local health department. Those trying to gauge the probability that today's A(H5N1) Chicken Little virus is the prophet post-mortem for a massive human pandemic or just the vehicle for relatively small isolated tragedies know how high the stakes could be. As Dr. Sabia said — Don't panic… but let's take the first steps to prepare ourselves and our families, hoping we never have to utilize the plans we put in place.
For more information, consult: www.pandemicflu.gov or www.dutchessny.gov or www.hhs.gov/pandemicflu/plan/sup4.html
