From extra hospital beds to Tamiflu,
readiness for outbreak varies widely
By Lauran Neergaard The Associated Press
Parts of southeastern Washington state are considering drive-through flu shots during a pandemic -- although a practice run this fall showed they had better hire traffic cops
If Alabama closes schools amid a super-flu, students might take classes via public television. In Dallas, city librarians could replace sick 911 operators.
States and communities are getting creative as they struggle to answer the Bush administration's call to prepare for the next influenza pandemic, whether the culprit is the much-feared Asian bird flu or some other super-strain.
The Associated Press took a look at those preparations and found wide differences in how far along states are -- and little consensus on the best policies, even among neighboring states, on such basic issues as who decides whether to close schools.
Almost half the states have not spent any of their own money yet to gird against a super-flu, relying instead on grants from the federal government.
Ethical queries abound about how to ration scarce drugs and vaccine. As Oklahoma epidemiologist Dr. Brett Cauthen puts it, that is "the toughest question out there."
Some states are debating whether to purchase the recommended anti-flu medications to store for their citizens or gamble that they will receive enough from a federal stockpile.
As the government's first official assessment of state readiness began this month, officials asked pointed questions but expect few states will have tackled some of the toughest issues:
How will you keep grocery stores stocked?
Will you reserve enough anti-flu drugs for utility workers so the water and electricity stay on?
If you close schools, will local businesses let parents stay home with their children or fire them?
When federal officials fly in your state's share of vaccine and medicine, can you store it properly and get it to patients without being mobbed?
"Nothing, we think, is better than having 5,000 communities right now wrestle with this," said Dr. William Raub, emergency-planning chief at the Health and Human Services Department. "What will seem to work happily in one community is probably not going to work in some others."
Super-strains of the easy-to-mutate influenza virus cause worldwide outbreaks every few decades or so; there were three in the past century.
The worst was the 1918 pandemic that killed about 50 million people worldwide, 500,000 in the U.S. alone. If a 1918-style pandemic struck today, up to one-third of the population could fall ill and 1.9 million people in the U.S. could die.
With another pandemic overdue, the CDC began telling states to prepare years ago. These plans have taken on greater urgency with the simmering H5N1 bird flu. In 2004, just 29 states had pandemic plans of some sort. Today, all have at least a draft on paper.
This spring, federal health officials will have their first report card on the quality of those preparations, based on a questionnaire that Raub shipped to the states. The questions go beyond health care and ask how communities would keep running.
Raub said he is not playing "gotcha" but that the responses are key to helping less-prepared states catch up and identifying best practices that neighbors can copy.
"Where you live shouldn't determine your level of preparedness," said Jeff Levi, executive director of the Trust for America's Health. "This is not a question of letting 51 flowers bloom. The federal government, as the primary payer and the entity that can see the biggest picture, needs to define a minimum standard of protection that every American can expect."
A shortage of beds
For now, hospital overflow, purchases of the anti-flu drug Tamiflu, plans for school closures, and how states are practicing for an outbreak are emerging as initial indicators of readiness.
A study by Levi's group suggests half the states would run out of hospital beds within two weeks of a moderately severe pandemic outbreak -- one not even as bad as the 1918 outbreak.
In interviews conducted by The Associated Press in every state, health chiefs repeatedly said they know their hospitals will be overrun but that having enough beds is not the most critical issue.
"We don't have the health-care workers to take care of all the patients," said Alabama State Health Officer Don Williamson.
Nursing shortages and other issues mean that today, hospitals might have staff available for just 60 percent or so of their beds. In a pandemic, some of those workers are going to be sick or caring for ill relatives and will not be at work.
That is where some states are getting creative.
Those trailers parked in strategic spots across Colorado hold a total of 6,500 beds that could be set up in school gyms or event halls -- anywhere with power, water and bathrooms.
"Where we're best prepared is a place to put people," said Dr. Ned Calonge, chief medical officer of the Colorado Department of Public Health and Environment.
The state is recruiting volunteers to care for the people who will lie in those beds, creating a master list of health workers not usually involved in flu care, from pharmacists to physical therapists, who could be credentialed now and put on standby.
Louisiana has discussed expanding visiting hours so relatives can help with some patient care or giving recovering patients some light duty.
"There's no easy answer. You have to be thinking creatively with what you have, rather than thinking you'll be able to find accessory staff," said Dr. Frank Welch, the state's immunization director.
Inside hospitals, shortfalls will go beyond beds. For example, Georgia predicts 20,000 of its residents would need ventilators during the months of a severe pandemic. In the entire state, there are 1,500. Officials just bought 2,000 portable versions to truck to different hospitals as needed but worry they will not be durable enough.
Vaccine availability uncertain
Because it will take months to custom-brew a vaccine once a pandemic begins, flu-treating medicines, mostly Tamiflu, form the backbone of the nation's preparations. World flu authorities recommend stockpiling enough for a quarter of the population, or 75 million people in the U.S.
The Bush administration is in the process of buying enough to treat 44 million people and will hold each state's share in a national stockpile.
States are supposed to buy enough to treat the remaining 31 million people, with doses the states would store. The federal government negotiated a cheap price and offered to chip in 25 percent of the cost but told states that "we need you to come the rest of the way," Raub said.
Most states say they do plan to buy at least some of those outstanding doses, although some still are awaiting money for the purchases from their legislatures.
At least four states do not know whether they will spend their own scarce dollars for the extra purchases, saying the drugs might not work against a super-flu -- or expire before they are needed.
What if states do all this planning and the next pandemic never arrives? Much of the work is applicable to other disasters, too, from quakes to bioterrorism.
"People forget that you're supposed to be doing all-hazards preparedness," Washington Secretary of Health Mary C. Selecky said.