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    Washington area officials prepare for possibility of flu pandemic

    By BRETT ZONGKER, The Associated Press
    Dec 16, 2006 8:48 AM (11 hrs ago)

    WASHINGTON - School buses in Fairfax County could be used to pick up pandemic-flu victims, who might be steered to alternative clinics rather than overcrowded hospitals. Health officials there also plan to conduct a "tabletop" exercise next month to test their ability to quarantine people showing signs of the disease.

    But like many involved in pandemic-flu preparation, the Washington suburb is struggling with a number of unanswered questions: Would there be enough vaccine and antiviral drugs if the plague actually strikes? Would enough nurses, doctors and utility workers show up to work critical jobs? And would coordination efforts in the private and public sectors pay off in a populous region that is home to the federal government?

    Most Washington-area health officials readily acknowledge that things wouldn't go exactly as planned. They know well that many governments were overwhelmed during the 1918 flu pandemic that killed more than 600,000 Americans and nearly shut down the nation's capital.

    "In a disaster, during such situations, things can't be perfect," said Dr. Gloria Addo-Ayensu, Fairfax County's health director.

    Local officials say they want people to prepare for the possibility of a pandemic, however remote. And they have made it clear they want to have their plans - and stockpiles - in place before it's too late.

    The District of Columbia, for example, is collecting more than 2.5 million masks for police, health-care workers and others. And D.C., Maryland and Virginia health officials plan to purchase the full stock of antiviral drugs allowed under federal guidelines, which are based on population.

    But many states aren't doing enough to prepare for health emergencies, including a flu pandemic, one report suggests. The study, released last week by the Trust for America's Health, ranked Maryland and the district at the lower end of the scale. Virginia, however, was among the 14 best-prepared states for a health emergency, including a pandemic.

    "We've come a long way," said Dr. Lisa Kaplowitz, a top health official in Virginia. "We're not there yet."

    The report found both Maryland and Virginia would run out of hospital beds within two weeks of a moderate pandemic outbreak. Although the district was in slightly better shape for hospital space, it failed to score points in several other areas, including flu vaccination rate for adults over 65.

    Maryland and D.C. officials disagreed with some of the report's criteria.

    "They're not measuring perhaps the most important thing, which is actual experience," said Dr. Gregg A. Pane, D.C.'s chief health officer. "The national capital region and D.C. Department of Health, in particular, have probably more experience standing up for various disasters or potential problems than any place in the United States."

    Maryland should have received extra points for its extensive drills and exercises, said Dr. Marsha Davenport, a medical epidemiologist for the state's Department of Health and Mental Hygiene.

    Maryland, Virginia and some local health departments have run mass vaccination drills to practice quickly dispensing antivirals and vaccine. Health officials across the region also are working to prioritize the distribution of medication, vaccine and equipment.

    "We all are dealing with the reality that there will be shortages of antivirals, of vaccine, as well as some essential equipment," said Dr. Ulder J. Tillman, Montgomery County's health director.

    The discussion about a vaccine assumes that one will be available to treat the avian-flu strain that has killed humans but has yet to pass easily from human to human and may never become a pandemic. But researchers are rushing for a solution to prevent a pandemic in case the virus ever makes that final leap.

    "If we can prevent people from getting ill and having some of the complications, then we can potentially avert that or make the pandemic no worse than a seasonal flu type of illness," said Dr. James Campbell, an assistant professor at the University of Maryland School of Medicine who is leading an avian flu vaccine trial for the National Institutes of Health.

    Both public and private-sector officials are worried about employees who would be absent because they are ill, tending to sick family members or afraid of catching the flu. In Prince George's County, officials are addressing this concern by working to "cross-train" employees so they can serve different functions.

    "We would lose approximately a third of our workforce at a time," said Gwendolyn Clerkley, the county's acting health officer. "We may be asking people to do jobs they are not accustomed to doing."

    The workforce shortage would likely extend to other critical industries - many of which have made their own plans. Verizon, for example, has been looking at ways to keep the dial tone operating in the event of a pandemic. But it acknowledges that high absence rates and possible quarantines could present problems.

    "While by and large the network keeps running, you need to still apportion your resources for people to move out and about," said Mark Marchand, a spokesman for Verizon's corporate center in Basking Ridge, N.J. "We need to be able to make sure if there are quarantines or whatever, that we can maintain those kinds of services."

    A unique challenge for Washington-area health officials is the sheer amount of coordination required in a dense region with 5 million residents, more than 20 localities and dozens of federal agencies.

    "One day (former Federal Reserve Chairman) Alan Greenspan's office called," said Pane, the district's chief of health. "They're just very concerned about this problem, and the Federal Reserve has done a lot to keep the economic backbone of the country running."

    The district's pandemic plans read like a laundry list. Along with stockpiling, city officials are trying to improve coordination with localities, embassies, the Smithsonian, the World Bank and many others.

    The city is working with hotels and building managers to encourage people to shelter there rather than rush to hospitals. It also is involved in a pilot program to mine the Medicaid database to identify where vulnerable citizens are located.

    Tabletop discussions and exercises to test emergency communications have involved federal partners, the military, area hospitals and regional leaders from Maryland and Virginia.

    "It was very good to be able to see whose plans maybe didn't intersect very well with somebody else's plans," said Beverly Pritchett, senior deputy director for the D.C. Emergency Health and Medical Services Administration. "We learned a lot from that before the day was out."

    Despite the plans, there are concerns that some important steps will not be taken.

    For example, local officials would be in charge of closing public schools, if necessary, to quell a pandemic. But private schools have been forgotten during past emergencies, said Susan Gibbs, spokeswoman for the Archdiocese of Washington, which operates Catholic schools for 33,000 students in the area.

    "What we've been really trying to do over the last five years is make sure we're on the radar screen," she said.

    Smaller localities are also working to prepare for a pandemic, but some are behind the larger, more urban jurisdictions.

    For example, Calvert County, Md., says it's making progress. But Dr. David Rogers, the county's health officer, said planning in the county of 90,000 residents is in "a fairly embryonic form."
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