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State Tabletop Exercise: Illinois bird flu scenario studied

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  • State Tabletop Exercise: Illinois bird flu scenario studied

    Illinois bird flu scenario studied
    Leaders ponder plan if humans stricken

    By Jeremy Manier and Judith Graham
    Tribune staff reporters
    Published March 17, 2006

    A group of Illinois emergency officials gathered around a table in Springfield this week to imagine a frightening and fortunately fictional scenario: an outbreak of bird flu in humans, spreading from a rural village in eastern Turkey to a family in Elgin within four months.

    Although the exercise was purely imaginary, it highlighted many real questions that have yet to be resolved as local and federal officials prepare for the likely arrival in the U.S. of migratory birds that carry a dangerous variety of influenza.

    That H5N1 strain cannot spread among humans, but experts worry that it may mutate into a form that could, spurring a worldwide flu pandemic. On Friday, Gov. Rod Blagojevich will host a pandemic flu summit in Rosemont for government officials and health-care workers, one of many sessions that the U.S. Department of Health and Human Services is holding around the country to build awareness about how to handle such an outbreak.

    Yet government officials have not solved many of the tangible issues that would loom large in the event of a real pandemic.

    For example, the Springfield tabletop exercise asked health officials to ponder whether they would close the Illinois-Missouri border if St. Louis had an especially intense outbreak. How would the state distribute scarce medical equipment such as ventilators? Who would get first crack at the antiviral drugs that could ward off the bug?

    "We have little information coming to us as physicians as to how all this is going to work," said Dr. Steven Wolinsky, chief of infectious diseases at Northwestern University.

    State and local health leaders admit they have a long way to go in preparing for a pandemic, in part because some of the questions are arising for the first time. But since bird flu raised concerns about a pandemic, health agencies and hospitals have given new thought to issues such as where to put up to 425,000 Illinois patients who might need hospitalization during an outbreak.

    Rather than offer bland assurances about such problems, the federal government's approach of late has been to acknowledge the shortcomings as it seeks to address them.

    "No state is as prepared as they need to be for a pandemic, nor is the federal government," said Christina Pearson, a spokeswoman for HHS Secretary Michael Leavitt, who will speak in Rosemont on Friday.

    For state and local leaders, even the lines of authority are foggy on issues such as who has the power to commandeer hospital equipment. Officials hope that pandemic simulations can help the city and state agencies learn to work together.

    Some of the planning will have to come from individual hospitals. At Advocate Health Care, which runs eight hospitals in the Chicago area, officials are considering such mundane dilemmas as how to guard supplies of antiviral drugs and flu vaccines, which would be in huge demand.

    They also are looking at where to put extra patients--a difficult task, as occupancy rates typically run over 90 percent. If schools are closed, officials speculated that Advocate's Park Ridge hospital might arrange with Maine East High School to treat some patients there, for example.

    "We're talking now about making contracts with a place like that in all of our communities," said Connie Cutler, director of clinical excellence for the Advocate system.

    To anticipate those needs, the federal Centers for Disease Control and Prevention has made a basic spreadsheet model, called FluSurge, to estimate the impact a pandemic could have on an area's bed capacity and need for ventilators.

    Some organizations are appealing to bioethicists to identify the thorniest issues. A hospital bioethicist attended this week's state pandemic exercise, where officials from the Illinois Department of Public Health and other agencies wrestled with how state officials might take control of limited medical supplies in an emergency.

    Filling the need for ventilators may be the toughest challenge. Machines that help patients breathe would be in high demand during a pandemic. For Illinois alone, experts estimate that between 2,800 and 32,000 people would need ventilators.

    For comparison, the entire U.S. supply of ventilators is slightly more than 100,000. Experts said doctors could have to choose between keeping alive critically ill patients or saving stronger individuals with a better chance of survival.

    During this week's state exercise, no one had a clear answer about how to distribute the available ventilators fairly, said Dr. Craig Conover, medical director of the office of health protection for the state Public Health Department. "That was an issue that came up for which clearly there needs to be a lot more discussion," he said.

    Chicago officials have been doing separate pandemic exercises, said Dr. William Paul, deputy commissioner of the Chicago Public Health Department. Paul said 14 city departments have worked on a pandemic response plan for the last year.

    For a moderate-level pandemic, "we're in quite good shape" in Chicago, Paul said. "But for something more severe, we need to do more."

    Early on in a pandemic, the city's primary goal would be early detection, which requires rapid testing of suspect patients. That would be especially important if it arose during flu season, when doctors may need to separate people who are merely ill from those with life-threatening conditions.

    But Conover said hospitals don't yet have widespread access to rapid tests for bird flu, in part because federal officials have not made the necessary testing compounds widely available. "This is kind of a moving target," he said.

    Conover, who said he wakes up at night thinking about pandemic flu, stressed that flexibility is crucial in any plan. There's no certainty that a pandemic will hit, and it may not be as intense as some experts fear.

    For instance, in a moderate pandemic it may be acceptable to use antiviral drugs widely to protect essential employees such as police and utility workers, rather than primarily to treat patients.

    "For some of these questions there's probably no right answer until we know what we're dealing with," Conover said.