Kansas health officials plan for pandemic influenza epidemic

TOPEKA, Kan. -- A new, virulent flu will hit Kansas someday. While health officials are confident it will happen, they can't predict when or what strain will cause the pandemic.

Against that backdrop, health officials are doing what they can to prepare and feel they are as ready as they can be.

"I truly believe that Kansas is as prepared as any place in the country to deal with a pandemic," said Dr. Howard Rodenberg, state Division of Health director.

That's not just idle boasting. The Trust for America's Health says Kansas met nine of 10 indicators for emergency preparedness, ranking it second behind Oklahoma. Last year the state met only half the criteria.

Rodenberg said that's because the state uses an all-hazards approach to emergency preparedness, covering such possibilities as pandemics, bioterrorism and natural disasters because much of the planning is the same.

Still, health officials face some big questions. How widespread would a pandemic be? What would be needed to keep society functioning? Will there be enough people and equipment to deal with the crisis?

A pandemic is a widespread human infection with a new virus that humans haven't seen before and therefore have no immunities against. Some estimates predict up to 486,000 Kansans _ one in every six _ will require outpatient care, and 10,700 will need hospitalization. Up to 2,500 would die.

"We have taken the term pandemic and implied it is a terrible thing and it doesn't necessarily imply the severity of the outbreak," Rodenberg said.

But nobody can predict when a pandemic will hit. Serious influenza pandemics occurred in 1968, 1957 and 1918. Some believe the latter outbreak originated in Kansas.

"Up until 10 years ago, the virus population was relatively stable, but in the last 10 years there have been four or five new strains popping up," Rodenberg said. "So you get the sense that at a certain point the dam is going to break and one of these things is going to break out."

Dr. Gianfranco Pezzino, public health studies director at the Kansas Health Institute think tank, offers a grim prediction: "No matter how prepared we are, there will be pain and suffering and there will be some deaths. That is inevitable."

As state health officer, Rodenberg oversees pandemic preparations. He would advise Gov. Kathleen Sebelius, who has ultimate authority, and the adjutant general's office, which oversees the National Guard and Kansas Emergency Management.

The state's plan covers such things as tracking the spread of influenza, hospitals handling patient overflows and delivering medications and supplies where needed.

Kansas has received $3.4 million in federal funds for preparations, with 69 percent going to local health agencies.

Rodenberg said many test runs have been done on parts of the plan, including a four-day drill in August in 30 counties. Rodenberg said the tests went well and only uncovered small issues, such as a minor lack of communication between agencies.

A major concern is hospital beds. The state has 128 community hospitals with some 10,600 staffed beds, and on average about 7,000 beds are available daily. If the pandemic is bad enough, the majority of beds could be needed for flu patients.

A pandemic could force hospitals to discharge non-critical patients, postpone elective surgeries or move patients to other hospitals. It also could require them to work with the National Guard to convert other facilities, such as hotels and dormitories, into temporary care facilities.

Kansas is the first state to have two 25-bed portable hospitals operated by the National Guard. It will get two more next year and has applied for a fifth. They have already proved their worthiness in Mississippi after Hurricane Katrina struck last year.

"If hospitals are overflowing, these could be used for that or to have medical resources where currently there are none," said Guard spokeswoman Sharon Watson.

Kansas has 37,000 nurses and 10,000 physicians, and the question is whether that would be enough.

"We will never know until we have that situation," said Mary Blubaugh, executive administrator of the Kansas State Board of Nursing.

State health officials have focused on public awareness over the past two years with scores of presentations to community groups and some 20 town hall meetings. The message is simple: Kansans should prepare to care for themselves, including stockpiling food and medications and taking normal precautions such as hand washing and staying home if sick. Local officials also will have to decide whether to close schools and other public places.

There probably won't be enough medication for everybody, forcing officials to consider giving it first to health care workers, public safety officials and those needed to keep the infrastructure operating.

"The majority of people in a pandemic will contract the flu but will get well. It is by no means a death warrant, but because of the nature of pandemic there will be increased hospitalizations and deaths," Rodenberg said.

There's been much talk about the H5N1 influenza virus, and one decision facing the state is whether to purchase additional Tamiflu medication from the federal government to combat the strain. Kansas is slated to get about 420,000 doses, but it needs more to meet federal guidelines for treating 25 percent of the population.

"One of my real concerns is that we are putting too much emphasis on Tamiflu," Rodenberg said. "It's not a magic bullet or anything like that."

He said it would be six to 12 months before the federal government would have enough Tamiflu available for states because the manufacturing capacity would be taxed. Also, he said, 20 percent of the H5N1 strain is resistant to Tamiflu.


Kansas Department of Health and Environment: