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N.C. girds for new type of disaster _ influenza pandemic

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  • N.C. girds for new type of disaster _ influenza pandemic

    N.C. girds for new type of disaster _ influenza pandemic
    Associated Press Writer
    Saturday, December 16, 2006

    RALEIGH, N.C. - With its history of hurricanes, North Carolina has plenty of experience coping with calamity.

    But even with that experience, officials acknowledge there's only so much they will be able to do if and when an influenza pandemic strikes the state _ and likely strikes again, and again. They forecast a grim scenario of inadequate medical supplies, curtailed freedom of movement and thousands of deaths.

    "A pandemic flu plan is different from a hurricane or even a chemical event, where the event happens and then you've got to deal with it," state public health director Leah Devlin said.

    "This is something that will come in waves that might last for six to eight weeks, and then you might have a quiet period for six to nine months and then another wave will come through," she said. "The whole thing may be going on for a year and a half or so. It's not something you can say, 'OK, we're done, now let's do the cleanup.'"

    Super-strains of the easy-to-mutate influenza virus cause worldwide outbreaks every few decades or so, including three in the last century. The Bush administration has urged states to prepare for the next pandemic, whether it be caused by the much-feared H5N1 Asian bird flu or some other super-strain of the virus.

    In 2004, just 29 states had pandemic plans of some sort. Today, all have at least a draft on paper. North Carolina finished the latest draft of its pandemic plan last January and has been tweaking it ever since.

    In February, officials ran daylong exercises for the state and local health departments, hospitals, emergency medical services and other agencies in eight regions statewide, with role-playing and response planning based on a variety of pandemic scenarios.

    Essential businesses, including Raleigh-based utility Progress Energy and the Lowe's Food grocery chain, took part in a statewide summit in March, Devlin said. The state is recruiting more companies and industry coalitions to participate in upcoming roundtables.

    The Division of Emergency Management ran a statewide pandemic exercise in May. The State Bureau of Investigation ran a simultaneous exercise, pretending the imaginary outbreak was a bioterrorist attack.

    A state Task Force on Ethics and Pandemic Influenza Planning has been meeting since May to discuss ethical guidelines for the state's doctors and nurses who will be faced with deciding who gets first access to scarce hospital beds, medicine and equipment.

    The 40-member panel has come up with some guidelines for rationing medicine and equipment, and for "social distancing" _ closing schools, churches and other public gatherings, encouraging people to stock up on supplies and stay home, or even issuing quarantine notices. It's due to issue a full report in the spring.

    "The plans that are in place revolve around one of the key elements, this idea of social distancing," said Jim Porto, professor of health policy at the University of North Carolina at Chapel Hill. "If we don't take these sometimes very draconian measures, the consequences are sometimes very high."

    But despite all that planning and practice, officials in North Carolina admit they see gaps in their efforts.

    Chief among them will be how to cope with limited medical resources. North Carolina hospitals already operate at 85 percent to 90 percent capacity, and even a mild pandemic would force doctors and nurses to ration supplies. There's also the question of how many of those doctors and nurses would be able _ and willing _ to work.

    "We know that some of the biggest challenges around pandemic planning are going to be managing medical surge capacity, whether it's hospitals or emergency medical services," Devlin said. "In a moderate case scenario, we would have five times the number of hospitalizations, the number of deaths _ five or six times."

    The state's hospitals have written or are drafting plans for alternate bed sites. North Carolina also is prepared to deploy its traveling State Medical Assistance Teams _ one that can create a 150-bed alternate care facility, eight regional teams that can establish 40-bed facilities, and 29 small, first-response teams.

    The most important supply gap will be the initial lack of a vaccine for the virus that causes a pandemic. Devlin said it could take four to six months at best to come up with a drug to protect against a hitherto unknown version of the flu virus.

    "It's going to be a virus that nobody has immunity to. It's also going to be one that we don't have a vaccine for and perhaps not antiviral (drugs)," she said.

    Because it will take months to custom-brew a vaccine, 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 Americans.

    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. North Carolina lawmakers provided $400,000 this year for Tamiflu, and the Division of Public Health has used it to buy 40,000 doses.

    Until that vaccine is ready, health officials will have to turn to the old-fashioned weapons of quarantine, canceling public events and asking people to stock up on supplies and stay home.

    Officials in Yancey and Mitchell counties got to test that authority in early November, closing their schools for several days to stifle an early flu outbreak.

    Devlin said should a pandemic strike, the governor might enact his emergency authority to dictate closure orders statewide as needed. The inclination would be to do so sooner rather than later, she said.

    The Department of Health and Human Services has created a set of handouts for individuals, businesses and community organizations with information about pandemics and checklists to help them prepare. Copies have been shipped to county health departments, and the documents can be downloaded off the DHHS Web site _ as can the entire state pandemic response plan.

    That plan will continue to be modified, piece by piece, until it's needed _ and will continue to be updated even at that point, Devlin said.

    "It's a continual process," Devlin said. "You always learn more, you exercise your plan, you improve it. The whole cycle is prevent, respond, then you clean up and then you improve. You always go back and improve."


    On the Net:

    N.C. Department of Health and Human Services:

    DHHS brochures on flu pandemic:

    State pandemic response plan: cle&c=MGArticle&cid=1149192211855&path=!localnews& s=1037645509099

  • #2
    Re: N.C. girds for new type of disaster _ influenza pandemic

    This is a really good article. The part about alternate care sites is addressed. I always wondered how they would do that so the article gives a little clarity regarding this.