DAY OF THE MANY DEAD

Nov 2 2005 day of the dead

Infection-Control Key to U.S. Flu Plan

By LAURAN NEERGAARD,

A flu pandemic that hits the United States would force cities to ration scarce drugs and vaccine and house the sick in hotels or schools when hospitals overflow, unprecedented federal plans say.

The Bush administration's long-awaited report Wednesday on battling a worldwide super-flu outbreak makes clear that old-fashioned infection-control will be key.

Signs that a super-flu is spreading among people anywhere in the world could prompt U.S. travel restrictions or other steps to contain the illness before it hits America's shores.

If that fails, the Pandemic Influenza Plan offers specific instructions to local health officials: The sick or the people caring for them should wear masks. People coughing must stay three feet away from others in doctors' waiting rooms. People should cancel nonessential doctor appointments and limit visits to the hospital.

A day after President Bush outlined his $7.1 billion strategy to prepare for the next pandemic, the details released Wednesday stress major steps that state and local authorities must begin taking now: Update quarantine laws. Work with utilities to keep the phones working and grocers to keep supplying food amid the certain panic. Determine when to close schools and limit public gatherings such as movies or religious services.

"This is a critical part of the plan," because states will be at the forefront of a battle that could have "5,000 fronts," said Health and Human Services Secretary Mike Leavitt, who will work with governors in coming weeks to push local preparations. "Every community is different and requires a different approach."

Also Wednesday, the government for the first time told Americans not to hoard the anti-flu drug Tamiflu, because doing so will hurt federal efforts to stockpile enough to treat the sick who really need it. Tamiflu's maker recently suspended shipments of the drug to U.S. pharmacies because of concern about hoarding.

A key question is how much of the financial burden of preparing must be shouldered by cash-strapped states. Bush's plan provides $100 million to update state pandemic plans, but also requires states to spend about $510 million of their own money to buy enough Tamiflu for 31 million people to supplement the federal stockpile.

Some states might not be able to buy the drug, said Rep. Nita Lowey (news, bio, voting record), D-N.Y.

"This is a national emergency. I believe very strongly it should not depend upon where you live as to what sort of protection you get," Lowey told Leavitt on Wednesday.

Lawmakers also grilled Leavitt — who appeared before House and Senate health appropriations panels — on why it took the administration more than a year to issue its plan.

"Could we have acted sooner to avoid the situation we are in now, in effect running for cover?" asked Sen. Arlen Specter (news, bio, voting record), R-Pa.

Pandemics strike when the easy-to-mutate influenza virus shifts to a strain that people have never experienced before, something that happened three times in the last century.

It's impossible to predict when the next pandemic will strike, or its toll. But concern is rising that the Asian bird flu, called the H5N1 strain, might trigger one if it eventually starts spreading easily from person-to-person.

The new HHS pandemic plan outlines the worst-case scenario: If the next super-flu resembles the 1918 pandemic, up to a third of the population could get sick and 1.9 million Americans die.

The illness will spread fastest among school-aged children, infecting about 40 percent of them. At the outbreak's peak, about 10 percent of the work force will be absent because they're sick or caring for an ill loved one, wreaking economic chaos. Health costs alone could reach $181 billion.

A cornerstone of Bush's preparations is to modernize the vaccine industry, so that one day scientists could spot a novel influenza strain and quickly produce enough vaccine for everybody.

That, however, will take years.

So the administration is also beefing up attempts to detect and contain a brewing pandemic wherever it starts in the world — with restrictions on international travelers attempting to enter the country as one potential step.

Here, HHS has the legal authority to order quarantines, if health officials think they would help stem infections. It's unclear how much quarantines would help fight influenza, as people can spread the virus a day before they experience symptoms, but the federal plan orders communities to get their own quarantine procedures in order just in case.

Also in the plan: Telling states how to prioritize who will get limited stockpiled doses of medication and vaccine.

The government wants to stockpile enough vaccine against today's version of the bird flu to treat 20 million people, with vaccine manufacturers, health workers and the medically frail first in line for shots.

It also plans to stockpile enough of the anti-flu drugs Tamiflu and Relenza for 81 million people, provided states come up with their share — enough for 31 million. Most of the drugs will be reserved for the sickest patients.

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Associated Press Writer Kevin Freking contributed to this report.

On the Web:

Flu pandemic: http://www.pandemicflu.gov