KANSAS AND THE CAROLINAS PREPARE

Kansas pandemic influenza preparedness, response were released

By ROBERT PIERCE
Southwest Daily Times

The Kansas Department of Health and Environment has released the Kansas Pandemic Influenza Preparedness and Response Plan.

The plan was developed with input from the Centers for Disease Control Prevention and the World Health Organization.

The term "pandemic influenza" refers to a potential worldwide outbreak of a new or unusual virus. People will have little or no immunity to such a virus.

The goal of the plan is to minimize the effects of an influenza pandemic on Kansas. KDHE and other agencies review and update the plan at least twice a year and exercise it once per year.

Seward County Health Department Administrator Martha Brown discussed some of the items in the KDHE plan during a recent county work session.

"An epidemic is a disease that spreads rapidly through a particular population of people," she said. "A pandemic has to have three things. It has to be a very variant organization. It has to be easily transmissible from human to human, and it has to be one that no one has any immunity to."

Brown said the avian flu fits all of the pandemic descriptions except for the human-to-human transmission.

She added there are three types of influenza.

"There's A, B and C," she said. "A is the one that causes human and bird flu, so that's the one we're concerned with. There's some subtypes, and they get their names by two components of the virus. One is hemagglutinin, and one is neuraminidase."

When the A strain is in wild birds, it causes very little in the way of problems, but when it reaches domestic birds is when residents should be concerned, according to Brown.

"All influenza A starts in wild birds," she said. "When it happens in wild birds, it's usually not a problem. The birds might produce fewer eggs and shed some. Not a big deal, but when it gets into domestic birds, then it has about a 52 percent mortality rate in domestic birds. If it gets in large groups of domestic birds, the virus changes, gets weird, and viruses shift. They drift. They mutate constantly, and when they do that, they are easily transmitted to pigs as well. Pigs are the big melting pots of viruses. Their bodies play havoc with viruses. That's when you start seeing human-to-human transmissions."

The biggest pandemic flu outbreak was in 1918, according to Brown.

"It was originally started in Hong Kong," she said. "It killed between 20 million and 40 million people. That is more than Vietnam, World War I, World War II and the Korean War combined. They've estimated that if the same virus were here today, it would kill more people in one year than does cancer, heart disease, chronic pulmonary disease, AIDS and Alzheimer's combined in one year."

Another outbreak came in 1957 with the Asian flu, according to Brown.

"In 1968 was the Hong Kong flu," she said. "It just changes a little bit, but it's a whole new animal when that happens. Each one of those killed more than a million people."

Later in 1976, there was the swine flu, according to Brown.

"Only one soldier actually died of the flu," she said. "All of the other deaths that resulted from that flu were from the vaccine that was given. I think this is where a lot of this fear of flu shots comes from."

The Avian flu started out in birds in 1961, according to Brown.

"It was in South African wild birds. In 2003, it became more prevalent in domestic birds," she said. "The first human case was in Hong Kong. There were 18 cases and six deaths. By June of 2005, there was a hundred cases with a 54 percent mortality rate. There's only been three to four cases of human-to-human transmission. Every human case has been in a person that's involved in caring for fowl, so most of the general population isn't at too much risk as long as it doesn't change enough that it's easily transmitted from human to human."

Vaccines are being developed currently to assist with cases, Brown said.

"By the time they get it where it works on a particular flu virus, the virus has changed," she said. "That's why we get a new flu shot every year. They base the current vaccine on what kinds, what strains were in that virus in the year previous to that. It also takes about six months to manufacture the right kind of vaccine."

Brown said even if a vaccine is developed to protect against Avian flu, enough vaccine could not be made to immunize everyone.

"With the people who are currently getting the flu and are sick with it, it's hard to come by anyway, so there's no point in doing a bunch of stockpiling," she said. "Then there's the distribution problem, and that's part of our planning process we've been doing with the bioterrorism anyway. The hospital plans, and the county plans. Emergency management. EMS. All of those have to decide if there is a certain amount of vaccine, you have to decide who's going to get it."

Most of that is based on a person's job or job description in the county government or city government, according to Brown.

"Most of the hospital personnel would be vaccinated," she said. "Public health would be. Commissioners would be."

Families of those people would also be included, according to Brown.

"You can't expect a guy to go out and pick up sick people and take care of their needs and see to them when their children are home sick," she said. "You have to have their full attention with their abilities to perform the jobs they have in the community."

Surveillance is currently being done on a daily basis with domestic birds, according to Brown.

"They're watching where the wild birds tend to migrate or congregate before they take off again and what domestic birds might be affected by it," she said. "As of yet, there has not been any Avian flu in the United States at all."

Brown said in the meantime, people need to take regular precautions such as handwashing and covering mouths when coughing to prevent problems. She also stressed the importance of staying home when dealing with sickness.

"If your kids are sick, don't send them to school. If you're sick, don't go to work," she said. "It's a whole lot better to stay at home a day or two than to go to work and risk infecting everybody you come in contact with."

KDHE received a grant through a bioterrorism program to assist with education about Avian flu, according to Brown.

"It includes a lot of county planning," she said. "They require public health to take the lead in a lot of this, public health is not really prepared to be emergency planners. There's a threat assessment team that involves people throughout the community that work in animal agriculture and some medical and emergency workers. What (KDHE) has done with the pandemic flu is an amendment to the bioterrorism contract, and we're getting some more supplemental money with that. There's quite a few requirements with that that involve planning such as meeting once a month."

Are we ready for possible pandemic?
Not yet, but here's how schools, hospitals, businesses are bracing for bird flu
KAREN GARLOCH
kgarloch@charlotteobserver.com

* Early detection key in bird flu fight
* FDA issues guides for human test for bird flu

If a bird flu pandemic erupts among humans, it won't be just a health problem. It could interrupt business, schools and life as we know it.

Are we prepared?

Not yet, based on interviews with Carolinas health officials and area schools and businesses.

"The health sector is coming along," said Dr. Jeffrey Engel, N.C. state epidemiologist. "Large businesses have good plans. But I don't think small and middle-size businesses have taken this on as a priority. We've got a ways to go with school planning ... and with families."

For several years, federal, state and local public health agencies have been planning for an eventual flu pandemic. It's not a matter of if, they say, but when.

Avian flu outbreaks have been reported in 45 countries, starting in southeast Asia in 2003, but have circulated almost entirely among birds. Experts fear it will mutate into a form easily spread among people.

A pandemic could come in waves that last six to eight weeks. In that way, it is starkly different from hurricanes or earthquakes, which strike quickly and allow emergency teams to respond. In a pandemic, no state could count on massive help from other states or the federal government.

"Any community that fails to prepare, with the expectation that the federal government will come riding in and rescue them, will be sadly mistaken," Health and Human Services Secretary Michael Leavitt said during North Carolina's recent pandemic bird flu summit.

The Carolinas have plans for closing schools, screening and isolating travelers and canceling mass gatherings to contain an outbreak. Both states have received the first installments -- $2.5 million for North Carolina and $1.5 million for South Carolina -- from $350 million approved by Congress for state and local pandemic preparedness.

"That will not cut it," said N.C. Gov. Mike Easley.

To be prepared, he said, states need more federal money to purchase antiviral drugs and to pay for training local and state emergency response teams.

Area hospitals have begun stockpiling antiviral medicines, such as Tamiflu, as well as masks, gloves and gowns to help prevent the spread of a pandemic flu. They also have plans to expand capacity for a surge of patients and to retain enough healthy employees to care for the sick.

In Mecklenburg County, hospital, public health and emergency response officials gather regularly to discuss a potential disaster. In February, they met for a simulation of pandemic flu conditions and responses. Another is planned in May.

Further behind on preparedness are businesses, schools, day-care centers, faith-based organizations and families. To assist these groups, the U.S. Department of Health and Human Services recently released numerous checklists, available at www.pandemicflu.gov.

"The history of pandemics isn't so much a history of public health. It's a history of human beings," Leavitt said. "Life has to go on."

Hospitals

Boxes of gloves, masks and protective gowns are stacked high on the shelves of a Kannapolis warehouse operated by Novant Health, parent company of Presbyterian Healthcare and its four Charlotte-area hospitals. The 57,800-square-foot building will soon have six weeks of supplies that would be needed in case of a bird flu pandemic.Among the items are stiff, cuplike N95 respirator masks that fit over the nose and mouth. They are thicker than surgical masks and better at keeping out airborne viruses, but they are also more expensive and require fitting to work properly.

These masks are recommended for health care workers and emergency responders. People who have the flu can wear plain surgical masks to decrease the spread of respiratory droplets. Federal health officials say there's no evidence that masks protect healthy people from contracting viruses.

Presbyterian and Carolinas HealthCare System are stockpiling medicines and equipment as well as working with local emergency management officials on preparing for a pandemic.

In response to an influx of patients, Carolinas Medical Center would use MED-1, the mobile hospital that most recently provided aid to Gulf Coast victims of Hurricane Katrina. Presbyterian Hospital would set up a triage area outside its Caswell Avenue emergency department.

If needed, certain hospitals or sections of hospitals would be used to separate flu victims from other patients. If more space is needed, schools or other large buildings could be used for patient care.

"Huge numbers are going to overwhelm the entire community," said Dr. Stephen Wallenhaupt, medical director of Presbyterian Healthcare. "That's what we all dread."

One of the challenges would be keeping an adequate supply of healthy nurses and doctors. Dr. John Baker, director of medical education for Carolinas HealthCare, said employees are encouraged, even today, to stay healthy by getting annual flu shots, limiting exposure to viruses by avoiding large crowds and washing hands frequently. Still, despite federal recommendations that all health care workers get annual flu shots, only 30 percent do.

In a severe pandemic, Baker said hospitals would look for federal standards on which patients would qualify for limited resources, such as ventilators to treat respiratory failure. Such machines cost more than $300,000 each, and no hospital would have enough to treat every patient in a worst-case scenario. Under normal circumstances, about 75 percent of ventilators at Carolinas Medical Center are in use at any time, Baker said.

"We don't want to end up with a first-come, first-served process in a pandemic," Baker said. "That would be unfair."

Health departments

Every day in Mecklenburg County, the health department's computerized surveillance system monitors school absenteeism, emergency room visits and medicine sales at drugstores. That helps public health officials quickly pinpoint a new illness in the community.

That system, developed after the terrorist attacks of Sept. 11, 2001, would be one of the ways public health officials would detect and control bird flu if it were to spread among humans.

Standard public health practices would be followed -- infected people would be isolated, those who may have been exposed to the virus would be quarantined. All those people and others caring for them would receive antiviral drugs to prevent or tame infection.

"If it's in the United States, it's going to get jumped on quickly and surrounded," said Dr. Stephen Keener, medical director of the Mecklenburg County Health Department. "The more I learn about this, the more I think it's manageable."

S.C. health officials plan a large-scale public awareness campaign, said Dr. Jerry Gibson, director of disease control. It will describe what a pandemic would be like and what people could do to protect themselves before a vaccine becomes available and when antiviral drugs are limited.

The messages are basic: "If you get sick with a flulike illness, stay home until you feel better," Gibson said. "Urge family members (who have been exposed) to stay home for an incubation period of three days. ...That will make a big difference in transmission."

Gibson said he hopes health officials can convince the public that "there is some serious planning going on" and that "everything reasonable to be done has been done. If we do that, there won't be panic."

Schools

To successfully prevent spread of a new virus, schools would be closed early in a pandemic, said Engel, the N.C. state epidemiologist. "If kids are coming to school sick, it's too late."Officials at Charlotte-Mecklenburg Schools are working with local health officials and city-county emergency preparedness teams to put pandemic procedures in place, spokeswoman Nora Carr said. School officials participated in the Charlotte-area pandemic simulation in February and brought in a speaker on crisis management to build awareness among senior administrators.

State and local health departments will help decide when to close schools, she said. If the closure lasts for an extended period, she said the system will need a plan to continue providing education to students. It might be possible to use the Internet or television to continue classes, but not all students have access to the Web. "If you ended up being shut down for weeks, it would be very difficult to address that in a way that would be equitable," Carr said.

"My sense is that we're fairly early into this process," she said. "At this stage of the game, we have more questions than we have answers."

Families

If a pandemic is declared and people start getting sick, Engel predicted healthy people will stay home from work and school voluntarily. "They're just going to do it because they don't want to be out in the world."

Families are advised to have at least a three-day supply of food, something residents of hurricane-prone areas already do. But Engel said most families don't have stockpiles that are constantly replenished. If, for example, a pandemic interrupted food deliveries to grocery stores for six weeks, people would be desperate to find food. "I just don't think any part of society has the ability to deal with that," said Engel.

In case of a pandemic, families should remember basic hygiene: Wash your hands. Stay home if you're sick. Avoid large groups. Avoid coughing and sneezing on others. Don't rush to the hospital if you're not sick. Don't go to the doctor just to see if you're OK.

"Those are the kinds of things we need to get in our heads and to practice," said Keener, Mecklenburg's medical director. "It's going to have to be a partnership with the citizenry."

The federal government's checklist for families includes a list of foods and supplies to keep on hand.

Businesses

Closing schools alone would have a ripple effect on families and business. As parents stayed home with children, absences from work would increase. Travel, shopping, mail delivery and other activities could come to a halt. Federal officials suggest businesses should plan for how to stay open if 30 percent to 40 percent of employees are absent.Utility companies, such as Duke Energy, have plans for large-scale disasters that have been practiced and used. Many large companies are also braced for an outbreak, but smaller companies are not, said Greg Santo, vice president of a Buffalo, N.Y.-based company that helps businesses plan for emergencies.

Attempts to organize flu-preparation classes for small and midsize companies in Charlotte have met with apathy, Santo said. "Seems like everyone's waiting until the eleventh hour."

Officials of Charlotte's two large banks, Bank of America Corp. and Wachovia Corp., and the area's largest grocers -- Harris Teeter, Food Lion and Wal-Mart -- said they have reviewed existing disaster-preparedness plans and are working to update them.

"We hope it will never need to be implemented," said Harris Teeter spokeswoman Jennifer Panetta.

SOURCE: World Health Organization: www.who.int/en/

Bird Flu Update

• The current outbreak of avian flu began in Southeast Asia in 2003. • Outbreaks in birds have been reported in Asia, Africa, Europe, India and the Middle East.

• 191 humans have contracted bird flu, and 108 have died, in Vietnam, Indonesia, Thailand, China, Azerbaijan, Cambodia, Turkey and Egypt. Most got the virus through close contact with birds.

• Bird flu is hard for humans to catch, but experts fear it will mutate into a form easily spread among people.

SOURCE: World Health Organization: www.who.int/en/

Checklist for Businesses

• Track avian flu reports and regularly review and update business continuity plans.• Make sure plans account for a minimum absenteeism rate of 25 percent to 35 percent.

• Identify "trigger points" when contingency measures should be executed.

• Cross-train essential personnel, and implement work-from-home policies.

• Coordinate contingency plans with suppliers and business partners.

• Educate employees on basic flu prevention; make it mandatory that ill employees stay home.

SOURCE: Business continuity firm DRI International

Checklist for Families

• Store a supply of water and nonperishable food, including ready-to-eat canned meats, fruits, vegetables and soups; protein or fruit bars; dry cereal; peanut butter and nuts; dried fruit; crackers; canned juices; cans or jars of baby food.

• Store medical, health and safety supplies, such as medicines to treat fever, coughs and colds and diarrhea; soap; thermometer; vitamins; fluids with electrolytes; flashlights and batteries; portable radio; manual can opener; garbage bags; tissues and toilet paper.

• Limit the spread of germs and prevent infection by washing hands frequently, covering coughs and sneezes with tissues and staying at home from work or school if you're sick.

SOURCE: www.pandemicflu.gov

Terms

QUARANTINE: Separation and restriction of movement of people who have been exposed to an infectious agent. Although they are not yet sick, they could become infectious.ISOLATION: Separation of people who have an infectious illness from those who are healthy. The restriction of their movement is intended to help stop the spread of that illness.

SOCIAL DISTANCING: Voluntarily staying away from crowds or staying home if you are sick.

Pandemic History in 20th Century

SPANISH FLU

1918-19

Killed more than 500,000 people in U.S., and 20 million to 50 million worldwide. Mortality rate of 1 percent to 2 percent.

ASIAN FLU

1957-58

Killed 70,000 people in the U.S., and 2 million worldwide.

HONG KONG FLU

1968-69

Killed 34,000 in the U.S., and 1 million worldwide.
Business writer Mike Drummond contributed.