States plans for avian flu pandemic

If an avian flu pandemic strikes, states will need to cope not just with severe strain on their hospitals but also with a serious impact on stores, schools, power plants and office cubicles, according to a report released Tuesday (July 18).

Governors would have a tough time just keeping basic services going. As many as 40 percent of workers might stay home for a period of up to 14 months, and outside help from the federal government or other states would be severely limited, the National Governors Association warned in the report.

“The difference between a pandemic and (Hurricane) Katrina is, as huge as Katrina was, it was a localized event to a particular geographic region of the country. Therefore, resources – first responders, National Guard, public safety – could be deployed from all states over the country to the Gulf area, and they were,” Arizona Gov. Janet Napolitano (D), the NGA’s vice-chairwoman, said in a telephone news conference.

“In a pandemic situation, you’re not going to have that kind of resource base, because every state is going to have to be focused on the citizenry within its own borders. That’s why the planning for the pandemic is different than the planning for a natural catastrophe,” she added.

A key consideration for policy-makers will be the depleted workforce that a pandemic would likely cause. Even people who aren’t infected might stay home, fearing they would contract the disease from others in public. That means policing streets, fixing power lines, cleaning wastewater, delivering food and keeping government agencies running could become difficult, the report noted.

The 32-page document released by the NGA’s Center for Best Practices is meant to help governors and their staffs prepare for the unique problems posed by pandemics.

The report centers on the possibility that a strain of the deadly avian flu that already has jumped from birds to humans will mutate, so that it can be passed more easily from one human to another. Birds have spread the virus into Europe, Asia and Africa. As of March 1, the virus had infected 174 people and killed 94 worldwide, according to the World Health Organization.

States will play a crucial role in responding to a pandemic, because they have the tools and the authority to respond to local conditions quickly, said John Thomasian, director of the Center.

Governors and their agencies can shut schools, close highways, deploy National Guard troops, coordinate medical personnel, stockpile and distribute equipment, communicate with the federal government and work with local business leaders.

In fact, with the help of the federal government, states already have conducted drills to practice for outbreaks, so most governors already are up to speed on the challenges, Thomasian said.

But the NGA’s primer can educate new governors – there will be at least nine freshmen governors after November’s elections – and help the executives inform other officials, he explained.

One of the key lessons the NGA’s report stresses is that governors will have to make decisions quickly under changing circumstances. The exact scenarios they’ll have to deal with likely won’t come up in drills, but the test runs are important because they develop relationships before disaster strikes, Thomasian said.

“You can only go so far in a book. Ultimately you’ve got to know the person to call on the other end of the line,” he said.

He said the coordination would be similar to the run-up to Y2K, when government agencies worked with private industry to prevent computer failures caused by the switch to the year 2000.

But in a pandemic, the scope of the problem wouldn’t be known until the disease attacks. The 1918 influenza pandemic killed as many as 50 million people worldwide in less than a year. But the 2003 epidemics of severe acute respiratory syndrome (SARS) were more limited, killing 800 people in Asia and Canada.

Minnesota Gov. Tim Pawlenty (R), who leads the NGA’s pandemic flu task force with Napolitano, said past lessons still play a crucial role in designing pandemic responses.

“We know some things. We’re not just guessing. We know a virus exists. We know it has mutated from bird-to-bird to bird-to-human. We know it has the potential to go to human-to-human. We know if that happens, that there’s a likelihood of pandemic. We know if there’s a pandemic, there’s certain things we need to do to minimize and contain it,” Pawlenty said.

Past pandemics have lasted as long as a year, coming in two- or three-month waves. The report cautions that governments must be ready for new waves of infections even while they’re recovering from the initial shock

So state officials can use the time between waves to recover, but they’ll also be dealing with a public distressed because of lost family and friends, fatigue and financial hardships, the report noted.

Pawlenty said it’s important to be forthright with the public when talking about the problems a pandemic poses.

“I think part of the challenge here is making sure people are aware and informed and prepared but not unduly alarmed. I think we have to be candid,” he said.

The Minnesota governor, for example, said he appreciated the up-front assessment of the U.S. Department of Health and Human Services, which has told states they can’t rely heavily on the federal government for relief during a pandemic.

The NGA’s Thomasian agreed. “It’s not that the federal government is abandoning states. It’s simply that (responding to) the pandemic flu requires a lot of human assets, and the federal government does not stockpile doctors or nurses or truck drivers or utility workers, so it really does it come down to the state level,” he said.

Thomasian said some federal agencies are helping states prepare better than others are. He said HHS has gone out of its way to plan for an outbreak. Just last week, the agency awarded states $225 million to prepare for avian flu (a state-by-state breakdown is here.)

But he said the U.S. Department of Homeland Security has lagged behind.

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