IT LOOKS, for all the world, like one of those horrible disaster dramas on prime-time television; a global avian flu epidemic infecting up to 40% of the world’s population. Utilities failing.  Emergency services, hospitals and doctors swamped.  Shortages of food and supplies because agriculture, manufacturing, shipping and retail sectors don’t have enough healthy workers to meet demand.  It’s a terrifying mental image, but it’s not unrealistic.  It’s happened in the U.S. before. 

During the autumn of 1918, near the end of the First World War, the Spanish flu took three weeks to spread into every community across the United States.  Only three weeks during an era without global commercial air travel or interstate highways.  More than 25% of the U.S. population became infected, more than 650,000 Americans died.  Globally, the Spanish flu pandemic killed more people (50 million) than were killed during four years of World War I (16 million). 

The World Health Organization (WHO) anticipates that the H5N1 strain of avian (bird) flu, not currently capable of passing from human-to-human, will infect someone already ill with another flu strain and evolve into something highly contagious to humans.  The WHO, based on current human cases of H5N1 avian flu, caught from bird/human contact, expects the pandemic to begin in Asia and spread rapidly world-wide.

Civista pandemic drill volunteers waiting for triage. Photo by A. Dailey for TheBayNet.com

According the U.S. Department of Health and Human Services (HHS), “Since 2003, a growing number of human H5N1 cases have been reported in Asia, Europe, and Africa. More than half of the people infected with the H5N1 virus have died. Most of these cases are all believed to have been caused by exposure to infected poultry. There has been no sustained human-to-human transmission of the disease, but the concern is that H5N1 will evolve into a virus capable of human-to-human transmission.”

The Charles County Health Department (CCHD), in cooperation with Civista Medical Center and county government also recently conducted an avian flu pandemic drill.  County medical personnel, emergency services, health department staff and volunteers spent 24 hours enacting plans to deal with a pandemic.  Part of the drill included educating local media. 

Bill Leebel, CCHD public information officer, suggests that natural disaster makes a good comparison for the flu pandemic.  To his understanding society can no more stop a pandemic from occurring than we could prevent a hurricane from hitting a coastline or steer a tornado through unpopulated areas of the Midwest.

“History tells us influenza pandemics are inevitable.  Experts tell us the world is overdue for a pandemic,” said Governor Martin O’Malley in a statement announcing Maryland’s recent state level pandemic flu drill.

Preparing for the Inevitable

An effective vaccine against avian flu can’t be developed until scientists know what human flu strain H5N1 merges with.  Once the virus mutates, however, the pandemic can spread worldwide in a matter of weeks, as compared to the six to nine months that the HHS says it takes to develop a vaccine.    

So the goal, according to Leebel, isn’t to prevent the pandemic; it’s simply to reduce the number of people sick with the virus at one time.  The fewer people ill at any given moment means less interruption of important services and the greater our chances of surviving the virus.  The best model that health experts have in planning for a deadly pandemic is that 1918 Spanish flu epidemic. 

The National Center for Disease Control (CDC) expects this next epidemic to spread across the U.S. much more quickly.  That drastically limits the amount of warning any of us will have before Southern Maryland is right in the thick of the virus.  Slowing the pace of infection is the largest problem facing county health departments. 

Toward this end, the CDC has the legal authority to mandate quarantine and isolation methods in the event of a national health emergency.  However, they’re mainly relying on people to quarantine and isolate themselves so as not to infect others.  Anyone familiar with American regard for traffic laws knows how well relying on people to obey the rules simply for the public good works.

“Really, that’s something that needs to be addressed because there is no answer as to how [to make people stay home],” Leebel told The Bay Net.

Local health departments and governments are required by law to have emergency plans in place for the flu pandemic.  Charles County toured The Bay Net through its plan during their drill earlier this month.  Calvert County mentions a flu pandemic plan on its health department website, but Calvert Bioterrorism Coordinator, Sharon Nazarek did not return our call for details on the plan.  St. Mary’s health department doesn’t have pandemic flu information on their website and Director of Community Health, Nancy Luginbill also didn’t return our call for information.

These plans are the beginning of social responsibility.  However, they face several problems which drastically reduce the actual usefulness of those plans.

Firstly, people infected with the virus will overwhelm Civista.  “When people are sick they feel safer at the hospital,” said Lauri Cress, Civista’s Director of Facility services.  “But not everyone needs to be here.  We can only treat symptoms.”

The best thing people can do is stay home, keep the sick drinking fluids and keep the fever as low as possible.  Debbie Shuck-Reynolds, Civista’s Emergency Department Manager told The Bay Net that having trouble breathing is one of the few reasons someone with the flu should come to Civista.  It’s a sign that the infection may have developed into pneumonia, which the hospital can do something about. 

Secondly, the workforce will be drastically reduced and very few local businesses have plans in place to keep them running on a skeleton staff.  None other than government agencies are required to have plans in place for operating under pandemic conditions. 

According to Leebel, the CCHD has approached essential services – local utilities, the court system, and county government – to make certain that those essential services have plans to help them remain operational.   But, very few other businesses have requested assistance developing plans; they are accountable to no one for their emergency preparedness. 

Children are at particular risk for catching and spreading the flu, but Charles County Public Schools hasn’t approached the Health Department for help formulating a plan.  They have emergency plans in place for a variety of other emergencies, but not for pandemic flu.  The CCHD has also tried to help special populations like day-care centers formulate plans, but they can only go where they are invited. 

Thirdly, those responsible for dealing with the remains of the dead will also be tremendously overwhelmed.  If we round Charles County’s population to 140,000, then current normal mortality rates for the county are about 1,092 annually, or 182 deaths every eight weeks.  The CDC estimates that the avian flu would infect 40% of the population; for Charles County that equals 56,000 people.  Despite the 50% mortality rate seen among current human cases of avian flu, the CDC estimates a pandemic mortality rate of 2%.  Locally, that means 1,120 people dead within 8 weeks, slightly more than our average annual mortality rate. 

Finally, although the government has been planning for a pandemic since 2005, but very few families or individuals know either about the warnings or what to do to ready themselves.  The simplest and most urgent need for most people are supplies to weather a six to eight week period of quarantine or isolation.  The graphic below from ProvidentLiving.org suggests basic areas to build a store of supplies by simply purchasing slightly more than you need during your weekly shopping.

Despite these problems, local and state officials are positive about our ability to handle a pandemic flu situation. 

“The emergency response and emergency capabilities are really some of the best in the state, because of the cooperation between agencies,” Leebel told The Bay Net.  “And, we’re not so large that we’re unmanageable.  They really have it together up here.”

Governor O’Malley promised, “Maryland is a world leader in advanced biomedicine, and we are determined to stay ahead of any pandemic flu.  This drill is an important step toward protecting our families in the event of an outbreak.”

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For more information…
http://www.pandemicflu.gov/ - The official HHS website for pandemic flu information.
http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf  - Identifies important, specific activities large businesses can do now to prepare, many of which will also help in other emergencies.
http://www.pandemicflu.gov/plan/pdf/informationsheet.pdf  - Family emergency health information sheet – all of your family’s important medical information in one place.

Food Storage advice from ProvidentLiving.org

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Charles County Editor, Anna Dailey welcomes your comments on all Charles County issues.
Please leave feedback in the box below or contact her via email:  annadailey@thebaynet.com.