Fear the flu
Preview of a possible pandemic

by David Edwards

“This was influenza, only influenza.This new influenza virus, like most new influenza viruses, spread rapidly and widely. As a modern epidemiologist ... has observed, influenza is a special instance among infectious diseases. This virus is transmitted so effectively that it exhausts the supply of susceptible hosts.
But this was influenza, only influenza. The overwhelming majority of victims got well. They endured, sometimes a mild attack and sometimes a severe one, and they recovered.
The virus passed through this vast majority in the same way influenza viruses usually did. Victims had an extremely unpleasant several days ... and then recovered within ten days. The course of the disease in these millions actually convinced the medical profession that this was indeed only influenza.”

So begins a telling chapter in “The Great Influenza,” John M. Barry’s account of the 1918 flu pandemic. Though the virus was dubbed the Spanish flu, Barry notes that it probably emerged in the United States, and it wasn’t until 1920 that the pestilence finally ran its course. By the time that happened, tens upon tens of millions of people around the globe had succumbed to its ravages.
Even today, those numbers seem mind-boggling. How could a viral nuisance cause such sheer loss of human life? The death toll becomes even more difficult to comprehend when one considers that a sizable percentage of the victims were healthy and in the prime of their lives. Yet it was not some unknown, exotic plague that killed them, no high-profile entry in the Doomsday book of disease.
It was the flu. Granted, it was a new and highly virulent strain, but really, who dies from the flu?
After recent fatal bird flu outbreaks in several countries, we now know better than to ask that question. Instead, people are asking how worried they should be, what they can do to prepare and what might happen if a flu epidemic were to occur. Health officials throughout northwestern Washington are glad people are asking those questions. They and their colleagues, both nationwide and worldwide, know the answers.

Identifying challenges
“Pandemics of influenza are a part of human history, with three pandemics in the last 100 years alone,” said Dr. Emily Gibson, the director of the health center at Western Washington University in Bellingham. “The risk of another pandemic of a unique or novel influenza virus is very real, but the timing is, of course, uncertain. The severity of a pandemic varies with the virus, so how much illness and death to expect is unpredictable until we face the situation.”
Although medical treatment of pandemic flu would be disease-specific, many other areas of dealing with such a crisis apply to virtually any widespread major disaster. As always, preparedness and planning are vital components of a successful pandemic flu response.
“It is important to recognize that during a pan flu event, or any large-scale infectious disease outbreak, an effective response will demand that communities work together,” said Nicci Noteboom, spokeswoman for St. Joseph Hospital in Whatcom County. “All healthcare providers, county health departments, law enforcement, county government, school districts and the community at large will need to be engaged in a comprehensive plan. In Whatcom County, these groups have been working together as part of the Whatcom County Pan Flu Task Force and have identified critical planning objectives that are now being addressed.”
The task force issued its report last July, and three pages of it are devoted to how the county can address the impact a flu outbreak would have on area businesses and the local economy.
Some analysts have predicted that commerce would grind to a halt as panic spread and illness stymied productivity. According to the task force’s report, such predictions are realistic.
“The ripple effect of possible economic disruption and economic losses in the event of an extended emergency, such as pandemic influenza, could be staggering,” the report states. “An influenza pandemic will likely cause significant disruption of privately owned businesses, many of which could provide critical infrastructure including transportation, commerce, utilities, public safety, agriculture, and communications.”
The task force’s recommendations include several strategies to minimize the disruption and losses. Among them are the possible use of scrip and bartering in case of pandemic flu. The task force also recommended that workers in critical infrastructure systems be reminded of their “legal, professional and moral” obligation to report for work should a flu epidemic occur.
In addition, the task force advised the county to plan its handling of residents’ inability to pay certain bills as a result of the epidemic’s effects on employment.
Furthermore, the task force recommended that the county identify businesses and service providers that would be subject to federal intervention during an outbreak. The county should then pursue agreements that would cede control of budget decisions and financial policies to local entities, the task force urged.
The overarching goal of the recommendations is to create a “culture of readiness to serve” and a “culture of reciprocity.”

Stay home, get vaccinated
Although workers in certain professions do have a moral, ethical or legal obligation to report to work during a widespread health crisis, the general advice runs counter to that. The American Red Cross’ guidelines state clearly that a person with signs of the flu should stay home and avoid contact with others. Local health departments second that suggestion.
“In a pandemic, by definition, this will be an influenza virus that is new, and there will be no vaccination available for a number of months,” Gibson said. “More likely is the concept of social distancing, with closure of any large public gathering places, including some work places, to keep the transmission of the virus as minimal as possible.
“Some employers will institute work-from-home policies if possible, and others will provide protective equipment to their employees, as well as antiviral medications, on an as-available basis. It certainly will not be a ‘work-as-usual’ situation.”
In another departure from ordinary working conditions, employees may be required to wear surgical masks – assuming they are allowed in the workplace to begin with. Employers should also put a premium on workplace hygiene, especially frequent hand-washing, and instruct their workers to cough or sneeze into a handkerchief, sleeve or other absorbent item.
The threat of a pandemic can remind people of the old adage that an ounce of prevention is worth a pound of cure. During the winter, in preparation for flu season, many employers sponsor health and wellness fairs that may include flu vaccine drives. In Island County, for example, Dakota Creek, the Port of Anacortes and Island Hospital offered flu shots to their employees.
People who prefer to avoid the needle can receive the vaccine in a non-injected form. The much-hyped FluMist, a nasally administered dose of the vaccine, is still available. However, the age range for recipients is somewhat limited compared with the universal flu shot. Also, FluMist is not covered by all health insurance plans, a notable consideration given the higher cost of the nasal form of the vaccine. Gibson said FluMist has not gained much traction because it remains more expensive than a flu shot.
While being vaccinated against the flu is advisable, the vaccine is not bulletproof. In conjunction with a sturdy immune system, it can fend off the strain of the flu during the season in which it is administered.
“The vaccine changes year to year based on the best predictions of world epidemiologists monitoring the strains of influenza in both hemispheres all year round,” Gibson said. “The vaccine prepared for our winter flu season is based on the viruses circulating in the southern hemisphere during their winter, but that decision is made about six to seven months prior to the shipment of the vaccine to healthcare settings. As a result of this time lag, there sometimes is imperfect coverage for the most active flu-season strains due to changes in the outbreak numbers or mutation of the virus.”

Hospitals prepare for pandemic
According to Gibson, developing a vaccine for a pandemic strain of the flu would take about six months – under the best-case scenario. Should an outbreak occur, first responders and hospitals would bear the brunt both initially and in the subsequent days and weeks. It just so happens that many of the hospitals in the four-county area have practiced their response to that scenario and are equipped to handle the logistical hurdles of pandemic flu.
Harborview Hospital in Seattle hosts a Web site that tracks bed availability at all hospitals in Western Washington. The Web site “allows hospitals to update bed capacity, communicate regarding facility capacity based on a variety of parameters, and communicate critical information to other hospitals in the region,” said St. Joseph’s Noteboom.
“It does rely on the diligence of each hospital to monitor and provide updates at regular and consistent intervals,” Noteboom added. “If phones go down for whatever reason, all hospitals have several redundant communication modes that would be available to establish communication. In Region One, which includes Whatcom, Skagit, Snohomish and San Juan counties, we have been working to establish additional redundant communication systems for the past three years. This includes amateur radio and satellite phones.”
Noteboom also said that for the last four years, the hospital has worked with its counterparts and several community health clinics in the four-county area to increase regional capacity. It’s all part of a plan designed “to meet the unique needs of a large number of acutely ill patients.”
Countering pandemic flu consists of a tag-team effort in Skagit and Island counties. The Skagit County Health Department maintains a wealth of pandemic flu information at its Web site, as well as links to other outstanding resources, both national and local. In addition, the department is coordinating an effort to identify all licensed professionals living in the county – working or retired – that could be activated to help out in an emergency situation.
Besides that, the health department has produced a DVD specifically about pandemic flu, and the DVD can be found in local libraries. Donna Smith, the department’s local emergency preparedness coordinator, has hosted a community forum and individual presentations on the topic.
The collaboration with Smith and the health department has benefited Island Hospital, said Barb Ringhouse, the hospital’s assistant administrator for patient services. Island Hospital joined the health department in a pandemic flu drill earlier this year.
“The drill went very well; our nursing supervisor was able to notify and activate the appropriate people and schedule immunizations,” Ringhouse said. “We’ve also been working on basic ‘surge capacity’ issues in disaster planning with other local and state agencies for quite some time. We’ve acquired extra temporary beds and plans for caring for sudden influxes of patients for any reason, along with protective gear for airborne illnesses.
“We’ve held drills of all types with other local agencies. I’m not sure anyone can ever be totally prepared, but I feel Skagit County and Island Hospital have been part of a very good coordinated effort.”
Northwestern Washington could soon find those preparations put into practice – with life-and-death implications. As the H5N1 avian flu spreads through Asia and Europe, health officials in the Western Hemisphere watch with a wary eye.
What’s disconcerting is that there’s no crystal ball and no effective deterrent.
“Current human influenza vaccines would be ineffective for avian flu,” Gibson said. “There is a developing H5N1 avian flu vaccine being tested in humans, for the current avian flu strain, but it is not the pandemic strain of flu that scientists fear will become widespread. So (it) may offer partial or no coverage to a pandemic avian flu. Even in the best scenario, influenza vaccination is not completely effective for all people, but it is the best tool we have for prevention and reducing severity of illness.”
The next-best tool is an acceptance of and healthy respect for an important reality: This is influenza, not only influenza.

Many pharmacies, including Island Drug in Oak Harbor, offer flu shots as an added service to their customers.