Pandemic plans keep improving

Health officials have a riveting way of speaking about pandemic planning.

It isn't "if" - it's "when."

Could the public health system respond well to a massive influenza or other pandemic today?

"It's getting there," said Joe Russell, head of Flathead City-County Health Department.

Russell said his department avoids planning for pandemics involving one virus or microbe. Instead, the staff focuses on building capacity for a robust response to any type of health emergency.

"You really want the system to work predictably with individuals who understand how to integrate many systems," he said.

Russell defines a pandemic most simply as any infectious disease for which humans have no immunity.

History abounds with examples, from bubonic plague to smallpox to the influenza pandemics of 1918, 1957 and 1968. The 1918 flu took the lives of 20 to 40 million people worldwide.

Dr. Ken Moritsugu, deputy U.S. Surgeon General, detailed the historic 1918 pandemic's raging attack in Montana at a state pandemic planning summit held in May of 2006.

He said the first cases were reported on Oct. 4, 1918. Then, officials became so overwhelmed by the pandemic that another report wasn't filed for two weeks.

By Oct. 21, the exhausted officials transmitted a "veryincomplete" report of 3,500 cases in Montana. A little over a week later, sick and dying patients numbered over 11,500.

According to Moritsugu, reports were so incomplete that the virus could have affected more than the 11,500 recorded victims. The message he was imparting was simple.

"If a pandemic strikes, it will come to Montana," he said.

While much has changed in the practice of medicine and public health since the last pandemic, modern travel means viruses travel farther and faster than ever before. No one knows the impact of the next pandemic.

"That's why we have to continue to practice our system," Russell said.

Flathead's health department took the lead a few years ago by testing its ability to provide mass inoculations with its annual flu vaccine program. The department has held four large clinics in three years at the local fairgrounds.

"Every mass clinic has been run as an incident command," Russell said. "I wasn't even around for the last one and it went fine."

His director of community health, Boni Stout, stepped up to assume the health officer's role. Each clinic has tapped community resources from student nurses to the sheriff's posse. The county's Office of Emergency Services handled logistics.

As recently as Feb. 1, Russell received a briefing on the latest plan from the Centers for Disease Control and Prevention (CDC) for dealing with a pandemic. The federal agency provides guidance and oversight to state and local public health officials.

"The basis of what we would do is a pandemic severity index," Russell said at a recent board of health meeting.

Based on the percent of fatalities, the CDC developed five categories of severity.

Russell said 1 and 2 mirror normal influenza season in Flathead County. Categories 3 through 5, reflecting a death rate of .6 to 2 percent of a population, would surpass the department's normal flu season.

Assuming a population of 115,000 from the greater area, the Flathead's death toll could reach 690 by the time three waves of a category 5 illness roll through.

"We don't want anyone to overreact to the information," Russell said. "The numbers can look a little alarming."

Health officials plan around the highly pathogenic strain of H5N1, an avian flu virus which has jumped in recent years from birds to people. A pandemic could occur if the virus mutates so it can jump from person to person while retaining its deadly traits.

Russell said the CDC would advise the department of the category of virus to expect, which would trigger a series of actions designed to combat spread of the virus.

"We're talking about nonpharmaceutical interventions," he said. "Basically, we have no vaccine and no antivirals that are effective."

Without advances in production, experts predict a minimum of six months to develop a vaccine. Planners expect a pandemic outbreak to last six to 12 weeks in a given community.

Without vaccine, social distancing provides an effective strategy. Public officials could close schools, cancel public gatherings and ask for voluntary isolation of cases and quarantine of household contacts.

Jody White, the health department's emergency preparedness coordinator, speaks to groups throughout the community about pandemics. She uses a recurring theme.

"Better individual preparation makes a big difference," White said. "That's going to make the biggest difference."

She said people need to think ahead to survive expected disruptions of basic services. With 30 percent of the work force ill, public services like water, electric and fuel deliveries may stop for several weeks.

With hospitals overwhelmed, people need to take care of moderately ill family members.

"We also need planning by businesses, churches, schools, daycares," she said. "I've gone to some schools and gotten them thinking how they would do things differently to stop the spread."

White said she has heard from businesses such as Bonneville Power, which have begun working on pandemic planning. She offers check lists for businesses with items such as appointing a pandemic coordinator, identifying essential employees and training an ancillary workforce.

Some of the most critical businesses, local health-care providers, began ramping up planning for a pandemic for at least the last year.

Bill Boyd, clinical safety officer, said during an avian flu presentation at Kalispell Regional Medical Center that the hospital has an emergency planning committee. They have strategies for dealing with surge capacity from a pandemic.

According to numbers provided by Russell, up to 792 people would require hospitalization in each wave of a category 5 influenza pandemic. Of those, 119 would require intensive care and 59 would need ventilators.

A hospital ethics committee has tackled such questions as who gets limited hospital beds and ventilators. Boyd said education and transparency about those decisions remain the best weapon against anarchy in times of panic and limited resources.

Russell said public health has initiated meetings in recent weeks with hospital officials, private health-care providers and even morticians to make plans. White continues to conduct as well as participate in exercises with all the agencies in the incident command system.

"Our goal is to minimize disease, save lives and minimize social and economic disruption," White said.

Mark Peck, director of the county's Office of Emergency Services, put his mark of approval on pandemic plans made by public and private health agencies. He said that the good news is that pandemics, unlike floods or earthquakes, allow some time to ratchet up.

"With the work that Joe (Russell) and Jody (White) have done, I think we are quite a ways down the road," Peck said.

Russell said the health department has taken advantage of planning money made available after 9-11 to work on training, collaboration and flexible leadership capacity within Flathead City-County Health Department.

"The only thing harder to do than planning for disaster is to explain why you didn't," Russell said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.