Bracing for a pandemic (with video reports)
This story was published Sunday, April 9th, 2006
By Jeff St. John and Stacey Palevsky, Herald staff writers
Experts say a pandemic flu will strike fast when it comes. Wherever you walk, you'll feel its effects as the world shuts down and hibernates. Play date with the 3-year-old neighbor? Canceled. A dress fitting for the wedding? Postponed indefinitely.
There is no crystal ball, no precise algorithm, no modern precedent for predicting what a pandemic flu outbreak would be like in the 21st century.
This is an era in which viruses travel from continent to continent at the speed of a jet plane and news travels through cell phones and blog posts faster than rumors in a high school hallway.
Until it happens, it's also impossible to tell how damaging a flu pandemic would be to society. It could be no more deadly than a typical flu outbreak, though it's likely many more people would get sick.
But if the pandemic is of a particularly virulent strain, death rates could climb -- and that would prompt a strong public health response.
That's the message Dr. Larry Jecha, medical officer for the Benton-Franklin Health District, has been spreading for several months.
"It affects everybody," he said.
The virulent avian flu known as H5N1 is rapidly spreading across the globe, and experts say migrating birds could bring it to the United States as early as this fall.
That flu has gone from birds to infecting humans and killed more than 100 people worldwide, according to the World Health Organization. But H5N1 is not yet transmittable from human to human.
However, if H5N1, or another like it, mutated into a form that can go from person to person,
it could shudder throughout society -- so preparation is needed, Jecha said.
Under state law, Jecha said he "can do anything to help prevent the spread of disease."
In a worst-case scenario, that includes closing schools and other public places such as the convention center and sports arenas. The authority also extends to private properties such as retail stores, shopping malls and churches.
Of course, "before I did any of this an emergency center would be set up and there would be an agreement with county commissioners, police and emergency people," Jecha said.
The actual response would depend on the number of cases and how severe they are, he said.
Complicating the issue is the fact a pandemic flu won't just affect those who are sick, Jecha added. People will need to stay home from work to care for sick relatives. If schools are closed, single parents and mothers and fathers who work may have to take time off to care for children.
And then there's the fact that a pandemic flu like the one that gripped the world in 1918 and killed as many as 675,000 in the United States and up to 50 million worldwide --
is most damaging to people ages 20 to 40, Jecha said. That's because the greatest risk is not from the virus itself, but from the overblown immune reaction the disease sparks. That means the healthiest people are hit the worst.
In a worst-case situation, Jecha warned, up to a third of the work force could be forced to stay home. "Employers need to come up with a plan to continue operations," he said, including how to protect employees and customers from infection.
Schools need to plan
Few school officials have thought much about how they'd respond to a pandemic.
"Our sense is that there isn't a lot happening in schools," said Julia Lear, director of the Center on Health and Health Care in Schools in Washington, D.C. She said people probably won't feel a sense of immediacy until a case of H5N1 bird flu is found in the United States.
For Mid-Columbia schools, Jecha's PowerPoint presentation is often the first push toward planning.
"The health department is the lead agency," said Rich Buel, Kennewick School District spokesman. "Right now, we're in a holding pattern, washing our hands."
Day care centers are thinking hygiene, too.
Kelly Egre, a spokeswoman for the agency that runs the Kindercare chain, said her staff has encouraged all Kindercare sites to partner with their public health department to keep kids healthy on a daily basis and during a crisis.
"We're proactive in providing special attention each day to limiting the spread of this and other illnesses through frequent hand washing and sanitizing toys and surface areas within our centers," Egre said.
Buel said Kennewick schools are only in the beginning stages of planning for a pandemic. So far, the finance director and the superintendent have learned about potential ramifications of a pandemic. The information will soon trickle down to principals, bus drivers and curriculum directors.
Kevin Velleke, who leads the emergency response plan for both Kennewick and Richland school districts, said it's premature to have a step-by-step plan for a pandemic flu outbreak. "I don't think it's going to be that sudden where you have to shut down schools and bus kids home at noon," he said.
Jecha said any decision to close schools would be based on how virulent the virus might be. Schools might not close if a pandemic was widespread but nobody was dying. But if death rates hit 1 percent to 2 percent, schools would be closed.
As for number of cases, schools now notify the Benton-Franklin Health District when they see a 10 percent absentee rate, Jecha said.
But if that climbed to 20 percent, closing schools could become a necessity -- not only to forestall the spread of disease, but simply because there may not be enough staff.
Hospitals, key services
Of course, hospitals would be on the front lines of any flu pandemic. But health officials agree that if up to one-third of the population is ill, there's no way hospitals will be able to care for everyone.
"There just aren't enough beds," said Chuck Barnes, Kennewick General Hospital's executive director for support services.
"We'll gear up to treat the sickest, and that's about all we can prepare for."
That will mean triage -- the medical term for sorting people based on their need for immediate medical attention.
"You want to contain those people that may be incubating the disease or with active symptoms, and keep them away from people who are well," said Joanne Dixon, infection control practitioner at Lourdes Medical Center in Pasco.
But hospitals may face their own staff shortages, Barnes said.
"Every business in town is going to have a percentage of their employees who are sick or at home taking care of family members who are sick," he said. "Hospitals would be in the same boat."
At the Hanford site, the U.S. Department of Energy and its contractors will need to keep critical operations going during a pandemic, said Dr. Sandy Rock, risk communicator for AdvanceMed Hanford's population health analysis section.
As the occupational medicine contractor for Hanford, AdvanceMed has begun talking to contractors and DOE about a number of possibilities, including having key employees live at the job, with backup-staff available if they happen to get sick, Rock said.
Some industries have considered "even the possibility of housing the families of these critical employees," he added. "You have no idea just how long a pandemic might last."
That has providers of other essential services looking at plans for how to keep the lights on, the water running and the streets safe.
"We have multiple people capable of performing multiple roles," said Brad Peck, spokesman for Energy Northwest, which operates the Columbia Generating Station nuclear power plant. But in a worst-case scenario, "if we didn't have the personnel to operate the plant safely, we'll shut it down," he said.
Representatives of Benton PUD and Franklin PUD said they would redirect all healthy workers to keeping essential services.
"Our employees are cross-trained to do other jobs in case of emergencies," said Karen Miller, Benton PUD spokeswoman. "We also have a close-knit relationship with other utility districts and can help each other out."
There are also more mundane questions, like how to get paychecks to employees who aren't coming to work, Rock said.
"If your place or business doesn't have a plan, ask them to devise one," he recommended. "Can you work at a distance? If you need to come into work, how will they protect you? A lot of businesses aren't even thinking about it."
Business struggles
Having a third of employees away from work in a worst-case situation would be a struggle for any employer.
"You're as prepared as you can be, but it would hurt," said Sharon Dossett, safety and health manager for Pacific Northwest National Laboratory.
Many PNNL employees are involved in scientific projects that demand constant attention, Dossett said. While the lab would continue as much work as possible in a pandemic, it might have to follow emergency closure procedures in a crisis, she said.
One option for some workers is to work from home over the Internet, she said. But too many people trying this at once could overwhelm telecommunications systems.
"We're looking at local bandwidth and our local IT (information technology) people are looking at procuring more services," Dossett said.
College campuses may shut down but learning likely won't. Improvements to computer software and Internet connections could allow Columbia Basin College faculty to videotape a lecture from their family room and upload it to the Web, where students could download it and watch it in their bedrooms.
"Distance technology is perfect for developing a contingency plan," said Rich Cummins, vice president for instruction. CBC staff developed distance learning a decade ago and about one-third of the student body take distance learning or Web-assisted classes.
"With all this talk being bandied about of a pandemic flu, I thought we've got to do something," he said. "We can't afford to shut down the college for three or four weeks."
Washington State University Tri-Cities also could survive temporarily via computers and broadband connections, said Leslie Couch, environmental and safety coordinator for the campus.
Individual responsibility
Overall, a pandemic "could have serious ramifications for our society and our economy," said Steve Sautter, spokesman for Benton County Emergency Services.
Given the seriousness of a worst-case flu pandemic, everyone needs to prepare, said John Scheer, director of Franklin County Emergency Management. That includes individual preparation, he said.
"We've always talked about a 72-hour kit," Scheer said. That means stocking up on enough food, water and basic medical supplies to hold out three days in an emergency. "Well, if we were going to have a pandemic, we're saying you need to store enough food and supplies for two weeks now."
One way people can prepare is to take seriously the basic rules of hygiene like washing your hands covering your mouth when you cough, Sautter said.
"It sounds like first-grade again, but these are proven ways to slow down the disease," he said.
Another key concept will be "social distancing," or simply keeping away from other people.
"We're not going to shake hands anymore," Sautter said. And for people in essential jobs, "You're going to have to make some tough decisions about who's going to go home at night and who's going to stay at work."
These individual, independent decisions will be especially important, given that in a pandemic, all areas of the country are likely to be affected -- and no one affected area will be able to appeal to another unaffected area for aid.
"If we have a pandemic," Sautter said, "we're essentially on our own."
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