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Is the U.S. prepared?

Officials say yes for seasonal flu, but worried over pandemic

By Manav Tanneeru
CNN

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Officials set up emergency hospitals, like this one in Kansas, during the 1918 flu pandemic. A pandemic today would shock the health system, experts say.

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(CNN) -- Public health officials say they are prepared for the flu season this year, but their confidence is tempered by fears of a possible bird flu pandemic.

The normal flu season is in its early stages, with a small number of states reporting flu activity, according to the Centers for Disease Control and Prevention.

The CDC does not expect any vaccine shortages this year, despite production problems at vaccine manufacturer Chiron's British plant. The United States went without half its doses last year after Chiron suffered contamination problems at the same plant.

Despite the early calm of this flu season, alarms over a possible pandemic flu outbreak have public health officials worried.

"The potential for a pandemic influenza is very real given the situation of the avian influenza problem in Southeast Asia. We think we're potentially very close to that virus mutating into one that can be readily transmitted to humans," said Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"The question is when? None of us know. Could it be tonight? Yes. Could it be next year? Could it be several years from now? All those are possibilities, but it's one that most of us believe will be inevitable."

An outbreak could occur along two possible scenarios, according to Dr. Arthur Kellerman, chairman of the Department of Emergency Medicine at Emory University.

The first is something similar to the 1968 outbreak, where there would be four times the number of cases of a typical flu season, according to Kellerman. The other scenario is an outbreak along the lines of the 1918 flu, which would "make Hurricane Katrina look like a rainy day," Kellerman said.

Both scenarios would be a shock to the public health system, Kellerman said, with the second completely overwhelming it. "There is no conceivable scenario where we would be able to provide the critical care in [a 1918-style outbreak]. What we would have is large hospices," he said. (Study: Trauma centers ill-prepared)

Vaccines and quarantines

Federal and state response plans for a possible pandemic call for a combination of vaccine policy after the flu strain is recognized, anti-viral medication, and other measures ranging from at-home health care and quarantine to shutting down airports and limiting public gatherings. (Worst-case scenarios)

Many of those measures, however, have flaws that make them far from ideal, critics say.

For example, a vaccine would not be available during the first wave of the pandemic. A vaccine is available that would fight the current avian flu strain, H5N1, but it would not be a perfect match because the strain will likely change before it gains the ability to spread from human to human.

"Because the structure of the virus changes so rapidly, vaccine development could only start once the pandemic began, as manufacturers would have to obtain the new pandemic strain. It would then be another six months before mass production of the vaccine," Osterholm wrote in an article published by Foreign Affairs magazine in October 2005.

Meanwhile, Kellerman says, many cities are ill-equipped to handle a sudden and large influx of patients. Many have emergency rooms that regularly divert ambulances -- even during optimal conditions -- because of overcrowding and lack of bed space, he said.

The national response plan estimates, based on extrapolations from the 1957 and 1968 pandemics, that there could be 9.6 million hospitalizations and 18 million to 42 million outpatient visits. Estimates based on the 1918 pandemic are substantially higher.

Kellerman also believes improvised shelters, which federal and state response plans call for, would not have the necessary resources. "People say we will make dormitories and hotels into hospitals, but we can't because of a lack of ventilators and other necessary equipment," he said. "A school isn't a hospital. It doesn't have oxygen lines, it doesn't have a lab, it doesn't have an X-ray suite."

Experts say quarantines will also likely be ineffective. "There has never been any evidence that you can quarantine effectively communities or regions against influenza," Osterholm told CNN. "This is a highly infectious virus. It's one that you actually can be infectious with before you get sick, and so, at the very most, if you tried to quarantine, you might just slow it down a little bit, but we really have no data."

'Pandemic preparedness'

Surveillance and containment are likely the most practical and plausible strategies currently available, public health officials say.

"The most effective way to protect the American population is to contain an outbreak beyond the borders of the United States. While we work to prevent a pandemic from reaching our shores, we recognize that slowing or limiting the spread of the outbreak is a more realistic outcome and can save many lives," according to the Department of Homeland Security's national strategy plan.

The federal plan calls for coordination with international organizations such as the World Health Organization and the Food and Agriculture Organization to isolate outbreaks. Domestically, surveillance networks overseen by the CDC are being counted on to monitor symptoms and detect an outbreak at the earliest point possible.

Health officials also hope to devise new ways of producing vaccine to increase speed and capacity, and to ramp up production of anti-viral agents like Tamiflu and Relenza.

President Bush, during a speech November 1, said he would ask Congress for $7.1 billion in emergency funding to prepare the country. Of that, $1.2 billion would go toward buying the current vaccine available for 20 million people and $2.8 billion for a "crash program" to accelerate the development of new technology to speed vaccine makers' ability. (Bush unveils plan)

The plan also calls for spending $1 billion to stockpile anti-viral drugs. Under the plan, the federal government intends to stockpile enough medication to treat 44 million people. State governments would be responsible for buying another 31 million courses.

Additionally, the plan seeks $583 million for "pandemic preparedness," that would include $100 million for state and local governments' emergency plans.

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