Wednesday, May 03, 2006
Pandemic plan not just for the birds
There is no question it is difficult to get people to pay attention to a "bird virus" that primarily exists on the other side of the world. Add in the fact that we can't say for sure whether this H5N1 virus will turn into a contagious human virus, and eyeballs tend to glaze over at its mere mention.

So, many people were probably surprised when the White House released a significant plan today to deal with a worst-case outbreak of the bird flu, where 2 million people might die, 50 million people might be infected and 40 percent of the workforce could be out of commission. The plan's price-tag: $7.1 billion.

This much is clear: We are not ready to handle the toll of a pandemic flu if it were to hit the United States tomorrow. Hospitals barely have enough intensive care beds and ventilators to care for the sick today, and if we suddenly had an additional 10 to 20 million critically ill people, hospital resources would be overwhelmed.

But from my reading of the White House plan, it looks like little of the $7.1 billion will go to expanding hospitals or other health centers. Most will be spent on stockpiling Tamiflu (an antiviral medication) and the production of vaccines, which would need to be changed if and when the virus mutates.

There are also plenty of recommendations for communities and states as to how they should begin programs of surveillance and preparation. But those recommendations aren't complete. For example, if someone arrives in Boston from Bangkok and is ill with flu-like symptoms, what would we do? Will there be an enforceable quarantine? Frankly, I am not sure how that will work in reality.

Despite these questions, the good news is the federal government is at least taking some concrete steps to prepare for an outbreak. As U.N. Secretary General Kofi Annan said recently: "We don't know if this will lead to a human pandemic, but we do know what a human pandemic is." Yes, we do.

It is estimated up to 50 million people died during the flu pandemic of 1918. With preparation, we can have some hope of avoiding a repeat of that deadly period in world history.
Posted By Dr. Sanjay Gupta, CNN Medical Correspondent: 5:42 PM ET
I am so glad this White House is focusing on a hypothetical doomsday scenario whilst avoiding the real one in Iraq. Forget Katrina, Iraq, Darfur, Iran, rising gas prices and others. Those are too real and bothersome. Let's focus on the bird flu because that is what everyone is worried about. Thank you Mr. President for looking out for our welfare. I'll make sure my friends and family stay away from crazy birds.
Posted By Anonymous Jennifer H. Richardson, Tx : 6:24 PM ET
You mentioned a big part of the problem, hospitals can barely manage as it is. Here in Arizona I fear the day when I have to take one of my children to an emergency room. They have become clinics. Over half of the people in our emergency rooms are there with problems they should be seeing their regular doctor for. The other part is widespread panic. Every year I watch hundreds of people wait in long lines for flu vaccines when they don't really need them. Instead of the very young and the elderly getting the vaccines they need; healthy men and women are getting them. At least someone is looking with foresight instead of hindsight.
Posted By Anonymous Melina - Mesa, AZ : 6:27 PM ET
Hi Dr. Gupta,
I remember a few years ago, when a big old Blue Jay Bird dropped dead right outside my kitchen window..It had the West Nile Virus..Now we have the bird flu..I hope this country will be able to help us all if we have an outbreak in humans..One can hope..But we can't live in fear of everything..I work with a huge amount of tourists from every country you could think of.. I must admit I've thought once or twice about how quickly we all could spread sickness so easily..Especially with all the Germ stories in the news..But we really can't live like that and so I'm glad you and other Drs. are trying to be prepared,thank you..But I think just for today, I'll try to just live my life and duck if I see falling birds..Thanks for your work..Take Care
Posted By Anonymous Lorie Ann, Buellton, Calif. : 6:36 PM ET
This story is really no laughing matter and I do appreciate Dr. Gupta's report - it was very informative.

However, I just hope this isn't another excuse for a barrage of fear-based, over-hyped, made for T.V. movies (I won't name the network). The same thing happened with Ebola, a legitimate concern, but Hollywood capitalized on people's fear and created a mild panic (I was a hand washing fanatic). So now I'm afraid were going to start seeing Alfred Hitchcock clips with bad animatronics on the news, you know just to add a bit of drama. If it gets that far - I'm turning off the T.V., grabbing my breathing apparatus and heading out to catch up on my bird-watching! I can only hope the vaccines are current!
Posted By Anonymous Lori Missoula, MT : 7:18 PM ET
If the H5N1 virus mutates into a contagious human virus, the precautions currently outlined in the National Strategy for Pandemic Influenza isn't going to make much of a difference.

For those infected, rapid medical treatment in a well staffed hospital is the best way to slow the progress of such a pandemic, and this plan does not take into account the need for more hospital care and the high volume of people who are going to be affected across the nation.
Posted By Anonymous Joseph Kowalski, North Huntingdon, PA : 7:20 PM ET
As has been said by scientists for decades, we need these diseases to ravage the world population. It culls out the weak in the gene pool, so that our population as a whole grows stronger. Maybe we should let nature take its natural organic, think wholestic, have a pandemic...all natural.
Posted By Anonymous Brant, Madison, Wisconsin : 7:25 PM ET
Flash cooked poultry on our shelfs at the markets could be one solution. Fry, bake or boil time would be cut to a few minutes and spoliation to a minimum.
Posted By Anonymous Dave Winfield Quincy, IL : 7:33 PM ET
I wish the government would spend that money on a real pandemic, AIDS, that is killing people everyday all over the world in huge numbers. Instead they spend it on a vaccine for a virus that will probably mutate and render the vaccine useless if it makes the jump to humans.

If the flu crosses over to us, a lot of people will die no matter how much vaccine we have, especially if the hospitals cannot effectively distribute and administer it.

Well, we all gotta go someday. It would certainly solve the overpopulation problem.
Posted By Anonymous Sarah, Baltimore, MD : 7:46 PM ET
Holy Cow!!!!

Can our elected White House officials complete anything these days?

We can't defend ourselves from terrorists, we're in no way prepared for hurricanes or earthquakes and now we aren't prepared for pandemic?

What are they DOING up there?
Posted By Anonymous Marisol, Aurora, Colorado : 8:06 PM ET
Oh Pleeez! Bird flu pandemic. Fresh out of the Whitehouse ANOTHER reason to be much afraid. Recommendation: Make sure the Katrina victims get the vaccines first!
Posted By Anonymous Debbi Maher-Pasadena, CA : 8:32 PM ET
Jennifer Richardson writes "I am so glad this White House is focusing on a hypothetical doomsday scenario whilst avoiding the real one in Iraq."

I strongly suspect that people with this point of view will be the first ones to blame President Bush if the U.S. is unprepared for a pandemic. While Iraq is a real issue, the possibility of a flu pandemic is also a real issue. There have been three pandemics in the last 100 years including the 1918 pandemic cited in Dr. Gupta's post. The next pandemic is a question of "when" not "if". Americans must continue to prepare for the pandemic when it arrives regardless if that occurs in one year or ten. Pretending this won't happen is a prescription for disaster.
Posted By Anonymous Steve Lynch, Colorado Springs, Colorado : 9:39 PM ET
The bird flu is a real problem, and the media keeps putting a spin on it, as always. People should actually read the plan that the men and women put so much effort into before they dismiss it as something that will never happen. The President is looking out for our welfare, because I'm sure as heck he doesn't want our country's population to drop several million. Think before you post a comment about "real" problems (Richardson). This is as big a threat as anything.
Posted By Anonymous Amy, Atlanta, GA : 10:00 PM ET
It seems too ironic that only last Thursday at an "industry" meeting, we discussed a meeting that apparently took place with the TSA and the Maritime Industry. And today, the White House plan for what will happen IF this situation turns into a Pandemic. I work at a Customs Brokers office in Virginia and we import freight and move it through Customs and Border Protecton, USDA and FDA among other government agencies. I find it odd that the TSA would be interested in our strategy to continue work should this flu become a Pandemic. We were advised that 40% of the Brokers, Dock Workers, Steamship line employees, Truckers, Port workers, Government Officers and Inspectors- everyone that has to do with the importing or exporting of freight into and out of this country - will catch the bird flu and of those 40% - half will die. Now, I am not an expert, but when the TSA is requiring a stratigic plan for how we will keep the businesses aflot and keep freight moving - and before an official announcement, it makes me think that this is more serious than what people are taking it as.

Yes, I empathize with people who say, what about Katrina, Iraq, Darfur, gas - etc.....However, unless you do the research and really look into what the bird flu is about and how it is spreading so rapidly, what good would this country be in if over a million of our own countrymen die when their deaths could have been prevented.

This being said, I personally won't live scared for what tomorrow may bring. There are so many evils in this world - unfortunately, most Americans don't look for good - they cling to what is negative and play the blame game.
Posted By Anonymous Rebekah, Norfolk, VA : 10:51 PM ET
"...and all the while, that sparrow was
getting in his little messages - Birds of the world, unite!"

Yours Truly,

Alfred Hitchcock
Posted By Anonymous Chris, San Diego, CA : 12:07 AM ET
The migration of H5N1 to the United States and its potential for human to human transmission is as inevitable as an earthquake rupturing on the San Andreas Fault. Its impact will depend on population density or in the flu's case - how efficiently it transmits from human to human.
This is not a case of "Chicken Little" and I am glad the government is spending money proactively to educate the public and those who will need this plan in advance of its arrival.
If only such a plan was in place for Katrina - but to the government's credit, this may well be an example of how we learn and evolve from our previous mistakes.
The thing is - if we are successful in staving off the severity of this pandemic - the masses might say it was a waste of money, all this proactivism. Prevention is boring news - but I would rather be bored than sick.
Thanks much to the CDC and all who worked for this master plan. I would rather our money be spent on our national and individual health. If I am paying taxes, then this is instant gratification back to me as an individual.
Posted By Anonymous Corinne Falicia, Los Angeles, Ca : 12:09 AM ET
This would all be much easier to handle if we had socialized medicine.
There would only be a slight increase in taxes because taxpayers already pay taxes for medicare and medicaid. With socialiced medicine those programs would be eradicated and the money would go towards health care for everyone. At least, Hospitals would have more beds and ventillators and be better prepared for such a case as Bird flu.
Posted By Anonymous Vanessa C., Canby Oregon : 1:10 AM ET
With no disrespect intended to you or your blog, Dr. Gupta, I believe that the increased talk and provisions being made for a bird flu pandemic in the United States simply replaces George W. Bush's terror alerts, which people have caught onto. Bush is simply looking for a new way to terrorize his subjects.
Posted By Anonymous Gypsy, Mexico : 2:56 AM ET
Where can one find the text of this 'significant plan' and is the federal government proceding with an effort to co-ordinate treatment proactively with the various state and local agencies? It's bad enough that FEMA and the rest of our emergency response system dropped the ball for the folks in the Gulf. How can they ignore or take a 'wait-and-see' attitude when even the possibility of this pandemic is likely? Pathetic that the animal most Americans and many legislators seem to mimic in these situations is the ostrich, a BIRD!
Posted By Anonymous Dan Lieberman - Wildomar, CA : 3:34 AM ET
Can't you people see that our gov't could be casting fear on the people by putting out all this retoric about diseases? Next thing they will do is declare Marshall Law and start quarentineing those who dissent. What do you think all the internment camps are being built for? Not for disease. They are trying to build the new Rome!
Posted By Anonymous Kenneth Laster, Soddy-Daisy, Tn. : 4:40 AM ET
It is good to see something good coming out of the White House (for a change). This makes me wonder if there is an angle or not. I don't know enough about medicine to tell what percentage a doomsday scenario is likely, but I do know that the rising population increases that percentage. Maybe preventative measures should be considered such as working to kill the virus outside of America's borders.
Posted By Anonymous W. Thomas, Phoenix : 4:51 AM ET
I've seen alot of talk about what if this and what if that, but I've seen NO action taken in prevention or preplanning. Yes they made a worst case scenerio, but have they done anything yet? To the nation's knowledge, no they haven't. They need to stop talking and take action, by the time they waste all these dollars talking about it, it will be at our backdoor. When do they intend to take action and stop trying to panic us when it is not here and do something about it before it does get here?
Posted By Anonymous AM Angola, IN : 7:03 AM ET
My eyes don't glaze over about the bird flu. In fact, I read everything I can on this. But the fact is I am utterly and totally powerless. There is absolutely nothing I can do to "prepare" for it. I'm determined to survive it along with my family, but tell me, what can I do? Wash my hands often? That's about the only concrete recommendation offered to individuals so far. Funny how it feels grossly inadequate.
Posted By Anonymous Brigitte M. Montreal Canada : 7:13 AM ET
Regardless if it's the bird flu or any number of other senarios, it never hurts to be a little prepared for something to happen. No one is going to look out for your family but you. Therefore, I think it is an excellent idea for people to have a 30-60 day supply of food, water and medications on hand. I don't look at it as some kind of "scare tactic", I look at it as preparation for a "any case" senario.
Posted By Anonymous Tammy- Lynchburg, Virginia : 7:59 AM ET
Dr Gupta,

In Canada, more specifically Toronto, there are pandemic plans for the hospital system. This has probably happened in no small part because of the SARS outbreak here some years ago. However the consensus in the medical community seems to be not whether, but when. A pandemic is due, and we are probably watching it take shape.

It is interesting that Tamiflu may be stockpiled in the USA, because I have heard it may not be effective if the virus mutates. I suppose there is a lot of contrary opinion to these thoughts, and I hope I'm wrong.
Posted By Anonymous Don Cooper Toronto Canada : 8:52 AM ET
Jennifer H. from Richardson, Tx said (sarcastically) that she was glad "this White House is focusing on a hypothetical doomsday scenario whilst ... Forget(ing) Katrina."

Let's go back one year ago and imagine the White House had released a detailed plan for dealing with the "hypothetical doomsday scenario" of a category 5 hurricane scoring a direct hit on New Orleans. Wouldn't we all be a lot better off right now?

What's that old scout motto? Be Prepared?
Posted By Anonymous Sharon, Indianapolis, IN. : 10:03 AM ET
After all the falderall and studies, I'm surprised "duct tape and plastic" didn't end up being the recommendation. If it can save us from chemical attacks, why not a silly flue virus?
Posted By Anonymous greg morra, new hartford, new york : 10:09 AM ET
I'm an emergency management student, and I can tell you that this is not a question of IF, but WHEN. We need to be prepared for this, just like we would be prepared for a hurricane, or a terrorist attack. We are so far behind right now, it's scary. Physicians and EM officials are doing their best, but it will take awhile. I can only hope that human-to-human transmissability will take a very long time to happen. Thanks for bringing attention to this.
Posted By Anonymous L.S., Bloomington, MN : 10:35 AM ET
I don't understand the math in the worst case scenario. Currently 113 people have died out of 205 infected. Our government is estimating that 40 million people may be infected but only 2 million people would die. That is only 5%, much lower predicted deaths than the greater than 50% of deaths that have already occurred. Does the government know something about treatment we don't know? 50 million people died in the 1918 pandemic. Why would there be less deaths with this pandemic?
Posted By Anonymous Lizabeth Hassel, Novi, MI : 11:08 AM ET
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