A Pandemic Flu Primer	PDF

By Dr. Frank James, San Juan County Health Officer and Brendan Cowan, Director of the San Juan County/Friday Harbor Department of Emergency Management

Natural disasters were in the news in 2005. Tsunamis, hurricanes, and earthquakes dominated headlines, but the past year also saw the issue of avian flu on front pages and newscasts. In 2006, we're likely to see even more attention focused on the development of the disease and efforts to prepare. Given the onslaught of information, not all of which is accurate or consistent, we here in the islands are left with a logical question: "What does it mean for us locally?"

In order to help answer that concern, we've put together some frequently asked questions:

Q. What is the difference between avian flu and pandemic flu?

A. To put it simply, avian flu affects birds, and a pandemic flu would affect people. It is a bit more complicated than that, but the important thing to know is that just because birds are sick doesn't mean there is a health risk to humans. It is very likely that wild birds in San Juan County will be infected with avian flu someday. It is much more uncertain as to whether the avian flu virus will mutate to where it can easily spread from person to person and become a pandemic flu strain.

Q. Where can I learn more general information about flu pandemic and its chances of happening?

A. There are lots of good sources of info. Click on the "Pandemic Flu" link at www.sanjuandem.net for links to online resources, or contact the San Juan County Department of Health and Community Services at 378-4474. For info specific to the islands we've put together the questions below.

Q. What would a Pandemic mean for San Juan County ?

A. Predicting the results of a pandemic is as much art as science. We use past flu outbreaks (like the ones in 1918 and 1957) to guide us. Current thinking suggests that somewhere between 3,500 and 4,500 islanders would become infected. Of those sick, there could be up to 500 deaths, but perhaps 120 fatalities is a more realistic figure.

Pandemics typically come in two to three waves of active infection. Each wave would last six to eight weeks and would be repeated after an interim period of little or no disease in the community. All schools, daycares, and public gathering spots will likely be closed for the duration of each wave. During each active phase of the pandemic, upwards of 30% of the workforce is likely to be staying home, either because they are sick, are taking care of someone who is, or are caring for children who are out of school.

Because a pandemic will affect communities across the globe, food, fuel, access to mainland healthcare, and other services and supplies we've come to count on may be in short supply.

Q. What do I need to do to prepare?

A. As with all disasters, being able to keep you and your family warm, fed, hydrated, and supplied with vital medications is critical. If islanders are prepared individually, the islands will survive collectively. During a pandemic, power, water, and other essential services will likely continue without interruption, but access to food, fuel, and routine healthcare may be limited.

Having a supply of 3-5 "N-95" masks for each of your family members is a very inexpensive and simple step towards protecting yourself. Talk to your local pharmacist about how to obtain them, or look on the internet.

It makes sense to stockpile a supply of food. Build up a surplus, rotate through what you've stored, and make sure you replace what you use. In addition to weathering shortages, if you and your family can take care of yourselves from home without frequent trips out, you'll minimize your chances of interacting with contagious islanders. For info on what and how to stockpile, go to www.sanjuandem.net.

Perhaps the hardest but most critical step to prepare is to truly understand that in the event of a pandemic, the world will be a different place. Routine services will be limited and much that we take for granted in our regular lives will be unavailable or stopped. To survive the challenge will take preparation, patience, and perseverance. It won't be easy, and there will be no magic solution.

Q. What is SJ County doing to prepare?

A. Planning for a flu pandemic is a tremendous challenge for all levels of government. Here in the islands, the primary focus is on increasing awareness- first within public agencies, and then within the general public. Meetings and table-top exercises with community leaders, public health staff, emergency responders, and health care providers have been happening since late in 2004 and are continuing. As in all disasters, communication is critical, and as cooperation and understanding increases, our ability to respond improves.

The San Juan County Department of Health and Community Services has stockpiled enough face masks for roughly one third of the islands' population, but having a supply of masks for your family is a great idea.

Q. During a pandemic, how will residents be kept informed of the latest updates?

 A. Many of the systems we use now will continue to be used, only with much greater frequency. Local papers, online news sources, nearby mainland radio stations, and bulk mailings to every islander will all be part of the communication plan. Unlike other disasters, a pandemic flu will not result in large community "town meetings" or other gatherings, as the idea is to minimize the spread of the disease.

Q. If available, how will vaccines or medications for the flu be distributed?

 A. Under the current U.S. National Health and Human Services Plan little if any of the necessary medication would be coming to the San Juans. There are about 6 million courses of medication for the entire nation as of the end of 2005. To complicate matters further, resistance to that particular drug seems to be on the rise. In short, here in the islands we will likely be looking at taking care of our sick much like they did in 1918 (keeping the patient warm, hydrated, and cared for). The most critical of the ill will have access to special facilities set up on the islands, but most of the sick will need to be cared for at home by their families.

Our ability to create a vaccine is improving, but for now, it seems unlikely that vaccines will be available for the first wave of disease. Once available, vaccines will be distributed first to health care workers and other essential personnel, then to high-risk residents, and then to the general population.

Q. Why are we not stockpiling the antiviral medications locally?

 A. Antivirals are expensive, have a limited shelf life, and may prove ineffective. The tremendous expense of stockpiling antivirals is far beyond the scope of local government at this time. That said, Canada , and many European nations have adequate supplies (enough to treat 25-30% of the population), and it is hoped that the U.S. government will decide to follow this path in the coming year.

 Q. Can we isolate the islands early on and prevent the spread of disease here?

 A. This is an appealing idea, but impractical and perhaps illegal. People are contagious with the flu before they show symptoms, so it is impossible to screen arrivals to the islands. The logistics of restricting all arrivals would take more manpower than we have locally, and the reality is that in the past this type of isolation has been ineffective in stopping the spread of disease.

A more effective approach is to aggressively close public gatherings of all kinds, and to strongly encourage residents to stay home and minimize exposure.

Q. If I am sick, will I be confined to my house?

 A. People with fever and cough will be strongly encouraged to stay at home. A phone triage system will be established to evaluate whether a patient needs more advanced care.

Forced isolation could be used in the case of a contagious individual who purposefully put others at risk, but it will truly be in everyone's best interest to minimize their own exposure, and once sick to avoid spreading the illness to friends, co-workers, neighbors, and other islanders.

Q. This sounds scary, why aren't we more panicked?

A. Pandemics have happened throughout history at regular intervals, and while another one will inevitably occur, there's no guarantee of a pandemic in any given year. The risk is real, but it is just one of a number of remote dangers we face everyday. Like strapping on your seat belt, it is relatively easy for a family to take the steps needed to prepare, and once you've taken these steps you'll find a sense of comfort in knowing you've prepared as best you can.