Portland Prepares for the Flu

The anniversary of Hurricane Katrina's landfall has brought the issue of emergency preparedness into the national spotlight. While hurricanes aren't a threat here in the Pacific Northwest, we nonetheless face a range of potential large-scale disasters, including volcanoes, floods, earthquakes and another sort of emergency that's on the minds of public health officials everywhere — an influenza pandemic.
"It's not a question of if we will have an influenza pandemic — it's a question of when," said Susan M. Allan, M.D., J.D., M.P.H., director of the state of Oregon's Public Health Division. "Some day there will be a pandemic."
Dealing with just such a pandemic was the subject of a statewide conference held last week at the Oregon Convention Center. Public health officials from the state, county and municipal levels, along with emergency response and law enforcement personnel, researchers and representatives of community health organizations met to discuss how they would work together in the event of a deadly flu outbreak.
The flu conference was a follow-up to another gathering earlier in the year that focused on broader strategies for dealing with public disasters, regardless of what particular form they might take.
When public health officials talk of an influenza pandemic, they're talking about an outbreak of a particularly virulent variety of the flu virus, one many people's immune systems won't be able to fight off. Such an outbreak is inevitable because the virus is constantly mutating and finding good places to reproduce — namely, the bodies of humans and other animals. Eventually, Allan said, a tough strain of the virus will evolve and get loose in human communities — who will then need a good plan in place to control its spread.
While the federal government has a role to play in helping communities prepare for a flu pandemic, that help at this time is mostly financial. The burden of organizing a response and — most importantly — delivering information to the public ahead of time, falls on state and local governments, Allan said. As preparedness for a flu outbreak becomes more of a priority, she said, the federal government's role should expand — finding ways to develop and produce doses of vaccine more quickly, for example — but for now, it's the lower levels of government that must take the lead.
"The responsibility for help and emergency preparedness falls to the states, and it's the locals who are actually there — they have the role of identifying symptoms and providing care," Allan said.
"Local organizations — hospitals, clinics, groups like the Red Cross — they're doing the brunt of the response."
But what exactly do governments do when there's a deadly outbreak of influenza? If there's a flood or an earthquake, the government can take immediate, physical action — evacuating citizens, reinforcing dikes and levees, administering immediate medical care.
But in the case of the flu, which leaves physical infrastructure intact, there's much less immediate action that officials can take. This is compounded, Allan said, by the fact that the flu is caused by a virus and not a bacteria; it can't be knocked out by antibiotics. Vaccines are only limitedly effective, and drugs like Tamiflu aren't a guaranteed fix either, she said.
Looking to the government to provide drugs in the event of an outbreak is what many people would be inclined to do in a pandemic scenario, Allan said, but it's not the answer. Flu drugs don't work against all strains of the flu, and at best, they only lessen the duration of symptoms by about a day and a half.
"That's not a miracle cure," she said.
In fact, she said, most people with the flu don't need to go to a doctor or a hospital. All that health care workers can do for the flu is treat symptoms, which does nothing to control the disease's spread. It can actually spread more quickly if sick people start congregating in hospitals.
"What we have to prepare for is the uncertainty when a new disease comes up and we don't know what direction it's going," Allan said. "We have to mobilize to head it off."
The challenge for local governments, then, is not handing out massive amounts of drugs or vaccines, but getting information out to the public ahead of time. The most effective defenses against a flu pandemic, Allan said, are knowledge and a good plan.
Before you panic, consider this — the precautions that are most likely to help you in the event of a flu pandemic are the same as those that will help you when there's an ordinary strain of the flu going around: Wash your hands, stay away from those who have symptoms, isolate yourself if you have symptoms, cover your mouth when you cough or sneeze, drink plenty of water and eat good, nourishing foods, Allan said.
"These things work with the regular flu, too," she added. "Roughly 36,000 people a year die in the United States from the regular flu. … A pandemic is different only in the extent of the penetration — the number of people who come down with severe symptoms."
And you can help safeguard your family by taking the same steps you would to prepare for other kinds of emergencies, she said. Prepare yourself for an extended stay in your home by stocking up on water and nonperishable foods.
"Some of things that people can do that are really powerful sound so simple that people might not believe how powerful they are," she said.
"We are trying to get business and schools and the general public to realize that if they are sick, they should stay home," she said. "They should not go to work, they should not go to school, they should not got to the grocery store. If they're sick, they should not share that disease with others."
This is easier said than done, she said. The conventional wisdom says that the responsible thing to do is to go to work or to school if at all possible. But in the case of the flu, Allan said, the responsible thing is to stay home.
"We need to change that culture that says we should go to work no matter what," she said. "It's irresponsible not to stay home when you're sick."
The job of local governments in such a situation, she added, is to form response teams that can visit homebound people and make sure they have food, water and medicine for their existing conditions — something that was addressed at the convention. In addition to checking on people's condition, the teams could also assess how the virus is spreading through the population.
So where do we stand in terms of flu preparedness?
"There's no measure of 'prepared' in an absolute standard," Allan said. "We're more prepared this year than we were last year, and next year we'll be more prepared than we are next year."
Ultimately, the public will be better served in a flu pandemic by preparedness and common sense than by massive government intervention, Allan said. Like any emergency, a flu pandemic requires citizens to be calm, informed and ready. Education and information are the greatest weapons.
"And chicken soup," she added.