California Avian Flu Plan Thinks 'The Unthinkable'

If an avian flu pandemic sweeps through the state, health authorities would consider quarantines, school closures and encouraging people to avoid mass transit and public gatherings.

Should a pandemic develop, it could last as long as two years and kill 35,000 Californians, state health officials said Wednesday as they released the state's draft avian flu plan. The state proposes spending $2 million now to stockpile 270,000 treatments of Tamiflu, an antiviral drug that eases the disease's symptoms.

"The biggest challenge is getting people to think the unthinkable," said Sandra Shewry, director of the California Department of Health Services.

No one knows if the avian flu, which first infected humans in 1997 in Hong Kong, will reach the United States and if the virus will mutate enough so that it is easily transmitted among humans.

The H5N1 strain of avian flu has been detected in domestic and wild birds across Southeast Asia. Reports of isolated outbreaks have come from Romania, Russia and Turkey.

At least 60 people have died. Most victims became infected through close contact with birds.

Despite the small number of infections, health officials worry because the strain appears to be particularly virulent and since it is new, no one has developed immunity.

"It causes severe illness and high mortality rates," said Dr. Mark Horton, the state's public health officer.

If the virus mutates, health leaders say they fear it could lead to a pandemic or worldwide outbreak similar to the 1918 Spanish influenza, which killed 40 million people.

The state's influenza plan notes that as many as 35 percent of California residents could become ill during a pandemic and 35,000 might die. It assumes the epidemic would come in waves and could last 18 to 24 months.

"This level of disease activity would disrupt all aspects of society and severely affect the economy," the report states.

Gov. Arnold Schwarzenegger has proposed spending $60 million next year to enhance the state's readiness for avian influenza and a natural disaster.

The California plan dovetails with President Bush's $7.1 billion avian flu proposal unveiled in November. It calls for stockpiling antiviral medication and accelerating vaccine development.

Contra Costa County health leaders completed their first pandemic flu plan in September and are revising it, said public health director Dr. Wendel Brunner.

"The thing that is the biggest challenge is that if there is a flu pandemic, it will occur nationally, so resources from outside the county will not be available," Brunner said.

That makes planning for a pandemic much tougher than gearing up for an earthquake or outbreak of botulism, for example. In those cases, state and federal agencies could be counted on to rush in with resources.

Contra Costa has about 1,500 hospital beds available and that could be expanded by 10 percent to 20 percent, Brunner said, "but that wouldn't be adequate in a major flu pandemic."

Local leaders would probably set up emergency hospitals in school gymnasiums and other large buildings if health care facilities become overloaded, he said.

A shortage of health care workers would also be a major challenge. The state plan suggests expanding the permitted duties of paramedics, emergency medical technicians, nurses, dentists, veterinarians, podiatrists and pharmacists during such emergencies.

The best strategy, Brunner said, would be to quickly get vaccine to large numbers of people. Contra Costa could immunize all 1 million of its residents within a few weeks, he said.

Whether a vaccine will be available and in what quantities, remain big questions. Manufacturers are developing vaccines based on the existing virus. However, those vaccines may not be effective once the virus mutates. Because vaccine production is a lengthy, cumbersome process, Bush has proposed spending $2.8 billion to develop quicker technologies.