County braces for bird flu

By: DAVE DOWNEY - Staff Writer | Monday, October 24, 2005 9:20 PM PDT ∞

If the worst fears of an avian flu pandemic are realized, Riverside County residents could find themselves wearing masks to work while their children stay home from school and their sick family members are treated by volunteers, the county's top health official said Monday.

Dr. Gary Feldman, county public health officer, made the comment on the eve of his scheduled delivery of a report on the avian flu threat to the Board of Supervisors today. The supervisors had requested the report to assess the threat and outline what the county would do if a pandemic were to occur.

For now, deaths from the disease have been confined to Southeast Asia, where 61 people have died from it, and it has yet to spread from human to human. However, the similarity between this strain and one that caused a deadly pandemic close to a century ago have sparked fears worldwide that another pandemic could be triggered.

When the so-called Spanish flu swept the world in 1918 and 1919, killing 20 million to 80 million people, masks were required in many areas of the United States, even though the thin material used at the time was useless for warding off the influenza virus. Feldman, in an interview, said modern masks are effective and could be an important tool for preventing the deadly disease's spread through the county, which has a population of nearly 2 million residents.

Another strategy that county health officials are weighing for containing a local outbreak is an order to close public schools. Feldman said that may be necessary because flu tends to spread faster among children than other segments of the population. Children are in close contact with each other, and they are less likely than adults to wash hands and cover mouths while coughing or sneezing, he said.

Containment would be a top priority, he said, as would treating those stricken by the disease.

Feldman said he is proposing that, in preparation for a pandemic, the county mobilize a large number of volunteers to attend to the sick and replace nurses, doctors and other health-care workers who would inevitably fall ill fighting the flu on the front lines.

"Just because you have a medical degree, that doesn't exempt you from biology," Feldman said.

Feldman said he would like to begin qualifying a pool of experienced volunteers who could quickly join health-care workers on the front lines. It would be better to qualify people ahead of time, rather than wait to see whether a pandemic occurs, he said.

"Trying to do it on the fly is not a great idea," Feldman said.

Even with an army of capable volunteers, he said, there may not be enough people to attend to all the sick, and there may be a need to relax rules for how many health-care workers are required. For example, in some hospital units, state licensing rules require that no more than five patients be treated by one nurse.

Besides not having enough people to treat the sick, the county would find itself short on medicine for treating them, because current technology for manufacturing vaccine is too slow to keep up with a pandemic, Feldman suggested.

"There will likely be long waits, triage and rationing of care," Feldman said in his board report. "There is a risk of civil disorder, especially if supplies of vaccine or antiviral medication must be rationed." He said officials are trying to figure out a way to fairly ration supplies.

At the same time, Feldman said he is recommending that the county not stockpile supplies of Tamiflu, the only medication known to be effective against avian flu.

Tamiflu is expensive, it has a short "shelf life" of about six months and there is no guarantee that it would even work against the strain of flu that may eventually crash onto the shores of the United States, Feldman said. And Tamiflu is effective only if it is given right after someone catches the flu, he said.

"It's not like somebody can get really sick, and you can give them Tamiflu and they will feel better," he said. "The point is, you have a fairly narrow window."

One key point of Feldman's scheduled presentation to the board is that a pandemic is a real possibility.

"The next flu pandemic is only a matter of time," Feldman said in his report. "H5N1 is a likely candidate."

H5N1 is the type of flu that has triggered poultry outbreaks in Southeast Asia in the last two years, and the strain has been confirmed recently in fowl in Russia, Romania and Turkey.

The flu virus has yet to develop the ability to mutate and rapidly spread from person to person. But health officials around the world fear that it may be only a matter of time before that happens.

"All the major flu pandemics have started with avian flu," Feldman said in the interview. "That is why we're so nervous."

There were three such pandemics in the last century. In 1957-58, the Asian flu killed 1 million people worldwide, and in 1968-69 the Hong Kong flu was responsible for 800,000 deaths.

As for 1918-19, when up to 80 million died, Feldman said no one knows how long the virus was around before it started to mutate and spread.

"What we do know is that, at the beginning of trans-Atlantic and trans-Pacific travel, it took 18 months or less to spread all around the world," he said. "It went everywhere, to places you would never think."

With worldwide jet travel, the spread would be much faster today.

"If avian flu acquires the ability to transmit from human to human, it will be everywhere in the world in a matter of days or weeks," Feldman said.

Contact staff writer Dave Downey at (951) 676-4315, Ext. 2616, or ddowney@californian.com.

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