County releases avian flu plan

By: GIG CONAUGHTON - Staff Writer | Saturday, October 29, 2005 11:41 PM PDT ∞

NORTH COUNTY ---- It's killing people in Asia, there are no vaccines ready and current medications don't affect it, but county of San Diego public health officials say they have a plan to help deal with avian flu if it shows up here.

The 223-page plan, which the county recently put up on its Web page, is short on details, such as closing schools or businesses, issuing masks for people to wear to prevent the deadly but still rare disease, or how to create more hospital space to treat the sick.

Instead the pandemic influenza plan establishes roles and responsibilities for local agencies, a chain of command, and a general guideline for how a response would be coordinated.

Avian flu ---- named because it almost exclusively attacks birds ---- is not currently a huge threat to people. Only 62 people in Asia have died from the disease since 2003. Human cases of infection are only in the low hundreds, and there have only been a few recorded cases of people passing the disease to other people, according to the World Health Organization.

But over the last two years, avian flu has spread like wildfire in bird populations from Asia into Europe, it has killed more than half the people who have contracted it, and it has been spread from human to human in rare cases.

That has led scientists, public health officials and most recently, U.S. politicians to publicly worry that the disease could become an out-of-control pandemic that could kill millions of people here and worldwide.

Having a readily available vaccine was identified in the report as the key medical response in any pandemic. Health officials in the United States and around the world are working feverishly to perfect an avian flu vaccine.

Dr. Nancy Bowen, San Diego County's public health officer, said there isn't a vaccine ready for production yet. And she said the county plan assumes there would not be one available until at least six months after a pandemic struck.

She said the county started working on its pandemic flu plan about a year ago.

Bowen said Friday that it is a "good plan," that lays out a logical sequence of steps the county would take to coordinate local hospitals, community clinics, law enforcement, the Red Cross and other agencies if a case of avian flu was discovered, and if the disease spread.

The steps would run from notifying state and federal officials to declaring a local emergency, to notifying the public. The plan also calls for a coordinated medical response to deal with the sick and prevent the disease from spreading.

But Bowen said the plan was only a first step and could be changed. She said other officials are now starting another plan to outline how local hospitals, agencies or governments would scare up more room for ill patients if a pandemic hit, whether that be in tents and cots or in hospital closets and administrative rooms.

And she said the county and local agencies are scheduled to spend much of the next year running training exercises to make sure everyone knows how the plan would work.

The plan

Generally speaking, Bowen said, if a local case of avian flu was detected, she would begin the process by immediately spreading the word throughout the health community.

Information would first go to the state and federal governments, in part to begin greater surveillance by laboratories, and then to all local hospitals, doctors, nurses, clinics and other health care workers. It would be transmitted through rapid electronic mail loops, radio and other communication systems that work around the clock.

From there, depending upon how many people could be affected, Bowen said, she and the county could open its Emergency Operations Center ---- the key command post in a regional emergency, according to the state department of health.

If the county center is opened, county Chief Administrative Officer Walt Ekard would become the "incident commander" for the pandemic, and would direct and coordinate emergency response with Bowen as chief consultant. Bowen said that she, Ekard and county supervisors would collectively make response decisions.

Working with the San Diego County Medical Society and other health experts, they also would be responsible for keeping the public informed about actions they could take to protect themselves and others, including telling them how and where medical supplies would be distributed.

Incident command

Under the state's emergency management system, the incident commander's agency becomes the one that takes responsibility for making decisions on how to respond.

Bowen said that is the case in disasters like wildfires and earthquakes, but could be slightly different in a medical response to a pandemic.

The National Centers for Disease Control and Prevention would be the lead federal agency, and would have all say over how any vaccine was delivered ---- if one were available.

Bowen said local officials would rely heavily upon advice from the CDC when making its decisions on how to respond ---- even though the county would legally maintain command.

"The local government is in charge," she said, "but there are legal responsibilities and guidance. Obviously they (CDC) have a lot of expertise, and can bring people together throughout the country."

In addition, if local health officials determine they can't come up with enough beds or medical supplies locally, the county would call in state health officials to bring in more supplies and mobilize state-operated Disaster Medical Assistance Teams comprised of doctors and nurses from around the state.

Bowen said county officials, emergency services officials from the county's 18 cities, hospitals, health officials and other agencies plan to meet throughout the year ---- to talk about the plan and to start putting it into practice in mock drills.

Meanwhile, questions about how massive quarantines or mass vaccination drives would be conducted remain to be answered.

"You clarify many of these (steps) with people when you train," Bowen said. "Drilling is going to be a big focus this year."

Contact staff writer Gig Conaughton at (760) 739-6696 or gconaughton@nctimes.com.