What if a Flu Like 1918’s Broke Out Now? and Correction

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March 23, 2008 What if a Flu Like 1918's Broke Out Now?

By AVI SALZMAN Correction Appended

WHEN an outbreak of the Spanish flu spread worldwide in 1918, a doctor

in Newark advised his patients that they could cure their illness with

red onions and coffee. In Atlantic City, the authorities closed

amusement parks and theaters indefinitely. And in upstate New York,

public health officials distributed a poster warning people against

" careless spitting, coughing, sneezing. "

Those precautions had mixed results, and an estimated 675,000

Americans died during that outbreak, according to the Centers for

Disease Control and Prevention in Atlanta.

Today, New Jersey, Connecticut and New York are much more prepared

than they were 90 years ago in the event that an influenza outbreak

turns into a pandemic. But five years after an avian flu outbreak in

Asia made pandemic flu planning a priority, some experts are concerned

that states have not been equally vigilant about preparing, and as

attention and federal financing begin to decrease, they fear that

preparedness efforts will slacken.

" There is a worry that there was a lot more attention to the issue two

or three years ago, " said Hamburg, government relations

director for Trust for America's Health, a Washington-based nonprofit

health watchdog. " The fact is that it's still spreading. There are

still cases throughout the world. Preparedness is not a one-shot deal.

You don't know if this will hit this year, next year, five years, 10

years from now. "

Federal officials are tracking the flu worldwide, but it is up to

cities and states to prepare their own public health plans. So in

2002, when fears of a new pandemic began to escalate, the federal

government agreed to send the states billions of dollars to prepare

for a pandemic. The health and human services secretary, O.

Leavitt, warned states in 2005 that if they expected the federal

government to bail them out when a pandemic hit, they would be

" tragically wrong. "

Trust for America's Health released a report late last year examining

how states were preparing for public health emergencies. The report

graded the states on their efforts to protect against a pandemic.

Thirty-seven states scored 8 or higher on a scale of 1 to 10, and the

lowest score given to any state was 6.

In this region, Connecticut received a score of 8; the state lost

points for failing to buy enough antivirals and failing to use a

disease surveillance system that is compatible with the federal system

to track the progress of an outbreak as it moves across the country.

New York scored a 9 — for failing to increase public health financing

as quickly as inflation, though state officials said financing has

since risen — and New Jersey received a 10.

Pandemics occur when the flu virus mutates into a more deadly form and

begins to spread easily from person to person. Health officials are

worried about pandemic flu now because they fear the avian flu that

has spread to Asia and Europe could mutate into a more deadly and

transmissible form.

During the 1918 flu pandemic, which killed about 50 million worldwide,

the federal government did not ask states to report their flu tallies

until weeks or months after the disease had begun to spread. This time

around, the government has been tracking the flu for years.

And in 1918, scientists were unable to make an effective vaccine; in

an outbreak today, a vaccine could most likely be created within six

months.

Connecticut, New Jersey and New York expect to use two basic methods

to keep the flu under control before the vaccine is ready: antiviral

drugs and a kind of mass crowd control. The federal government has

bought 50 million courses of antiviral drugs that federal officials

said could limit the severity of flu infections and possibly serve to

protect uninfected people from the disease.

The Department of Health and Human Services has urged states to buy

antivirals through a discount program that offers a federal subsidy,

cutting the cost of a course of drugs (enough for one person) to $20

from $80, said Dr. F. Raub, science adviser to Secretary

Leavitt. The eventual goal is to have enough antiviral medication to

cover at least one-fourth of the population.

In the region, the states have taken different approaches to

stockpiling antivirals. Connecticut decided not to buy its full share

of antivirals, though it has bought about 11,000 courses with federal

money and sent a letter to the federal government indicating it wants

to buy 8,465 more. Even after including the 520,000 courses in the

federal stockpile designated for Connecticut, the state would still

have only enough antivirals for about one-sixth of its population.

Gerrish, a spokesman for the Connecticut Department of Public

Health, said state officials haven't put as much emphasis or money

into antivirals as other states because they have " limited utility and

limited shelf life. "

Indeed, federal officials are uncertain just how effective antivirals

would be in the event of a pandemic and whether they could serve some

prophylactic purpose. And because antivirals currently have a

five-year shelf life, states are spending millions of dollars on

medicine they may have to throw away in the next few years. But other

state officials said they weren't willing to take chances.

" If you had a novel strain causing a pandemic that was responsive to

antivirals and your state had no stockpile, I could predict that the

public would be pretty upset, " said Dr. Eddy Bresnitz, the state

epidemiologist in New Jersey, which has bought 850,000 of the 900,000

courses available under the federal cost-sharing program. He

acknowledged, however, that if the antivirals expire, " that's a lot of

dollars flushed down the drain. "

Similarly, New York has gone so far as to buy supplies of antiviral

medications that were initially designated for other states that

decided not to buy them.

The bulk of the planning, however, has focused on other methods to

keep people from getting sick during a pandemic, ranging from

surveillance to shutting down public gatherings and schools to

quarantining people who are exposed to the flu and isolating those who

have it.

The states have held drills for public health and safety workers to

determine what to do when the flu hits, and they have developed

increasingly sophisticated reporting systems that make doctors pick up

the telephone immediately after seeing signs of certain diseases.

New Jersey has been particularly diligent: the state compiles analyses

of school absenteeism and flu diagnoses each week and links to its

pandemic flu plans from the top of its Web site. The challenge, state

officials say, is keeping their plans current and local officials up

to date on flu preparedness.

Meanwhile, state officials said they have received less money for

outreach to local communities that they have done in the past.

Congress turned down the president's request for $870 million in this

year's budget for flu preparedness, and state officials said they

expected future grants to be much more competitive.

" It means the system is a little bit thinner, " said Dr. Gus Birkhead,

New York's deputy commissioner for public health.

This article has been revised to reflect the following correction:

Correction: March 30, 2008

Because of an editing error, an article last Sunday about preparations

for a flu pandemic included outdated rankings on

emergency-preparedness given to states last year by Trust for

America's Health, a Washington-based nonprofit health watchdog group.

Thirty-seven states scored 8 or higher on a scale of 1 to 10, and the

lowest score given to any state was 6. More than half the states did

not receive a score of 5 or lower last year. (Those rankings were from

a 2005 report.)

http://www.nytimes.com/2008/03/23/nyregion/nyregionspecial2/23rflu.html

Correction

What if a Flu Like 1918's Broke Out Now? Published: March 30, 2008

Because of an editing error, an article last Sunday about preparations

for a flu pandemic included outdated rankings on

emergency-preparedness given to states last year by Trust for

America's Health, a Washington-based nonprofit health watchdog group.

Thirty-seven states scored 8 or higher on a scale of 1 to 10, and the

lowest score given to any state was 6. More than half the states did

not receive a score of 5 or lower last year. (Those rankings were from

a 2005 report.)

http://www.nytimes.com/2008/03/30/nyregion/nyregionspecial2/30cxct.html