Community involvement key to fighting bird flu outbreak

Health department holds workshop on possibility of bird flu pandemic

Friday, Feb. 8, 2008

‘‘Resilient communities” would be the most important factor in combating a pandemic, or worldwide, influenza outbreak, presenters said at a workshop sponsored by the Calvert County Health Department, because supply and personnel shortages and social disruption could limit the effectiveness of outside aid to local residents.

The most likely contender for pandemic flu is the bird flu virus, also called avian flu or H5N1. So far, the only documented cases of bird flu in humans seem to have been caught directly from infected birds, but a mutation allowing human-to-human transmission of the virus could cause a devastating outbreak, said presenters at the Feb. 2 meeting at the Huntingtown Volunteer Fire Department.

‘‘There is a real expectation it will mutate so that human-to-human transmission becomes more likely,” said Daniel Stone, senior associate with a firm hired by the county to collect the input of citizens who attended the workshop. ‘‘It was considered a remote possibility at one time. That is no longer the case.”

Dr. David Rogers, head of the county health department, said that during a bird flu pandemic the county could see up to half of its population fall ill, with 5,000 to 10,000 dying within a period of several months, ‘‘if it’s anything like 1918.” Rogers was referring to the Spanish flu pandemic following World War I, which killed an estimated 50 million to 100 million people worldwide, more than both world wars combined.

Nor would the young and healthy be spared during a bird flu pandemic — during the 1918 pandemic, about half of the deaths were of young adults, perhaps in part because they were less likely to take public health precautions seriously, presenters said.

Other global flu outbreaks included the 1957 Asian flu, with about 70,000 U.S. dead and the 1968 Hong Kong flu, with about 34,000 U.S. dead. The next pandemic is ‘‘overdue,” said Judith Sturgis, a registered nurse who retired from Calvert Memorial Hospital at the end of 2007 but is still working on infection control projects.

Sturgis urged listeners not to expect the government to save them during a catastrophic outbreak, saying that federal government dysfunction during Hurricane Katrina in 2005 should be a wake-up call.

‘‘Katrina: That was a local emergency; this will be a global emergency,” Sturgis said

Flu can be transmitted through droplets of saliva or mucus or items contaminated with these secretions. Some measures to prevent infection are social distancing, or standing at least six feet away from others during an outbreak; avoiding crowds; keeping one’s hands away from one’s face; washing hands with soap; and cough etiquette, or coughing into the crook of one’s arm instead of the palm of the hand or the air, Sturgis said.

Calvert residents should also keep a stash of necessary medicine, food, emergency and other supplies to sustain them and their families during an emergency, she said.

‘‘Are there any pharmacists in the room?” Sturgis asked, then said ‘‘Good,” when no one raised his hand. She then explained that prescription medicines can be stockpiled by refilling prescriptions as soon as allowed by an insurance company, which could yield up to five extra pills at a time, she said.

However, it is necessary to rotate the medicine and food in the stockpiles to prevent them from expiring.

Also recommended is a battery- or crank-operated radio, a three-day supply of drinking water, over-the-counter fever medicines, hygiene and first-aid supplies. Residents should wear surgical masks in public or near infected people during an outbreak, and the infected should wear face-fitted respirators, Sturgis said.

Rogers seconded Sturgis’ advice on a backup supply of medicine but said he was not in favor of stockpiling food.

Another challenge is the flu’s long incubation period; a person could be infectious for seven to 17 days before showing symptoms, presenters said. They recommended that sick people — and those exposed to them — stay home from work or school to avoid exposing others.

Self-reliance will be important during a pandemic because help may not be available. Anti-viral drugs could be in short supply and a vaccine will probably not be available because the virus will be a new one; previous flu vaccinations will probably be ineffective for the same reason, presenters said.

Also, social chaos could limit the effectiveness of outside aid.

‘‘People are quick to respond to natural disasters but in case of infectious disease people are going to think about themselves first and how to get around that is one of the things that we are thinking about,” said Deborah Griffin of the Calvert County Health Department.

‘‘You can’t wait on the government. The government is not coming,” said Tom Parran, a St. Leonard resident and member of a Community Emergency Response Team.

Reflecting the trend of low concern about flu pandemic among the young, virtually none of the workshop participants were below the age of 24, with most above middle age. Workshop participants suggested remedies for this, including education about flu preparedness in public schools.

‘‘They’re doing most of the kissing, that’s for sure,” said participant Dale Yoe, a nurse at Calvert Memorial Hospital, of risks to the 15- to 24-year-old demographic.

To reach the public at large, participants favored government and media education campaigns to advertise the dangers.

It’s vital that ‘‘communities prepare so citizens can step up and do their own role even as government agencies do their part,” Stone said. ‘‘... It’s our belief this is one of the fundamental challenges facing our country and our world in the coming years.”

‘‘I think what citizens need to do for themselves should be in bigger print,” said Dr. David Denekas, medical director for Calvert’s emergency medical service. ‘‘I think we have a general feeling that somebody will rescue us. ... If health care service providers are wiped out by the flu, there’s no one to take care of sick people.”

Despite the devastation wrought by the 1918 epidemic, Rogers thinks its memory has faded because it did little material damage.

‘‘I think people rise to the occasion, and to go back to history, people seem to forget about what happened in 1918,” he said. ‘‘It didn’t really damage our infrastructure like Hurricane Katrina did. While it’s going to be horrendous while it’s happening, I think we’ll make a quick recovery.”

But that’s no reason to ignore the problem.

‘‘When Noah built the ark, it wasn’t raining,” Stone said.