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Northwest Prepares For Flu Pandemic

They say it's not if, but when. A worldwide influenza epidemic, a pandemic, is coming, and the Northwest may be poised to be the first target in the U.S. Bird flight patterns could bring the deadly avian flu virus from Asia, where most of the human cases have occurred, to our doorstep.

King County and Seattle have been touted as being better prepared for a flu epidemic than other cities. How are we preparing to deal with the sick and dying? What steps should be taken now? Earlier this year, public health officials and first-line healthcare professionals gathered at Harborview Medical Center in Seattle to discuss it.

These days, one can't watch TV or read the newspaper without hearing something about the avian flu. While some might think the reporting seems like hype, Seattle and King County have been quietly planning practical solutions for prevention, containment and public education in the case of a pandemic. At the Regional Pandemic Flu Conference, speakers included a local public health official, two scientists from the Centers for Disease Control and Prevention, administrators, doctors and nurses from Harborview and University of Washington. The main message is that the government, public health and healthcare-givers are working together to limit the casualties.

Worst case scenario: 1.2 million people would be sick with flu and 11,000 dead in King County in a six-week period. These computer model-generated figures were presented by Jeffrey Duchin, chief of communicable diseases of the public health department of Seattle and King County. Duchin outlined the responsibilities of the Public Health Department for rapid response in diagnosing, treating and containing an outbreak.

There wouldn't be enough hospital beds or respirators for all the predicted sick people in a flu pandemic, so some tough decisions would have to be made. This was one of the issues brought up at the conference by Chris Martin, administrative director of emergency services at Harborview. What makes Seattle different than other cities, she says, is the spirit of cooperation here. "All the [regional] hospitals have a huge commitment to the citizens." says Martin. Not only are all the hospitals in the area working together, the large outpatient clinics, such as the Polyclinic, are also involved.

If the estimated 35 percent infection rate proves true, there will be workplace shortages everywhere. People need to be prepared for the possibility of "no transportation, having to work from home, the potential of lost income, and no way to get cash," Duchin warns. Public education is key.

More than a year ago, King County Health Department started working with local businesses to make plans for such a disaster. Last year, the Seattle Mariners hosted a business forum. Sixty businesses showed up to talk with the King County Health Department about what needs to be done to minimize person to person contact, yet keep businesses open. Michael Loehr, director of preparedness of the King County Health Department, says some ideas are to use Plexiglas shields between customers and employees, as some banks already do, and to figure out ways to prevent people from having to wait in lines, such as more delivery of goods.

In the event of a true pandemic, some crowd-gathering places would have to shut down, such as stadiums and movie theaters, says Loehr. During the 1918 pandemic Seattle's mayor at the time, Ole Hanson, was castigated for doing just that, but his decision probably saved many lives.

What about schools? Loehr says the health department has also been working with them, setting up a checklist of guidelines based on those at the national level. Pamela Hillard, a nurse with the Health Education Office of the Seattle Public Schools says she's heard that the Risk Management Office is forming a plan and that her office will be the one to implement it once it reaches her.

Marcus Douglas, a science teacher at Challenger Alternative School in Spanaway, has added the avian flu virus to his lesson plan on infections. "I feel it is my responsibility to inform students to the fullest degree about the most recent scientific developments." he says. But so far he is the only one at his school discussing pandemic flu.

Are people worried enough? Martin says what she's heard "runs the gamut from people who worry about every new development to others who think the avian flu is a lot of hype." Her advice is not to ignore the warnings but it "needs to be balanced" with attention to other healthcare issues. Duchin says not worry, but more awareness by the general public is needed so everyone can be prepared for any type of general emergency.

Most of the human cases of avian flu stemmed from contact with chickens, which probably caught it from wild birds. So, chicken owners should be particularly cautious. Theo Smith is raising several hens in his backyard in Seattle's Ballard neighborhood. He is aware of the dangers of virus spread from migrating birds to domestic birds, and watches for wild birds in his yard. But, he says, he is "not going to be consumed by fear" as long as there are no cases in the US.

Karen Luetjen is the executive director at Seattle Tilth, a nonprofit organic and sustainable gardening organization. She says they are prepared for flu questions in their Chickens 101 classes. Since they are not flu virus experts, she refers people to the USDA website, which has advice for bird owners.

Timothy Dellit, assistant professor of medicine at Harborview, enlightened the conference audience on the biology of the avian flu strain of concern, called H5N1 for the two proteins found on its surface. The H, or hemagglutinin, protein is what the virus uses to attach to the surface of human cells, and is the major target of the immune system's antibodies. Humans have never been infected with the H5-type virus before, so our immune systems are completely na´ve to it. This is a major difference from the types of flu that come around every year. These viruses undergo small changes, or mutations, from year to year, which is why we need a new vaccine each winter.

There have been three flu pandemics in this century. The first and most serious was the Spanish flu of 1918, which killed 40 to 50 million people around the globe. The 1957 Asian flu and the 1968 Hong Kong flu were milder than the Spanish flu. In all of these pandemics, the virus carried a new H-protein.

The 1918 flu, an H1N1-type virus, was re-created a few years ago thanks to its preservation in a woman whose body was buried in the permafrost in Alaska. Now H1N1 is being studied extensively. Scientists want to find out why this particular virus was so deadly and able to spread from person to person so easily. "The scary thing is what we don't know" about the flu virus says Michael Katze, professor of microbiology at the University of Washington. He is part of a team that is testing pieces of the H1N1 flu virus to see which pieces played the biggest role in its spread and deadliness.

Researchers now know that like H5N1, H1N1 started as a bird virus, and, like H5N1, the human immune system had no previous experience with it. In animal model testing, H1N1 can be directly spread between animals, whereas H5N1 cannot. So far, the H5 protein is more adapted to infect birds than humans, and this is why almost every human infection with H5N1 has been through close contact with an infected bird. But H5N1 has proved to be more lethal with a 50 percent death rate, compared to H1N1's estimated two percent death rate. The virus RNA (like some other viruses, influenza uses RNA instead of DNA as its genetic code of life) can mutate easily. This is what worries the flu-watchers: a few mutations in the right places and H5N1 could be spread person to person, the route to a pandemic. New research shows H5N1 has already undergone mutations similar to H1N1.

Today's air travel could spread a human flu virus around the world in less than three months (in 1918, it took six to nine months). But today, says Duchin, we have better surveillance: scientists can monitor H5N1 in both wild and domestic birds and humans, Alaska is tracking and testing birds now; we have more sophisticated communications; we can study the genetic changes in the virus; and we have effective anti-flu drugs. History need not repeat itself.

The King County Public Health website has guidelines and a checklist for the public. Visit http://www.metrokc.gov/health/avian/index.htm

Kay Greeson is a Ph.D. student in Public Health Pathobiology at University of Washington.

Images

Top: Is Seattle ready for more than 400,000 people out sick with the flu? Photo: Kay Greeson

Middle: Seattle's bird owners should be wary of flu spreading to their flocks. Theo Smith and friend pose in their backyard. Photo: Kay Greeson


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