Planning for a pandemic

Hospitals overrun with patients. Highway off-ramps closed to cut off infected urbanites fleeing their cities. Health officials quarantining families, while armed guards speed to the capital to make sure medicines make it home.

Sound like something out of a movie? Well, it could be—Hollywood has told epidemic tales before, from The Andromeda Strain to The Stand to Outbreak.

This is not from a script, however. It’s from the strategic planning of Scott Gruendl, Chico’s mayor and Glenn County’s health services director.

“What I lose sleep over right now is not the city plaza or Bidwell Ranch,” Gruendl said in an interview far removed from Chico politics. “It’s avian flu and West Nile virus.”

West Nile may be the more immediate concern, but influenza is the more serious. Pandemic flu last struck in 1918, killing more than 20 million people worldwide; we’re due again, based on our once-a-century pattern. Avian flu has garnered global media attention, as well as the scrutiny of health officials concerned about its potential virulence.

Gruendl is particularly concerned. To him, this is not a Y2K scare. Pandemic flu will happen, later if not sooner.

“My best guess is around 2008 we’ll have to take action,” he said. “Right now we’re planning.”

As are counterparts in Butte County’s Public Health Department and at local hospitals. Even if they don’t match his zeal or echo his timetable, they are making sure measures are in place when a pandemic—or another disaster—strikes.

“I wish I had a crystal ball for pandemic flu,” said Dr. Mark Lundberg, Butte County’s health officer. “I think right now we’re a long ways away from it. I’m trying to plan for the worst and hope for the best.”

That is the approach hospitals are taking, fitting pandemic preparations in with overall disaster plans.

Enloe Medical Center has conducted drills under HEICS—the Hospital Emergency Incident Command System. “We’ve learned from Katrina, we’ve learned from 9-11 the importance of communicating and coordinating and having that command structure in place,” said Bob Kiuttu, manager of EMS communications and disaster planning.

In the past eight months, the staff has simulated treating victims of an explosion and of exposure to hazardous materials. The response to flu would be similar, said Cheryl Richardson, Enloe’s environment-of-care manager; “just the people coming to the table would be different,” such as the World Health Organization and Centers for Disease Control.

Already, the hospital has received grants for additional equipment, such as ventilators, and to build its reserve of supplies. To accommodate overflows of patients, the hospital would convert space in some of its other facilities into treatment centers.

That “scalability” is the key to Oroville Hospital’s plans. President/CEO Bob Wentz said his hospital has 160,000 square feet and an adjacent office building at its disposal. Also in place are arrangements with suppliers, transport companies and refrigeration firms for food and medicine.

“It’s a long-term thing,” Wentz said, “not like an earthquake that hits and you recover from.”

Which brings us back to Gruendl and his sleepless nights.

Avian flu is particularly troubling because humans are not very resistant to its strains. Migratory birds are fairly resistant to it, and since the flu passes easily from bird to bird, it can spread over long distances—even continents, thanks to the intersection of American and Asian/European migrations in the Bering Strait of Alaska.

Cases of bird-to-human transmission are rare, and human-to-human transmission has not been documented. Viruses mutate, though. Health professionals believe it is just a matter of time before avian flu does become contagious, and that’s when we’ll have the makings of a pandemic.

Estimates of infection rates range from 30 percent to 50 percent. “Responders are in that group,” Gruendl said, and other local health officials agree there likely will be no vaccine to counter the flu at the outset. The illness is expected to incapacitate the afflicted for about 90 days with about a 15 percent mortality rate.

“In every disaster, you need more personnel than you have,” Gruendl said, “and here you’ll have one-third to one-half of what you usually have.”

Toward that end, Kiuttu said, emergency medical services in the North State are pooling resources to develop a medical reserve corps—retirees and health professionals not currently working in patient care but who could do so if needed.

They likely will be. Gruendl anticipated a pandemic will be “wave-like in arrival": striking for eight weeks, followed by a period of calm, then striking again. Hospitals will fill, putting surge plans to the test. He and other health officials will have to institute quarantines. Many people will isolate themselves—"social distancing” to avoid infection. That impulse will prompt people from the Bay Area and Sacramento to seek less densely populated areas such as ours; ergo, the idea of blocking exits off Interstate 5.

Gruendl has tabled the plan to send armed personnel to Sacramento; the California Highway Patrol will transport medication to counties. But the fact he even considered it shows how real the threat is to him. He says he and his deputy director spend about 15 percent of their time pandemic-planning, and he has a nurse dedicated full-time to preparations. Lundberg’s team in Butte County participates in many of the same state-run drills as Gruendl’s, including a recent “tabletop” on legal issues regarding isolation.

Still, said Dr. Roy Shannon of Oroville Internal Medicine, “if this pandemic occurs, not everything about it is going to be predictable. We’re going to be doing a lot of problem-solving on a day-to-day basis.”

So, in light of all this effort toward preparation, should we be reassured or terrified? Reassured, say the health professionals.

“Pandemic flu is far enough away from hitting that people can be interested in it, but there are other ways they can reduce their risk of death than worrying about it,” Lundberg said, exercise and diet among them. “There are positive things people can be doing to make a difference in their lives.”