Influenza: Planning For a Coming Pandemic
D. Morris MD, MPH, Bemidji, MN
Member, Water Quality & Health Council
avian or bird influenza (H5N1) spreads throughout bird
populations across Asia and, recently, into Europe,
health and government officials are warning the public
of an impending pandemic that reaches beyond bird species
and into the global human population. The unthinkable
fact is that pandemic flu potentially threatens to kill
tens of millions of people around the world; disrupting
basic life services and causing a form of havoc in international
healthcare systems that none of us have witnessed or,
perhaps, can fully appreciate.
analysis will examine not only the threat of avian flu,
the general assumptions of a pandemic flu and how it
could affect our society, but also the necessity for
preparation by those businesses and institutions that
are critical for a successful response to this approaching
(Bird) and Pandemic Flu
flu (H5N1) has recently been discovered in Western European
nations and will undoubtedly make it way to Northern
America in the near term. The current avian flu strain
primarily infects poultry and other birds with devastating
effects. The virus has cost Asian countries billions
of dollars in the poultry industry. It has also proven
to be equally lethal to humans, with a 50% mortality
rate in individuals known to be infected with the H5N1
The U.S. Centers for Disease Control & Protection (CDC)
defines a flu pandemic as a "global outbreak of disease
that occurs when a new influenza A virus appears or
emerges in the human population, causing serious illness
and spreading easily from person to person." H5N1 presents
two of the three essential ingredients to produce a
worldwide influenza pandemic.
- H5N1 is a "novel virus" in that it has not previously
infected humans. Unlike seasonal flu where most individuals
have some degree of immunity, there is no immunity
in the general public to the avian flu.
previously mentioned, H5N1 is an extremely aggressive
and lethal virus when it does infect humans. Of the
almost 200 known avian flu human infections, nearly
one half have been fatal.
third factor is for the virus to mutate just enough
so that it can be easily transmitted from human to human.
This meaningful shift has not happened yet. However,
if it does, H5N1 will no longer be an avian or bird
flu. Instead, it will be a human influenza capable of
infecting hundreds of millions of people around the
much as medical researchers, government officials and
healthcare practitioners around the globe would like
to know, no one knows for sure if the final mutation
will occur with H5N1 or not. However, what scientists
do know without a doubt is that a pandemic will occur.
Just as tsunamis and category 5 hurricanes occurred
in the past and have occurred again to devastating effect,
pandemics have been visited upon world populations before
and another will occur in the not-too-distant future.
have been 10 pandemics in the past 300 years of world
history. Three have occurred in the past 90 years. The
last two occurred within a relatively short timeframe,
1968 and 1957, and were considered mild, producing only
moderately elevated death rates in the U.S. The 1918
or "Spanish Flu" pandemic was far more devastating,
causing 500,000 deaths in this country alone and at
least 40 million deaths worldwide. While is uncertain
if the next pandemic will reach the severity of 1918,
it is imperative that all segments of society prepare
for when, not if, it occurs.
help plan a response, public health officials have developed
several key assumptions about the impacts of a possible
new flu pandemic. These assumptions are informed by
previous events, particularly the 1918 pandemic.
30% of Americans will become ill.
only moderate impact, 856,000 people will require
hospitalization over an 8-12 week period and there
will be over 200,000 deaths.
the pandemic equals the severity of 1918, there will
be 9.9 million U.S. hospitalizations and up to 2 million
officials will likely close schools, along with a
variety of other public places, and large gatherings
will be cancelled for several weeks.
will be encouraged to limit their exposure to others
and practice "social distancing".
business community can expect 25 to 30 percent of
its workforce to be absent from their jobs for weeks
at a time either from illness or caring for family
these conditions, businesses and governments would face
serious challenges in maintaining critical infrastructure
services, from providing healthcare to furnishing medications
to supplying food and safe drinking water.
Flu Planning and Response
in the U.S., President Bush has recently asked for and
received initial funding from Congress to modernize
flu vaccine development and stockpile antiviral medication.
While these efforts are good first steps, they are not
a solution to our pressing health care response needs.
It may take years to complete a timely pandemic flu
vaccine and the usefulness of antiviral drugs in dealing
with a pandemic is being debated in the medical community
due to established drug resistance by the virus. Public
health officials at the federal, state, and local government
levels are planning for community wide containment and
control measures such as group quarantine, work quarantine,
community-wide infection control measures and social
distancing practices such as "snow days", self-shielding
and closures of schools, public transportation, office
the business community is being asked to develop "continuity
of operations" plans for its critical services in the
face of a severe pandemic. One example of a critical
infrastructure issue is the key concern of clean drinking
water. The use of chlorine and the disinfection of water,
as well as other critical chemicals in our society,
will be as vitally important as ever during the course
of a pandemic. But the question remains: How will chlorine
and other critical products be transported and put into
operation with key skilled personnel unavailable?
this end, the federal government is asking the U.S.
business community to begin the planning process to
protect employees and maintain operations during a pandemic.
Keeping the systems up-and-running that keep the nation
up-and-running will be a matter of life and death for
many, whether infected with the virus or not. Attached
is a letter from the Secretaries of Homeland Security,
Health and Human Services, and Commerce asking for help
in the critical matter (Attachment
1). Also, attached is a downloadable checklist designed
for use by the business community to get started in
the planning and response process (Attachment
2 - PDF).
can't stop the inevitability of a pandemic. History
has proven this time and again. However, we can do what
other generations have not been able to do as well as
we can today: Prepare. It is our best, and in a larger
sense, our only true defense.
Quality & Health articles are published periodically
by the Water Quality & Health Council, an independent,
multidisciplinary group that promotes science based
practices and policies to enhance water quality and
health by advising industry, health professionals, policy
makers and the public.