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The Honolulu Advertiser
Posted on: Sunday, January 1, 2006

Flu plan foresees 1,000 dead, roads closed

 •  PDF: State report on flu preparedness

By Kevin Dayton
Advertiser Big Island Bureau


  • How various agencies would coordinate during an outbreak.

  • How the disease would be tracked.

  • How vaccines and medicine would be distributed.

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    The state plan to cope with an influenza pandemic in Hawai'i paints a grim picture of the possibility of overwhelmed hospitals, 1,000 influenza deaths statewide in eight weeks, and hospital workers who become sick themselves trying to cope with the outbreak.

    The model the state used to estimate the impact of an influenza pandemic assumes one in four people statewide would become ill, and 5,000 would need to be hospitalized in an eight-week outbreak.

    The draft "Pandemic Influenza Preparedness and Response Plan" warns that the state's isolation may mean outside help will be slow to arrive, especially if the pandemic is sweeping Mainland states just as Hawai'i begins to suffer its effects.

    Of all of the hazards that could confront Hawai'i's hospitals, no threat is greater than the possibility of an influenza pandemic, according to an analysis by the state Department of Health.

    Dr. Linda Rosen, the department's deputy director for health resources administration, said the "million-dollar question" is how likely such a pandemic really is.

    "All we can say is there will be another infectious disease threat some time in the future," she said. "It's inevitable, given the history of the spread of disease through populations, but whether that's going to happen in six months or six years is really very difficult to predict.

    "I think everybody would agree that this type of planning, with a sense of urgency, is appropriate, because it could come sooner, and we want to be as prepared as we could be."

    Experts believe there would be one to six months between the identification of a novel influenza virus, and a widespread outbreak in the U.S. How dangerous a new pandemic might be would depend on how severe the virus is, how readily it passes from person to person, and how communities respond to the outbreak.

    The 1918 Spanish flu pandemic killed more people in the United States than all the wars of the 20th century combined, and the report notes the world is much more densely populated and interconnected now.


    The draft Hawai'i plan, which is pending final approval from state Health Director Chiyome Fukino, calls for the Health Department to stockpile and assume control over all antiviral medicines as an alert is issued or influenza virus first appears in animals.

    The plan is to distribute the drugs to provide the most benefit, vaccinating essential people such as high-risk medical personnel first. However, the report repeatedly observes there may not be an effective vaccine available during the pandemic, and it would likely take at least six to eight months from the time the virus is identified before any vaccine arrives.

    Anti-viral medications should be stockpiled in advance because that would be the most effective medicine available in the early stages of a pandemic, and exploding worldwide demand would mean the anti-virals probably would not be available after a pandemic alert, according to the plan.

    Gov. Linda Lingle last month announced plans to ask the Legislature for $15 million next session to stockpile antiviral drugs for 300,000 people, and for data management systems to track the effectiveness of the drugs during a pandemic.

    The pandemic plan calls for public health campaigns in the early phases of the alert to teach people about hygiene and use of masks if that becomes necessary, and to encourage people to plan for the possibility of quarantine.


    A state Health Department Operations Center would be activated as the first cases appear in humans, with hospitals and laboratories preparing their "surge capacity" to cope with expected additional patients.

    By then, the Health Department will have stepped up surveillance efforts to make sure experts understand who is getting sick, and where they are.

    As it becomes clear the virus is being transmitted between humans, the plan calls for quarantine and isolation efforts to try to stop the influenza spread. Quarantine can be declared by the state health director or the governor, and state Civil Defense would oversee those efforts with the help of law enforcement authorities.

    The plan sets out a progression of strategies to restrict the spread of the flu, starting with educational campaigns to remind people to limit travel and avoid public gatherings. If the epidemic spreads, authorities would take steps such as closing schools, limiting the use of private vehicles, stopping bus service and closing major highways to limit travel.


    Dr. Duane Gubler, director of the Asia-Pacific Institute of Tropical Medicine and Infectious Diseases at the University of Hawai'i's John A. Burns School of Medicine, said the state plan is a good one, but it needs money and support from other arms of the government, including the Legislature.

    "Do it, and do it right, and make it broad enough that it will protect us against all these exotic infectious agents that will be coming in on the airplanes that are so vital to our survival here," Gubler said.

    He said Hawai'i's vulnerability was underscored by a recent paper in the Proceedings of the National Academy of Sciences that ranked Honolulu among the top 25 central cities in the world in the global airport network.

    He praised the efforts of the Health Department in enlisting more doctors and other healthcare providers in state disease surveillance efforts to more rapidly report patients who may be suffering from new infectious diseases.

    Identifying a new pathogen early will be critical to containing the epidemic, and the money the state and federal government spend on preparation now will be worth it, he said.

    "The pandemic is only the latest threat. If you look at the last 25 years, we've seen this dramatic global re-emergence of infectious diseases, we have seen repeatedly the introduction of exotic diseases into the United States," Gubler said.


    One major fear is that Hawai'i hospitals, which in normal times have about 90 percent of their beds filled, would be utterly swamped in a pandemic.

    Toby Clairmont, emergency program manager for the Healthcare Association of Hawai'i, said $1 million in federal money is being used to stockpile equipment and hospital supplies on O'ahu and the Neighbor Islands this year and next to prepare for an infectious disease outbreak.

    By mid-July, the state hospitals will have adequate supplies to manage a pandemic, he said.

    That was possible because the effort to prepare for a pandemic dovetails with federal efforts to prepare Hawai'i hospitals for bioterrorism, and the federal government has been pumping $2.5 million a year for the past three years into training, communications equipment and supplies and exercises, Clairmont said.

    Over the past several years the hospitals developed a communications network so they can talk to each other, created teams to deploy crews from around the state to the site of emergencies, and ran training programs to prepare for emergencies.

    By the end of 2006, five mobile acute-care modules will be deployed around the state that can set up shop in public buildings such as shopping malls or an airport terminal, he said.


    A potential shortage of health-care professionals to care for patients is another cause for concern, with the response plan estimating up to 25 percent of healthcare workers would be ill in a pandemic.

    In January, the association will launch Na Lima Kako'o to sign up retired or inactive healthcare workers who would be willing to help during an emergency. The plan is to create medical "reserve corps" on O'ahu, Maui, the Big Island and Kaua'i, and train the volunteers in advance on how to help in a disaster.

    After the association has recruited people trained in medical fields, the program will recruit volunteers without medical training to fill roles in an emergency such as a pandemic, he said.


    One issue that troubles Clairmont is how the community would cope with a pandemic, which would drag on longer than abrupt disasters such as hurricanes. If people are required to stay home to avoid spreading infection, that raises concerns about how businesses function, and how people get the food and other goods they need to survive.

    Ed Teixeira, vice director of state Civil Defense, said those are among the issues his agency will try to address in an operations supplement civil defense will draft in 2006.

    A major issue is how the state would cope with interruptions in shipping, for example. "We're going to have major, major challenges in logistics," he said.

    Dr. Paul Effler, state epidemiologist with the Health Department, said plans are under way to convene a governor's advisory panel on a pandemic this month or next to bring together state and private officials involved in industries such as tourism, transportation and defense.

    Among other issues, the panel would look at how vital industries can continue to function in a sustained disaster that could last for weeks or months, he said.

    Reach Kevin Dayton at kdayton@honoluluadvertiser.com.