THERE was the killer asteroid scare that spawned two big-budget 1998 movies. Anxiety about SARS in Canada led to a movie-of-the-week last summer. And this week, the Bush administration is expected to release its pandemic flu plan, which could generate its own movie epic.
The New York Times obtained a draft of the plan, dated Sept. 30. No one would confuse the 381-page document with a screenplay, but pages 45 through 47, the section titled "Pandemic Scenario - Origin and Initial Spread," are gripping. They describe a flu epidemic moving from a village in Asia to the United States, where it causes panic and as many as 1.9 million deaths.
The plan's writers might have been inspired by John M. Barry's hair-raising history of the 1918 flu epidemic, "The Great Influenza," which President Bush, in an Oct. 5 press conference, said he had recently read. After criticism of his response to Hurricane Katrina, Mr. Bush, who said he was taking the risks of a pandemic "very seriously," has been eager to show that his administration is aggressively preparing for it. Top health officials, including Michael O. Leavitt, the secretary of health and human services, spent last week in Asia discussing avian flu preparations. On Friday, Mr. Leavitt called the newly confirmed spread of the disease to Turkey a "troubling sign." The administration is expected to ask Congress this week for $7.1 billion to respond to the threat.
Is a flu pandemic likely in the next few years? No one knows. The deadly H5N1 strain of avian flu does not currently spread from person to person, but the government's vision of what a pandemic would look like is grimly compelling. Excerpts from the document follow.
Act I: Illness Strikes a Village
In April of the current year, an outbreak of severe respiratory illness is identified in a small village in a country known to have experienced recent avian influenza disease. At least 25 cases have occurred, affecting all age groups. Several household clusters with infection of multiple family members are identified. Twenty patients have required hospitalization at the local provincial hospital, five of whom have died....
Specimens collected from several patients are sent to the World Health Organization ... and the Centers for Disease Control. C.D.C. determines that the isolates are of the avian subtype ... but that the viral genome had undergone changes consistent with an increased ability to spread between people.
The novel influenza virus begins to make headlines in every major newspaper and becomes the lead story on major news networks. Key United States government officials are briefed on a daily basis and surveillance is intensified throughout many countries....
The National Institutes of Health studies whether a vaccine developed against the avian viral strains provides some protection against the pandemic virus; and influenza manufacturers are placed on alert. Laboratory studies suggest that the vaccine developed previously for the avian strain will only provide partial protection against the new virus.
Over the next weeks, the W.H.O., with assistance from the United States and other governments, attempts to contain the outbreak but new cases continue to occur and to spread to neighboring countries.... Cases are reported in all age groups and case-fatality rates range from 2 percent to 15 percent, depending on the quality of medical care provided. Travel restrictions... are implemented at borders and quarantine stations.
Act II: An Airport in America
In late June, the C.D.C. reports that the virus has been isolated from ill airline passengers arriving in four major United States cities.... Vaccine manufacturers are requested to shift vaccine production from annual to pandemic vaccine.
In July, small focal outbreaks begin to be reported throughout the United States. The first doses of a new pandemic vaccine become available in September. Despite full-scale production by manufacturers, supply remains very limited.... Community-wide outbreaks begin to occur more frequently as children return to school, and by late August, outbreaks are occurring simultaneously throughout the country....
Overall, about 2 percent of Americans with influenza illness die. In communities during the peak weeks of ... outbreaks, about a quarter of workers are absent because of illness, the need to care for ill relatives and fear of becoming infected.
Hospitals are overwhelmed and staff shortages limit capacity. Intensive care units at local hospitals are unable to provide care for all who need it, and there are shortages of mechanical ventilators for treatment of patients with severe pneumonia. Makeshift hospitals established in schools and armories care for those who are unable to be treated in regular hospitals....
Act III: The Pandemic Rages
During the peak of disease activity in the community, police, fire and transportation services are limited by personnel shortages, and absenteeism at utility companies leads to spot power outages. Supplies of food, fuel and medical supplies are disrupted as truck drivers become ill or stay home from work.
In some areas, grocery store shelves are empty and social unrest occurs. Long lines form where food and gasoline are available. Elderly patients with chronic, unstable medical conditions hesitate to leave their homes for fear of becoming seriously ill with influenza.
Riots occur at some vaccination clinics as people are turned away or supplies run out. Several trucks transporting vaccine are hijacked, and a gray market develops for vaccine and antiviral drugs - many of which are counterfeit.
Pig herds acquire infection with the pandemic virus and are decimated; large numbers of workers in those settings become ill.
Family members are distraught and outraged when loved ones die within a matter of a few days. Public anxiety heightens mistrust of government, diminishing compliance with public health advisories. "Worried well" seek medical care despite their absence of influenza illness, further burdening the health care system.
Mortuaries and funeral homes are overwhelmed.
Epilogue
The peak of cases occurs in mid-October. By early December, virtually all communities have experienced outbreaks and sporadic cases continue to occur. A second influenza disease wave begins in later January and peaks about a month later.
Although vaccine production and vaccination have been ongoing between disease waves, the majority of people still have not been vaccinated at the time of the second wave, and antiviral drugs, for which stockpiles were exhausted during the first wave of disease, are available in very limited quantities.
'Is Tamiflu A Prescription For Survival?'
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