Bird-FLU Pandemic Just 'Plane Ride Away'

WASHINGTON -- Every morning, a dozen or so staffers at the Tacoma-Pierce County Health Department get together to review records from hospital emergency rooms and ambulance calls from the previous 24 hours.

It's part of the department's surveillance effort to detect infectious diseases. Four ambulance calls overnight could be a sign of a meningitis outbreak. During the winter, a spike in flu-type cases could signal the outbreak of the flu season or that people were getting sick from eating a bad batch of cottage cheese.

And as health officials worldwide warn of a global outbreak of avian influenza, the department's early warning system could offer the first indication the disease has arrived locally.

"We are assuming there is a strong possibility in the near future there will be a flu pandemic," said Joby Winans, a spokeswoman for the health department. "If it's not this one, it will be another one."

Though avian flu has been confined to Asia so far, public health officials in Washington state are taking the threat seriously.

They're preparing for the worst even as the Bush administration has proposed cuts in federal funding for agencies already cash-strapped because of bioterrorism responsibilities in the wake of Sept. 11.

A recent study estimated more than 1.4 million people in Washington state could contract avian flu in a pandemic, with 48,600 requiring hospitalization. The flu could result in the deaths of almost 11,000 people in the state, according to the Trust for America's Health, a Washington, D.C.-based nonpartisan research group.

Nationwide, about a quarter of the U.S. population could be infected, 2.3 million people hospitalized and more than a half-million could die, the research group estimated.

"The warning signs that are lining up are extremely troublesome," said Shelley Hearne, the group's executive director.

Because it is a gateway to and from Asia, the Pacific Northwest could be one of the first regions in the United States affected.

More than 1,200 people arrive daily at Sea-Tac Airport from Asia.

Another 900 land in Portland and 4,000 more at Vancouver, B.C.

A steady stream of ships from the Far East calls at the ports of Tacoma and Seattle.

"It puts the area at a little higher level of risk," Hearne said. "It (avian flu) could be a plane ride away."

The West Coast also could be a gateway for the geese, ducks and other migrating birds that carry avian flu.

In Alaska, birds from Asia mingle with fowl that migrate up and down the Pacific Flyway. Field biologists there hope to take intestinal samples from 5,000 birds to check for the disease.

A similar effort is under way in California.

Due for a major outbreak

First detected in 1997, avian flu, or H5N1, has been found in birds and poultry in nine Asian countries. More than 100 people have been stricken by the disease and at least 60 have died. Tens of millions of birds have been destroyed in an effort to contain the disease.

So far, the disease has spread only to people who have come into contact with infected birds. There are no reported cases of the disease having spread human to human. But that could be just a matter of time.

"All it may take is someone to have avian flu and regular flu at the same time," said Hearne.

Epidemiologists predict a flu pandemic will emerge three or four times every 100 years.

During the past century, a pandemic of so-called Spanish flu killed 20 million to 40 million people worldwide in 1918-19.

Outbreaks of the Asian flu in 1957-58 and the Hong Kong flu in 1968-69 each killed more than 1 million people worldwide.

"Certainly we are due for a major flu outbreak," said Mary Selecky, secretary of the Washing- ton state Department of Health.

"It's absolutely prudent for state and local agencies to start planning."

Selecky said her department and local health agencies in the state had a jump-start on planning for a flu pandemic as a result of the SARS -- sudden acute respiratory syndrome -- scare in 2002.

Because of Washington state's location on the Pacific Rim, its potential per capita rate for SARS was considered one of the highest in the nation, she said.

Although there were suspected cases of SARS in the state, none was confirmed. But Selecky said it was a dry run for what could be expected if there were an outbreak of avian flu.

"We saw the potential for a pandemic needed to be a high priority," she said.

The state has a "robust" plan, updated continually, for dealing with a massive flu outbreak, Selecky said.

The state has run "tabletop exercises," including one with officials from Vancouver, B.C., to test its plan. It also is tightening its existing surveillance system, as early detection and containment are critical.

If a nightmare scenario unfolds, Selecky said, state and local public health officials could declare an emergency and close businesses, halt mass transit operations and cancel public events such as meetings and concerts.

"We could just tell a community to stay home," she said.

Fighting for federal funding

State officials have been talking to the business community, law enforcement agencies and local governments about what could happen.

They have launched a public education campaign about the need for "respiratory etiquette" and hygiene.

Hearne said Washington is better prepared than a lot of places.

"They have a good public health system, they have surveillance systems and they have hired some of the best and the brightest," she said.

Even so, the one thing Selecky said the state could use more of is federal funding. Selecky, who recently testified before Congress, said the administration has provided no additional funding to help public health agencies prepare for a flu pandemic.

Instead, the White House has said the agencies should use dollars earmarked for bioterrorism planning.

But Selecky said the administration has proposed cutting the bioterrorism funding by $130 million in the next fiscal year.

"Public health has been under-funded for decades," she said.

"We need more money to expand the system, not just piling things on."

Local health officials agree.

"It's a little scary," said Tacoma-Pierce County's Winans.

"We are already lean. We can staff 9 to 5, five days a week. But a flu pandemic would be 24/7."

She said a draft plan -- including contingencies for setting up 18 to 20 emergency clinics across the county and isolating people who might have the virus or quarantining those who have been exposed to it -- has been prepared in Tacoma and Pierce County,

"It's an ongoing discussion, almost daily," she said. "We write plans, we test them, we rewrite them.

"Are we thoroughly prepared? No. But we are far down the road." Editor Notes: (From McClatchy News Service, for use by New York Times News Service clients.)