Planning for Flu

Pandemic preparation plans still don't deal with the central question: How will America's hospitals cope?

IN THE next few days, the federal government is expected to release another flu pandemic response plan, this one designed to guide the behavior of federal agencies in case of a disaster. According to a briefing given to Post staff writer Ceci Connolly, preparations include plans to print money abroad if U.S. mints cannot operate; to close cafeterias and cancel meetings; and even to define what, exactly, the federal government's basic functions are. Some agencies at the moment list as many as 400 "essential tasks" in their emergency plans, an unrealistically high number.

This is all very well, as far as it goes. But neither this plan nor any previous one has honestly confronted the central question of any pandemic: what to do with hundreds -- or hundreds of thousands -- of sick people. No one has produced an effective flu vaccine. Until someone does, any contagious flu virus -- or bioengineered virus -- will make many people ill. And neither America's hospitals nor any other part of the medical system is ready to deal with them.

True, there are plans for mobile medical units, and there have been rudimentary attempts to define and measure the nation's "surge capacity." But most of America's 5,000-odd hospitals are unprepared. Nearly half of the nation's emergency rooms report being at or over capacity; 80 percent of emergency doctors say their hospital is unprepared for an epidemic or terrorist disaster, and about a third of hospitals are losing money, meaning they can't invest in spare capacity. Yet models based on the 1918 flu pandemic show that a similarly infectious virus would require, by the fifth week, more than four times the number of existing hospital beds and more than double the number of existing ventilators.

More important than the shortages of equipment, though, is the shortage of medical staffers. In a pandemic it will be impossible to provide traditional hospital care to everyone. But even makeshift military field hospitals will require minimally trained staff. Health and Human Services Secretary Mike Leavitt has been traveling the country to warn states and cities, rightly, that they should be doing the hardest thinking about these shortages, but more federal input is needed. Congress and the White House should be improving and expanding the Disaster Medical Assistance Teams -- which were bogged down by logistical problems in the wake of Hurricane Katrina -- and possibly supporting a volunteer corps, including retired medical professionals or students, that could also help out as needed. Until this central question has been dealt with, almost all other federal government "preparations," however impressive-sounding, are of lesser importance.