Residents Expected To Be Self-Sufficient
By Brigid Schulte
Washington Post Staff Writer
Thursday, June 14, 2007
When Alexandrians opened their June FYI newsletter, out slipped a slick brochure with a photo of a stern-faced crowd staring out from the cover. "Be Ready, Alexandria!" the boldface type warned, "For a Pandemic Flu Outbreak."
The brochure is the latest in the city's 18-month-long effort to plan for a worst-case-scenario outbreak that could sicken as many as 1 in 4 in the city -- and around the world.
"We must take this risk very seriously," Mayor William D. Euille said in an interview. "If a pandemic were to occur, we are going to have a lot of people infected. People are going to die. Some people are going to have to be quarantined. Events are going to have to be canceled. Schools are going to have to be closed. It's a serious state of affairs.
"Rather than wait until something happens and be reactive, my position is to be proactive," he said.
So seriously have Euille and city leaders taken the threat of a flu pandemic that they have gathered representatives from government, business, hospitals, churches, nonprofit groups and other organizations for meetings. They have been meeting since November 2005 to figure out how to respond to an outbreak. Eight work groups are considering such matters as how government would continue to function, where emergency health stations could be set up, how to keep the supply of groceries flowing and, most soberly, finding warehouse space for bodies should fatalities overwhelm local mortuaries.
The mayor had his first flu pandemic town hall meeting on May 30 -- planned well after the flu season so as not to panic residents -- to talk about the efforts and to encourage residents to come up with their own emergency plans. In recent months, the city has experimented with setting up an involuntary quarantine and held a court hearing of a mock appeal by closed-circuit television. Euille said he plans to release his finalized pandemic plan to the public in September.
The main message to residents is this: If the worst happens, you have to be able to fend for yourself. Wash your hands. Stay home if you have flu symptoms, unless the situation becomes dire. Don't expect grocery stores to have as much food as usual or restaurants to be serving. Have medicines and a supply of water and canned and dry food on hand.
"People are going to need to do some of this themselves," said John Clizbe, emergency planner for the city's Health Department. "There isn't anything that the government or the private sector can do to assure people that everything is going to be like it normally is, because it won't be.
"The important message in that brochure is, people need to start thinking how they are going to be accountable for some of their own health care," he said. "There are things people are going to have to do differently if a pandemic comes."
There were three major flu pandemics in the 20th century, including the 1918 Spanish flu that killed 20 million to 40 million people worldwide in less than two years. An estimated 20 percent of the world's population was affected by the virus. The 1957-58 Asian flu and the 1968-69 Hong Kong flu each caused an estimated 4 million deaths worldwide.
Public health officials have been warning for years that another pandemic is not only possible but also likely. "It's just a matter of time," said Mark Penn, Alexandria's emergency management coordinator.
The genetic makeup of the common flu virus "drifts" and mutates every year, making it hard for researchers to predict the change and devise an effective vaccine from year to year. But once in a while, that genetic drift becomes a radical shift, officials explained, and a new virus is born to which humans have no immunity. That's what makes a pandemic so deadly.
When a new deadly flu virus, H5N1, began appearing in 2003 in Asia and later in Europe, it was a different enough strain that public health officials became concerned. Governments around the globe began making plans to deal with that avian flu.
In 2005, the Bush administration announced the National Strategy for Pandemic Influenza, laying out the government's plans. The following May, the administration announced it was putting $7.1 billion into pandemic planning efforts at the federal, state and local levels. State health departments, including Virginia's, began putting plans together. Pandemic planning became a hot topic at the U.S. Conference of Mayors and the National League of Cities. Euille attended conferences on the topic.
There have been no reported cases of the avian flu in North America. The World Health Organization reports that since 2003, despite numerous fatal outbreaks in bird populations, there have been only 310 cases of avian flu in humans and 189 deaths. To date, the virus has spread largely by bird-to-human contact. It is not easily spread by the much more contagious human-to-human contact, officials said. But that can change as the virus mutates. Its symptoms are similar to the regular seasonal flu.
"I don't think we can assume that every pandemic is going to look like 1918," said Charles Konigsberg, Alexandria's health director. "On the other hand, we should plan in case it is."
In a geographically contained natural disaster, a city or region can call for help from other areas, but one of the biggest challenges with a fast-moving and contagious pandemic is that many people elsewhere will be sick, too. "We won't be able to say, 'We've got the flu here, so we'll get help from New York or Richmond,' " Konigsberg said, "because, at least for a while, everyone's going to be dealing with the same thing."
Alexandria's working groups are looking at mental health services and how government could continue to function if one quarter of city employees were sick. Another group is developing a priority system for who would be vaccinated first, should a vaccine be developed. (The first priorities: health-care workers, those with compromised immune systems, and people who provide essential services such as law enforcement and garbage collection.)
One group is studying how to effectively communicate before and during a pandemic. "There is that tone in our culture that encourages people to go to work if they're sick. People have the feeling that they're invaluable or are a martyr," Clizbe said. "One thing we're trying to encourage in our communication is: If you're sick, stay at home." And that goes for businesses and the expectations they communicate to employees as well, he said.
Another working group is studying how isolation and quarantines would work. How would a mandatory quarantine work? (It wouldn't, Clizbe said. At least not once the numbers became overwhelming or the deputies guarding the houses got sick.) And if people are quarantined voluntarily or are simply sick at home, a separate "mass care" group is looking at how to get food and supplies to them. "Alexandria is a city of 65,000 households," Clizbe said. "If 20 percent of them are sick at one time, you're talking about a huge problem."
One group has been looking at how the city would handle a surge of medical patients. They have identified several places, including some isolated school gymnasiums and recreation centers, where "community care stations" could be set up. They also have identified places where they could set up more intensive hospital-like equipment and services and room for additional patients. "I'm less concerned with finding space," Clizbe said. "The real problem will be to have enough staff."
The federal plan has called for beefing up local teams through the Medical Reserve Corps. Clizbe said Alexandria might be able to call upon them. "But frankly, that's why we're putting so much emphasis on people caring for their loved ones at home rather than depending on the health-care system," Clizbe said. "There isn't any surefire guarantee that we would have the health care that people are accustomed to getting."
A separate working group has been talking with morticians and ministers and putting together a "fatality management plan." They have identified "fatality surge spots" -- spaces for bodies in case the number of the dead overwhelms mortuary capacity -- and they are educating members about the rites and requirements of religions when it comes to the timing of burials.
Some government officials are setting an example for preparedness. Clizbe said he and his wife have a closet set aside with extra canned food, a can opener, medicine, a crank radio, flashlights and batteries. Konigsberg and his family have stockpiled tuna, beans and peanut butter. And Euille has a kit prepared with crackers, tuna, Spam, fruit, cereal, medicine and water. And, because even bottled water expires, he updates his stock regularly.
Euille said he is prepared for a severe storm, terrorist attack or pandemic. "All the essentials are the same," he said.
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