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Governors Differ On Flu Response
Md. Releases Details; Va. Is Cautious

By Ashley Halsey III and Anita Kumar
Washington Post Staff Writers
Saturday, May 2, 2009

When they awoke Monday to the increasing reality of a swine flu pandemic, top officials on either side of the Potomac chose virtually identical words to reassure the worried public.

"We've been planning for a situation like this for many years," said Virginia Gov. Timothy M. Kaine (D).

"We've been planning for this for years and years," said Maryland Health Secretary John M. Colmers.

In the days that followed, it became clear that the years of preparation had produced two very different plans.

Maryland officials unleashed a tsunami of information, paraded out agency heads and experts each day, and made spokesmen available to provide all but the most revealing personal details about the first victims.

Virginia took a more cautious approach, sharing only the information deemed necessary to protect public health.

After a week in which 50 states implemented 50 slightly different plans for handling the crisis, the agency with responsibility for all of them, the federal Centers for Disease Control and Prevention, summoned all the governors to a telephone conference call yesterday.

"They upgraded and changed their initial guidelines," said Maryland Gov. Martin O'Malley (D). "This situation will evolve as the science evolves, and the guidelines need to evolve with it."

Tactics for disseminating information to the public during a moment of crisis has been developed into a fine art since the terrorist attacks on the World Trade Center and Pentagon nearly eight years ago. State and federal agencies have prepared and tested plans to spread necessary information and contain panic under all sorts of scenarios, including the likes of a biological or dirty-bomb attack. Those plans were first tweaked and fine-tuned to handle a potential natural threat -- avian flu -- in 2006.

The differences in approach became apparent Monday, when O'Malley appeared at a state emergency command center and predicted that swine flu would surface in his state. Kaine, holding a similar news conference with Virginia Health Commissioner Karen Remley, said he hoped his state would be spared.

After the first six probable cases were reported to O'Malley on Wednesday, he huddled with his top advisers. David Paulson of the Department of Health and Mental Hygiene described the decision to go public.

"The earlier we communicated to the public, the more that we were able to tell them without compromising the privacy of the individuals, the better the public would be able to prepare and deal with this," Paulson said. Although no names were released, state officials described the flu patients by their age, where they lived and whether they had traveled to Mexico.

"I do believe you share what you know, why you know it . . . and what you're going to do about it," O'Malley said last night. "When you're dealing with an unknown like this virus, the more information you can give, the better."

As the week unfolded in Virginia, health officials declined to release much information. Kaine said the state would discuss only cases confirmed by the CDC and would not disclose whether there were any probable cases.

Kaine also was confused about the designations being used by the CDC, which counts as a "probable" case someone who has tested positive for type A influenza. Because swine flu falls into the broad type A category, that test result is sent on to the CDC to determine whether it is the H1N1 strain known as swine flu.

"The reason we are not talking about probable cases is that so many people who are experiencing symptoms that might seem like flu symptoms are checking with their health-care providers to determine whether or not they have swine flu that you don't really know what is a probable case," Kaine said.

"People with allergy symptoms are calling in. People with seasonal flu are calling in. And so whether to label something a probable case to me is really a meaningless term. We will make announcements when we have confirmed cases," he said.

Kaine and Remley held a news conference Monday to present Virginia's plan to combat potential cases -- a plan originally designed in 2006 to combat bird flu.

Then they held a second news conference Thursday night to announce that two state residents had contracted swine flu while traveling in Mexico. They told reporters that the separate cases involved a woman from the central part of the state and a man from the eastern portion.

How old are they? Where do they live? When did they go to Mexico? State officials refused to say.

Remley said she is following guidelines from the CDC, which allows individual states to decide how much to release.

"From a public health perspective, I can tell you we can't share a lot of details,'' Remley said. "People's privacy is respected unless there is a public health threat. There was no public health threat. There's no public health reason for us to give out that information."

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