As reported by the New Haven Register, October 21, 2007.

Flu 'Pandemic' Coming?

By Abram Katz

Before the first cough or ache of influenza this year, Gov. M. Jodi Rell started to encourage Connecticut residents to prepare for a deadly pandemic that could claim millions of lives around the world.

Wash your hands, cover your mouth and create a family preparedness plan, the governor's office recommended in a little-noticed announcement late last month.

Some physicians and health care workers said they thought Rell's pronouncement was unnecessarily alarming, considering that no pandemic is looming on the epidemiological horizon.

The Rell administration and federal public health officials disagreed.

"While no one knows for sure when a pandemic will strike, we know that pandemics do happen," Rell wrote. "Fortunately, we can take steps now to prepare for this serious public health crisis."

The governor warned, "During an influenza pandemic, the influenza virus spreads easily from person to person, causes serious illness and can sweep across the world in a short time."

The statement then summarizes the Spanish flu of 1918, which killed an estimated 40 million people worldwide, including about 500,000 in the United States.

The release coincides with a $963,000 preparedness grant from the U.S. Department of Health and Human Services, part of a $750 million government allocation to the states for disaster planning and training.

Dr. Robert S. Baltimore, pediatric epidemiologist at Yale-New Haven Hospital, said the tone of the statement was perhaps a tad too ominous under the circumstances. Dr. Kevin Diekhaus, chief of infectious diseases at the University of Connecticut Health Center also said the release seemed alarmist.

Other health care workers also found the message a little more frightening than required.

But that's exactly the point, government and disaster planning personnel said.

"There's nothing wrong with being prepared. There's nothing in there (the statement) that should or would induce panic," said Rell spokesman Rich Harris.

Maybe so, said Dr. Anthony Tomassoni, medical director of the Yale-New Haven Center for Emergency Preparedness and Disaster Response. It had to be.

"It's realistic to prepare for pandemic flu. At some point, we'll have a pandemic event. It doesn't make an awful lot of sense not to listen. But you don't want people to panic," Tomassoni said.

"We're putting out information that's not alarming," he said.

"You know it's going to happen, it's out there, and it's unpredictable. That's what makes it challenging to the public," he said.

A typical influenza season seems most likely this year. And in 2007-08, there really should be enough vaccine to go around.

The U.S. Centers for Disease Control and Prevention estimates that 132 million doses will be available from domestic suppliers. That would represent the largest supply of flu vaccine ever available in the United States, according to the American Medical Association.

Several million of the doses are specifically free of thimerosal, a preservative that some people believe is linked to autism and other disorders.

William Gerrish, spokesman for the state Department of Public Health, said Connecticut ordered 50,000 doses for public vaccination programs. The rest of the vaccine is delivered to private doctors and cannot be tracked.

"There should be plenty of vaccine this year. In the past, not all of the vaccine has arrived at once," Gerrish said.

A significant vaccine shortfall in 2004 left millions of Americans unprotected, and supply and distribution problems marred the last two years.

About 36,000 people in the United States die every year from complications of influenza, such as pneumonia.

This year's vaccine, as usual, includes two A-strains and one B-strain of influenza. The injected vaccines contain dead viruses or parts of viruses, neither of which can cause infection.

They prime the immune system to recognize and attack influenza viruses.

Everyone should be vaccinated, especially the very young and very old, people with chronic disease, including chronic obstructive pulmonary disease, diabetes or heart disease, the state health department advises.

Vaccine should be available from private practitioners. The American Lung Association can help locate public clinics. Call (800) LUNG-USA.

Gerrish said vaccines can usefully be administered through March, and possibly into early spring.

Flu viruses originate in birds. When fowl, people and pigs share close quarters, a virus may acquire the ability to infect humans.

So-called Avian influenza, the new and potent bird-killer, became the prime pandemic-causing suspect in 1997. The H5 N1, or bird flu, virus does not spread easily between people, which so far has prevented the virus from infecting large numbers of people.

The U.S. Centers for Disease Control and Prevention have developed a vaccine against one strain of avian influenza. Three strains have emerged, A H5, A H7 and A H9. Each has several potential subtypes, complicating development of a more effective vaccine, said Holly Babin, spokeswoman for the U.S. Department of Health and Human Services.

The CDC also is recommending two new licensed antiviral drugs this year to fight the flu, Oseltamivir and Zanamivir. Both are neuraminidase inhibitors.

Two other drugs, amantadine and rimantadine, were so overused that they have lost their effectiveness.

Stockpiling drugs is only one aspect of planning for a pandemic, Tomassoni said.

"If we're going to survive a pandemic, we need to harden our critical infrastructure," he said. The foundation is people who are aware of the measures that must be taken, he added.

A key is social distance, and creating more of it, he said. Elements include school closures and telecommuting over secure channels. Hospital personnel, however, will have to get close and personal with potential influenza carriers.

"How do you persuade them or convince them?" Tomassoni said.

"I really worry about what if it's not H5 N1. It's six months to a vaccine. We don't have a great solution. That doesn't get you off the hoods, masks and gloves. We need to prepare the staff now. Nobody will be spared. Consequently, we have to plan."

Recommended measures such as coughing into your arm, washing your hands frequently and staying home if you are ill might delay a mortality spike to buy more time to develop antivirals and vaccines, he said.

The state Department of Public Health also suggests creating a stock of prescription medicines, and a supply of canned foods and water. The people who run pharmacies and work at grocery stores may all be stricken.

Flash lights, radios and extra clothes are also a good idea.

Christopher Cannon, national director of the Yale-New Haven Center for Emergency Preparation and Disaster Response, said Rell's stern warning and HHS grant "definitely coincide with each other."

But that's not a problem, he said.

"It think it's good that the government is putting out public education so we know the basic information, and the basics of what we should do," he said.

"It's realistic to prepare for pandemic flu. At some point, we'll have a pandemic event. We need to get personnel and the work force ready," Cannon said.