Federal Anti-Flu Document Raises Questions

The U.S. government will release a 108-page document telling Americans how to minimize disaster if a new flu pandemic strikes. Some say it's an excessive response to failures in past emergency planning.

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Another medical concern is forcing the federal government to plan to get treatment or some kind of help to almost anybody in America. Today, it puts out 108 pages of plans for a flu pandemic. This is the plan that tells you when you should stay home, when it's okay to go to work, when school should shut down in your community. And now all that's left is the debate over whether any of that advice will work.

NPR's Richard Knox reports.

RICHARD KNOX: The new guidance, as it's called, is the product of no fewer than 14 federal agencies. And it bears the stamp of the government's traumatic failures in dealing with Hurricane Katrina. It even proposes that flu pandemics be rated like hurricanes, on a scale of 1 to 5.

Dr. MARTY CETRON (Deputy Director, Centers for Disease Control and Prevention): So a Category 5 pandemic, like a Category 5 hurricane, would be very severe. It's in that same range of a 1918 pandemic.

KNOX: That's Marty Cetron of the Centers for Disease Control and Prevention. The 1918 Pandemic he's talking about killed around 675,000 Americans. With today's population, the government says a Category 5 pandemic would kill at least 1.8 million unless drastic measures were taken.

For a Category 1 pandemic, the government's only advice is for people who are sick to stay home. For 2 and 3, local communities might consider measures that put more distance between people - things like teleconferencing and staggered work schedules. But for Categories 4 and 5, officials would pull out all the stops, starting with anyone who has sickness in the household.

Dr. CETRON: If you are a family member of someone who's ill, we're asking you to voluntarily stay at home for a period of a week because of the possibility that unsuspectingly, you may not only have caught the virus, but may be able to transmit the virus without your knowing.

KNOX: Beyond that, the plan says public events should be canceled. People should avoid crowded buses and malls - and most draconian, children should be kept home from school until the flu wave has passed. The government says that could be up to three months.

Dr. CETRON: Schools are very densely packed. Transmission of these types of viruses often amplifies dramatically. So dismissal of school-age children from classrooms and closure of daycare centers is an important part of the planning for a Category 4 or 5 pandemic.

KNOX: The plan also urges communities to make arrangements for the most vulnerable people in society, another echo of the Katrina catastrophe.

Dr. CETRON: We can anticipate the kinds of things that didn't go well in the Katrina situation, and particularly, identifying in advance where are the elderly, the individuals who are at home without caregivers, the disabled? And how can we plan for taking care of those individuals?

KNOX: Cetron says the pandemic planners realize all this is a lot to ask of every city and town - not to mention every business, police department and visiting nurse association, especially since the plan does not address who will bear the costs.

Dr. CETRON: As hard as it is to think about this in advance, confronting an unmitigated pandemic without preparedness will be completely intolerable.

KNOX: So now the focus shifts to localities. Even the best prepared may feel daunted. Jeff Duchin is head of disease control in Seattle-King County, which has been planning in earnest for a pandemic for nearly two years now.

Dr. JEFF DUCHIN (Head of Disease Control, Seattle-King County): We don't really understand yet what the full impact of this would be. What would happen in a community if a large proportion of adults weren't coming to work and if children were home? Could it be done?

KNOX: Tom Inglesby has serious doubts about it. He's with the University of Pittsburgh Center for Biosecurity.

Dr. TOM INGLESBY (Chief Operating Officer and Deputy Director, University of Pittsburgh Center for Biosecurity): For some of these recommendations - such as prolonged school closures - there is honest, legitimate debate about the effectiveness of closing schools, about the feasibility of closing schools for two months or three months at a time, and about the downside and how we could cope with that in a community.

Fifty-four million kids go to schools in K to 12 in America, and 29 million of them get meals at schools.

KNOX: Perhaps the biggest unknown, it's how families would cope if breadwinners had to miss work to look after all those children.

Mr. INGLESBY: If this is going to be a nationwide plan that's real and that communities are really preparing for, then we have to take questions like what is the impact for people who work paycheck to paycheck? And how would they get by for the next three months if their livelihood would shut down?

KNOX: Now that federal planners have delivered their advice, Inglesby says it's time for ordinary Americans to think through the recommendations, especially the elected officials who will have to stand in front of the microphones when the pandemic strikes and tell their anxious communities what to do.

Richard Knox, NPR News.

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