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Q&A: Preparing for a Flu Pandemic
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Q&A: Preparing for a Flu Pandemic

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Q&A: Preparing for a Flu Pandemic
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ROBERT SIEGEL, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MELISSA BLOCK, host:

I'm Melissa Block.

And we're going to start this hour with answers to your questions about bird flu. One particularly worrisome strain of the virus, H5N1, has been showing up mainly in birds in Asia. More than 150 million birds have either died from the disease or have been killed in an attempt to stop its spread.

SIEGEL: More than a hundred humans have been infected with H5N1 since 1997. More than 60 of them have died, including one man in Thailand who passed away earlier this week. No bird or human has been infected in the United States.

BLOCK: Yesterday, Dr. Hon Ip of the US Geological Survey's National Wildlife Health Center answered your questions about the basics of the virus and how it spreads. You can find those answers on our Web site, npr.org.

SIEGEL: Today we'll try to answer your questions about what the government is doing about bird flu and what you can do in case of an outbreak in the US. To help us do that, we have asked Dr. Anthony Fauci to come, and he's director of the National Institute of Allergy and Infectious Diseases.

Dr. Fauci, welcome to the program.

Dr. ANTHONY FAUCI (Director, National Institute of Allergy and Infectious Diseases): Thank you. Good to be here.

SIEGEL: And we're going to start with a question from Jerry Amos in Hollis, New Hampshire. `How well-prepared is the US for the bird flu compared to other countries?'

Dr. FAUCI: Well, I think we can say with confidence that no country is adequately prepared at this point for a bird flu if it comes in its most fulminate form. If you look at what we're doing--we, the United States--vs. other countries, I think we are clearly as prepared or better prepared than any other country in the sense of our attention to it, the issue of having a vaccine in hand, though we have not been able to produce enough to be able to get up to the point where we would feel confident. And then there are supplies of antivirals like Tamiflu. So getting back to what I mentioned just a moment ago, no one is adequately prepared at this point, but we're not any worse prepared than anyone else.

BLOCK: Well, here's a related question about preparation and this one comes from Rich Clark in Cold Spring, New York. `Are first responders being trained to deal with a potential emergency?'

Dr. FAUCI: First responders are being trained as part of even a broader program of how you handle emerging diseases, like, for example, the SARS experience was very, very important in not only being a manifestation of how training helped handle that, but also was experience to be gained for a future approach for emerging and re-emerging infections. So, yes, they are being trained, but we need to do a lot more.

BLOCK: I bet Rich Clark would be wondering, `Is my local EMT, Fire Department, being trained in Cold Spring, New York, to know what to do if we have an outbreak?'

Dr. FAUCI: You know, again, not--obviously, we're not where we need to be, and I think it gets to the ability to respond to a natural catastrophe in general. When you have catastrophes that are moderate in their impact or localized or regional in their impact, you can certainly handle them better than something that is essentially omnipresent. There really isn't any nation or region or whatever that is adequately prepared at this time for an overwhelming health crisis like this. I mean, the hospitals certainly don't have the surge capacity to be able to take care of millions, millions and more sick people in an abrupt manner. Those are things that we have to work for, but it's certainly not there now.

BLOCK: This next listener, Claire Molner of Proctor, Vermont, is wondering about these plans. She says, `As a nurse with some education in epidemiology, I wonder if and how emergency management of a serious bird flu epidemic would be handled. Do we have a plan for mobilization of medical forces, quarantine, triage?'

Dr. FAUCI: Well, certainly the issue of quarantine--the president signed an executive order not too long ago adding a pandemic influenza to the list of quarantinable diseases. In preparation for a biodefense type of an approach, for example, a smallpox attack or things like that, you might recall that a few years ago resources--and we still need to do more--were given to the states to try and prepare for these public health emergencies. And certainly a pandemic flu would fall right under the category of a public health emergency.

SIEGEL: But where might people be quarantined?

Dr. FAUCI: Well, again, we've got to be careful that we understand what we're talking about, quarantine. I mean, there's quarantining of a plane that comes in where there may be someone who'd been onboard who was sick, so you quarantine the plane or you quarantine the ship. The other is a situation, for example, if you have a localized outbreak in a particular town, a particular city, a particular state or what have you, you might want to restrict movement in and out, even if it's on almost a voluntary basis. It doesn't necessarily have to be enforced. But to try and get people to restrict their movements. I think there's a lot of misconception about what quarantine really is.

SIEGEL: OK. Well, here's a question; it's a message from our voicemail box.

Mr. TOM PRITCHARD: Hi. This is Tom Pritchard from Atlanta, Georgia. My question is: What as a family can one do to prepare? Is there a preparation kit or a Web site with any preventative measures that one needs to take?

Dr. FAUCI: Well, certainly the Web site that is most commonly used, and a very good Web site, is the Centers for Disease Control and Prevention, the cdc.gov Web site. But if you listen to the CDC recommendations about how you handle any communicable disease that's communicated by respiratory spread, and its fundamental basic public-health issues: hand washing, covering your face and your nose and your mouth when you sneeze or you cough. If you get sick, if your child gets sick, don't sent them to school. If you're sick, don't go to work. Avoid crowded places where people are confined in an indoor space. Those are general, fundamental public-health measures that any family can prepare for.

BLOCK: What about vaccine? Anything on the horizon that would be viable that--how quickly would that take to develop?

Dr. FAUCI: Well, the United States government isolated a virus about a year and a half ago from a North Vietnamese patient who was infected from a chicken, an H5N1, which is the virus in question that we're concerned about--made a vaccine and began vaccine trials, the first stage of which shows that the vaccine is safe and it's actually capable of inducing an immune response that you predict would be protective against this particular virus. One of the sobering issues associated with this is that the dose that's required to induce that level of immune response is considerably higher than the standard dose that we use with seasonal flu, which compounds a problem that exists of production capacity.

SIEGEL: But if a vaccine has been developed to counteract the flu that somebody has caught from a chicken...

Dr. FAUCI: Right.

SIEGEL: ...would that necessarily work against the same virus after it has become a person-to-person--and mutated into a person-to-person virus?

Dr. FAUCI: We don't know that. It likely will work, certainly, in a less effective way than if it's the virus that you made the original vaccine. Let me explain. As the strain--the H5N1, evolves--hopefully it never will--but as it evolves to become more efficient and then starts to spread efficiently from person to person, it is conceivable, if not likely, that as it evolved, it evolved away from strict protection from the vaccine. So if you had, for example, an 85 percent effective, it may go down to 40 or 50 percent or even less.

SIEGEL: Ben Layman(ph) in North Potomac, Maryland, asks: `If we do become ill, should we report it and to whom?'

Dr. FAUCI: Well, when you say `ill,' I'm sorry, I'd have to say, `What do you mean by ill?'

SIEGEL: What do you mean by ill? Should everyone who gets the flu in the coming months call up a public-health authority?

Dr. FAUCI: No. I mean, everyone who starts sneezing and coughing right now, particularly from an epidemiological standpoint, there's no indication that pandemic flu or bird flu is in the United States, and that is the H5N1. There are bird flus that circulate all the time, but the H5N1 is not here in the United States. So the answer to the question is certainly if somebody just starts sneezing and coughing, you're going to not want to overwhelm the system by calling it up. If there is detection of the H5N1 in this country and we have start to spread, public-health authorities, particularly the Centers for Disease Control and Prevention, will be tracking that very carefully, I can assure you.

BLOCK: There's been a lot of talk about the drug Tamiflu. That's one available treatment, even though the World Health Organization is not sure just how effective it is, and it's in short supply. We got an e-mail from Renee Rivera(ph); she's a listener in Ho Chi Minh City, Vietnam. And she writes: `I work as a volunteer social worker. My organization has distributed Tamiflu to each of us. How effective is it with avian flu?'

Dr. FAUCI: Well, right now I would tell her not to take the Tamiflu since, first of all, there's not a threat of spread of human-to-human right now. And when you start taking Tamiflu inappropriately, it can lead up resistance of the virus in question to Tamiflu. That's the first thing. As far as how effective Tamiflu is against the serious complications or the serious nature of H5N1, we don't really know. We're assuming that it will work with an H5N1. But there's no definitive proof that it would make a difference with regard to hospitalization or life or death.

SIEGEL: Let's take another voicemail question.

Mr. DAVID WHITE: Hi. My name is David White. I live in Statesville, North Carolina. My question about the bird flu is how is the government going to prioritize who gets medication out of the national stockpile and what their other contingency plans are for getting more of it on short notice.

Dr. FAUCI: Well, very soon the plan of--the medical and public health preparedness plan for pandemic flu will come out and there will be a prioritization, and it'll be similar to the types of things that the CDC has been putting out each year, particularly if you have a shortage. There was the health workers would get exposed, there are people who are 65 years of age and older, individuals with chronic disease, pregnant women, people who take care of people in care facilities like nursing homes.

SIEGEL: Just to go back to something very basic for a second. If indeed there were this particular avian flu in the US and someone caught it, it would be evident that that's not an ordinary flu and it would be evident soon?

Dr. FAUCI: Not necessarily. Not necessarily. Because remember, the regular, seasonal flu claims 36,000 lives a year in the United States. So you can get severely ill from the run-of-the-mill seasonal flu. You distinguish it if it's really very virulent and it's widespread in the community, and you have a lot of young people who wouldn't generally get seriously ill from the seasonal flu. But just on looking at a seriously ill patient, you can't say that that is H5N1 vs. any other flu.

BLOCK: You said earlier that we're not where we should be on preparations. What more needs to be done right now?

Dr. FAUCI: Well, you know, it's not anything that can be done right now. What we need is that we need certainly to have the capacity to make vaccine in a surge capacity manner so that if, in fact, you have an outbreak, you can make enough vaccine to cover the vast majority if not all of the population. We don't have that capacity right now. You need more drugs. You also need the ability to respond in a medical health standpoint to a number--a large number of seriously ill people. So you're talking about things that we can aim for and we could work our way towards, but it's not something you can turn around overnight by any means.

BLOCK: Dr. Fauci, thanks very much for talking with us.

Dr. FAUCI: You're quite welcome.

BLOCK: Dr. Anthony Fauci is director of the National Institute of Allergy and Infectious Diseases.

SIEGEL: And you can get answers to more of your questions at our Web site, npr.org.

You're listening to ALL THINGS CONSIDERED from NPR News.

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