U.S. Releases Second Phase of Bird-Flu Plan The White House presents a new plan for implementing its national strategy in the event of an avian-flu pandemic. Phase one was released in November. Guests examine the administration's action plan.

U.S. Releases Second Phase of Bird-Flu Plan

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This is TALK OF THE NATION. I'm Neal Conan in Washington.

A couple of hours ago, the White House released Phase two of its national strategy for pandemic influenza. Phase one, you may remember, was released in November.

Today's document spells out the steps that the federal government will take in the event of a flu pandemic. And while the document is full of plans on how best to contain the disease outside our borders, it concedes that probably won't work. And while there are pages about how it will coordinate with state and local governments, it also warns they should not expect massive federal help.

Companies, it says, also need to plan for extended absences, and individuals need to figure out how best to help themselves and their loved ones.

Let's step back. This is a plan in the event of an avian flu pandemic. So far, only a couple of hundred humans worldwide have been infected by avian flu influenza, but scientists are closely watching the H5N1 virus in case it mutates and becomes transmissible from human to human.

Today, we'll look at the new White House plan and talk with DA Henderson, the former director of the Office of Public Health Emergency Preparedness. He's the former director of the World Health Organization's effort to eradicate smallpox.

If you have questions about what the federal government proposes to do, or about what it realistically can do, in the event of a flu pandemic, give us a call. We'd also like to hear from those of you who own or operate businesses. What's your plan?

Our number here in Washington is 800-989-8255. That's 800-989-TALK. E-mail us, talk@npr.org.

Later on in the program, our weekly visit with Political Junkie Ken Rudin. On the agenda: Ohio secretary of state won the GOP nomination for governor yesterday. He's one of the nation's few black Republicans in office, and one of several running for statewide office this fall.

If you have questions about yesterday's primaries, the upcoming mid-terms, or early maneuvers for 2008, give us an e-mail now: talk@npr.org.

But first, the White House plan for pandemic influenza. Joe Neel, NPR's health editor, joins us here in Studio 3A.

Always to have you here on the program, Joe.

JOE NEEL reporting:

Always nice to be here Neal.

CONAN: And which part of the federal government coordinates this? Who'd be in charge?

NEEL: Well, the plan lays out that the Department of Homeland Security would be in charge. They would coordinate all of the various working parts of the federal government in trying to get them into place when a pandemic breaks out. A pandemic would break out over a month or two and would require fairly rapid response.

It's a little controversial in some quarters that Homeland Security is in charge of this, because people have been viewing a pandemic, a possible pandemic, as a health crisis. And the department that's in charge of health in this country, the Department of Health and Human services; Secretary of Health and Human Services Michael Leavitt has been on a tour of many states. He, I think, is planning to hit all 50 to encourage states to get going and get planning for it.

But when it does break out, the Department of Homeland Security will be in charge, and if disputes break out between the various agencies over decisions it's made, the decision-making will go up a notch to the White House and then, ultimately, to the president.

CONAN: Mm-hmm. One of the curiosities of this--I've just read the executive report, 15 pages or so--you've been trying to pour through, what, 225 pages of the whole thing?

NEEL: Yeah, 225.

CONAN: And one of the emphases--or the points of emphasis, is that this is obviously going to be a national situation, but it's going to be experienced locally because it comes in waves. It doesn't hit everywhere at the same time, and it could last a year or more.

NEEL: That's right. It would unfold over, probably, it's either 120 or 180 days, and there's an animation that I've seen showing how it would first start--I mean, it more or less comes in through the main ports of entry--through-- probably through airports. So you see New York, San Francisco, L.A., Seattle, Atlanta, the major international airports sort of being the first cities that get struck. And then, in this particular model, and there are many different ways, many models of how it might spread, it then goes out from there.

So you might have a major epidemic occurring in a major city like Chicago, whereas rural areas two or three hundred miles away don't get hit until three or four weeks later. So it's an evolving thing. And, though, at any one time during the peak, there may be a three or four-week period where there are tens of millions of people who are sick, and that could cause incredible disruption.

CONAN: From what you've been able to see, is the federal government, at this point, over-blowing the danger here? Or underestimating the danger?

NEEL: Well, I--you know, I've been following this for several years now, as have several of our reporters, and it is completely plausible that a pandemic could sweep through this country. And, if it is as severe as the 1918 pandemic was, it could kill up to 2 million people. That's the worst-case scenario.

And I think that--a couple of years ago, when there were only a couple of countries with bird flu cases and it was not--hadn't moved into too many humans, it was a really theoretical risk-or a really theoretical construct that it was going to hit this country. But now that it's--bird flu has moved to 50 countries, birds in 50 countries, and there are more than 200 human cases and 113 of them have died, you know, its notching up.

So it's impossible to predict whether it will happen. It just depends on when the virus mutates. But I think that preparation and planning is probably prudent.

CONAN: We'd like to get you involved in this conversation. What questions do you have about the federal plan? What preparedness operations are under way locally? If you own or operate a business, what are you doing to get ready? 800-989-8255, e-mail is talk@npr.org.

Let's begin with Timothy(ph). Timothy calling us from Taos, New Mexico.

TIMOTHY (Caller): Yeah, hi. Can you hear me?

CONAN: Yes, you're on the air, Tim. Go ahead, please.

TIMOTHY: Yes. I'm an emergency physician, and, you know, we have a lot of concerns about--in a rural area, concerns about having this being done through Homeland Security. The reason being is we're so far away from their reality that I don't see how they could help us if they couldn't help people in a city like in New Orleans.

And if you look at how they're talking about distributing Tamiflu, they're talking about doing it through state health departments. And it would make sense to me to get those state health departments involved, because our issue in emergency medicine, if this were to happen, is number one, are people going to come to work at our place? And number two, how do we keep these people out of the hospital? Because there'll be so many of them that there's all these scenarios for putting them in high school gymnasiums and what not. And I was wondering what your guest thinks about that.

CONAN: Joe, a lot of good questions there.

NEEL: Yeah, I don't know where to start. The plan that's come out today puts great emphasis on getting states mobilized, and that's been the primary focus of the federal government for the last six months, because the report quite flatly states that the federal government just can't do it all. It's too big of an event; it's not a point-disaster like a hurricane hitting a region or even a tornado hitting a city, that comes and it goes. Of course, in the Gulf area, where it's going on, the disaster continues.

But in typical disaster response, you can coordinate and have people come in, move in supplies, do what's needed, and you move out. This, as you pointed out, involves moving a lot of drugs to the right people, drugs that are in short supply, drugs that may not work totally to help prevent it. So I think that the emphasis here on getting states and cities to try to think about this is the right approach, and--because the federal government from Washington can't necessarily, you know, they are not--they're too big and bulky to know what's going to be needed in Taos, you know, on week three of the pandemic.

CONAN: And Joe, reading between the lines of this report, in a lot of ways, it says local, state governments, you're on your own.

NEEL: Yeah, it does say that. It provides a lot of support to them, gives them outlines of how things may unfold and what they may want to do. They might want to consider school closures and it talks a lot about shutting down--the effectiveness of shutting down transportation, for example--maybe when a community has an outbreak, closing it off or limiting transportation.

CONAN: Which, it suggests, may give you time elsewhere, but it's not going to prevent anything.

NEEL: That's right. The kinds of restrictions on travel, both air travel, rail travel and trucking, will only have-will only slow it down.

CONAN: Timothy, thanks very much for the call.

TIMOTHY: Thank you.

CONAN: Joining us now is Dr. DA Henderson, distinguished scholar at the Center for Bioterrorism at the University of Pittsburgh; former director of the Office of Public Health Emergency Preparedness. He joins us from his office in Baltimore, Maryland. Nice to have you on the program today, sir.

Dr. DA HENDERSON (Professor of Public Health and Medicine, University of Pittsburgh; Former Director of the Office of Public Health Emergency Preparedness): Happy to be here.

CONAN: I mentioned you had a chance to glance at this plan. Does it seem to be scaled properly to you?

Dr. HENDERSON: Well, I think there is an emphasis here, which I think is distracting, and that is the hope that somehow or other you're going to be able to contain or slow an outbreak. And I think what the difficulty is, there are very few people who've gone back to 1968, 1957, which were both pandemic years--or 1918, and looked at how rapidly this virus spreads across the country.

For example, at the end of August 1957, there were only a few outbreaks in the south of the United States, and--mainly in Louisiana where schools seemed to have opened early. And seven weeks later, every state in the union had outbreaks, and 47 of the 50 states had more than half of their counties with epidemics.

So you've got a tidal wave like this, which moves very, very rapidly. And to be distracted and thinking we're going to quarantine or put up some sort of (unintelligible), or we're going to be able to screen people at airports, or what have you, it's unfortunate that there are those putting emphasis on this, when that is not the best use of resources.

CONAN: What do you find encouraging about the plan?

Dr. HENDERSON: Well, I think it's encouraging in the sense of making it clear that this does have to be done at local levels. The planning has to be done at local levels, and there's not going to be resources to come in. And I think this is something that's very difficult for many to accept. And I think the difficulty here--and the biggest problem we're going to face, is going to be the tidal wave of patients. And we've seen, really, every year, in a few cities, there's been flu around, and when it's gone into a city, you have the hospitals fill up very quickly and then they go on what they call bypass, or they do not accept more patients because they have as many--they've accepted as many patients as their professional staffs can handle.

Well, one can predict very safely, that if we have the pandemic through, we're going to have--every hospital is going to be in that position.

CONAN: And flu healthcare resources, the report points out, are not very mobile. It's hard to move them from one place to another, or in case of hospitals, you really can't do it. It's very difficult.

Anyway, we're going to take a short break. Stay with us if you would, Dr. Henderson. Joe Neel will stay with us, as well. More of your calls after the break; 800-989-8255; 800-989-TALK. Our e-mail address is talk@npr.org. I'm Neal Conan. This is TALK OF THE NATION from NPR News.

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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. The Bush administration, today, came out with an updated plan for dealing with a possible flu pandemic. The report is based on a worst-case scenario. Obviously, no flu pandemic right now. It recommends vaccine stockpiles, quarantines, travel restrictions, among other steps, which may be necessary. You can read the full report at our website npr.org.

Our guests are NPR Health Editor Joe Neel. Also, DA Henderson, distinguished scholar at the Center for Biosecurity at the University of Pittsburgh; former director of the Office of Public Health Emergency Preparedness.

If you have questions for us, 800-989-8255; 800-989-TALK. E-mail is talk@npr.org.

And, Dr. Henderson, just before the break, you were saying people are going to find it hard to accept the idea that considerable federal aid is not going to be available in the event of a flu pandemic. Why not?

Dr. HENDERSON: Well, you have--a flu pandemic will involve a good part of the nation fairly quickly, and there will be needs at virtually every city. The federal resources are comparatively limited and I think they can handle a focal problem, be it an explosion or a hurricane or tornado, by moving people around, but the demand here is just so overwhelming, there's very little you can do.

In terms of hospitals, people have talked about field hospitals or portable units that might be moved. There are very few of these in the first place. And the second problem that you have coming in is not only bed space, but who's going to care for the patients? And if you create more beds, that means you really need more people to take care of the patients, and that's going to be in short supply, because I think the attack rates--that is infection rates--in hospital staffs are going to be very high, because they are the ones that are going to be in contact with a lot of patients. So it's going to be a critical problem in this area.

NEEL: Dr. Henderson, Joe Neel here. What about the idea of, since there's going to be a shortage of Tamiflu--in the earlier proposal, there was a suggestion that Tamiflu be targeted to healthcare professionals and other first responders to keep them on the job. I take it that you're not too fond of the idea of using Tamiflu or--where do you stand on that?

Dr. HENDERSON: Well, the Tamiflu, it is hoped, might be effective in preventing the disease, but it would mean that an individual would have to take a capsule every day. If you assume that an outbreak is going to go for at least 10 to 12 weeks in a particular city, which is what the history has shown, you would be using the equivalent of 10 treatment doses just to prevent one case of flu and--the treatment of flu requires much less, because you're only giving it for five days--so that if you begin using it for prevention, the very limited supplies that we have are not going to go terribly far.

CONAN: Let's get another caller involved in this conversation. Let's go to Rachel(ph). Rachel calling us from Philadelphia.

RACHEL (Caller): Hi. Can you hear me?

CONAN: Yep. You're on the air.

RACHEL: Hi. I'm a medical student and I learned in my classes that most of the people who died in the 1918 flu pandemic, died not of the flu, but of secondary bacterial infections, bacterial pneumonia, which we can treat today with antibiotics. And I'm always interested that when this discussion comes up, nobody talks about that. They talk as though most of the people died of the flu itself.

CONAN: Mm-hmm. Dr. Henderson.

Dr. HENDERSON: Well, actually, this is not true. In fact, we have gone back and looked at records in 1918 and it was surprising the number of patients who died within a matter of three, four days, which would be primary flu infection. There were certainly some cases where there'd be secondary infection, that is, pneumonias, which could be treated with antibiotics. But I think the feeling is that we're not going to have--the great majority are going to have to be treated that way.

RACHEL: May I ask a second question?

CONAN: If you can keep it short.

RACHEL: How about the supportive care we can provide today with fluids, that sort of stuff, which I know will be more limited with the, as you say, the strain on the medical system?

Dr. HENDERSON: Well, I think there are a number of things that can be done, because influenza will be a problem for individuals who have heart trouble or trouble with their lungs or diabetes or what have you; so we know that we would get a number of patients in with influenza who are going to have other problems that are going to get worse, and that will need treatment. So that there's going to be a need--a considerable need for medical treatment of patients well beyond just flu, and I think many people have had the feeling we could do like in 1918 and put people in gymnasiums or in armories. But in 1918 we couldn't do very much and we couldn't do very much in medicine, period, in support.

So they were really warehoused and given food and fluid, but now, you really need more care, and I think this is what worries many of us: what we're going to do to provide anywhere near the quality of care that really is needed to see a lot of these people through this serious problem.

CONAN: Rachel, thanks very much.

RACHEL: Thank you.

CONAN: And good luck with your studies.

RACHEL: Thank you.

CONAN: Let's go now to--this is Terry(ph). Terry in Grand Rapids, Michigan.

TERRY (Caller): Hello.

CONAN: Hi, Terry. Go ahead, please.

TERRY: Thank you again for a wonderful program. My question is, do you have any idea of when it may happen? And the second question is, what could we do, individually, such as hydration, washing our hands, using a face mask, so forth and so on?

CONAN: I'll be bold enough to take the first part of that question. No. Dr. Henderson, can you help us out in the second part.

Dr. HENDERSON: Well, the question, what individuals can do, is fairly limited. And, I think we would say, wash your hands; if you're sick, stay home. But beyond that, what can you do--you really can't do anything more than--if you have access to Tamiflu and you get it within 48 hours, this may be helpful. But I think many of us are not terribly optimistic about the Tamiflu, because the flu virus, the H5N1, seems to develop resistance fairly quickly.

So, as far as an individual's concerned, there are just fairly limited things that one really can do.

NEEL: Dr. Henderson, Joe Neel again. This report will probably be remembered--I mean, there are only a few things that can actually go into the stories that reporters are writing, but the one thing I think will capture people is the idea that the government is recommending that everyone stay three feet apart from each other when they're in the workplace. Do you think that--is that based on science? Is that a reasonable thing to expect?

Dr. HENDERSON: Well, that's pure speculation. I don't think there's any science base for that. That's the problem. And, there is the concern about--if you're ill, you should stay home, but we should not forget that the individual influenza is able to excrete the virus for a couple of days before he gets sick. So if he stays home when he has symptoms, that's nice; but the two couple of days before, he's already been around to spread it as much as he'd need to spread it.

CONAN: And what about Terry's other question? Masks--would they provide protection?

Dr. HENDERSON: Well, masks are suggested to be put on the people who have the flu and then who may be expelling droplets. It will prevent some spread by way of droplets, but experience is with the masks, by and large, that they do block a certain amount of air coming through, in particular, if they're a little moist, and then the air just flows around the mask, and so you're really doing very little with it.

CONAN: Thanks very much for the call, Terry.

One final question for you before we let you go, Dr. Henderson, and that is that, this reads like a government report. It's dry language. It, as you say, skirts around some issues like where we're going to get, you know--whether or not it can be stopped at the border. It says probably not, but the one thing that it doesn't contain is the whiff of panic that might be in the air if this starts to happen.

Dr. HENDERSON: Yes, this is true. And I think my experience in dealing with epidemics--and I've certainly dealt with a lot over my career--is that, to the extent you can keep the things going normally in a city and what have you, and trains running and food purchase and so forth, you have less anxiety; you have less panic. It's when things get seriously disrupted--the normal services and so forth, that apprehension begins and things get worse.

And this is one of the things that worries me about suggesting that people voluntarily quarantine or we try to quarantine people. There are an awful lot of people out there that if we're going to quarantine a lot of people that are not going to be able to get paid. They're hourly workers and they need to continue their jobs.

You have situations here where you would wind up--they're talking about trucking in food, and maybe having to have the Army to drive trucks with--to deliver food. This is I think--really would be seriously disruptive if you were to this point. And my own thinking that we--very little we can do to keep the flu from spreading, that is quite clear.

And I would say, try to keep things going as much as normal in a city or wherever. Those who are sick, stay home. Wash your hands, that's fine. But beyond that, let the city go on as it will. I think we'll be in better position.

CONAN: Dr. Henderson, thanks very much for being with us, today. Appreciate your time.

Dr. HENDERSON: Yes, indeed.

CONAN: DA Henderson, Distinguished Scholar at the Center for Bioterrorism at the University of Pittsburgh, former director for the Office of Public Health Emergency Preparedness, with us from his office in Baltimore, Maryland.

And let's see if we can get another caller on the line. This is Kate(ph). Kate calling from McMinnville in Oregon.

KATE (Caller): Yes, thank you for taking my call.

CONAN: Sure.

KATE: My grandmother died in the epidemic of 1918. My mother was a child, but she told me, in detail, what it was like when the flu came to this small town in upstate New York.

CONAN: Mm-hmm.

KATE: And she remembers vividly how the entire infrastructure of the city simply collapsed. There were so many people ill that many of them got no healthcare whatsoever because the doctors and all of the healthcare professionals, such as they were for 1918, completely overwhelmed. They could not build coffins fast enough to bury the dead and simply stacked them--this was in December of 1918 in New York, so the bodies froze. And they simply stacked them up and left them stacked like cords of firewood until the next spring.

And my questions is, is this--and my grandmother died, as a medical student said, died in four days, so it was clearly of the...

CONAN: Flu, yeah.

KATE: ...flu, itself. Healthcare is not delivered on the national level. It's delivered on the local level. And when I hear the national government is making plans for it to take over the delivery of healthcare services, frankly, it makes me pretty nervous. And so, is there anything in the national plan that will move decision-making power down to not just the state level, but to the local level?

CONAN: Joe, that's not my reading of this plan, at all. It seems to put a lot of emphasis on local and state governments.

NEEL: Yeah, I think so. I don't see--I don't see a federal takeover in this plan, at all. I think the federal government is actually stepping back and saying, states and local communities, it's your job to figure this out, and local hospitals, you should have a plan. And you're absolutely right in your first observation that the infrastructure goes very quickly and that's what this plan is pretty--pretty devoted to, is trying to figure out how to mitigate the effects of having the, you know, people who drive the trucks get sick and possibly die and who replaces them and telecommunications breaking down because repair people can't fix things; and, you know, people not being able to run the back offices at the banks and the financial system going awry.

So there's a lot of attention paid to the infrastructure, not that much on telling hospitals and healthcare what to do.

CONAN: Thanks, Kate.

KATE: Are those plans being monitored? Are the local plans being monitored in any way to make sure that they are, in fact, in place?

CONAN: Hang on just a second, Kate, and we'll get to that.

You're listening to TALK OF THE NATION from NPR News.

And let's put this question to Dorothy Teeter. She's the director and health officer for Public Health in Seattle and King County in Washington State. She joins us from her office in Seattle. Thanks very much for being with us today.

Ms. DOROTHY TEETER (Director and Health Officer, Public Health, King County, Washington): I'm delighted to be here.

CONAN: And obviously this plan throws a lot on you, and we're also asking about Kate's question, are you being asked by the federal government to let them know what you're doing?

Ms. TEETER: Part of the Federal Response Plan that we have worked through the state is, for those in our local health departments, in particular, to report back on a periodic basis on the status of our plan.

But I would point out that that is actually necessary but certainly not sufficient. Each local government has to be monitoring its own plan to make sure it's on track and going forward, and not to be doing it simply because there's a federal requirement to do so.

CONAN: Mm-hmm. And this plan seems to be saying, local, state governments, there's going to be a--we'll help you where we can, but you're on your own. Does that seem to be your reading of it?

Ms. TEETER: Well, I think the way we're reading it is, number one, we absolutely have to accept local responsibility for those parts of that plan that are ours to do. The caller that said healthcare is local is absolutely right. Response to something like this has to be extremely well executed at the local level.

However, part of that execution to be successful has to be for local government to be working to understand, with its healthcare partners and business partners, what it's going to take to respond; and then, in turn, to have a very concrete set of requirements and resource needs that are really beyond the reach of a local government and turned back to the federal government with that very concrete set of resource requirements, and continually request those resources.

CONAN: Are you--by the way, Kate, thanks very much for the call. Appreciate it.

KATE: Thanks.

CONAN: Are you concerned about the level of federal support you may get in the event of a pandemic?

Ms. TEETER: We have, in King County, assumed, from the beginning, that the federal level of support, because of the nature of the pandemic like this where it's nationwide and, in fact, worldwide, would not be the same level of support we could expect, for example, with an earthquake.

So we have assumed all along that this is really on our shoulders and we have good fortune in our county to have a county executive who also shares that perspective and has been working with us to identify some local resources that do go beyond the federal resources to do our local planning.

So we have entered into this with all of our community and business and healthcare partners assuming that this would fall on us as a responsibility, but not assuming that there would be no federal financial assistance once we understood what that gap was between what our available local resources are and what we would need to actually respond.

CONAN: And we just have a few seconds left before we have to go to a break, but are you--is the county stockpiling food and bottled water and Tamiflu and that sort of thing? Are you advising your citizens to do that?

Ms. TEETER: Yes, yes, and yes. We have passed an appropriation in our county for enough Tamiflu to get us started with healthcare workers and first-line responders. And we are also advising our families and our communities to stockpile food, water, and medications for chronic diseases to last up to six weeks.

CONAN: Stay with us, if you would. We're going to take a short break. Joe Neel will be with us, as well. We're going to continue our conversation about the plan for a possible flu pandemic.

And then, our political junkie will join us, as he does every Wednesday; Ken Rubin will be here. If you have questions for him, 800-989-8255; talk@npr.org. It's NPR News.

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CONAN: Type your name into Google and you may be surprised at what you find. Here's blogger, Jonathan Colson(ph).

JONATHAN COLSON: The one group that I guess it does concern me that they might read my blog would be future employers. This is a big concern for a lot of people my age.

CONAN: I'm Neal Conan, and lessons learned in cyberspace, what do they know about you? Next TALK OF THE NATION from NPR News.

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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington, and here are the headlines from some of the other stories we're following here today at NPR News.

A state mining inspector's shouts during the Sago Mine disaster may have been what led relatives of 12 missing miners to believe that all had been found alive. Speaking at a hearing today, Bill Tucker said he was just screaming for help and may have said the words, they're alive.

And beverage makers and the William Clinton Foundation have announced a plan to stop most soda sales to public schools nationwide by 2010. Under the deal, only water, unsweetened juice, low-fat milk will be sold in lower grade school buildings and diet soda in upper grades. Details coming up later today on ALL THINGS CONSIDERED from NPR News.

Tomorrow on TALK OF THE NATION, what's changed in the Palestinian territory since Hamas took control of the government and most western aid was cut off? We'll talk with Palestinians about their lives and their hopes tomorrow on TALK OF THE NATION.

In a few minutes, Political Junkie Ken Rudin, will join us. If you have questions about the week in politics, give us a call. 800-989-8255. That's 800-989-TALK; e-mail, talk@npr.org.

But let's wrap up our conversation about the new White House plan for a potential flu pandemic. Our guests are NPR Health Editor Joe Neel and Dorothy Parker, excuse me, Dorothy Teeter, the director and health officer for Public Health in Seattle and King County, Washington State.

And let's get another listener on the line, and why don't we go to Brent(ph). Brent's with us from Kansas City.

BRENT (Caller): Yes, I'm a funeral director and I'm curious if the federal government's considered, you know, how people are going to pay for funerals. I mean, funerals don't do financing, finance planning or anything like that and most people don't have that kind of money to come up with all at once. And you know, charities are going to be tapped out, so where's the money going to come from to bury all of the dead? And do they have anything in place to maybe do like mandatory cremations or have they addressed any of that?

CONAN: Dorothy Teeter, is this again local or federal responsibility? I would think this would be local.

Ms. TEETER: I think the question that we are facing in our county regarding that is simply, first of all, the safe-the number of deaths, as you're pointing out, that might be imminent within a six to eight period--week period of time. And we're just beginning to get our arms around those numbers. I do not see anything in the federal guide that addresses that issue, in particular. And so I think, again, every local county and health department needs to be looking to see what those fatalities might, in fact, be and what some of those plans might be.

But in terms of funding, I don't believe that's addressed in the federal plan.

BRENT: Well, is that something on a local level that you all have taken into consideration because, you know, from what I understand, I mean, there's going to be far more people ill that can be helped through the healthcare, but that seems to be the main focus. We're going to have so many bodies that--and with regulations today, you know, you just can't stack people like cord wood back in 1918.

CONAN: And it may not be January in Buffalo. Anyway.

BRENT: Right.

Ms. TEETER: We do have a team working in King County on massive fatality planning just because of the issues that you're addressing; and I think it's important that we come up with a plan that is both very respectful of those families that are grieving, as well as something that will also meet the needs in terms of the public health requirements for how to actually manage that number of potential deaths in a very short period of time. So we're just in the beginning, but we do actually have a team, that's our mass fatality planning team, to take a look at all those questions.

CONAN: Joe Neel?

NEEL: And I might--I might point out that Seattle is one of the cities that's most advanced in its planning. So, in terms of what's going on in terms of other cities and states, probably this issue hasn't even crossed the radar screen yet.

Ms. TEETER: Yeah, I would agree with that.

CONAN: Brent, thanks for the call.

BRENT: Thank you.

CONAN: Here's an e-mail question, this from Roger(ph).

(Reading) When the SARS outbreak was occurring a few years ago, it didn't get anywhere near this amount of news coverage. What made that human transferable virus less worrisome compared to this one, which can't, as yet, be transferred by humans yet?


NEEL: Well, that's a good question. It--there were--I don't know that I can answer that. It's--I think our concern about pandemic is based on history. And Dr. Henderson, who was with us earlier, was talking about 1918 and how quickly it spread across the country.

We have a lot of experience with the flu. We see the flu every year. We know that the flu virus is extremely easily spread. So I think the concern is warranted. Why did SARS stop and be contained? There was an aggressive public health intervention done in several places where it was starting to break out. That was quite successful. And it just didn't, for whatever--I can't remember my SARS history at the moment, as to how virulent the virus really was. But it would have to do with whether SARS is more virulent than the flu, and also how quickly, or how easily it spreads.

So, I--there was quite a bit of panic when SARS was spreading, so I think that in part is--has generated, has helped generate concern here about a possible pandemic flu.

CONAN: And there are plenty of other questions out there, but I think we're going to have to leave it there, at least for today.

Joe Neel, thanks very much for being with us.

NEEL: Thank you, Neal.

CONAN: NPR health editor Joe Neel with us here in Studio 3A.

And Dorothy Peter, thanks so much for being with us today.

Ms. PETER: You're welcome.

CONAN: Dorothy Teeter, Director and Health Officer for Public Health in Seattle and King County in the State of Washington. She joined us from her office in Seattle.

When we come back, the Political Junkie.

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