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Possible Pandemic on Health Officials' Minds

INDIANAPOLIS -- The discussion in Indianapolis this week is hardly light-hearted banter.

If a pandemic influenza spread into the U.S. population, up to one-third of the people could be sickened, many would die, vaccines would not be available for six months and antiviral treatments might not work. Schools would be closed, public gatherings canceled and the economy would face major disruptions, officials said.

That was the grim scenario health officials from 30 states and three U.S. territories discussed this week in Indianapolis during a conference on the ethics of treating a pandemic flu.

The conference was organized over concerns about the H5N1 strain of avian or bird flu virus, which killed more than 150 people in Asia. Currently, H5N1 has been observed to spread only from infected poultry to people who handled the birds, and not directly from person to person, but there's concern the virus could mutate and be transmitted by people to each other.

Since it would take scientists four to six months to develop a vaccine once a pandemic strain is isolated, states instead are stockpiling flu antiviral treatments. But Dr. Judy Monroe, Indiana health commissioner, noted that it's uncertain whether antivirals used against the seasonal flu would work against pandemic influenza.

In the meantime, people would have no pre-existing immunity to pandemic influenza; seasonal flu shots would not be effective against it.

Since a pandemic would put unprecedented burdens on health care providers, first responders, government, utilities and business, more than 80 health officials from around the U.S. gathered this week to discuss what legal and ethical issues states should consider.

"We expect the challenge we would face in caring for sick and dying people would be very serious until there were a vaccine developed," said Dr. David Sundwall, president of the Association of State and Territorial Health Officials. "With new technologies, there may be a vaccine available in as soon as six months (after an outbreak), but they are not available now."

A pandemic flu could mean scarce resources, Monroe said. Up to a third of the workforce could be sickened, and others would be home caring for family members, which would disrupt health care resources and critical infrastructure, she said.

Indiana's State Department of Health already has a plan that would involve closing all schools during a pandemic flu. Public gatherings, such as funerals and football games, also likely would be canceled, Monroe said. Employers would be asked to let employees work from home or to shift work hours to minimize day care needs.

Quarantines and self-isolation of infected individuals also are possible, raising civil liberty concerns.

"The fact that their ability to move around might have to be limited or they might be encouraged to stay in their home community ..is borne out of the public's need to be protected from harm that would be far greater than they've probably ever experienced," said Dr Eric Meslin, director of the Indiana University Center for Bioethics.

Moreover, third-party health insurance companies would be swamped with claims, Sundwall said.

One bit of reassuring news is that the H5N1 virus has not spread to North America, and so far has not shown the ability to jump from person to person. Those who died in Asia often were poultry handlers who caught it from domestic poultry that contracted the virus from wild birds.

"We are concerned that when bird flu actually comes - and if a duck or a goose has bird flu - that people may panic and think a pandemic is here," said Janet Archer, chief nurse consultant of the State Department of Health.

But a pandemic would occur only if the virus develops the ability to spread between people, she said.

Although seasonal flu shots would not be effective against a pandemic outbreak, health officials still recommend people receive them, since it would be one less infection to worry about.

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