If Avian Flu Hits, Do What the Doctor Says
Public health officers plan for potential pandemic
By Jenny Lim
SAN MATEO AND SANTA CLARA COUNTIES, Feb. 2-
You may not know their names, but there are 61 men and women in the state of California who can stop you from going to the mall. Or the movies. Or school.
Each of California's 58 counties, along with the cities of Berkeley, Pasadena and Long Beach, have a legally appointed physician health officer: a doctor who enforces public health laws and spearheads efforts to control infectious diseases in their territory.
The doctors are charged with prepping their counties for mass threats to public health. Appointed by a city or county's governing body, they must also manage the local health department's response to medical crises that break out in their region.
If the H5N1 virus, or avian flu, hits California, it's these relatively unknown physicians who will decide whether or when to close schools and public places. But before the virus even migrates to the Golden State, each officer is working on a game plan to make sure their county or city is ready for a bird flu pandemic.
Like good doctors, they know prevention is key to good medicine.
The state's health officers are instrumental players in the creation and implementation of each county's pandemic flu plan, said Roberta Lawson, executive administrator of the California Conference of Local Health Officers.
Here in San Mateo and Santa Clara Counties, Drs. Scott Morrow and Marty Fenstersheib are the chief medical officers heading the effort to plan for a pandemic flu.
Since November, the two doctors - along with representatives from local hospitals, emergency management services and the health department - have been drawing up blueprints for a Peninsula public health response to a bird flu pandemic. Both counties could have portions of their respective plans completed as early as the end of March.
Even though no case has occurred yet in the U.S., the counties are planning for the worst-case scenario: the avian flu strain mutates so that it can easily transmit from human to human, said Fenstersheib, Santa Clara County's health officer.
The results of that mutation could be deadly, according to Fenstersheib and the U.S. Department of Health and Human Services. The H.H.S. Web site suggests if the avian flu is as severe as the 1918 "Spanish Flu" pandemic, 90 million Americans could be infected with the illness. Based on the 1918 flu pandemic statistics, H.H.S. projects 1.9 million Americans could die from avian flu.
It was clear after Hurricane Katrina that federal emergency response efforts were sorely lacking, said Morrow, San Mateo County's public health officer. A pandemic might require people to stay isolated in their homes, so people need to stock up on food and water, as they would for a hurricane or earthquake, he said.
"You will need to be prepared," said Morrow, past president of the California Conference of Local Health Officers. "Don't assume someone else is going to come and save you."
The two MDs said teaching the public how to be self-sufficient during a pandemic is a key component to the counties' prevention plans.
"Before a pandemic starts, we need to educate the public about what to expect, how to prepare," and how the disease will affect their day-to-day lives, said Fenstersheib, who also coordinates CCLHO's legislative agenda.
Other priorities in the local pandemic plans include: surveying early detection of avian flu cases; controlling the spread of the disease between people; stocking equipment such as ventilators; and prioritizing which patients to vaccinate or hospitalize.
The plans for pre-emptive and early response are critical, since no vaccine exists for avian flu. It will take six to nine months to create a vaccine that can treat the mutated strain of avian flu that causes a pandemic. By then, it's still unlikely there will be enough vaccinations to treat every person, Morrow said.
Neither health officer is counting on stockpiling Tamiflu, an anti-viral medication that has effectively treated some human cases of bird flu in Southeast Asia. The medication is in scarce supply, so neither county can depend on acquiring enough Tamiflu to treat the 700,000 San Mateo County or 1.65 million Santa Clara County residents. The anti-viral, already needed to treat seasonal flu, may not even work against a mutated avian flu strain, medical experts say.
Though Fenstersheib and Morrow are brokers in formulating their county's respective pandemic plans, neither will be the person "in charge" if a pandemic unfolds. That power is not vested in one person.
"It's not like there's a 'head of pandemic flu planning,'" Morrow said.
Both doctors are working with eight to a dozen health professionals to formulate the pandemic flu plans. They said that when a pandemic hits, the county health department is just one of the local, state and federal agencies that must work to squash the spread of the disease. The 170-page California pandemic flu plan lists 116 acronyms of agencies to be involved in a pandemic flu response. The 396-page federal plan lists 37, including the Center for Disease Control and Protection, the Department of Homeland Security and the U.S. Department of Agriculture.
But local health officers will be the frontline defense against avian flu, should it arrive in the United States. As chief medical authorities in their counties, they will make critical decisions and provide the official directions about what to do and when, should a pandemic start, said Joy Alexio, spokeswoman for Santa Clara County's health department.
The health officer also has police power during public health crises, CCLHO's Lawson said. He or she can close any function or gathering, isolate or quarantine on a mass level, or require evacuation or property destruction, according to the Health Officer Guide for Communicable Disease Control in California.
To some extent, Morrow and Fenstersheib see their responsibility as prompting other institutions to get their own pandemic flu plans in place.
Severe absenteeism from work and disruption of food and fuel delivery will be inevitable during a pandemic, Morrow said. Businesses, schools and churches need to have plans in place to help people access necessary services and goods, he said.
"Hopefully everything will be fine," Morrow said. "But we are very dependent on a tenuous system of fuel and food (delivery) that may not always be there."
Morrow said there is a 100 percent chance the pandemic will happen. The severity of the pandemic or the virulence of the virus, however, is up for debate.
"When the pandemic comes - and it will come - we just don't know how bad it will be," he said.
Contact Jenny Lim at jennylim@stanford.edu
