Metro Public Health Department Establishes
Community Information Hotline on Pandemic Flu

Channel 2 to Air Bird Flu Movie May 9

ABC television, WKRN, Channel 2 in Nashville, will air a made-for-TV movie, “Fatal Contact: Bird Flu in America,” Tuesday, May 9 at 7 p.m.  The movie follows an outbreak of the H5N1 avian flu virus from its origins in a Hong Kong market through its mutation into a pandemic virus that becomes easily passed from human to human and spreads rapidly around the world.

The Metro Public Health Department knows that such a movie may cause concerns or raise questions among members of our community.  The Health Department has set up a Community Information Hotline in an effort to provide information to the community about bird flu.

The Health Department’s Community Information Hotline will offer a recorded telephone message that provides basic information about bird flu that will begin Tuesday evening.  In addition, there will be an opportunity to speak to health department staff by calling the hotline number beginning Wednesday morning at 8 a.m.  The Community Information Hotline telephone number is 340-2221.

Bird flu information is available on the Health Department’s Internet site located at healthweb.nashville.gov (please be aware there is no “www” in our Internet site address.).   Community members who visit the Health Department’s website will have access to e-mail questions about bird flu.

The Health Department is working with community groups and businesses on what they can do now in the event of a flu pandemic.  If you are part of a community group or business in Nashville and would like more information call 340-5632.

Bird Flu Information:

The Metro Public Health Department wants the community to know the following about the threat of a flu pandemic:

• The ABC Movie “Fatal Contact: Bird Flu in America” is a movie drama, not a factual accounting of a current real world event.

• There is no influenza “flu” pandemic among humans anywhere in the world at this time.

• It is important to know that a flu pandemic occurs when a new flu virus becomes easily passed from person to person.

• The H5N1 avian influenza virus (bird flu) that is the topic of the movie is at this time almost exclusively a bird disease in Asia, the Middle East, Africa, and Europe.

• The H5N1 bird flu is currently not passed easily from person to person.

• The H5N1 virus has not yet appeared in the U.S. in birds or people.

• If the H5N1 virus appears in the U.S., among birds does not mean the start of a flu pandemic.

• The Metro Public Health Department is working closely with the Tennessee Department of Health, Tennessee Department of Agriculture, and the Centers for Disease Control and Prevention, to monitor human illness and illness among domestic bird populations as a safety mechanism to detect the presence of disease, including the bird flu virus.  Again, no disease has been found among birds or humans anywhere in the U.S. or North America.

Basic Pandemic Flu Information:

• The next influenza pandemic could be substantially less severe than what the movie depicts or that occurred in 1918.  For example, the influenza pandemics of 1957/58 and 1968/69 caused much less illness and death than did the 1918/19 pandemic that many Americans at that time did not distinguish them from seasonal influenza and were unaware that a pandemic was underway.

• While the movie does serve to raise awareness about avian and pandemic flu, we hope it will inspire preparation – not panic.  There are steps individuals, families and communities can take to prepare.  You can keep a supply of food and medicines on hand in case you have to stay home, you can practice good public health measures like frequent hand washing and staying home when sick. There is good information available on www.pandemicflu.gov.

• The film does depict scenarios that could unfold should a severe pandemic ever develop, including limited availability of antivirals and vaccines as well as the potential for disruption of supplies, medicines and other essential services.

• The film also illustrates the expected months-long delay in developing an effective vaccine against a pandemic strain of influenza once it emerges.  This is why, at the President’s request, the Congress approved funding for the Department of Health and Human Services to make significant financial investments to improve the technology for vaccine development and to build up our domestic vaccine production capacity, to ensure more rapid availability of vaccine for the population in a pandemic.

• The drama highlights an important aspect of planning – individual and community planning and cooperation that will be so vital to sustaining communities and neighborhoods during an extended wave of an influenza pandemic.   HHS has developed an extensive set of planning documents, including planning checklists for businesses, schools, health care providers, community organizations and states as well as an individual and family planning guide.  All of these materials are available at www.pandemicflu.gov.

• While the H5N1 virus has not yet appeared in the U.S., and there is no influenza pandemic in the world at this time, it is important for all Americans to be informed about this potential public health threat and some of the steps individual Americans can take to protect themselves and their families in the event of a pandemic.

PANDEMIC FLU MOVIE QUESTIONS AND ANSWERS

Many people in the movie are seen wearing surgical masks.  Will masks protect me?

Surgical masks would be recommended for health care workers if they are performing medical procedures on infected patients known to have bird flu. Surgical masks would also be recommended for patients who are infected to help reduce the potential for spread of virus when these people cough or sneeze.

The movie shows the virus spreading in many ways besides coughing or sneezing, such as handshakes, kissing, sharing drinks, etc.  Is that correct?

The influenza virus is primarily spread by airborne droplets that reach the eyes, nose or mouth but can also spread by touching contaminated surfaces and then touching one’s face.  This highlights the importance of learning and practicing good personal hygiene, including:

• Wash hands frequently with soap and water.
• Cover your mouth and nose with a tissue when you cough or sneeze.
• Put used tissues in a waste basket.
• Cough or sneeze into your upper sleeve if you don't have a tissue.
• Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.
• Stay at home if you are sick.

The film indicates that there will be a shortage of Tamiflu (or other antivirals) in a pandemic.  Will there be?  And if so, what is the government doing to prevent that?

The Federal Government is stockpiling enough antivirals to treat 25% of the U.S. population should a pandemic occur in the U.S.  This figure is based on historical data from past pandemics indicating that roughly 25% of the population would get sick in a pandemic and would benefit from antiviral treatment if started early in the course of illness.  To date, the U.S. government has purchased 26 million antiviral treatment courses and expects to have on hand a total of 81 million treatment courses by the end of 2008.

In the movie officials quickly find out that there is no vaccine available when the pandemic occurs nor will any be available for many months.  Will we have vaccine available if a pandemic occurs?

There likely will be no vaccine initially available that precisely matches the pandemic strain when a pandemic begins.  Because influenza viruses continually evolve and mutate, it is not possible to develop a vaccine until after the pandemic strain actually comes into existence.  Only after the strain emerges, is isolated and characterized can a vaccine be developed and manufactured.  Based upon current vaccine production processes and capacities, it will take at least 6 months to begin producing pandemic vaccine once a pandemic strain occurs.

The Federal Government has been developing and stockpiling an experimental “pre-pandemic” H5N1 vaccine that may offer some level of immune protection should the H5N1 virus mutate into a pandemic strain.  Having a stockpile of this vaccine for up to 20 million people, may help delay or lessen the initial impact of a pandemic while vaccine against the actual pandemic strain is developed and produced.

The Federal Government is making significant financial investments to improve the technology for vaccine development and to build up our domestic vaccine production capacity, to ensure more rapid availability of vaccine for the population in a pandemic.

Many neighborhoods were quarantined in the film.  Even the Governor of Virginia quarantined himself, his staff and his family from the rest of the world.  Will the government quarantine people in a pandemic?

The purpose of quarantine is to separate people who have been potentially exposed to a contagious disease and may be infected but are not yet ill to stop the spread of that disease.   The last large-scale quarantine measures that were imposed in this country were used in the early 20th century to contain outbreaks of plague, yellow fever, and smallpox.  

Today, quarantine typically refers to confining potentially infected persons to their homes or community-based facilities, usually on a voluntary basis.  Quarantine can be used for a defined group of people who may have been exposed at a public gathering, or who may have been exposed while traveling, particularly overseas.

In the case of pandemic influenza, quarantine may be one of the public health tools employed in the early days of an emerging pandemic if efforts are undertaken to contain the outbreak before it spreads too widely.  Once a pandemic has begun to spread, quarantine is not likely to be effective in controlling the spread, and instead efforts may turn to “social distancing.” Social distancing includes measures to increase distance between individuals, such as staying home when ill unless seeking medical care, avoiding large gatherings, telecommuting, and school closures.

To date, the U.S. government has purchased 26 million antiviral treatment courses and expects to have on hand a total of 81 million treatment courses by the end of 2008.  Of its antiviral purchases, the U.S. is buying approximately 80% of its supply as Tamiflu and about 20% of its supply as Relenza.  This is due in part to product availability but also to the need to diversify the supply so as to not rely solely on one medication.

Many essential services (e.g. electricity, food, water, etc.) become scarce in the film’s scenario.  Could that happen?

An especially severe influenza pandemic could lead to high levels of illness, death, social disruption, and economic loss. Everyday life would be disrupted because so many people in so many places become seriously ill at the same time. Impacts can range from school and business closings to the interruption of basic services such as public transportation and food delivery.

In addition, a substantial percentage of the world's population will require some form of medical care. Health care facilities can be overwhelmed, creating a shortage of hospital staff, beds, ventilators and other supplies. Non-traditional sites such as schools may need to be used for patient care to cope with demand.

The film depicted many people who simply walked off their jobs.   Would that really occur?

In a severe pandemic, it is very possible that up to 40% of a business’ or organization’s workforce will be out sick or at home taking care of sick family members.  It is also possible that a small percentage of this amount will be people who are healthy but who may be too frightened to venture out into public.

The numbers of health-care workers and first responders available to work can be expected to be reduced as they will be at high risk of illness through exposure in the community and in health care settings, and some may have to miss work to care for ill family members.

What will be do with the overwhelming number of deceased bodies if we have a severe, 1918-like pandemic as was depicted in the film?

Addressing the possibility of a large number of deceased individuals in a pandemic is one of our top pandemic planning priorities.  Currently, we are working on modeling studies to try to determine as clearly as we can what we could possibly expect in terms of numbers of deaths over the course of several pandemic waves.  Until these studies are done, we won't be able to speculate on details of what we might or might not expect.  We expect this work to be done in the next few months.

Regardless of whatever estimates are developed, it is highly unlikely that in the 21st Century in the U.S. that we would ever resort to mass graves.  We are working with many government agencies (e.g. VA) as well as the private sector (e.g. the funeral industry, the cemetery industry) to develop guidance for states, local communities and others that maintains the dignity of the deceased, honors family wishes, and respects religious and social customs.

Deciding who gets vaccine was a major question in the film.  In a real pandemic, how will you decide who gets vaccine first?

The Metro Public Health Department each year offers flu shots based on the guidance of the CDC.  The greatest risk of hospitalization and death—as seen during the last two pandemics in 1957 and 1968 pandemics and during annual influenza—will be in infants, the elderly, and those with underlying health conditions.   The CDC will decide if these individuals, along with health care providers, who are critical to maintaining a health care system in a pandemic, would be the first individuals to receive the first supplies of vaccine.  However, in the 1918 pandemic, most deaths occurred in young adults, highlighting the need to remain flexible on determining priorities for vaccination groups based on the epidemiology of an emerging pandemic.

As part of planning efforts, two Federal advisory committees—the Advisory Committee on Immunization Practices and the National Vaccine Advisory Committee—have made recommendations for prioritizing critical populations that might receive the first supplies of vaccine.  These recommendations can be found in the HHS Pandemic Plan, which is available at www.pandemicflu.gov.

In the movie, the Virginia governor's son dies because he cannot get diabetes medicine; other drugs are not available in pharmacies.

Essential supplies, including medicine, may become unavailable during a pandemic.  As part of effective planning, individuals and families should talk to their doctor about how to maintain adequate access to prescription medications.