Dr. Shelley Stonecipher, epidemiologist and field officer with the Centers for Disease Control, addressed a group of local business and government officials last week about preparing for the potential of a bird flu pandemic, including a list of possible symptoms to look for should an outbreak occur.

In a worst case scenario, should the United States be caught in a worldwide pandemic of avian influenza, millions of Texans would fall ill and hundreds of thousands of people could die across the state.

Some businesses might have to close at least temporarily as untold numbers of employees stay home because they are either sick, afraid of getting sick or are caring for a loved one who has the disease.

There may be food and gas shortages and medical facilities would be overwhelmed with patients either seeking treatment for symptoms or demanding a vaccine which may not be developed in time.

Or, none of the above scenarios may ever occur. Health officials may be able to contain the current outbreak of bird flu overseas and the disease might never mutate into a form where it can be easily transmitted from person to person.

Dr. Shelley Stonecipher, epidemiologist and field officer with the Centers for Disease Control (CDC), met with a group of local business and government officials this past week to give them the latest information on the potential for a flu pandemic.

She cautioned how, at the present time, there are just too many variables to predict what may happen if and when the flu will strike the United States.

“A lot of the questions you are going to have, we are not going to have the answers to,” Stonecipher said. “Some people are saying three months, some people say a year. It may never get here.”

Still, she readily repeated the mantra being spread by others in her profession; that now is the time to begin preparations, just in case.

“The fact that we are here is worrisome,” Stonecipher said of the need for such a meeting.

Currently, there is not a human influenza pandemic. A new strain of influenza virus, known as H5N1, has been found in birds in Asia and has been shown to infect humans through direct contact. There have been no cases reported in the United States.

According to the CDC, the H5N1 virus has raised concerns about a pandemic because it is especially virulent, is being spread by migratory birds and continues to evolve.

Most of the human cases reported throughout Asia so far are believed to be connected to direct exposure to infected poultry. While there has been no reported sustained human to human transmission so far, the fear is that the virus will evolve or mutate into a form where it can easily be spread among humans.

Stonecipher said the difference between the avian flu and the influenzas which typically spread across the country each year is that even with the strongest forms of human flu, some people have an immunity, whether through previous exposure or through having received doses of a vaccine.

“This virus is a new subtype,” Stonecipher said. “No one has any immunity.”

The development of a vaccine won’t be possible until if and when the virus evolves into a form which can be easily transmitted among humans. From there it would take months to make enough of the vaccine, which at first would be limited in doses to individuals considered top priorities.

Health care personnel with direct patient contact, essential and emergency service providers and young children would likely be among the first to receive any vaccine. The health care personnel would be needed to administer the vaccine and care for the sick, the essential service providers would be called upon to maintain the day-to-day operations of a city and children because they could rapidly spread the virus to classmates, teachers and the rest of their family. The vaccine, once it is created, would probably require two doses a couple of weeks apart.

As there may not be a vaccine alternative available for some time, Stonecipher stressed how other measures will be used in battling the potential for a pandemic.

“We’re going to be relying on prevention, containment and control,” Stonecipher said.

The most important strategy right now is prevention.

“That means staying as healthy as possible,” she said.

Making sure to wash your hands, using a tissue or a sleeve (not your hands) to cover a sneeze or cough, and getting a yearly flu shot are among the steps being recommended.

But what if the worst case scenario does occur? Based on the totals from the last major influenza pandemic which occurred in 1918-1919, between 5 and 10 million Texans would become ill, with between 200,000 and 400,000 people requiring hospitalization. There could be anywhere between 75,000 and 500,000 deaths from the flu, Stonecipher said, noting how businesses should be making plans now for how they would continue to operate in the event of a major influenza outbreak.

“There will be a possibility your employees will be too sick to come to work,” Stonecipher said. Others would want to stay home, afraid of coming into contact with infected people, while some employees may be placed in a position of caring for children or spouses who are at home sick. Some businesses might prefer their employees work from home whenever possible.

“Up to 40 percent of the workforce could be absent for two to three months,” Stonecipher warned.

Wearing “doctor’s masks” might help, she said, but it would depend on how the influenza is spread. Anti-viral drugs such as Tamiflu are also going to be in limited supply, Stonecipher explained, adding they may only have limited effectiveness against the flu and can carry their own adverse side effects.

The best idea for now, she added, is to stay informed about the disease and how it may be spreading or evolving.

“This is going to be a moving target,” Stonecipher said, promising health officials will be doing everything possible to keep the public aware.

“You are not going to be alone in this, I assure you,” she said.

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