"I think there's reason for concern and reason to take this very seriously," says Dr. Paul Carson, infectious disease specialist at MeritCare. "Though the avian flu virus - H5N1 - has yet to evolve into an easily transmissible form among humans, if it did, it could spread very quickly, likely causing a worldwide outbreak of disease. This may never happen, but then again, it could happen at any time. We need to be prepared, not just for this particular pandemic, but for any that could occur."
From a world perspective...
In the last 300 years, it's believed that approximately 10 pandemics have occurred, the most recent one in 1968. Dr. Carson says the world today is better equipped to deal with a pandemic, with considerable progress yet to be made.
"One of the major tenets of controlling a pandemic is good surveillance - looking for the virus, seeing where it's coming up new, then mobilizing resources to those areas. The World Health Organization and the Centers for Disease Control have invested considerable resources into doing this," he says. "We're better than ever at detecting the virus, tracking it and containing it."
Another hope lies in improved laboratory methods. "Today's methods are much better in helping us understand the genetics of the virus. By looking at subtle changes and shifts, we know what makes a virus more pathogenic (disease-producing) and less pathogenic. These are tools we didn't have in the past," says Dr. Carson.
And of course hope lies in the aggressive efforts now underway to develop and test a vaccine to protect humans against the avian flu virus. "There's now a hard push to update vaccine technology to readily meet new demands - that has been needed for years," says Dr. Carson. In terms of treatment, the traditional flu-medication Tamiflu appears to have some activity against avian influenza, but the supply needs to increase.
Steps taken by MeritCare and the community
An important aspect in dealing with a possible pandemic is preparation by medical facilities and the community. "Several times in recent years we have prepared for dealing with potential threats - anthrax following 9-1-1, the need for widespread smallpox vaccination, a SARS outbreak, whooping cough outbreaks in North Dakota. We've had to analyze and plan how we would ramp up very rapidly if confronted with certain situations," says Dr. Carson. "Now we're doing the same type of preparations for a possible avian flu pandemic. Thanks to past preparation, we've already done much of the homework."
Preparation is at the forefront for Joan Cook, infection control manager at MeritCare. "When it comes to emergency-preparedness, you're always scanning the horizon, paying attention to what the potential risks are and planning strategies to lessen those risks," she says. In addition to equipping herself with the most current and accurate information, she works closely with employees - and the community. For several years, Joan and representatives from area health care organizations and agencies have met on a regular basis to develop plans and strategies for meeting anticipated needs. Last year's need was the flu-vaccine shortage. "We have a very active community group with a history of working together effectively," says Joan. "It's important to have that in place before a crisis occurs."
Another piece already in place is emergency-preparedness training. Joan and more than 30 MeritCare employees have been educated and certified in the National Incident Management System. In addition, MeritCare regularly holds "table-top drills" to ensure familiarity with the management structure, decision making and communication process that would come into play in an emergency.
Steps you can take
Given what is known - and not known - about the possible avian flu pandemic, what can you as an individual do? "Being in good health to begin with is one of the best safeguards against developing complications from any infection," says Dr. Carson. Steps include:
- Get your flu vaccine (if you're in a risk group). "People have all kinds of reasons not to get a flu vaccine, but this year more than ever, they should get one," says Dr. Carson. "Even though the flu shot doesn't specifically address avian flu, it's a good step toward staying healthy. Plus, immunity against one type of flu might offer better protection against a new strain that emerges."
- Cover your cough. Cover your nose and mouth with a clean tissue every time you cough or sneeze. If you don't have a tissue, cough or sneeze into your sleeve.
- Wash your hands thoroughly and often. And for times when you can't wash, keep a pocket-size bottle of alcohol-based antiseptic gel handy - and use it.
- Avoid touching your eyes, nose or mouth. "A number of viruses can be transmitted by touching contaminated surfaces, then touching your eyes, nose or mouth," says Joan. "A good prevention strategy is to keep your hands away from face."
- Stop smoking. "Much of the influenza-related mortality comes about with the secondary development of bacterial pneumonia," says Dr. Carson. "Smokers have a much higher incidence of developing this type of pneumonia than do nonsmokers."
- Stay informed. Keep up-to-date by relying on credible sources, such as the Centers for Disease Control (www.cdc.gov). In an actual emergency, follow the plans relayed by public health officials.
"Yes, people need to be concerned about the possibility of an avian flu pandemic, but not panicked," says Joan. "Keep yourself knowledgeable and practice the basics your mother taught you - good nutrition, stress management, good sleep, covering your cough, and if you're ill, stay home. Do all you can to stay healthy - and keep others healthy, too."