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Friday, September 16, 2005

There's flu, and then there's Flu.

This year, doctors are on the lookout not just for seasonal influenza, but also for the possible arrival, later on, of a lethal and highly contagious strain of avian flu from Southeast Asia.

"Basically, bird flu has the same symptoms as regular flu, except you don't get better," said Dr. Barry Prystowsky, a pediatrician in Nutley. Prystowski is one of about two-dozen doctors in New Jersey designated by the state as "sentinel physicians," who keep a watchful eye for signs of pending epidemics.

"You quickly dehydrate and get pneumonia at the same time. You would need hospitalization within a few days, then end up on a respirator and probably die," Prystowsky said.

It's a dire diagnosis, but New Jersey health officials believe the state is ready.

Sentinel physicians are one component of a comprehensive early detection and response system outlined in a draft of the state's 2005 Influenza Pandemic Plan. An updated version of the plan, first conceived in 2002, is posted online. It will be revised to keep up with emerging infectious diseases, officials said.

A pandemic is an epidemic that can spread across a country and to other parts of the world. Bird flu, which emerged last year in Vietnam and Thailand and moved recently to Russia, has killed more than 50 people, mainly poultry workers. What has not happened, but what health officials fear, is that the avian flu virus - known as H5N1 - will be spread further by migratory birds.

The even bigger fear is that the virus will combine genetically with a human viral strain that can be transmitted person to person.

That new strain would be highly contagious and deadly, scientists say.

Some experts have predicted darkly that, if such a strain develops, the world could face a pandemic like the so-called Spanish flu of 1918 that killed more than 20 million people. There is no way to say if and when bird flu will hit the United States, but European officials worried this summer that they will have to deal with it sooner rather than later. One British scientist told reporters bird flu presents "a national emergency. ... Many people are threatened by a virus that can decimate a country."

As it is, New Jersey health officials estimate that an eight-week pandemic would cause 1.5 million outpatient visits and nearly 41,000 hospital admissions, including 9,553 patients in intensive care and 4,775 on respirators. There would be 8,141 deaths, they estimate.

Across the United States, officials predict that a pandemic could kill upward of 207,000 and hospitalize 733,000, compared with 36,000 deaths and 114,000 hospitalizations in an average flu season.

Sentinel doctors

Sentinel physicians such as Prystowsky are on the outlook for increasing numbers of patients with symptoms such as sore throat, fever and cough. The doctors file a weekly report with New Jersey's Local Information Network and Communication System and state health officials analyze the data for spikes in the numbers.

If a suspicious illness appears, the sentinel physician may send a sample to the state labs in Trenton to be tested and forwarded to the federal Centers for Disease Control and Prevention, which oversees the sentinel program.

New Jersey's Pandemic Plan is a "generic" defense against any invading microbe, said Dr. Eddy Bresnitz, the state epidemiologist.

"The approach would be the same whether for bird flu or other flu," Bresnitz said. "This is flu. We're going to test it. When we do surveillance, we don't presuppose for what. If we knew what strain it was, we wouldn't have to test for it."

New Jersey will also monitor any "influenza-like illness" reported by hospitals, nursing homes and elementary schools, as well as the amount of over-the-counter drugs sold by pharmacies, as possible early indicators of flu.

Also, six cities - Paterson, Jersey City, Elizabeth, Newark, Trenton and Camden - are among 120 cities nationally that will tell the CDC each week how many death certificates involved pneumonia and influenza.

New Jersey's response to a flu pandemic would include informing the public about supplies of vaccine and antiviral medication - such as Tamiflu, an effective prescription flu treatment if used shortly after symptoms appear - school and business closings, suspended public meetings, travel restrictions and quarantines. More than 3,000 crisis counselors would be deployed.

The state is a lot better prepared since Sept. 11 and the subsequent anthrax and bioterrorism scares, Bresnitz said. "We've really improved all our capabilities of responding to emerging infections," he said.

In months to come, New Jersey will stage a flu-pandemic exercise similar to the simulated bio-terrorism attack drills held at hospitals in the spring, Bresnitz said. The state Department of Agriculture also has an avian-flu detection and response plan, including the culling of infected poultry flocks if necessary.

Flu is airborne

Bresnitz said there is more than just a whimsical distinction between sentinel physicians who gather information, and the so-called sentinel chickens used by health officials in years past to detect the presence of West Nile virus-infected mosquitoes.

But surveillance is only a tool for early detection and might not stop a pandemic, Bresnitz said.

"Influenza is an airborne disease spread very efficiently, with a short incubation, so we'd have to depend on other things," he said. This includes common sense personal hygiene such as hand washing and covering coughs and sneezes.

Seasonal influenza and flu pandemics have many similar public health issues, such as potential vaccine shortages, Bresnitz said. Federal scientists, for example, announced this month they had successfully tested a potentially effective bird-flu vaccine in people, but are unsure whether they can produce enough of it in time.

"But a pandemic is a different beast," Bresnitz cautioned. "A novel virus strain that nobody is experienced with has higher mortality and greater number of people infected."

New Jersey will also encourage hospitals statewide to develop "surge capacity" guidelines, similar to ones issued during last year's flu-vaccine shortage, to accommodate the anticipated crush of thousands of pandemic patients. They will have to decide whom to admit and whom to send home.

"I think they're all as prepared as they can be," Aline Holmes said of the New Jersey Hospital Association's 105 members.

"Everyone has their plans in place to work closely with the Health Department," said Holmes, a nurse and the association's flu liaison with the state.

Prystowsky, the Nutley sentinel physician, is less sanguine.

If bird flu combines with a human viral strain and begins to spread, he said, "I think it's going to be devastating."

"I think thousands of people are going to die, especially the fragile, the elderly, the very young, the babies. I don't think we'll have the vaccine supply because they won't be able to produce it. If it hits, hopefully we'll have enough Tamiflu to save some of us."