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State getting ready for pandemic flu

By Desiree Hunter
Associated Press Writer

MONTGOMERY — Piled high on wooden pallets and dozens of blue and orange metal racks, the Saran-wrapped boxes sit like packages of goods at any bulk-club store warehouse.

But these boxes, with their varying shapes and sizes and labels with words like “bio” and “specimen,” could mean the difference between life and death for millions of Alabamians.

The state, along with the rest of the country, is in high-gear preparations for a pandemic, stockpiling medical supplies, conducting drills and creating educational materials in hopes of lessening the devastation of a deadly flu outbreak — or whatever disaster may be coming at the hands of terrorists or Mother Nature.

“For a while there we were focused on smallpox and sometimes we were focused on hurricanes and sometimes we were focused on biological attacks, but now we’re just kind of an all-hazards approach,” state emergency planner Kent Speigner said, his voice echoing in the cavernous warehouse.

“There’s about 15 scenarios of things that could happen nationally, so we’re trying to be prepared for a wide range of events ... we’re looking at the broad and big picture,” he said. “We really don’t know what’s coming next.”

State Health Officer Don Williamson said the biggest concern is a lack of staff to provide pandemic-scale emergency medical services — and the ethical dilemma of who should get vaccination shots first.

At least one of 12 practice drills suggested by the Centers for Disease Control have been conducted in all of Alabama’s 67 counties and most of those have included business and community groups, said Cindy Lesinger, the health department’s pandemic influenza coordinator.

“That’s still something some of our counties have to work on — getting involved with some of these groups that we haven’t traditionally worked with in pandemic planning,” she said. “Business was already involved in some places and the goal is to make sure we have all the seven sectors involved in planning.”

Williamson said the practice drills were successful, but the other trouble spots remain, including who should get drugs if supplies are scarce.

Would the emphasis be on preserving individuals and thus every patient on a first come, first served basis, or would preserving society be the priority, with drugs given to essential folks first?

Major ethical decision

“That is a major ethical decision that has not yet been reached at a national level,” Williamson said.

The state currently plans to make sure first responders and medical staff are vaccinated first, followed by individuals, with priority given to the young and old, Williamson said.

Health and Human Services estimates say 12,975 Alabamians would need hospitalization in a mild outbreak like the 1957 Asian flu and 1968 Hong Kong flu outbreaks. A severe 1918-like outbreak, when “Spanish flu” killed 500,000 in the U.S. and millions more around the world, would mean hospitalization for 148,500 and 28,545 deaths in Alabama. An estimated 3,135 people would die in the state in a moderate outbreak.

Williamson said he wasn’t as worried about bed space in the event of a moderate outbreak because the state has 7,000 hospital beds and can quickly create about 1,200 negative pressure rooms, which create sterile hospital-like environments. Staffing is his concern.

“It’s that we don’t have the health care workers to take care of all the patients that would be potentially impacted,” he said.

The state has purchased 900 portable cots that can be quickly set up in a church, school gymnasium or empty store buildings, Speigner said, and there are plans to buy about 250 more.

Lesinger said about $1.6 million in federal funds has been received for pandemic flu planning since May and a second-phase installment of $3.4 million became available Oct. 1.

Nearly $7 million in state funds has been appropriated to buy Tamiflu, but the state plans to use around $6 million for the 474,000 courses it has committed to buying, Williamson said.

Tamiflu in stock

Alabama has 31,400 courses already in stock.

The Tamiflu is kept in the department’s original warehouse, where it can be refrigerated, but the other supplies — including 500,000 surgical masks, 300,000 syringes and thousands of cotton balls — are housed in two new warehouses that total 70,000 square feet.

Officials are tightlipped about the location of the nondescript brick buildings for security reasons and to avoid a rush of residents going there if an emergency occurs, Speigner said.

“Just imagine how bad that would be,” he said. “We had lines of elderly people waiting outside clinics in terrible weather and that was just for the seasonal flu. Think about what it’d be like if we had four or five thousand healthy young men coming here.”

Senior epidemiologist Chris Sellers coordinates the state’s flu surveillance and said 20 hospitals statewide send in their lab reports and more than 50 doctors report cases of Influenza Like Illness, or ILIs, to the department.

Providers can input the information at the department’s website or fax it in each week and the department of education also sends in its absentee information and that’s used to track flu activity, Sellers said.

School plans

Sue Adams with the ADOE said generalized pandemic plans have been given to each of the state’s 131 school systems with local superintendents making changes to fit their specific needs.

Education officials have partnered with Alabama Public Television to make school lessons available on TV if schools are closed, but those plans are still being worked out, she said.

Williamson said the decision to close schools will be made after a meeting between State Superintendent of Education Joe Morton, Gov. Bob Riley and himself, with Riley making the final announcement to the public.

Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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