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Preparing for Pandemic

County Health Department prepares for possibility of flu pandemic.

Over the last month Fairfax County health officials begun preparations to control a pandemic outbreak of the flu. Some scenarios envision a pandemic that could result in as many as 2 million Virginians becoming ill, with more than 6,000 deaths.

A pandemic, or global epidemic, is an outbreak of an infectious disease that affects people over an extensive geographical area.

It is unclear when or if a pandemic could affect the United States but, with the recent media attention focused on the spread of the avian flu overseas, county health officials are taking no risks when it comes to preparation.

“Plans need to be made now,” said Dr. Raja’a Satouri, deputy director of medical services, Fairfax County Health Department.

“A pandemic might not be connected to the avian flu,” she said. “But, because there has been so much attention to it, and to the influenza situation in Asia, we have been working to make sure the public knows we are prepared.”

At the request of Fairfax County chairman Gerry Connolly, representatives from the county’s health department presented the Board of Supervisors with a plan to implement before, during and after a possible pandemic.

“Experts are preparing for the possibility that this virus [avian flu] could develop the ability to efficiently spread from person-to-person,” Connolly said about the avian flu in his Oct. 17 report to fellow supervisors. “If this were to happen, they predict that if 35 percent of Virginians become ill with flu, it could result in 1.08 million to 2.52 million people becoming sick, 12,000 to 28,500 hospitalizations and up to 6,300 deaths.”

The county’s plan is continually updated and has been included to its existing Emergency Operations Plan — a guide to address specific situations during a pandemic influenza outbreak.

“We took an existing strong emergency plan and were able to embed communicable diseases and a possible pandemic,” said Satouri.

THE CURRENT RISK to Americans from the avian flu outbreak in Asia is low, according to the Centers for Disease Control and Prevention. The strain of avian flu virus found in Asia and Europe has not been found in the United States, and there have been no human cases of avian flu in the United States, according to the CDC.

But, because many travelers come through the Washington, D.C. area, including Washington Dulles International Airport, the CDC has set up screenings for people coming from the regions where avian flu was detected. The CDC and local health departments have built preparation plans from existing procedures that were used during the SARS outbreak in Canada and Asia.

Avian, or bird flu, is an infection caused by bird influenza viruses that occur naturally among birds, according to the CDC. Wild birds across the globe carry the viruses in their intestines, but usually do not get sick from them. But, bird flu is very contagious among birds and can be deadly in domesticated birds, including chickens, ducks and turkeys, according to the CDC.

Typically, bird flu viruses do not infect humans, but several cases of human infection with bird flu viruses have occurred since 1997, according to the World Health Organization.

So far, the spread of the avian flu from person-to-person has been rare and has not continued beyond one person. However, because all influenza viruses have the ability to change, scientists are concerned that the current avian flu virus reported in Asia one day could be able to infect humans and spread easily from one person to another, according to the CDC. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If the current virus were able to infect people and spread easily from person-to-person, an influenza pandemic outbreak could begin, according to the CDC.

“If a pandemic happens, it is going to be global but it will also have complications locally,” said Satouri. “Each jurisdiction is going to be in the same boat.”

In preparation of a potential outbreak, health officials have an ongoing surveillance set up to record each case of the flu reported across the county, said Satouri. This allows the health department to track a certain strain of the influenza virus, as well as keep a record of what regions may see an increase in infections. Health officials are also crossing jurisdictional lines to work on a regional plan, versus a plan strictly for Fairfax County, said Satouri. If one jurisdiction were to have an outbreak, neighboring counties would be informed and prepared to assist by opening up hospitals or other areas.

PRIORITIES OF THE COUNTY health department during a pandemic influenza outbreak will be to “assure the continuation and delivery of essential public health services while providing for the emergency needs of the population,” according to an Oct. 17 report by the county health department before the Board of Supervisors.

Coordination and decision-making ultimately comes from the federal government and the state health department, said Satouri. The Virginia Department of Health will inform each jurisdiction how to respond.

If an area of Fairfax County were to be infected with the flu, health officials would work quickly to contain infected persons as best as possible. Some methods could be through quarantine and isolation, or by closing schools and other public buildings where the disease could easily be spread, said Satouri.

“There is an aspect of knowing that if you’re sick, you might need to stay home,” she said. “Social distance is the key to pandemic control.”

During the Oct. 17 meeting, questions arose surrounding the issue of quarantine and whether or not county officials had legal authority to designate an area as off limits. The county health department’s attorney has been working on issues of isolation and quarantine, said Satouri, although she was not able to give further information.

Connolly asked if the health department could issue some type of guidebook for citizens to outline what they should do if a pandemic flu outbreak did occur.

“If we become part of a particular wave of a pandemic that spreads across the East Coast,” said Satouri, “containment measures will not be possible and we will have to push our preventative measures.”

These include hand washing and coughing etiquette. Cough etiquette means covering one’s mouth when sneezing or coughing and then immediately washing hands to prevent the spread of disease. People are contagious seven days before they show symptoms of sickness, and seven days after symptoms show, said Satouri.

Other highlights of the county’s preparedness plan include a six-phased outline that follows guidelines from the World Health Organization. This includes an interpandemic period where the health department strengthens preparedness, and a pandemic alert period where immediate identification and detection of the disease occurs. Ultimately in the pandemic alert period, the virus should be contained or delayed through isolation and quarantine while measures are taken to quickly develop a vaccine and implement pandemic response measures.

“It could be avian flu or it could be any other mutation of the influenza virus,” said Satouri about a possible pandemic.

“We have on-going changes with the plan and we continue working on it to make sure we cover everything,” she said. “We want the community to know that preparedness efforts are well under way and a lot of areas are being addressed.”