US readying response to flu outbreak

WASHINGTON -- President Bush is expected to approve soon a national pandemic influenza-response plan that identifies more than 300 specific tasks for federal agencies, from determining which front-line workers should be the first vaccinated to expanding Internet capacity to handle a flood of people working from home computers.

The Treasury Department is poised to sign agreements with other nations to produce currency if US mints cannot operate. The Pentagon, anticipating difficulties in acquiring supplies from the Far East, is considering whether to stockpile millions of latex gloves. And the Department of Veterans Affairs has developed a drive-through medical exam to quickly assess patients who suspect they have been infected.

The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak and continue functioning through what could be an 18-month crisis, which in a worst-case outcome could kill 1.9 million Americans.

Bush was briefed on a draft of the implementation plan on March 17, and he is expected to approve it within the week, but it continues to evolve, said several administration officials who have been working on it. White House officials offered a briefing on the near-final version of its 240-page plan.

When the plan is issued, officials intend to announce several vaccine-manufacturing contracts to jump-start an industry that has declined in the past few decades.

After the government's response to Hurricane Katrina, the White House is eager to show it can manage the medical, security, and economic fallout of a major outbreak.

Some agencies are far along in preparing for a deadly outbreak, according to administration officials and specialists in and out of government. Others have yet to resolve basic questions, such as who is designated an essential employee and how the agency would cope if that person were out of commission.

''Most of the federal government right now is as ill-prepared as any part of society," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm said the administration has made progress but is nowhere near prepared for what he compared to a worldwide ''12- to 18-month blizzard."

Many crucial decisions remain to be made. Administration scientists are debating how much vaccine would be needed to immunize against a new strain of avian influenza, and they are weighing data that might alter their strategy on who should have priority for antiviral drugs such as Tamiflu and Relenza.

The new analysis, published in Proceedings of the National Academy of Sciences, suggests that instead of giving medicine to first-responders and healthcare workers, as currently planned, it might be wiser to give the drugs to every person with symptoms and others in the same household, said one senior administration official.

To keep the 1.8 million federal workers healthy and productive through a pandemic, the Bush administration would tap into its reserve of medicines, cancel large gatherings, encourage schools to close, and shift air traffic controllers to the busier hubs.

Retired federal employees would be summoned back to work, and National Guard troops could be dispatched to cities facing possible ''insurrection," said Jeffrey Runge, chief medical officer at the Department of Homeland Security.

Much of the federal government's plan relies on quick distribution of medicines and vaccine. The Strategic National Stockpile has 5.1 million doses of Tamiflu on hand. The goal is to secure 21 million doses of Tamiflu and 4 million doses of Relenza by the end of this year and a total of 51 million by late 2008.

The administration hopes to help contain the first cases overseas by rushing in medical teams and supplies. ''If there is a small outbreak in a country, it may behoove us to introduce travel restrictions," Runge said, ''to help stamp out that spark."

Even an effective containment effort, however, will merely postpone the inevitable, said Ellen Embrey, deputy assistant secretary for force health preparedness at the Pentagon. ''Unfortunately, we believe the forest fire will burn before we are able to contain it overseas, and it will arrive on our shores in multiple locations," she said.

As Katrina illustrated, a central issue would be ''who is ultimately in charge and how the agencies will be coordinated," said former assistant surgeon general Susan Blumenthal. The Department of Health and Human Services would take the lead on medical aspects, but DHS would have overall authority, she noted. ''How are those authorities going to come together?"

Bush is expected to adopt post-Katrina recommendations that a new interagency task force coordinate the entire federal response and a high-level Disaster Response Group resolve disputes among agencies or states. Neither entity has been created.

The federal government and private businesses should expect up to 40 percent of the workforce to be out during a pandemic, said Bruce Gellin, director of the National Vaccine Program Office at HHS.

Some will be sick or dead, others caring for a loved one, depressed, or staying at home to prevent spread of the virus.

Alarm has risen because of the emergence of the most dangerous strain to appear in decades: the H5N1 avian flu. It has primarily struck birds, but about 200 people worldwide have contracted the disease, and about half have died. Researchers project the next pandemic could kill 210,000 to 1.9 million Americans.