In flu crisis, we all can't stay home

WASHINGTON -- Ask Americans whether they would hole up at home to keep from spreading a super-strain of flu, and at first they pledge to cooperate.

But probe deeper, and here come the doubts. One in 4 adults says there is no one to care for them if they got sick, raising the specter of Grandma gasping alone in bed or a single mother passed out while her children wail.

Another 1 in 4 could not afford to miss work for even a week.

And 1 in 5 fears the boss would insist they come to work even if they were sick and contagious.

So concludes a survey by Harvard researchers that will bring the concerns of average people into government deliberations on how to fight the next worldwide outbreak of a super-flu.

"If you want to contain the flu, you have to make it livable for people" to comply with infection- control steps, said Robert Blendon, a health policy specialist at the Harvard School of Public Health. He planned to present the survey today at a meeting of public health officials.

Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people have never experienced. This has happened three times in the past century.

Old-fashioned infection control is one strategy to try to slow a pandemic's spread until vaccines become available: staying home if you are sick or may have been exposed; closing schools; and avoiding crowded gatherings such as church services, sports events, and shopping malls.

It is far from clear how well such measures would work, or some could cause more harm than good. So the government asked the Institute of Medicine to bring together health specialists, state and local officials, and industry this week to debate that issue.

Harvard's Blendon was pleasantly surprised that his survey of 1,697 adults suggests people are paying attention to pandemic discussions.

Some 94 percent said they would stay home, away from other people, for seven to 10 days if they had pandemic flu and 85 percent would do so if a household member were sick. Equally high numbers said they would heed calls not to leave their community while pandemic flu circulated.

But as the survey probed more consequences of containment measures, people began to realize what hardships could await them.

"If you want to guarantee that society will collapse in terms of the economy, tell everybody to stay home," said Michael Osterholm, a University of Minnesota infectious-disease specialist who has advised the government on flu preparations.

"Somebody's got to move the food, take away the garbage, provide healthcare, law enforcement, to assure that communication continues."