'U' prepares disaster plan for possible flu pandemic

BY ARIKIA MILLIKAN

Published October 23, 2006

Years ago, Dean of Students Sue Eklund took an emergency resuscitation class where she learned the Heimlich maneuver and CPR.

Maybe she'd never use those skills, she thought at the time, but maybe they'd save a life.

With the threat of an avian influenza pandemic growing as birds migrate south for the winter, every University department is making preparations that could potentially save your life.

Eklund's sentiments on her CPR skills echo those of administrators involved in the efforts to prepare for an influenza pandemic: You never want to have to use it, but it's good to know.

Robert Winfield, the man at the nucleus of the University's pandemic response preparations, said he would much rather be safe than sorry when it comes to the avian flu. As a co-chair of the University's Infectious Hazards Planning Group and the University's chief health officer, Winfield is mobilizing each of the 19 colleges at the University as well as non-academic units like the Division of Student Affairs.

It's impossible to tell if, when and how a pandemic will strike campus, but each department is developing a plan to determine how it could maintain the flow of daily business in that situation.

Winfield said his focus is not only on how to respond to the problem but how to get the campus back on its feet after it ends.

Using the Spanish influenza pandemic of 1918 as a model, Winfield has asked departments to plan their emergency procedures based on a situation where 30 to 45 percent of the campus population would incapacitated for up to 3 months.

According to Science magazine, the 1918 pandemic is "the largest recorded outbreak of any infectious disease."

Winfield has turned to the book "The Great Influenza" by John Barry for historical reference and insight into pandemic planning. According to the book, the 1918 flu killed more people in 24 weeks than AIDS has in 24 years.

Last year, scientists at the Centers for Disease Control reconstructed the virus responsible for the 1918 pandemic and found that the virus was extremely similar to current strains of avian influenza, also known as H5N1. In addition to genetic similarities, both viruses are particularly lethal to otherwise healthy people between the ages of 15 and 34 because of the immune response it provokes. Both cause the overproduction of viral defense proteins, which flood the body and turn lethal as they accumulate.

According to Terry Alexander, executive director of the University's Occupational Safety and Environmental Health department, the current H5N1 virus has the potential to be even more lethal than the 1918 Spanish strain. Where the 1918 influenza virus killed only 4 to 8 percent of those infected, he said, the current avian flu strain has a mortality rate of about 50 percent.

Still, Alexander doesn't expect casualties on the level of the 1918 flu.

"Since then, there's been a huge amount of progress in medical technology," he said. "Perhaps we will have the tools to fight this disease."

The ability to reconstruct the 1918 influenza strain has given researchers at the CDC insight into what genetic components made the virus so harmful. This information will help in the development of new drugs and vaccines to fight H5N1.

Vaccine production traditionally involves the inoculation of chicken eggs and takes about six months. According to the World Health Organization, a new technique called reverse genetics would shorten production time to three to four months.

Winfield said experimental avian flu vaccines appear promising at this point, showing a desirable immune response in infected mice.

Unfortunately, pandemic planners cannot place all of their inoculated eggs in one basket. Vaccine production would only be useful if it were known which strain would cause a pandemic.

This is a major problem that Alexander and Winfield have anticipated.

"Nobody knows what kind of virus will cause a pandemic," Winfield said.

Another problem, preventable by nothing short of time travel, is that nobody knows where the virus will strike, if it does.

Hypothetically, the virus could start in Ann Arbor as a result of all the international travelers that come here, Alexander said.

"There are so many unknown aspects to this at this point in time," he said. "We're kind of in a waiting game to see what nature will throw at us."

Experts at the Institute of Medicine of the National Academy of Sciences and elsewhere say the pandemic is inevitable, even overdue.

For the past 300 years, there have been three pandemics per century. Drawing on this pattern, experts predict that another will come sometime in the next 10 years.

"It's been over 40 years since the last pandemic," Alexander said. "We're probably due for something."

Or it could never happen.

"We're hopeful that we're doing all this planning for nothing," said Diane Brown, University facilities and operations spokeswoman.

Pandemic planning efforts are centered not only on medical necessities but also communication and action procedures, in large part because of the unpredictability of the virus.

Planning at this scale takes a lot of coordination. A thick stack of papers sits on Alexander's desk in his office near Michigan Stadium, each page containing business continuity plans from around the University to ensure that the students, faculty and staff will be taken care of in a pandemic situation outside of the medical realm.

Eklund is working to assess student needs and devise plans for a massive increase in emergency support services. She's no stranger to emergency response: She led the University's response to victims of Hurricane Katrina and the tsunami of last year.

She said dealing with these events has provided her insight on the scope of human need.

If a pandemic strikes, some of the most important tasks will be dealing with housing concerns, making sure food and other necessary resources will continue to be provided and knowing how to communicate information to students.

"The good news is, we don't have to put a plan into action tomorrow, so we've got some time to think about how to do this," Eklund said.

Confirmed Cases

Countries with the most human cases of avian flu:

1. Vietnam - 93(42 deaths)
2. Indonesia - 72 (55 deaths)
3. Thailand - 25 (17 deaths)
4. China - 21(19 deaths)
5. Egypt - 15 (6 deaths)

Total cases worldwide: 256
Total deaths worldwide: 151