If a flu pandemic reaches Milwaukee County, top health officials will be alerted via pager, BlackBerry and fax. -- Special masks will be worn by anyone who steps out of the house. -- Community events will be canceled, schools and businesses closed. -- Refrigerated trucks housing bodies will line 9th St. in Milwaukee. - - Mass screening and treatment facilities will open. -- Nearly 300,000 people will be sickened and nearly 6,000 killed, county officials estimate.

A pandemic would have a lesser, but still staggering, impact on surrounding counties. That's why many of them have similar response plans and are partnering up with neighboring counties to coordinate their preparations.

"Obviously, the flu will not stay in one municipality; it will cross borders and we will all be in this together," said Jennifer Stohler, public health preparedness coordinator for the Milwaukee- Waukesha County Consortium.

In addition to the government efforts, 31 hospitals across nine counties in southeastern Wisconsin have simulated different scenarios to figure out what they need to do to be ready for a dramatic surge in illness. They've spent hours talking about the number of staffed hospital beds, intensive care unit beds, special breathing masks, mechanical ventilators, surgical gloves, stethoscopes and thermometers available throughout the region. They've figured out how to rearrange hospital rooms and outpatient centers to hold at least 50% more patients. They've even identified a slew of volunteers, and set up agreements with medical supply manufacturers to expedite hospital deliveries.

Yet, in the face of a real pandemic, such as the one feared with bird flu, no one is certain that any of this planning will work.

"There is no way to plan or project specifics or to foresee what we would do, but what we can promise is that what we will do is respond as best we can," said Brian Buggy, an infectious disease physician at Columbia St. Mary's, Milwaukee Campus, who has been involved in that hospital's planning efforts. "Everybody would be called in to assist, we would create separate areas for those with flu-like symptoms, we would have separate recovery rooms, we would cancel surgeries, we would all live in the hospital and give up our individual freedoms."

No vaccine, anti-virals

The scenario they are envisioning falls under "pandemic phase 5," widespread human-to-human transmission of an influenza virus, according to the World Health Organization. Today, the world is at a pandemic alert level of 3, meaning that a new influenza subtype is causing disease in humans, but is not spreading efficiently and sustainable among humans, the organization says.

The worst pandemic in modern history, the 1918-'19 Spanish influenza, killed an estimated 40 million to 50 million people worldwide. In Milwaukee, 18,000 got the flu and 1,100 people died.

One way in which a modern response would be different is the level of communication. The City of Milwaukee Health Department, for example, would rely on local media, its Web site and a hotline, with messages prepared in English, Spanish and Hmong.

"We still have to make sure we get out public health messages such as frequent hand-washing, keeping your hands away from your nose and mouth, and staying home from work and from school if you're sick," said Bevan Baker, Milwaukee health commissioner.

After that, it gets a little murky. There is still no vaccine approved for the H5N1 virus, and the availability of massive amounts of anti-viral drugs is a long way off.

As for casualties, preparations vary from county to county. Eileen Weller, administrative manager at the Milwaukee County medical examiner's office, said her department can handle 60 bodies on-site. It has an emergency plan to close off 9th St. so bodies can be stored in refrigerated trucks, and permission to rapidly cremate bodies, if needed.

Separating people

Another problem the area faces is how to carry out mass isolation and quarantine, if needed, said Paul Biedrzycki, Milwaukee Health Department's manager of disease control and prevention.

"Will it be voluntary or involuntary? Will it be done en masse or based on geography?" he asked. "Isolation and quarantine may be an effective tool early in the disease in slowing the spread, but it will likely be useless once the pandemic is full-blown and disease incidence is high and transmission is rampant."

Isolation and quarantine were used on a widespread basis during the 2003 SARS outbreak, but that didn't affect the U.S. much. Patients who were ill were isolated in their homes or at hospitals until they were no longer infectious. Those exposed to a patient were quarantined, regardless of whether they got sick or not.

Wisconsin dealt with modest isolation concerns during the 2003 monkeypox outbreak. Twelve people in the state, including eight in the Milwaukee area, were sickened after contact with prairie dogs. Three of the eight were hospitalized and placed in isolation at Froedtert Memorial Lutheran Hospital in Wauwatosa.

"Monkeypox was good practice for us," said Charles Edmiston, a professor of surgery at the Medical College of Wisconsin and epidemiologist with the hospital.

Yet, pandemic influenza will test the health care system at a whole different level, he said.

"We could possibly be inundated with patients," he said. "This would be trying for a hospital because hospitals take care of everybody, not just those with influenza."

Though the U.S. Centers for Disease Control and Prevention has some authority to detain, examine and release people suspected of carrying certain communicable diseases, states generally have to declare and enforce their own quarantine laws.

That means laws could differ widely among states.

"There really aren't any ordinances or statutes that speak to this pandemic," said Milwaukee Assistant City Attorney Stuart Mukamal, adding that quarantine during a pandemic could "grind the city to a halt."

"One thing different about flu is that it's not a situation where you have to isolate or quarantine a few people," he said. "We're likely talking about isolating or quarantining an entire city."

Mukamal said that a state of emergency would likely be declared by the governor, but lines of authority between the state, local and federal governments could become problematic.

"Many normal procedures that govern go out of the window," Mukamal said.

So many unknowns

On Nov. 1, President Bush requested a $7.1 billion appropriation to implement a national plan that emphasizes vaccine development, anti-viral drug stockpiling and local preparedness plan strengthening. He warned states that they would be responsible for handling their own situation. The next day, Health and Human Services Secretary Michael Leavitt reiterated the need for states and municipalities to further develop their own plans.

"A pandemic is unique to all other natural disasters," he said. "Hurricanes are constrained geographically, a pandemic is not. It's quite likely a pandemic will be occurring in as many as 1,000 multiple locations in the country and many more in the world."

Thomas Haupt, influenza coordinator for the Wisconsin Division of Public Health, said the state plan must constantly evolve. "This plan is a work in progress," he said. "It's not something that will ever be complete. We are preparing now for what we expect to happen, and we will prepare until it happens and even continue while it's happening."

John Whitcomb, the bioterrorism and physician coordinator for Aurora Health Care, said a pandemic now would not be as deadly as the 1918 pandemic at least not in the U.S. because of improved antibiotics and other advancements that allow rapid testing and treatment.

And not everyone exposed to the virus would get seriously ill. "That means that many people will be able to take care of themselves at home with the things your grandmother told you about chicken noodle soup, fluids, Tylenol, bed rest and a sympathetic person beside you to make you take it," Whitcomb said.

Still, he said, everyone will need a personal plan just as the hospitals and governments need their plans.

BIRD FLU

ARE WE PREPARED?

SUNDAY: Under the microscope, the bird flu virus doesn't look so dangerous. But it is. And our weapons are limited in fighting it. Can we catch up?

MONDAY: One thing's for sure if this pandemic arrives, it will be by bird or by plane.

TODAY: Southeastern Wisconsin prepares for the worst, and trusts that its plans will work.

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Copyright 2005 Journal Sentinel Inc. Note: This notice does not apply to those news items already copyrighted and received through wire services or other media
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