For all the attention to the bird flu, discussions of its potential dangers are, for the time being, hypothetical. The disease may never spread from birds to any large segments of the human population, or, if it spreads rapidly among humans, it could be in a form that is not fatal. Still, the less optimistic possibilities are already prompting worldwide worry â€“- and that includes in New York City.
Some of the scenarios being spun if there were ever a full-fledged avian flu outbreak in the city are not reassuring. As imagined recently by several public health experts such an outbreak could kill 300 people each day, leave Grand Central Station and other public spaces completely devoid of people, and require forced quarantine of infected neighborhoods.
“The city would look like a science fiction movie,” said Dr. Irving Redlener of Columbia University’s school of public health. “This would look like an armed camp basically.”
While extreme-sounding, Redlener’s vision of an avian flu pandemic -â€“ a widespread outbreak of a disease whose victims currently consist mainly of birds in Asia -â€“ is not much different from that of the federal government. The worst-case scenario laid out in a plan of action from the Department of Health and Human Services includes riots at vaccination clinics, shortages of food and power, and $450 billion in costs. It predicted as many as 1.9 million American deaths.
New York City is also developing strategies to deal with pandemic avian flu, and believes it is better prepared than most cities to handle an outbreak. Still, a lack of faith in the federal government and unanswered questions about the nature of the disease itself continue to concern local officials.
FEARS CAUSED BY A NEW STRAIN
A disastrous pandemic flu outbreak is not without precedent. There have been three such outbreaks in the last 100 years, the most serious of which, the Spanish Flu of 1918, killed 500,000 Americans and 40 million people worldwide
The current cause of concern is a strain of avian flu called H5N1 that emerged in 1997. The strain is most prevalent in Asia, where the disease is responsible for the deaths of 100 million birds and about 60 people -- the only human cases to date.
The avian flu is more deadly than most flu strains, killing about half the humans it infects. But it is not easily spread. In its current form, the only way to contract avian flu is through contact with the feces or bodily fluids of infected birds; properly cooked meat cannot carry the flu. What worries health experts is the possibility that the flu could mutate so that it could be spread between humans, which might lead to a pandemic on a global scale.
Again, this may never happen. But the possibility is already prompting worldwide action. China has said that it will vaccinate each of its 5.2 billion chickens, one by one; international organizations and governments are developing plans to encourage drug development and identify outbreaks early; and the United States is spending $250 million to help contain outbreaks in other countries before they spread, while also tightening surveillance at its ports.
NEW YORK CITY’S PLAN FOR AVIAN FLU
The city’s Department of Health has been working on its response to avian flu for over a year, improving its disease detection system, running planning exercises involving hospital and other health workers who would be involved in coordinating any pandemic response, and offering free flu shots to see how well it can operate clinics deluged by large numbers of people. It will publish a full plan in early 2006.
As they contemplate their response to avian flu, city officials begin by acknowledging what they cannot do.
City officials will not be able to keep avian flu from entering New York City, said Isaac Weisfuse, deputy commissioner of the Department of Health. “Once it arrives, we can only try to slow its transmission,” he said. “We will not be able to halt it.”
Still, since 9/11, when the city turned its attention to the threat of a bio-terror attack, New York has been building its capability to deal with a major public health emergency.
“Although there is unquestionably a great deal to be done to prepare, the New York region is fortunate to have many aspects of the required preparedness infrastructure already in place,” said Susan Waltman of the Greater New York Hospital Association.
The first thing the city has done is to bolster its ability to identify disturbing disease patterns by improving the system it uses to track diseases like the regular flu. In doing so, the city is attempting to strengthen its relationships with the network of hospitals, clinics, and other health care providers that would also be involved in any response to an outbreak.
Such coordination would be essential, since health experts agree that the city’s hospital system would be overwhelmed by a full-blown pandemic flu. These concerns seem to run counter to the discussion about hospitals taking place on the state level, in which many argue that overcapacity is hurting the finances of New York’s health care institutions.
City Hall is already ruling out some of the more extreme measures that have been floated. City officials have rejected mass quarantine and the widespread use of masks, saying that neither would be effective if an outbreak did occur. Nor is New York City stockpiling drugs, focusing instead on refining the way it will distribute drugs if needed.
In fact, no vaccine for avian flu currently exists, and it is not clear whether Tamiflu, the antiviral drug used to ease symptoms of the regular flu, would have any effect on the disease. For the moment, the city is leaving it to other levels of government and the private sector to develop useable drugs and make them available if needed.
But city officials are also wary of leaving too much in the hands of the federal government, particularly after its performance handling Hurricane Katrina. This feeling of distrust was compounded at a recent city council hearing on avian flu to which both state and federal officials were invited to testify. Neither Albany nor Washington sent a representative.
“We would like to think, and it probably makes us sleep easier at night, that big problems like avian flu outbreaks or epidemics will be taken care of by the federal government. I don't know if it ever was [the reality], and it certainly no longer is,” said Christine Quinn, head of the council’s health committee. “Rightly or wrongly, the burden is going to fall on the cities.”
THE FEDERAL RESPONSE
The federal government does have a $7.1 billion plan to confront avian flu, which deals largely with developing and stockpiling drugs.
The federal plan also calls for state and local governments to develop their own emergency responses to a future pandemic. It provides $644 million to ensure that all levels of government are prepared for an outbreak, and is asking that state governments chip in on the cost of buying drugs in addition to coordinating treatment for patients.
Critics say that the federal government's plan doesn't provide state and local governments with adequate funding to carry out the tasks it has assigned them. "The plan sets lofty goals but largely passes the buck on practical problems," wrote the New York Times in an editorial last week. Weisfuse, of the city's Department of Health, told the city council that "the federal allocation was peanuts for state and local health departments."
FOR MORE INFORMATION
New York City Department of Health Avian Flu Fact Sheet
Centers for Disease Control and Prevention Avian Flu Pandemics Fact Sheet
White House Fact Sheet on its Pandemic Flu Plan
Department of Health and Human Services Pandemic Flu Plan