Local health departments brace for bird flu

Sandra Lilley News producer • E-mail

Is your town ready for a possible pandemic of bird flu or any other large-scale health emergency?

Dr. Karen Smith, public health director for Napa County, Calif., wanted to find out. The answer was a real eye-opener, she said, and has kept her awake at night.

“We examined five nursing homes in our area and asked them what plans they had if they had to evacuate," said Smith. "Each of the nursing homes told us they had a contract with a local van service. What they didn’t know is that they were all counting on the same service."

The lesson is that “if there is a crisis, no one is affected individually, so one cannot plan alone. That is why we need a community plan," Smith added.

As countries around the world report the presence of the H5N1 avian influenza virus in poultry and wild birds, health officials are preparing for the arrival of the deadly germ on U.S. shores. The biggest fear is that the virus will eventually mutate and become easily transmitted from person to person, sparking a massive outbreak.

But if a deadly virus becomes widespread in the United States, will local public health departments — the “Marines” on the front lines of the outbreak — be prepared?

‘All public health is local’
“The lesson we learned from Katrina is that ultimately, all public health is local,” said Dr. Paul Etkind, an epidemiologist and deputy director for public health in Nashua, N.H.

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In the event of a disaster or deadly pandemic, "local public health departments have to be ready to shoulder the load and do it without any external help, at least for the first couple of days,” said Etkind. “The federal government has been quite clear. They've said, 'We don’t have any personnel to come to your rescue,' and the states are saying the same thing."

Last fall, President Bush proposed approximately $7 billion in emergency funding to help states prepare for a possible outbreak of bird flu. But only about $600 million was earmarked for local public health departments. Congress has approved roughly $3 billion of Bush's proposed funds, setting aside around $350 million for local preparedness.

The bulk of the funds are slated for the development and stockpiling of vaccines and anti-viral drugs, but what about funding for personnel to distribute these medications?

Preparation pitfalls
Etkind has been working on various pandemic scenarios, and one of his biggest concerns is the shortage of local health workers and other vital staff. Nashua’s Department of Public Health has only six nurses, at most.

“If we have a pandemic flu, we’ve estimated we would immediately need 230 people to run mass clinics of two shifts a day,” Etkind explained. And in order to handle approximately 200,000 anxious people, nurses would be just part of a larger emergency scenario. There would also be a need for administrative staff, parking and traffic control personnel, janitorial services, as well as vendors to provide food and water.

Smith, of Napa County, wishes she had a full-time staffer in her local public health department whose sole job was to work with the community to coordinate disaster plans. But public health agencies have lean budgets, and the necessary funding is not available.

Cutting through red tape
In a major emergency, there is no time to waste, and the more doctors and nurses who show up to help, the better. But finding medical workers who can legally perform duties in a particular area is not as easy as it sounds.

“Nashua, N.H., is right near the border with Massachusetts. If doctors or nurses from there volunteer, right now I couldn’t use them since licensing is done at the state level. Am I going to turn them away?” asked Etkind, adding that he’s constantly calling for changes to these antiquated laws.

And what about the friendly retired school nurse who offers to help out?

“If there is one thing I would be doing instead of stockpiling Tamiflu, it is changing the liability laws,” said Smith. “Everyone is worried about getting sued. So, for example, our local hospitals could not 'lend' a nurse to us if we needed one.”

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