Planning for a Pandemic

April 2, 2007 -- It’s not a question of if; it’s a matter of when.

Ask Dr. Jim Turner what the chances are of a worldwide fl u pandemic and he answers unequivocally and without hesitation: “100 percent. I would not be at all surprised if I turned on the news tonight and saw that an outbreak had begun in Asia and Eastern Europe. It would not take long for it to reach the United States.”

Or, it could happen years from now. There is no telling when bird influenza will transform to a pandemic strain and make the leap to widespread human infection, but Turner has no doubt that at some point it will. It will travel from person to person with a cough or a sneeze, and it will likely reach the United States by plane.

And so the University is preparing.Turner, executive director of the Department of Student Health, chairs a Universitywide pandemic planning committee, charged with ensuring that the University is prepared to successfully manage a major outbreak of infl uenza. The University is coordinating efforts with the city of Charlottesville, Albemarle County, the Thomas Jefferson Planning District and the state.

According to Turner, about 40 percent of the U.S. population could become infected with a pandemic strain of bird influenza, and about 2 percent could die. Health offi cials are preparing for the possibility of as many as 1,000 deaths in Charlottesville during a four- to 12-week period. The area could be devastated by an outbreak, forcing health care workers into overdrive, closing schools and offi ces, and isolating people who become infected. And there could be two or three waves of pandemic fl u over an 18- to 24-month period.

The Pandemic Planning Committee, comprised of administrators from across Grounds, has been meeting monthly since June 2006. They are continually revising their plan based on state and federal guidelines and are in contact with officials at other universities, sharing information and suggestions on how to manage a public health crisis. Universities are particularly vulnerable to high infection rates because of the regular close contact between students in classrooms and residence halls and the high rate of international travel by faculty, administrators and students.

“In the event of an outbreak the governor would expect all state agencies to remain open and to provide essential services,” Turner said. Police officers, firefighters, most health care providers, facilities operators and many researchers would remain on the job. Some employees, depending on their functions, would be allowed to provide services from home, communicating by phone and e-mail.

But the University will coordinate work schedules to allow employees to take care of family members and household affairs.

“Employees who are essential to the operation of the University or the hospital will need to plan in advance for the care of their family members, their pets and their homes with the help of family and friends and neighbors,” Turner said. “We all will really need to support each other.”

Antiviral medications such as Tamiflu may be in short supply. Vaccines will be developed, but because of the difficulty of isolating a new virus and making huge quantities, it would take six to 12 months for immunizations to become available to the public. The first batches would be reserved for health care workers and emergency services providers.

Because of limited access to vaccine and medication, in the early stages of an outbreak, U.Va. will practice “community mitigation strategies” designed to reduce the risks for people to infect one another. Classes will be canceled and students sent home until the crisis has subsided. Health care providers and emergency services workers may use residence halls vacated by students as a means to isolate these workers from their families during the period when risk of disease transmission is highest.

“Classes would be closed for a period of about four to 12 weeks, depending on the severity of the pandemic,” Turner said.

Some classes could be continued via “distance education” means such as online and through the mail. In the near future, the provost’s office will be working with academic departments to advise faculty about options for canceling classes or developing alternative means to complete coursework. Once the crisis has passed, the University will as quickly as possible return to a normal schedule.

U.Va. also will ask employees not to travel to areas of the world where the pandemic is beginning or most severe, likely certain parts of Asia and Eastern Europe. And U.Va. people already in those areas will be asked to return home.

Sports events, concerts and other public events will be canceled. The public will be asked to “self quarantine” by avoiding unnecessary travel and visits to stores and other locations where large numbers of people normally gather. Health officials suggest that families maintain a two-week supply of food and water.

Health care centers will set up a triage system, determining which patients will be hospitalized and which ones treated at clinics or at home. Turner says many patients will recover at home, and that the vast majority will survive their illness. The elderly, children, adolescents and young adults, and people with serious preexisting health problems likely will be most vulnerable to severe complications from the flu.

“It is hard to predict who will be at greatest risk until we actually enter a pandemic,” Turner said. “There will be a high level of fear and the health care system could be overloaded with people coming in with nothing more than the sniffles. But the symptoms to watch for are high fever, shortness of breath and chest pain, and coughing up blood.”

The public will be kept informed of what to do through the news media and public health reports on the Internet.

In the meantime, the Pandemic Planning Committee is meeting monthly, and starting next fall will be holding a series of town halltype meetings around Grounds, soliciting feedback and suggestions.

“We cannot predict how serious it will be, but the worldwide spread of the current avian flu strain puts us at greater risk,” Turner said. “People will get tired of hearing us talking about the coming pandemic, and I worry that they will think we’re crying wolf, but the fact is, it’s coming.

The key to reducing the severity is through mitigation strategies including social distancing — each person playing a role in helping to reduce the chances of transmitting infection.”

Turner noted that pandemic planning is also useful for other disasters. “The aftermath of Hurricane Katrina could have been better managed if there had been a pandemic plan in place. Everything from severe weather to the 9-11 and anthrax attacks require planning, so we can learn from those events to prepare for future disasters, such as a flu pandemic.”

With careful planning and cooperation from the University community and citizens at large, “we can minimize the impact of a major public health outbreak on our area,” Turner said.