The cavalry isn't coming

The National Journal (much read by congressional staffers) must be reading Effect Measure. Either that, or "the obvious" is stating to be, well, obvious:

If a bird-flu pandemic hits the United States, don't expect to see the federal government riding to the rescue. "Communities, in large part, will be on their own," predicts Pat Libbey, the executive director of the National Association of County and City Health Officials.

By definition, a pandemic affects a vast geographic area and a huge number of people. Avian flu would spread fast and easily from person to person (especially in buses and other confined public spaces), since it is contagious before symptoms develop. By the time the first victims appeared, epidemiologists would have to presume that the flu had already spread far and wide.

Every community in America would go on red alert. At that point, the federal government "can't come in and take over," Libbey said. "The math alone just doesn't work."

The federal role in such a pandemic would be largely policy-oriented and advisory, Libbey and local health officials explain. The Centers for Disease Control and Prevention would issue technical advice to health care workers, such as what symptoms to watch for in the population, how to administer a vaccine or an antiviral, and which groups of patients should receive treatment first. (The National Journal; subscription only, alas)

Besides advice, the feds might also distribute vaccine--except for the minor point that there isn't one.

But beyond all that, the federal government can't provide much tactical help. "It's every community for itself," says Gary Oxman, the health officer for Multnomah County, Ore., which includes Portland. This comes as no surprise to local officials. Ever since the 9/11 attacks and the October 2001 anthrax mailings, communities have been gearing up for a bioterrorist attack, the effects of which could mirror a flu pandemic. In the process, they've taken a hard look at their own limits.

The rest of the National Journal article is about the obvious medical and public health issues of surge capacity (additional hospital beds and equipment). But the more important issues relate to how all parts of the community--public services, businesses, schools, transportation, supply lines, etc.--will cope with a projected 30% prolonged absenteeism. This has the potential to cause a set of cascading problems, such as interruptions with food deliveries, essential drugs like insulin or blood pressure medications, water and power, and more. Many of the problems are foreseeable. Prior planning can greatly lessen the consequences.

So there's no sense waiting for the federal government to tell us how they will respond. They won't. Every community will be on its own. Time to get ready. For ideas, visit The Flu Wiki.