Acushnet Fire & EMS Department

A human pandemic of the dreaded H5N1 bird flu virus might not happen, but pandemics at large are inevitable, scientists say. And they usually arrive sooner than most people think.

"Each new human case gives the virus an opportunity to evolve towards a fully transmissible pandemic strain," the World Health Organization warned more than a year ago about bird flu.

Since that WHO report was published, more than 140 new human cases have been confirmed. Most have been traced to direct contact with infected poultry, but a few people have gotten the virus through close personal contact.

On Nov. 28, a 35-year-old woman in Indonesia became the latest to die.

Scientists have raised their eyebrows at H5N1's ability to infect a variety of mammal species, including pigs, tigers, leopards and domestic cats in addition to humans. The more it adapts to different conditions, the more likely it is to achieve rapid human-to-human transmission.

Dr. Jeffrey Greene, infectious disease specialist at New York University Medical Center, points out in his new book, "The Bird Flu Pandemic," that H5N1 has met three of the four conditions necessary for a pandemic to begin:
     -It has spread over a vast geographic area in animals.
     -It is a new strain to which humans have no immunity.
     -It has the ability to infect humans, killing roughly half those infected.

All that remains is for the virus to pass easily from person to person.

Working Together

Last year's health and sanitation crisis after Hurricane Katrina proved that communities can't rely on immediate federal help, said Acushnet Fire and Rescue Chief Kevin A. Gallagher. He and a handful of other local officials started last spring planning for a pandemic.

Representatives from seven towns, New Bedford and UMass Dartmouth (acting as a voting member for its town-size population of 8,700) continue to develop their coalition, called the Southcoast Emergency Planning Partnership.

Mr. Gallagher is part of the partnership's three-member steering committee and the emotional leader of the movement, spurred in part by a personal connection to the deadly flu pandemic of 1918. A relative on his mother's side, Edward Dahill, was fire chief in New Bedford when the pandemic hit, and he believes some of his relatives died in the outbreak.\

Members of the partnership are towns that consider St. Luke's their local hospital — Acushnet, Fairhaven, Dartmouth, Freetown, Mattapoisett, Marion, and Rochester, along with New Bedford and the university.

Lakeville, Westport, and Wareham have not been invited to join because of their proximity to other hospitals.

The group's "biggest success to date," Mr. Gallagher said, is creating a unit of the Medical Reserve Corps, part of a federal program established after the terrorist attack of Sept. 11, 2001.

Its main role is to pre-credential and train volunteers, both medical and non-medical, to participate in emergency relief.

Louise Donaghy, New Bedford public health nurse, is serving as the Medical Reserve Corps coordinator on a volunteer basis.

If and when funding is available, a handful of full-time positions could be created to keep the training and credentialing up to date.

The corps has started building a Web site through the U.S. Surgeon General's Office at gnbmrc.com, and each community has a contact person in the corps.

Among the contacts are Mr. Gallagher and the two other members of the Southcoast Emergency Planning Partnership steering committee: Dartmouth Director of Public Health Wendy W. Henderson and Kathleen M. Stefani, a representative of New Bedford Mayor Scott W. Lang.

"As we are still in the infant stages," Ms. Donaghy said, "we have not yet defined our infrastructure."

'Battle Scars'

In addition to doctors, nurses, pharmacists and mental health professionals, the corps needs many non-medical people — perhaps as many as 10 times the number of medical volunteers, they say — to serve in support roles doing language translation, child care, driving, food preparation, data entry, custodial work, and review of forms.

The corps has applied for a variety of grants and entered an agreement with the Community Foundation of Southeastern Massachusetts to serve as its fiscal agent.

Both of the new groups, the Southcoast Emergency Planning Partnership and the Medical Reserve Corps, are designed to help the public cope not only with pandemics, but any mass medical emergency, such as a natural disaster or bioterrorism attack.

The Medical Reserve Corps will be modeled, in part, after its sister organization on Cape Cod.

The Cape Cod Medical Reserve Corps, founded in 2002, provided health care for Hurricane Katrina survivors who were flown to Otis Air National Guard Base.

Cheryll Bushnell, director of the Cape Cod group, said the volunteers saved the state more than $60,000 in Katrina relief funds.

"We have many battle scars," she told an October gathering of about 45 SouthCoast emergency planners.

One of the challenges of planning for emergencies, she said, is that volunteers flood the phone lines only after an emergency begins. Two days before Katrina, the corps had 89 volunteers. A month later, it had more than 400, and not until September — a year after the hurricane — did the group finish processing all the applications.

"That's why we do it ahead, because it's a nightmare to credential people at the same time as you deploy them," she said.

Independent of the Medical Reserve Corps, local health authorities hope state funding will be set aside for pandemic flu preparation.

They are working with Southcoast Hospitals Group and the Greater New Bedford Community Health Center to plan for rapid flu vaccination at existing sites called Emergency Dispensing Sites throughout the region. New Bedford alone has nine.

Those operations would be activated only for a large-scale emergency, not for standard flu vaccination.

Hospitals around the state are also planning off-site infection care units that could be opened in case of a pandemic.

Geoffrey Wilkinson, executive director of the Massachusetts Public Health Association, said a Dec. 31 deadline is looming for lawmakers to agree on a pandemic plan in order to receive discounted Tamiflu, a prescription medication that can lessen the duration of influenza symptoms, through the federal government.

One Step Ahead

After Hurricane Katrina, Gov. Mitt Romney issued a $36.5 million proposal to fund emergency preparedness. But the House and Senate have their own plans. The Senate, for example, would cover pandemic planners at the local level in a way the governor's plan does not, Mr. Wilkinson said.

The House Ways and Means Committee is looking at the Senate proposal, he said. The Senate plan includes a rewrite of the Health Powers Act, which involves things like quarantine and the taking of private property to respond to an emergency.

"I think they will take action, but perhaps on a stripped-down approach," Mr. Wilkinson said. "The House may wait on a rewrite of Health Powers."

Massachusetts has made progress on its bird flu preparedness, but still has a long way to go, he said, especially with regard to so-called special populations — children, elders, low-income people, and linguistic minorities.

"They really don't have risk communications, even for the general population, nailed down," he said.

Pandemic planners say they may not be able to prevent an outbreak, but they can try to minimize illness and social disruption.

Dr. Marc Siegel, associate professor at the New York University School of Medicine and author of "Bird Flu: Everything You Need to Know About the Next Pandemic," contends that while stockpiling will help in the short term, a better long-term strategy would be to improve vaccine technology so new vaccines can be developed faster in response to new viral mutations.

The world saw not one, but three influenza pandemics in the 20th century. The "Spanish" flu of 1918, by far the most virulent, is well known, but smaller pandemics in 1957 and 1968 go largely unremembered outside scientific circles.

Human deaths from the latest threat, H5N1, have increased each year since 2003. The virus was first identified in China, and human cases have appeared as far west as Turkey and Egypt. The total death count is now at 154, with 76 this year alone.