Imagine a disease — one that previously has not affected humans — racing through the United States in a matter of weeks, forcing 40 percent of Brown County residents to miss work and leaving more than 500 in the county dead.
That’s the worst-case scenario, but a pandemic outbreak of influenza is a matter of when, not if, according to Robert Warren, volunteer with the Pecan Valley Chapter of the American Red Cross. The spread of a lethal strain of bird flu through Asia, Africa and Europe over the past three years has fueled fears of a possible pandemic in the United States, he said.
But a devastating strain of flu is not the only disaster that could strike Brown County. Local emergency planners are making preparations certainly to prevent all of them, if possible, but also to respond if the worst imaginable situation develops — whether it’s a tornado, a terrorist attack, a chemical train car derailment or a communicable disease.
“We don’t know when a pandemic might strike,” Warren said. “We have three viruses that potentially could turn into a pandemic, but the the most likely is N5N1, or Avian flu — bird flu.”
A pandemic, Warren explained, is any disease for which humans have no natural immunity and that is easily spread from human to human. Historically, three pandemics develop in the world each century.
The most recent pandemics have included deadly strains of human flu in 1918 and 1957. While the 1918 pandemic killed 50 million people worldwide, the 1957 event was moderate.
Warren has presented three programs in recent weeks hosted by the Brownwood Area Chamber of Commerce and the Early Chamber of Commerce concerning local plans that are under way to address such a crisis.
The chambers of commerce are assisting by notifying business owners and managers of the need to develop plans to implement in case a large percentage of their employees become too ill to work, or must miss work in order to take care of sick family members. The chamber offices also serve as a resource for businesses as they prepare to handle a pandemic or other major catastrophe.
Grants to the Brown County Health Department are funding personnel to help handle such planning. John Thomas, one of the employees whose position at the health department is funded by those grants, has also been giving programs and participating in the planning.
Meanwhile, local leaders are meeting monthly as an Emergency Preparedness Task Force to coordinate efforts and report progress.
“We have plans in inoculate every resident of Brown County within 48 hours,” James Cook, emergency management coordinator for the City of Brownwood and Brown County, said. “We will stay ready to do what is possible to contain it and not have it spread.”
The plan addressing a pandemic is part of the larger emergency management plan adopted by Brown County and each municipal body within it — Brownwood, Early, Bangs and Blanket. That plan includes specific duties for a variety of public officials, response organizations and support entities.
“It’s an all-hazard plan,” Cook said. “We anticipate being ready in Brownwood to take care of whatever might happen.”
The plan outlines steps to be taken in any disaster situation, including weather events, chemical spills or releases, destructive attacks such as those by terrorists and widespread outbreaks of disease.
Cook said the plan addresses four phases of emergency management, including eliminating or reducing the probability of disaster; helping governments, organizations and individuals develop plans to save lives and minimize damages; detailing activities that occur during an emergency in response; and outlining short- and long-term recovery activities designed to return the community to normal or improved standards.
Federal and state funding is helping provide resources for the preparations. Locally, a $200,000 grant to the health department has been received this year.
“It’s a real good thing for us,” Cook said. “That has funded two positions at the health department, and they are working on bio-terrorism.” Funding is provided through the Texas Department of State Health Services.
In order for the local response to be effective, an army of local volunteers is being assembled to help with the massive inoculation clinics that will be opened, should a pandemic hit.
“I need volunteers,” Thomas said. “The health department will need them to do anything and everything. We’ll have certified volunteers like nurses, pharmacists and doctors to handle specialized duties, but we’ll also need greeters and people to fill out forms.”
He said if people who come in for inoculations are showing symptoms, they will be sent to the hospital.
“We’re required to have everyone in the county inoculated with 48 hours,” Thomas said. “That’s almost 40,000 people. That’s a tremendous task.”
Three of the anticipated five clinic sites needed in the county have been identified, with two more to be selected. Locations are not being announced in advance for security reasons, as one eventuality for which the plan is anticipating is bio-terrorism.
“We have to prepare for many possibilities in addition to pandemic flu,” Thomas said, “and that means terrorism — anthrax, smallpox, anything. We’ll work it through the county plan and the emergency management coordinator.”
“We want to get as many people involved as we can,” Alicia Long,” administrator of the Brownwood-Brown County Health Department, said.
“The decontamination exercise that was held at the Camp Bowie National Guard Training Complex this spring was part of this. We have to come together, because anything can happen. People need to realize how important it is.”
Warren, citing medical sources provided by the Red Cross and health organizations, said Avian flu viruses experience sudden changes in genetic structure that become capable of infecting humans as well as fowl. When that virus becomes able to reproduce and spread from one person to another, a pandemic occurs.
So far, no sustained cases of human-to-human transmission have been documented, but as of the end of June, 317 confirmed human cases with 191 deaths have been reported worldwide, the World Health Organization reported.
“Illness will spread quickly and globally when the virus changes,” Warren said. “It would likely arrive in the United States in less than three months. Once it mutates, it will easily spread.”
The flu pandemic in 1918 took about six months to spread around the world, Warren said, but improved travel options will hasten that timetable now. The 1918 crisis killed between 40 and 50 million people worldwide, a death rate 25 times greater than previous epidemics. In Texas, 106,000 cases were reported and 2,100 died, state health officials said.
The flu primarily affected and killed younger people.
The world’s population is three times what it was in 1918, Warren noted. That means if the next pandemic is equal to it, 150 million people could be expected to die.
When bird flu first mutates, Warren said, vaccine will be non-existent or very limited. Because no one will have a natural immunity to the virus, the situation could persist for six to eight months.
“The health care delivery system will be overwhelmed,” Warren said. “We can expect infection rates of at least 20 to 35 percent of our community.”
Existing medical and emergency organizations will be challenged to overcome manpower shortages, as perhaps 30 to 50 percent of their staffs will become ill.
In the worst-case scenario, mutual aid from outside the county will be limited or unavailable because of their own situations, and simple supplies may become difficult to obtain.
Ongoing transmission of the virus will continue for up to two months, and it will continue in waves throughout the community for up to 18 months. The good news is, that after the second wave, the disease probably won’t be as serious.
“At the Red Cross, we want to help the individual,” Warren said. He recommended basic health precautions like washing hands frequently, avoiding people who are sneezing and practicing simple hygiene.
“Handwashing prevents more diseases than any anti-viral,” Warren said.
Meanwhile, being vaccinated for traditional flu is another way to guard against bird flu, because it’s possible that the lesser disease could mutate.
Warren said suffering from a case of bird flu does not mean certain death.
“With a little planning, it’s something we can live through,” Warren said. “We should be afraid of this, but we shouldn’t panic. Plan, prepare, but don’t panic.”
The overall good health of Americans will also be an advantage.
“A moderate pandemic here would be a severe pandemic in China,” Warren said.
According to the World Health Organization and the U.S. Department of Health and Human Services, the world sits at the midpoint of a six-stage progression — the first three steps being mitigation and preparedness, and the last three being response before a pandemic exists at the final level.
“Pandemic influenza is the most important threat that we are facing right now,” Julie Gerberding, director of the Centers for Disease Control and Prevention, said in 2005.
That was the year the flu’s spread from birds to humans “started taking off,” Warren said. The first human cases were reported during 2003 in China and Vietnam. By last year, it had reached places like Turkey, Egypt and Iraq. So far this year, it has arrived in Nigeria and Laos. Almost two-thirds of those cases and deaths have been identified in Indonesia and Vietnam, according to lab-confirmed reports listed by the WHO.