We've all heard the doomsday scenarios of what could happen if an avian flu pandemic takes a grip on the United States: millions dead, millions more sick, basic utilities and services unavailable, hospitals overrun and unable to cope, communities reduced to devastation like something out of Stephen King's "The Stand."
What's known is human-to-human transmission of bird flu is inevitable as H5N1, a type of bird-flu virus, mutates. "It's going to happen," said Dr. Joseph Agris, a Houston physician. "It's no question. It's just a question of when."
But what will actually occur in your life if there is a pandemic? Will you go to work? Will your kids stay home from school? How will your community services work if employees are sick? Is your local hospital prepared to deal with the influx of people who fall ill?
First of all, the virus may not be as intense in human cases in the United States as it has been elsewhere in the world because the flu in general tends to weaken as it reaches North America, said Agris, CEO of the Agris-Zindler Children's Foundation, which makes medical trips around the world to care for children.
"Right now what I'm seeing seems scary," he said, "but I think it's going to be less of a problem by the time it gets here than what is anticipated."
That doesn't mean, however, that an outbreak would be easy. "Even if you take the smallest number possible -- 1 percent of the sickest portion of the U.S. population getting the disease -- that's a million and a half people who'll either get sick or die," he added.
Even facing this threat, it is important to keep a sense of control, said David Ropeik, who teaches risk communication at the Harvard School of Public Health and who co-wrote "Risk: A Practical Guide for Deciding What's Really Safe and What's Really Dangerous in the World Around You."
"The risk you can't do anything about feels scarier than the one you can," Ropeik said. "Washing your hands a lot, sneezing into your elbow, knowing that avoiding crowded places if there's a flu epidemic of any kind, those are applicable. ... They're emotionally reassuring in the face of some new threat. New threats are always scarier than ones we've lived with for a while. It's just their newness."
Getting Things Ready at Home
Best-case scenario: People abide by imposed quarantines, work from home if possible and ride out the course of the virus with minimal health problems.
Worst-case scenario: People are forced to stay home but fail to stock the necessary food and supplies and venture back out, catching bird flu and infecting their families.
According to health experts, there are basic steps that everyone should take to stay healthy, and they are the same as what you'd do to avoid any flu: Wash your hands often, don't shake hands with others, cover your mouth when coughing or sneezing, avoid crowds.
At the same time, you should stock up on essential items in case you get stuck at home for extended periods because of your own illness or quarantines.
"I think every person should have a little stockpile of food and water, a little bit like the air-raid shelters in the Cold War," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "The No. 1 strategy in protecting yourself from avian flu is to minimize contact with others."
Agris agreed, saying people should "stock up on a certain amount of basics -- dried foods, pastas, extra canned goods, bottled water -- a small amount of that will go a long way."
Caplan said people should also have a supply of high-quality HEPA, or high efficiency particulate air filter, masks and "a lot of soap -- you have to wash your hands."
For more information on how you and your family can prepare, click here.
Businesses Brace for 'Global Blizzard'
Best-case scenario: People work from home when possible and business gets done while children and sick family members are cared for.
Worst-case scenario: Mildly symptomatic people go to work on mass transit, infecting other commuters and co-workers, which only intensifies the spread of bird flu. Businesses are crippled by mass illness and supply-chain disruptions. The nation's food supply is compromised.
Make no mistake: Dragging yourself to work with even a few flulike symptoms could be devastating to those who commute with you and work beside you. Experts said employers will have to cope with absences because of illness, the need of their employees to care for others, and their reluctance to ride mass transit. They also should put policies in place to prevent the spread of the virus at work.
Dr. Eric Toner, senior associate at the Center for Biosecurity at the University of Pittsburgh Medical Center, said that in addition to figuring out who could telecommute and how businesses could function on a reduced staff, companies should provide masks, cancel meetings and increase "social distance" to reduce transmission from person to person. They'll also need to reconsider sick leave policies.
"It's important not to have sick people coming to work," Toner said. "That's the worst thing possible. But what if people exceed their available sick time? For businesses that have contact with the public and their employees get sick, is that covered under workers compensation?"
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, hosted a recent national summit for businesses on planning for pandemic flu. The discussion has begun, he said, but there's a long way to go for companies, as their response will help determine how the virus spreads.
"We have to look at this as a 12- to 18-month global blizzard," Osterholm said. "What companies are now beginning to realize is, even if they have business preparedness and continuity plans for other disasters, none of them have really been planned for addressing a pandemic."
Economic impact will be severe, he said. "Unfortunately, they understand today that they live in a global, just-in-time economy that has basically no surge capacity," Osterholm said, adding, "Part of that is due to the fact that much of planning depends on things beyond the organization -- outsourced supply chains, transportation, utilities, any number of things like that."
Osterholm noted that 80 percent of all drugs in the country use raw ingredients that come from offshore, which will be hard to come by in a global pandemic. "Every country will be in it," he said. "Everything will be in really short supply at a pandemic and needed around the world."
Regarding employees' health, telecommuting is an option for some jobs but far from for all. "For many industries, you can't telecommute. You can't make steel or grow food at home," he said. "The second thing is, no one really knows for certain the actual capacity of the Internet system today if everybody were to use it for primary [communication]."
Agris said it will be important not to shut down the nation's transportation, or cities will not be able to get critical supplies. "You need to keep transportation open and keep those people healthy who handle the warehouses," he said.
For more information on how businesses can prepare, click here.
Will Hospitals Help or Hinder?
Best-case scenario: Well-prepared hospitals have a stockpile of masks, gowns and gloves, as well as staff trained to manage an influx of patients and set priorities for the neediest cases, which will help keep the virus from spreading.
Worst-case scenario: Hospitals lack basic supplies and end up spreading the infection from unsanitary conditions rather than treating the sick.
The health care system's response to a pandemic will be crucial to how it plays out, experts said. But what happens if doctors and nurses panic and don't want to jeopardize their own health by treating others?
"Pay close attention to what happens to health care workers," Caplan said. "Get them in to work. They have to feel as safe as possible. ... I'm very worried that since we've turned health care so much into a business, people will say, 'I'm just an employee. I'm not going to put myself at special risk.'"
And assuming they do come in to work, how many hospitals will be ready for mass illness? Toner said it would be tough to organize.
"Very few hospitals, if any, are well-prepared," Toner said. "No hospitals have adequate supplies of basic items to last through a pandemic. Nobody in modern business, particularly hospitals, have stockpiles of anything anymore because we have this just-in-time supply chain."
And that could prove to be deadly. "Hospitals not only will be unable to protect their staff and patients, they likely will become major amplifiers of the epidemic because the sick people will infect other people," he said. "If the pandemic is like 1918 or worse, which is possible, people won't be able to stay at home. This will be a life and death decision."
What about those who are uninsured or in the country illegally? Caplan said the health care industry must figure out who will pay to treat the sick.
"Insurance companies, managed care companies, HMOs -- they have to make it clear that they're going to pull out the rules and people can get what they need, including illegal aliens," he said. "If we do have a pandemic, have an emphasis on getting to the doctor, not having people worried they're going to be deported."
For more information on how health care providers can prepare, click here.
Will Uncle Sam Help?
Best-case scenario: The federal government, already preparing, clearly communicates an action plan for a bird-flu pandemic. Local governments reach out to residents to provide resources, keep order and ensure calm prevails.
Worst-case scenario: Communities cannot provide essential services due to extensive employee illnesses, panic ensues.
Despite extensive preparations being made by the federal government in vaccine supplies and public education, there likely won't be much for it to do if a pandemic strikes.
"Once the pandemic starts, very little can be expected from the government," Toner said. "This is not meant to be critical of the government, but there's only so much that the government can do, and it can't do it in 5,000 communities at one time."
Perhaps its most important role will be providing information, Caplan said. "I think from the point of view of the government, they need to have some very clear and transparent rules in place so that the public understands what's going on," he said. "If they have to restrict your movement, if they have to quarantine people, why it's going on, that it's not permanent but will last a few weeks."
Caplan said such things as imposing a quarantine and determining how to ration masks would be difficult. "People are skeptical, too," he said. "because they watched the response to Katrina and they're not sure they can trust the authorities."
For more information on how communities can prepare, click here.
School's Out -- For a While, at Least
Best-case scenario: Schools shut down for extended periods of time, saving the lives of many children, teachers and staff who could be infected in close quarters.
Worst-case scenario: Schools stay open, parents who must work send their children to school, hastening the spread of infection.
Experts said it is very likely that schools and day care centers will be shut down as soon as a pandemic begins. "They're incubators for infection," Caplan said.
But Toner said he is skeptical that it will be completely effective. "I'm not sure that it's the right thing to do, if for no other reason than a few weeks is not enough," he said.
But if you don't send kids to school, what are you going to do with them? "Most parents can't stay home to take care of kids," he said, "and if they do, they can't go to work. Most people need to work. Day care is worse. There are not any great options, but I think the school systems will decide to close."
For more information on how schools can prepare, click here.
Take a Deep Breath
In preparing for a bird-flu pandemic, two things are certain: Knowledge is good, panic is bad. But the more we know, the more frightened we tend to get, which doesn't help in the panic area.
"The more aware we are of a risk, the more afraid we are," said Ropeik, the risk expert. "Awareness will be up, and so will our worry, with the first bird in North America, and then just magnify that a zillionfold with the first human case in North America or the United States. And magnify that a zillionfold when word breaks out anywhere in the world should the mutation happen that allows it to become human to human."
Not to say bird flu is not scary -- it just may not be as bad as we expect. "The two factors, newness and awareness, are characteristics of risk that make them seem scarier," he said. "Now sometimes they really are scarier and sometimes they aren't, but the fear bells will be hit with those -- people will go to hospitals a lot more, rush to doctors for any kind of vaccine, the price of Tamiflu on eBay will go sky high and people's stress levels will rise."
And worrying, he said, can only make everything worse. "Stress suppresses your immune system," he said, "so the more worried you are about getting sick, the more likely it is that you will, or that your sickness will be worse or possibly fatal because your worry is making it harder for your immune system to protect itself."
His advice? Be prepared, but also be calm.
"Stay informed and try to keep things in perspective," he said, "so you don't stress out about any risk."