In the event of a major pandemic, school and universities would send students home and close their doors for 12 weeks or more.
Offices would shut down, and flights would be grounded. The sick and their families would be encouraged to quarantine their households in order to contain spread of the disease.
Such would be the scenario according to a guidance document issued Thursday by the Centers for Disease Control and Prevention (CDC), which offers a glimpse into what changes might take place in day-to-day life should a major pandemic occur.
The strategies outlined in the 106-page document are not modest ones. But the authors of the guidance say that keeping people physically apart could offer the best chance of minimizing the spread of a severe pandemic -- at least in the months it would take before a well-matched vaccine became available.
Disease experts say such measures, if properly followed, could save lives.
"Properly applied, anti-viral treatments, effective social distancing, proper protocols and movement restrictions will have a major impact," said Dr. David Nabarro, senior United Nations system coordinator for avian and human influenza. "These measures could indeed lead to total containment."
But if a pandemic like the one that occurred in 1918 were to happen again, the scope of the measures that would be implemented through the proposed guidelines would have a dramatic economic and societal impact.
"There are very significant repercussions of these guidelines, and there need to be systems in place to deal with these repercussions," said Dr. Jeffrey Duchin, chief of communicable disease control at the University of Washington's Division of Allergy and Infectious Disease. Durbin is also part of the working group that devised the recommendations.
"A lot of the burden of these measures falls on individuals and communities," he said. "They would need to figure out how they can survive the cure.
"The disease is bad, but the cure in this case is no cakewalk."
Categorizing the Pandemic Threat
The extent of the response to a pandemic situation would be largely determined by how many people get sick from it, as well as what percentage of those with the disease die from it.
The CDC report categorizes future pandemics in much the same way as hurricanes are measured, on a scale of severity from Category 1 to Category 5.
"Not all pandemics are equally severe, and we can use what we know about epidemiology to create a security index," CDC Director Dr. Julie Gerberding said Thursday in a press teleconference.
Thus, the measures taken in response to a Category 1 or 2 pandemic, such as the ones that occurred in 1957 and 1968, would be correspondingly moderate. Most of the recommendations would center around commonly practiced personal hygiene measures -- washing hands, covering mouths and noses when coughing, and staying home from work when sick.
On the other end of the spectrum, a Category 5 pandemic such as the one seen in 1918 would require much more drastic efforts to separate people to limit the spread -- and thus the mortality rate -- of the disease.
"When we're talking about Category 4 and 5, we're talking about a pandemic that would have 10 to 20 times the impact as a regular flu season," Duchin said. "It would result in up to 1 million deaths."
In addition to limiting large gatherings, this could also involve isolating people who have been known to have had contact with infected individuals. Telecommuting and distance learning would replace attendance at schools and jobs.
"These measures may also result in the overall ability to sustain society, keeping our economies running and our businesses moving," Gerberding said.
Measures Could Bring Hardships
However, the authors of the guidance acknowledged in the document that the sweeping changes that would take place with the implementation of the measures would be a difficult adjustment for many.
"There would be a large number of people who would not be able to work," Duchin said. "There would be a loss of income for businesses, as well as a loss of personal income."
"Most people are unlikely to have insurance or leave from work that would carry them through 12 weeks without work," he said.
The Department of Labor is currently researching ways to mitigate these effects. But even with assistance from the federal, state and local levels, the impact on individuals -- as well as on the economy as a whole -- would likely be huge.
"When you start closing schools, closing businesses, and closing subways, it brings cities or communities to a standstill," said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University School of Medicine at the Seasonal and Pandemic Influenza meeting in Washington.
"Economic, social, and other parts of society, would be completely different," he said. "That's to me one of the issues in this planning that people have not completely grasped... They sort of assume that the rest of life would go on."
Guidelines Not Yet Ready for Implementation
Even now that the CDC has formally presented the guidelines, it is unlikely that the measures provided for in the guidelines could be implemented in time to save lives if a Category 5 pandemic were to begin tomorrow.
"This is not something that we can just pull out of a hat; it is not an off-the-shelf solution," Duchin said. "We're not yet prepared nationally at the local level to carry out these measures."
Some of the measures, however, could be enacted in order to slow down the spread of disease. Duchin said school and office closings and other social distancing measures could go forward.
"Isolation of the sick is ready to go, but the difference in this case would be the scope," he said. "Social distancing can be done pretty quickly without a lot of planning."
Adding to the difficulty of effective implementation is the fact that every virus -- and every pandemic -- presents new and different challenges.
"Through this, the federal government is saying that based on all of the information we have, with no vaccine and not enough retroviral treatment, that this is the best advice we can give you in terms of protection," Duchin said.