It's inevitable, say government officials: a pandemic will strike the United States and the impact will be profound.
Schools and businesses will be closed. Hospitals and clinics, overwhelmed by the sheer number of patients, will force many of the sick and dying to be housed in gymnasiums and community centers. Travel restrictions will cause further economic collapse. And a severe shortage of drugs means many will go untreated.
A Jerry Bruckheimer film? Not according to information released by the U.S. Department of Health and Human Services.
"Pandemics happen," said HHS Secretary Mike Leavitt in a teleconference today. "They happened before, and they'll happen again. If it isn't the H5N1 [bird flu] virus, it'll be another virus."
Documents released by the HHS present a chilling scenario in which an influenza pandemic will wreak havoc on a world that is largely unprepared. Highlights from the report include the following:
When a pandemic influenza virus emerges, its global spread is considered inevitable.
Nations [are] unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.
The need for vaccine is likely to outstrip supply.
The need for antiviral drugs is also likely to be inadequate early in a pandemic.
Death rates are high.
'The System Will Collapse'
Past pandemics have caused millions of deaths worldwide. The Spanish flu of 1918 killed as many as 40 million people.
"No one today can say how many people might die if the virus does mutate," said Dr. David L. Heymann, executive director of communicable diseases for the World Health Organization, speaking today at the TIME Global Health Summit in New York. "It's an unknown. The worry is what's not known, and with this disease, we know very little."
The existing public health system is, according to many experts, woefully inadequate to address a pandemic.
"Our emergency departments are inevitably going to be on the front lines in the battle against a major flu epidemic, but ERs nationwide are already straining under a system that underfunds and over-litigates," said Dr. James A. Wilde of the Department of Emergency Medicine at the Medical College of Georgia.
"Even now there is little to no excess capacity to absorb more patients, but when pandemic flu arrives there will be a tidal wave of patients arriving in clinics and ERs nationwide," said Wilde. "If it happens tomorrow, the system will collapse."
As many as 50 percent of health care workers will refuse to show up to work unless they are fully protected from the virus, according to Dr. Irwin Redlener, associate dean of Columbia University's Mailman School of Public Health.
No Proven Medication Exists
Many have placed their hopes on antiviral medications or on the eventual development of a vaccine. There are currently two antivirals available for influenza, Tamiflu (oseltamivir) and Relenza (zanamivir), but neither has been proven effective against the avian flu in humans.
"A focus on one antiviral is misplaced," said HHS Secretary Leavitt. "There's no certainty that they'll be effective."
And it will be six months or more before a vaccine is available. "Those 180 days to get the vaccine will be unfortunately very difficult because people will die while we're waiting for the vaccine," said Redlener. "Until we get antivirals and vaccines up to speed, we'll be dependent on the health care system and it's a fragile mess."
Are We Crying Wolf?
A pandemic's impact on society and the global economy will be immense. "Travel bans, closings of schools and businesses and cancellations of events could have major impact on communities and citizens," according to HHS documents. "Care for sick family members and fear of exposure can result in significant worker absenteeism."
But is all this information and preparedness unfounded fear? We are not crying wolf, according to Leavitt. Our current preparations will serve us well, even if avian flu never becomes a human pandemic.
"There is no certainty that H5N1 will mutate into a human-to-human transmissible virus," said Leavitt. But he warned, "There will be another virus at another time."