Governments around the globe have moved swiftly and aggressively against the fast-spreading A/H1N1 flu virus. But should it evolve into an especially deadly strain, the consequences will likely overwhelm even the most advanced health systems in the U.S. and other Western countries.
By one important measure -- stockpiles of antiviral drugs such as Tamiflu -- the U.K. is among the countries best prepared to cope with the emerging pandemic. It has enough of the medicine on hand to treat 33 million people, or 54% of its population. France is also a leader, with drugs also to treat 54% of its people, as well as one billion surgical masks in its stockpile. Austria, with antivirals for 40%, and Japan, at 28%, are close behind.
India, which announced plans Thursday to purchase enough Tamiflu to treat nine million people, adding to its current stock of doses to treat one million, lags behind other nations. In Africa, which hasn't reported any confirmed cases of the new virus, the World Health Organization's regional office has about one million doses available to countries in need, according to Phillip Muthoka, who works in Kenya's health ministry. He has just 400 doses of Tamiflu now.
With scarce resources, a poorly organized health system, and a population battling other diseases, African nations would be especially vulnerable should a deadly strain of the virus take hold on that continent, officials say. "We are very concerned," Dr. Muthoka said. "Our people are traveling all over."
For its part, the U.S. has enough antiviral medication in reserve to treat 50 million people, or about 16% of the population. It has also poured some $7 billion into strengthening its public-health infrastructure since the Sept. 11, 2001, attacks and the SARS and avian flu epidemics prompted concern about the ability of communities to respond to such events. Improved surveillance and detection efforts and better-trained local public-health agencies are among the payoffs.
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"The response has been excellent," said Robert M. Pestronk, executive director of the National Association of County and City Health Officers in Washington. But Congress zeroed out federal allocations for pandemic-flu planning during the past two fiscal years, he said. The recession is wreaking havoc on state and local budgets, putting further pressure on state, county and municipal health authorities charged with managing surveillance, monitoring and response at the ground level of any epidemic. "The question is that under a full-scale epidemic, can [the response] be sustained?"
Indeed, if the strain ultimately turns very lethal and approaches, say, the scale of the Spanish flu outbreak that took about 40 million lives in 1918-19, it would be no match for even the most-prepared agencies and governments. Last year, congressional investigators at the nonpartisan Government Accountability Office said a modern-day equivalent would hit about 90 million people in the U.S., with nearly 10 million requiring hospitalization. With fewer than one million hospital beds in the U.S., "a severe pandemic would far exceed the capacity of the U.S. hospitals," they concluded.
Another critical weapon, flu-vaccine development, remains hampered by 1950s production technology. It can take several months to develop a vaccine for a new virus, and much longer to produce and deliver it to enough people to have an impact.
"There really is limited vaccine-production capacity," said Michael T. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. "We're very ill-prepared."
Meanwhile, governments and public-health officials on high alert around the world are using lessons learned from past outbreaks to mitigate the impact of the new virus. Singapore, in one of the stricter moves by a government to stop potential infection from travelers abroad, announced Thursday that people who have recently traveled to Mexico will be quarantined for seven days when they enter Singapore and undergo phone surveillance for symptoms of swine flu.
Japan has posted military doctors and nurses at Narita airport near Tokyo, using thermal-imaging cameras to screen passengers coming in on flights from Mexico, Canada and the U.S. If a case of the flu is reported, the government plans to open several hundred "fever clinics" across Japan.
To raise awareness of the flu's dangers, the French government has posted billboards in major airports warning passengers traveling to Mexico to avoid large crowds and to wash their hands regularly. The country also urged the European Union to suspend outward flights to Mexico, but the EU ruled out the idea on Thursday.
In Southern Africa, health ministers from countries who belong to the Southern African Development Community, a regional regulatory body that deals with trade, politics and other issues, put their countries' surveillance system on "high alert" and agreed on a travel advisory against visiting affected countries.
On Tuesday, an Air Tran jet arriving at Baltimore-Washington International Thurgood Marshall Airport from Cancun, Mexico, was detained on the tarmac while emergency medical workers boarded to examine two sick passengers. Federal officials tracking the A/H1N1 virus were contacted.
The passengers were diagnosed with gastric distress, frequent among visitors to Mexico, and the passengers disembarked and headed home. Had the men been suspected of having the flu, the plane could have been isolated away from the terminal until health officials determined how to help all the passengers. The other passengers likely would have been given health-alert notices on how to monitor fever and other symptoms at home, and the U.S. Centers for Disease Control and Prevention would have tracked the health status of any passengers from the flight.
So far, the new flu strain appears mild. Adewale Troutman, director of the Metro Louisville Department of Health and Wellness in Kentucky, says it resembles the pattern of regular flu with "multiple cases and not that many hospitalizations." During two days of races at this weekend's Kentucky Derby, some 300,000 people will jam the track, he says. Additional hand-sanitizers may be deployed at the track as a precaution, he says, but other special measures aren't planned.
"The whole public-health system is much better prepared now than it was five to 10 years ago," said Jeffrey Koplan, director of the Global Health Institute at Emory University in Atlanta, and a former director of the CDC. Still, he said, "preparedness is a relative thing. Any system has constraints in capacity."
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