Local Matters
MONTPELIER -- Want a helpful hint on how you could help slow the spread of an avian flu pandemic? David Harp of Middlesex suggests carrying a jalapeño around in your pocket for a week.
Harp isn't saying that the hot pepper is a preventative or cure for the H5N1 virus. Nor is he superstitious. Harp isn't even a public-health professional. He's just a concerned citizen who's been closely following news of the global spread of avian influenza and the range of public responses to it.
Harp is also a member of the Middlesex Pandemic Health Emergency Committee and an expert on behavioral psychology. He says that one of the keys to preparing Vermonters for the possible arrival of a pandemic flu will be to modify their behavior in simple but effective ways that could slow the rate of infection. By carrying around jalapeños for a week, people would suddenly become very aware -- in a visceral, painful, way -- of how often they touch their mouths and eyes with unwashed hands.
Harp was one of about 50 people who attended last week's regional pandemic flu summit at Montpelier High School. The 3-hour event was one of nine held around the state in recent weeks, sponsored by the Vermont Office of Emergency Management, the Department of Health, and Vermont Homeland Security. The sessions, which were attended by more than 700 local officials and first responders, were an outgrowth of the Governor's Pandemic Flu Summit on January 12 in Burlington.
From the start, officials from the health department emphasized that the current strain of avian flu is not yet a pandemic and may never become one. Though it's decimated some bird populations and killed about 100 people overseas, there's no evidence yet that H5N1 is spreading from person to person. Nevertheless, public-health officials around the world are preparing for the worst.
In Vermont, the regional flu summits were intended to help local emergency-planning committees prepare for such an outbreak. The Montpelier event demonstrated how varied those local preparations have been, and how much more work remains to be done.
Vermont State Veterinarian Kerry Rood opened the summit by giving a brief primer on the avian influenza virus, including how it might mutate and become a human-to-human illness. Rood noted that in many respects, Vermont is an unlikely candidate for the first U.S. outbreak. For instance, the state doesn't have live bird markets such as those in Boston and New York City.
But Vermont does have plenty of domestic waterfowl, as well as live bird "swap meets" and livestock exhibitions, which could become potential points for avian flu transmission. Rood said that the Agency of Agriculture routinely monitors those events and has a pandemic flu response plan in place should a case appear.
If a contaminated bird were found in Vermont, Rood said, the infected flock would immediately be quarantined and "depopulated," that is, euthanized. However, he said that Vermont livestock owners need not fear that neighboring or nearby flocks would automatically be quarantined as well. As Rood put it, "We're not going to go door to door killing poultry. That just doesn't make sense."
Rood's biggest concerns are the spread of misinformation about avian flu, and that officials will "lose focus" once the next public health crisis arises. As he put it, "How many of you remember SARS or monkey pox?"
Dr. Patsy Tassler, an epidemiologist with the Vermont Department of Health, offered some possible scenarios should avian flu mutate into a human-to-human disease. Based on flu epidemics from 1957 and 1968, Tassler estimated that as many as 186,000 Vermonters could be infected, with several thousand requiring hospitalization. Such an epidemic, she said, could result in an "overwhelming number of people who are sick and dying," as well as major disruptions in essential services.
But one audience member challenged Tassler's figures and underlying assumptions. "We don't know if [this disease] has a 50 percent mortality rate, or a 2 percent mortality rate," he said. "Frankly, these figures aren't all that useful."
Similar questions arose following the presentation by Barbara Farr, director of Vermont Emergency Management. As she noted, an avian flu outbreak could last four to eight weeks, if not longer. In such a case, Farr said, all of Vermont's resources "are going to be stretched," and state and local officials cannot assume that the federal agencies will have the resources to come to their assistance.
Farr didn't discuss how local officials should prepare for such devastating reductions in staff, nor how planners should prepare for the "continuity of operations" that would be needed to keep society functioning.
In fact, when the 3-hour summit was over, one attendee (who asked not to be identified) remarked that while the various presentations were full of government acronyms and organizational flow charts, they were "surprisingly short" on marching orders. "I was expecting more," he said.
In July, Vermont emergency planners will get to put their flu plans to the test when the state participates in "Operation Pandemic Flu." The 2-week event, which will simulate a viral outbreak on a real chicken farm, has been described as "the largest functional exercise of its kind in Vermont history." Emergency planners insist that no birds will be harmed during the exercise.