State Not Ready for a Flu Crisis

Los Angeles County and the rest of California have nowhere near the capacity to treat the hundreds of thousands of people who might need medical care should a pandemic flu strike, according to health officials and experts across the state.

Officials are only beginning to work out how they would find the extra hospital beds, health workers and equipment needed in such a crisis. County and state authorities could not say, for instance, how many ventilators might be on hand to keep severely ill people breathing.

“No one, and I repeat no one, is prepared for a pandemic that starts tomorrow,” said Dr. Howard Backer, an official with the California Department of Health Services.

Three flu pandemics occurred in the 20th century, in 1918, 1957 and 1968. Another could come any time, experts say. No one knows when -- or if -- the avian flu virus that has killed millions of birds, mostly in Asia, and more than 100 people will ever mutate into a strain that would spread easily among humans.

But U.S. Secretary of Health and Human Services Michael Leavitt has been prodding state and county health agencies to make immediate preparations. He embarked on a 50-state tour, visiting California last month, to urge local authorities to dust off “ethereal plans” and turn them into “community action.”

Doing so is proving to be much tougher than simply stockpiling anti-flu drugs.

At a recent statewide summit on pandemic flu preparedness, Dr. Mark Horton, the state health officer, said “surge capacity,” or the ability of hospitals to handle huge waves of patients, is “perhaps going to be our single greatest challenge in addressing the pandemic.”

“We don’t have enough hospital beds to take care of patients in a regular, ordinary flu season,” said Dr. Michael Sexton, president of the California Medical Assn.

Dr. Brian Johnston, an emergency room physician in Los Angeles, said some ERs in the county are so jammed now that ambulances routinely are diverted to neighboring facilities.

“The famous line from emergency medical services is, we have trouble handling a Friday night,” Johnston said. “Handling a large pandemic, by most estimates, is out of the question.”

The county and state are hardly alone in grappling with the threat, and experts said it is hard to compare their progress with other parts of the country. But they are not among the recognized leaders in the area, such as New York City, which has plans for where and how mass vaccinations might be administered, and Seattle, which has identified indoor ice rinks that might serve as morgues.

The federal government’s preparations, in many respects, are just getting into gear.

As early as this week, President Bush is expected to approve a national pandemic influenza response plan that identifies more than 300 tasks for federal agencies, such as determining which front-line workers should be vaccinated first and expanding Internet capacity to handle what would probably be a flood of people working from their home computers.

The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak and continue functioning through what could be an 18-month crisis, which in a worst-case scenario could kill 1.9 million Americans.

Some agencies are far along in preparing for a deadly outbreak. Others have yet to resolve basic questions.

“Most of the federal government right now is as ill-prepared as any part of society,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm said the administration has made progress but is nowhere near prepared for what he compared to a worldwide “12- to 18-month blizzard.”

If a pandemic of up to 18 months did occur, about 30% of the population in affected areas could fall ill, the federal government estimates.

In Los Angeles County, that translates to 3 million people, and depending on the severity of the pandemic, between 30,000 and 330,000 of them might need hospitalization.

But there are just 25,000 licensed hospital beds in the county. Between 5,000 and 8,000 more could be created by discharging patients early, canceling elective surgeries and establishing tent shelters at 11 designated medical centers, said Kay Fruhwirth, assistant director of the Los Angeles County emergency medical services agency.

“There will never be enough surge capacity in our existing hospitals,” Dr. Jonathan Fielding, Los Angeles County public health director, said at the summit last month. “Even if there were enough beds -- which there won’t be -- there won’t be enough people. We have trouble getting enough nurses now.”

The problem exists statewide, said Backer, the state public health official.

“The healthcare system has been contracting or has been eliminating bed capacity for at least 20 years, and now we’re asking them to be able to greatly increase their capacity on a very short notice,” Backer said.

A county survey released in March showed that 67% of hospitals in L.A. County that responded to a survey in 2005 did not have plans for coping with a flu pandemic, and only three of five facilities reported having extra supplies of gloves, masks, gowns and Tamiflu, an anti-flu medication.

Some critics said the state has been moving dangerously slowly.

“Without a detailed blueprint for action, we fear chaos when the pandemic actually hits,” the California Medical Assn. said in a February letter to the state Department of Health Services.

The letter questioned how key resources, even those as basic as face masks, would be distributed, as well as how hospitals might prepare for a surge in patients. Since then, the association has begun working with the state to improve preparations.

One serious shortcoming is the lack of ventilators. Across the nation, there are only about 105,000, experts say. A pandemic flu could require more than six times that many, said Osterholm, an expert on pandemic flu preparedness.

Backer said the state was still trying to count the number of ventilators in California. The machines are not easy to come by, at a cost of more than $30,000 each.

Indeed, California now is counting all of the necessary supplies and resources it has, and it needs those results before deciding what purchases to make, Backer said.

For its part, the county is creating a reserve volunteer medical registry of doctors, nurses and respiratory therapists who could be called out in an emergency, Fruhwirth said. The county already has a reserve corps of about 600 retired doctors and nurses whose licenses are not active.

The county also is identifying additional “surge capacity” in schools, gymnasiums and community centers that could house and feed ill patients, Fielding said.

After the anthrax attacks of 2001 on the East Coast, the county health department received more than $40 million in federal bioterrorism grants to prepare for a disaster. Some of that money has gone to the creation of 11 disaster resource centers based at hospitals, each of which has one self-inflating tent to house up to 20 patients. Each center also has 16 extra mechanical ventilators and 70 disposable ventilators.

Federal officials have essentially warned local health authorities around the nation that they would be largely on their own in a pandemic, perhaps for an extended period.

Experts say an influenza pandemic lasting up to 18 months would have at least two peak waves, each lasting several weeks.

“Any community that fails to prepare, with the expectation that the federal government or ... the state government would step in and rescue them, will be tragically wrong,” said Leavitt, the Health and Human Services secretary, at the summit.

Jeffrey Levi, executive director of Trust for America’s Health, said local officials should be planning ways of keeping people from infecting one another. Such “social distancing measures” would put areas where people congregate in large numbers off-limits.

“Will we close the schools? Will we shut down theaters? Will we shut down Disneyland? And what will that mean for the Orange County tax base?” Levi said. “Those kinds of things need to be talked through ahead of time.”

*

Times wire services contributed to this report.