Bird Flu Scare Stokes Demand for Medicine

After reading a magazine article on “The Next Killer Flu,” Cindy Gesner felt sick with worry.

The Malibu mother of three wondered what would happen to her young boys if a lethal bird-flu pandemic hit. Would there be enough antiviral drugs for them? Or would the limited supply of Tamiflu in the United States run out?

She immediately asked her sons’ pediatrician to prescribe some for a family stash.

Forget it, the doctor told her, explaining that the bird flu wasn’t an immediate threat.

Gesner was reassured -- at least until her brother called from the East Coast. “He said, ‘Everyone has it. Go get it.’ ”

So she did.

Gesner is among a growing number of worried well people, as alarmed about avian flu as many were about the anthrax threat four years ago. Back then the drive was to find Cipro, the supposed magic-bullet antibiotic.

Now, it’s a race for Tamiflu.

It is no magic bullet, but it could be the best protection available if, as some health forecasters fear, the bird flu hits with the force of the global flu pandemic in 1918. For the near term, there is no commercially available vaccine for the avian virus, H5N1, which has killed about half of the 122 people reported as infected. All of the deaths were in Southeast Asia.

As concern about bird flu draws national headlines, people are growing more intent on snagging a personal supply of antiviral medication, mainly Tamiflu. Doctors say patients are arriving with news clippings in hand, bent on leaving with a signed white slip of security.

But their task has become tougher. This week, scattered pharmacies in Southern California reported that they were out of Tamiflu, which was originally designed to reduce the severity of the conventional flu. And the sole manufacturer, Roche, announced it had suspended sales to nongovernment sources in the United States.

The reason: to discourage hoarding.

The U.S. strategic stockpile has about 2.3 million doses of Tamiflu, with an additional 2 million on order, according to the Department of Health and Human Services. But for an effective response in a flu pandemic, at least 81 million treatment courses of approved antiviral drugs would need to be stockpiled, according to the national Pandemic Influenza Plan.

Although generic manufacturers may enter the market to ease the squeeze -- and ramping up production may not take nearly as long as originally predicted -- not everyone is content to wait.

“It’s not just one person getting the prescription,” said West Hollywood pharmacy owner Eddie Bubar. “It’s almost everybody in the family ... it’s two, three, four, five prescriptions, so everybody has a box and can be covered.”

Worry seemed to escalate in early October, doctors and druggists said, after President Bush spoke of using the military to enforce possible quarantines in the event of an outbreak.

And they seemed to spike in recent weeks as some experts conceded that the nation was strikingly unprepared for anything like the 1918 pandemic. This week, Congress received a report from the Bush administration predicting that up to 1.9 million people could die in such a scourge today.

So far, the bird strain has been devastating mainly to bird populations in Asia. The fear is that the virus will mutate so that it can spread easily among humans, though many experts say there is no reason to expect such a scenario this flu season.

Gesner was spurred to action in September, when she picked up an arresting issue of National Geographic, with double-page photographs of a cemetery, health workers in biohazard gear and a comatose patient hooked to a ventilator. An elaborate graphic predicted that up to 360 million people could die in a global calamity -- one of the most extreme projections to be published.

“It scared me, and that’s why I went to the doctor,” Gesner said. “That was the first time I heard about this avian flu.”

After the first doctor balked at her request, Gesner tried again. A second pediatrician in the same office was more amenable. Gesner walked out with Tamiflu prescriptions for each of her sons, ages 2, 5 and 8.

Gesner said she felt guilty after the doctor reminded her that Tamiflu was needed for people infected with the conventional flu, especially the elderly and those at high risk of complications.

“I do feel bad about taking it off the shelves,” Gesner said. “But in the case of my kids, I’ll do anything to keep them protected.”

It doesn’t hurt to have connections in the health profession.

When a Los Angeles doctor refused to give musician Ernie Fields Jr., 70, a Tamiflu prescription, he called a pharmacist friend in Oklahoma, who agreed to hold some in reserve for him.

It’s a “kind of better-safe-than-sorry theory,” said Fields, a Mt. Washington resident. “I wanted to make sure that I had it if I needed it.”

William Bao, an internist in Hacienda Heights, said he had his own supply on hand.

“In case there’s a pandemic, I want to be able to do something for my family,” Bao said, noting that he would be at risk of exposure to the disease as a physician.

Bao said he had granted about 10 requests for Tamiflu to people traveling to Asia, including one person who came in armed with neatly circled news articles. In California, especially, many people are frequent travelers to and from that continent and fear they are at risk, although some doctors say the real danger is in going to a Southeast Asian chicken farm.

“I don’t have reason to refuse,” Bao said.

Other physicians decry the personal stockpiling. One likened it to building home nuclear fallout shelters during the Cold War.

“It sounded good at the time, but in retrospect it was kind of a silly thing to do,” said Robert Frenck, a professor of pediatrics at Harbor-UCLA Medical Center.

Santa Monica pediatrician Sheila Phillips said she stopped prescribing the medication to patients who clearly were acting out of fear.

“They’re panicking. I don’t want to play into it,” she said, adding that she tries to tell worried parents, “the idea of the avian flu is something we need to be concerned about. But not this year.”

It is not even clear that Tamiflu would be effective in a bird-flu pandemic, experts say. The flu virus could mutate into a strain Tamiflu can’t touch, said Jeffery Goad, an assistant professor of clinical pharmacy at USC.

But Tamiflu, which goes by the generic name oseltamivir, is the only medication available in pill form that might improve a patient’s prospect for survival, according to the World Health Organization. (Another medication, Relenza, is inhaled and is trickier to administer.)

When taken within 48 hours of the onset of symptoms, Tamiflu can stop the influenza virus from replicating, reducing the severity and duration of illness. It can sometimes prevent illness altogether.

“We’re telling the general public to discuss their concerns, as well as the need for antivirals, with their clinicians,” said U.S. Centers for Disease Control and Prevention spokesman Tom Skinner.

The U.S. Department of Health and Human Services has warned against personal stockpiling.

Some healthcare providers are starting to take a tougher stance.

Last week, Kaiser Permanente’s West Los Angeles hospital set up a new screening plan for Tamiflu prescriptions. The hospital doesn’t want to run out.

Many patients come in “worried and they want it,” said Dr. Mark Salzman, a Kaiser pediatric infectious disease specialist, explaining the need for a more formal approach. “Some physicians do have trouble saying no.”

Jack Pivko, a Beverly Hills pediatrician, said he tries to talk parents out of getting a prescription. But if they persist, he relents.

“If they want it, they can have it,” he said. “I keep my patients happy.”