by The Associated Press
(Atlanta, Georgia) In the worst case of a global flu epidemic, schools would close for three months and public events would be canceled.
In the most optimistic scenario, people merely would be told to wash their hands and stay home if they feel sick.
Those are the options the government plans to consider depending on the strength of a possible deadly flu epidemic. And the options would be graded like hurricanes: The worst case would be Category 5. The least-threatening outlook, Category 1.
Federal officials last week released a grading system for flu pandemics. The steps were taken to give the public some help in deciding how anxious to get if a deadly new flu appears in the United States.
The government also is releasing a wave of radio and TV spots to remind people not to be complacent about a potential contagion.
"As avian influenza slips from the headlines, people may begin to believe that the threat is no longer real," said U.S. Secretary of Health and Human Services Mike Leavitt, in a Thursday press conference in Atlanta.
The system has been eagerly awaited by state and local health officials, who will have to make many of the decisions about how to control the impact of the next pandemic flu.
Federal officials say they don't expect a vaccine will be available for such a virus until at least six months into a pandemic. On Thursday, Leavitt granted companies protection from lawsuits for vaccines against the bird flu virus.
Under his declaration, all H5N1 vaccines developed through a grant, contract or cooperative agreement would be protected through all production stages from testing to use. The protection would run through February 2010.
And although the U.S. government has enough medicine for more than 22 million people, it's not clear that they will work against whatever virus emerges, and it's doubtful that will be enough if many of America's 300 million residents becomes ill.
So health officials plan to rely on old-fashioned measures ranging from home quarantine to closing schools and postponing sporting events. But those measures can increase a pandemic's economic fallout, and even have unintended consequences. Closing schools, for example, can keep adults home from work to care for children. And it doesn't help if older kids are sneezing on each other at the mall.
The new guidelines, from the U.S. Centers for Disease Control and Prevention, don't spell out exactly what infection-control steps states should take. But they do give an idea.
For example, in a Category 1 pandemic, there's no need to dismiss schools. But in a 2 or 3, states should consider dismissing students for up to four weeks. In a 4 or 5, they should consider closing the schools for up to 12 weeks.
CDC officials said categories are important because until now many people have thought of pandemic flu in black and white terms: Either a deadly contagion is upon is, or it isn't.
"Not all pandemics are equally severe," Dr. Julie Gerberding, the CDC's director, said Thursday in unveiling the new guidelines.
The CDC copied the nation's hurricane ranking system to help people size up the situation and to help communities make what Gerberding called "real tough decisions" about when and how to cut back normal activities.
But not everything is covered in the new guidance. For example, it says little about whether sick people or healthy people should wear masks, and if they do, what kinds.
"It's not a simple matter," Gerberding said, adding that more detailed advice on masks should be coming out soon.
Flu pandemics can strike when a mutating flu virus shifts to a strain that people never have experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu might trigger one if it starts spreading easily from person to person.
Most planning until now has focused on the worst-case scenario of an outbreak as severe as in 1918, when 50 million people worldwide died. But the 20th century's other two pandemics, in 1957 and 1968, were far less severe, claiming 2 million and 1 million lives, respectively.
The 1918 pandemic was a primary model for current pandemic flu planning. Dr. Howard Markel, a University of Michigan health historian, said he believes the government's new grading system might have made a difference back then.
Federal health officials put out guidance then, too, but cities varied on what steps they took, said Markel.
States still have leeway, of course, and neighboring states may institute different measures in a new pandemic. But if the government comes out with clear advice, it will probably be followed more closely than it was in 1918, when governmental power was more local, he said.
"The federal government telling a local or state health board to do something was not met with warmly," he said.