PETERSON AIR FORCE BASE, Colo. – Living a sensible, healthy lifestyle and staying away from crowds may be two of the most important ways to avoid becoming infected with a pandemic influenza, according to a senior U.S. Northern Command medical official.
"It's really pretty simple," said Cdr. Tanis Batsel, USNORTHCOM Chief of Preventive Medicine. "Washing hands frequently – that means 20 times a day with warm water and soap, if you can. [Alcohol-based hand gels] are an alternative, but they don't replace washing your hands with soap and water. Just keeping yourself healthy. Rest, exercise, healthy diet, not smoking ... not drinking excessively.
"If you're ill, don't go to work. Try not to expose others to yourself. If your children are sick, keep them home. Encourage co-workers to go home if they're sick."
Batsel also recommends periodically wiping down frequently touched and shared surfaces such as desks, telephones and doorknobs with a household disinfectant.
Coughing should be done not into your hand or a handkerchief, but either into a tissue that can be thrown away or into your upper arm or sleeve. Avoid touching your eyes, nose and mouth, and don't share personal items, such as pens, toothbrushes, cups or utensils, that may have been in someone else's mouth.
Of course, no one knows if or when a pandemic influenza will develop, but a particularly dangerous strain of avian flu known as H5N1 is being closely monitored around the world for signs it may be spreading from human to human.
"H5N1 has typically been an avian influenza, meaning it infects birds, not humans," Batsel said. "It's still considered an avian influenza, with accidental infections occurring in humans. It's not a pandemic influenza, but it has the potential to become one.
"So far, there have been about 200-plus infections [in humans] that we recognize, and about 50 percent, slightly more, of those people have died."
To date, there have been no cases of H5N1 in either animals or humans in the United States.
The lethality of H5N1 is what makes it so potentially disastrous, Batsel said, although officials aren't sure yet if the strain really is especially lethal or if the people who have contracted it didn't have proper medical care or had it too late.
"In these locations where it's occurring so far," she said, "the public health infrastructure is not sufficient to pick up on these cases, and these people aren't showing up until they're very, very ill."
If the H5N1 avian flu virus mutates into a strain that spreads from person to person, it won't be the first time.
"The last three human pandemic influenzas arose from avian strains," Batsel said, "so it wouldn't be surprising to see that happen again." In fact, the 1918 pandemic flu that killed about 500,000 people in the United States and 50 million worldwide was a mutation of an avian flu.
One thing we learned from the 1918 pandemic, Batsel said, is that quarantines are not effective.
"What will help is self-sequestering, or social distancing, which means you minimize your trips to crowded environments; you go to the store when fewer people are likely to be there; you maintain a two-meter distance between people; you try and keep your family at home."
Preparation is key to riding out the six- to eight-week "waves" of illness that are typical of influenza.
"It's just like preparing for a snowstorm or hurricane or anything else," she said. "The issue here is that pandemic influenza isn't going to be an event. It's not going away in a week. It's going to be an environment."
During each wave of illness, a significant percentage of the work force is expected to be absent. About 30 percent will be sick while others will be caring for them; still others will be healthy but staying home out of fear. That means that, among other things, grocery stores are unlikely to be kept at normal stock levels because truck drivers are sick and deliveries aren't being made. Essential services such as water, electricity and trash pick-up may also be interrupted.
Despite the unpleasantly predicted events of a pandemic influenza, there is some good news.
Thanks to the public health structure and intensive medical surveillance in the United States, an outbreak of pandemic flu is not likely to go unnoticed and untreated. When the 1918 pandemic started, Batsel said, "there was a lot of denial" and officials did not react quickly to minimize the spread of the virus. Two other factors that work in our favor: today's world population is, on average, healthier and better-fed than our early 20th-century counterparts, and more medical and technological options are available to treat illness.
On the other hand, the concentrated populations of our modern urban centers and the ease of international travel may help a pandemic flu virus spread more easily and quickly from city to city and nation to nation.
In the event of a pandemic, USNORTHCOM is primarily concerned with continuity of operations and force protection. The command also expects to be asked for some form of military assistance to civil authorities.
In the meantime, Batsel has been educating USNORTHCOM's senior leaders on pandemic influenza and giving them training materials which they can use to educate members of their directorates.