Imagine the situation begins at Elliot hospital in Manchester.
A man walks through the doors of the emergency room with all the symptoms of flu.
Baxter: Cough and fever, muscle aches, sometimes joint pain, and that’s garden variety flu.
Doctor Greg Baxter, head of Elliot Hospital’s emergency department, says the type of flu won’t be determined until hours or days later.
But for the first response it doesn’t matter if it’s garden variety flu or the new pandemic strain.
Baxter: You take appropriate universal precautions for every patient regardless of whether they have bronchitis, pneumonia, or flu, to basically try to protect both them and everybody else by having them wear a mask and then the staff using appropriate precautions which would also be mask, gown and gloves to deal with anybody who is potentially infected.
Next come the diagnostics: blood and mucous tests will be sent to the state’s Division of Public Health to confirm the strain of flu, and staff asks questions about travel history and other health conditions.
In our scenario the symptoms and possible exposure all lead Dr. Baxter to believe he is dealing with the state’s first case of the avian flu that has been spreading across the globe.
He sends the patient to a special isolation room.
At the flip of a switch Baxter can seal off the room’s ventilation system and send air out of the building.
Baxter then calls in the hospital’s Director of Infection Control, Linda Caine.
She makes sure the hospital is prepared to take on the additional cases that are likely to follow.
Caine: We have over 25 negative pressure rooms, but we could convert a couple of floors to negative pressure as well as having isolation units delivered from the state. There are portable units available, so we could have an awful lot of rooms.
Baxter’s team treats the patient and Caine safeguards the hospital.
She contacts the city and state public health departments, which alert a network of responders to mobilize their efforts simultaneously.
That network includes pharmacies, emergency rooms, schools, and health clinics, which would monitor and report signs of other flu cases to catch outbreaks early.
The Manchester Public Health Department interviews everyone who was in contact with the patient and urges them to stay home on quarantine.
Up until this point, the response is swift and without snags—these groups have been drilling these activities for years, and the communications, surveillance systems, and protocol are in place.
But now enter the variables...first, the drugs.
Cooney: We don’t have a vaccine. We don’t have mass quantities of antivirals.
Mary Anne Cooney, Director of the State’s Division of Public Health, says that could change by the time a pandemic might arrive.
There is currently a vaccine in the works and pharmaceutical companies are accelerating antiviral medication production.
Cooney: We would be able to handle more than one case with what we have now, but we would be anticipating the potential for us to be able to give antivirals to those potentially long term that need to maintain the infrastructure such as our emergency personnel, the people that work within laboratories, hospital individuals and their families, those that work in critical infrastructure such as electric, communications.
But even with just one case of avian flu Cooney calls the Centers for Disease Control and requests the national stockpile of drugs, which includes additional antivirals.
The stockpile would land at Pease Airforce Base and the National Guard would bring it to a warehouse for distribution.
But even this stockpile is limited nationally and antivirals are not guaranteed effective.
Cooney says quarantine could be the key factor in squelching the flu’s spread.
Here our hypothetical situation encounters another variable.
What if the patient’s contacts—his wife, his coworkers, his children—don’t want to be quarantined?
Current quarantining laws include a twenty four hour waiting period before cases are heard in court if someone refuses quarantine.
Cooney says she wants to see that change before a pandemic hits.
Cooney: We are currently having discussions with the attorney general’s office and the courts so that if we are ever faced with this issue we can do this quickly and in mass amounts. So that if we have more than a hundred people for instance that we need to consider quarantining that we can do it efficiently and it wouldn’t overburden the courts.
Rich DiPentima, deputy director of the Manchester Public Health Department says quarantine will help, but it might not matter anyway.
DiPentima: The reality it’s probably going to be impossible to prevent further introduction of influenza into the state. Even if this case were controlled and the context of this case were controlled just by the nature of influenza and the way it spreads person to person.
DiPentima predicts that several weeks after the first case walks into Elliot Hospital, flu would spread around the state.
Hospital beds would fill and a backup crew of healthcare workers would be summoned.
DiPentima: We’ve worked over the years and developed a large volunteer database. We’ve contacted every physician, every nurse, every dentist, every veterinarian, every pharmacist, every podiatrist that live in the surrounding Manchester area.
In the best case scenario, health care workers are able to handle the surge of patients.
Buses and stoes operate with limited staff.
Churches and community programs deliver food, diapers, medicine and other essentials to those quarantined or sick at home.
Vaccines and antivirals effectively squash the virus in its tracks.
But right now, none of those safeguards are guaranteed.
And without them, says DiPentima, New Hampshire faces the worst case scenario.
DiPentima: Then we would be sort of at the mercy of the virus and using the best methods we have in terms of using hygiene and education to prevent the spread and maybe to prevent large gatherings and looking at things like closing schools.
Health officials predict a death toll in New Hampshire from an avian flu pandemic between three hundred sixty and two thousand people.
Typically about two hundred people die each year from the flu.
DiPentima says that even with several more years of preparing, there will be variables that cannot be anticipated.
When it comes to a pandemic, he says, it is the microbes that are in charge.
SOQ
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One way to predict how New Hampshire might fare in a flu pandemic is to look to the past.
Tomorrow we’ll recount how the state made it through the worst pandemic recorded—the Spanish flu of nineteen eighteen.
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Bird Flu Masks (NanoMasks) have been purchased by the US Department of Defense for military soldiers, and the NanoMask filters have been shown to kill the Bird Flu (H5N1) by an independent laboratory. The Nano Mask is the first face mask in the world to utilize nanotechnology enhanced filter media to effectively isolate and destroy viral and bacterial contaminants. Nanoparticles enhance the intrinsic filtration efficiency of the media by acting as a destructive absorbent to kill virus and bacteria that come in contact with the filtration system. (NanoMask Testing and Time Kill Study)
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