The state has covered a lot of ground but still has a long way to go before Alaska's more than 320 communities are fully prepared to handle an outbreak of pandemic flu, say public health officials.
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The state's pandemic plan outlines some basic steps, thanks to a 30-member working group from various state and federal agencies, municipalities, private industry, church-based groups and local organizations.
Members meet once a month, often working through different scenarios of how the disease might spread through Alaska.
Jim Mackin, preparedness program manager with the state Division of Public Health, said they are looking for creative ways to head off a potential catastrophe, not knowing if, when or what strain of the disease might arrive.
"There are so many layers on this onion and there's no textbook," said Mackin. "Sometimes I get up in the morning and feel like blood is coming out of my ears when I start thinking about all the ifs and whats and ands."
Officials estimate between 2,000 to 20,000 people could fall ill in Alaska, depending on the type of flu and severity of the pandemic, but there are only 1,400 hospital beds in the state with only 1,100 staffed at any one time.
"In the best case scenario, that system might be strained literally to the breaking point, in the worst case scenario it's completely crushed," said public health division director Jay Butler.
So the challenge, he said, is figuring out how to increase hospital bed capacity and the numbers of people caring for the ill while finding ways to avoid the crush in the first place by reducing the spread of disease early on.
Preparation can include everything from teaching basic hygiene in schools to conducting a community-wide drill.
As with any disaster training, workers rely on simulated events to help them prepare, Mackin said.
Seven communities in the state held mass vaccinations this fall, practicing emergency procedures and lining up volunteers while dispensing real flu shots as well.
Though vaccines likely will be in short supply at first - health officials have no way of knowing ahead of time what strain might emerge - Mackin says the exercise is still a good way to rally the troops.
In Valdez last fall, 200 volunteers, almost 5 percent of the population, participated in a daylong event that brought in about 2,500 residents, either for a flu shot or just to walk through the exercise.
"To put one on requires an incredible civic commitment," said Mackin. "And it's good practice in doing what we have to do for targeted dispensing."
The state also has drawn up blueprints for home health care and the creation of alternative care centers. Many communities already have a cache of cots, linens and blankets for use in emergency shelters. In Ketchikan, volunteers set up a care center at an elementary school last October and took care of 10 live and 10 dummy "patients" overnight.
Assistant Fire Chief Jim Hill said the exercise helps establish critical relationships.
"You're getting to know your counterparts and their capabilities," he said. "It's a lot better than exchanging business cards at a disaster."
Such local efforts are invaluable, said Mackin, who preaches self reliance and advance planning when he travels to communities around the state to talk about pandemic preparation.
A deadly outbreak of avian influenza or some other strain of the disease could cut off transportation and supply lines, leaving isolated towns and villages to fend for themselves.
"They shouldn't count on us or the feds to come over the horizon because everyone will be similarly afflicted," said Mackin.
Private industry can help out on a local level.
For example, the Alaska Commercial Co., which has grocery and general merchandise stores in 21 rural communities, plans to build up stocks of basic goods by an extra 20 percent next year.
"Our biggest concern is what is going to happen if a pandemic affects the supply chain, so we are getting our stocks ramped up in anticipation," said company president Rex Wilhelm.
The state's plan also includes moving anti-viral medication to regional hubs if the World Health Organization formally declared a pandemic in the United States. If the spread of the disease is severe enough, the state will begin recommending that schools close.
Butler said local school officials will have to weigh many factors before making the final decision.
"It's not as simple as saying we will close the schools," said Butler. "Because the issue is trying to keep children and teenagers from gathering together. If everyone just goes to the mall instead, we haven't gained anything."
If there is a prolonged closure in the Anchorage, school district communications director Michelle Egan said, school officials would rank those with the highest needs, such as seniors needing credits to graduate, while offering all students instruction through online, cable or post office channels.
Though global pandemics have occurred over the last four centuries at least, including three of varying severity in the last century, it was the recent spread of a deadly strain of Asian bird flu that brought home the urgency of preparing for a pandemic moving into human populations once again.
Scientists at first thought the virulent H5N1 virus could arrive on the shores of North America by way of Alaska because of the many migratory bird routes that cross the state, but now believe it is more likely to arrive through domestic poultry smuggled into the country.
When and where that strain or another will mutate into a form that is easily passed from human to human is an even bigger question but scientists say it is inevitable. And though it is likely to start elsewhere, they estimate it will take only one to six months to arrive in Alaska.
That's why Mackin says he can't stress enough the importance of being prepared ahead of time.
"When are you prepared enough? You are never really sure when you are there," Mackin said. "But pandemic flu, more than any other kind of event, is truly a community event because everybody will be impacted."
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