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CDC issues guide on influenza pandemic

Plan would keep people at home

ATLANTA -- States should be prepared to keep children out of school for three months, businesses should be ready to operate with skeleton workforces, children should be prepared to play mostly with their siblings, and parents should be ready to lose income as they skip work and cobble together child-care arrangements.

That is the picture sketched yesterday by the federal government in guidance it issued for how to fight pandemic influenza in the months before a vaccine becomes available -- if one ever does.

"We have tools in our tool kit that we can use now to slow down pandemic flu," said Martin Cetron, the director of global migration and quarantine at the Centers for Disease Control and Prevention, the country's chief public health agency. "These are tools we just are not used to using in recent decades, when all the attention has been on magic bullets."

The 106-page document released yesterday by the CDC is the government's latest effort to help prepare the United States for a global flu epidemic that most specialists say is inevitable. It outlines "non pharmaceutical interventions" against a virus that can sometimes be caught simply by standing near an infected person. The chief strategy is to keep people physically apart as much as possible during the six- to eight-week waves of illness that characterize pandemics.

The picture it paints of the United States in the first months of a flu pandemic is in many ways an antique version of both society and medicine: People would spend most of their time with close relatives and a few neighbors. They probably wouldn't go to the movies, run to the supermarket on a whim, or hug people they barely know. The sick would be cared for at home unless they were near death. Everyone would shun the houses of the ill.

At the same time, it also reflects modern possibilities and expectations.

Many adults would simply telecommute to work in a season of near-endless "snow days." Children would probably still do their homework, handing it in over the Internet. Prescription drugs would be prescribed liberally as preventive medicines in households where someone is sick. A government-woven safety net would probably provide food, personal care, and financial assistance to people who couldn't cope on their own.

One possible preventive tool, face masks, isn't addressed in the "Community Strategy for Pandemic Influenza Mitigation" booklet. That's because CDC planners are still doing research, both experimental and historical, to determine how useful they would be. They expect to provide guidance on masks in a month or so.

To help states, cities, and towns decide when to employ various measures, the new document outlines a five-category system for grading pandemic severity that is analogous to the one used for hurricanes. Wind speed is the key variable in hurricanes; for pandemics it is "case fatality ratio."

Case fatality ratio is the fraction of ill people who die. In the epochal "Spanish influenza" of 1918, which killed at least 50 million people worldwide, the ratio in the United States was about 2.2 percent. Without a good mitigation strategy, a 1918-type pandemic today would kill 1.8 million Americans. It would be a Category 5.