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Would Americans Panic In A Flu Pandemic?

A large majority of Americans would comply with government orders to avoid work, school, or other public places in the event of a flu pandemic, according to a survey released Thursday.

The results suggest public health officials could easily convince most people to temporarily alter their daily lives in a bid to stem the spread of influenza.

But researchers warn such willingness would likely erode after just a few weeks as lost wages, food shortages, and runs on medical attention mounted.

"You would find significant levels of cooperation early on," says Robert J. Blendon, author of the report and a professor of health policy at the Harvard School of Public Health. "The question is, how are we going to provide essential services as they [the public] can't go to normal places?"

More than 90 percent of the 1,700 U.S. adults surveyed said they would postpone air travel and avoid public venues like movie theatres and shopping centers if asked by public health officials.

Ninety-four percent said they would stay home for 7 to 10 days to help authorities control disease spread.

Federal, state, and local officials have been planning for the possibility of a flu pandemic since bird flu began infecting humans in Southeast Asia in 2003.

The highly aggressive strain H5N1, though it is not easily spread between humans, had sickened 256 and killed 151 people as of Oct. 16, according to the World Health Organization.

Government researchers and private companies have collaborated on developing an effective bird flu vaccine against the H5N1 strain since 2004.

But there is no guarantee that the H5N1 virus would be the one to spark a pandemic. Even if it is, vaccine manufacturers say it would take them at least six months to make enough vaccine for all Americans.

"I think we can say safely we will not have a vaccine for at least the first wave of an epidemic, and probably will have inadequate vaccine for a second year," says D.A. Henderson, a scholar at the University of Pittsburgh Center for Biosecurity, who is a government advisor on epidemics and bioterrorism.

That means basic measures like hand washing and social distancing are likely to be the most effective ways of stemming an outbreak in its early stages, Henderson says.

Blendon says findings in Thursday's study would give government officials a cushion for gaining the public's help in controlling a pandemic.

But there were also warning signs.

One-quarter of those surveyed said they have no one at home to care for them if they get sick. Roughly the same number said they would likely lose their job if they stayed away from work for a week to 10 days. In each case, those people were more likely to be low-income or hourly wage-earners.

Those results are an alert that government officials must plan early for how to provide food, schooling, and other services to low income citizens, Blendon says.

The aftermath of Hurricane Katrina showed that poor residents are much more vulnerable when disaster strikes. It also showed that chaos can ensue when people perceive signs that their government is not helping them.

A similar lack of planning for the potential upheaval of a major flu outbreak would quickly undo the public's initial goodwill, Blendon told a panel convened by the Institute of Medicine.

"The people that are going to run out of gas first are very low income, they're hourly workers." Blendon said.

"If things go wrong, people are going to change their behavior," he warned.

In issuing federal guidelines for pandemic planning last year, federal health officials said they would serve mostly a coordinating role during a pandemic. Detailed planning for hospital services, school closings, and emergency response would remain the responsibility of state and local planners, they said.

But Henderson says local planning waned sharply after media attention on the threat of pandemic flu faded in the spring.

Few hospitals have planned for the surges in patients that would likely turn up for medical attention in the first wave of a pandemic, Henderson says. Few have stockpiled filtration masks or other medical supplies.

"Here we have fallen down almost completely," Henderson says.

SOURCES: Pandemic Influenza Survey, Harvard School of Public Health Project on the Public and Biological Security, Oct. 26, 2006. Robert J. Blendon, professor, Harvard School of Public Health. World Health Organization: "Cumulative Number of Confirmed Human Cases of Avian Influenza (H5N1) Reported to WHO," Oct. 16, 2006. D.A. Henderson, scholar, University of Pittsburgh Center for Biosecurity.

By Todd Zwillich
Reviewed by Michael Smith