Rhode Island health department officials and other members of the newly formed Pandemic Flu Working Group are escalating efforts to improve Rhode Island's preparedness for an outbreak of avian flu and a potential flu pandemic. Though Brown's explicit role in coordinating emergency response plans remains unclear, these pre-emptive measures, which are coming in response to instructions delivered last week by Gov. Donald Carcieri '65, will engage the University on multiple levels.
University administrators will likely be called upon to help develop strategies at the local level, according to David Gifford, state health department director. In addition, the health department will draw on the expertise of Brown's medical faculty in controlling the spread of disease and minimizing the effects of a potential pandemic.
Carcieri issued a press release Nov. 1 announcing the formation of the working group "to update Rhode Island's comprehensive plans to address a potential pandemic flu outbreak." In the release, Carcieri called on Gifford to chair the group and "report back to me with a final plan" by Dec. 20, adding that "the seriousness and unpredictability of this threat" mandate a swift and comprehensive response. Carcieri granted the state health department permission to work with the General Assembly to "expend every resource necessary" in increasing the state's supply of Tamiflu, an antiviral medication used to treat influenza.
Human cases of avian flu first appeared in Southeast Asia in 1997, said Professor of Medicine Leonard Mermel, who is also the medical director of the department of infection control at Rhode Island Hospital. The first case appeared in Hong Kong, where an outbreak that began in poultry killed six people, according to the Centers for Disease Control. In the past year, Avian Influenza A (H5N1) has spread over birds' migratory flight paths into Russia and Croatia. This trend, coupled with "a recent flurry" of human cases and the virus's documented ability to mutate, make the possibility of pandemic especially alarming this year, Mermel said.
"Our concern is that it could undergo mutation, whereby it could spread easily person-to-person," Mermel said. "That would herald the pandemic."
Medical officials remain largely in the dark regarding the speed at which a potential pandemic might spread. "That's the million-dollar question to which nobody knows the answer," Mermel said.
Currently, there is no FDA-approved human vaccine for avian flu. Though antiviral drugs do exist, "unfortunately we're in a tough situation nationally where we don't have enough of the antiviral drugs that would treat this virus," Mermel said.
According to his own "back of the envelope" calculations, Mermel said that in order to prevent up to 75 percent of the state's population from requiring hospitalization, Rhode Island would need enough antiviral medication to treat roughly 20 to 25 percent of the population. This equates to about two million doses.
"That's a problem. We're not vaguely close to having that amount of antiviral drugs in the state," Mermel said. "We won't have (a vaccine) if this happens in the next few years."
In addition to the Nov. 1 press release, Carcieri released a letter addressed to Gifford that further stressed the damage a flu pandemic could inflict on Rhode Island. "While straining our health care system, pandemic flu could also inhibit our ability to provide and maintain essential services at all levels of government and the private sector," he wrote.
Carcieri's statement and letter came shortly after President Bush's speech at the National Institutes of Health in which he announced his plans to ask Congress for $7.1 billion in preparation for a possible flu pandemic.
Though Carcieri did not ex-plicitly cite Brown as a potential player in the state's emergency response plans, Jeff Neal, the governor's press secretary, told The Herald that the Rhode Island Department of Health has been collaborating with public health institutions in Rhode Island, including hospitals and research groups, over the past several months. "It is clear that responding to a flu pandemic would require the cooperation of health care providers and researchers throughout the state," Neal said.
Gifford, the state's health department director, told The Herald that the Pandemic Flu Working Group will conduct "very high-level coordination oversight" of various smaller working groups throughout the state.
Rhode Island currently has a statewide emergency operating plan that features 17 different components. At the Pandemic Flu Working Group's first meeting, members discussed potential modifications to this plan.
More specific assignments, such as how to keep "banking and grocery stores and the infrastructure of society" operational should pandemic flu occur, will be administered to smaller working groups this week, Gifford said. These groups will then report back "over the next few weeks," giving the Pandemic Flu Working Group ample time to present a revised plan by Carcieri's Dec. 20 deadline.
State hospitals also have disaster response plans in place, though these "need to be amended with regards to how to handle something like pandemic influenza," Mermel said. "I think it's reasonable to believe that there's more that we can, should and will do in regards to local preparedness."
Rhode Island Hospital has put together a working group to evaluate responses to various stages of a potential pandemic. In particular, the group is trying to outline an appropriate course of action if birds carrying avian flu are identified in North America or if clusters of human cases appear to suggest person-to-person transmission. The potential spread of avian flu is "what we're most concerned about right now," Mermel said.
In particular, "what we need to think about is what we can do to prevent transmission in the community," Mermel said. Efforts to do this include distributing gloves and masks to hospital workers and encouraging residents to avoid gathering in large crowds should a pandemic occur. Healthcare institutions can establish separate waiting rooms for flu patients and educate patients on appropriate "cough etiquette" and hygiene practices, he said.
The possibility of quarantine for flu victims prompted the Rhode Island chapter of the American Civil Liberties Union to issue a statement Nov. 2 urging members of the Pandemic Flu Working Group to preserve individual rights when drafting an emergency response plan.
Steven Brown, executive director of the state's ACLU chapter, told The Herald that state laws regarding emergency planning grant "far-reaching" powers to government officials implementing emergency response plans and offer very few safeguards protecting personal liberties.
"The law gives the governor broad power to suspend state laws and regulations that might hinder dealing with the emergency," Brown said. "There is very little protection from abuse with that."
In addition, Rhode Island's laws lack certain individual protections that other states offer, such as ensuring the right of quarantined victims to be continually tested so they are not held longer than necessary, Brown said.
"If the state quarantines a person, they have no obligation to check up on them," he said. "Theoretically, they could keep them there for months without reviewing their status."
Brown said he supports less restrictive measures to stop the spread of flu, such as allowing quarantined victims to remain in their homes instead of relocating them to a hospital or government facility.
Brown's preparation
The University formed a Crisis Communications Com-mittee following the terrorist attacks of Sept. 11, 2001. The committee drafts general response plans for incidents of bioterrorism, natural disasters and other health crises, according to Edward Wheeler, director of Health Services.
The committee is headed by Vice President for Administra-tion Walter Hunter and operates on three levels: upper-level administrators are charged with making policy decisions; a core crisis team meets more frequently and brings together representatives from the Department of Public Safety, Facilities Management and other University departments; and an operations group is responsible for implementing policies.
Wheeler said he believes "we have the mechanism in place that we can meet quickly" if called upon by the state health department to provide emergency assistance, though, as of Friday, Health Services had not been notified of any communication between the University and the health department.
Following the 2003 outbreak in China of Severe Acute Respiratory Syndrome, commonly known as SARS, the crisis committee met to discuss a plan that drew on recommendations from the Centers for Disease Control and the state health department, Wheeler said.
Similarly, the University's response to pandemic flu would largely depend on instructions administered by the CDC and other health agencies, he said.
"It's not like a pandemic is going to hit Brown and not hit Providence. We would follow their guidance," Wheeler said.
Beyond responding to directives from government officials, broader policy decisions like whether to institute a quarantine or close the University "are going to be really tough," Wheeler said. The University has "plenty" of vaccinations for regular influenza, he added.
Gifford said he has been in contact with Professor of Medical Science Terrie Wetle via e-mail and expects Brown will be involved with the revision and development of pandemic response plans on a more local level.
"I think one of the questions that people have asked is what is going to happen with the universities and colleges," Gifford said, adding that the proximity of large numbers of college students "puts them at an increased risk of spreading any flu-like symptoms."
"We need to have an appropriate plan for that," Gifford said. "Brown will be part of that discussion."
