With at least 11,000 airline passengers flying from Asia to California each day, the state would be more vulnerable than most should a deadly flu virus break out in the Far East, health authorities say.
Despite stepped-up efforts to prepare for such a catastrophe, California -- like the rest of the nation -- is strikingly underprepared, these experts say.
On the Pacific Rim, Los Angeles and other cities may be "the port of entry" for the avian flu and similar diseases, said Linda Rosenstock, dean of UCLA's School of Public Health.
"I don't think anyone is going to be sufficiently prepared if it comes," she said. "We should be better prepared than we are."
Fears of a global influenza outbreak have recently intensified, especially in the last week as a study reported key similarities between the 1918 Spanish influenza pandemic and a lethal avian flu virus that has surfaced in Asia.
The pandemic was one of the deadliest in human history, killing an estimated 50 million people. The current outbreak in Asia, which has spread to people mostly via birds, has sickened 116 and killed about 60. But the virus would become far more deadly if it mutated and began spreading from one person to another, experts say.
On Friday, President Bush met with executives of several major pharmaceutical companies and urged them to push ahead on experimental avian flu vaccines. State Department officials also met with representatives from 81 countries to improve planning for a global pandemic.
Earlier last week, the president said Congress should consider allowing the military to enforce quarantines in case of an epidemic. Three days later, the Senate passed a military spending bill that included $4 billion to stockpile antiviral drugs that could protect people against the so-called bird flu.
But the increased political attention only underscores how ill-prepared the nation is for an outbreak, despite years of warnings, experts say.
A draft of a plan prepared by the Bush administration -- obtained by the New York Times -- showed that an outbreak in Asia could reach the United States within "a few months or even weeks," overwhelming hospitals, leading to riots at vaccination clinics and causing power and food shortages, the newspaper reported.
Worry is growing in California.
"I've been asked ... 'What's the thing that keeps you awake at night?' And, consistently, I say, 'Avian flu,' " said Dr. Jonathan Fielding, Los Angeles County's health officer.
Fueling the anxiety is the fact that a vaccine against the avian flu is not commercially available and the most likely medication to help in an epidemic, an antiviral drug called Tamiflu, is in short supply, Fielding said.
There is also a risk that a mutated strain of the flu could become resistant to antiviral drugs.
The state has only one laboratory that can identify the avian flu virus, said Dr. Carol Glaser, chief of the viral disease lab at the state health department.
Twelve health departments throughout the state -- including those in Los Angeles and Orange counties -- are striving to develop that capability within two months.
National projections for the number of possible infections and deaths vary widely.
The nonprofit Trust for America's Health has predicted that nearly 67 million would be infected and more than 500,000 Americans -- including nearly 61,000 in California -- would die in a medium-level pandemic. The nonprofit group estimates that 273,000 Californians would be hospitalized.
Los Angeles County hospitals could quickly run out of beds, making them available for only the sickest patients.
"In some scenarios, we could easily outstretch the surge capacity of hospitals," Fielding said. "Then we'll have to find other places to put seriously ill people."
Auxiliary hospitals would need to be set up, he said, meaning that buildings would have to be commandeered. Because health workers would be in high demand and vulnerable to the illness, family members and other untrained caregivers might need to be recruited to help, Fielding said.
To prevent an outbreak from spreading, Glaser said, state officials also might have to implement extraordinary measures such as asking workers to telecommute, closing schools and discouraging large public gatherings. Travel restrictions also might be implemented, she said.
For now, health officials in California are focusing on tracking the avian flu virus if it appears in the state. Officials have asked physicians to report any patients hospitalized with flu-like symptoms who recently have visited Asian countries.
And at Los Angeles International Airport, the national Centers for Disease Control and Prevention is doubling its quarantine staff -- from three to six -- to monitor passengers arriving from abroad. The CDC also plans to set up a quarantine station in San Diego, primarily to monitor the border with Mexico.
In the event of an avian flu outbreak, health officials advise that people stay home, wash their hands frequently and cover their nose and mouth when sneezing or coughing.
"This is the kind of flu to which none of us have ... immunity," Fielding said. "It's not going to be an easy matter to contain."