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State Not Ready for a Flu Crisis

A pandemic would quickly overwhelm the healthcare system, which lacks sufficient beds, medical staff and equipment, officials say.

April 17, 2006|Rong-Gong Lin II | Times Staff Writer

Los Angeles County and the rest of California have nowhere near the capacity to treat the hundreds of thousands of people who might need medical care should a pandemic flu strike, according to health officials and experts across the state.

Officials are only beginning to work out how they would find the extra hospital beds, health workers and equipment needed in such a crisis. County and state authorities could not say, for instance, how many ventilators might be on hand to keep severely ill people breathing.

"No one, and I repeat no one, is prepared for a pandemic that starts tomorrow," said Dr. Howard Backer, an official with the California Department of Health Services.

Three flu pandemics occurred in the 20th century, in 1918, 1957 and 1968. Another could come any time, experts say. No one knows when -- or if -- the avian flu virus that has killed millions of birds, mostly in Asia, and more than 100 people will ever mutate into a strain that would spread easily among humans.

But U.S. Secretary of Health and Human Services Michael Leavitt has been prodding state and county health agencies to make immediate preparations. He embarked on a 50-state tour, visiting California last month, to urge local authorities to dust off "ethereal plans" and turn them into "community action."

Doing so is proving to be much tougher than simply stockpiling anti-flu drugs.

At a recent statewide summit on pandemic flu preparedness, Dr. Mark Horton, the state health officer, said "surge capacity," or the ability of hospitals to handle huge waves of patients, is "perhaps going to be our single greatest challenge in addressing the pandemic."

"We don't have enough hospital beds to take care of patients in a regular, ordinary flu season," said Dr. Michael Sexton, president of the California Medical Assn.

Dr. Brian Johnston, an emergency room physician in Los Angeles, said some ERs in the county are so jammed now that ambulances routinely are diverted to neighboring facilities.

"The famous line from emergency medical services is, we have trouble handling a Friday night," Johnston said. "Handling a large pandemic, by most estimates, is out of the question."

The county and state are hardly alone in grappling with the threat, and experts said it is hard to compare their progress with other parts of the country. But they are not among the recognized leaders in the area, such as New York City, which has plans for where and how mass vaccinations might be administered, and Seattle, which has identified indoor ice rinks that might serve as morgues.

The federal government's preparations, in many respects, are just getting into gear.

As early as this week, President Bush is expected to approve a national pandemic influenza response plan that identifies more than 300 tasks for federal agencies, such as determining which front-line workers should be vaccinated first and expanding Internet capacity to handle what would probably be a flood of people working from their home computers.

The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak and continue functioning through what could be an 18-month crisis, which in a worst-case scenario could kill 1.9 million Americans.

Some agencies are far along in preparing for a deadly outbreak. Others have yet to resolve basic questions.

"Most of the federal government right now is as ill-prepared as any part of society," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm said the administration has made progress but is nowhere near prepared for what he compared to a worldwide "12- to 18-month blizzard."

If a pandemic of up to 18 months did occur, about 30% of the population in affected areas could fall ill, the federal government estimates.

In Los Angeles County, that translates to 3 million people, and depending on the severity of the pandemic, between 30,000 and 330,000 of them might need hospitalization.

But there are just 25,000 licensed hospital beds in the county. Between 5,000 and 8,000 more could be created by discharging patients early, canceling elective surgeries and establishing tent shelters at 11 designated medical centers, said Kay Fruhwirth, assistant director of the Los Angeles County emergency medical services agency.

"There will never be enough surge capacity in our existing hospitals," Dr. Jonathan Fielding, Los Angeles County public health director, said at the summit last month. "Even if there were enough beds -- which there won't be -- there won't be enough people. We have trouble getting enough nurses now."

The problem exists statewide, said Backer, the state public health official.

"The healthcare system has been contracting or has been eliminating bed capacity for at least 20 years, and now we're asking them to be able to greatly increase their capacity on a very short notice," Backer said.

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