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.
