SAN FRANCISCO – Could you work from home for weeks at a time? How long could you hole up without needing to go to the grocery or drugstore? Would you be willing to wear a face mask and isolate yourself from others?
Harvard researchers are surveying Americans on questions like these as the government wraps up work on a plan to use primitive infection-control measures to deal with a killer flu outbreak until drugs and vaccine become available.
The federal Centers for Disease Control and Prevention is pitching the plan at medical meetings and aims to send it out for review by the end of the year. State and local governments have asked for unusually detailed and specific advice on such matters as closing schools and canceling public events, one CDC official said.
This week, CDC awarded $5.2 million in grants related to the plan, including research on whether to recommend face masks to the public. CDC also asked the Institute of Medicine, a group of scientific advisers, to meet on these measures later this month.
"We can't afford to neglect some of the traditional approaches to contagion control because we very well may find ourselves in a situation where that's all we've got for a period of time," said CDC's quarantine chief, Dr. Marty Cetron.
However, skeptics say parts of the plan amount to wishful thinking with little evidence they would work.
"A lot of these things sound good but they lack practical application," said Michael Osterholm, a University of Minnesota health expert involved in the planning.
Advising people in big office buildings to avoid elevators and stay 6 feet away from each other is impractical, and people can't stay in their homes for weeks or months without needing insulin and other medications, he noted.
The nationwide survey by the Harvard School of Public Health is an attempt to get a handle on how Americans would follow such advice.
As for hygiene tips like sneezing into your sleeve, "we have no data that that makes any difference" in controlling a pandemic, Osterholm said.
The bird flu that has ravaged poultry in Asia and killed at least 140 people is "still smoldering" as a human threat, showing no signs yet of morphing into one that spreads easily among people, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
If it does, severe travel restrictions would delay its spread in the United States by only a week or two and at extreme cost, the CDC's Dr. David Bell said at a recent meeting of public health and disease experts in San Francisco.
Thermal scanning to try to detect people with fevers during the SARS outbreak turned up no cases and caused many false alarms. But voluntary quarantine, voluntary isolation of infected people and hygiene measures like hand washing, "cough etiquette" and face masks did help and might for flu, too, Bell said.
Dr. Frederick Hayden, a University of Virginia virologist currently working on global flu planning for the World Health Organization, agreed.
"The classic public health measures did work in SARS," he said. They won't be enough to stop a flu pandemic but could prolong and spread out its impact to prevent hospitals from being swamped and running out of respirators to keep the sickest alive.
The CDC plan will list multiple scenarios for pandemics that range in severity or attack certain age groups like children or college students, and recommend corresponding control measures.
These will include voluntary isolation of sick people, voluntary quarantine for those exposed to the germ but are not ill, and protective sequestration to separate healthy people or communities from a source of infection.
"Quarantine has gotten a very bad name and for very good reason. It has been abused in the past. It works best when we obtain and maintain the public trust," Bell said.
However, Osterholm said there's not enough science to recommend some measures, like "keep your distance" campaigns. Scientists know flu spreads through hand contact and big droplets when people cough or sneeze, but they don't know how far tiny particles remain in the air, or how important that is for spreading the germ.
In fact, experts know surprisingly little about what enables a flu germ to spread.
Health officials need to give advice but should be honest about the limits of what is known "and not oversell it, which there is a tendency to do in times of crisis," Osterholm said.
If that happens, "we will lose credibility quickly," he said.