WASHINGTON – Ask Americans if they would hole up at home to keep from spreading a super-strain of flu, and at first they pledge to cooperate.
But probe deeper, and here come the doubts. One in four adults says there is no one to care for them at home if they got sick, raising the specter of Grandma gasping alone in bed or a single mom passed out while her children wail.
Another one in four could not afford to miss work for even a week. Would they heed doctors' calls to stay home or go sneeze on co-workers?
And one in five fears the boss would insist they come to work even if they were sick and contagious.
So concludes a survey by Harvard researchers that will bring the concerns of average people into government deliberations on how to fight the next worldwide outbreak of a super-flu.
"If you want to contain the flu, you have to make it livable for people" to comply with infection-control steps, said Robert Blendon, a health policy specialist at the Harvard School of Public Health. He planned to present the survey Thursday at a meeting of public health officials.
"This is really a Catch-22 here. If you can't help the people make it at home, then the epidemic's going to get much more severe."
Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people have never experienced. This has happened three times in the past century. Concern is rising that the Asian bird flu might trigger a pandemic if it starts spreading easily from person to person.
Old-fashioned infection control is one strategy to try slow a pandemic's spread until vaccines become available: staying home if you are sick or may have been exposed; closing schools; avoiding crowded gatherings such as church services, sports events and shopping malls.
It is far from clear how well such measures would work, or if some could cause more harm than good. So the government asked the Institute of Medicine to bring together health specialists, state and local officials and industry this week to debate that issue.
Harvard's Blendon was pleasantly surprised that his survey of 1,697 adults suggests people are paying attention to pandemic discussions and are open to public health advice.
Some 94 percent said they would stay home, away from other people, for seven days to 10 days if they had pandemic flu and 85 percent would do so if a household member were sick. Equally high numbers said they would heed calls not to leave their community while pandemic flu circulated.
People were mostly confident they could care for sick family members at home, and find a relative or friend to help out with child care if schools closed for months at a time.
But as the survey probed more consequences of containment measures, people began to realize what hardships could await them.
Millions of people live with no other adult who could care for them if they fall ill, Blendon noted. Communities need to plan how to provide emergency in-home help, perhaps through properly trained charity groups.
Then there were practical survival issues. More than 40 percent of those surveyed said they would run out of diapers, baby formula or medications if they had to stay home for even a week.
Blendon said workplace worries were a major problem, too. Many people live paycheck-to-paycheck, and more than one-quarter of respondents said they would lose a job or business if they had to stay home for seven days to 10 days. Only one-third thought they still would get paid if they missed work.
This real-world feedback is important as long as policymakers understand people will act less rationally in a crisis, said Michael Osterholm, a University of Minnesota infectious disease specialist who has advised the government on flu preparations.
His bigger concern is that the stay-at-home plans are far too simplistic.
"If you want to guarantee that society will collapse in terms of the economy, tell everybody to stay home," Osterholm said. "Somebody's got to move the food, take away the garbage, provide health care, law enforcement, to assure that communications continues. ... We will very much put at risk things like electricity, food."
The Harvard poll was conducted by telephone between Sept. 28 and Oct. 5 by ICR of Media, Pa. It has a margin of sampling error of plus or minus 2.5 percentage points.
The Institute of Medicine is part of the National Academy of Sciences, a private organization chartered by Congress to advise the government of scientific matters.