Fighting Bird Flu at Home: How to Prepare for the Possible Pandemic

Ever hear the amusing expression, "So much as been written about everything, it's hard to find anything out about it?"

This certainly applies to H5N1, avian flu, bird flu, or whatever you want to call it.

Naturalists are eyeing the migratory birds overhead and scientists are counting the human cases-most of whom, if not all, caught the disease from a bird, not a family member.

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For complete bird flu coverage, visit's Bird Flu Center.

Weighing the Odds

The key to widespread outbreaks or a multicontinent pandemic is for the virus, carried by domestic and wild birds, to morph into a form that can be passed from human to human via a cough or sneeze. Scientists are all over the map on whether this will happen.

Robert G. Webster, the Rosemary Thomas Chair at St. Jude's Children's Research Hospital in Memphis, Tenn., is sometimes called "The Flu Hunter." Webster recently says there is a 50-50 chance the virus will become transmissible human-to-human. If it does, he projects that half the people in the country would die. He has stored a three-month supply of food and water at his house.

Others cite the swine flu scare of several decades ago. That one fizzled.

The upshot is no one knows for sure. The World Health Organization, Centers for Disease Control, U.S. Department of Health and Human Services, Department of Homeland Security, and countless local governments are taking bird flu seriously and trying to plan.

The irony may be that for all of this planning, taking care of cases will probably fall to individuals and take place in the home. This is the view of Gratton Woodson, MD, a primary care doctor at the Druid Oaks Health Center in Decatur, Ga., who has made a years-long study of bird flu on behalf of his patients and has published a bird flu preparedness manual to help them cope.

The CDC also has put up a web site helping people to prepare for this possibility. It's

Facing a Pandemic

Tom Skinner, a public affairs officer for the CDC, tells WebMD that the CDC believes individuals should have an emergency preparedness plan for all purposes, including the bird flu, should it come.

"Remember, the confusion after Hurricane Katrina?" Woodson asks. "Multiply that — the emptied stores, stranded people, lack of transportation, services, and supplies — times every state and probably every continent."

You couldn't ride it out for a few weeks — the flu would probably come in waves, and even come back to an area, according to Woodson.

Both Woodson and the government are operating on the assumption that a vaccine, though in the works, probably will not be ready by the time the virus got cranking. Supplies might be scanty compared with need in a genuine pandemic.

The antiviral drugs, such as Tamiflu, may or may not work against bird flu, although the government is trying to assemble 20 million doses.

Skinner warns of social disruptions if the virus starts leaping from person to person.

On the CDC's web site:

The government urges you to plan for the overcrowding or closing of hospitals, banks, stores, restaurants, and post offices. Schools may be closed for extended periods. Parents need to think about their children's needs and possibly even childcare requirements if the parents are able to get to work.

Woodson doesn't want to be a Chicken Little, but he does foresee a scenario in which utility companies would run out of coal and hospital generators out of diesel oil — just because there was no one healthy enough to deliver these items. "Most doctors would want to stay open," he says, "but in our office, without electricity, we would have to close the office."

Hospitals may cease to be a refuge. According to the U.S. Department of Health and Human Services, Woodson says, there are 1 million hospital beds in this country, and 10,000 ventilators. Almost three-quarters of the beds are already full at any one time. "There is no possible way the hospital system could cope," he says.

Yet in many cities and municipalities, forward-thinking planners are trying to prepare the health care system for the coming of the virus. Jeff Kalina, MD, leads the Texas Medical Center's Pandemic Flu Task Force. He also spearheaded the center's hurricane efforts for Katrina and Rita.

"We mirror the Centers for Disease Control and FEMA guidelines," he says. "We are creating a plan and when we get it, we will drill it. If there is suddenly a ground zero and Person A gives it to Person B and Person C, we will spread the word about flu hygiene [hand washing and so on]. We also will be planning to create wards [of hospital beds]. We will turn the lights on; get triage going." Probably, says Kalina, people will be sent to places other than hospitals, where vulnerable people would be more susceptible to the bug.

Skinner adds that the CDC is developing software called FluSurge for hospitals to use in their planning and detection of viral spread.

Home Care May Be Crucial

Woodson advises his patients to prepare to stay home unless they are really severely ill. In other words, we are back to pioneer days.

Extrapolating from past viruses, Woodson says statistics suggest, although this is not a sure thing, that some people will not contract bird flu, should it go transmissible. No one knows exactly why, but they could be immune. According to these calculations, some will get it and will be very ill and contagious. Others may get a light case or no case, but will show antibodies, meaning it got into their system and they have formed antibodies against the virus.

The well people will take care of the sick. And a lot of this care will probably be done at home.

"This is flu," Woodson says. "You can do a lot of care for people using low-tech means."

On its web site, the CDC lists supplies to have on hand, including over-the-counter painkillers, such as acetaminophen (Tylenol) and ibuprofen (Advil or Motrin) for headaches and muscle pain, and antidiarrheal medicine. Plenty of cleansing agents, such as hand cleaners and detergent, also are listed.

The CDC recommends stocking nonperishables such as:

—Canned foods

—Protein or fruit bars

—Dry cereal

—Dried fruit

—Bottled water

—Baby food

—Pet food

Also on the CDC list: flashlights, batteries, portable radio, manual can opener, garbage bags, diapers, and toilet paper.

Skinner recommends having a supply of your prescription drugs as well.

To these Woodson would add crackers, Gatorade, and other foods good for sickness.

"I think stockpiling is a grand idea," says planner Kalina. Skinner says he has large stocks of canned food and bottled water at home.

Woodson also says some people might also want to consider:

—An alternative power source

—Organizing your neighborhood. If everyone in a house is sick, Woodson says, would the neighbors help out — or could you help them? He also has bought some medical supplies not only for his family, but his neighbors.

Could Your Family Members Die?

Even without a "Mad Max" scenario with the breakdown of society, Woodson says many people, perhaps the young and the elderly, may not be able to fight off the virus and will weaken within a few days.

Well people should steer clear of the sick if possible.

Skinner urges that well children be kept away from sick kids. Kids should also cover their coughs and wash their hands frequently. This goes for adults, too. The time to start this training is now.

"Of 100 people, only three will die with proper at-home care, in my opinion," Woodson says.

Too Scary to Contemplate?

Is all this too horrible to think about?

"Come on," Woodson scolds. "The United States is a frontier country. We live a fancy life, but we all have ancestors who experienced this sort of thing. Physicians need to teach their patients what to do at home. Taking care of people there is pretty simple: Rehydrate, keep them clean and warm, and give them painkillers. If you get sick, have someone else to step in."

"We are just asking for common sense preparedness," Skinner says.

By Star Lawrence, reviewed by Louise Chang, MD

SOURCES: Gratton Woodson, MD, primary care doctor, Druid Oaks Health Center, Decatur, Ga. Tom Skinner, public affairs officer, CDC, Atlanta. Jeff Kalina, MD, associate director, emergency services; chairman, Texas Medical Center's Pandemic Flu Task Force.