On
Tuesday, May 9 at 8 p.m., the ABC television network aired a made-for-TV movie
titled "Fatal Contact: Bird Flu in America." The movie follows an
outbreak of the H5N1 avian flu virus from its origins in a Hong Kong market
through its mutation into a pandemic virus that becomes easily transmittable
from human to human and spreads rapidly around the world. The Department of Health and Human Services
prepared a Viewer's Guide and some anticipated Questions and Answers to provide
factual information for viewers of the movie.
Viewer's Guide
ˇ The
ABC Movie "Fatal Contact: Bird Flu in America" is a movie, not a
documentary. It is a work of fiction designed to entertain and not a factual
accounting of a real world event.
ˇ There
is no influenza pandemic in the world at this time.
ˇ Also,
it is important to remember that H5N1 avian influenza is almost exclusively a
disease of birds. The H5N1 virus has not yet appeared in the U.S.
ˇ Should
the H5N1 virus appear in the U.S., it does not mean the start of a pandemic.
ˇ An
additional point to remember is that the next influenza pandemic could be
substantially less severe than what the movie depicts or that occurred in 1918.
For example, the influenza pandemics of 1957/58 and 1968/69 caused so much less
illness and death than did the 1918/19 pandemic that many Americans at that
time did not distinguish them from seasonal influenza and were unaware that a
pandemic was underway.
ˇ While
the movie does serve to raise awareness about avian and pandemic flu, we hope
it will inspire preparation - not panic. There are steps individuals, families
and communities can take to prepare. You can keep a supply of food and
medicines on hand in case you have to stay home, you can practice good public
health measures like frequent hand washing and staying home when sick. There is
good information available on www.pandemicflu.gov.
ˇ The
film does depict scenarios that could unfold should a severe pandemic ever
develop, including limited availability of antivirals and vaccines as well as
the potential for disruption of supplies, medicines and other essential
services.
ˇ The
film also illustrates the expected months-long delay in developing an effective
vaccine against a pandemic strain of influenza once it emerges. This is why, at
the President's request, the Congress approved funding for the Department of
Health and Human Services to make significant financial investments to improve
the technology for vaccine development and to build up our domestic vaccine
production capacity, to ensure more rapid availability of vaccine for the
population in a pandemic.
ˇ The
film highlights an important aspect of planning - individual and community
planning and cooperation that will be so vital to sustaining communities and
neighborhoods during an extended wave of an influenza pandemic. HHS has
developed an extensive set of planning documents, including planning checklists
for businesses, schools, health care providers, community organizations and
states as well as an individual and family planning guide. All of these
materials are available at www.pandemicflu.gov.
ˇ While
the H5N1 virus has not yet appeared in the U.S., and there is no influenza
pandemic in the world at this time, it is important for all Americans to be informed
about this potential public health threat and some of the steps individual
Americans can take to protect themselves and their families in the event of a
pandemic.
ˇ
Questions
& Answers
Many
people in the movie are seen wearing surgical masks. Will masks protect me?
For
health care workers exposed to infected patients, N95 respirators are
recommended. Surgical masks are recommended for patients who are infected to
help reduce the potential for spread of virus when these people cough or
sneeze. The Department of Health and Human Services (HHS) and the Department of
Labor (DOL) will continue to review and update as needed its public health
guidance on the use of masks and respirators by the general public and at-risk
workers.
The
film indicates that there will be a shortage of TamifluŽ (or other antivirals)
in a pandemic. Will there be? And if so, what is the government doing to
prevent that?
HHS
is stockpiling enough antivirals to treat 25% of the U.S. population should a
pandemic occur in the U.S. This figure is based on historical data from past
pandemics indicating that roughly 25% of the population would get sick in a
pandemic and would benefit from antiviral treatment if started early in the
course of illness. To date, the U.S. government has purchased 26 million
antiviral treatment courses and expects to have on hand a total of 81 million
treatment courses by the end of 2008.
The
movie shows the virus spreading in many ways besides coughing or sneezing, such
as handshakes, kissing, sharing drinks, etc. Is that correct?
Influenza
virus is primarily spread by airborne droplets that reach the eyes, nose or
mouth but can also spread by touching contaminated surfaces and then touching
one's face. This highlights the importance of learning and practicing good
personal hygiene, including:
ˇ
Wash
hands frequently with soap and water.
ˇ
Cover
your mouth and nose with a tissue when you cough or sneeze.
ˇ
Put
used tissues in a waste basket.
ˇ
Cough
or sneeze into your upper sleeve if you don't have a tissue.
ˇ
Clean
your hands after coughing or sneezing. Use soap and water or an alcohol-based
hand cleaner.
ˇ
Stay
at home if you are sick.
In
the movie officials quickly find out that there is no vaccine available when
the pandemic occurs nor will any be available for many months. Will we have
vaccine available if a pandemic occurs?
There likely will be no vaccine initially available that
precisely matches the pandemic strain when a pandemic begins. Because influenza
viruses continually evolve and mutate, it is not possible to develop a vaccine
until after the pandemic strain actually comes into existence. Only after the
strain emerges, is isolated and characterized can a vaccine be developed and
manufactured. Based upon current vaccine production processes and capacities,
it will take at least 6 months to begin producing pandemic vaccine once a
pandemic strain occurs.
HHS has been developing and stockpiling an experimental
"pre-pandemic" H5N1 vaccine that may offer some level of immune
protection should the H5N1 virus mutate into a pandemic strain. Having a
stockpile of this vaccine for up to 20 million people, may help delay or lessen
the initial impact of a pandemic while vaccine against the actual pandemic
strain is developed and produced.
However, HHS is making significant financial investments to improve the
technology for vaccine development and to build up our domestic vaccine
production capacity, to ensure more rapid availability of vaccine for the
population in a pandemic.
Many
essential services (e.g., electricity, food, water, etc.) become scarce in the
film's scenario. Could that happen?
An especially severe influenza pandemic could lead to high
levels of illness, death, social disruption, and economic loss. Everyday life
would be disrupted because so many people in so many places become seriously
ill at the same time. Impacts can range from school and business closings to
the interruption of basic services such as public transportation and food
delivery.
In addition, a substantial percentage of the world's population
will require some form of medical care. Health care facilities can be
overwhelmed, creating a shortage of hospital staff, beds, ventilators and other
supplies. Non-traditional sites such as schools may need to be used for patient
care to cope with demand.
Many
neighborhoods were quarantined in the film. Even the Governor of Virginia
quarantined himself, his staff and his family from the rest of the world. Will
the government quarantine people in a pandemic?
The purpose of quarantine is to separate people who have
been potentially exposed to a contagious disease and may be infected but are
not yet ill to stop the spread of that disease. The last large-scale quarantine
measures that were imposed in this country were used in the early 20th century
to contain outbreaks of plague, yellow fever, and smallpox.
Today,
quarantine typically refers to confining potentially infected persons to their
homes or community-based facilities, usually on a voluntary basis. Quarantine
can be used for a defined group of people who may have been exposed at a public
gathering, or who may have been exposed while traveling, particularly overseas.
In extreme cases, quarantine could apply to an entire geographic area, in which
case a community may be closed off by sealing its borders or by a barricade,
known as a "cordon sanitaire".
In the case of pandemic influenza, quarantine may be one of
the public health tools employed in the early days of an emerging pandemic if
efforts are undertaken to contain the outbreak before it spreads too widely.
Once a pandemic has begun to spread, quarantine is not likely to be effective
in controlling the spread, and instead efforts may turn to "social
distancing." Social distancing includes measures to increase distance
between individuals, such as staying home when ill unless seeking medical care,
avoiding large gatherings, telecommuting, and school closures.
Informational Announcement
To date, there have been no cases of the H5N1 virus in the United States nor
has there been a human transmission of the disease in a form that could fuel a
pandemic. However, experts around the world are monitoring the Avian Flu
situation closely and are preparing for the possibility that the virus could
begin to spread from person to person. For information on the virus log onto pandemicflu.gov.
In
the movie, we learn that the virus is beginning to develop resistance to
TamifluŽ, rendering the drug useless. Could that happen? If so, why are we
buying so much TamifluŽ for the stockpile?
TamifluŽ, and another antiviral, RelenzaŽ, have shown
effectiveness in treating influenza. Early evidence suggests that TamifluŽ may
be effective in treating those patients who have been infected with the H5N1
avian flu virus. While there have been a few reports of TamifluŽ resistance
developing on therapy, there has been no transmission of a resistant virus. The
resistance developing on therapy has been associated with starting the drug
late or using low doses of this drug. TamifluŽ, when used at proper doses and
started within a few days of the appearance of symptoms should be effective
treatment of this infection.
RelenzaŽ has not been used in treating human H5N1 cases to
date, as it has been unavailable in many countries that have had people
infected with H5N1. But experts expect it would be an effective treatment also.
HHS
is stockpiling enough antivirals to treat 25% of the U.S. population should a
pandemic occur in the U.S. This figure is based on historical data from past
pandemics indicating that roughly 25% of the population would get sick in a
pandemic. To date, the U.S. government has purchased 26 million antiviral
treatment courses and expects to have on hand a total of 81 million treatment
courses by the end of 2008. Of its antiviral purchases, the U.S. is buying
approximately 80% of its supply as TamifluŽ and about 20% of its supply as
RelenzaŽ. This is due in part to product availability but also to the need to
diversify the supply so as to not rely solely on one medication.
The
film depicted many people who simply walked off their jobs. Would that really
occur?
In
a severe pandemic, it is very possible that up to 40% of a business' or
organization's workforce will be out sick or at home taking care of sick family
members. It is also possible that a small percentage of this amount will be
people who are healthy but who may be too frightened to venture out into
public.
The
numbers of health-care workers and first responders available to work can be
expected to be reduced as they will be at high risk of illness through exposure
in the community and in health care settings, and some may have to miss work to
care for ill family members.
What
will be done with the overwhelming number of deceased bodies if we have a
severe, 1918-like pandemic as was depicted in the film?
Addressing the possibility of a large number of deceased
individuals in a pandemic is one of our top pandemic planning priorities.
Currently, we are working on modeling studies to try to determine as clearly as
we can what we could possibly expect in terms of numbers of deaths over the
course of several pandemic waves. Until these studies are done, we won't be
able to speculate on details of what we might or might not expect. We expect
this work to be done in the next few months.
Regardless of whatever estimates are developed, it is highly
unlikely that in the 21st Century in the U.S. that we would ever resort to mass
graves. We are working with many government agencies (e.g., VA) as well as the
private sector (e.g., the funeral industry, the cemetery industry) to develop
guidance for states, local communities and others that maintains the dignity of
the deceased, honors family wishes, and respects religious and social customs.
Deciding
who gets vaccine was a major question in the film. In a real pandemic, how will
you decide who gets vaccine first?
The greatest risk of hospitalization and death-as seen
during the last two pandemics in 1957 and 1968 and during annual influenza-will
be in infants, the elderly, and those with underlying health conditions. These
individuals, along with health care providers, who are critical to maintaining
a health care system in a pandemic, would likely be the first individuals to
receive the first supplies of vaccine. However, in the 1918 pandemic, most
deaths occurred in young adults, highlighting the need to remain flexible on
determining priorities for vaccination groups based on the epidemiology of an
emerging pandemic.
As part of planning efforts, two Federal advisory
committees-the Advisory Committee on Immunization Practices and the National
Vaccine Advisory Committee-have made recommendations for prioritizing critical
populations that might receive the first supplies of vaccine. These
recommendations can be found in the HHS Pandemic Plan, which is available at www.pandemicflu.gov.
In
the movie, the Virginia governor's son dies because he cannot get diabetes
medicine; other drugs are not available in pharmacies.
Essential
supplies, including medicine, may become unavailable during a pandemic. As part
of effective planning, individuals and families should talk to their doctor
about how to maintain adequate access to prescription medications.