Stateline Story

States Prep for Possible Swine Flu Pandemic

As health officials across the country ramp up preparations to battle the swine flu , the head of a national coalition of state health officials warned Congress Tuesday (April 28) that states could be in trouble if infections reach a pandemic level.

Paul Jarris, executive director of the Association of State and Territorial Health Officials , urged a Senate subcommittee to spend more than $1 billion to help states respond to a pandemic flu. He said federal funding cuts for state and local preparedness efforts and layoffs of health workers caused by the recession could hamper states' ability to respond.

Jarris requested $350 million to help states update their pandemic response plans and conduct more drills to practice them. He also wants $122 million to help states buy enough antiviral medicine, like Tamiflu or Relenza, to treat 8 million more people, which would boost the nation's stockpiles to a total of 81 million courses of treatment. Jarris also asked for $563 million to protect doctors, nurses and other health workers with antiviral drugs and protective gear.

On Tuesday President Obama also asked Congress for $1.5 billion to prepare for a flu pandemic.

The swine flu outbreak that originated in Mexico has led to at least 91 confirmed cases in 10 states: Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio and Texas, with the largest number of cases, 51, in New York, and the first death, of a 23-month-old child, in Texas. Other state health departments are reporting more possible cases that have not yet been included in the federal tally.

California Gov. Arnold Schwarzenegger (R) declared a state of emergency Tuesday to ensure the state could react swiftly to the crisis. California plans to conduct its own tests to screen for swine flu, instead of relying on the federal government.

"There is no need for alarm. I issued my emergency proclamation to make sure all agencies are working in sync with the (Department) of Public Health," the governor wrote on his Twitter account.

Most of those infected in this country are recovering, but in Mexico, more than 2,000 people have been infected and more than 150 have died.

Jarris said that states are able to respond to the emerging outbreak because of preparations they made, working with the federal government, over the last few years. The federal government paid for that planning with $600 million Congress approved in 2006 in response to fears over the avian flu threat. That funding ran out in August.

Another challenge is that the economic downturn is taking its toll on public health workers, critical for a full pandemic response, Robert Pestronk, the executive director of the National Association of City and County Health Officials, told reporters Monday (April 27). About 10,000 public health positions were eliminated in 2008, and more layoffs are expected this year, he said.

"The capacity to do the kind of response that is under way right now may not be there if the cases rise significantly and if the severity of the cases continues," Pestronk said. He added that a wider outbreak could cause between 30 percent and 40 percent of health workers to become ill, taking them out of commission.

Federal funding for state and local preparedness has been cut more than 25 percent since 2005, and states aren't receiving any supplemental funding for pandemic flu preparation. In fiscal year 2008, 11 states and Washington, D.C., cut funding for public health services from the previous year and that was before the economy took a nosedive.

"Were this to go to a full pandemic ... we would have to begin staffing seven days a week, 24 hours a day, and that would be a phenomenal challenge to mount with the workforce losses we have now," Jarris said. "We will do everything that's humanly possible, but only so much is humanly possible."

U.S. Sen. Tom Harkin (D-Iowa), who convened Tuesday's hearing, said he worried states wouldn't be as prepared for a major outbreak as they should be. But officials in most states still untouched by swine flu are preparing as though they will be by setting up hotlines, urging residents to stock up on food and medicine and encouraging clean hygiene.

"This is not a time for alarm; rather, this is a time for prevention, and for caution," said Iowa Gov. Chet Culver (D) in a statement. "We continue to monitor the situation and take every step to prevent an outbreak from occurring within our borders."

Public agencies are tapping into their experience preparing for Severe Acute Respiratory Syndrome (SARS) in 2003 besides the avian flu threat in 2005, when the U.S. created a national plan for a flu pandemic.

Jeffrey Levi, the executive director of Trust for America's Health, a public health advocacy organization, said the preparations the country has made since then "are now paying off."

"In the last three and a half years, we've made monumental improvements in surveillance, coordination, communications, and control and treatment capabilities," Levi said.

All states are have increased surveillance at hospitals of people with flu-like symptoms. Some schools with confirmed or suspected cases in California, New York, Ohio and South Carolina have been shut down, including an entire school district in Texas. Health officials everywhere are getting the word out about commonsense ways to prevent the spread of the disease that include washing hands, covering sneezing or coughing, and staying home if infected.

The current strain of swine flu is actually a blend of flu viruses found in humans, birds and pigs. Health officials say it spreads by human-to-human contact, and that eating pork is still safe. No vaccine is yet developed for the current virus, and it could take at least six months to produce one.

Swine flu symptoms are similar to regular flu symptoms, including fever, aches, chills, severe coughing, and a sore throat. Antiviral medicine like Tamiflu and Relenza can alleviate the illness and cut it short.

The federal government's declaration of swine flu as a public health emergency on Sunday (April 26) allowed the release of 12 million courses of these antivirals to the states from the country's strategic stockpiles, and states are stocking up.

The federal plan calls for the country to have 81 million treatment courses of antiviral drugs in case of a flu pandemic, with 50 million courses kept by the U.S. Department of Health and Human Services and 31 million by the states. So far, states have only bought 23 million courses. The federal government has authorized $170 million to pay up to 25 percent of the cost of the drugs for states.

But 16 states bought less than half of their share of the drugs, according to a December report by Trust for America's Health. Maine, which bought no antivirals in advance out of its allowed allocation, is expecting to receive 30,000 to 40,000 courses of the drugs from the federal stockpile. Dr. Dora Anne Mills, director of Maine's Center for Disease Control and Prevention , said tight budgets prevented the state from stocking up on antivirals, according to the Kennebec Journal . Mills also noted that Maine could still get the medicines from the federal stockpiles.

Colorado, which bought only 0.05 percent of its allowance, expects to receive 160,000 courses from the federal stockpile. "We're not second-guessing that decision," said Mark Salley, a spokesman for the state Department of Public Health and Environment. He noted that between the federal allocation and the more than 13,000 courses of Tamiflu available at pharmacies in the state, "that amount alone is more than all the reported cases in Mexico."

Some states that did buy their entire allocation, such as Alaska and Michigan, are also requesting more from the federal stockpile.

Homeland Security Secretary Janet Napolitano said supplies are en route to Arizona, California, Indiana, New York and Texas, with Arizona and New York expected to receive them Wednesday (April 29). All states will receive the antivirals by May 3.