COURTESY STATE DEPARTMENT OF HEALTH
In a flu pandemic preparedness exercise in August, state workers set up an air conditioned field hospital on the Big Island, where patients with a highly contagious, deadly flu could be held. In this photo, a state worker helps a "patient" while another employee looks on.
Tourist hub leaves isles vulnerable to bird flu
The state prepares for an unlikely but potentially deadly strain of virus
An avian flu pandemic could spread to the islands with one sick tourist. Everyone on the plane would be exposed, along with those who came in contact with the visitor in a hotel, riding a tour bus or even sharing an elevator.
Dozens, potentially hundreds, of people could get sick and pass the highly contagious virus on to family members, who could pass it on to their co-workers, friends and neighbors. The scale of the outbreak would grow exponentially within days, and, would almost surely cause deaths.
A Trust For America's Health report, issued in June, says as many as 2,400 people could die in Hawaii if the world was gripped by a so-called "mid-level pandemic flu," which they estimated to be about three times more lethal than the most recent flu pandemic in 1968.
Though the possibilities of such a catastrophic pandemic are remote, state health officials are planning and preparing for that kind of doomsday scenario -- especially in light of new fears about avian flu.
Earlier this year, state health officials drafted a pandemic influenza plan. The department declined to release the draft plan until it is approved, which is likely by the end of the year.
Officials at the state's laboratory in Pearl City are also setting up a procedure for testing cultures for avian flu. Within a month, the lab is expected to be ready to provide a preliminary diagnosis for avian flu that is 95 percent accurate.
Definitive results would still have to come from the Centers for Disease Control in Atlanta, which could take days.
There is a sense of urgency in the state's efforts.
In its present form, avian flu is not easily transmitted between humans, which would be required for a pandemic to happen.
But researchers say such a transformation could happen. So far, the flu has sickened more than 100 people worldwide, and killed 60.
Dr. Alan Tice, an infectious-disease specialist and associate professor at the University of Hawaii, said concern over avian flu has gradually increased in recent weeks for two key reasons.
For one, cases of avian flu are being found more often and farther apart. And some preliminary tests show the flu is resistant to antibiotics.
Tice, reached at a conference on infectious diseases in San Francisco on Friday, said the state is as prepared as it can be for a flu pandemic. But, he added, "you can always do more."
He also said it would be difficult -- if not impossible -- to stop a pandemic's deadly influenza strain from spreading to the islands because of the number of flights from Asia that arrive here every day.
"We're in the position in Hawaii where there's a lot of traffic and travel," he said, "and that makes us a little bit more at risk."
EVEN THOUGH a flu outbreak in the islands could spread fast, state health officials contend it could also be contained quickly, primarily with isolation and quarantine.
The sick would be cared for in designated hospital rooms, whose air ducts are not connected to other wards.
Dr. Linda Rosen, state deputy director of health resources, said most major hospitals in the islands could take about one to two sick patients in such rooms. If there were more sick, a whole hospital could be designated for influenza-patients only. Or, field hospitals could be set up.
The state has two tent hospitals, each of which accommodates 100 patients. "We don't have a lot of extra hospital capacity," Rosen said. "So that's (the field hospitals) basically our contingency plan ... if we had a lot more severely ill people at once."
In August, the state Health Department practiced setting up a field hospital in north Kohala on the Big Island.
As part of the exercise, nurses and doctors transported a patient supposedly sick with a highly contagious, deadly flu in an air ambulance from a hospital to the field hospital.
The "patient" was carried on a stretcher in a plastic containment bubble, while nurses and doctors wore protective bio-safety suits.
"There is a whole education curve in learning how to behave in a (infectious disease) emergency," Rosen said.
The sick, though, aren't the only part of a pandemic.
The state must also contend with those who have been exposed to a deadly flu, since they could become sick or pass the disease on even if they don't develop symptoms. That's where quarantine comes in.
Ross said those who have come in contact with a sick person would be asked or required to stay at home until they either show symptoms or are no longer at a threat of getting others sick.
Visitors who are exposed to the flu, Rosen said, would likely be housed on quarantine floors in Waikiki hotels. Whole families and whole neighborhoods could be quarantined in their homes.
And, Rosen said, "if you're going to ask people to stay in their house, you better make sure you get them food and water and health care."
THE STATE has already instituted several early-detection programs in hopes of heading off a pandemic's spread to the islands.
State and federal health officials now screen patients at Honolulu Airport's clinic for flu-like symptoms that could be avian influenza.
Also, "sentinel physicians" in the community have been asked to look for similar illnesses and report them to the state Health Department. The doctors regularly send the state batches of cultures from sick patients, which are tested.
But Rosen agreed that the avian flu could spread easily to Hawaii if it became contagious between humans.
"We certainly do have a lot of visitor travelers," she said. "That does put you at risk at picking up something from everywhere in the world. And we do have concerns" about avian flu.
A Northwestern University study released in May ranked Honolulu in the top 1 percent of world travel hubs, and therefore a place to watch during a contagious disease outbreak.
Other places to monitor included Paris, London and New York.
But officials say Hawaii's centrality for visitors has meant more preparedness in the event of a public health crisis.
Since 1997, when avian flu was first identified, the state Health Department has been watching the influenza strain and its potential for causing a pandemic.
And just two months ago, more than 115 officials from city, state and federal agencies gathered at the Blaisdell Exhibition Hall to discuss how they'd respond to an outbreak of avian influenza at a poultry farm on Oahu.
Under those circumstances, said state veterinarian James Foppoli, a state Agriculture Department employee would be sent out to the farm within hours of a report of dying birds.
Right away, measures would be taken to make sure the flu didn't spread to others, with workers taking showers before they left the premises and washing their shoes.
Once avian flu is definitively confirmed, Foppoli said, the poultry at the farm would be destroyed, a process that could take another week.
A report on the avian flu exercise, which involved the state Health Department, will likely be released next month.
Other agencies, too, have been planning for an avian flu outbreak. In exercises, state Civil Defense has coordinated different departments, including law enforcement.
Reservists and active-duty military are also in the mix.
Maj. Chuck Anthony, spokesman for the Hawaii National Guard, said the governor could request the Guard's assistance in the event of a pandemic.
She could also request the active-duty military's help through the National Response Plan, said Navy Lt. Cmdr. Jason Salata, spokesman for the U.S. Pacific Command in Hawaii.
"Just like if a hurricane hit Hawaii and you have this incredible pool of military here," Salata said.
MAJOR OUTBREAKS OF INFLUENZA
1918: The "Spanish" flu pandemic killed 500,000 in the United States and 50 million worldwide.
IN HAWAII AND AROUND THE WORLD
1945: A flu epidemic on Oahu sickened thousands, including several hundred military personnel stationed here. The outbreak forced officials to close all movie theaters and cancel other gatherings.
1953: Nearly 8,000 people in the islands reported coming down with influenza during a spring outbreak. The number is thought to be as much as double that, since many people did not see a doctor for medications.
1957-58: A flu from China spread across the globe, killing about 70,000 in the United States.
1968-1969: The "Hong Kong flu," the most recent pandemic, affected millions worldwide and disrupted world economies. Some 750,000 people died worldwide, including 34,000 in the United States.
In Hawaii, there were six confirmed reports of Hong Kong flu. Four were military personnel who had just returned from Asia, one was a resident who had also just gotten back from the region and the sixth had been exposed by a visitor from Asia.
Source: World Health Organization and Star-Bulletin news reports