Microbiologist Rebecca Sciulli, coordinator of the state Health Department's bioterrorism preparedness laboratory in Pearl City, handled infectious samples Wednesday inside a secure chamber.
Isles take lead in preparations against fatal flu
A program to test sick arriving passengers envisions a quarantine at the Honolulu airport
A tourist from a country in the throes of a pandemic influenza outbreak boards a plane for a Hawaii vacation. On the way, the passenger develops a high fever, a sore throat, and starts vomiting.
Health officials in the islands hope they never see anyone with a rapidly spreading, deadly influenza virus like this traveler.
But, perhaps more so than in any other state, they are preparing for the possibility. Officials have launched an airport screening program, planned limited quarantines and amassed a supply of protective gear for doctors and nurses. Next month, the state will hold a seminar to help employers learn how a pandemic could affect their workers and businesses.
The state's identity as a tourist mecca has given Hawaii a heightened sense of the dangers of a global pandemic. The islands' distance from other population centers, meanwhile, has instilled in officials the need for self-reliance and preparation.
"We are very concerned in Hawaii about the fact we are the western doorway to the United States," said Dr. Chiyome Fukino, director of the state Department of Health. "We see a large number of visitors ... and a good proportion of them are from the Far East, where we know a good number of emerging diseases are originating."
In the past, the islands have suffered the ravages of infectious diseases.
The introduction of syphilis, smallpox, measles and other disease by Europeans after Capt. James Cook arrived in 1778 killed thousands of native Hawaiians who lacked natural immunity to the illnesses. By the late 1890s the diseases -- together with war and famine -- shrank the Hawaiian population by 90 percent.
Today, the threat to Hawaii -- and the world -- stems from the possibility of a particularly deadly and fast-moving form of influenza. Any outbreak would likely hit before health officials would be able to prepare a sufficient supply of vaccine to protect everyone.
Doctors do not know what virus strain will trigger an influenza pandemic, but they are concerned a variety called H5N1 that birds have carried from Asia to the Middle East, Europe and Africa could be the one. The strain has already killed more than 100 people from Vietnam to Turkey since 2003.
Humans cannot easily catch the H5N1 virus from other people, but experts warn this could change if it mutates.
Hawaii is particularly exposed to travelers carrying disease.
The state of 1.3 million residents hosts an average of 171,000 travelers at any given time. About 20,000 people fly in each day.
Hawaii's airport plan calls for a nurse to take a swab from a potentially infected passenger on any plane, at the gate or inside the airport. If tests show the traveler has a pandemic virus, authorities are prepared to quarantine the entire jet. Officials are also ready to cordon off a gate or other section of the airport to isolate people exposed to the passenger.
Still, officials know they will be unable to fully block the virus even with this approach because some people with the disease will not immediately show symptoms and will not be singled out for testing.
Instead, the state expects the screening to alert officials to the presence of the illness so they can contain it as much as possible, said Dr. Sarah Park, deputy chief of the Health Department's disease outbreak and control division.
"You can't guarantee a 100 percent barrier. You need to think more in terms of how do we detect it and, once it's detected, how do we control it?" Park said.
During an outbreak, Hawaii expects to test 6,000 samples per day from people who have or might have contracted the virus.
That is enough for more than a third of Hawaii's population over eight weeks -- roughly the length of time experts estimate each outbreak will last before petering out.
Dr. Gregory Poland, director of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, Minn., said Hawaii authorities understand the danger posed by the disease.
"Very definitely you guys are in the vanguard, in the lead of state-level and local-level preparations," Poland said on the sidelines of a Waikiki conference convened to educate island nurses, doctors, police and others about the flu. "I think you've crossed the biggest hurdle, which I said is imaginability. People here seem to get it."
If the next pandemic proves to be as virulent and deadly as the 1918 Spanish flu, the federal government estimates 90 million people will contract the disease and 1.9 million people will die from it nationwide.
Even if Hawaii is not the first state to suffer heavy losses, experts say it is vital that the islands be prepared.
Robert Kim-Farley, a professor at the University of California at Los Angeles' School of Public Health, said Hawaii is right to get an early start because all 50 states will be too busy dealing with their own outbreaks to help anyone else if the disease strikes.
"A pandemic is a local emergency happening worldwide. It's something that has to be handled and dealt with on a local level," said Kim-Farley. "We will never be blamed for preparing too far in advance. We will be blamed, however, if we prepare too late."