ASSOCIATED PRESS Fears of a bird flu pandemic mount as Asian countries report new outbreaks, as China did on Thursday.

Hospital shortage feared in pandemic

Lawmakers grill health officials on potential gaps in state response plans

State officials say they are taking aggressive measures against a potential bird flu pandemic, but there are concerns that Hawaii's hospitals could be overwhelmed if the deadly illness reaches the islands.

If a flu pandemic occurs, "Hawaii hospitals will experience an unprecedented demand for our services far exceeding our design capabilities and existing resources," said Toby Clairmont, Healthcare Association of Hawaii emergency program manager.

Clairmont and representatives of state agencies, the military, hospitals and nursing homes briefed four state House committees yesterday on what they are doing to prepare for a possible pandemic of the H5N1 flu.

House Health Chairman Dennis Arakaki (D, Alewa Heights-Kalihi Valley-Fort Shafter) commended the planning but said there are still gaps.

"What really worries me is a lack of capacity, if we don't find facilities to provide care and quarantine and isolation," he said.

Clairmont said he had just returned from meetings in Alaska and Texas, and "nobody is better prepared than we are, but nobody is prepared."

About 15 percent of Hawaii's population is considered at "high risk" for the avian flu if it should spread into a pandemic, according to the U.S. Centers for Disease Control and Prevention, said Dr. Linda Rosen, deputy director of the state Health Department Health Resources Administration.

But Hawaii's hospitals might be a few hundred beds short of what is needed in the event of a pandemic, she said.

"We don't have much surge capacity. They are pretty full even on regular days, so it is pretty daunting," Rosen said.

Increasing the state's laboratory capacity and maintaining a skilled pandemic-flu preparedness work force are other challenges, she said.

Rosen said the Health Department is building a command control center to make quick decisions and mobilize resources if necessary.

Clairmont said a three-tier logistical system is being established with equipment and supply caches at all hospitals, area-level mobile treatment systems on all islands, and a state-level cache with bulk supplies for respiratory protection, biomedical and other equipment.

Isolation units are being upgraded at all hospitals with more than $500,000 in federal funds, he said.

Five 20-bed acute-care units are available for deployment to any island hospital or alternative site, or they can be combined for a 100-bed facility, he said.

State and private agencies also are collaborating to develop a human resources management system listing all available health care workers in Hawaii, he said.

The result, he said, will be four Medical Reserve Corps units for Kauai, Maui, Oahu and the Big Island; hospital emergency response teams for each hospital; and continuing support for the Hawaii Disaster Medical Assistance Team and Red Cross Disaster Health Service.

Gov. Linda Lingle is asking the Legislature for a $15 million emergency appropriation to stockpile antiviral medications and improve the state information system to track illnesses.*

Legislators had many questions about the stockpile proposal, since avian flu vaccines are not available yet and it is not known how effective they will be.

Arakaki said it is important to stockpile vaccines because of Hawaii's isolation, but he is concerned that the state might be throwing away money.

He said if the shelf life of the vaccines is only one year, it is not worth it, but it is justified if the shelf life is five years, as state health officials expect.

The officials addressing the House Health, Agriculture, Transportation and Public Safety and Military Affairs committees said much remains to be done, although they have been meeting and working on plans for 1 1/2 years.

A draft of the state Health Department's "Pandemic Influenza Preparedness & Response Plan" can be seen Tuesday on www.hawaii.gov health. The final plan will be issued in January.

Rear Adm. Robert Hufstader, U.S. Pacific Command surgeon, said the command "considers the pandemic threat to be very real and very significant" and is monitoring the situation closely.

The bird flu has affected about 130 humans, killing 67, since 1997, mostly people in Southeast Asia who work with poultry. Health authorities fear it could mutate and begin spreading from human to human, leading to a pandemic.

Rosen said it is "a little scary" because the incubation period is only one to three days. Infected people could pass it on to others before they have any symptoms, so it could spread quickly, she said.

Hufstader said military priorities are to maintain operational capability of forces in the Pacific, protect the forces, including civilians and family members, and protect bases and stations across the Pacific needed for defense.

He said local commanders can respond to requests from civilian officials to assist with emergencies but that the Federal Emergency Management Agency is the lead U.S. government agency for disaster response.