University plans for bird flu outbreak

University emergency planners are preparing to protect the campus community in the event of virulent pandemic influenza.

Last Wednesday, officials met with representatives from the Princeton Regional Health Commission, Mercer County and the State of New Jersey to discuss how to coordinate responses to a possible outbreak of bird flu.

"We've been proactive. It was the University and health services who have actually forged these connections," Chief Medical Officer Daniel Silverman said. "Nobody came looking for us; we came looking for them."

In recent months, the federal government has urged local communities to begin planning for pandemic flu, which could kill millions of people in the United States alone.

"Any community that fails to prepare — with the expectation that the federal government can or will offer a lifeline — will be tragically wrong," Deputy Secretary of Health and Human Services Alex Azar said in a speech Jan. 24.

Pandemic planning in Princeton received priority only after it was emphasized by the federal and state governments, said David Henry, who leads the joint health department of the Borough and the Township.

"We're really glad that the University reached out to us so that we could really work closely together in beginning to map out a plan," Henry added.

The threat

The last major flu pandemics occurred in 1918, 1957 and 1968. The "Great Pandemic of 1918" was by far the most deadly, killing at least 40 million people worldwide, according to the Centers for Disease Control and Prevention (CDC).

At Princeton, the 1918 pandemic "taxed McCosh Infirmary to the limit," and the 1957 pandemic "overwhelmed the campus, requiring the conversion of the Student Center into an influenza ward with 100 beds," Alexander Leitch '24 wrote in "A Princeton Companion." Neither pandemic resulted in the death of any University student.

Today, medical experts and government officials are concerned about an outbreak of avian influenza or "bird flu" — common names for the H5N1 subtype of the Influenza A virus.

According to the World Health Organization (WHO), the H5N1 virus, which is prevalent in birds throughout Southeast Asia and China, is unusually lethal when transmitted to humans.

As of last Friday, the WHO reported that a total of 204 people had contracted the H5N1 virus, 113 of whom have died. The WHO suspects that most of those people had direct exposure to infected poultry.

"No one will have immunity should an H5N1-like pandemic virus emerge," the WHO notes on its website.

If such a virus does emerge, the New Jersey health department predicts more than 8,000 deaths within the state.

"If there was a pandemic flu that was extremely virulent like the 1918 flu, there would be no vaccine," Silverman noted.

It would take six to nine months to develop a vaccine, by which time millions could be dead around the world.

The preparation

University planning for a pandemic is handled by a subcommittee of the Emergency Preparedness Task Force (EPTF), a group of University administrators formed after the terrorist attacks of September 11 and the anthrax attacks in October 2001.

While no vaccine would initially be available for pandemic influenza, antiviral drugs such as Tamiflu could be used to treat victims.

The University is not able to maintain a stockpile of antiviral medicine for students, faculty and staff, Silverman explained.

"Tamiflu is expensive and the manufacturer, which was Roche, has been under government restrictions about how much they can sell and to whom. They don't want a hoarding of the medication. It's probably better for everyone that those supplies are controlled through the federal and state governments," Silverman said.

The EPTF is considering whether the University should stockpile equipment such as high-quality face masks, sterile medical gloves and gowns, and "basic amenities for students and staff who would remain on campus, everything from toothpaste to soap to bottled water," Silverman said.

Silverman expressed concern that a highly virulent pandemic could disrupt the flow of necessities to the University.

"We don't have the ability to store weeks and weeks of fresh food. We would be dependent on the food supply chain," Silverman said.

In the worst-case scenario, many truck drivers would fall ill, halting deliveries of food to the campus and the wider community.

The EPTF is assessing its preparations for pandemic flu against a planning checklist for colleges made by the CDC, Silverman said.

During a disaster

"We've had plans for years for what to do for a local disaster," Silverman said.

In the event of a small-scale disaster, such as a dormitory fire, students would be housed in Dillon Gym on cots that the University has stockpiled, Silverman said.

If virulent pandemic influenza spread to Princeton, more drastic measures would be needed.

Henry suggested that students could isolate themselves in their dorm rooms and wait for instructions broadcast on television. Silverman said the University would post emergency updates on its website.

"We're beginning to branch out to how we would make a decision about whether to keep open or close the University. Some students might have the liberty to shelter at home whereas other students can't go home," Silverman said.

Since close quarters can aid in the transmission of certain diseases, the University "might well want to redistribute the students remaining on campus so they're not on top of one another," he added.

Federal and state officials would have broad legal authority to mandate quarantine for any members of the University community who contract the flu.

In addition, the University plans to offer officials the use of certain facilities for the benefit of the community.

"We have created what's known as a POD plan — a point of delivery plan — that would use Jadwin Gymnasium to administer vaccines or provide treatment to about 35,000 people," Silverman said.

Mercer County might deploy the 300 local citizens who have been trained and organized into Community Emergency Response Teams. County and municipal offices of emergency management would coordinate the response of these volunteers and local health and public safety officials, County Spokesman Silvio Marcacci said.

'It depends'

University actions during a pandemic are contingent upon so many unpredictable factors — the lethality of the particular flu strain, its geographic distribution, the time of year — that "it depends" has become a mantra for campus emergency planners, Silverman said.

Silverman said the University should have at least some forewarning of a bird flu pandemic, which would most likely originate in Asia.

Even if the country can foresee the arrival of a pandemic, Silverman said he fears a massive, multilevel failure to respond effectively, as happened with Hurricane Katrina.

"Are we as a nation really prepared for a pandemic? I have to say, with all honesty, no."