CDC issues flu pandemic guidelines

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At issue are old-fashioned infection-control measures that may help slow the spread of the next worldwide outbreak of a super-flu until vaccines become available, steps that range from home quarantine to closing schools and postponing sporting events.

But those measures can increase a pandemic's economic fallout and even have unintended consequences. Closing schools, for example, can keep adults home from work to care for children. And it doesn't help if older kids go sneeze on one another at the mall.

The new guidelines, from the federal Centers for Disease Control and Prevention, don't tell states what infection-control steps to take -- and make clear that rushing to implement them could do more harm than good.

Instead, the new "pandemic severity index" suggests when a super-flu's threat becomes great enough to justify gradually escalating those strategies.

The top example: Just as coastal communities don't evacuate for a Category 1 hurricane, schools shouldn't close for a Category 1 flu pandemic. But if the next pandemic appears to be a super-lethal Category 5, the guidelines recommend states close schools for up to three months.

It is advice that states, grappling with exactly how drastic their pandemic preparations should be, have been awaiting anxiously, said Dr. Robert Stroube, Virginia's health commissioner and president of the Association of State and Territorial Health Officials.

"You kind of plan for the worst, but the odds are it won't be," Stroube said.

Even adjoining states often have been unable to agree on best policies.

Consistent policy for all

With the guidelines, "we're coming out with consensus so we don't have to reinvent it in every state throughout the country," he added.

Influenza pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people never have experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu might trigger one if it starts spreading easily from person to person.

Most planning until now has focused on the worst-case scenario of an outbreak as severe as in 1918, when 50 million people worldwide died. But the 20th century's other two pandemics, in 1957 and 1968, were far less severe, claiming 2 million and 1 million lives, respectively.

There's no way to tell how bad the next one will be until it begins. But once the next pandemic strain begins circulating, gene testing and how fast it spreads will let scientists predict its lethality fairly quickly, said Dr. Pascal James Imperato, a former New York City health commissioner who now directs public health at the State University of New York-Downstate Medical Center.

Federal officials are "concerned about pulling the trigger too fast" on drastic infection-control measures, added Jeff Levi of the Trust for America's Health.

That's where the CDC's new hurricane-style ranking system comes in.

If the CDC decides a new flu strain will be the least severe, with the potential of killing no more than 90,000 people, states would be urged to just isolate the sick, mostly at home, minimizing visitors who might catch the virus.

With a more moderate 1957- or 1968-like strain -- 90,000 to 450,000 potential deaths -- states might consider closing schools, but CDC doesn't recommend it and says any closures should be less than a month.

If more than 900,000 deaths are predicted, a Category 4 or 1918-like Category 5 pandemic, then CDC does recommend closing schools, from one month to three months, depending on each community's level of illness. Other steps are recommended too, including avoiding crowded gatherings and encouraging people to work from home.

States also should consider having everyone in the household of a sick patient voluntarily stay home for seven days, in case they are silently incubating the virus, in all but the least severe pandemics. And if states have enough anti-flu medication, they should consider giving family members doses during quarantine to ward off infection.

But with the rankings come stern warnings. In a recent Harvard study, one in four adults said there was no one to care for them at home if they got sick, another one in four couldn't afford to miss work for even a week, and one in five said their bosses would insist they come to work even if they were sick and contagious.

The guidelines lay out that kind of fallout, and urge communities to figure out ways to minimize it.

"This is the start of that discussion, not the end," cautioned Levi, the public health advocate.