Maryland Flu Plan Needs Update, Officials Say
By Jacqueline Ruttimann
Capital News Service
Friday, Oct. 21, 2005
WASHINGTON - Maryland has had a plan for dealing with a widespread
outbreak of disease since 1999, but it's not specific enough and must be
updated to deal with the growing threat of avian flu, both its authors and
"I feel confident that Maryland is preparing," said Maryland
Department of Health and Mental Hygiene epidemiologist Dr. David Blythe, one
of the co-authors of the plan.
Yet he and other DHMH officials say the response plan will be updated
after the Bush administration releases its strategy, expected later this
Originally detected in migratory waterfowl in Southeast Asia, the deadly
H5N1 avian influenza virus has spread across Russia and most recently into
parts of Europe. Researchers suspect it could reach pandemic proportions if
it manages to become transmittable from human to human.
Medical officials also say another pandemic is imminent, whether caused
by this particular virus or a similar one. The last three major pandemics
that occurred -- the Spanish flu in 1918, the Asian flu in 1957 and the Hong
Kong flu in 1968 -- were caused by an avian flu virus.
A "medium-level" U.S. pandemic would affect 15 percent to 35 percent of the
population, cause 89,000 to 207,000 deaths and 314,000 and 734,000
hospitalizations, according to the Centers for Disease Control and
Prevention Web site.
If the virus crosses into the United States, Maryland
might be in particular danger because of its large poultry industry.
Maryland's current plan is in its fifth version and was last updated in
The plan, developed by about 150 individuals representing 90 state,
local, private and volunteer organizations, outlines six phases of the
pandemic and how local health departments, three state agencies -- DHMH,
Maryland Emergency Management Agency and Maryland Institute for Emergency
Medical Services Systems -- and the federal government should act.
The plan sees the pandemic in six phases:
- identification of the virus in
a small number of people;
- identification of multiple cases in the same area;
- high mortality rates in multiple areas;
- virus and deaths in multiple
- a second wave of multiple infections; and
- an end phase, in which
the virus is under control.
An additional six "essential components" are discussed in the plan:
command and control procedures, surveillance, vaccine delivery, anti-viral
medication delivery, emergency medical services and communications.
All government agencies involved are to collaborate. Each agency also has
its own role, such as the federal government's responsibility for anti-viral
and vaccine stockpile development and distribution. The local health
departments would provide normal influenza and pneumococcal vaccines for
those at high risk and health care workers; survey available hospital bed
space; and create additional treatment centers such as schools and
gymnasiums. They also would create temporary morgues, if warranted.
The head state agency is the Department of Health and Mental Hygiene, would be responsible for monitoring
and distributing information from the Centers for Disease Control and
Prevention and the World Health Organization, as well as surveillance
testing of viral strains.
It is also responsible for creating a reporting
system on any adverse effects from the administration of antivirals such as
Media communications and the declaration of a public health emergency
will be handled under MEMA.
The third state agency, MIEMSS, would be responsible for the monitoring
of available hospital bed space and medical supplies. To track that, it has
established a database, which runs in all regional hospitals, county health
departments, 911 centers and lead law enforcement agencies, as well as
neighboring states, such as Pennsylvania.
"We can inventory in a matter of minutes where in the past it took days
to do," said State Emergency Medical Services Director Dr. Richard Alcorta.
Critics say the plan is outdated.
"It's a sketch not a plan," said Dr. Jeffrey Levi, senior policy adviser
of Trust for America's Health. "It needs to be updated on what we know now."
Recently, the Association of State and Territorial Health Officials
posted guidelines for state preparedness plans. While Maryland's plan covers
most points, it fails to address key issues, such as liability laws for
volunteer health care workers who will replace those who fall sick,
interstate and intrastate transportation circumvention and arrangements for
hospital overflow of patients.
Others, such as former Baltimore Health Commissioner Dr. Peter Beilenson,
said the current plan is too generalized.
"It's relatively generic to any biological infectious disease plan," said
Beilenson. It needs to consider a ring vaccination for those far enough from
the start of infection, but close enough to be exposed; cancellation of all
public outings, such as schools and theaters; and use of hospitals for
supportive care, since past pandemics have spread the fastest within
hospitals, he said.
Health officials further recommend the public employ respiratory hygiene
measures such as sneezing and coughing into the crook of the elbow and hand
They also suggest stockpiling several days worth of water, food and
toilet paper, and keeping flashlights and batteries handy.
"While they seem simplistic and mundane, they really are important," said
Health officials caution the Maryland plan is an overarching schematic
for many plans that focus on the avian flu.
"There are a series of embedded plans," said Alcorta. "To the question of
'Is this all we have?' I'd say no. We have a system, and it works."
Dr. Michael Sauri, medical director of Rockville-based Occupational
Health Consultants, said Maryland is at the forefront of pandemic planning.
"Maryland is by far the most organized of states because of ... fear of
being in the ground zero of things," said Sauri, who just returned from
helping hurricane survivors in Louisiana and Texas. "The purpose of the plan
is one of coordination. I think it's achieving that."
However, he said, "You never know how good a plan is until there is an
Hurricanes Katrina and Rita provided valuable lessons, Sauri said.
"The kind of plan that Houston had and the lack of one that Louisiana had
was an eye-opener," he said.