Q:
Many neighborhoods were quarantined in the film.
Even the governor of Virginia quarantined himself, his staff and his
family from the rest of the world. Will the government quarantine
people in a pandemic?
A: The purpose of quarantine is to separate people who
have been potentially exposed to a contagious disease and may be
infected but are not yet ill, to stop the spread of that disease.
The last large-scale quarantine measures that were imposed in this
country were used in the early 20th-century to contain outbreaks of
plague, yellow fever and smallpox.
Today, quarantine typically refers to confining
potentially infected persons to their homes or community-based
facilities, usually on a voluntary basis. Quarantine can be used for
a defined group of people who may have been exposed at a public
gathering or who may have been exposed while traveling, particularly
overseas. In extreme cases, quarantine could apply to an entire
geographic area, in which case a community may be closed off by
sealing its borders or by a barricade, known as a "cordon sanitaire."
In the case of pandemic influenza, quarantine may be
one of the public health tools employed in the early days of an
emerging pandemic if efforts are undertaken to contain the outbreak
before it spreads too widely. Once a pandemic has begun to spread,
quarantine is not likely to be effective in controlling the spread,
and instead efforts may turn to "social distancing." Social
distancing includes measures to increase distance between
individuals, such as staying home when ill unless seeking medical
care, avoiding large gatherings, telecommuting and school closures.
Q:
In the movie, we learn that the virus is beginning
to develop resistance to Tamiflu, rendering the drug useless. Could
that happen? If so, why are we buying so much Tamiflu for the
stockpile?
A: Tamiflu, and another anti-viral, Relenza, have shown
effectiveness in treating influenza. Early evidence suggests that
Tamiflu may be effective in treating those patients who have been
infected with the H5N1 avian flu virus. While there have been a few
reports of Tamiflu resistance developing on therapy, there has been
no transmission of a resistant virus. The resistance developing on
therapy has been associated with starting the drug late or using low
doses of this drug. Tamiflu, when used at proper doses and started
within a few days of the appearance of symptoms, should be effective
treatment of this infection.
Relenza has not been used in treating human H5N1
cases to date, as it has been unavailable in many countries that
have had people infected with H5N1. But experts expect it would be
an effective treatment also.
Of its anti-viral purchases, the U.S. is buying
approximately 80 percent of its supply as Tamiflu and about 20
percent of its supply as Relenza. This is due in part to product
availability, but also to the need to diversify the supply so as to
not rely solely on one medication.
Q:
Many essential services, such as electricity, food
and water, become scarce in the film's scenario. Could that happen?
A: An especially severe influenza pandemic could lead
to high levels of illness, death, social disruption and economic
loss. Everyday life would be disrupted because so many people in so
many places become seriously ill at the same time. Impacts can range
from school and business closings to the interruption of basic
services such as public transportation and food delivery.
In addition, a substantial percentage of the world's
population will require some form of medical care. Health care
facilities can be overwhelmed, creating a shortage of hospital
staff, beds, ventilators and other supplies. Nontraditional sites
such as schools may need to be used for patient care to cope with
demand.
Q:
The film depicted many people who simply walked off
their jobs. Would that really occur?
A: In a severe pandemic, it is very possible that up to
40 percent of the work force of a business or organization will be
out sick or at home taking care of sick family members. It is also
possible that a small percentage of this amount will be people who
are healthy but who may be too frightened to venture out into
public.
The numbers of health care workers and first
responders available to work can be expected to be reduced, as they
will be at high risk of illness through exposure in the community
and in health care settings, and some may have to miss work to care
for ill family members.
Q: What will be done with the overwhelming number of
deceased bodies if we have a severe, 1918-like pandemic as was
depicted in the film?
A: Addressing the possibility of a large number of
deceased individuals in a pandemic is one of the top pandemic
planning priorities. Currently, the Department of Health and Human
Services is working on modeling studies
to try to determine as clearly as we can what we could possibly
expect in terms of numbers of deaths over the course of several
pandemic waves. Until these studies are done, we won't be able to
speculate on details of what we might or might not expect. We expect
this work to be done in the next few months.
Regardless of whatever estimates are developed, it
is highly unlikely in the 21st-century U.S. that we would
ever resort to mass graves. We are working with many other government
agencies, such as the Veterans Administration, as well as the
private sector, including the funeral industry and the cemetery
industry, to develop guidance for states, local communities and
others that would maintain the dignity of the deceased, honor family
wishes, and respect religious and social customs.
Q:
Deciding who gets vaccine was a major question in
the film. In a real pandemic, how will you decide who gets vaccine
first?
A: The greatest risk of hospitalization and death -- as
seen during the last two pandemics in 1957 and 1968 and during
annual influenza -- will be in infants, the elderly and those with
underlying health conditions. These individuals, along with health
care providers, who are critical to maintaining a health care system
in a pandemic, would likely be the first individuals to receive the
first supplies of vaccine. However, in the 1918 pandemic, most
deaths occurred in young adults, highlighting the need to remain
flexible on determining priorities for vaccination groups, based on
the epidemiology of an emerging pandemic.
As part of planning efforts, two federal advisory
committees, the Advisory Committee on Immunization Practices and the
National Vaccine Advisory Committee, have made recommendations for
prioritizing critical populations that might receive the first
supplies of vaccine. These recommendations can be found in the
"HHS Pandemic
Influenza Plan," which is available at
www.pandemicflu.gov.
Q:
In the movie, the Virginia governor's son dies
because he cannot get diabetes medicine; other drugs are not
available in pharmacies.
A: Essential supplies, including medicine, may become
unavailable during a pandemic. As part of effective planning,
individuals and families should talk to their doctor about how to
maintain adequate access to prescription medications.
