WASHINGTON - A medical reality is complicating federal preparations for the next pandemic: Flu spreads in ways that make it extremely unlikely the U.S. could avoid being hit.

Even shutting U.S. borders against outbreaks abroad offers little reassurance, because people can spread flu a full day before they show symptoms. With 1.1 million people legally entering the country every day, that means a super-strain would probably be incubating here by the time it was diagnosed abroad.

 

The government’s latest national response plan, obtained by The Associated Press, acknowledges the difficulty as it warns that states, cities and businesses shouldn’t count on a federal rescue if a super-strain of influenza strikes — and that people may have to rely on creative if not scientifically proven ideas such as staying 3 feet away from co-workers and not shaking anyone’s possibly contaminated hand.

 

It’s an incremental step, one already drawing political attacks that the Bush administration isn’t moving fast enough.

'Needless delays'
“Other nations have been implementing their plans for years, but we’re reading ours for the first time now. These needless delays have put Americans at risk,” Sen. Edward Kennedy, D-Mass., said

But infectious disease experts hope the new details being released Wednesday will help businesses and local governments better determine exactly what they should be doing — and what aid they can expect from the federal government if a pandemic strikes.

“Everybody is asking, 'Well, we want to do something. How do we do it?”’ says former Health and Human Services Secretary Tommy Thompson, who heard those questions Tuesday while addressing pandemic preparations at a Michigan law-enforcement conference. “We’ve got to be much more specific.”

Influenza pandemics strike every few decades when a never-before-seen strain arises. It’s impossible to predict when the next will occur, although concern is rising that the Asian bird flu, called the H5N1 strain, might lead to one if it eventually starts spreading easily from person to person.

Regardless of what causes the next pandemic, the 228-page draft version of the government’s plan outlines a set of steps federal officials will take at different stages.

We’re currently in Stage 0 — worrisome flu strains are circulating in birds. Stage 5 would be widespread U.S. cases. In between, U.S. health officials would help world authorities try to detect and contain any potential pandemic-triggering outbreaks abroad

But many travelers will seem healthy even as they shed virus, warn flu specialists.

Trying to meet and quarantine lots of planes, “I’m dubious, No. 1, that just physically that’s feasible. And, No. 2, I frankly wonder exactly what degree of effectiveness can be expected by that,” said Dr. William Schaffner of Vanderbilt University, an adviser to the government on flu vaccine.

A pandemic wouldn’t shut down the country at once. Instead, the document paints a picture of communities battling active infections for six to eight weeks, before the flu spreads to the next area

Each ill person is expected to infect two others. Symptoms should appear within two days. Flu spreads most among school-age children — expect a 40 percent attack rate among them compared to 20 percent among working adults. But, with caring for sick relatives and stay-at-home precautions to avoid infection, 40 percent of the workforce could be absent for weeks at a time.

To minimize workplace infection, the report gives the most in-depth advice yet for businesses to take such steps as cleaning offices — flu can live on hard surfaces for 48 hours — and minimize employee contact by not shaking hands and staying 3 feet from co-workers.

But the 3-feet advice assumes flu only spreads in the large droplets of coughs and sneezes; tiny droplets that stay suspended in the air for long periods can spread it, too.

“Those are the kinds of uncertainties that make it hard to be very dogmatic” about health tips, cautioned Dr. John Treanor, a University of Rochester flu specialist.