The Daily Inter Lake

Imagine if pandemic flu hit Flathead County with its population of 82,000.

Based on previous pandemics, the virus likely would sicken 27,000 and kill 1,350. Bill Miller of CADRE, Inc. presented that scenario at a training session Tuesday at The Summit.

"Think about that many people sick in your county," he said. "This is reality. Understand, every county in Montana would be in the same shape."

Miller said that means you can't send overflow sick people to Missoula or expect to borrow medical staff from other areas. Even with care, about 5 percent will die from a pandemic flu virus.

"How are you going to handle 1,350 dead?" Miller asked. "You better hope this happens in winter."

These were just a few of the sobering scenarios pondered by local officials from hospitals, nursing homes, public health, emergency services and law enforcement.

The pandemic flu exercise wrapped up two days of training aimed at developing emergency responses to epidemics. A federal grant to the state paid to bring the consultants and program to major cities across Montana.

In Kalispell, about 40 people from doctors to deputies tackled the bleak problems of a community under siege. It occurs when the influenza A virus makes a genetic shift to become a pathogen of mass infection to a population without immunity.

Miller and other experts drew parallels with the Spanish Flu of 1918 that caused mass panic and crippled health-care systems and economies of cities. Most experts say another pandemic is only a question of "when."

He said the new influenza will crop up in a Third World country.

"It's going to go like wildfire but we're going to have some warning," Miller said. "We need to start ramping up."

At this point, the group decided that the county health officials would head up the initial response with surveillance and prevention. Communication with the public becomes crucial to prevent hysteria from overwhelming emergency rooms.

"It's extremely critical that we use a consistent message," said Joe Russell, county health officer.

He said it was important to staff a telephone line for citizens to call to ask questions since not everyone can understand and digest printed and broadcast messages.

The thorniest issue tackled Tuesday was developing a priority list for the first limited doses of vaccine to arrive in the valley.

Should all health workers and their families receive vaccine or just the most critical? How about utility workers, snow-plow operators and/or truck drivers who deliver vaccine and other medical supplies?

"Do you think you are going to have problems as citizens began to clamor for vaccine?" Miller asked. "You'd better be prepared."

As the pandemic progresses, new and more difficult ethical questions emerge such as who gets limited hospital beds and the few ventilators available? What happens when accident victims need care?

Bill Boyd, clinical safety officer, said that planning was under way at Kalispell Regional Medical Center.

"The hospital has asked the ethics committee to provide guidelines for people who have to make those decisions," Boyd said.

He proposed education and transparency about this process as the best weapon against anarchy in times of panic and limited resources.

As more people get ill, emergency planners must decide whether to ban public gatherings or close down schools. But who has that authority and, if you close schools, where do essential workers take their children?

Miller pointed out other dilemmas that crop up with 30 percent to 40 percent of county residents unable to work due to illness.

"Can we keep our grocery store open?" he asked. "Where are you going to get the food to sell?"

Explosive civil situations emerge with intensive care units overwhelmed and family members become distraught and outraged. A well-armed population might turn to guns to get medicine for their children.

"Do you think we might have to go under martial law?" Miller asked.

Some disagreed, saying that 95 percent of the population won't turn to violence. But others point out that Martial Law brings resources like the National Guard to back up law enforcement efforts.

Earl Hall, project coordinator with the Montana Bioterrorism Training Project, helped the group identify action items to accomplish in the next three or four months.

These included developing a priority vaccine distribution plan, a public education system and a county command structure to deal with an infectious disease emergency. Russell, as the county health officer, was delegated to lead those efforts.