Bird watchers

Nevada health officials plot strategy against a flu outbreak

Emergency preparedness analyst Nancy Mead worked on RNA for influenza samples.

Emergency preparedness analyst Nancy Mead worked on RNA for influenza samples.

By David Robert

“Because of tourism, especially in Southern Nevada, and direct flights coming from Asia, there might be direct introduction of the H5N1 avian influenza into Southern Nevada, which could easily, very quickly spread to the Reno area,” says Dr. Louis Dee Brown, director of the Nevada State Health Laboratory.

H5N1 is the bureaucratic name for avian flu, the virus that has caused 64 known human deaths worldwide and threatens a possible pandemic outbreak.

To prepare for such a scenario, the State Health Lab has been collaborating with the University of Nevada, Reno’s Student Health Center and the Institutional Biosafety Committee (IBC) to decide what should be done if avian flu were to appear at UNR.

“Historically, the student health center on campus has often been the first to report flu cases during each flu season in the Washoe County area,” says Dr. William Courchesne, chairman of the IBC. “So I think it tends to show up on campus before elsewhere in the county.”

If the bird flu were to hit campus, officials at the State Health Lab say they would likely detect it quickly.

“The state laboratory has, for many years, been doing diagnostic testing for influenza in general,” says Brown. “Now, for the first year here at the state lab, we have a new genetic method for detecting different types of influenza within one working day, and that would include the H5 variant, so we would be right on the front line of early detection.”

What happens after detection is the main topic of discussion. It’s clear that UNR would have to coordinate with both the Washoe County Health Department and the State Health Department to determine the next step and decide whether to isolate infected people or close the campus.

“One of the issues that has to be taken into account when making a decision about closing the campus is that if the campus closes, students living in dorms will go home, and many of them will travel to Las Vegas, and if they are infected, they carry the flu with them, and that, obviously, is not desirable,” says Courchesne.

“The role of the Student Health Center certainly would be in serving as a triage site,” says Dr. Cheryl Hug-English, medical director of the Student Health Center. “Obviously, for severely ill patients, they’re going to need more support than we can offer at an outpatient clinic. And that would mean if someone required oxygen or ventilator assistance or IV therapy, a hospital setting would be more appropriate. So we need to arrange triaging and transporting, if need be, to more appropriate facilities.”

At present, none of these policies or procedures has been adopted.

“We’re in the early to mid-level stages of the process,” says Courchesne. “Actually, the role of the IBC and the steps it needs to take are pretty well advanced. We will be passing the ball, so to speak, to the administration, probably in the month of March sometime. Then the administration will have to implement a plan that includes coordination with all aspects of the campus.”

But Brown is quick to say that there isn’t necessarily any rush.

“You have to understand that avian influenza is not the same as pandemic,” says Brown. “In fact, we hope it doesn’t become a pandemic. In order to have a pandemic, you have to have sustained person-to-person transmission. If I were a bird, I’d call this a pandemic because it’s decimating bird populations, but only in a few cases has there been transmission to humans, and only from birds. The reason we’ve been asked to plan for a pandemic is that even if the current flu—the H5N1 avian influenza—does not mutate and become a pandemic influenza, there will be one sometime in the future.”

There’s no way to predict exactly when a pandemic will occur, but in the last century alone, there have been three major pandemic influenzas.

“There was one in 1957 and one in 1968, I believe, so that’s only 11 years apart, but the earlier one was in 1918, so that’s 39 years, so there’s quite a range there,” says Courchesne. “Right now we’re in that higher sort of range. That doesn’t mean it’s going to happen in the next year or two, but the health and scientific communities who have expertise in these matters have sent down warnings that there are a lot of signs that say a pandemic flu could occur, so it’s really important that we all prepare.”

And though the catalyst for these precautionary measures is the threat of bird flu, the procedures established will likely be useful when dealing with other infectious outbreaks.

“There’s a lot of current media attention to the avian influenza, but no one should ever forget that the ordinary flu is still out there, and it still has the potential to kill people,” says Brown.

But the applications of these policies could even stretch beyond influenza.

“It would probably have to be looked at carefully, but this plan may even be useful in terms of responding to a bioterrorist attack,” says Courchesne. “Once this plan is established and put into place, we might be able to look at it and see if we could modify it so that it works with all sorts of potential problems.”

Whatever the case, the overriding view is that it never hurts to be prepared.

“Pandemics have just occurred throughout human history, so it is going to happen,” says Brown. “We just don’t know when. The planning will serve a very useful purpose because if this isn’t the one, there will be one, and we’ll be ready.”