02:29 PM EST on Wednesday, November 2, 2005

Frank the moderator: TODAY at 1 pm. Join Dr. David Gifford , head of the R.I. Health Department, to discuss the possible threat of pandemic here and how the state is planning to prepare.
Submit a queston now and return later. Thanks.

Frank the moderator: Governor Carcieri has asked Dr. David R. Gifford, head of the state's Health Department, to form and take charge of a "Pandemic Flu Working Group" that will finalize the state's plan for preventing and responding to an outbreak of pandemic influenza in Rhode Island. Gifford said the group will bolster plans for informing the public on how to prevent the spread of a pandemic flu, "how to make sure we have capacity to treat people who are sick, and what to do with people who die." [From today's Journal: R.I. storing vaccines, fortifying response to a regional disaster]

Frank the moderator: Dr. Gifford has just arrived and will be answering your questions soon.

flufighter: Realistically, how can one escape catching such a flu, if there is a new strain and no vaccine is available? What measures can a state take? An individual?
Dr. David Gifford: Ways people can avoid "catching" the flu are similar to steps people can take to avoid catching the common cold or typical yearly flu. These include handwashing frequently or using alcohol-based hand gels, covering your mouth/nose after sneezing or coughing, staying well rested. Also, avoiding public gatherings. Also, you should get the flu shot (influenza immunization) each year. In prior pandemics, the young were most likely to die or have complications contrary to what we know that the elderly or individuals with chronic diseases are most susceptable to influenza. This apparent contradiction can be explained by having been exposed previously to different influenza strains that led to a cross reactivity of your immune system with the pandemic version of influenza. Thus, the more often you have been exposed (e.g. immunized) the better you are at fighting off influenza including pandemic influenza.

flufighter: Why should we here in Rhode Island be concerned about a pandemic flu? Is it more or less likely to strike certain areas?
Dr. David Gifford: Pandemic flu refers to worldwide spread of a new version of influenza. We are currently most concerned about "avian flu - H5N1" strain infecting birds in asia. There has been some cases of spread from birds to human (approximately 100 cases to date) but no evidence of spread from human to human. The influenza virus needs to mutate before it can spread from human to human. If that occurs, it is most likely to occur in Asia, which may give us some early warning.
Given the frequent and rapid way people travel around the world, it is hard to predict where it will first start in the United States or how quickly it would spread to RI.
RI needs to be prepared and that's why Governor Carcieri has asked me to chair a workgroup to make sure we are as prepared as possible.

rose: Will the Rhode Island hospitals be asked to partner with the Health Department on this issue?
Dr. David Gifford: We are working with all the hospitals to help plan and build the capacity to handle the large number of people who might need care should there be a pandemic. The hospitals have been very cooperative and helpful. We meet with them regularly.

Frank the moderator: From an email:
If someone were to walk into an E.R. with flu-like symptons, would there be an available blood test to determine if, in fact, it was the avian flu?
Dr. David Gifford: We monitor influenza-like activity every year, which includes notification from emergency rooms, hospitals and physician offices. We also are notified about influenza activity from the various laboratories around the state. In addition, the RI Department of Health labratory recently acquired the technology and training to test for the avian - H5N1 strain of influenza that is the most likely culprit for the next pandemic.

kortgiesen: What would you suggest for college students, where colds and flus spread relentlessly?
Dr. David Gifford: College students should take the same precautions and actions as others - frequent hand washing (best done with alcohol based hand gels), avoiding large groups of people, covering nose/mouth when coughing/sneezing (wash your hands afterwards!), staying well rested.

whatif: What would our day to day lives be like? What would be expected of individuals, employers, academic institutions et al
Dr. David Gifford: This will depend on the magnitude of the pandemic (e.g. how many people get sick). The more people that get sick and miss work the greater impact on your day to day lives. Governor Carcieri has asked me to chair a work group to address how to minimize the impact on our day to day lives by making sure we have plans to address key services should a large proportion of the workforce miss work due to influenza.

Sheila: Doctor, you recommend "covering your mouth/nose after sneezing or coughing." But then the hand that covers your mouth touches keyboards, doorknobs, and faucets others may use. Which is worse -- spraying your sneeze or spreading it by hand? (How long do these germs live?)
Dr. David Gifford: Excellent point! This is why I think the alcohol hand gels are best to use since they can be readily available to clean your hands after sneezing or coughing. Of course you should also consider using a kleenex or coughing sneezing into your arm. Getting use to these behaviors now will not only help with limiting spread of pandemic flu should it hit us, but will help limit the spread of the common cold we often pick up each winter season.

zzkp: What is the availability of medications which might be of benefit
Dr. David Gifford: There are several medications that are used both to treat people infected with influenza and that can also help prevent people from contracting influenza. The federal government is in process of stock piling the medication "tamiflu". Governor Carcieri also has asked me to work with the legislature to begin to stockpile tamiflu beyond what the Federal government will provide us.
However, these medications are not a panacea. They do not work like antibiotics which kill bacteria. These antiviral medications prevent the replication of the virus. People who take these medications are less likely to get influenza or those who have influenza, they have slightly fewer days with symptoms.
We will not know the dose of these medications for a pandemic, since a pandemic will be caused by a new version of influenza that we have not seen before.

Sheila: Most of us have limited sick days, so we'd drag into work because bills still have to be paid. Has there been any discussion of something like "paid flu leave" in the interest of public health?
Dr. David Gifford: We are looking at this issue but I am confident that Rhode Islanders will rise to the challenge and work to help each other as we have always done when confronted with an emergency or challenge.
We will need to work together to address the challenges a pandemic will cause.

J222: What is the status of efforts to find a vaccine for the avian flu?
Dr. David Gifford: There is a prelimary vaccine tested for the avian flu. However, production is labor intensive and long. Part of President Bush's announcement and request for money from Congress is to purchase this vaccine and to develop new technologies to produce vaccines more quickly.
Currently vaccines are produced by growing the virus in eggs. Collecting the virus, killing the virus and packaging it in a vaccine. (Hence why people allergic to eggs should avoid influenza vaccine). This takes about 4-6 months.
We also do not know if the next pandemic of influenza will be due to "avian flu" or some other version. If we "put all our eggs into one basket" and stockpile vaccines for avaian flu and a different version strikes us, we will need a method to more rapidly make vaccines, than the current 4-6 month delay.

natefromri: Doctor, we had a health care seminar at work, and they said that there were not enough flu-vaccines to give out this year, so nobody got any vaccines. Will the state have enough flu vaccines to vaccinate people this year, and will this even work against preventing people from contracting this strain?
Dr. David Gifford: We are expecting more than enough vaccines for influenza this year. Some organizations and companies have had delays in their shipments but we are in constant contact with the Centers for Disease Control in Atlanta and are assured of enough vaccines. They may not arrive until later this month or December or January.
You can go to our Web site to find influenza vaccine clinics. www.health.ri.gov

zzkp: Will health-care workers receive prophylactic medications in the event of an outbreak in rhode island
Dr. David Gifford: Prophylactic medication needs to be taken throughout the time you are at risk of being exposed to the virus. In a pandemic, the typical pattern is two to three waves each lasting about 6-12 weeks. Thus, you would need to take medication for the entire period of time. Also, taking the medication is not foolproof protection in any way. Currently, there may not be enough to treat everyone who is infected let alone take for prophylaxis.
Until, a process for producing more medication (which President Bush has requested money from Congress to research), the federal government, Centers for Disease Control and infectious disease experts are not recommending we use medications for prophylaxis.

JoeRichmond: Your Web site lists a biological terrorism response plan. Is this the type of plan that would be used to handle emergencies like this. Would we have mass immunization?
Dr. David Gifford: Much of the bioterrorism plan will be helpful, however, a pandemic will be slightly different in that it will be worldwide, come in two to three waves each lasting 6-12 weeks. Thus, Governor Carcieri has asked me to form a workgroup to look at all the emergency plans to make sure they are applicable to pandemic flu and make the necessary changes.
Mass immunization will depend on the type of influenza that causes the pandemic and the availability of vaccine. The federal governement is stockpiling vaccine for "avian flu" which will allow for mass immunization if the pandemic is due to avian flu. If another strain causes a pandemic, we will need to wait for a new vaccine to be made. President Bush is funding research to improve our technology to prepare vaccines more quickly so we can utilize mass immunization should a pandemic occur.

J222: Oftentimes infants, young children and pregnant women are viewed as the most susceptible to the flu and are prioritized for vaccination - however could there be cause for concern of using such relatively new and untested vaccines on such vulnerable populations?
Dr. David Gifford: There are always risks and benefits to any medication or vaccine. Usually the benefits outweigh the risk when taking the population into consideration. However, if you happen to be the person who has an adverse event that is no comfort. The influenza vaccine has been tested extensively in these populations and has little risk to children and pregnant women. A vaccine for pandemic influeza should carry no different risk since it is essentially the same as every other vaccine except it targets a slightly different version of the typical influenza.
You should always discuss the risks and benefits with your health care provider and make the decision that is best for you. Clearly, the handwashing is safe for all and the most effective method to prevent spread of viruses such as influenza.

natefromri: How prepared is Rhode Island currently for an asian bird flu epidemic?
Dr. David Gifford: We are currently prepared but Governor Carcieri has asked me to chair a workgroup to make sure we are as best prepared as possible. Some of the lessons learned from Katrina have made us go back and look at our plans to make sure we are as well prepared as possible. No matter how much planning we do, a large pandemic may still overwhelm some sectors and all the preparation can not be done by the state alone. This is why we are working with the hospitals, physicians, law enforcement and local governments. We also will need the public to help should a pandemic hit us.

J222: Hypothetically, is 100% innoculation, (if adviseable and appropriate vaccine is available) feasible in RI? Clearly the health system would be over-taxed. Could National Guard, police, fire and rescue be quickly trained to assist in such a statewide innoculation?
Dr. David Gifford: We are working with the Emergency Management Agency, National Guard and state police in our planning. I am confident that if we have enough vaccine, everyone will help to make sure the vaccine or medication is distributed as widely and quickly as possible.

Sheila: Hello, Doctor, thanks for coming. On the net, I see it mentioned that in 1918 people who were treated with aspirin died of the flu more than people who weren't. Why was that, and does that mean we should avoid aspirin?
Also, I've read that young strong people died because their robust immune systems overreacted. I've tried to build up my immune system for years. Is there any way to suppress these reactions without making ourselves vulnerable to whatever else our immune systems protect us from?
Thanks.
Dr. David Gifford: Origninally, it was thought that robust immune systems in the young caused the higher mortality and complications in the young. However, this does not appear to be the case and is more likely related to not being exposed at all to the pandemic version of the virus. The deaths that occured quickly appear to be related to rapid infection rather than overreactive immune system. The elderly who had seen different versions of influenza appear to have had some cross reactivity and hence lower mortality than the young. Thus, I recommend getting your flu shot each year to hedge your chances of cross reactivity with the influenza virus causing a pandemic.

J222: Would you agree with the assessment of some that it is not a matter of "if", but "when" a worldwide pandemic will occur? It seems that in the case of the bird flu, most health experts expect and assume that a human spreading mutation will occur? But is it not just as likely that a mutation will NOT occur?
Dr. David Gifford: Excellent point. Many people are acting like the pandemic will occur this year due to the bird flu. Public health officials are worried about a pandemic since we have not had one since the 1960s. Historically, we have a pandemic about every 30 years. Also, the emergence of the avian flu widely infecting birds in Asia makes us concerned that this may be the next virus to cause a pandemic. Pandemics occur usually when an influenza virus infecting animals (most often pigs or birds) mutates so that it can infect humans easily and spread from human to human. Avian flu has not developed the ability to spread from human to human and has only limited ability to spread from bird to human (e.g. only about 100 cases in past three years). Thus, some infectious disease experts think avaian flu may never spread since it has not done so yet. Regardless, a pandemic is likely in the future which could be this year or 10 -20 years from now. Nonetheless, we need to prepare now.

Frank the moderator: Thank you Dr. Gifford for coming in and answering some questions from our readers.
Dr. David Gifford: I enjoyed hearing your questions and concerns. We are working hard to be as prepared as possible. We will need your assistance should pandemic occur, which I am confident all Rhode Islanders will do as they have done so in the past.