By Brian Carty, MD, MSPH
April 25, 2008
Thanks to a strict naval quarantine, the island of American Samoa was virtually untouched by the devastating 1918 influenza pandemic which killed at least 50 million people worldwide. Would this strategy enable you to survive a flu pandemic? Probably not. You would have to live on an island and be able to enforce a quarantine, or you would have to completely avoid contact with the rest of society for the duration of the influenza pandemic, as long as a year or so.
Imagine that you, your family and friends have sequestered yourselves to escape a plague. Then suddenly you discover contagion in your midst. A chilling fictional account of a group of people in a similar predicament is found in Edgar Allen Poe's short story "The Masque of the Red Death." In this tale, a prince and his friends seclude themselves in a castle during an epidemic of an illness known as the "Red Death." An elaborate masked ball is held. But a stranger is discovered who is not only costumed as a corpse, but as a victim of the Red Death. The stranger is unmasked; the Red Death has arrived:
And now was acknowledged the presence of the Red Death. He had come like a thief in the night. And one by one dropped the revellers in the blood- bedewed halls of their revel, and each died in the despairing posture of his fall. ... And Darkness and Decay and the Red Death held illimitable dominion over all.
Make Preparations Now
Now that's a gruesome ending, but the history of plagues and epidemics teaches that isolation and quarantine alone often fail. Still, there are a number of steps you can take to prepare for the influenza pandemic which is certain to occur. When it will occur and what strain of influenza virus will be responsible are unknown, but influenza pandemics often cause an enormous number of serious illnesses and deaths.
Preparations include insuring basic food, water and shelter. Information from health departments, the Centers for Disease Control, and other entities will be vital. Face masks and frequent hand washing may be beneficial. Avoiding crowds in theatres, workplaces, schools, and the like may help prevent or delay infection, but these measures, as noted, are likely to be only partially effective.
In addition to these general infection-control measures, vaccines for H5N1 (avian influenza) are in development. Still, there is no guarantee that such vaccines will provide protection or will be available in adequate quantities. You should get whatever yearly flu vaccine is available. This will give you significant protection against the yearly epidemic flu virus or viruses and possibly some partial protection against pandemic flu.
To hopefully prevent infection, anti-influenza drugs can be taken daily during a pandemic, as long as a year if necessary. If infection occurs, the drugs would be used for treatment. Various governments are acquiring flu drugs, but the quantities are sufficient to treat only part of the population for a short period of time. So once a pandemic starts, these drugs will be in short supply. Stockpile them now before you need them.
There are several antiviral drugs active against influenza. Both H5N1 (bird flu) and the flu strains which cause yearly epidemics are now resistant to amantadine and rimantadine. However, because the pandemic flu strain which eventually emerges may be sensitive to these drugs, you should stockpile amantadine or rimantadine. Both are relatively inexpensive. People over age 65 or who have impaired kidney function should not take amantadine.
There are two other drugs active against influenza – Tamiflu (oseltamivir), an oral drug, and Relenza (zanamivir), an inhaled drug. I suggest obtaining a one year supply of Tamiflu for each person to be protected. The cost for Tamiflu, 75mg twice per day for a year, is about $2700, not cheap, but there is no substitute for this drug. If you can't afford a one year supply, spring for a three or six month supply.
You Will Need Prescriptions
Your physician will likely cooperate by giving you prescriptions for these medications. If not, find one who will. Law enforcement officials have intercepted counterfeit Tamiflu, so buy from a reputable pharmacy.
It's also probably a good idea to stockpile some antibiotics to treat bacterial pneumonia which often follows influenza. My recommendations are azithromycin, levaquin, and linezolid.
People May Be Desperate for Anti-flu Drugs
If you decide to stockpile these drugs, don't tell anyone. Furthermore, the need to protect your stash against robbery and theft is obvious.
Make Reasonable Preparations, Then Relax
Many aspects of pandemic flu planning are beyond the capacity of individuals. Even so, if you follow the above recommendations, you will have done everything reasonably possible to prepare for pandemic flu.
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