Local, state and federal emergency response officials are preparing for a worst-case scenario of a passenger with bird flu (avian influenza) arriving at Los Angeles International Airport (LAX).
More than 75 people from more than 30 agencies prepared for an outbreak of the disease Thursday, October 20th, in a drill conducted by the Centers for Disease Control and Prevention (CDC).
“It is important for all of us to remember that avian flu, or H5N1 influenza, remains primarily a bird disease and does not yet efficiently transmit from person to person,” said Ram Koppaka, chief of the CDC Quarantine and Border Health Services Branch.
Bird flu is an often quickly fatal disease in humans caused by direct or indirect contact with infected birds, notably domestic poultry such as chickens and turkeys.
The influenza has devastated domestic poultry flocks in Asia and killed more than half of the 100 people who contracted the disease from birds.
In birds, the influenza causes multiple organ failure and death within 48 hours.
Humans with bird flu experience symptoms unlike a regular flu because H5N1 influenza is aggressive and causes rapid organ deterioration even in healthy people.
Bird flu remains a disease transmitted from birds to other birds and from birds to humans.
If a new strain of the bird flu virus were to emerge and become a communicable disease among humans, a pandemic would occur because there is currently no vaccine or reliable treatment except for two prescription drugs.
The drugs are zanamivir, known by its brand name Relenza, and oseltamivir, known by its brand name Tamiflu, which is currently much in demand and short in supply.
LAX officials are worried about pandemic bird flu because the airport has more than 26 international flights to and from Asia, which is one-third of the airport’s total daily international operations.
An estimated 10,000 tourists and business travelers arrive at LAX from Asia every day.
“The airport is considered the key entry point for possible transmission of bird flu into the United States because it is the number one air gateway from Asia,” said Jens Rivera, LAX airport operations manager. “One-third of the airport’s workforce is directly engaged in ensuring that a unified and comprehensive response to any emergency occurs at LAX.”
At the airport, 40,000 employees work at 300 companies.
Robert Kim-Farley, director of Communicable Disease Control and Prevention for the Los Angeles County Department of Health Services, said bird flu could easily transmit from human to human.
If a person has the regular flu and bird flu at the same time, a new form of influenza could emerge, Kim-Farley said.
The new flu could be communicable among
humans, as the regular flu transmits easily from human to human and it could also have the severe and fatal effects of the bird flu.
“Pandemic influenza is not an issue of ‘if it will occur’ but ‘when it will occur,’ regardless of whether the influenza is this avian influenza or not,” Kim-Farley said. “We have had pandemic influenza in the past and in the last century, the 1918 Spanish influenza killed 40 million people worldwide and 500,000 deaths were in the U.S.
“This is why we are looking closely at the situation in Asia. We have to make sure we are in a position to respond,” he said.
Last week’s CDC drill is part of an emergency response plan that is expected to be completed in November.
“This is part of a planning process that we have been at for months,” said William Mac Kenzie, medical officer for the CDC Quarantine Station in Los Angeles. “We have to prepare for what might come.”
The premise of the drill was a radio call to LAX from an airline pilot who says five passengers on board have flu-like symptoms.
The flight had departed from an Asian country where bird flu existed and the five ill passengers had been to a funeral of a person who died of bird flu.
Response agencies participating in the drill chose to treat the ill passengers and quarantine the remaining passengers.
“The foundation for the avian influenza plan already exists in our comprehensive emergency preparedness and operations plan that has been evaluated, tested, and modified with each emergency that has occurred at LAX,” Rivera said.
“The plan is a logistical challenge, but we have established an experience level in responding to SARS [Severe Acute Respiratory Syndrome] in 2003 and the Ebola virus before that,” he said.
Koppaka said a standard procedure has been in place for all communicable diseases and action starts with a federal law that requires airlines to notify the local CDC Quarantine Station prior to landing of an ill passenger on board.
The CDC would then notify its partner emergency response agencies and passengers would not be allowed to deplane.
Medical teams would board the plane to determine if the ill passenger needs treatment.
The ill passenger would be questioned about whether he or she has been exposed to birds, exposed to other people who have been exposed to birds, or exposed to other people who have bird flu.
Other passengers on the plane would be evaluated and a decision would be made on whether to deplane or take preventive measures such as isolation and quarantine.
“Our ultimate goal is to ensure that individuals get the care they need,” Koppaka said. “Quarantine and isolation are important public health tools used only when absolutely necessary to prevent the spread of infectious diseases within the community.”
Isolation is the separation from other people of individuals who are ill with a communicable disease.
Quarantine is the separation or detention of individuals not yet ill but who have been exposed to a communicable disease.
“Decisions about how to respond to an individual who has symptoms compatible with the flu are based on a variety of factors,” Koppaka said. “Among them are where the individual has been and current situations in various parts of the world.
“We do not quarantine because we are not in a situation where there is efficient human to human transmission.”
If a passenger has bird flu and the virus is known to transmit from human to human, LAX and airline officials would need to provide temporary shelters for one or more passengers or possibly all of a plane’s passengers.
“We have conducted a survey of airport facilities and looked into other types of arrangements, including identifying related issues such as food service, sleeping arrangements, passengers with special needs, foreign language translators, and long distance phone lines,” Rivera said.
Kim-Farley said Los Angeles County is prepared for longer quarantines.
“We realize that we are probably not going to have long quarantine situations at the airport,” he said. “We will have to find accommodations elsewhere in the county and sheltering large numbers of Hurricane Katrina evacuees have proven to be beneficial for our plans.”
Fifty years ago, the U.S. operated quarantine stations at every international port of entry and actively screened arriving passengers.
With the invention of vaccines and therapies for infectious diseases, the need for extensive screening efforts waned.
By 2003, eight stations were in operation at the largest ports of entry, with more stations opening up at an accelerated pace because of SARS.
While public officials work on formal plans to deal with bird flu, people can take personal measures to prevent communicable diseases, said Lisa Benton, public health medical officer for the California Department of Health Services.
“The public should do some basic respiratory hygiene things such as covering their coughs, washing their hands, using hand sanitizers, and staying home or telecommuting to work if they are sick,” she said.
“People should also get the seasonal flu shot because the shot will protect them from the regular flu that goes around every year and this helps healthcare providers make decisions about whether to test sick people for avian flu.”