State and federal officials have a serious message for Hawai'i residents regarding the next pandemic flu outbreak: Be prepared to protect yourself and your family because the government won't be able to do it all.

"Government is preparing, but individuals have to prepare as well," said state epidemiologist Dr. Paul Effler.

Hawai'i health officials say they have enough stockpiled anti-viral medication to treat everyone in the Islands who comes down with the flu. They are training volunteer medical teams statewide. They are making plans to establish field hospitals. And they have established a system to quarantine infectious passengers who arrive on international flights.

But health officials say their plans won't be enough.

"We're cognizant that government is not going to have all the resources it takes," Effler said.

One of the keys to effectively managing the crisis will be a public that is educated in what to do and what to stockpile at home if a quarantine is required.

In previous outbreaks, governments have sometimes opted to downplay the severity of a pandemic for various reasons. But today, the healthcare community believes thorough and accurate information is one of its best allies in tackling a flu pandemic.

What's more, many of the preparations for a flu pandemic are also useful for other mass disasters such a tsunami, hurricane or terrorist attack.

Pandemic flu spreads readily and quickly, and almost nobody in the population has immunity to it. The state Department of Health, with the support of the U.S. Centers for Disease Control and Prevention and other federal agencies, is trying to get ahead of the curve and is embarking on an extensive public education campaign.

Members of the public are being encouraged to educate themselves about how to keep from getting sick, how to behave if they get sick and how to prevent them from spreading their disease to others.

ADVANCE PREPARATIONS

Hawai'i residents will be asked to be able to shelter themselves at home, since health officials may request people isolate themselves in a voluntary quarantine. Residents are being urged to prepare in advance. That means having food, medical and pet supplies for two weeks at home.

Schools, many government offices and some businesses may be closed — to limit further infection because employees stay home due to their own illness, or they're at home caring for sick family members.

"Think about what a 40 percent absenteeism does," Gaynor said, including the sick, those staying away to keep from getting sick and those staying home to care for the sick.

Businesses are being urged to cross-train employees so the loss of skilled workers doesn't bring operations to a halt. They're also asked to plan for distance work — allowing workers to do their jobs from home or from places where they won't be in contact with people who have the flu.

Both employees and businesses are being asked to review sick-leave policies.

Said Effler: "If an employee is out of sick leave, do you really want them to come to work?"

Is this all too grim? Effler said officials merely need to look at the history of pandemic flu to understand the risk.

"The 1918 pandemic flu, which was commonly called the Spanish Flu, was the worst plague in human history," Effler said.

In Hawai'i, it killed nearly 1 percent of residents. Flu-ridden ships arriving from abroad dropped anchor with bodies of dead crew members aboard. Hawai'i military bases were closed. Public gatherings—including going to movies and using public transportation — were discouraged by the Territorial Board of Health. At its worst, nearly 200 people died in a single week. There were less severe pandemic flus in 1957 and 1968.

MATTER OF TIME

World health officials say it's a matter of time before the next massively fatal global flu comes along. They fear that it will come from a mutation of the fast-spreading bird-flu virus H5N1. Only about 200 humans have caught this virus worldwide thus far, but more than half of them have died — an indication of how severe it can be.

"Most of the pandemics we have seen historically have started out as a really severe bird flu virus," said state pandemic flu coordinator Dr. Kate Gaynor.

So far, H5N1 doesn't pass from human to human except in extremely rare circumstance, but if it evolves to do so — and viruses evolve readily — it could cause a new global health crisis.

"We know it mutates all the time," Effler said of the virus.

A vaccine would not be a magic bullet for a new pandemic flu. That's because it probably would not be generally available for six months or more after the illness begins to spread — it will take that long to identify the virus and begin mass-production of the vaccine. The remaining medical tools are anti-virals, which are taken after infection but before the disease progresses. They can prevent infected cells from infecting other cells in the body.

The state, with federal assistance, has built stockpiles in Hawai'i and on the Mainland with enough anti-viral medication to treat 30 percent of the state's resident and tourist population. That is more than the 25 percent expected to come down with the disease. But anti-virals are only effective if taken early — if people recognize early that they have symptoms, and are able to get treatment.

Complicating all control efforts will be the millions of tourists who come to the state each year — some of whom may arrive sick and others who may get sick here.

"Hawai'i's visitor-to-resident ratio presents a unique planning and logistical challenge," says the state's pandemic flu response plan.

FLIGHT PLAN

Federal authorities have a process in place to have pilots on international flights radio ahead if there are passengers who appear to be sick. Those passengers are met at Honolulu International Airport, taken aside and tested for flu and other illnesses. There are quarantine facilities at the airport for passengers who are sick and for those who may have been exposed to a virus.

The state is also establishing a statewide Medical Reserve Corps — teams in each county of doctors, nurses and nonmedical personnel that will be trained in emergency response. Health authorities will be able to call on them to assist in addressing medical needs.

"During a pandemic, our demand for healthcare is really going to spike, and it's already near capacity now," said Gaynor, the state's designated Medical Reserve Corps coordinator. The state flu plan anticipates as much as 25 percent of hospital workers may not be able to go to work — further reducing healthcare capacity.

The Department of Health will conduct an exercise in July with the military to help prepare for marshaling resources in case of a pandemic flu.

So that such a flu can be recognized early, the state has several tiers of influenza surveillance in place — testing a proportion of people who show up for medical care with flulike symptoms; paying special attention to sick people who have traveled recently and may be bringing in new viruses; checking on people whose symptoms are severe enough to require hospitalization; and keeping track of the progress of regular seasonal flu, which could also evolve into a new form.

"No one can predict when or how severe it will be, but history predicts there will be another pandemic, so our efforts won't be wasted," Effler said.

Reach Jan TenBruggencate at jant@honoluluadvertiser.com.