OLYMPIA - Federal, state and local governments are stashing hundreds of millions of dollars to prepare for a potential flu pandemic, an event health professionals see as inevitable.
But no amount of money and preparation will change the sobering reality that most people simply will be asked to save themselves.
"You're part of this," said Mary Selecky, secretary of the state Department of Health. "This isn't about somebody else taking care of it."
Public officials are straining to raise awareness with "cover your cough" advertising campaigns in hopes people will get the message in time to fend for themselves when a pandemic hits.
In the meantime, they're cobbling together response plans, planning to build a national stockpile of medical supplies and figuring out how they would exercise those response plans through many layers of government.
A call to action
At least 850 local public health officers, emergency management organizers and other public officials are expected to attend a state-sponsored summit Friday in Tacoma.
Virtually every state is holding one at the request of the federal government and Washington's is expected to be one of the largest.
"We've put the invitation out far and wide," said Tim Church, a state Department of Health spokesman.
But the most critical audience may be the reporters who will attend to spread the message to more than 6.2 million Washington residents.
"It's the call to action," Selecky said.
When earthquakes hit and hurricanes strike, aid can be rushed in from other states or countries. But this crisis will be global, with everyone scrambling for the same scant resources.
The federal government will not be there to rebuild cities as is being done in New Orleans. Rather, government has seemingly modest goals to only coordinate what resources will be available while "maintaining the civil order," Selecky said.
"Should it occur, every community will need to rely on its own planning and its own resources as it fights the outbreak," Michael Leavitt, secretary of the U.S. Department of Health and Human Services, wrote in a report issued last month. "It will demand that every aspect of our communities be self-sufficient."
In December, Congress approved $3.8 billion to begin preparing for a flu pandemic, a prospect that's risen in profile with the emergence of the H5N1 bird flu virus.
The federal health agency is spending almost $1.8 billion of that to research and develop vaccines to treat the H5N1 virus and its mutant forms.
Should effective vaccines be developed, new production facilities would be needed to generate massive quantities. The agency is expected to issue a formal request for proposals this month.
Though their effectiveness is disputed given that a flu virus can become resistant, the federal government also has set aside $731 million to produce existing antiviral drugs and to research and develop new ones for the bird flu virus.
About $162 million has been set aside to buy other medical equipment, including 6,000 ventilators, 50 million surgical masks plus respirators, face shields, gloves and gowns.
At the state level, the Legislature this year passed a bill requiring local health districts to develop response plans and provided $2 million in funding - a 10th of what was requested. Lawmakers also approved $200,000 to allow the state departments of Health and Agriculture to monitor, track and test for unusual types of flu.
Response plans developing
Response plans at all levels of government are somewhat skeletal.
Conceptually, the response will escalate with a broader public outreach campaign once a virus starts being transmitted from human to human in limited numbers outside the country.
A sample of local physicians would be asked to begin checking their patients for symptoms and report back.
Should transmission begin escalating, state health workers may be reassigned to work phone banks answering calls from the public, to repackage and ship federal medical supplies, to shore up local medical staffs or to perform other priority tasks. Travelers coming into the state may be screened.
The state's Emergency Operations Center would be activated should a flu virus begin to spread globally, and the federal stockpile of emergency and medical supplies would be tapped. The governor would declare a state of emergency once the virus reaches the state and supplies would begin to be distributed.
Beyond that, there's many other details to work out.
Dr. Larry Jecha, director of the Benton-Franklin Health District, said any supplies, antivirals and vaccines would be distributed at 17 locations throughout the health district. Medical and emergency personnel would be first in line. Staffing is a primary concern, especially if doctors, nurses and first responders begin to fall prey to the virus.
After that, those who figure to be most vulnerable to the flu - likely those with the strongest immune systems - would come next. But a specific method for prioritizing who gets help hasn't been determined.
The healthiest people are most vulnerable because the greatest risk is not from the virus itself, but from the overblown immune reaction the disease sparks.
It's almost certain people will have to be screened to determine whether they'll be eligible to receive antivirals or vaccines and there won't be enough to go around. Crowd control could become an issue.
"We will face a challenge because there will be clamoring for it," Selecky said.
Coordination is key
Just as they are designed to, simulations involving local emergency management officials keep blowing holes in response plans. New questions keep coming up. Many remain unanswered.
"It shows a lot of your shortcomings," Jecha said.
The good news is key questions are being identified now, before a pandemic hits. That's why Leavitt and others are pressing for more simulations - to find more holes to plug.
"They're very difficult questions and they're not easily addressed," said Rob Harper, a spokesman for the state Military Department's Emergency Management division.
"Communication is probably our weakest link," Jecha said.
To that end, the state Military Department's role is to be the bridge between federal, state and local governments. That's a big undertaking considering the number of agencies and other governmental entities involved.
Selecky said there's much to learn from the coordination breakdowns between governments in the wake of Hurricane Katrina.
"They were humbling and sober lessons to learn from," said Selecky, who has spoken regularly to her counterpart in Mississippi.
She learned it's important to "know your partners and know them ahead of time and trust they'll do the things they're good at and build their trust you'll do the things you're good at."