In a Flu Pandemic, What Can the Government Do to You?"

http://abcnews.go.com/Health/SwineFluNews/story?id=8437630

A CDC report raises concern over Washington's potential response to H1N1.

What might life be like during the kind of major swine flu pandemic predicted by the White House to hit the U.S. this fall?

The worst-case scenarios percolate on the edges of thought: bans on public gatherings, restricting the movement of afflicted individuals, and compelled vaccinations. Conspiracy theorists go farther, suggesting that the World Health Organization is behind a secret plan to inoculate Americans at gunpoint with immune-system depleting vaccines to depopulate the globe.

The CDC's report, released Monday, may well create some level of hysteria. It said 1.8 million Americans could become seriously ill this fall and as many as 90,000 could die.

In truth, America's national pandemic response plan has been shaped by lessons from the 1918 Spanish flu epidemic, which killed millions globally and did include gun-point quarantines. If the circumstances are deemed dire enough, the government's "Pandemic Influenza Plan" allows for strong measures, such as banning public gatherings and calling in the military to help with law enforcement.

Yet the far greater concern for public-health officials right now is more mundane: trying to make sure that there is enough vaccine to meet demand – and that there are enough healthcare professionals on hand to handle a potential influx of patients.

The Department of Health and Human Services has fast-tracked production of a vaccine, but it will not have 120 million doses ready by the expected peak of the season, as it had hoped. Forty-five million doses will be available in mid-October, with 20 million more available each week afterward.

Massachusetts public-health officials, for instance, are urging nearly 90 percent of residents to get vaccinated.

In the event of a health crisis, the federal government has broad powers. New rules enacted by the Bush administration include swine flu among quarantinable communicable diseases. For its part, the Obama administration is also reportedly reviewing proposals to strengthen three-decade-old federal quarantine policies, including, according to some reports, presidential power to impose a six-day quarantine on those affected by swine flu. The Department of Health and Human Services has asked the Pentagon to assist local health officials in the event of a pandemic.

But these are clear attempts at preparing for the worst.

"There's not going to be compulsory vaccination," says Jennifer Nuzzo, an analyst at the Center for Biosecurity at the University of Pittsburgh Medical Center. "But what you may be picking up on is that the military does have a lot of healthcare professionals, so [the government] may be enlisting some of the extra hands that are out there."

Because the H1N1 flu has proven less deadly so far than initially feared, the Obama administration has actually ratcheted back immediate response plans.

For example: The administration is hinting that it will urge fewer school closings than took place during the spring outbreak. Colleges are being asked to formulate preparedness plans, but so far those include primarily voluntary dorm quarantines and suggestions for afflicted students to refrain from kissing – or at least to wear surgical masks when they do.

Compared with many other countries, "this administration has been pretty measured about wanting to balance the need to control a health threat with not wanting to interrupt society … [with] heavy-handed responses," says Ms. Nuzzo.

As to the fears about a WHO conspiracy, Nuzzo adds: "The WHO staff is smaller than the New York City Health Department, so its ability to impose worldwide martial law would be a miracle."

Yet some fears about the government potentially overstepping its bounds are justified, civil libertarians say.

Since 9/11, pandemic planning has taken a more authoritarian tone that harks back to the pre-vaccine days of forced quarantines during outbreaks, according to an American Civil Liberties Union report released in January 2008.

Pandemic flu plans adopted by the federal government and nearly every state and locality "rely heavily on a punitive approach and emphasize extreme measures such as quarantine and forced treatment," the report says. "People, rather than the disease, become the enemy."

Yet some pandemic experts predict that the police and military will more likely be used to protect clinics and hospitals against angry mobs demanding vaccination than to force Americans into quarantine against their will.