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The Spanish flu that spread across the globe in 1918-19 caused sick people to flood hospitals to such a degree that many had to be treated in field hospitals under military tents, such as these patients in a U.S. Army Camp Hospital influenza ward in Aix-Les-Bains, France in 1918.

The Spanish flu that spread across the globe in 1918-19 killed an estimated 20 million to 50 million people worldwide, including at least 500,000 people in the United States.

People wore surgical masks in public to protect themselves from the deadly virus. Sick people flooded hospitals to such a degree that many had to be treated in field hospitals under military tents. Schools closed, business slowed, and some cities reported shortages of coffins, morticians, and gravediggers.

Widespread infection like this throughout a country, a continent, or across the globe is known as a pandemic. It is rarely seen and, almost a century after the Spanish flu pandemic, people have become so confident in modern medicine that they believe another pandemic is impossible.

But experts in communicable diseases say it’s only a matter of time before another pandemic flu strikes. Two others have occurred in the 20th century, including one that many may still remember: The Hong Kong flu of 1968-69 killed nearly 34,000 U.S. residents, while the Asian flu of 1957-58 killed 70,000 in this country.

To prepare for the next pandemic flu, the federal government has put together a national Pandemic Influenza Response and Preparedness Plan, which outlines a coordinated strategy in the event of an influenza pandemic. The plan provides guidance to national, state, and local policy-makers and health departments for public health preparation and response.

Throughout the country, public health officials in each community are developing influenza preparedness and response plans. The idea is for local groups and state governments to coordinate with one another. State governments, in turn, would coordinate with one another and the federal government.

Mona Bedell, RN, MSPH, BSN, a nurse epidemiologist for Denver Public Health, the department responsible for monitoring and dealing with Denver’s communicable disease outbreaks, says the health department has been meeting regularly with county and regional officials. They’re working to develop a plan for handling a flu pandemic and to come up with ways to monitor flu outbreaks, provide vaccines and antiviral medications, and communicate with the public.

She says officials from each county have imagined what might take place in such an event and have designed exercises to test their ability to provide mass vaccinations and communicate with both the public and one another. She says the various health entities have been sharing their plans with one another and coordinating them so that they’re not duplicating one another’s activities.

Bedell says that Denver Health, the hospital that provides medical care to 25% of Denver residents, organized a mass vaccination clinic for employees earlier this year to simulate on a small scale what would happen in the event of a surge in patients. She says the exercise helped identify how many people would be needed to provide mass vaccinations.

“I think that there are many concerns about how to deal with the numbers of people, whether they’re the ‘worried well’ or whether they’re sick and how you organize health care for them,” she says.

Concerns include how to relay information to people of many different cultures, structuring mass vaccination clinics, distributing drugs and vaccines, and designing a plan to make sure there are enough personnel to deal with the sick.

Rob Leeret, RN, nursing operations manager for emergency nursing at Denver Health, says one of the major problems he foresees is determining who is potentially infected with the flu virus and then separating them from patients who come to the hospital for other reasons.

“I think handling the influx of patients 85 and making sure they’re segregated from the get-go [will be important],” he says.

Killer bugs

Experts estimate the next pandemic flu, aided by the ease with which people now travel, will likely kill between 89,000 and 207,000 Americans. Annual U.S. influenza deaths number between 20,000 and 40,000, according to the CDC.

One reason another pandemic flu outbreak is considered inevitable is that it’s impossible to prepare for the virus that would lead to it. In almost every case, the flu virus that circulates each winter is a genetic cousin of a microbe already in circulation. Changes are carefully monitored and a new vaccine is developed each year.

But every once in awhile, a chance fusion and recombination of a human flu virus and a flu virus carried by birds or pigs occurs. The result is a microbe that is easily passed from human to human that has the potential to affect the entire globe. No one is immune to it because there have been no previous infections, and scientists don’t have enough time to develop a vaccine that will prevent widespread transmission.