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“Anywhere we are not obligated to do a smallpox plan, we use pandemic influenza as the model because it actually represents a worst-case scenario,” he says. “If you’re on the road for preparing for an influenza epidemic, you’ll also be well on your way for smallpox or any other communicable disease outbreak.”

Seattle health officials are keeping an eye on the avian flu that has hit Vietnam and China, Plough says, because a lot of people travel between the Pacific Northwest and Southeast Asia.

Plough says although King County, which includes 32 cities and roughly 2 million people, has a plan, that doesn’t mean it has the capacity for dealing with the large number of sick that would result from a pandemic.

He says officials have done some modeling to determine the impact a pandemic flu would have on the area. He says it is estimated that within the first six weeks 1 million people would be infected, 200,000 would become ill, 2,000 would be hospitalized, and 600 would die.

“I would challenge anyone to have the quarantine and clinical capacity to deal with this,” he says.

Plough says hospitals should not be expected to handle all aspects of pandemic flu because they will still have to treat people who with other ailments. Alternative sites will have to be set up in strategic locations. He says as part of the King County plan, officials are getting commitments from gyms, conference centers, and other public facilities promising to serve as alternative sites.

A pandemic will affect more than the health care industry, he says. People will begin staying home whenever possible, major sporting events will be cancelled, and unnecessary public interaction will be discouraged.

In Colorado, a database of retired nurses and physicians is being compiled to allow health officials to “call up” people when they need help, Cantrill says. He says the state has plans to set up trailers that can be converted into 500-bed units in what might be considered the modern equivalent of the tents used during the Spanish flu outbreak.

Denver Health officials have met with the hospital’s engineering staff to come up with a plan for changing the air conditioning system to allow them to vent more areas into the outdoors rather than circulating the air. This would allow them to set up larger isolation areas in order to protect staff.

The threat of bioterrorism, SARS, and the avian flu outbreak have served as a wake-up call for public health officials and public officials, and health care providers hope for the public at large as well.