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During the 1918 flu pandemic that killed up to 50 million people worldwide, Medford was the first city in Oregon to ban public gatherings as an effective way to combat the spread of the disease.

Ninety years later, the plan in Jackson County for responding to a possible flu pandemic rests heavily on the same strategy because officials don't know what strain of influenza will strike.

The federal government has poured billions of dollars into developing and stockpiling vaccines to prepare for the flu threat. But local emergency planners are preparing for nightmare scenarios in which suitable vaccines aren't available and already-strained hospitals are overwhelmed by an influx of patients.

"We know we don't have the tools to stop it," said Gary Stevens, program manager for Jackson County Environmental Health. "We would use some of the same strategies used in 1918: social distancing, closing down public functions, closing the schools."

In 2007, the Food and Drug Administration approved the first human vaccine against the latest strain of the bird flu, H1N5, which has killed about 200 people, mostly through bird to human transmission.

Time Magazine named it as one of the top 10 medical breakthroughs in 2007.

The federal government's goal is to stockpile enough of the vaccine to serve 25 percent of the population based on the rate of infection in 1918.

But influenza could also mutate into other strains that now lack vaccines. Since humans won't have an immunity to them, the approach will be to contain them, said Beth DePew, Jackson County's director of health care preparedness.

"If there is a new strain of the virus that looks like it has pandemic potential that no one has immunity to, we would try to overwhelm the area where it appears with antiviral drugs and quarantines," said Bill Hall, a spokesman for the U.S. Department of Health and Human Services. "We would put all of our abilities into stamping out the spark before it starts spreading everywhere because once the disease spreads, you can't put the genie back in the bottle."

The reality is a pandemic will come — it's just a matter of time, according to public health experts.

"If a pandemic occurs anywhere in the world it is only a matter of weeks to months before it would arrive in our area," said Dr. Jim Shames, medical officer for Jackson and Josephine counties.

An attack by a new strain of influenza could cause as many as 30,000 to 70,000 people to fall ill in Jackson County, if infection rates followed the patterns of 1918. In 1918, about 2 percent of people who fell ill perished from the disease.

"That fatality rate feels like a worst-case scenario to me," Shames said.

It is unknown what the fatality rate would be in Southern Oregon.

Counties began planning more aggressively for a flu pandemic and other emergencies after the Sept. 11 terrorist attacks in 2001. Hospitals have been planning for a pandemic for longer than that, but now there is much more coordination with local governments, DePew said.

"We are building private and public partnerships to prepare for such an event," DePew said. "Hospitals work very closely with the county. They do exercises with us to coordinate preparedness."

Local governments last year received about $425 million from the federal government specifically to prepare for a flu pandemic, about $60,000 of which went to Jackson County.

The county received about $180,000 this year for general emergency preparedness planning for crises such as a pandemic, other communicable diseases, bioterrorism and severe weather events.

Hospitals and clinics in Jackson and Josephine counties received $240,000 in federal funds in 2006 for gearing up for infectious diseases and other hazards. The money was used for equipment, training, planning and amassing a medical reserve corps. In 2007, counties and hospitals in the two counties received $140,000 to maintain those plans.

Jackson County's plan focuses on where and when to use resources. For example, if there are only 30 ventilators in the county, who gets them? Where do people go if the hospitals are full? What happens if emergency workers fall ill?

"The idea is to make it very orderly with lots of communication so people don't panic, and we don't have civil unrest," Stevens said.

Schools are the latest component of the plan. School officials are set to meet Feb. 25 to discuss their preparedness plans.

"The reality is we would close schools, and we would close them for up to three months," said Steve Boyarsky, superintendent of Southern Oregon Education Service District.

Students would likely make up classes during summer vacation, Boyarsky said.

Research shows children are the fastest vehicle for spreading disease. The 1918 pandemic taught planners that school closures and other means of social isolation are the most effective means of containing the disease.

In St. Louis, where the mayor banned public gatherings and shuttered schools in 1918, the death toll was substantially lower than in Philadelphia, where officials were slower to take such measures. On the peak day of the pandemic, Oct. 16, 1918, 700 people perished in Philadelphia. In all, about seven out of 1,000 people who became ill died in Philadelphia, compared with two out of 1,000 in St. Louis.

Jackson County officials anticipate there would be a shortage of health care workers in the event of a pandemic. Experts also anticipate such a shortage on a national level.

"People in health care are already stretched," DePew said. "We can prepare, but we can't produce more people."

Jackson and Josephine counties have established lists of retired medical workers who are willing to volunteer in the event of a pandemic. So far, however, less than 10 people are on Jackson County's list. Josephine County has double that. A statewide health care volunteer roster is also in the works.

Local hospitals have plans in place for prioritizing bed space and sending patients to alternative health care centers that would be set up in the event of a pandemic.

Hospital responses would occur in stages as space was needed. Non-emergency surgeries might be canceled, or some patients might be sent to nursing homes or other alternative centers to make room in hospitals for more critical patients.

However, in many cases, people would have to take care of themselves.

County officials have been encouraging businesses to prepare for what to do if they were to lose half of their workforce. The county's Web site also provides guidance to businesses and families about how to prepare.

Precautions during a pandemic would be similar to those recommended during flu season: wash your hands, cover your mouth when coughing, wear a mask if you have to come into contact with others, stay at home if you're ill and disinfect surfaces.

The difference between 1918 and today is officials believe they'll be able to see a pandemic coming before it strikes.

"We have surveillance and will see which strain of the disease is coming," Shames said. "We will start developing an effective vaccine and will be waiting to institute measures whereby we'll be closing schools and businesses to help do everything we can to isolate people."

Reach reporter Paris Achen at 541-776-4459 or pachen@mailtribune.com.

Providence Hospital medical technician Matt Cable wears a positive air pressure respirator which would protect hospital workers from air born diseases in the case of a pandemic event. - Bob Pennell