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Pandemic Flu Frequently Asked Questions

Many of the following questions came from the county's Pandemic Flu Town Meeting on April 18, 2006. Additional questions have been added as health department officials receive questions from county residents. Questions are categorized into several broad categories. Additional questions and answers can be found on pandemicflu.gov, the official U.S. Government Pandemic Flu Web site.

Q. What is the difference between seasonal flu, avian flu and pandemic flu?
A. Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available. Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. (definitions from pandemicflu.gov)

Q. Do the annual flu shots provide any protection against bird flu?
A. No. While annual immunization is the most effective way to avoid getting seasonal flu, it will not provide protection from bird flu or any other influenza strain that emerges to create a pandemic. The annual influenza vaccine is only effective against circulating influenza viruses in the human population and includes the influenza strains expected to be in circulation during that year's flu season. Because we do not know what influenza virus will cause the next pandemic, a pandemic vaccine cannot be produced until a new pandemic flu virus emerges and is identified.

Q. How long was the H1N1 Spanish flu around killing birds before it crossed over to being contagious to humans?
A. Many questions about the “Spanish” influenza pandemic of 1918 remain unanswered, including the origin of the virus and the evolutionary path that led to the emergence of a pandemic virus. There are no historical data, either in 1918 or in any other pandemic, for establishing that a pandemic precursor virus caused an outbreak in poultry.

Q. What is the current estimated probability that a strain will develop that will easily pass human to human in such a way to cause the pandemic?
A. Although no one can predict with certainty the timing of the next pandemic and what the pandemic virus will be, the risk of an influenza pandemic is serious. Scientists are monitoring the H5N1 strain because it currently meets two out of three conditions that have to be met for a pandemic to occur. As this virus spreads, the risk that more human cases will occur increases and each additional human case gives the virus an opportunity to improve its ability to spread from person to person and develop into a pandemic strain. Simultaneous infection of H5N1 and human influenza in humans and animals, such as pigs, provides the opportunity for the mixing of the genetic material from both viruses, which could result in a new virus that can spread easily from person to person.

Q. Electrolytes are an important treatment. I have looked for a recipe for electrolytes on the internet and have not found a reliable site. Can you post one on the Fairfax County Web site?
A. Use of oral rehydration solutions are often used for infants and children who have diarrhea, vomiting or fever. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose or another carbohydrate such as rice powder to enhance absorption in the intestinal tract. Oral rehydration products are readily available in most drug stores, and many pharmacies carry their own brands. The secret is to begin giving fluids early in the course of an illness instead of waiting until the situation becomes urgent. In an emergency you can make your own oral rehydration solution by mixing:

1 quart (32 ounces) or 1 liter clean water
1/2 teaspoon of salt,
2 tablespoons of sugar

Mix well. DO NOT HEAT OR BOIL after mixing. Be sure to measure accurately because incorrect amounts can make the solution less effective or even harmful. Many children will drink this solution without flavorings. If your child is refusing rehydration solution, you can try adding a pinch of NutraSweet, or sugar-free drink mix (any brand), or sugar-free Jello mix. Just make sure that the drink mix is sugar free. Whatever alternative you choose, be sure to give enough solution. Your doctor may suggest specific amounts, depending on your age and degree of dehydration, but a general rule of thumb is to keep giving liquids slowly until your urine becomes clear-colored.

Q. If bird flu shows up in the United States, will it be safe to eat poultry (chicken, duck, turkey)?
A. Yes. According to the U.S. Department of Agriculture, there is no evidence that anyone has been infected with H5N1 influenza or other bird flu viruses by eating properly cooked poultry or poultry products (e.g., eggs) derived from infected birds. Cooking food thoroughly will kill bird flu virus and other infectious agents if they are present.

Q. Birds carry fleas. If there are fleas on an infected bird, can people and animals be infected by contact with those fleas?
A. No. Although fleas can transmit some diseases, such as bubonic plague, they are not part of the lifecycle of influenza viruses. Influenza spreads from person to person through respiratory contact with infected secretions. To date, the mode of transmission for H5N1 in the human cases has been from direct contact with infected poultry, or surfaces contaminated by their feces and secretions.

Q.I live in Fairfax, not near water, and I found a dead bird in my yard. What should I do?
A. At the present time, we do not have the highly-pathogenic avian influenza in our birds in the United States. It's always best to avoid contact with any dead animal. If possible, leave the dead bird where you found it and let nature take its course. If the dead bird is located in a visible or obvious place that would be an eyesore or a nuisance, it is best to wear disposable gloves, double bag the bird (plastic grocery bags work well) and discard it with your trash, using an outdoor trashcan with a tight-fitting lid. Remember to discard the gloves as well. Wash your hands thoroughly with soap and warm water afterwards. If you're not sure what to do, you can call the Health Department for guidance at 703-246-2300, TTY 703-591-6435. If the bird is a waterfowl (a dead duck or goose), you can report it to the Virginia Department of Game and Inland Fisheries’ Fredericksburg office at 540-899-4169.

Q. Have you planned for alternate medical sites (e.g., hotels) to protect our hospitals from the infected?
A. The issue of alternate care sites is being looked at primarily to deal with surge capacity for the healthcare system and not specifically for individuals infected with a pandemic flu virus. Good infection control practices and cohorting of patients (keeping ill patients together) can limit the spread of the virus in the hospital setting. Because individuals can transmit the virus one day prior to the onset of symptoms, the most effective way to help stop the spread of disease is proper and frequent hand washing, covering your coughs and sneezes with a tissue or your upper sleeve, and staying home when sick.

Q. What plans for international flights into Dulles International Airport?
A. The Centers of Disease Control and Prevention’s (CDC) Washington Quarantine station is located at Dulles International Airport and covers all ports in Washington, D.C., Maryland, Virginia and West Virginia. The staff at the Dulles field station conduct surveillance, public health emergency response and communicable disease prevention activities for all public health threats, including possible pandemic influenza. The Fairfax County Health Department has been working with the Washington Quarantine station since July 2005 to develop and ensure a coordinated public health response plan. Specific plans are in place and have been exercised, for Dulles International Airport, which address possible isolation and quarantine of international flights exposed to a potential pandemic influenza strain.

Q. How do we care for the tens of thousands of people who are seriously ill but can't fit into hospitals? Do we open schools as emergency hospitals? If so, where will the supplies for those facilities come from? If people need help at home, who will provide it? Do we have a list of people we can call on in an emergency?
A. Fairfax County Health Department and the Office of Emergency Management are working together with local health care facilities to help them plan for a surge in patients. Areas for consideration and planning include: patient triage strategies, cohorting patients, emergency staffing, cross training for healthcare staff, rapid or alternate credentialing of staff, changes in standards of care, cancelling of elective services and accelerating discharge of patients. Communication with the public will include information on how to self-care for influenza at home and what signs and symptoms indicate that health care is needed in order to keep the hospitals available for those in greatest need of hospitalization. Fairfax County is working on plans to ensure that essential needs will be met for our most vulnerable residents who need to be isolated at home while sick.

Q. What is being done to increase the amount of antiviral drugs?
A. The U.S. Department of Health and Human Services (HHS) is working with private-sector partners to increase the current production of antiviral medication. These additional stocks of antivirals will be procured for the Strategic National Stockpile (SNS) and distributed to individual states to treat those individuals identified at the time of the pandemic as recommended by the Virginia Department of Health and HHS.

Q. Do the police have a use of force plan to protect food and medical sites?
A. The Department has been involved in infrastructure protection for some time, in fact long before Pandemic Flu concerns arose. Included in that infrastructure protection are protocols, scene assessments and contingencies to address issues associated with protecting the county’s critical needs.

Q. The police and fire departments will also be experiencing heavy absenteeism. Do we keep open all fire stations with reduced staffing, or should we consolidate so we have a smaller number of full-staffed stations?
A. Fire and Rescue Services are going through the planning process for dealing with a pandemic flu with minimum staff requirements.

Q. How do you plan to operate your offices in the event of a flu pandemic?
A. With the expectation that we could face an absenteeism rate of 25-35% among staff for many weeks, if not months during a pandemic outbreak, Fairfax County is currently developing plans to address this particular situation and provide for continuity of government to the greatest practical extent possible. Additionally, we expect that many of our external partners (utility companies, contractors, suppliers, and vendors) with whom we interact with on a daily basis will experience similar business continuity issues that could impact county governance. We are actively engaging these entities to determine the extent that essential services, supplies, and materials provided by these companies can be maintained during an outbreak.

We are currently engaging all county agencies to prioritize their essential business operations and prepare for the possible suspension of other non-essential business functions for a period of time. This prioritization involves consideration for the reassignment of available employees to support critical agency functions, increasing the number of employees available to work from home, determining what face-to-face services currently offered can be altered to reduce contact, assuring cross-training for essential skills and positions, and developing line of succession contingencies within all agencies (staff 3 deep) for top management and mission critical positions.Equally important, is the preparation being undertaken to provide resources for maintaining safe and healthy offices (providing infection control supplies such as hand sanitizer, antibacterial soap, tissues and waste receptacles) to protect our employees during an outbreak.

Q. Will you require personnel to stay at home if they contract the Avian Bird Flu?
A. The Fairfax County Department of Human Resources is currently preparing the official policy regarding this question. It is certainly our desire that any employee remain at home while they are contagious or ill with an avian influenza infection. We would not expect that an employee would report to work while sick under normal conditions, and that expectation would hold particularly true during the time they are attempting to recover from an avian flu virus. Prudent infection control practices for the workplace dictate that employees who are ill from such a potentially contagious and infectious disease stay at home so as to not pass the virus among other staff.

Q. Do you plan or have in place provisions for personnel to work from home in the event of an outbreak?
A. Yes. We believe an important aspect of caring for our employees and maintaining a safe and healthy workplace during a pandemic flu outbreak will involve having personnel work from home as necessary and practical. Fairfax County began a telework program (currently also known as telecommunicating) for government employees in 1995 as one way to improve traffic and air quality. The program allows employees to work from a home-based office or local work center during normal work hours, instead of commuting and there are currently more than 1,000 employees enrolled in the program. In the event of a pandemic flu outbreak, our intention would be to reduce the potential exposure of personnel to the virus through various means such as increasing the number of “telework-ready” employees (to compensate for a possible 25-35 percent absenteeism rate) with particular focus on mission critical positions not previously identified for telework. This will help to reduce the number of employees that need to travel to and from work and potentially limit them from coming into close contact with other people and thus the virus itself.

Q. When should schools be closed? Do you anticipate school system closure in the event of pandemic flu?
A. Outbreaks of influenza can occur wherever people are in close proximity to one another. Children are known to be efficient transmitters of seasonal influenza and other respiratory illnesses. Although data are limited, school closures may be effective in decreasing spread of influenza and reducing the overall magnitude of disease in a community. Results of mathematical modeling suggest a reduction of overall disease, especially when schools are closed early in the outbreak. School closures due to a pandemic influenza event will be determined by the epidemiology (or strain) of the virus. Schools may be mandated to be closed by local/state health officials to prevent the spread of the influenza if the epidemiology warrants that decision, which will be made by the local/state Health Department under their authority during a public health emergency.

Q. Should there be plans in place to continue instruction over the Internet?
A. Currently, there is some capacity for Internet and cable television distance learning in Fairfax County Public Schools. FCPS is assessing that capacity and other distance learning media solutions.

Q. What about SOLs and other testing?
A. This issue is one of the several issues that will be coordinated with the Virginia Department of Education.

Q. If schools are closed for six weeks, does the school year count?
A. Any decision about whether to exempt “snow days” and/or school closures days that exceed the mandated school year requirements of 180 days will be made by the Virginia State Department of Education. Within the typical FCPS school year calendar there are make up “snow days” built in to the calendar.

Q. At what level of affected individuals will result in closure of schools?
A. FCPS has plans to keep the business of schools up and running. We call them “continuity of operations plans,” and they address employee lines of successions, essential personnel, and resource allocation. In terms of school based teachers, FCPS has a database of 5,000 substitute teachers to avoid teacher shortages. Additionally, FCPS is developing plans to identify non-essential services that can be suspended and reallocating those resources to provide essential functions.

Q. What percentage of school students being ill/absent from school before the schools is to be shut down?
A. There is no quantifiable number nor can one be speculated. For example, a school that has no cases of influenza may be closed by order of the local/state Health Department to minimize the spread of the disease detected regionally. It is not uncommon to have ten to twenty percent of a school population out during a seasonal influenza outbreak and those schools are not closed. FCPS will take steps necessary to prevent and mitigate the spread of any illness by following strict infection control techniques and provide for a safe and healthy environment for FCPS students to learn.

Q. Regarding Fairfax County Public Schools, I am a teacher with FPCS and I am very involved with my school as a Team Facilitator; however, I am unaware to date of any emergency plans whatsoever vis a vis a potential pandemic. Do you have any current information regarding the same?
A. Since the fall of 2005, Fairfax County has been developing a Pandemic Influenza Plan in accordance with the emergency plans of the Virginia Department of Health, the Centers for Disease Control and Prevention, and the World Health Organization. Two coordinating committees, the Public Health Coordinating Committee and the Critical Infrastructure and Resource Management Coordinating Committee are comprised of representatives from 30 county agencies.

FCPS directors and staff members from the Offices of Community Relations, Food and Nutrition, Procurement Services, and Safety and Security are members of the Public Health Coordinating Committee and the directors of the Office of Community Relations and the Office of Safety and Security serve on the Critical Infrastructure and Resource Management Coordinating Committee. FCPS’ Pandemic Influenza Plans are being developed in conjunction with the county-wide plan.

School based infection control measures (including hand washing and surface cleaning) and universal hygiene measures have been found to be effective in mitigating and preventing the spread of influenza, and FCPS currently has several programs and procedures in-place, including:

Accessible infection prevention supplies, e.g., soap, tissues, paper towels and receptacles for their disposal.
Daily cleaning of contact surfaces by local Plant Operations staff with appropriate cleaning solutions (current cleaning solutions, Quaternary Ammonia Compounds (QACs), are effective against influenza viruses).
Hand washing awareness and instruction campaign administered in a variety of instructional programs K-9.
Fairfax County Health Department – School Illness Monitoring System (SIMS) student absenteeism surveillance.
Using the Keep in Touch messaging, backpack letters, and Web/television based communication and educational programs to disseminate information about the FCPS pandemic influenza preparedness and response plan.

Every FCPS school facility has an adequate number of sinks to allow students to wash their hands. In most elementary school classrooms there are hand washing sinks in the classrooms.

The Office of Safety and Security provides a variety of outreach programs that include hand washing encouragement posters. These posters were distributed to every FCPS facility in numbers that would allow schools to place them in every bathroom. Additionally the Fairfax County Health Department has distributed a hand-washing awareness poster.

FCPS also supports hand washing by having hand washing in the curriculum. In grades 1-5 hand washing is found in the Personal Health and Safety Unit. There are additional hand washing segments found in: Grade Six “Health Me: Keeping Infections Away,” which discusses hand washing as the number one way to help prevent spread of infection; Grade Seven’s Disease and the Human Body unit; and Grade Nine’s Nutrition Unit.

Q. The Medical Reserve Coordinators are being assigned to county high schools. However, it is not clear that if there is a vaccine or shot that the public will know to go to the high schools. How will the public be alerted?
A. Vaccine will not likely be available in the early months of an outbreak thus, the emphasis on personal and family prevention and social distancing. When vaccine is available, the Fairfax County Office of Public Affairs, the Health Department and Fairfax County Public Schools will coordinate a schedule of which facilities will be opened and what times. This schedule will be issued through all local media and published on the Fairfax County Web site to inform the public of the dispensing sites. Medical Reserve Corps teams will also be informed well in advance where and when they will be asked to dispense flu vaccine.

Q. How can I join Medical Reserve Corps?
A. Joining the Medical Reserve Corps could not be easier! If you have Internet access, log onto www.fairfaxmrc.org, click on New User and the system will lead you through the registration process. If you would prefer, contact the Medical Reserve Corps office by phone at 703-246-2433, TTY 703-591-6435, and staff will assist you.

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