The federal government has its emergency plan for a possible pandemic, but what about local governments? Host Steve Curwood talks with Doctor Jonathan Fielding, director of public health in L.A. County.
CURWOOD: The federal government has an emergency plan, but what about local governments? They are going to be the ones shouldering most of the burden of preparing for a possible pandemic, and then dealing with the devastating effects of one if it does come. With me to talk about what Los Angeles County is doing is Dr. Jonathan Fielding. He’s director of public health there.
Dr. Fielding, it sounds to me like a mind-boggling task. I mean, how do you run a county that may have up to 40 percent of its 10 million residents sick?
FIELDING: Well, it depends on how it shows up. I think we’ve been working closely with the quarantine unit of the Centers for Disease Control. We are a major stopping off point for travelers and it’s likely if something came here it would come via air. Although there are certainly other possibilities, as well. We’re also working to get our lab so that it can, in fact, identify this strain. At this point only one lab in California can. Within a month ours and several others will be able to as well.
CURWOOD: One of the issues that can happen if there’s widespread illness is that health care workers themselves get hit and it kind of knocks out the system that will be caring for people. What do you do about that factor?
FIELDING: You’re absolutely right, and there’s two aspects to that. One is making sure that they understand and remember and observe the protections that we need to do to try and reduce transmission from patients to healthcare workers, and from healthcare workers to other patients. But, in addition, we have to be concerned about the mental health aspects, about the psychological aspects.
Because that was one of the issues that Toronto had dealing with SARs. You have to make sure that people feel comfortable coming to work, and that they’re not going to be put at excessive risk, that their families are not going to be put at excessive risk. And we’ve, in fact, embarked on a training program for all our personnel talking about families first and how to make sure you’re protecting your family.
CURWOOD: Back in 1918, when the big flu epidemic killed so many people, medicine hadn’t gotten to the stage where it is today. What are some of the basic things that can be done to treat somebody who might come down with a very aggressive flu that we can do today that we couldn’t do back then? And that could be done on a widespread basis? Not necessarily in a very sophisticated setting, but in a, you know, very simple setting?
FIELDING: I’m not sure that we’ve progressed all that much. Most of the treatment for influenza is symptomatic treatment. For our usual garden variety of influenza it’s treating the symptoms. But we do have anti-viral medication, that is a big difference. And there are a number of anti-virals that work against type A flu. Of those, the one that appears to be effective at this point is Tamiflu against H5N1. Again, there’s been a limited experience base with that. But that’s the primary.
The second thing we have which we didn’t have then is preventing complications through giving pneumococcal vaccine. If you look at the garden variety flus, most of the people who die from that die from the complications of the flu, not from the flu itself. And the most common is pneumonia, and particularly in the elderly. And so pneumococcal vaccine, which is routinely recommended, reduces that risk very substantially.
So we’re much better – we have a lot of antibiotics to treat bacterial super infection, which is one of the most common complications. But to treat basic flu, it’s really the anti-virals that have been the major advance.
CURWOOD: Now, what kind of stockpiling of anti-virals do you have there in Los Angeles that you could use if this were to show up?
FIELDING: There’s a very limited number of antivirals. There’s a long waiting list to get it from the sole manufacturer. The federal government has a couple million doses. There’s another million and a half doses, as I understand it broadly, in the private pipeline. So, there’s no stockpile. We’re on the list with a lot of others to get a limited number, but it’s going to wind up a federal distribution. And our hope is that there will be a ramp-up in the manufacture in time should avian flu become a problem here. And again, I don’t think it’s inevitable, but we have to plan as if it will.
CURWOOD: Can you go anywhere in your public and private life without people asking you about this right now?
FIELDING: It seems to be top of mind for most people. But what I tell people is, this is a time of great urgency for public health because our job is to focus on the things that may not happen, but could and that could be very serious. It is not a time for people to panic. It’s hard not to be concerned about it, but it’s not a time for panic. And it’s a time, basically, to focus on what you need to do for your regular flu season – that’s here and now, and don’t forget about that.
CURWOOD: Dr. Jonathan Fielding is the director of public health for the county of Los Angeles. Thanks for talking with me.
FIELDING: My pleasure.
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