Are you a sitting duck for bird flu? By Anita Manning, USA TODAY Thu Dec 8, 6:49 AM ET Will Stewart is bracing for a disaster: a flu pandemic that scientists and public health experts say in a worst-case scenario could cause worldwide calamity, kill millions of people and disrupt the global economy. An engineer who lives on a farm in Loudoun County, Va., outside Washington, D.C., with his wife and two children, Stewart is stockpiling food, water, medicine and even guns to defend his family in the event of civil unrest. Though his actions may seem over-the-top, he says, he is not overreacting, only preparing. "I've never felt panicked by this. I've just seen that this is likely to be so many months away, so let's take steps to prepare." Having read about the so-far unstoppable spread of bird flu in Southeast Asia and into Eastern Europe, the H5N1 virus that has infected 134 people, killing 69, he knows it is one mutation away from having the ability to spread easily from person to person. The threat of a flu pandemic has led governments and public health ministries around the world to make plans. "Pandemics happen," U.S. Health and Human Services Secretary Mike Leavitt says. There have been 10 in the past 300 years, he says, and "we're overdue and underprepared" for the next one. His agency has advised Americans to plan "as you would for other public health emergencies." Stewart, who does risk assessments for engineering projects, is one of a focused minority of Americans who are going a bit further. While odds that a flu pandemic will occur in the near future are unknown, and in fact may be quite low, if it happens, the consequences are so serious that action is warranted, he says. A cadre of prepared Americans believe it's important to be ready for a flu pandemic at least as deadly as the 1918 pandemic that killed roughly 50 million people worldwide, including 500,000 in the USA. These people are talking to neighbors and relatives, making contingency plans and discussing their concerns online at websites such as fluwikie.com. The site, launched six months ago, is visited by 3,000 to 4,000 people a day, says publisher Melanie Mattson of Falls Church, Va. Judging from traffic to the site, Mattson estimates that thousands of people in the USA and Canada are taking steps to prepare for a pandemic. This level of concern poses problems of its own, says Marc Siegel, an internist, associate professor at New York University and author of False Alarm: The Truth About the Epidemic of Fear (Wiley, $24.95). "We're going to have a lot of problems if we keep alarming ourselves about things that aren't going to happen," he says. If the H5N1 virus starts to spread among humans, it could become less virulent, or it could fizzle out, he says. Siegel doesn't discount the possibility of a future pandemic, only its likely imminence. "There are a lot of disagreements among public health experts, but one thing everybody agrees on is there is no sense that this is about to happen." Stockpiling medicine Vaccines are being developed, but they may take years to produce. Many countries are stockpiling antiviral drugs Relenza and Tamiflu, which are thought to be effective in preventing or lessening the impact of the avian flu, and thousands of people have secured prescriptions, just in case. U.S. health officials and infectious-disease specialists have discouraged individual stockpiling, citing shortages and the risk of widespread misuse leading to drug-resistant viruses, but some doctors disagree with that advice. Washington, D.C., internist Bruce Rashbaum says he has had "many, many patients ask for Tamiflu," and he has written more than 50 prescriptions for it. "It is useful for seasonal flu and has a five-year shelf life," he says. Several patients have asked for multiple courses of treatment. "People are starting to panic," Rashbaum says. "These are smart, intelligent people." No 'cavalry' to the rescue Rashbaum says he won't write a prescription for multiple courses of treatment, but he doesn't see harm in allowing patients to keep one five-day treatment course (10 tablets) on hand. "There's so much anxiety out there, and the medicine is really very benign," Rashbaum says. Internist Grattan Woodson of Decatur, Ga., says that when he first started to read about the possibility of a pandemic, "it was hard as heck for me to believe we could be at risk for something like this." "I couldn't come to terms with the fact that our modern hospitals and medical systems couldn't save us. Then I realized we are more vulnerable today than in 1918 because we live in cities, we're so utterly dependent on food being brought in from outside and on the electrical grid, and also we're much older. There are a lot of people alive today who are really frail, who are highly susceptible to flu." In a disaster such as an earthquake or hurricane, help can come from outside the region, but "when we have a pandemic, there is no outside," Woodson says. "There won't be a cavalry coming over the hill to rescue us. We'll all be on our own, each town, each village, each neighborhood, and the neighbors are going to need to pull together to take care of each other." Woodson, author of The Bird Flu Preparedness Planner (Health Communications, $4.99), has his own plan in place. (Related: A look at two approaches) He will keep his office open as long as possible, then, if necessary, he will move out to a farm in the country and continue to practice medicine. He has supplies, solar collectors, a well, and yes, he has bought a handgun and a shotgun. "I'm concerned about the medical consequences of pandemic influenza," he says. "I think there could be quite a bit of illness and death." That could "spill into civil effects, resulting in a period of anarchy and civil disorder, and that could result in more deaths. That's the reason to have a gun," he says. "I live very close to the city, and I think there's a possibility the police would not be able to function well here." Woodson hopes his preparations will not be needed, but "I think we're getting ready to have a serious pandemic of influenza, and I think it's going to happen soon." Stewart's plan of action For several weeks, Stewart has been assembling a supply of water and food, enough to last three to six months. He is buying equipment, such as rain barrels to capture fresh water and Mylar bags to store bushels of barley and soybeans. His home is solar-powered, and he has a well. He keeps a few sheep that could provide food if necessary, and he is prepared to provide a safe refuge for his immediate family, his siblings and their families. He says he has a "varmint gun" at the farm and plans to buy one or two more weapons because, like Woodson, he believes that if employees are too sick to go to work, grocery shelves will empty quickly, and there could be panic. "I believe there's going to be different classes of marauding people," he says. "There will be gangs just looting, five or eight people in a gang. Depending on how long this lasts, there could be marauders who are former military. So there will be four male adults in this house who know how to use firearms." Peter Sandman, a risk analyst and consultant to international businesses and governments, including the HHS, says that in any situation of perceived threat, there are those, such as Stewart, who go to extremes. "They periodically turn out to be right, but it's a bell curve, with one edge doing absolutely nothing and saying, ' Bird flu? What's bird flu?' " Sandman says. "That's a rather bigger edge" than the other extreme. The goal of risk communication is to move people from the idea that "this is something for the government to worry about" to the attitude that "this may be serious. Let me consider what I can do and do what is practical for me, and then I'll get back to my normal life and stay vigilant, and if it comes, I'll be better prepared." Sandman says of greater concern than the too-ready are those who do nothing: "the huge numbers of people who don't have three days' food in their house, and more to the point, who have not yet thought if there is a pandemic" what they'll need to do. "That kind of thinking isn't nutty. It may turn out to be necessary, and if not, it doesn't disrupt your life. We want as many people as possible thinking about what a pandemic is like and what a severe pandemic is like." The last ones, in 1957 and 1968, were mild. "It was a big deal for hospitals," Sandman says. "There were not enough ventilators. Some schools closed down for a couple of weeks. The only thing you have to do to get ready for (a pandemic similar to the one in) 1957, if that's what's coming, is hope the feds know what they're doing. But if it's 1918, then it's not all medical," Sandman says. "You don't have to go to the extreme of being a survivalist and moving to Montana. There's a middle ground." He suggests buying such items as face masks. "You won't be able to get masks after the pandemic starts, but they're available now, and it wouldn't hurt to get a box of 50 or 100," Sandman says. Think about what to do if doctors' offices are shuttered and hospitals overwhelmed. "If you have to treat a child at home, think, what do I need. It's not stupid to be thinking about it," he says. "A big hunk of preparedness is emotional. When athletes prepare for the big game, they don't just swing bats. They imagine the game. If you want to be able to cope with moments of crisis, it helps to have thought about it."