Panic, staffing issues, and geographic boundaries are some of the challenges that public health specialists need to address as they plan for a possible influenza pandemic, entreats a report from Purdue University, West Lafayette, Ind. "Most public health experts who are leading planning efforts

"This is problematic because if there is an outbreak, planners need to take into account the people and health-care systems that are or are not around them. Counties that border other states may experience nonresidents seeking treatment in their area, while other counties may be home to the only isolated hospital system in the region and can expect the population from other states to travel there for care. Health care, especially in a crisis, is not defined by county or state lines." For instance, instead of each county health department making plans for its individual county, plans should be developed, or at least coordinated, regionally, Avery suggests.

Influenza hospitalizes 200,000 Americans annually and kills 36,000. In 2005, global concern was raised about a possible influenza pandemic because the number of human deaths related to bird flu was increasing in some Asian countries. There are predictions that, if the virus were transmitted human to human, a global outbreak could result in millions of deaths. As a result, Federal, state, and local leaders continue to plan.

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"Another significant planning concern is related to staffing, especially at alternate care sites," divulges Mark Lawley, associate professor of biomedical engineering. "During a pandemic, we can expect that caregivers will become ill; some caregivers will be reluctant to work. and others will stay home to care for their own family members. Many planners are suggesting alternate care sites during an outbreak, but finding additional staff members for these units will be a big impediment. The public has expectations about the standard of health care. For example, doctors prescribe medications and nurses administer them. but what happens if one group is understaffed during a crisis? How are roles reassigned and how is that communicated to the patients?"

"In several countries, many planners are anticipating devastating impacts that even exceed the worst-case scenarios historically," Avery points out. "The confusion results in a sense of helplessness among some planning teams because they believe any planning will be rendered useless by the magnitude of the problem."