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WASHINGTON - A superflu could kill as many as 1.9-million Americans, according to a draft of the government's plan to fight a worldwide epidemic.
Officials are rewriting that plan to designate not just who cares for the sick but who will keep the country running amid the chaos, said an influenza specialist who is advising the government on those decisions.
"How do you provide food, water . . . basic security for the population?" said Michael Osterholm of the University of Minnesota, a government adviser who has a copy of the draft plan and discussed it with the Associated Press.
"This is a much more comprehensive view than has previously been detailed," he said Saturday.
The Bush administration has spent the past year updating its plan for how to fight the next flu pandemic. While it is impossible to say when one will strike, the fear is that the bird flu in Asia could trigger one if it mutates to start spreading easily among people.
A recent draft of the plan, first reported by the New York Times, models what might happen based on the last century's three pandemics.
In a best-case scenario, about 200,000 people might die.
But if the next pandemic resembles the 1918 Spanish flu, as many as 1.9-million could die, Osterholm said. Millions more would be ill, overwhelming hospitals.
"You plan for the worst-case scenario," he said. "If it's less than that, thank God."
The government has on hand enough of the antiflu drug Tamiflu to treat 4.3-million people. Manufacturing of $100-million worth of a bird flu vaccine just began.
The draft makes clear that tens of millions more doses of each would be needed. That is far more than the world has the capacity to manufacture quickly.
Federal health officials have been role-playing what would happen if a superflu struck now - not next year, after more medicines and vaccines have been stockpiled. The strategy, Osterholm said, is, "Don't emphasize what you can buy, emphasize what you can get your hands on. If it happens tonight, how do you deal with order?"
Health and Human Services Secretary Mike Leavitt recently met with Cabinet secretaries to get other federal agencies to determine their role in stemming rioting at clinics; when to close schools; how to keep gasoline, electricity, food and water supplies running; and how to manage the economic fallout.