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The worst-case scenario suggests as many as 2 million Americans could die.

Whether it's the so-called bird flu or a virus not yet on the radar screen, Mr. Leavitt urged more than 500 health officials, doctors, nurses, law enforcement officers, and others attending Ohio's first flu pandemic summit to start the "buzz" now to prepare for what will surely come.
"Pandemics happen," he said. "They've been happening for centuries. There's no reason to believe the 21st century will be markedly different."

There were three global pandemics in the 20th century, the worst in 1918, killing an estimated 500,000 Americans. The last, in 1968, was tame by 1918 standards.

"If we were to have a pandemic of equal proportion to the one that happened in this country in 1918, we would see 90 million Americans contract the disease," said Mr. Leavitt, a former Utah governor.

"We would see half of them, over 45 million people, who would become sick enough that they would require serious medical attention," he said. "Regrettably, if we have a pandemic of similar proportion as in 1918, nearly 2 million of our citizens will die."

Mr. Leavitt came with the promise of $3.2 million in federal aid for Ohio to help state and local planning efforts, part of $100 million that has been appropriated nationwide by Congress from $350 million President Bush has requested.

Similar summits are happening in states across the nation.

Lucas County Deputy Health Commissioner Larry Vasko, who attended the summit, said he has never seen as much government money reaching local efforts for planning.
But he said he understands Mr. Leavitt's point about local communities being largely on their own in a worst-case scenario in which the number of deaths could be "staggering."

"If everybody is struggling with the same crisis, natural or man-made, they're aren't enough people to go around," he said. "That's a major concern, but you've got no other choice. When you look at some of what we've done over the last four or five years, whether its with hurricanes, anthrax, or smallpox, it shows that it's important to have a good public health infrastructure."

Some of those in attendance, however, questioned government's commitment.

"We're talking about having more surveillance, but at the same time they're not giving the local school boards and districts the support they need to be able to keep their school nurse staffing levels," said Deborah Strouse, central Ohio representative for the Ohio Association of School Nurses.

"You can expect the highest incidents to be in school-age children, and that will probably be at a rate of about 40 percent, and we're usually going to see them before they're sick enough to go to the hospital," she said.

The Ohio Department of Health adopted a Pandemic Flu Preparedness Study two years ago and has since updated it. The 59-page document provides instructions on such things as communications during a crisis and how to prioritize who gets a newly created vaccine while it remains in short supply.

Families are encouraged to keep a stock of food, water, and other supplies in case they have to quarantine themselves for perhaps weeks at a time.
Marjorie Broadhead, Seneca County's health commissioner, said Ohio is probably better prepared than most states.

But even as it prepares for a pandemic threat for which there may be no vaccine, she said the federal government could do a better job encouraging for the elderly to take pneumococcal vaccine now to reduce the chances of a fatal secondary infection attacking weakened flu victims.

"This is something that we can physically do for preparation, because so many times people die of the secondary infection, which is pneumonia from flu," she said. "If we can immunize people against pneumonia, doesn't it make sense to do that? We have that vaccine now."