The message from the White House this week was crystal clear: Cities should prepare for a bird flu pandemic, but not expect much help from the federal government, which will likely be overwhelmed in the event it actually spreads between people.
Baltimore is the 18th biggest city in America, squeezed between Washington, D.C., and Philadelphia. For nearly a year, they've been planning for a bird flu pandemic. That's enough time, says Mayor Martin O'Malley, to realize there's no way Baltimore could go it alone without federal help.
"The reason we have a federal government is to provide for the common defense from things like pandemic flu or terrorist attack," says O'Malley.
An advanced bio-monitoring system is already in place, tracking the number of sick children out of school each day, and which viruses are coming through city ambulances and hospitals.
At the University of Maryland Medical Center, they've stocked up on bio-hazard suits for medical staff, and opened 10 brand new isolation rooms for contagious patients.
"You close this door, all of the airflow in this room would go out of the room and out the back of the building," demonstrates Dr. Tim Babineau, the hospital's chief medical officer.
The plan, he says, is to identify and triage flu patients in large tents outside.
"To try to deal with as many patients as we can outside the walls of the hospital, if possible, before they get in and infect other patients and before we even knew they had the flu," explains Babineau.
But in a city of 650,000 people, there are only 3,800 hospital beds.
When NBC News visited Baltimore on Wednesday, six hospitals were so busy they diverted patients away. Some are concerned a pandemic could push the entire system beyond its capabilities.
Health Commissioner Dr. Joshua Sharfstein says he'd likely urge people to stay home.
"You could have a cycle of panic that really strips away the ability of society to work and that happened the last time," says Sharfstein.
The "last time" was October 1918. The Great Influenza killed 3,000 people in Baltimore alone.
Medicine has come a long way since then and doctors are already telling hospital stafftheywould be protected. But the city also admits partof its plan would be to simply take it day-by-day.