The potential consequences of a bird flu pandemic are almost beyond comprehension. Emergency rooms would be overwhelmed by the sick and dying.
"A pandemic would be happening all across the country, for that matter all across the world, simultaneously," says U.S. Secretary of Health and Human Services Mike Leavitt. "It could be happening in a thousand different communities, and it could happen over the course of a year."
But Leavitt must envision this worst scenario as the administration plans its response. The effort, he admits, has a long way to go.
"We are not nearly as prepared as we would like to be," he says.
A draft of the government’s response plan has been circulating for more than a year. Critics say it is overdue.
"We should have had a plan 10 years ago," says Dr. Shelly Hearne, the executive director of Trust for America's Health. "We should have been operational last year. What more do we need to wake up to?"
Sources say one reason for the delay is bureaucratic turf battles. For example, who decides where medical supplies go? Would the decision be made at Health and Human Services or at the Department of Homeland Security or by state and local governments? The idea is to have those lines of authority worked out in advance.
Such planning was lacking in the response to Hurricane Katrina, but Leavitt says that is not a factor in his actions.
"We were working on pandemic planning long before Katrina," says Leavitt.
The Bush administration, says Leavitt, did not do more about bird flu before now because most Americans were not worried about it.
"The public," says Leavitt, "has not until recently found this to be a compelling issue."
But now, he says, the administration is paying a lot of attention — with a detailed plan to be released soon.