By Angel Perkins News-Mirror Editor
Are you prepared for a pandemic, a large epidemic of a major virus such as the H5N1 (avian influenza) or bird flu? Whether you are or not, chances are your town isn’t.
In fact, the State of Indiana may be looking at a proposed plan created by Bourbon EMS Advisory Board member and Deaton-Clemens Funeral Home Director Terry Clemens because they have yet to come up with their own. “The Centers for Disease Control has recognized that we will probably have a pandemic,” he said before the Bourbon Town Council. “We already have human-to-human transmission.”
The avian (bird) flu known as H5N1 is a type of flu which currently threatens bird populations because it can kill thousands at a time and has infected a small number of humans. This virus appeared first in Hong Kong and has steadily been migrating toward other countries being found in Turkey, Romania, most of Asia and Indonesia.

Though yet to be found in humans in the United States, a poultry farm in West Virginia was found to have a weaker strain of the virus, the subtype H5N2 in April of this year. The Center for Disease Control said that there are four subtypes of the avian flu for humans and that two of those caused outbreaks in pigs.
Two additional subtypes were found exclusively in horses and dogs. The virus is contracted primarily from direct contact with infected birds (through their saliva, nasal secretions or feces) or by coming in contact with their contaminated environment (water, feed, cages, or living area surfaces) or through an intermediate host such as  a pig.
Clemens explained that he had been working with others within the Marshall County Funeral Directors Association and discussed potential procedures that could be put in place as special care must be taken to prevent further transmission. “As a mass casualty situation, it’s easier to look at it like the Palm Sunday tornado or another natural catastrophe,” he said. “Based on the population, we’re looking at 300-400 casualties in the Bourbon area. The state has left it up to each individual town what they want to do.”
Should a pandemic happen, the funeral director and town officials would likely be deputized as medical examiners and coroners as there would be no transporting of bodies out of town and quarantines would be strictly enforced. Also, officials in other towns would be taking care of their own areas such as public hospitals, buildings, meetings, even grocery stores and schools, places of employment and anywhere that the public can mingle, will be immediately closed down.
Clemens noted that many deaths would be related to the outbreak, not necessarily those infected with the virus. “People wouldn’t be able to fill their medications or get deliveries of medical supplies like oxygen,” he said.
Clemens asked the council to consider his written proposal as a guideline and suggested they create a plan. “This is just food for thought — there is no funding for this,” he said.
He went on to describe a disturbing, yet very real vision that could come as a result of one person, unknowingly infected, flying in to another country and which resulted in bar-coded body bags being deposited to nearby drop off points and mass burial graves.
“No plan will be perfect,” Clemens said. “Should this happen, I may not be here to help with the proper disposal of the bodies and you may have to use town employees and equipment to move the deceased and to make the graves. It isn’t pleasant, and not very respectful, but if you had lived (during a similar viral pandemic) in 1918, that’s the way it was.”
An article posted as reference on FOXNEWS.com says that a computer model revealed (April 2006) that the avian flu could spread very quickly. Researchers started a simulation with 10 highly infectious influenza cases and the results showed the virus peaking in 90 days, infecting 100 out of every 1,000 residents in just about every corner of the country.
The computer simulation also showed that approximately 33 percent of those infected wouldn’t develop symptoms and could unknowingly transmit the disease. Therefore studies and simulations suggest that quarantines and travel restrictions may not necessarily foil the spread of human-to-human transmission. But such measures could buy time for vaccine production for the specific flu strain by delaying the spread, but could not entirely stop it, by any means.
Nonetheless, certain precautions must be taken. Clemens said that based on contagiousness of the avian influenza, casualties would have to be in a contained environment as a holding facility that would require constant security, and suggested the Bourbon Community Park building as such a center. “The schools are considered Red Cross facilities in emergencies,” explained Bourbon Clerk-Treasurer Kim Berger.
Clemens said that his reasoning included two factors. “The park building has limited access (as there is only one street that enters and exits the area),” he said. “And, we’re not sure if the holding facility (used to input information about those deceased before burial) would have to be destroyed afterward (to prevent further contamination). They don’t really know the incubation period.”
Clemens’ proposed preparedness plan could also be instituted for other major medical emergencies or mass casualty situations such as a tornado or other catastrophe. “You can plan for this thing but we don’t know who we’re going to have (to help with the bodies) or how many (bodies) we’ll have,” said town council president Bill Keyser. “It’s not just bird flu; I can think back to when we had roads blocked and we were looking for bodies.”
According to Graeme Laver, a flu expert at the Australian National University, quarantine won’t work because people without symptoms can spread influenza. The CDC agrees, saying that the virus cannot only mutate but could become resistant to approved medicines.
Even with vaccinations and drugs like Tamiflu, which may reduce symptoms and infectivity, the drugs must be taken within 48 hours after symptoms appear, if not sooner. And, due to the several strains and constantly mutating virus’ it would probably still take several months to produce and distribute enough of a vaccine when it is needed — if the specific vaccine would be found.     
The World Health Organization (WHO), in charge of designating the six phases of defining pandemic alerts and the making of decisions when to move from one phase to another, agrees with the experts who say that another influenza pandemic is inevitable. As of July 17, 2007, the world is reportedly (says WHO) in phase three, meaning a new influenza virus subtype is causing disease in humans, but that it is not yet spreading efficiently and sustainably among them unless they are in close proximity.  
And while it is impossible to accurately predict when or where the next influenza pandemic will take place or how severe it will be, should it do so, everyone would be at risk.
The WHO organization estimates that in a typical year, strains of flu infect 10 to 20 percent of the world’s total population. But with the current strains of the avian influenza, more than half the people who caught it perished as a result.
Since 2003, there have been 318 confirmed human cases and 192 of them resulted in death. A global outbreak would have the potential to replicate the run of the 1918 pandemic dubbed the “Spanish flu” which killed some 40 to 50 million people.
Even with consideration to this grim statistic, given the extremely large population of humans who live in regions with the virus, the number of infected human cases is still very low.
Bourbon officials chose to go over the material and fact sheets provided by Clemens and to make a decision as to some sort of plan to go into town policy prior to the next meeting.

Information gathered to create this story can be found at www.info.gov, www.who.int, www.cdc.gov, www.avianflu.gov and statistics found from the Universities of Indiana and Iowa and the Department of Health and Human Services.