Influenza planning remains a mess.

• Position: Pandemics

Panic, staffing issues, and geographic boundaries are some of the challenges that public health specialists need to address as they plan for a possible influenza pandemic, entreats a report from Purdue University, West Lafayette, Ind. "Most public health experts who are leading planning efforts for an influenza outbreak are focusing on specific geographic areas. usually counties, as defined by political lines," laments George Avery, assistant professor of health and kinesiology and member of the Alternative Care Site Planning Team.

"This is problematic because if there is an outbreak, planners need to take into account the people and health-care systems that are or are not around them. Counties that border other states may experience nonresidents seeking treatment in their area, while other counties may be home to the only isolated hospital system in the region and can expect the population from other states to travel there for care. Health care, especially in a crisis, is not defined by county or state lines." For instance, instead of each county health department making plans for its individual county, plans should be developed, or at least coordinated, regionally, Avery suggests.

Influenza hospitalizes 200,000 Americans annually and kills 36,000. In 2005, global concern was raised about a possible influenza pandemic because the number of human deaths related to bird flu was increasing in some Asian countries. There are predictions that, if the virus were transmitted human...