For most people, August is a month for swimming pools and summer vacations, with the aching misery of fall and winter flu outbreaks still safely distant.
This year, however, public health experts say the H1N1 flu that emerged in April is poised to return with a vengeance much earlier than the regular seasonal flu -- possibly as soon as the end of this month, when many schools reopen.
Drug makers are scheduled to begin testing this week of two potential vaccines to help prevent H1N1, or swine flu. Immunizations against the disease, however, aren't expected to be available until mid-October.
Even then, the government plans to first distribute the H1N1 shots to 159 million people -- about half the U.S. population -- in certain high-risk groups, such as pregnant women, children, adults with chronic diseases, health care workers and emergency medical workers.
People in those groups also will receive priority in getting doses of antiviral medication such as Tamiflu. Government officials say they don't expect shortages of H1N1 vaccines, although they caution that availability and demand may be unpredictable
If supplies are limited at first, the remainder of the population-- most of the healthy adults who help provide the nation's services and keep its economy running -- will have to wait to receive vaccine and anti-flu medications, according to the Centers for Disease Control and Prevention.
In the meantime, public health experts say, individuals and families might be asked to stay home from work, school, church, public events, public transportation and other crowded places for as long as four months -- the worst-case scenario -- to help prevent the spread of disease.
While inconvenient, such "social distancing" measures can help contain an epidemic, saving lives and ultimately saving companies money by keeping workers healthy and productive, said Dr. Bruce Lee, an infectious diseases expert at the University of Pittsburgh.
"Pay very close attention to what the CDC and what other public health officials are saying -- and that's actually a big problem because I think a lot of people don't pay much attention -- and take it seriously," said Dr. Lee, an assistant professor of medicine, epidemiology and biomedical informatics. "If they say to implement social distancing, do it."
Recent surveys have shown most Americans aren't worried about the resurgence of swine flu. Nor do they believe they will get sick.
But government agencies at every level have been working with urgency for months to prepare for a major epidemic they believe has the potential to overwhelm hospitals, doctors and 911 centers, and disrupt services and supplies such as water and sewer service, trash pickup, utilities, food and medicines.
In some federal government estimates, as much as 40 percent of the population could contract swine flu over the next two years. Every year in the United States, between 5 percent and 20 percent of the population gets the seasonal flu. More than 200,000 people are hospitalized from flu complications and about 36,000 people die from flu-related causes.
When swine flu emerged last spring, Pennsylvania health officials already had been working to improve the state's ability to respond to a flu pandemic. The federal government, which initially was concerned about avian flu, required in 2008 that each state submit an influenza pandemic preparedness plan to the U.S. Department of Health and Human Services.
Like many states, Pennsylvania's plan was found lacking in several areas -- including the state's ability to continue operating during a pandemic, to help provide health care, to manage mass fatalities, to lessen the impact of a pandemic on all workers in the state and to ensure emergency medical services and 911 centers aren't overwhelmed by calls for assistance.
Then swine flu quickly spread from Mexico to the United States and much of the rest of the world, and pandemic planning took on new urgency. The state began filling the gaps in its plan, according to Shannon Fitzgerald, director of public health preparedness with the Pennsylvania Department of Health.
State officials, she said, have decided what operations would and would not be essential during an emergency. They have planned how they would continue those essential operations with far fewer people and trained workers in multiple jobs to make them more versatile.
The state also has purchased what amounts to field hospitals --19 mobile "medical surge" trailers with 50 cots each and eight portable hospitals with 50 beds each, along with mobile equipment and extra medical supplies. The state also has purchased hundreds of extra ventilators to send to hospitals if necessary.
"Obviously we want to make sure the most acute patients are taken care of in the hospital, but in some cases there are patients with less acute needs that could be transported out of hospitals and be taken care of at one of these alternate care sites," Ms. Fitzgerald said.
The state also has stockpiled about 1.8 million courses of antiviral medication, or enough to treat a little less than 15 percent of Pennsylvania's population of 12 million. The federal government has set aside enough antivirals to treat another 10 percent of the state's population.
The state and federal stockpiles, however, ultimately might not stretch that far. Also, certain groups such as pregnant women, young children and health care workers would receive the stockpiled medication first.
"You could potentially need to take more than one course of the antiviral if you're re-exposed to the disease, so it's not necessarily one for one," Ms. Fitzgerald said. "We don't necessarily have enough antiviral."
State officials also are trying to inform the public about how to avoid getting sick and spreading illness.
Wash hands frequently or sanitize, they say. Cover the nose and mouth with a tissue when sneezing or coughing. Stay home when sick for at least seven days or until symptom-free for 24 hours.
In the meantime, Ms. Fitzgerald, families and individuals should store enough food, water and medical supplies to stay home for at least seven days -- and possibly much longer, if the pandemic gets serious enough to close schools and keep workers home. That could mean big disruptions for workers' paychecks and businesses' operations.
"Especially for families with children, they need to be prepared for possible school or daycare closures, and talk to employers about the potential for missed work and what the implications of that are," she said. "The primary focus is taking care of the health of the citizens but you have to recognize there are social and economic impacts."
To encourage local firms to develop their own pandemic preparedness plans, state health officials held a workshop for business and industry at Westmoreland County Community College on July 21. More than 100 representatives of businesses and agencies attended, ranging from executives from Giant Eagle and UPMC to smaller manufacturing and technology companies.
One of the state's main messages was that companies need to consider how they would continue operating with a much-reduced staff, and how and when they would allow employees to work from home, said Kelly Barcic, a founding member of the Pittsburgh Regional Business Coalition for Homeland Security. The group helps businesses in southwestern Pennsylvania plan for disruptions ranging from pandemics to transit strikes to the G-20 summit.
"What's your trigger point? Is it when the first 10 people get sick?" said Ms. Barcic, whose group allows businesses and members of the public to sign up for free emergency alerts including storm, traffic, hazard and flu warnings under its "beacon" system, at www.prbchs.org.
"A lot of people might have limited sick days -- how do you handle that situation?" she said. "You recognize they're sick but that they don't want an unpaid day, and at the same time you don't want to put your other employees at risk."
Most companies at the workshop already had begun work on pandemic response planning, although the levels of preparation varied widely, according to Melanie Lucht, who attended the session for Philips Respironics, a respirator and ventilator manufacturing company with offices in Murrysville.
Her company created a pandemic preparedness team when avian flu became a concern several years ago, Ms. Lucht said. Since then, the team has created contingency plans and trained employees in multiple duties to help cope if many workers are sickened during a pandemic, she said.
While workshop participants had begun planning for a public health emergency, Ms. Lucht said, most also seemed to want and need more information about how to handle a flu pandemic.
"What do you do? What can you do? What are the options?" she said. "Those were the questions that were continually being asked."
Amy McConnell Schaarsmith can be reached at 412-263-1122 or firstname.lastname@example.org .