andemic is a Latin word used to describe an infectious event occurring over a wide geographic area and affecting an exceptionally high proportion of the population. Most recently this word is being used to describe the likely event of a global H5N1 influenza outbreak within the next several years.

Influenza is a disease with which we are all familiar. We line up diligently for vaccination yearly and consider ourselves protected. The probable characteristics of an H5N1 pandemic preclude the likelihood of effective immunization practices protecting us, our families or our patients. It is currently unknown how many people have been exposed to but not contracted the disease. Death rates of as high as 50 percent have been reported in outbreaks since 1997.

H5N1 is an avian influenza virus now, as most influenza viruses are. Currently it is not capable of sustained human-to-human transmission. One concern is that this virus will mutate and develop the ability to pass from human to human resulting in a pandemic with a high death rate similar to that of the pandemic of 1918, known as the Spanish Flu, which has historical death rates listed from 5 percent to as high as 50 percent of infected individuals. Another concern is the probability that the deaths will be highest in the 20- to 50-year-old age range, resulting in a huge impact on the global economy.

H5N1, a .1-micron virus particle, is thought to be spread by droplet, aerosol and direct contact. This means that when we intubate infected patients, we are at high risk of becoming infected if we are not protected. We also are putting others at risk who may be in the room with us as we perform intubation.

How should we protect ourselves from the high death rate associated with infection by H5N1? There are those who suggest that N-95 face protection is sufficient. This was the recommendation to physicians during the SARS outbreak, and many health care workers were infected … and some died.

The common sense approach to preparedness for a pandemic would be:

1. Family preparedness first and foremost: Get a kit, make a plan and be informed. Please visit the Red Cross Web site at www.redcross.org/services/prepare/0,1082,0_ 239_,00.html.

2. All elective health care stops, including elective surgery in the event of a pandemic. Prepare for surge.

3. Personal protective equipment and powered air-purifying respirators should be utilized while performing high-risk procedures with infected patients, such as intubation and bronchoscopy; and a fitted N-95 respirator (a government efficiency rating that means the mask blocks about 95 percent of particles that are 0.3 microns in size or larger) should be worn by all hospital personnel caring for patients with known or suspected H5N1 influenza.

If you would like to learn more about this topic and all-hazards preparedness in general, please attend this year’s ASA Annual Meeting and the panel “Are We Ready: All-Hazards Preparedness and Response: Role for Anesthesiologists” at 9 a.m. on Saturday, October 13, in San Francisco. Check the ASA Annual Meeting program book for more details.

Jill A. Antoine, M.D., is Associate Clinical Professor of Anesthesiology, University of California at San Francisco, San Francisco, California.

Tai L. Antoine, M.P.H., is a J.D. candidate for 2009, Case Western Reserve University School of Law, Cleveland, Ohio.