( ce Dr. Cetron said. The federal go...)U.S. Issues Guidelines in Case of Flu Pandemic,Health

ce, Dr. Cetron said.

The federal government has taken primary responsibility for developing and stockpiling vaccines and antiviral drugs, as well as masks and some other supplies.

Today’s guidelines are partly based on a recent study of how 44 cities fared in the 1918 epidemic conducted jointly by the C.D.C. and the University of Michigan’s medical school. Historians and epidemiologists pored over hospital records and newspaper clippings, trying to determine what factors partly spared some cities and doomed others.

While a few tiny towns escaped the epidemic entirely by cutting off all contact with outside, most cities took less drastic measures. These included isolating the sick and quarantining homes and rooming houses, closing schools, churches, bars and other gathering places, canceling parades, ball games, theaters and other public events, staggering factory hours, barring door-to-door sales, discouraging the use of public transport and encouraging the use of face masks.

The most effective measure seemed to be moving early and quickly. For example, said Dr. Howard Markel, a medical historian and one of the study’s leaders, Philadelphia, the worst-hit city, had nearly three times as many sick and dead per capita as St. Louis, which had was hit weeks later by the virus moving inland from the Eastern Seaboard and had time to react as soon as flu cases rose above averages.

“No matter how you set up the model,” Dr. Markel said, “the cities that acted earlier and with more layered protective measures fared better.”

Any pandemic is expected to move faster than a new vaccine can be produced; current experimental vaccines against H5N1 avian flu are in short supply and based on strains isolated in 2004 or 2005. Although the government is creating a $4 billion stockpile of the antiviral drug Tamiflu, it is only useful when taken within the first 48 hours, and Tamiflu-resistant flu strains have already been found
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