DR. DOUGLAS CAUSEY: Thank you, Rick. Because of the time I don't think I will give the presentation I had planned. But I'm here in town so look me up if you're interested.

What I was going to talk about, and I will use this as a means to introduce the next section. We have ongoing research here at the University of Alaska, UAA and UAF. We are undertaking many aspects of research that has not currently been ongoing outside of the state of Alaska. Because, as you heard, we are a major highway for migratory birds. A lot of the work that is focused on migratory birds is being done here by the university.

And for -- I'd also like to make a comment as well, that -- and which was raised, that whenever we are dealing with infectious diseases like this, where there's a possibility of a pandemic and one thinks of the swine flu a few years ago, we can't predict. We can prepare and we can monitor. There is a lot of energy being put forth on H5N1 and if it goes away we'll all be happy. Believe me, we'll all be happy.

But one of the most critical things about influenza, and this is what I've been saying for 25 years, and others longer that I have, is that Jay gave an analogy of a card deck being shuffled. The card deck is being shuffled every year. We're dealing with H5N1 now. We don't know what we're going to deal with next. And so the preparations that we're taking now are preparations we should have taken 25 years ago. So this is not wasted effort. Preparations for public health is in everyone's interest. So having said that we now have some questions before me and if others of you have questions Tana can pick them up.

The first one, you know, could we discuss the coordination and relationship of the group represented and the head table from the CDC at the airport? And I don't know whether Jay or Richard can answer that. Jay?

MR. BUTLER: Yes. The CDC support team program has recently undergone a much needed expansion from eight ports of entry primarily in international airports up to now I think about 16 is the current count. One of those ports includes Anchorage. So we actually have a CDC quarantine station within the office of Ted Stevens International Airport.

Right now the staff is a staff of one but it's a step in the right direction. And Shahrokh Roohi is director of that office and has been I think very integral and doing a very good job in coordinating with the agencies that are already here to provide the -- we use the term quarantine since the name of it is bureaucratic organization, services that will be necessary in the event of a pandemic or other infectious disease threats.

During SARS the Seattle quarantine station basically deputized the staff of the CDC office here in Anchorage to be the investigations program, not part of the division of quarantine to provide those services. So we actually -- in some ways we're better staffed than the majority of other international airports to be able to have people available to meet incoming flights from SARS effected areas. And memoranda of agreement are still in draft form as that will be a new source that will also be available in the future.

I see Dr. Chandler back there. I'm sure he remembers well on the fly how coordinated these activities during 2003 with SARS and we anticipate that level of coordination will increase now that we have somebody full time committed to the issue of public patrol, public health -- of communicable disease spread through the ports of entry based in Anchorage.

DR. CAUSEY: Thank you, Jay. All right. The next question is for those of us who deal with various public transportation forms, how would we deal with pandemic conditions for the public as well as work (indiscernible). Richard?

DR. RICHARD MANDSAGER: That question summarizes the conundrum of the planning right now. Because I believe that we're going to have to do some kind of protection of the people at work in public transportation systems. My prayer, frankly, is that we don't have a pandemic for a couple three years and that the antiviral medication industry is allowed time to ramp up again with bigger stockpiles. If this were to happen next month we're in trouble. Because there aren't enough antiviral medicines to protect the people that work in the transportation industry, families will be concerned and they'll see that their family members that as pilots or work as inner craft airline attendants, I don't want you there. And airplane is just a viral incubation factory. And if you're not in there (indiscernible). I'm not an airline spokesman.

DR. CAUSEY: I think you better leave it at that, Richard.

DR. MANDSAGER: So we're in trouble and we're going to have to all work together if it were to happen this spring. I hope we have time.

DR. CAUSEY: Thank you. The next question, I'm going to reinterpret this so it's a little bit different. The question is about Tamiflu, and asks how can Tamiflu be used to provide -- how can Tamiflu be thought to be a viable remedy for the flu virus. And I think the issue here is perhaps the difference between Tamiflu and antiviral in the vaccine. Richard?

DR. MANDSAGER: Yeah. That's a very good question. I think there's probably -- there may be a number of questions in there when you try to unpackage it a little bit. Some of the limitations of the antivirals are that for treatment of some infectious influenza they have to be started in the first 48 hours after onset of the illness based on what we know the treatment of the current human influenza strains. What we don't know is exactly how Tamiflu or other antivirals will work with on H5N1. We have -- the good news is we only have 147 cases. That's not enough to do -- to monitor a trial that would give us the answers to that question. Plus we have laboratory evidence that these drugs should be beneficial for H5N1 protection in the majority of cases, so it wouldn't really be ethical to do this kind of studies either.

One of the challenges with antiviral drugs is resistance. There have been strains of H5N1 that are resistant to Tamiflu and (indiscernible) Ace inhibitors that are fairly expensive class -- a new class of anti influenza drug. The majority have been resistant to a (indiscernible) than the older cheaper drugs. If there's any good news about what's going on in Turkey, the isolettes tested so far seem to have reacquired some ability to (indiscernible). That's good news in terms of there being a cheaper agent available.

I spoke almost entirely about treatment of the influenza. Antiviral drugs for prophylaxis I think is a much more greater issue. During a pandemic how long are we going to go with antiviral drugs? We use antiviral drugs prophylactically in certain institutional outbreaks such as if we have a nursing home where the majority of the residents are not vaccinated, we will oftentimes put them on an antiviral drug to protect them while they're immunized until they have time to produce their own antibodies. In the situation of a pandemic, particularly with a completely novel strain, it may be six to nine months before we have vaccine. That's a whole lot of antiviral drug to be taking. There are certainly limitations on the wisdom of being on an antiviral drug for months on end. That's part of the difficult decisions I think we are going to make is how much of the drug should be used early in the treatment of people who are infected, how much should be designated for prophylaxis. I think we will probably want to restrict the use of prophylaxis to very limited situations. An example that might come to mind would be the communities that has only one health care provider. Clearly health care providers that we want to be providing care to people who are sick with influenza, if that one person is ill there is no doctor or nurse in town, those may be the situations for prophylaxis.

Can I add something? The governor and legislature is considering right now that the states beginning to -- is proposing to begin a stockpile of antiviral medicines. As I said earlier, there's this plan to have a federal/state partnership. So the budget that you will be considering in the legislature this session begins that process of our beginning to stockpile antiviral medication. And it's probably wise -- I pray we have it on time. Now buying is one thing. The national budget of congress just approved has money how for the (indiscernible). I'm hopeful that our legislature will agree that we should partner in buying too. But then we're going to get in a queue with this limited production capacity of companies all over the world. So when we will have drugs in state available is an unknown and unanswerable question.

DR. CAUSEY: Thank you. Here's a question for Rick. How long do you see the ongoing monitoring effort to continue? Is this a one year program?

MR. RICK KEARNEY: The funds to support the wildlife Avian influenza surveillance effort have been added to the budget for the Department of Interior and therefore it will continue until it is needed elsewhere. That's something that I didn't point out very well, and I apologize for that, is I see Alaska being at the crossroads of migratory flyways.

As you probably know, there are many species of water fowl and shore birds that nest here and spend the winter in other places. Places like Asia. Places like Siberia, over the South Pacific. These are the species that we're going to be checking very, very closely in the spring of the year as they return from the areas where there have been outbreaks of H5N1 among poultry. At the same time there are other kinds of water fowl and shore birds that nest in Alaska that spend their winter down in the Lower 48. And so Alaska could be that place where the virus arrives in North America and is transferred from one kind of water fowl to another and is delivered into the Lower 48.

At this point in time we recognize the very key position Alaska holds at the crossroads of these migratory flyways and that's why our emphasis is here. Should Avian influenza arrive in an infected chicken product at some port in the Lower 48, of course there's going to be a shifting of focus to a place that has some known H5N1 event going on. And so I can't promise that there'll be the same intensity of surveillance going on from this year onward, but I can tell you that until it shows up some place else this is the point -- the place where the most intensive effort is going to take place.

DR. CAUSEY: Thank you. Unfortunately we have only time for one more question. But I will tell you that those of you who have questions that aren't on the table, or other that you have, you can e-mail me and I'll get an answer to you. My e-mail is dcausey, d-c-a-u-s-e-y, at uaa.Alaska.edu. And I'm sure the others will be available as well. So -- and if you want, I have cards I can give to you.

So the last question we have time for, what top three pieces of advice would you give to a business owner planning for impacts of a pandemic?

DR. MANDSAGER: The top three. I think number one is are you prepared and what have you done with your employees to plan for working remote. Number two is what are you essential services and how are you going to staff essential services if you got 30 to 40 percent people sick for eight to 12 weeks. And number three is can you rapidly change the culture of your organization as sick people stay home rather than come to work. What do you say Jay?

DR. JAY BUTLER: I've learned early in my career not to disagree with my boss but – so that was excellent. The only thing I would add to that when you consider employees, consider families. I heard a very interesting presentation last week (indiscernible – away from microphone) who oversees terrorism preparedness planning for Israel. One of the things he realized is that a lesson learned from the scud missile attacks in 1991 is that they need to plan on maybe 50 percent of their first responders not reporting until they know their families are safe. I think several others we have to realize, every employer, at least the vast majority, has other people behind them that they're going to be worried until their situation is cared for.

MS. ALICE GALVIN: Thank you all very much. Would you join me in just thanking the speakers. I think we all learned a lot. And very greatly informative. Thank you.

I just have a couple closing announcements before we go. One is if you're a guest today, I want to thank you for being here and to encourage you to become a member of Commonwealth North. And there's lots of information out on the table for you. We are a membership organization and depend on you to create informative events like this. And for everybody else, if you feel like it we would love to heard what you think. There's a comment card on your table. We really do read them and pay attention. And it helps us stay relevant to you. Really, part of what I miss is all that.

The flyer on the table tells you that a lot of events are coming up, they all look pretty good. And encourage you to participate and look forward to seeing you there. With that we have gifts for our presenters which I'll hand out in just a minute, but I know that everybody's anxious to move on. So I will just say thank you again for coming. It was great to see you and we stand adjourned.

(END OF PROCEEDINGS)