Infectious-disease experts at the Health Department have been meeting every two weeks to prepare a strategy for protecting the city against diseases such as the Asian bird flu, or H5N1, which many scientists believe is just one crucial mutation away from turning into a monster malady.

The written blueprint, which officials expect to complete before the next flu season starts in late fall, spells out how the agency will tackle potentially controversial measures.

The issues addressed include how to handle quarantines, test virus samples for new strains, cope with overcrowded hospitals and ration lifesaving vaccines and other treatments.

"It's very high on our priority list," said Dr. Isaac Weisfuse, the city's deputy commissioner of disease control who is spearheading New York's pandemic plan. "This is clearly an issue that we're concerned about."

Officials are honing the plan as more and more evidence suggests H5N1 is evolving rapidly since it reappeared in Asia with a vengeance in late 2003.

The World Health Organization unveiled an alarming report Wednesday indicating the virus is becoming more contagious - from birds to people and possibly even among people.

But critics say the city's plan may not go far enough, particularly if it counts on a share of the meager federal stockpile of Tamiflu, the antiviral drug that is the only known treatment against bird flu, also known as avian influenza.

"It's irresponsible that we are not stockpiling more of the antivirals," said Rep. Nita Lowey (D-N.Y.), a member of the congressional committee that overseas federal health agencies.

"We could really fail to adequately respond if there is a pandemic."

Federal authorities have purchased 2.3 million doses of Tamiflu - barely enough to treat 1% of Americans. Antivirals can reduce the severity of an illness and lower the infectiousness of people with the flu.

Britain, France and New Zealand have ordered enough Tamiflu to cover up to 20% of their populations, with Canada covering about 17%, according to Roche, the Swiss-based maker. Roche plans to open more plants in the United States by this fall and has fulfilled all orders, company spokesman Terence Hurley said.

Even before Britain placed its order, London officials independently bought about 100,000 doses of Tamiflu for its police, fire and transit workers after WHO issued a sobering warning about the growing threat of a pandemic.

New York officials said the city has not decided whether to stockpile Tamiflu, and cited major obstacles to stockpiling.

Because a pandemic can last up to two years, "we would have to buy a tremendous amount of Tamiflu because you would have to continually give it," Weisfuse said. "You're looking at a fairly major investment."

It costs about $2 million for 100,000 doses.

Also, there is no consensus among public health officials on how to use antivirals during a pandemic and who should get priority when supplies are limited, Weisfuse said.

But independent experts said city officials may be walking a fine line - trying not to upstage federal counterparts, whom they have to lean on in times of crisis.

Dr. Martin Blaser, president-elect of the Infectious Diseases Society of America, an association of physicians, agreed that details on how and when to use Tamiflu must be resolved.

"But the bottom line is that it is a good idea to stockpile it in some reasonable amount," he said. "Should New York City have its own supply? Probably so."

Lowey put it more bluntly:

"You can't play nice-nice when it comes to people's health and their lives. States and cities have to take the initiative to protect their own populations."

A pilot bird-flu vaccine is in clinical trials at the National Institutes of Health. But large-scale production of any new vaccine would take at least six months once an epidemic breaks out.

KILLER BIRD FLU

Q. What is bird flu, or avian influenza?

A. A type of flu that normally infects only birds. But sometimes the virus changes and jumps to other species, including pigs and humans. Scientists are calling this strain hitting Asia H5N1.

Q. Where and when was H5N1 first detected?

A. In Hong Kong in 1997. But it reappeared in Asia in late 2003.

Q. How many people have been infected with H5N1 since 2003?

A. At least 92, killing 36 Vietnamese, 12 Thais and four Cambodians.

Q. How many birds have died of H5N1 or have been culled?

A. More than 100 million.

Q. How many people have caught H5N1 from other people?

A. Scientists have been able to confirm only two cases — involving an 11-year-old Thai girl who infected her mother and aunt.

Q. Why are officials so worried about H5N1?

A. It is showing signs of mutating into a strain that could cause a worldwide epidemic, or pandemic, in people. It has also been found in pigs, which can carry both human and avian viruses. This means pigs can act as mixing vessels where the two types can swap genes and create virulent new strains.

Q. How many flu pandemics have there been in the past century?

A. Three. The 1918 Spanish flu killed 20 million to 50 million people. The 1957 Asian flu killed 1 million to 4 million. The 1968 Hong Kong flu killed about 1 million. All three pandemics were caused by viruses that originated in birds.

Originally published on May 22, 2005