Senator Eliot Shapleigh - El Paso, Texas

Five million to 10 million Texans could get sick, as many as 400,000 could be hospitalized and as many as 250,000 could die during the first wave of an influenza pandemic, according to the state's latest plan to prepare for a worldwide flu epidemic.

The draft plan, which the Texas Department of State Health Services posted on its Web site this week, predicts a second wave of flu about three to nine months after the first bout. It estimates that there will be fewer infections and hospitalizations, and 18,000 more deaths.

Additional waves of illness are possible, according to the plan, but no one really knows how many people would get sick or die because so much depends on the bug's potency.

"It really is a numbers game," acting State Epidemiologist Tom Betz said. Infection rates "range from 25 percent to as high as 80 percent, and you use a certain percentage of that overall group" to estimate illness and death rates. "We felt like we were shooting for something in the middle."

Betz and other members of the committee who worked on the plan took into account the bird flu that is sweeping across Asia and parts of Europe, as well as past pandemics and other factors, when estimating infection rates and death tolls.

But deaths are not the only worry, according to the plan.

"If millions of people get sick at the same time, major social consequences also will occur," it says.

Hospitals would be overrun, medical professionals could become ill and people in charge of protecting the community could quickly be overwhelmed, according to the plan. A vaccine would have to be made, and there would be problems getting enough doses made and distributed to the public, it says.

The plan estimates that it would take at least six months to develop a new vaccine and that the United States would not get more than 5 million to 6 million doses a week. Prescription anti-viral drugs that guard against flu could be the only protection during the first wave, the report says, and are reportedly in huge demand now, with worried citizens stockpiling them against the advice of many health officials.

Overall, the plan defines how local, state and federal officials would work together to provide vaccines to people based on guidelines for who should get them first, monitor outbreaks and contain the illness, including closing schools and isolating people who are sick.

State officials said the plan is intended to be compatible with similar plans produced by the World Health Organization and the U.S. Department of Health and Human Services. Its goals are to minimize serious illness, hospitalizations and death; preserve the health care infrastructure; and minimize social disruptions, according to Emily Palmer, a spokeswoman for the state health department.

About three times a century, a flu pandemic occurs. In the previous century, pandemics happened in 1918, 1957 and 1968.

"It's not a question of if it's going to occur, it's when it's going to occur," Betz said. "The question is, 'How bad is it going to be and how is it going to affect us?' "

Hospital officials said the plan looked reasonable and thorough, although they were quick to say that any community could quickly be overwhelmed by a pandemic.

On the upside, they said, hospitals recently learned that they can handle some surges in patients.

"Two months ago, if you asked me is there any significant surge capacity in Austin, I would have said it's minimal," said Dr. Pat Crocker, chief of emergency medicine for Brackenridge and Children's hospitals, which are operated by the Seton Healthcare Network. "But somehow in 24 hours, the Seton network created 178 inpatient beds for Hurricane Rita (evacuees). . . . We have to make some judgments about how far that will go in treating a true pandemic."

Dr. Steve Berkowitz, chief medical officer for the St. David's HealthCare Partnership, which has four Austin-area hospitals, said the recent hurricanes demonstrated how well the two major hospital systems and local authorities worked together in preparing for a crisis.

To view the state's plan or comment on it before it becomes final early next year, see the Web site at www.dshs.state.tx.us.. The deadline for comments is Nov. 23.