Drugs are stockpiled. Ventilators are in place. Starting last week, disease surveillance in the state went way up. It's all part of a detailed, 400-page state plan that has yet to be tested by a real outbreak.
Will this be it? Despite growing fears that the 1,600 infections and 149 deaths in Mexico portend a global pandemic that has been predicted for years, U.S. health officials say they still don't know exactly what they are facing.
So far there have been no cases of the new H1N1 influenza, also known as swine flu, reported in Minnesota. Of the 40 people who tested positive for it in the United States, all had relatively mild cases and have recovered. Only one was hospitalized, federal officials said Monday.
As of late Monday, the Minnesota Health Department had tested 14 cases of upper respiratory infection, but none was identified as a possible H1N1 infection. Another 32 specimens are in process, said Dr. Ruth Lynfield, Minnesota's state epidemiologist.
Still, hospitals, doctors and clinics across the state are on alert -- which is also part of the state's flu pandemic plan.
Officials at Allina, the Twin Cities' biggest hospital and clinic chain, said anyone who appears in their emergency rooms with symptoms of upper-respiratory illness will be asked to wear a face mask and be separated from other people by at least 6 feet. They will be asked if they recently traveled, and where. Their throats and noses will be swabbed, and if they test positive for influenza, those samples will be sent to the Health Department for further testing. The Mayo Clinic in Rochester is doing much the same.
State health officials are also making extra efforts to communicate with Latino communities in Minnesota. They are providing information to Spanish-speaking media about the outbreak, and advising that anyone with flu symptoms like fever, cough and fatigue get tested, especially if they or people they have had contact with have recently traveled to Mexico.
"The major concern I have is lack of insurance" among people in those communities, said Ann O'Fallon, head of immigrant and refugee health for the Health Department. "That could be a barrier to people seeking health care."
The public is on alert as well.
On Monday morning, La Clinica in St. Paul was handing out face masks to patients who came in coughing or complaining of sore throats. The clinic, which has a largely Hispanic clientele, heard from dozens of patients who were worried because they had relatives who had arrived ill from Mexico, said Dr. Mary Nesvig, the medical director.
"They're not overreacting, but they're concerned," she said. None of the patients appeared severely ill, she said, and about 10 patients were given flu tests. Any that come back positive will be forwarded to the Health Department.
"There's definitely a heightened awareness," she said.
That's also true at other clinics.
"Monday tends to be busy," said Sarah Smothers, a scheduler with the Allina Medical Clinic in Farmington. "Today was extremely busy." She said calls from patients were up by 10 percent, mostly from people worried about symptoms and whether they should be tested.
If it gets worse
If -- or when -- the first case is identified, Minnesota authorities will ratchet up their efforts.
"We would recommend that sick people stay in their homes," said Lynfield. "But the response depends on severity of the virus."
If all future cases are as mild as the ones so far, then health officials would continue their enhanced surveillance, but treat it like the seasonal flu outbreak that occurs every winter. They would recommend what they always recommend -- wash your hands frequently, cover your cough and sneeze, stay home from work or school if you get sick.
If people start getting severely ill, however, then everything changes. That's when the state government might invoke many of the same precautions now underway in Mexico.
Patients and their families may be quarantined for as long as 10 days, and airline passengers may be quarantined if a suspected case is on their flight.
The public would be warned to avoid touching other people -- no more affectionate kissing or hand shakes -- to reduce the chance of infection.
Public gatherings and school events could be canceled, and public transportation may be disrupted. Employers would tell nonessential workers to stay home or work from home.
The health department has stockpiled 419,000 doses of anti-viral medications, and is expecting 189,000 more from the federal government, a fourth of the 754,000 that could be allocated to Minnesota.
Workers critical to limiting flu-related deaths or keeping civil order would be first in line for anti-viral vaccines. In the general population, groups such as pregnant women, young children and the elderly who are all at disproportionately high risk of contracting flu, would also be high on the list.
If hospitals are overwhelmed, makeshift hospitals in schools or other sites would be opened.
"We do have plans for all those possibilities," Lynfield said.
In a briefing Monday, acting CDC Director Richard Besser said the CDC is recommending that Americans forego all nonessential travel to Mexico as a precaution, but he disagreed with European Union health officials who said traveling in the United States was an unnecessary risk. With only 40 confirmed cases, travel in this country is safe, he said.
At this point, panic is likely to be a greater threat than a pandemic, said Michael Osterholm, a former state epidemiologist and infectious disease expert at the University of Minnesota. Following sound advice such as hand-washing and other guidance from health officials, he said, is likely to be most effective at this stage.