Prepare for the worst.

Byline: The Register-Guard

A good way to become very afraid very fast is to spend just a few minutes glancing down a list of potential consequences should the H5N1 bird flu virus mutate to a form easily passed from person to person.

We're talking global catastrophe with a capital "C."

For one thing, flu pandemics are neither hypothetical nor rare events. They occur an average of three times a century. The most recent was in 1968; the most deadly killed at least 50 million people worldwide in 1918, including more than half a million Americans. Epidemiologists agree that the next pandemic isn't a question of "if," but "when," and the world is already overdue.

Based on the 60 or so deaths that have occurred so far among people infected with H5N1, the fatality rate is an astonishing 55 percent. By contrast, less than 1 percent of the millions of people who catch an ordinary flu virus each year die from it.

No vaccine exists for H5N1, and current technology requires about a six-month lead time between the isolation of a specific virus strain and the ability to mass-produce an effective vaccine. Though the expensive antiviral drug Tamiflu can suppress H5N1 at the beginning of an infection, it isn't a cure. More important, it's essentially ineffective if it isn't taken at the right time, hasn't been approved for use in children and could quickly become useless as the virus mutates.

Never mind what President Bush said about using the military to enforce quarantines in a widespread outbreak of bird flu. That's a dumb idea for a lot of reasons, but the administration's medical experts have surely told the president the biggest flaw in his thinking: Influenza is almost impossible to contain. The virus spreads two ways - explosively through coughs and sneezes and even normal speech; and stealthily, through carriers who don't appear to have outward symptoms but still are contagious.

Unlike most influenzas, which most often attack the very young and the very old, healthy adults would be the most vulnerable to H5N1 infections. That means huge disruptions in work forces and national economies.

Worst-case scenarios from the Centers for Disease Control peg a bird flu pandemic death toll in the millions in the United States, with more than a third of the nation's population becoming infected by the virus.

Scared yet? It gets worse, especially after factoring in the global death toll and the havoc it would wreak on economic, political, social and military institutions in every nation.

Then again, with hard work, careful planning and a whole lot of luck, it's conceivable the world could emerge from the next flu pandemic in far better shape than the worst-case scenarios predict. The Bush administration clearly sees a need to get in front of the problem, and Congress is sending the right signals that preparation and planning for a flu pandemic have the highest priority.

Vaccine manufacturers are being consulted, and Swiss-based Roche, holder of the Tamiflu patent, said it will meet with other companies in coming weeks to work out licensing agreements that would allow them to produce Tamiflu. Efforts to completely revamp vaccine production are being seriously discussed, and the National Institutes of Health has been conducting flu vaccine research.

But the best thing Bush could do today is to establish clear responsibility for the overall federal coordination of efforts to prepare for and respond to a bird flu outbreak. The chaotic response to Hurricane Katrina illustrates the importance of having command and control protocols firmly in place before disaster strikes.