They gathered around a hotel conference table in Howard County, planning for what might be Maryland's worst public health crisis.
More conservative estimates from the U.S. Centers for Disease Control and Prevention suggest 1,600 to 3,700 Maryland deaths and 16,000 hospitalizations. But public health leaders can't be optimists.
"We have to plan for the worst-case event," said Dr. Jean Taylor, who heads Maryland's pandemic-planning efforts at the state Department of Health and Mental Hygiene.
To safeguard Americans against a pandemic that scientists generally agree is inevitable, federal, state and local officials are developing extensive plans encompassing needs such as hospital and mortuary capacity and production of antiviral medication and vaccines. Local health departments have begun identifying locations such as school gyms and community centers that could accommodate temporary hospitals -- space that might be needed for months.
This month, President Bush signed an executive order authorizing use of quarantines for avian flu cases.
Despite the enormous efforts, critics are warning that the federal government hasn't done enough. Among them are Andrew Pavia, chairman of the Infectious Diseases Society of America's task force on pandemic influenza. He told Congress late last month that "the United States is woefully unprepared for a pandemic that might occur in the next few years."
Much of the concern focuses on the nation's capacity to provide antiviral medications and vaccines.
Antiviral drugs like Tamiflu are essential tools in slowing the spread of disease until a vaccine can be developed to immunize people -- a process that can take six to eight months from the time a killer virus is identified. The United States has enough Tamiflu on hand to care for 2.3 million people, significantly less than some other nations.
But federal authorities said substantial progress is being made: