WASHINGTON – Raising fears of a deadly flu pandemic, President Bush said Tuesday that he is considering the use of military troops to impose a quarantine in the event of an outbreak.

Bush, in response to a question at a news conference, echoed warnings from health experts who fear a replay of the 1918 pandemic that killed an estimated 50 million people worldwide.

He outlined a series of steps to deal with an illness that could overwhelm the nation’s health-care system.

The World Health Organization says that an influenza pandemic is “just a matter of time.” Some health officials particularly are concerned about avian flu because it seems to be extremely lethal when it jumps from birds to humans.

Of the 116 known cases in humans since 2003, more than half – 60- ended in death. There are no confirmed cases of human-to-human transmission, but that could change at any time because influenza viruses constantly mutate.

“It’s not a question of if, it’s a question of when. It’s scary,” said Sen. Tom Harkin, D-Iowa, who has urged the administration to take a more aggressive approach. “If that pandemic hit next month, we’d be in a world of hurt.”

Bush left no doubt that he takes the threat seriously.

“I am concerned about avian flu. … I’ve thought through all the scenarios of what an avian flu outbreak could mean,” Bush said. “I’m not predicting an outbreak. I’m just suggesting to you that we’d better be thinking about it.”

White House officials said Bush’s fears were heightened last summer when he read “The Great Influenza,” a nightmarish account of the 1918 pandemic by writer John Barry. In that outbreak, an avian flu virus passed to humans and left a trail of death across the globe. Most of the victims developed an extremely virulent form of pneumonia.

Unlike a typical flu outbreak, the illness struck hardest against people in the prime of life.

Jam-packed hospitals turned away patients and left many of those who were admitted without treatment. Morgues ran out of caskets. Schools, government buildings and churches closed in a desperate and futile attempt to stop the spread of the disease.

If it happens again, experts say the death toll and economic devastation could far surpass the damage from Hurricane Katrina. And some fear that the government’s response could be equally inadequate.

“The entire world has a long way to go to achieve even the most fundamental levels of preparedness,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy. “We’re going to need every possible asset within all of government – federal, state and local – to respond to a pandemic.”

Drawing a lesson from Katrina, Bush suggested that he should have the authority to use federal troops to seal off an infected region in a pandemic, as well to help deal with natural disasters.

“It’s one thing to shut down airplanes. It’s another thing to prevent people from coming in to get exposed to avian flu,” Bush said. “One option is the use of a military that’s able to plan and move.”

Bush said he is encouraging work on a new vaccine against the flu. No such vaccine currently exists, and developing one is difficult before a human-to-human virus emerges.

Bush said he used his visit to the United Nations last month to “talk to as many leaders as I could find” about the need to report any outbreaks as quickly as possible. All of the known human cases have occurred in Asia.

“Obviously, the best way to deal with a pandemic is to isolate it and keep it isolated in the region in which it begins. … We’re watching it very carefully,” Bush said.

He did not mention the cost of preparing for an outbreak, but health officials and members of Congress say it easily could cost billions of dollars to stockpile the necessary vaccines, anti-viral drugs and other supplies. The Senate approved an amendment last week that added $3.9 billion to a defense spending bill for anti-viral drugs and other flu-related expenses.

“That is like trying to fill Lake Superior with a garden hose. That’s just a start,” Osterholm said.

Barry, who spent seven years on his book on the 1918 outbreak, said no one can know how bad the next pandemic will be until a new virus emerges. It could be a replay of 1918, or it could more closely resemble the 1968 Hong Kong flu, which caused 750,000 deaths.

“We don’t know whether it’s going to be a 1968 virus or a 1918 virus,” Barry said. “That’s frightening, without a doubt. We need to take it very, very, very, very seriously.”

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