Know thine enemy.

That was the crux of Dr. Adi Gundlapalli's presentation on avian flu to local health care providers from Timpanogos Regional Hospital at Riverside Country Club in Provo on Monday. The infectious diseases specialist from the University of Utah detailed how deadly an avian influenza outbreak could be and warned repeatedly about the hazards of underestimating the danger.

"Just as an aside, do you think it'll ever happen to usfi" he asked. Most said yes.

"If we think living in Utah we are not at risk, let's think again," he said

The avian flu is not a human pandemic, but it's closer than ever, he said. Three of the four criteria -- a large reservoir of the virus, a new virus and the ability to infect people -- are present.

"The only thing that's missing today for the bird flu circulating around the world is no efficient person-to-person transmission," he said.

A number of other factors contribute to the flu danger in general, and specifically avian influenza.

One is history. The 1918 flu outbreak is now thought to be bird flu and so is a plague that hit Athens in 430 B.C. Two outbreaks in Asia several decades ago that resulted in more than 100,000 deaths in the United States were a bird flu virus that mixed human and bird flu genes, and an extremely fatal 1997 outbreak in Hong Kong had the first recognized bird-to-human transmission.

The rest is numbers.

Pandemics typically impact one-third of a population. That's 2 billion people worldwide, 100 million nationwide and more than 800,000 people in Utah. There's never enough vaccine to immunize everyone, and the pandemic could last for about a year. Thousands of young, healthy people in Utah will die, Gundlapalli said.

She stressed the importance of knowing what to look for when someone with acute respiratory symptoms goes to the doctor or hospital. Someone who goes to the hospital today with all the symptoms of bird flu probably doesn't have it, he said, but take the necessary precautions anyway, he warned, especially if the person has traveled in the past 10 days to a country where bird flu has been identified.

"Here we're less worried today than the rest of the world," Gundlapalli said.

He also told the health care providers to assess their capabilities and know how much they could handle in an emergency situation. It varies for hospitals throughout the county; as the biggest, Utah Valley Regional Medical Center is licensed for 395 beds, but that could change if more is needed.

"In a disaster situation, you can get, basically, permission from the state to go past your licensed capacity," said hospital spokeswoman Janet Frank.

That could mean additional beds set up in spare rooms, and it would also probably mean access to the county's and state's emergency resources and a command center.

Gundlapalli said the waves of people coming in over a period of time can make handling a potential disaster difficult, but Frank said that same feature could make the process easier on the local hospitals.

"It's not like a different disaster, where we're going to be getting a mass of people all at once," he said.

Timpanogos spokeswoman Jacque Brown said the hospital staff is in the middle of looking at surge capacity and staffing needs in an emergency situation, and last week took part in a mock disaster drill to test how large an influx the hospital could handle.

"I think everybody's still in the planning stages," she said.

One aspect of the response to a potential disaster is sure, though.

"The cavalry is not coming, so we have to be prepared on a local level," Gundlapalli said.

Heidi Toth can be reached at htoth@heraldextra.com.

This story appeared in The Daily Herald on page D1.