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A pandemic would sink the strained health care system, experts say.

The federal government's voluminous plans for dealing with pandemic flu do not adequately account for the overwhelming strain an outbreak would place on hospitals and public health systems trying to cope with millions of seriously ill Americans, some public health experts and local health officials say.

The Bush administration's plans, which run more than 1,000 pages, contemplate the nightmare medical scenarios that many experts fear, but critics say federal officials have left too much of the responsibility and the cost of preparing to a health care system that even in normal times is stretched to the breaking point and leaves millions of people without adequate access to care.

"The amount going into actually being prepared at a community level is not enough," said Patrick Libbey, executive director of the National Association of County and City Health Officials.

The Bush administration argues that it is doing a lot to help communities as part of its three-pronged strategy for dealing with the flu threat. It has doled out hundreds of millions of dollars in preparedness grants for hospitals and public health systems every year, subsidized the stockpiling of antiviral drugs, and conferred with governors and encouraged resource-sharing plans among hospitals.

Its larger strategy involves working with other countries to quickly identify and contain potential outbreaks overseas, developing vaccines and other medical measures to limit the virus' spread if it reaches U.S. shores, and working with state and local officials to keep the economy and society functioning as normally as possible. But administration officials acknowledge that gaps remain.

"We're seeing substantial progress across the board in terms of various aspects of preparedness for flu," said William Raub, science adviser to Health and Human Services Secretary Mike Leavitt. "But I won't sugarcoat this. In virtually every area, we have a good way to go. ... It would not take much of an unmitigated pandemic to overwhelm the hospital system."

A serious outbreak and its fallout would probably overwhelm medical centers, cause lengthy delays in emergency and routine care, and trigger shortages of beds, ventilators, drugs, masks, gloves and other supplies, experts said. Unlike a hurricane or a terrorist bombing, the crisis would drag on for months and affect communities nationwide at the same time.

Michael Osterholm, director of the Center for Infectious Disease Research & Policy at the University of Minnesota, said that a serious flu outbreak would be nearly impossible to contain and that building the medical capacity to treat the surge of victims would require billions more in federal aid.

Michael Greenberger, director of the Center for Health and Homeland Security at the University of Maryland, said the federal effort amounts to a "classic" unfunded mandate.

Since late 2005, Congress and the president have devoted more than $6-billion to pandemic flu preparedness. The vast majority has been spent on researching vaccines and building the capacity to manufacture and distribute them, and on antiviral drugs and overseas disease surveillance, analysts said.

Near the end of 2005, the government also allocated a separate $600-million, one-time pot of money for pandemic preparedness grants to states and localities, as well as $170-million to help states buy antiviral drugs. Other grants for state and local bioterrorism preparedness and hospital emergency preparedness total hundreds of millions of dollars annually, but they have declined.

Raub, the HHS official, said the government's strategy and funding are sound.


Three-part strategy

The Bush administration says it has a three-pronged strategy for dealing with the flu threat:

-Dole out hundreds of millions of dollars in grants for hospitals and public health systems every year.

-Subsidize the stockpiling of antiviral drugs.

-Confer with governors and encourage resource-sharing plans among hospitals.