CHECKING CHICKENS: A health official examines residents' chickens in Dangin Tukadaya village in Bali after a bird flu pandemic was declared in the area during a simulation on Friday. (JP/R.Berto Wedhatama)When SARS struck several countries in 2003, the world was in shock. It was not prepared for the airborne infectious disease that moved like wildfire.

In the aftermath of the SARS outbreak, history repeated over and over and there were many could-haves and should-haves in dealing with it.

Ugly pandemics are part of our history. Years ago, in a less globalized world, the 1918 influenza pandemic and 1968 Hong Kong flu were precursors to the avian flu. They can teach us a lot about how to handle a pandemic.

It seems the world doesn't want to take any more chances. A disease outbreak could trigger a more horrid pandemic with a mere lack of preparation contributing to the death of millions.

When the avian influenza, originally a poultry disease, first emerged in Hong Kong in 1997, many scientists feared the H5N1 virus causing the flu could potentially become a pandemic transmitted between humans.

However, others have contradicted this theory, saying the fear is all hype.

Amid ongoing debate, Indonesia, the hardest hit country by the spread of avian influenza, has stepped up measures in anticipation of a pandemic.

"We didn't have proper warning systems in place for Indonesia's past natural disasters, including floods and earthquakes," said I Nyoman Kandun, the Health Ministry's director general of communicable disease and environment health.

"We'd like to be prepared for an avian influenza pandemic should it occur here," he said.

On Friday, the Health Ministry started a pandemic simulation in Bali. The simulation kicked off at Dangin Tukadaya village, two hours' drive west of Denpasar. The village is home to 4,300 people. Last year, the village reported two human deaths from bird flu.

The Health Ministry's head of infectious disease control directorate, Tjandra Yoga Aditama, is in charge of the simulation.

For the simulation scenario, he said, the H5N1 has been transmitted from human to human, making the village the pandemic's epicenter.

Jembrana regent is slated to announce the condition to the media, while the Health Ministry has the authority to declare the situation after receiving confirmed laboratory results from virology tests.

"People are banned from leaving their houses to prevent the infection spreading, chickens are culled and the antiviral prophylaxis is distributed to the masses," said Tjandra.

"Bali was chosen because we could test more than just health and clinical aspects. The tourism aspect is also worth being explored," said Erna Tresnaningsih, head of the Health Ministry's zoonotic disease directorate.

More than 66 million people in Indonesia could be affected by the disease if a pandemic occurs, according to official estimates.

Furthermore, there would be tremendous economic and social losses; those infected would not be able to maintain their usual economic activities and there would be widespread unrest with people fighting over antiviral medicine, hospital beds and information from authorities. The economic and social losses have not yet been quantified.

Chief executive of the National Commission for Avian Influenza and Pandemic Preparedness, Bayu Krisnamurthi, said such a simulation was urgently needed in Indonesia in order to evaluate the newly completed National Pandemic Plan.

The country is now in phase three, said Bayu citing the World Health Organization. During this phase the disease can be transmitted from animal to human but not from human to human.

Earlier this year, at least two pandemic simulations were held on a much smaller scale in Serang and Tangerang of Banten province. Other countries, like Singapore and South Korea, have held similar pandemic simulations using computers. They didn't, however, involve real life conditions.

"We plan to have at least eight simulations on various scales throughout this year," he said.

Bayu said no country could successfully stamp out the virus.

The virus is endemic in Indonesia's sprawling islands, where the majority of the population depend on agriculture for their livelihood.

The virus has seen animal and human health officials working more closely than ever before.

"Our agricultural sector must respond to any virus developments by intensifying campaigns about best farming practices. It is not only bird flu we should be wary of, but any zoonotic diseases," he said.

Only three of the country's 33 provinces have not reported any bird flu cases among poultry.

"Since it's endemic and has been here all along, we need to find ways to live with it. It's literally in our hands," Bayu said.

Hand-washing campaigns have begun. In most human cases of avian flu, the victims had been in direct contact with a sick or dead chicken.

Indonesia has the highest number of human deaths from avian influenza, reaching 107 this week. Worldwide, 350 people have been infected with the disease.

Indonesia reported its first human case of bird flu in 2005.

Despite intensified public campaigns about preventive measures, there is a continued reluctance from the public to comply with basic hygienic practices, such as hand-washing. Poor sanitation is frequently cited by officials as the major contributor of human deaths from the virus.

There is no cure for the virus if detected too late as it ravages the lungs within a matter of days. However, the antiviral oseltamivir, if taken within the first two days, can save lives.

The symptoms at the onset of avian influenza are similar to those of the common cold, making detection difficult. Once it gets worse, detection becomes easier as severe pneumonia starts to occur.

A decade after bird flu's emergence, several cases worldwide were categorized as human-to-human cases, known as cluster cases. This shows the possibility of human-to-human transmutation exists and is not a matter of how but when.

Indonesia needs to be prepared for the possible pandemic. Louis Pasteur said in his book The Demon in the Freezer, "Chance favors the prepared mind."

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