"There will be a pandemic," he said. "It will be a flu pandemic of some kind."
For a pandemic to occur, the virus must be able to infect humans, have a susceptible population and move from person to person. The current strain of avian flu has the first two traits.
Washington County Health Department Health Officer William G. Christoffel said county officials have been planning for a large scale pandemic since the SARS outbreak about five years ago.
There are six pandemic phases, and avian flu is on phase No. 3 - human infection without spreading from person to person, he said.
The final phase is an increased and sustained transmission in the general population, according to the World Health Organization.
To combat widespread disease, hospital, health and emergency officials have several pandemic preparedness steps in place.
Surveillance, mass vaccination, an anti-viral medications plan, diminished spread of the disease, maintaining health care service and communication will be important before and during a pandemic, Christoffel said.
An emergency operations center would also be in place, working as the county's command center.
Officials have been in the surveillance phase for some time, monitoring the spread of avian flu.
Christoffel said Health Department officials have begun to prepare for a mass vaccination in Washington County.
If a flu pandemic were to occur, he said, a mass immunization could mean vaccinating the entire county in 72 hours, he said.
During the Health Department's annual flu vaccination clinics in November, officials used that time to gauge vaccination capabilities and prepare for a large-scale need.
Christoffel said the Health Department was able to vaccinate 6,000 people in eight hours.
Officials also were testing several locations as places that could be used during a mass vaccination.
"I think it went very well," he said.
An avian flu vaccine being tested now is about 50 percent effective, Christoffel said. A new vaccine will need to be made to combat whichever strain of flu emerges as the pandemic.
Assuming there will not be enough vaccine, Christoffel said anti-viral medications like Tamiflu will be used to either prevent viral infection or treat people who have been infected with the flu virus. Anti-virals might limit the impact of some symptoms in those already infected and reduce potential for serious complications in high-risk groups.
High-risk groups for the pandemic might not be young children and the elderly, commonly believed to be the most susceptible to illness.
Newby said during the 1918 pandemic the young and healthy were the ones to die from the virus.
"You don't die from the virus, you die from the body's response to it," he said. "It's similar to the 1918 flu."
The avian flu causes the body's immune system to attack the body, eventually causing bleeding in the lungs. Those with the most capable immune systems might be the most susceptible to the virus.
There is already a supply of anti-virals in Washington County, Christoffel said. After a mass immunization and distribution of anti-virals, social distancing will allow the disease to dissipate, he said.
CDC spokesman Tom Skinner said it will be important for residents to prepare to be isolated in their homes for some time, similar to how they might prepare for a hurricane or a power outage. Stock up on food and be sure prescription medications have been filled, he said.
There is also a hospital plan to accommodate the large number of people who most likely would seek medical help from Washington County Hospital, Christoffel said. Because the hospital could not accommodate the number of people expected to be infected by the pandemic, some people would need to remain in their homes.
"They would have food supplied to their homes, telephone checks and medical supplies," he said. "Family members would have to provide their care."
The final step in the county's pandemic plan is communication. Christoffel said a health officer would be transmitting information about what residents should do to protect themselves.
Christoffel said Washington County received a $74,000 federal grant for pandemic flu planning. All Maryland districts decided to combine their federal money and hire someone at Johns Hopkins or the University of Maryland to draft a comprehensive pandemic flu plan.
Each county would be able to tailor the plan to meet its particular needs.