According to a report by the organization Trust for America's Health (TFAH), hospitals in the U.S. are not properly prepared to handle patients who would arrive after a disaster or a pandemic.
The trust says that most states have few plans in place for coping and the federal government has not taken charge.
Despite the release amongst a great fanfare of President George W. Bush's influenza pandemic plan, and even though federal health experts have been issuing dire warnings for years, little has actually been done to get the nation ready, says the TFAH.
The report from the non-profit health education group, says that whilst considerable progress has been achieved in improving America's health emergency preparedness, the nation is still not adequately prepared for the range of serious threats it faces.
The report which was based on a survey of 20 public health experts, who evaluated 12 aspects of health emergency preparedness, says that to achieve an appropriate level of preparedness, efforts must be rapidly enhanced and accelerated, and improved policies and funding at all levels of government is required.
At present this is particularly so with the threat of H5N1 avian influenza, which is moving steadily through poultry and which has infected about at least 130 people, and has killed 69.
Experts predict that should the virus acquire the ability to pass easily from human to human, it will cause a pandemic that could kill tens of millions within a few months.
Apparently the TFAH estimates that a mid-severity pandemic outbreak could cause over half a million deaths and two million hospitalizations in the United States alone, and could also disrupt the global economy.
The predictions from the U.S. government are much more dire again, and say two million people could die and a third of the population would become infected.
It also predicts that up to 40 percent of the work force will be absent due to sickness or fear.
Early this week U.S. health officials urged state and local governments to hold summits as soon as possible to plan for a possible pandemic.
However some state and local health officials have complained that the federal U.S. flu plan provides good guidance on vaccines and drugs but does little to address the more immediate problem of what already stretched hospitals will do if a third of the population gets sick at once.
Some are also quite skeptical regarding government warnings and promises.
However the Trust report does warn that hospitals in over 40 percent of states do have insufficient backup supplies of medical equipment to meet surge capacity needs during a pandemic flu or other major infectious disease outbreak.
It also adds that over one-quarter of states do not have sufficient bioterrorism laboratory response capabilities.
The report claims that only two states have hospitals which have created sufficient plans, incentives, or provisions to encourage health-care workers to continue to come to work during a major infectious disease outbreak.
As the Trust reminds, the effects of Hurricane Katrina, which devastated Gulf of Mexico states in August and September, showed the poor level of U.S. preparation.
Lowell Weicker, president of the Trust's board and a former senator and governor of Connecticut, says the response to Hurricane Katrina was a sharp indictment of America's emergency response capabilities, and the report provides further evidence of the major gap between response 'plans' and 'realities'.
He says there is need to 'get real' in planning for health emergencies.