Isolating the sick, quarantining the exposed, limiting large public gatherings and figuring out how to handle millions of frightened visitors are among the challenges faced in the event of a worldwide outbreak of a virulent flu virus, state health officials said yesterday.

More than 300 people attended the state Pandemic Flu Planning Meeting at the Renaissance Ilikai Waikiki Hotel, including business leaders, representatives of nonprofit agencies, clergy and lawyers.

While Hawai'i is ahead of most states in planning for the crippling effects of a highly contagious and deadly virus at the state level, planning needs to be conducted at every level of society, state health director Dr. Chiyome Fukino told the gathering.

The meeting was a preliminary step, an opportunity for people from different walks of life to understand the issues and begin the process of figuring out how to deal with them, said Dr. Sarah Park, deputy chief of the state Health Department's Disease Outbreak Control Division.

"We're mostly posing a lot of questions," Park said, "but not necessarily solutions or answers."

Those who attended are expected to return to their workplaces, professional organizations and community groups to decide how best to meet the challenges, she said.

In breakout sessions yesterday, social agency workers discussed how to best care for the most vulnerable, legal officials talked about how to cope with healthy but exposed people who leave their homes in violation of state Health Department quarantine orders and business people considered ways of allowing employees to work from their homes when the schools are closed.

Methods of keeping the public informed — from the pulpit to traditional media — were debated.

About a dozen people attended a morning session on pandemic flu planning in the tourism sector — a lively discussion that covered how to best keep sick tourists from trying to leave hotels, what to stockpile and how to train housekeepers to recognize signs that a hotel guest may be infected. But an afternoon breakout session on tourism was canceled after only three people signed up to attend.

"This is only the beginning of the process," said Marsha Wienert, state tourism liaison. "I'll call a meeting very soon and get down to the details."

The Ilikai, she said, has a well-developed pandemic plan that other hotels may be able to use as a template.

Maria Lutz, Hawai'i's director of disaster services for the American Red Cross, said her organization is working closely with the state Health Department and other organizations to train a pool of volunteers to help those quarantined in their homes.

Unless they are sick enough to warrant hospitalization, most affected people will be encouraged to remain at home, and those who are healthy but have been exposed to the disease may be quarantined. People with compromised immune systems may be encouraged to stay inside, and volunteers are needed to help them deal with the isolation.

Dr. Frederick Burkle, an internationally recognized specialist in public health and an O'ahu resident who is helping the state Red Cross train volunteers, said during a recent phone interview that much of the information on responding to a pandemic has come from the experience of cities dealing with the SARS outbreak.

"Toronto quarantined 30,000 people," he said, "and contacted them every 24 hours. We'll need a very large cadre of volunteers."

Lutz said providing supplies and staying in touch with residents who must remain in their homes will be among the volunteer duties.

"We'll bring home-based care to them," Lutz said. "Meals, supplies and whatever medical materials they may need."

The volunteers will be trained to avoid catching the disease by leaving food at the door and communicating with residents by phone, through doors and windows and by notes, she said.

"We'll only work in the 'cool zones,' " she said. "There will be no direct client contact."

Lutz said she thought that part, although necessary to protect volunteers, will be difficult.

"It's hard when you don't have that element of touch," she said. "It isn't a feel-good thing, like draping a blanket over someone."

Reach Karen Blakeman at kblakeman@honoluluadvertiser.com.