Utah health officials have run plenty of drills to get ready for a disaster. But, in the words of University of Utah Hospitals and Clinics Chief Medical Officer Tom Miller, it's a little like playing poker without any money.

The H1N1 swine flu, then, might be like a friendly home game: The public emergency is real, because the flu strain is new and there is no vaccine. But with symptoms mild and few hospitalizations or deaths nationally -- at least so far -- it is no world series tournament.

Instead, the outbreak has provided a test of government response plans. It showed how quickly agencies could mobilize their command centers and hospitals could deliver protective gear and flu swab kits to their employees, and how prompt health departments were in watching for patients with the disease.

But it also showed gaps in how to distribute antiviral medications and how to treat and educate the uninsured and non-English speakers. Federal and state public health labs were overwhelmed. And school closures in Park City and Salt Lake County reminded businesses and families to make their own emergency plans.

It also provided a glimpse into the level of alarm that could play out when the threat is more serious, with parents crowding into Primary Children Medical Center's emergency room, customers emptying pharmacies of N95 masks and Tamiflu and protesters blaming immigrants for the outbreak, even though Utah's initial cases were among children born in the U.S.

"It did allow us to look seriously at the plans that we have in real time with the real pressures," said Gary Edwards, director of the Salt Lake Valley Health Department. "We want to continue looking at what we did and use the lessons we learn from it to become even better."

'Too early to say.' As government officials shift from focusing on the number of flu cases to tracking its characteristics, they plan to issue "after-action" reports to improve their response for the next public health emergency. That could emerge quickly if the flu turns more deadly. It could happen in the fall during normal influenza season, if H1N1 mutates and returns with a vengeance, as infectious-disease experts fear.

"We don't think this is over," cautioned David Sundwall, executive director of the Utah Department of Health, who expects dozens if not a hundred more H1N1 cases. He said he has "butterflies" because he doesn't know where the flu is headed. "It's too early to say we've got a good plan."

He's already noted some "surprises."

There was confusion and debate among the state and local health departments on how to use Utah's government stockpile of 142,000 doses of antiviral medications -- who should get the drugs and when. "I would have thought that was all clear in our plan," Sundwall said.

Tamiflu, one of the stockpiled drugs, must be taken within 48 hours of the onset of symptoms.

But it wasn't until early last week that the state posted its guidance: The stockpile should be reserved for hospitalized patients and patients at higher risk for complications, such as the elderly, infants and people with underlying health conditions. Sick patients' household contacts who are at risk for complications can also have access.

"We could be faulted for taking more time than was necessary had this been more serious," Sundwall conceded, predicting officials will be more nimble next time.

Demanding Tamiflu, delaying tests. The delay wasn't a problem because flu patients could buy Tamiflu on their own, with a prescription. But some pharmacies were starting to run out as customers attempted to stock up for trips to Mexico or just to have on hand.

Sundwall wants to work with the Utah Medical Association and the Utah Pharmacists Association on a campaign to prevent a run on antivirals and ensure they are available to the sickest in an emergency.

But Utahns may not listen.

When the H1N1 flu scare is over, buy Tamiflu, recommends Paul Ray, a state lawmaker who wants to boost the state's antiviral stockpile. Put the medication, which has a five-year shelf life, "with your food storage," the Clearfield Republican advises.

Sundwall also found too many doctors were unnecessarily testing for the flu on patients who had only colds or allergies, which overwhelmed the public health lab. Next time, the state will tell providers to be more judicious.

It also took days for the federal Centers for Disease Control and Prevention to confirm cases, until it shipped out test kits to the states.

"If you had a lot of people getting sick and people dying, I don't know if we could afford this time delay between submitting the test and getting the confirmation," said Gary House, director of the Weber-Morgan Health District.

In a more serious outbreak, officials know now they would have to take "drastic" measures like canceling mass gatherings without knowing if patients were infected, he said.

'Scaring people.' To observer Sabrina Morales, who was on Gov. Jon Huntsman's 2007 task force on pandemic flu preparedness, it's clear there is no plan for educating non-English speakers or the uninsured, except to send the latter to emergency rooms.

Morales, executive director of Comunidades Unidas, which works with immigrants on health care issues, said the state didn't send out prevention information in Spanish until last week, even though the epidemic is believed to have started in Mexico. The state notes that materials were posted on the CDC Web site.

"The lack of local education efforts around swine flu has been pretty bad," she said. "Everyone's getting their news from the Mexican news channels. It's scaring people even more."

With few medical interpreters available, she wonders how people who speak other languages would be cared for.

And most low-cost community health centers that care for the uninsured lack funds and aren't accepting new patients. Some uninsured say they are leery of heading to an emergency room due to the cost.

Morales suggests developing temporary free or low-cost sites in stricken communities. "There should be a plan in place that looks at how are we going to serve the uninsured," she said.

hmay@sltrib.com