At the start of a flu season that strikes every year, state health officials are focused on a far deadlier version of the virus that could cause a worldwide epidemic and kill more than 66,000 North Carolinians.

If a flu pandemic delivers its worst to the state, it would overwhelm hospitals with gravely ill and dying patients and outflank an emergency management system designed to handle hurricanes and floods.

Medical researchers say a future global outbreak is inevitable and long overdue, but they are unsure of when it will strike and how lethal it will be.

"Predicting the pandemic is like predicting an earthquake in San Francisco -- you know one's coming, but you don't know when and you don't know how big," said Dr. David Weber, professor of medicine, pediatrics and epidemiology at the University of North Carolina at Chapel Hill.

A rogue mutation of the flu bug could kill more than 2 million people in the United States, recent federal reports and computer models show. In North Carolina, the number of victims would dwarf the annual average of 1,000 deaths caused by the milder type of flu that is a misery-making hallmark of winter.

During such a biological disaster, the state would shut down any gathering where the virus could be easily spread. Schools, churches, shopping malls and theaters would be closed. Concerts and sporting events would be canceled.

North Carolina public health officials have either spent or requested more than $12 million in state and federal money to plan and prepare for pandemic flu. Health professionals are concerned that there would be:

* No vaccine that specifically targets a pandemic flu virus available for up to six months.

* Not enough beds, medicine or equipment to treat all of the more than 290,000 North Carolinians expected to need hospital care in a severe pandemic.

* Not enough ventilators -- machines that help flu-stricken patients breathe. During the worst week of an extreme global epidemic, demand could outstrip the state's supply of these devices by more than 300 percent, federal computer models indicate.

* Up to 40 percent of the doctors and nurses in the state's hospital system sick with flu, treating a loved one at home or too scared to come to work. That same level of absenteeism could hit other crucial jobs, from police and paramedics to garbage collectors and power plant technicians.

* Strict rationing of scarce medical resources on an unprecedented scale, with patients denied care if their chances of survival are too slim. And, a pecking order for distributing limited supplies of antiviral drugs first to front-line medical personnel, cops, paramedics and employees of vital services such as utilities.

* A disaster that lasts up to two years, striking in three distinct and lethal waves of six to eight weeks each -- a far lengthier impact than a hurricane or flood.

State leaders know that talking publicly about these sorts of possibilities won't necessarily prod many to take a possible pandemic seriously. But they're trying to get people to think about how to prepare, including a conference later this week at UNC-Chapel Hill.

As proof of a flu pandemic's inevitability, medical experts and federal health officials point to historical chronicles that show these worldwide outbreaks strike about three times each century, or once every generation. The last one struck in 1968; dubbed the Hong Kong flu, it was relatively mild, killing about 34,000 Americans. An earlier pandemic, the Asian flu of 1957, killed roughly 70,000 in this country.

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