Pandemic Rehearsals Like War Games

Devastate The Economy? Or Devastate The Human Population? CDC Faces Tough Choices In Declaring A Pandemic

The Centre For Disease Control in the United States held a 'war game' last week, to see how various government agencies would handle the outbreak of a H5N1 human pandemic.

The CDC, in Atlanta, is in the front line of fighting such a pandemic, and the war game appears to have shown them just how under-prepared they, and a multitude of other US government agencies are.

Similar rehearsals have been held in Australia, the UK, Russia, China and across the EU, and all keep coming back to the same number one way to stop the spread of a highly infectious human form of the bird flu virus : quarantine, closing schools, workplaces, cinemas, shopping malls, office towers.

To virtually shut down entire cities and even small towns for the duration of a pandemic outbreak, usually estimated to last eight to twelve weeks, would destroy the American economy, already staggering under unprecedented debt levels, plunging house prices and quicksand growth.

While rehearsals like the CDC's, discussed below, are used to see how emergency crews, govenrment agencies and medical and health facilities can work together to lessen the spread of a pandemic virus, they are also used to try and find a way to stop such a spread by not shutting down cities and towns.

This is one of the reasons why such faith is put into bird flu vaccines and anti-viral medications. The US government, like other governments around the world, are trying to find any other alternative than mass quarantines and city shut downs, knowing full well the devastating economic impacts such quarantines would deliver, even if they did save tens or hundreds of thousands of lives.

To avoid devastating economies, agencies like CDC have to play a very dangerous game : when is too soon to declare a pandemic and shut down society? As detailed below, in the CDC rehearsal, more than two dozen human infections are confirmed but they still decide against publicly declaring a pandemic outbreak.

The CDC scenario of how the virus reaches the US, and how quickly it spreads, is very similar in scope to preparendness rehearsals staged by the Australian and British governments. In all the rehearsals I've read about, the H5N1 virus always arrives inside a person returning by aircraft from Indonesia.

From MSNBC :

The exercise, which ended on Friday, was designed to simulate how the Centers for Disease Control and Prevention would marshal its resources, coordinate with other branches of government and, crucially, reassure the public while preparing it for a possible pandemic.

In the script, a student infected with a new strain of H5N1 virus returns from Indonesia where a bird flu outbreak is under way. He dies but not before infecting others, including members of a swimming team.

On Day One, 12 people contract the disease in four states and 25 percent die, a rate that shows the virus to be particularly lethal.

By Day Two, there are 25 cases and CDC is forced to consider whether to recommend ordering schools to close, banning flights from Indonesia or even shutting U.S. borders.

They decide against these measures but send experts to Indonesia, release a quarter of the U.S. stockpile of flu vaccines and force all international flights to land at just 10 airports to screen passengers and limit the disease’s spread.

Behind the scenes, planners draw on a wealth of research.

In calculating whether to close the border, for example, there are hundreds of studies on the movement of pathogens, the impact of public health decisions on the economy and the potential social and political repercussions.

“What we do (in the exercise) is tailor our thoughts over the last few years to the specific scenario that is playing out. These are the facts on the ground: do our theoretical constructs hold,” said Martin Cetron, CDC director of the division of global migration and quarantine.

Another consideration was whether to adopt a “containment” model, by trying to stop the virus’ spread, or a “mitigation” model, by taking steps such as closing schools to lessen its impact once it can pass freely from person to person, he said.

If they overreact, it could stifle the economy and cause a host of unintended consequences. If they do too little they could fail to impede the spread of the disease.

So will the United States be safer? The exercise is part of a long-term plan involving multiple layers of government to prepare for public emergencies. The game, set up by a team of former military planners, is followed by an extensive effort to analyze mistakes.

....in an ominous note, the next stage of the exercise to be held over the summer will start with the assumption that the bird flu outbreak has become a full blown pandemic.

As for the involvement of the military during a pandemic, President Bush declared in 2005 that he already has the power to deploy Army and National Guard troops across the nation to stop people looting during food shortages and storming hospitals in search of a cure for their dying family members.

Compared to the outbreak of a H5N1 pandemic across the US, the threat of anything less than full-blown nuclear terrorism seems almost trivial.

Indonesia Goes Into Blackout Mode Over Bird Flu Data And Deaths

The outbreak of bird flu-related human deaths in Indonesia has, thankfully, gone quiet over the past two weeks. That doesn't mean that nobody else has died in Indonesia since local media reported 9 deaths in just 10 days, only that the government is not officially reporting new outbreaks or deaths to the World Health Organisation, who keeps the official world tally of H5N1 deaths and infections.

Now comes the revelation that the Indonesian government is once again refusing to share its bird flu data with the World Health Organisation :

Indonesia has gone back on its pledge to resume sending bird flu samples to the World Health Organization (WHO), while upping the rhetoric in a standoff that has pitted poor countries against the rich.

Health officials from the nation hardest hit by bird flu say it's unfair for WHO to simply hand over their H5N1 viruses to drug companies, arguing any vaccine produced from their specimens would likely be out of reach for many cash-strapped countries.

Some international scientists have accused the government of holding the virus hostage, keeping experts from monitoring whether it is mutating into a dangerous form that could spread easily among people.

"We don't care," Triono Soendoro, head of the National Institute for Health Research and Development, said to the mounting criticism, maintaining that his country was fighting for a bigger cause.

"Exploitation by industrialized countries toward poor countries is not something new," she wrote recently in an editorial. "This situation brings poverty, suffering and stupidity."

...some experts say she has a point, and that Western governments should realize a pandemic that starts in Asia would not only kill indiscriminately but also cripple economies everywhere. There is capacity to produce up to 500 million doses of flu vaccine a year -- far short of what would be needed in a pandemic.

"It's not just about altruistic public health," said Michael Osterholm, a University of Minnesota infectious disease specialist. "When we realize Southeast Asia and China are shut down economically from a pandemic perspective, so goes our economy. So goes many critical products and services that we count on every day."

The WHO hasn't counted any Indonesian bird flu cases since the country stopped sending samples, keeping its official count at 63. Indonesian officials have recorded 11 deaths since then.

And how many more have died since that have not been reported in the media?

Egypt Reports 14th Human Victim

A 15 year old girl has died from the H5N1 virus in Cairo. She was hospitalised and treated with Tamiflu and put on a respirator :

Amr Kandeel, who is the director of communicable diseases at the Ministry of Health, stated that the girl died because she did not receive treatment quick enough due to her not reporting her symptoms when they first started appearing.

According to the girl's family she did not come in contact with any infected poultry, thus how she contracted the virus is currently not known.

Another report carries a quote from a WHO spokesperson on how she may have contracted the virus :

She is believed to have contracted the virus three weeks ago when she bought a chicken at a market in Shoubra, Cairo, while shopping for her Christian family's preparations for the Easter holidays...

The Worldwide Human Toll So Far

The World Health Organisation has released a compilation of human bird flu infections and fatalities, by region, since the H5N1 re-emerged in 2003.

The Indonesian toll, claims the WHO, has not been updated to include the most recent deaths, 11 in the past three weeks, because they remain "unconfirmed", although you will see stories listed below on this blog that detail WHO confirmation of at least eight human bird flu deaths in Indonesia in a recent ten day period.

From our own tally, the Indonesian toll actually stands today at 74 deaths, from just over 100 confirmed cases of infection.

The tally doesn't include infections and deaths in Egypt in the past three weeks, so consider this to be the WHO official toll for about mid-March, 2007.


Indonesia 63 (out of 81 cases)

Vietnam 42 (93)

Thailand 17 (25)

China 15 (24)

Egypt 13 (34)

Cambodia 7 (7)

Azerbaijan 5 (8)

Turkey 4 (12)

Laos 2 (2)

Iraq 2 (3)

Nigeria 1 (1)

Djibouti 0 (1)

How One British City Is Preparing For The Pandemic

The city of Portsmouth has filled a local warehouse with emergency medical supplies in preparation for the bird flu pandemic. Here's what they've set aside for the local doctors and nurses who may have to deal with more than 50,000 very sick Portsmouthians :

5,000 masks...a similar amount of plastic gloves and aprons...Another 50 specialist masks – which offer greater protection – have also been bought for staff who would treat infected people.

Other emergency plans, revised after warnings from the British government's health department to pepare for "the worst case scenario", include :

Improving the staff database which will include staff who have left in the past two years but who could be called back to help out;

Stepping up links with voluntary organisations such as St John Ambulance;

Making the plan available to the public on the PCT website and informing staff through briefings and inductions;

Making health and council bosses available to talk to the media to reassure the public in the event of an outbreak.

Portsmouth GPs and medical staffs have been told the first wave of a bird flu pandemic could last as long as four months, with more to follow over a period of some two years.

Edward Borodzicz, professor of crisis and risk management at the University of Portsmouth, said nothing can prepare the city.

He said: 'We can't possibly imagine the impact of 30 per cent of the population having a flu that could kill 60 per cent of those who get it.

'Organisations are trying to make plans. It's better than having nothing, but often plans are nothing like what happens on the ground."

Government health department officials have told Portsmouth city council and the local health authority to prepare for the worst case scenario, and they changed their emergency response plans accordingly.

You can hear worldwide death toll figures of a 30 million or 100 million, and the numbers are all but incomprehensible.

But when the predicted infection and fatality rates from a bird flu pandemic are scaled to a British city the size of Portsmouth, the human toll comes into a more realistic, clearer and shocking focus.

Experts predict the flu virus would affect up to 30 per cent of the local population over the first two years – that's 57,600 people in Portsmouth...

With a nightmarishly high human fatality rate - 60% according to the World Health Organisation, almost 80% from Indonesian figures - that means a pandemic would likely kill more than 45,000 people in Portsmouth alone.

A commenter on Portsmouth Today did the math on the stockpile of masks, the 16 week length of a pandemic 'wave' and the number of GP/doctor practices in the city. Here's what they came up with :

...the stockpile is enough for 2 masks per day per practice. Who do you reckon should get the masks, the GP, the nurse, or the receptionist? And that's assuming nobody needs to change their mask half-way through the day cos somebody just coughed in your face! Good luck for staff turning up for work in a pandemic!

How local doctors, hospitals and health facilities across the world are going to ensure their staff turn up for work during a pandemic is one of the most troubling issues of all for those now planning how cities, towns and villages will deal with such lengthy outbreaks of the H5N1 virus.

Particularly when you consider that doctors, nurses and paramedics are likely to have sick relatives to look after themselves, and all those who fall ill will be quarantined inside their homes once the hospitals fill up.

Two Teenage Girls Die From H5N1, Two Year Egyptian Girl Infected

Along with the death of a 16 year girl in Indonesia, yesterday also saw confirmation of the following :

Cambodia : A 13 year old girl died from the virus.

Kuwait : Four Bangladeshi workers are confirmed to be infected with H5N1. They remain under quarantine.

Egypt : A two year old girl is now confirmed to be infected with H5N1.

Indonesia's Bird Flu Body Count Grows Rapidly

Nine Confirmed Dead In Ten Days

News of bird flu deaths and infections is coming thick and fast at the moment, so go here for the latest updates from this blog.


The death toll from H5N1 in Indonesia is mounting, and compared to the pace of deaths in the archipelago last year, the past two weeks has seen a frightening increase. A rough comparison between reported infections and reported deaths sets the fatality rate for human bird flu infections in Indonesia at a stunning 75-80%.

Accurate details on how each person who died in Indonesia in the past month actually contracted the virus are few and far between in the media.

The official human death toll from the H5N1 virus for Indonesia now stands at 74.

On January 8, it was 57.


April 7 : A 29 year man who died on Thursday in Central Java was confirmed Saturday as being H5N1 positive.

April 6 : 16 year old girl dies in Jakarta, believed to have had contact with sick chicekns.

April 5 : 29 year man in Central Java dies.

April 4 : 23 year old woman dies.

March 29 : 14 year old boy in West Sumatra dies - 28 year old woman in Jakarta dies.

March 28 : 39 year old man dies in Surabaya.

March 27 : 15 year old boy in West Java dies - 22 year old woman in Sumatra dies.

March 20 : 21 year woman in East Java dies.

March 16 : 32 year old man dies in Jakarta.

March 12 : 20 year old woman dies in East Java.

Indonesia is an archipelago made up of literally thousands of islands. While Indonesia has won praise from the World Health Organisation and the United Nations for its efforts to stop the spread of bird flu, amongst human and avian populations, complete eradication of the virus is next to impossible.

In all likelihood, the human death toll from bird flu in Indonesia is likely to be far greater than 74.


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Shut Down The Cities To Stop Pandemic Flu Spreading

Studies Reveal Pandemic Spread Could Be Reduced By Closing Schools, Cinemas, Workplaces, Shopping Malls And Borders

A remarkable story from yesterday on the results of two comprehensive studies that looked at how authorities in American cities tried to stop the spread of the 1918-1919 bird flu pandemic.

The studies conclude that American states that rapidly brought in restrictions on public gatherings - including theatres, schools, and large funerals - were able to reduce the overall infection rates and eventual death tolls. In comparison to cities that were slow to introduce such bans, the difference in death tolls may have been as high as 50%

The cruncher in these conclusions is that banning people from gathering in crowds in any social environment may be more effective at stopping pandemic-related deaths than the use of anti-virals or vaccines. At the very least, such bans would delay the onset of larger numbers of people becoming infected and, theoretically, buy more time for effective vaccines to be developed.

Therefore, the studies conclude, it is more effective to stop people becoming infected in the first place, by cutting off their physical contact with one another, than it is to try and stem the effects of bird flu infection with medicines.

But how long would authorities need to enforce bans on public gatherings? Be they in schools, cinemas, subways, restaurants, weddings, large funerals, shopping malls, office blocks?

Perhaps as long as three months.

Apparently, some American states and cities already have bans on public gatherings included in their emergency response plans to fight pandemic bird flu.

But will local, state and federal governments have the willpower or political strength to enforce such bans? Will National Guard troops be ordered to shoot people who break curfews or quarantine zones? What will happen to local economies if people stop going to work?

There's literally thousands of such questions that haven't even begun to be addressed or debated, let alone answered.

Clearly the effect of such bans on public gatherings would devastate economies and isolate entire populations of city dwellers, not to mention the psychological impact and the issues of sanitation that would result from people isolating themselves in their homes for extended periods.

You will know how seriously the conclusions of such studies are being taken worldwide by the frequency of warnings from your country's leaders, in the coming months, that go like this : "We may need to discourage people from going to concerts and nightclubs, for their own good, should a pandemic break out."

Once the idea of the need to restrict social outings in the event of a pandemic settles into the general public consciousness, and becomes a reasonable idea, then the idea of shutting down subways, shopping malls and work places will slip into the debate.

Not mentioned explicitly in the story, but an obvious conclusion, is that such lengthy bans on public gatherings would need to be introduced in the earliest days of human-to-human transmission of the H5N1 virus, as they were in the US cities with significantly reduced death tolls during the 1918-1919 pandemic.

As the virus can live inside a human for one to two weeks without showing itself, a 'hot' person could pass the virus on to literally thousands of people in the space of 14 days in a big city.

Presumably, then, authorities would need to launch and enforce wide scale bans on public gatherings when the first few cases of human-to-human transmission show themselves in the larger cities of the world.

But what governments will be brave enough to shut down the economic lifeblood of their cities after only a few people have died from communicable H5N1?

The likelihood is that most governments would leave such public bans to the very last minute, under pressure from corporations and local businesses, and deny the existence of communicable H5N1 for as long as possible. Just in case organisations like the World Health Organisation are wrong about the severity of a bird flu pandemic.

It's quite an amazing concept to imagine a government or city council announcing to the public that, "All public gatherings will be banned for 10 to 12 weeks to stop the spread of this deadly virus."

Three months at home?

With the family?

Three whole months?

Let's hope there's something good on TV, if the electricity continues to flow, of course.

From France24 :

Scientists with their eye on the possible outbreak of a bird-flu epidemic found from studying past practice that by intervening early and aggressively to restrict the public's freedom of movement, they may be able to curb the transmission of a virus in the early phase of an epidemic and buy time for investigators to come up with a vaccine.

The findings come from two analyses of US cities in the 1918 Spanish influenza pandemic that killed 600,000 people in the United States and tens of millions around the world.

In 1918, many US cities sought to contain the epidemic by closing schools, theatres, churches and dance halls. Kansas City banned weddings and funerals involving more than 20 people while San Francisco and Seattle ordered their citizens to wear face masks.

...US researchers found that in cities where officials responded to the epidemic early and with numerous bans on social or other gatherings, the peak weekly death rate was about 50 percent lower than it was in cities that responded more slowly.

In St. Louis, the peak mortality rate was one-eighth that of Philadelphia, the worst hit city of all the 17 metropolises included in the survey.

Officials in St. Louis moved with broad public health measures within two days of the first reported influenza cases, while their counterparts in Philadelphia waited two weeks to act.

"Our results show that non-pharmaceutical interventions may substantially slow the spread of a pandemic," said Neil Ferguson, a researcher at Imperial College London, who led the European research team.

"However, if we want these measures to save substantial numbers of lives, they really need to be kept in place until we have enough vaccine to immunize the population."

But he cautioned that there would be "huge social and economic consequences of imposing such measures for the three or more months that would be required for optimal effect."

US authorities have already incorporated many of the lessons of 1918 into planning, drawing up guidelines for closing schools, canceling public gatherings, teleworking strategies and voluntary isolation of cases.

...one infectious disease specialist noted, much will depend on the political will to make unpopular decisions that could cost the economy a bundle.

World Health Organisation : Get Ready, The Pandemic Is Coming

UPDATE : A very serious warning about the coming pandemic is announced publicly by the chief of the World Health Organisation and it gets very little media coverage. At least, very little in comparison to, say, the latest news about whether or not Paris Hilton will go to jail for drunk driving.

Here's WHO chief Margaret Chan speaking in Singapore on April 2 :

"The next pandemic will certainly happen..."

'We cannot let our guard down,'' Chan said. ''My advice for all member states is to maintain vigilance, to prepare for the pandemic. One thing we know for certain is that any country that is prepared will see less damage.''

Previously...

It's been tipped as a very likely possibility for almost four years now, but we just heard a radio report that appeared to be stating that a worldwide bird flu pandemic is now coming.

According to a report on Australia's 'Radio National', Margaret Chan, the chief of the World Health Organisation, told a meeting of avian influenza experts in Singapore that the world must now prepare for the bird flu pandemic.

Chan said it was no longer a possibility, but a certainty.

She urged all the governments of the world to begin, or to finalise, their preparations for the bird flu pandemic, to cope with the hundreds of millions who will need to be hospitalised, and the many millions who are expected to die.

No links up yet, as this information was taken from a radio report. We'll update when news media start running reports on the net.

You can only hope she's ramping up the hype, for whatever reason. The world, on the whole, is clearly not prepared for a repeat of, or something worse than, the 1918 pandemic, when more than 60 million people out of a worldwide population of less than one billion died.

Bird Flu Virus Continues To Spread Across The Planet

China, Indonesia Report New H5N1 Deaths, Infections

The past week has seen a sharp increase not only in the number of countries reporting new H5N1 infections in poultry birds, but also human infections and deaths.

This will not be a completely comprehensive round-up of the latest news, just what I believe are the main and most important cases. While new outbreaks and deaths are being reported by the mainstream media, few are putting all the new together in the same story. By spreading the news out across small articles on different days, the full impact of this alarming increase of new infections and deaths is diminished.

For example, two more people have died of bird flu in Indonesia, but three died last week. That means Indonesia reported five human deaths in less than nine days, and reported a spate of new human infections, including the infection of a doctor who was treating a boy who died.

The World Health Organisation is growing extremely concerned, as are the governments of China, Bangladesh, Indonesia, Russia and the EU. Indonesia now regards the virus as endemic across the peninsular, but there is a mounting sense of panic amongst bird flu experts as nothing done is being seen as halting the spread of the virus, or stopping new human infections.

At the same time, the 'miracle' drug Tamiflu is not living up to expectations. The anti-viral is being given to people infected with the virus, but more are dying than surviving. Some of the countries with the highest infection rates are now looking at using double-doses of Tamiflu.

Comparing the number of human infections that resulted in the victims dying, the fatality rate for humans infected with the virus in Thailand, Indonesia and Egypt now sits above 69%.

The H5N1 virus is spreading, it's spreading fast and it appears to be growing more lethal.

INDONESIA : A 22 year old woman and a 28 year old man have died from the virus, the government reported yesterday. A doctor who treated one of the three victims who died last week was hospitalised himself after becoming infected with the virus. Indonesian scientists have admitted they are "baffled" by the random nature of new outbreaks and infections, as they are not able to detect a pattern to the spread of the virus.

BANGLADESH : The H5N1 virus has spread to five more poultry farms in the past week. Sixteen farms have now reported infections. More than 60,000 birds have been culled.

CHINA : A 16 year old boy was reported to have died from the virus yesterday. He was hospitalised on March 20 and died seven days later. The Chinese government remains tight-lipped about how many regions are reporting infections. A second person is reported to have died, but no details have yet been released.

EGYPT : Three children under eight years old have been hospitalised after falling ill with H5N1, all three are being treated with Tamiflu. All three are believed to have caught the virus from poultry birds. The virus was first found in Egypt in February 2006. Since then more than 30 people have caught the virus, killing 13.

KUWAIT : The government is culling more another 1.1 million poultry birds to stop the spread of the H5N1 virus. More than 1.5 poultry birds have already been culled. The culls have devastated Kuwait's egg production, with more than 60% of layer birds now destroyed. Kuwait has shut down it's only zoo, has closed live bird markets and closed hundreds of shops that sold poultry birds. Bird imports and exports are now also under a ban. The government claims there are no human infections. The virus was first reported in Kuwait in late 2005.

VIETNAM : Only days after claiming the spread of the virus was contained, the government has reported two more duck farms have become infected. Vietnam was hailed by the World Health Organisation as a prime example of how the virus can be contained when the virus was believed to have been eradicated in 2005. Vietnam went a year without any new outbreaks.