Monday, April 30, 2007

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. 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.

No comments: