American Pandemic Preparations Slow To A Crawl

News about the dangers of a bird flu pandemic in the human population of the United States has dropped out the news cycle in the past few months, so the vast majority of Americans, and their community, city and state leaders have lost interest in planning for such an eventuality :

Last November, Gartner Inc. analyst Ken McGee gave a presentation on the risk of an avian flu pandemic to an audience of IT professionals at a conference in Las Vegas. He concluded with this recommendation: Complete your pandemic planning by Q2 of 2007.

This year's second quarter ended on Saturday. But despite his admonition, McGee believes that few IT organizations are ready for a possible pandemic.

"Most clients would not be prepared if this descended upon the world tomorrow -- they just simply would not be ready," he said. "I think it's just part of the human condition: You don't put the stop sign up until after the traffic accident."

McGee is as concerned as ever about the threat of a pandemic, but he's worried that fears are waning in the U.S. And, he said, he's afraid "that people will learn the hard way that they cannot respond to a pandemic situation once it has been declared, because everyone will be trying to do that and nothing will get done."

The declining level of concern cited by McGee was backed up by poll results released Monday by Ipsos Public Affairs, a research organization that has offices in New York, Washington and other U.S. cities.

Ipsos conducted an online survey of 1,438 U.S. residents who are over the age of 18. When asked about the issue of avian flu in the U.S., 27% of the respondents said they were "concerned" -- down from 35% in a similar survey last year. Forty-one percent said they were "not concerned," compared with 31% a year ago.

The Ipsos poll received almost no news coverage, according to a Google News search. Indeed, one of the poll questions asked, "How much have you read, heard or seen about bird flu?" In 2006, 74% of the people who were surveyed answered "a lot/some." This year, the percentage of respondents who chose that answer fell to 56%.

Scott McPherson, CIO of the Florida House of Representatives and head of the Florida CIO Pandemic Preparedness Committee, tracks news about the avian flu on a daily basis. He can quickly cite the most recent mortality rates or list recent incidents, such as the death of five swans and a goose in Germany due to the H5N1 bird-flu virus. McPherson said he's mystified by the lack of attention that the threat is getting in the U.S.

He contrasted that with the level of interest that the avian flu gets in countries such as Indonesia. "If you live in Jakarta, this is all you think about it," McPherson said. "If you live in the United States, all you think about is Paris Hilton. What the heck has happened to us?"

"Climate Of Fear" Expected To Smash Asian Economies When Bird Flu Pandemic Hits

Even a short pandemic, of only a few weeks duration, killing a few thousand people, is expected to absolutely devastate the economy of the country most unfortunate to suffer such a fate.

What makes economists so nervous about the dreaded H5N1 pandemic is that the idea of a "short pandemic" is fiction. The World Health Organisation, and most recently Australian health minister Tony Abbott, talk of pandemic 'waves' lasting a few months each, with perhaps as many as three or four subsequent 'waves' in the next two or so years.

The economic devastation comes from such a wide array of financial impacts it's almost impossible to sum them up briefly. But the short version is this : when people start dying of bird flu, and a pandemic level outbreak is announced, most people will stop going to work, and public gatherings and public transport systems will be shut down, to halt the spread of the infection.

People won't be going to the mall, but there won't be people to serve them or stock the shelves even if they did go. Now imagine that paradigm across every aspect of the social and business life of a city, or large town.

The "climate of fear" under discussion in the story below also includes the possibility of widespread panic, and subsequent extremely negative economic impacts that follow, even when the human death tolls are low, and the spread halted quickly.

Well, the World Health Organisation has spent three years now scaring the crap out of people about how dangerous and deadly H5N1 can be, and how careful people need to be around poultry birds that may be infected. Of course there is going to be a "climate of fear", the WHO helped to create this reality.

From Hindustan Times :

Asia-Pacific health ministers said on Friday that a "climate of fear" that accompanies the outbreak of infectious diseases such as bird flu could have a devastating impact on Asia's economies.

The APEC Health Ministers conference in Sydney ended on Friday with a commitment to share virus specimens and vaccines and to work to encourage investor and consumer confidence to help Asia-Pacific economies recover in the event of a pandemic.

"The climate of fear that disease outbreaks such as avian influenza bring can rapidly sap the confidence and enterprise that underpins the economic dynamism of our region," Australian Health Minister Tony Abbott told the conference.

The health ministers endorsed a plan called "APEC Functioning Economies in Times of Pandemic Guidelines" which aims to assist in managing economies during a pandemic. The guidelines cover communications, essential services, financial systems and movement between and within countries.

"We recognise that healthy populations contribute to economic growth and development. Conversely, any threat to the health of a population can have a devastating effect on prosperity," the ministers from the 21-member Asia-Pacific Economic Cooperation forum said in a statement.

The ministers said that the Asia-Pacific needed to replicate the co-operation seen during the SARS respiratory crisis in 2003 to combat the threat of a bird flu pandemic.

"The global nature of pandemic influenza and other virulent disease demands international solidarity, co-operation and co-ordination of efforts...for the sharing of information and resources," said the ministers.

Don't Kiss, Keep Your Distance At Work, Don't Shake Hands And Don't Let H5N1-Friendly Children Sneeze In Your Face

US Government Guidelines Vague On Benefits Of Face Masks To Stop H5N1 Infection

Don't Call It 'Quarantine', Call It 'Social Distancing'

Illustration by Joon Mo Kang, from the New York Times

While most other countries are stockpiling vast reserves of paper and cloth face masks in anticipation of a global bird flu pandemic, new guidelines issued by the US Health Department are vague, at best, on whether such masks will actually stop people from becoming infected with the virus.

The guidelines spell out a clear agenda of preparing the state governments and local councils and authorities to get used to the idea that in the event of a pandemic, public spaces - including schools, cinemas, work places, train lines - will be shut down. If state or local councils refuse to do so, President Bush now has the authority to federalise the National Guard to shut down any place deemed to be likely to encourage the spread of the H5N1 virus through the human population.

Further down, you will find excerpts from an early 2006 New York Times article about how Americans will need to stop kissing and shaking hands, if or when the dreaded pandemic breaks out.

From the New York Times :

Part of the hesitation (about recommending face masks), officials said, is that even though common sense says masks protect against flu germs, there is little scientific data proving they do.

“If there were a fail-safe, perfect solution, we’d recommend it absolutely,” said Dr. Michael Bell, chief of infection control for the national preparedness center at the C.D.C. “But there isn’t a crisp, hard guideline. It’s not like a seat belt, something you should wear at all times.”

Also, officials fear that if millions of nervous citizens rush out to buy masks, that will create shortages for health care workers, who need them more.

“I would not like people to stockpile to the extent that they’d cut off the supply to hospital workers,” Dr. Bell said.

The guidelines released yesterday re-emphasized earlier suggestions that in a pandemic, people should shun crowds, avoid close contact with anyone at work or school, and stay home if they are sick, or anyone in their household is sick.

They should also wash their hands frequently, use hand sanitizers and cover their noses and mouths when coughing or sneezing.

Masks are most useful, said Dr. Julie Gerberding, director of the disease control centers, when placed on people who are already sick — to keep in droplets from their sneezes and coughs. They are also important for health care workers or family members tending anyone with flu, especially during potentially dangerous procedures like giving nebulizer treatment to an asthmatic child or suctioning a patient with a chronic breathing problem.

But, Dr. Bell said, “they do provide some protection, for example, during that unfortunate moment in the grocery store line when some little kid sneezes in your face.”

An extremely revealing comment from a Parisian on the psychological benefits of face masks :

Dr. Didier Houssin, chief medical officer for flu at the Paris Hospital Center, said at an avian flu conference in February that his country’s emphasis was “not so much from medical reasons as from psychological and political reasons.”

Political reasons? As in appearing to provide ways of stopping the pandemic spread, when the reality may be that it is very difficult to do so?

Dr. Jeffrey Levi, executive director of Trust for America’s Health, makes a very good point that face masks should be made in smaller, children's sizes, as the 'seal' of the mask over the mouth and nose must be tight to be even moderately effective.

The H5n1 virus has, so far, killed no-one over the age of 40 years old, with children under 10 being particularly vulnerable. At least as far as the reported deaths and infections so far would indicate.

Something I didn't know about the vulnerability of face masks :

...masks can become contaminated by sneezes and soggy on humid days, and it is unclear whether changing them carelessly is more dangerous than not wearing them.

They also require a lot of “social engineering,” Dr. Bell said. If they are recommended only for the sick, for example, everyone may avoid them because it marks a person as infectious.

'Social distancing' is probably the most chilling new term of government-speak I've heard in many years. What does it mean? Exactly what it says. In social situations, keep your distance. No kissing, don't shake hands and stand a few good feet back from your work mates or people in your local grocery store. Which may turn out to be extremely difficult to do. How do you practice 'social distancing' on the subway? You don't. That's why the government will shut them down if, or when, a bird flu pandemic breaks out.

Have you tried out the 'elbow bump' yet, as an alternative to shaking hands?

From New York Times :

To the pantheon of social arbiters who came up with the firm handshake, the formal bow and the air kiss, get ready to add a new fashion god: the World Health Organization, chief advocate of the "elbow bump." If the avian flu goes pandemic while Tamiflu and vaccines are still in short supply, experts say, the only protection most Americans will have is "social distancing," which is the new politically correct way of saying "quarantine."

But distancing also encompasses less drastic measures, like wearing face masks, staying out of elevators — and the bump. Such stratagems, those experts say, will rewrite the ways we interact, at least during the weeks when the waves of influenza are washing over us.

...the social revolution is likely to focus on the most basic goal of all: keeping other people's cooties at arm's length. The bump, a simple touching of elbows, is a substitute for the filthy practice of shaking hands, in which a person who has politely sneezed into a palm then passes a virus to other hands, whose owners then put a finger in an eye or a pen in a mouth. The bump breaks that chain. Only a contortionist can sneeze on his elbow.

...other likely steps will strike at things New Yorkers are loath to give up. Dr. Isaac Weisfuse, the deputy city health commissioner in charge of avian flu preparation, said his first move would probably be to ban Major League Baseball games, Broadway shows, movies, parades and other large gatherings.

Closing schools or shutting the subways might be even more effective, because children are much more efficient than adults at spreading flu, and subways are enclosed spaces where sneezes linger in the air — but doing that would be harder to pull off, Dr. Weisfuse said.

"People talk about 'flu days' like snow days," he said, "and if it was just days or a week, that would be simple. But if it's weeks or months, that becomes another matter." Without mass transit, no one gets to work and the economy collapses, he pointed out, and many poor children depend on the free breakfasts and lunches they get at school.

The government of Taiwan...three years ago during the SARS epidemic...ordered everyone who had a cough or fever, or who cared for a family member or patients who did, to wear a mask if they ventured outdoors. The head of Taiwan's version of the Centers for Disease Control correctly noted that studies showed that masks do much more good if the sick wear them, keeping sneeze droplets in, than if the healthy do.

But masks were rare on the streets, and the mayor of Taipei, the capital city, decided to ignore the data and pay more attention to the psychology. The sick and exposed would never wear masks, he reasoned, if it marked them as disease carriers. So he simply issued a mayoral order: no one without a mask could ride the subway. The next day, everyone in Taipei was wearing them. Within a week, they had become a fashion item, printed with logos like the Nike swoosh, the Burberry plaid and the Paul Frank monkey.

Pictures of the 1918 flu epidemic include much evidence of that sort of mass psychology. In a photograph of ranks of Seattle police officers, all are wearing masks; in one of 45 Philadelphia gravediggers digging trenches for the dead, none wear them. In a photograph of dozens of beds in a military field hospital, almost all of the patients, doctors and nurses seem to have masks — but most in the foreground have pulled them down for the photographers. People act as the group acts.

When a disease seems far away, as avian flu still does, notions like mask fashion and elbow bumping sound like jokes. But when people start dying, panic ensues, and nothing seems too far-fetched to try. In the 1918 epidemic, Prescott, Ariz., outlawed handshaking. Some small towns tried to close themselves off, barricading their streets against outsiders and telling any citizen who left not to plan on coming back. In factories, common drinking cups gave way to a new invention: the paper cup.

When you start seeing characters on popular sitcoms or television dramas bumping elbows instead of shaking hands, you will know you are in the process of being re-educated for the new era of 'social distancing'.

United States : Pandemic Impact On Local Schools Examined

Lots Of Questions, But Few Answers

A local meeting of school officials, community leaders and parents in Tuscaloosa, Alabama, aimed to examine the local impact of US government guidelines that schools will have to be closed down for eight to twelve weeks during outbreaks of pandemic bird flu.

Actually sitting down and discussing the effects of school closures on students, parents and the local communities throws a harsh and disturbing light on just how improbable such plans to stem the spread of pandemic bird flu actually are.

The US government, and state governments, may demand school closures, but actually doing will create a vast array of logistical problems, severe economic impacts and even the breakdown of local communities.

Finding and reading local newspaper reports, like the one excerpted below, reveal just how devastating the impact of a bird flu pandemic in the United States, and around the world, will actually turn out to be, and that's outside the huge death tolls and the large percentage of the population expected to fall seriously ill.

The plans to cope with pandemic bird flu are being examined on local levels now, but such meetings reveal just how completely unprepared communities are, and will probably remain for the next few years at least.

From AL.com :

Closing schools has been determined to be one of the best defenses to slow the spread of a flu outbreak, but the implications of long-term school closings are staggering. A flu outbreak of huge proportions would force school doors shut for weeks, if not months.

School administrators, health officials, law enforcement officers and business executives gathered recently to discuss how to handle closing schools for such an extended time. They also received a lesson on the realities of a flu pandemic.

One scenario being discussed is a widespread outbreak that comes in three waves, each lasting eight weeks. That's more than half a year.

"The cycle we depend on to work would be completely disrupted," said Andy Rucks, an associate professor at the University of Alabama at Birmingham's School of Public Health.

Rucks, who works with the South Central Public Health Partnership, led the tabletop exercise on school closings as a way to counter pandemic influenza. He and others are conducting similar exercises across the state.

"It could disrupt the school-year cycle permanently, so much that we will have to rethink how graduation or education will continue to work," Rucks said.

With kindergarten through 12th grades closed indefinitely, the balance of the community work force and life would come unhinged. Schools, after all, provide a form of day care for working parents.

From there the effects would spiral. Without a full work force, the local economy would be disrupted.

The federal government has urged everyone from individuals to businesses to establish detailed pandemic flu preparedness plans.

The Alabama Department of Education began working with the state Department of Public Health in February 2006 to create awareness about bird flu and start drafting a plan, should the illness become a reality here.

Closing schools for occurrences such as inclement weather is significantly different from closing them in the case of a pandemic. Once the weather event is over, schools typically reopen. But with widespread illness possibly affecting teachers, students and bus drivers, the impact would go beyond a few days.

The questions ran the gamut:

_How would students still receive an education during that time?

_Would teachers and staff be paid?

_How would students who receive free or reduced lunch be fed?

_Would latchkey children become the overwhelming norm? Or would parents have to take off work to stay at home with their child?

Answers, however, were limited.

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.

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.

'FLUCASTERS' TO KEEP WORLD INFORMED DURING PANDEMIC

"The United Nations is considering using 'flu-casters' modeled on television weather forecasters, to publicize vital information if a global flu pandemic strikes. "

Broadcasts to beam to the world from the UN/World Health Organisation's $5 million Flu Bunker in Geneva.

Should a pandemic occur, the Flu Bunker will become the UN/WHO Global Command Centre.