About
About Flu Wiki
How To Navigate
New? Start Here!
Search FW Forum
Forum Rules
Simple HTML I
Simple HTML II
Forum Shorthand
Recent Active Diaries
RSS Feed

Search




Advanced Search


Flu Wiki Forum
Welcome to the conversation Forum of Flu Wiki

This is an international website intended to remain accessible to as many people as possible. The opinions expressed here are those of the individual posters who remain solely responsible for the content of their messages.
The use of good judgement during the discussion of controversial issues would be greatly appreciated.

Assessing the Risk of a Worldwide Avian Flu Pandemic

by: SusanC

Fri Feb 08, 2008 at 20:17:43 PM EST


from a recent presentation by David Nabarro,  UN System Senior Coordinator for Avian and Human Influenza, at the National Emergency Management Summit
SusanC :: Assessing the Risk of a Worldwide Avian Flu Pandemic
This is a synposis from the notes I took of his presentation, which I thought was one of the best analysis of pandemic risk from the global perspective, as befits his work, I guess.

The major theme is the same as what he reiterated before, at the Katrina meeting, that pandemics are wicked problems with no easy answers, only uncomfortable knowledge and clumsy solutions.  He also spoke of pandemics as an example of large scale or 'megadisasters' which another speaker Irwin Redlener from Columbia University, defined as a disaster that overwhelms the ability of local and regional government to respond.  As with other such similar disasters including HIV/AIDS, it is the poor who will suffer the most.

The 1918 pandemic swept through the world inexorably from continent to continent, with very bad consequences for some island states in the Pacific and some parts of New Zealand and Australia (NB.  Note this reference to very high mortality among some island states and Alaska, in this commentary on EU public health measures ) but there is good evidence now that those countries and communities that practiced "proper and adequate PH" were able to reduce consequences, both in human loss, as well as sociao-economic losses.  He referred again later in the speech to social distancing measures as the first and most important strategy for mitigation, when compared to antivirals and vaccines.

On H5N1 specifically, Nabarro calls it "the nastiest flu virus we've ever known, and I'm going to keep repeating that".  The virus is now in > 60 countries, and is being transmitted continuously among poultry in many of these countries, ie the virus is now enzootic.  In West Java, for example, the virus is entering the environment in large amounts, and has been isolated not just from poultry, but in the water, in fish, as well as in some mammals.  The presence of such large amounts of virus in the environment means the risk of human infection continues and is not going away, despite efforts at eradication in the past few years.

H5N1 is a strong candidate for a pandemic
because it replicates within humans, producing severe pneumonias and cytokine reactions (in comparison to other avian viruses causing only mild and localized human infections eg conjunctivitis rather than systemic disease).  Despite the use of tamifu, the CFR in Indonesia is still >80%, although later in the speech he did say there seems to be some reduction in mortality in Egypt with the use of tamiflu.  Although 2007 was a relatively good year in terms of human cases, 2008 is getting off on a bad start.

Indonesia is the major epicenter, but a new epicenter is opening in West Bangal, where culling has been extremely difficult because of poverty and the reluctance of people to give up on their livelihood.  What's more, since we do not know for sure that H5n1 is going to cause a pandemic, it becomes very difficult to justify asking people to give up their livelihood.

This combination of the possibility of a global megadisaster with huge uncertainties bumping up against people's livelihood is an example of what he said earlier, about wicked problems.

Some people see the main impact of a pandemic as on people's health, with maybe 30% people sick and 2-3% of them dying, healthcare overwhelmed etc.  but pandemics cause a lot more problems beyond health, including problems in systems of government, security systems, prison systems, police service, military.  Also in social and humanitarian needs, to satisfy populations' demands for food and other essential services.  There will be severe economic disruptions due to disturbance in trade and commerce, and breakdown in banking and other systems.  

Taken together, social, economic, governance and humanitarian consequences need to be treated with greater urgency than public health and clinical health problems.

SARS gave us a foretaste of things to come.  Although it only resulted in 8000+ cases and 774 deaths, ie the human suffering was relatively small, and by all accounts it was a major public health success, it caused huge economic losses of 50 billion.  The World Bank estimates that even with mild pandemics such as 1957 or 68, the economic losses will be in the order of 2 trillion dollars with 5% reduction in global GDP, not just from absenteeism but from the extraordinary efforts people will take to "insulate themselves from infection".  Interestingly, on this, Nabarrro said "as long as they do the right thing at the right time, much rather they do that than expose themselves to risk", but the consequences are huge - markets will close, utilities will become unreliable, telecommunications will break because of heavy load, cash will be in short supply.  

He summarized the consequences of a pandemic into these areas:

  • Livelihood
  • Human health
  • Governance and security
  • Social and humanitarian needs
  • Economic systems

He also says pandemic is a threat to global security, that those involved in peacekeeping, for example, views this threat very seriously.

What is needed is multi-sectoral pandemic preparedness, globally.  Since there really is no global 'government' then consensus needs to be built every step.  They started in 2005 with the first agreements, to start work on the bird problems first, because it was the only way to get the attention of heads of governments.  Now they are moving towards human disease, but every thing needs consensus from 192 countries.  His office deals with 500-1000 different parties, such are the complexities in developing a global strategy.

The first part of the global strategy involves dealing with the initial outbreak.  The key is to get there quickly.  Nabarro says they have about 20 days to get there and work with local authorities, to try and contain it, otherwise containment will fail.   But if the initial outbreak is near an international airport, if people start traveling, etc then we won't have those 20 days.

There are 3 strategies for containment, one of which he said will not work.  The first and most important is social distancing, personal protection, restriction of movement from the affected area, and maintenance of infrastructure to satisfy the needs of the communities isolated.  The second is the careful use of antivirals, potentially only to those exposed to the virus so that it will not be wasted.  We don't know if it will work, but it's only the best we have.  The third is rapid deployment of vaccines, but that is unlikely to happen since we simply do not have them.

He commended the US government for having done the most work on the use of NPI, and that these measures should be at the center of control measures.

If containment fails, the next we will have to depend on mitigation.  We need to build resilience.  Governments have to reach out and work with private entities and voluntary bodies, something that governments are not used to nor good at.  Also, government and voluntary bodies have to get ready for large scale humanitarian relief.  

Next, what we need by way of procedures:

  • Robust information systems - so we don't have blockage of data
  • Protocols for use of stockpiles of antivirals and vaccines
  • Synchronize civil society, ngo, govt - right now different sectors are preparing separately, must get them to synchronize.  Nabarro's office is working with 500-1000 stakeholders
  • System for dissemination of information to public -  via media developed and tested
  • Continuity plans for different entities - simulated and lessons applied
  • Concept for putting multiple plans into practice, together, developed and put to the test(CON-OPS) - not good enough to have separate plans

Finally, some enabling factors for global success:

  1. Good info
  2. Effective interventions (requires political direction)
  3. Rapid scale up
  4. Social mobilization
  5. Incentives for prompt reporting
  6. Alliances - of all goverments and different partners
  7. Management

UPDATE Dr Nabarro's slides are available here

Tags: , , , , , , , , , (All Tags)
Print Friendly View Send As Email

he also gave a link
to this UN page on avian and pandemic influenza http://www.un-influenza.org/ where you can find the latest report written jointly by the UN (Nabarro's office) and the World Bank.  http://www.un-influenza.org/do...

Direct link to pdf report is here http://un-influenza.org/files/...  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


page 11: "only a small proportion of preparedness plans focuses on sectors other than health" :-(


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
yes, that is THE major concern
moving forwards.  There is improvement from when there were NO plans and NO awareness, now we need to move awareness out of the health sector to other sectors.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
more presentations - some of them quite recent
http://www.undg.org/index.cfm?...

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
the presentation 080208 London has the "wicked" word (last slide)


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
probably sleep deprivation here - but i don't understand this sentence
"as long as they do the right thing at the right time, much rather they do that than expose themselves to risk".

What's "the right thing at the right time"?

I get the gist of it, i think, so this is a minor issue.

And, as usual, thanks for the report.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


I didn't ask him
that was only the notes that I took, as much as I could take typing as quickly as I could.

I'd imagine it means appropriate measures, eg school closure and avoidance of public gatherings, but not necessarily total cessation of activities.  At the right time probably means when the virus is in the community, and not shut everything down long before the virus arrives!

Just guessing.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
when the virus is in the community-is leaving it pretty late to batten down the hatches, IMO.
I wonder what the percentage of exposure would be when people in one's own community start dropping.  I suppose it could depend on how many have outside contacts in communities with international travel (at first), then when it's in the US, contacts in big cities with airports?  Is there a supercomputer modeling of this, I wonder?  It might help mayors or whomever make decisions about when to urge their communities to SIP.  Unless the tallying of who has kids where and when did they visit (or who had visits from traveling salesmen or delivery truck drivers) might lead to blaming them for virus spread.  

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
when the virus is in the community
means after it arrives.  Similar to the CDC recommendations, first cluster diagnosed.

If your surveillance is based on state-level criteria, for example, that means first cases in your state OR your neighboring state.  When any of these states have confirmed the first cases, you implement measures.  But that's just my interpretation of what is 'the right time'.  Pulling the trigger too early will have consequences, particularly with regards to mitigation fatigue, and subsequent non-compliance.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
percentage of exposure
at diagnosis of first cases in your state, depends on what is the population of your state, right?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
read this diary
on CMG, #4 of the 5 things you need to know, on timing of intervention, and the rationale.  http://www.newfluwiki2.com/sho...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
global government
   The UN is means of co-ordinating countries If I have that right.

 Even if there was a global government how would that work better than a local one?

 How can a global government provide people, supplies and help when it is the whole globe that is in trouble?

  The more diverse the group the harder it is to stockpile for them - unless you do individual stockpiles for individuals. That is where individuals stockpilling for themselves seems to work.

 It is just my opinion that in this case bigger is better only in co-ordination not education or provisions.

Kobie


"the nastiest flu virus we've ever known"
  Not to split hairs on 7million dead v.s. 9million but is this
 a) "the nastiest flu virus we've ever known" as in recent bugs

 or

  b) ""the nastiest flu virus we've ever known" surpasing spanish flu of 1918?

 BTW, on the TV show "Human Pandemic: Avian flu" (I think that was the title) on the science channel

  "SARS lasted only two months but reduced the GPD by 2% in tiwan"  - hope I got that right.  

  H5N1 would be far worse.

Kobie


as it is read
nastiest flu virus we've EVER known.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
"the nastiest virus" - I *hate* to agree
When reviewing the FAQ finally uploaded to http://www.getpandemicready.org (thanks, ACM!) I suggested a minor change of language when talking about which virus will cause the next pandemic.  And I did call it "nasty".

http://newfluwiki2.com/showCom...

H5N1 has no precedents that we know of: it's a nasty virus able to infect and kill a huge number of poultry and other birds, and also a worrying number of mammals (humans included).  In humans, so far it kills more than 60% of those who fall ill.  It has already diversified genetically, and there are several "flavors" of it in different countries.  It won't be going away anytime soon.

Now, it really worries me when people working at the same subject from very different positions do use the same language.  If we were looking for prominent figures to validate our concerns, this looks like it.  :-/

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
words
better use numbers to specify its amount of nastyness.

H7N7 in Netherlands was also pretty nasty, 20M poultry dead.
H7N1 in Italy also nasty.

Well, maybe H5N1 is nastier .. but how much nastier ?
Nastier than 1918 H1N1 ? Yrsenia Pestis ?

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
at least an order of magnitude nastier, and yes, and yes (i think)


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Lugon - stunned
Lugon,

 "H5N1 virus of 2008 is an order of magnituded worse than 1918 virus"

 Ummm. Am I reading your post correctly??

Kobie
quietly waits.


[ Parent ]
Kobie, "nastier", not "worse".
I meant it's more deadly now that it's not pandemic: "60+% CFR for current H5N1" vs "2-3-6% (whatever it was) for pandemic H1N1 in 1918".

All this came about 'cos GS asked "how much nastier"?  And I tried to put it numerically.

I have no deeper knowledge than we all share here.  I don't know if H5N1 will become pandemic, or what the CFR will/would be.  But as it is, it is nasty - with no hidden implications for the future, which is still in the dark.

Sorry, because in retrospect I see it could be misunderstood. :-/

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
Wow, I understand
Lugon,

 Thanks.

 I understand. With some people saying 7 million dead when H5N1 killed 20 million it seemed that H5N1 might not be that bad. I was more concerned with lots of people getting sick.

 Note: even if H5N1 did not kill anyone but rapidly spread like wildfire making everyone sick that would be, in my mind, all it takes.

 Why? Two reasons.

 First imagin what would happen if 90% of the people got sick. They just took two weeks off from work. No one dies but 90% of the population with a half weeks worth of food and no water take off from work for two whole weeks.

 Second imagin 60% of the people getting sick and needing 24 by seven care. Who feeds the children? Who runs the sewage adn water plant? Who runs the control room that tells the power plants what to do and maintains the infrastructure?

  Ever notice how many repair trucks are on the road during a good day? Hundreds of repairs and maintenace items are done every day on water, power, fuel and communication systems as well as the vehicals.

  Thanks for clearing that up.

  I trust your opinion and understanding.

  Onward, upward and with a better understanding of what to teach the kids.

 "Older mids study that younger minds may learn." - Kobie

Kobie
Back on his feat again & picking up speed (that is going faster :0) ha ha  


[ Parent ]
Kobie...with a CFR of 60% plus
Yes it is, at this time. That's not to say that, if it goes H2H, it won't drop, but right now...yup!

[ Parent ]
BB I hope it drops. Please see my response to Lugon n/t


[ Parent ]
government and voluntary bodies have to get ready for large scale humanitarian relief
Who has heard this message?  If they all had to deliver large-scale humanitarian relief today, what would the success rate be?  And to do it in the midst of pandemic, with the problems of resupplying, and having the first quantity of supplies, and delivering it in PPEs, and fuel for trucks, and the manpower, and knowing who needs what and how much of it....  Just staggering.

Nabarro is right to say it, and I hope governments and NGOs are listening.  "You're on your own" would be too harsh a message for people living on the edge of survival in normal times.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


He IS saying it
remember he works with all these member countries and other organizations.  Like the spokes of the wheel all going through this coordinator.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
where ? when ?
and how could I miss it ?

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
well, there's a page
of his presentations, from lugon's link.  http://www.undg.org/index.cfm?...

You can check them out there.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
risk
so, how big is the risk ?
why the headline ?
who is (not) "assessing" the risk and when and why ?

ask experts for their subjective
panflu death expectation values
and report the replies


the risk
is not just about what are the CHANCES of a pandemic, but also about what is the scale of consequences of a pandemic.  Both are hard to estimate, but we know for sure that most current national efforts are not adequate.  It's a work in progress, just keeping at it and hope we'll out-race that virus!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
sure ?
how can you ever know that for sure, whithout somehow
measuring/quantifying the risk ?
It's a logical imossibility.

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
of course, nobody is sure
which is why he says it's a wicked problem.  Read what he said about the difficulties of culling, of taking away people's livelihood with very little certainty of whether it is justified!!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Nabarro
"sure" was refering to:
> we know for sure that most current national efforts are not adequate.

you could argue that
the more critical the situation is, but without becoming pandemic,
the less likely it is that it might evolve into a pandemic.

e.g.
The more unreported H5N1 problems in China are revealed,
the less likely a pandemic becomes.

Suppose we figure out what we are seeing in Indo or India
or Egygt already happened in China and even worse -
but didn't go pandemic. That would be good news

didn't Nabarro recently say the situation had improved ?

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
plateauing
Nabarro Dec.2007:
"The first thing to say is that the situation has changed, between 2004 and 2007, the rate at which new countries are being affected by H5N1 has reduced, we've got a bit of a plateauing [leveling out], the number of human cases, which act as a sentinel, has slightly decreased, and the human deaths have also decreased.
...broad epidemiological evidence suggests that the H5N1 virus situation is not quite so serious.
...It's microbes, particularly microbes that come from the animal kingdom, that represent one of the greatest threats to humanity and certainly even to its survival as we know it."


ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
You could argue it both ways
you could argue that
the more critical the situation is, but without becoming pandemic,
the less likely it is that it might evolve into a pandemic.

This is one way.  The other way is just that we don't know what it takes for the virus to go pandemic.  There may be threshold barriers that are not a function of time, but a function of the right combination of mutations or events, or a set of conditions that we do not have the knowledge to ascertain.

In other words, we don't know means we don't know.

didn't Nabarro recently say the situation had improved ?

Well, he said the numbers in 2007 appeared to be down, but that's not room for complacency because the virus is just everywhere and it's defying all efforts at eradication.  As long as it's not eradicated, the threat remains.  In that sense, the number of human cases within the current range or variation is really not a good measure of pandemic potential.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
threat remains (but is lower ?)
what is a better measure of pandemic potential ?
I'm very interested in this !

It seemed to be a good measure in 2006 (AFAIR).
Fluwiki had the graph of human infections
on its main page.

You must somehow get the impression that fluwiki
is just trying to make people believe the threat
is high, thus suppressing good news.
I observed this even back in 2005 and it hasn't changed.

People are not trying to be objective and weighting
the arguments.

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
fluwiki does not have a consensus opinion
You must somehow get the impression that fluwiki
is just trying to make people believe the threat
is high, thus suppressing good news.

Everyone has their own opinion.

Is the threat less?  I don't know.  I only know that it didn't evolve as quickly as we feared.  But since this was based on a n=1 situation, http://www.newfluwiki2.com/sho... we cannot use any of our past experiences to predict the future.

As I have always said.  Consistently.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
GS - we all have our own theories
 Fact: H5N1 has a slow inexerable creep

 Watching a virus we can not stop is not unlike seeing techtonic stress build up along a fault line before an earthquake. There will be a disaster we just can not say when.

 Yes H5N1 could just vanish. However it seems to have a foot hold in two places.

 As for where and when my first guess is August 2008 summer olympics in China. lots of people, mass produced food, lots of travel and sigh seeing. This is only a guess.

 Lets say we are totaly wrong GS and H5N1 never happens. are we better off working on preparations and disaster recovery ifrastructure or just flipping to another web page to watch the news, Paris Hilton or geek stuff on Slash dot ?

  Tornados, fire, earthquakes, floods, water contamination, etc all happen. Yet after living through teh cold war and air raid sirens I find people are not prepared for a black out or job loss!! I kid you not. There are adults who know far less about starting and putting out a fire than many scouts.

 Some known threats that also have no date:
 Metorite impact
 Solar storm wipes out power distribution for over a year - no grid! Ditto for Gamma ray burst
 EMP that covers teh US or Europe and wipes out all power and electronic devices. I will not say how to do it but it it is getting easier for other countries to do it.
 Super volcanic eruption - yellow stone national park
 La Palma Islnads give way wipiing out the east coast.
 Dirty bombs in cities.
 The list goes on.

   GS even if none of this ever happens in the next 600 years little disasters that can wipe out a city will. To this end I want my childredn adn grand children to live in a world that can respond or even tolerate that sort of disaster with little to no suffering or loss of life.

 While I believe H5N1 is a viable threat worth spending time and rescources on I can not say who, what, when or where. I can only say that I would be embarrased to think 21st century man or woman can not do as well as 1918 person did during a pandemic. Infact, the silver lining in this cloud for me is that we create teh means for the next generation to survive the next pandemic in 2080 or what ever far better than us.  

Regards,
Kobie


[ Parent ]
average
take the sum or average of the poster's opinions.
Take the main page www.fluwiki.com

when you claim you don't know when the threat declines,
it's hard to believe when you claim that you do know
when it inclines. (new cluster, Chinese New Year,
Osterholm interview, ...)

ask experts for their subjective
panflu death expectation values
and report the replies


you can't sum or average words
and different people's opinions.

Your complaint is, as usual, dismissed without prejudice. ;-P


[ Parent ]
Another way to assess risk

This is war: humans against a killer virus.

In warfare, you look at your opponent for weaknesses, but you also must objectively assess defenses: your own weaknesses.  In this particular war, as in all others, the aggressor (viral) takes advantage of the opponents weaknesses.

So let's list a few, shall we?

1. Pending global famine, regional famine in place and growing.  These occur for several reasons, the least of which is climate.  We have crops poorly adapted to climate change, and monocropping that has vastly increased disease risk in croplands throughout the world.  We have a very rapid change in market demand cycles, contrary to the relative lag in response (large-scale farming runs in 6-9 year crop planning cycles).  And, we have suddenly offset food production with a mounting secondary use for cereal grains that has had a repercussive effect on global commodity prices.

2. Regional drought in  in place, a residual of a larger drought affecting many regions between 1999 and 2004. A new cycle may occur, pending weather conditions in the next year (caused by a rolling deficit).

3a. Global dependency on inexpensive animal protein (fowl) in both developing and developed countries.  

3b. global adoption of modern food production technologies that reduce local independence for food supply.  Good when staple supply is checked locally (drought/natural disaster/insect/ plant pathogen invasion).  Bad when the staples supply is reduced globally - by change in global demand (the idiocy of biofuels), by 5-year to decade-long change in climate patterns affecting many regions, or when commerce and climate aide in transporting plant disease over long distances.

All three are present problems in regional supplies of base food commodities, global food economy and supply.  Match this against a marked reduction in the amounts stored (for various reasons, including the stupidity of precious local stores being burned by riot-maddened people in both Asia and Africa and also due to low yields from drought and more recently heavy snows, and rat-infestation in several parts of Asia due to a sudden return of rains).

When you hear of people in North and Central Africa, the Caribbean and Bay of Bengal regions being reduced to eating dirt and roots to survive...be afraid. They are are your weak link.

The global supply of monetary and material aide is being drained and will be in short supply - a very poor position to be in, when a pandemic hits.  You do not want this catalyst starving people to be present.

4. Many decades of antibiotic over-use has spread resistance genes far and wide. The result is that we have a cadre of secondary infection type microorganisms that are primed to take advantage of those who become ill but survive this pandemic 'flu.  Secondary infections cause increased longterm mortality among all age groups that get sick with highly virulent, pathogenic influenza.  We will not have the drugs available to combat the infectious agents that typically follow viral respiratory infection, because of growing number of multi-drug resistant strains circulating in our hospitals.

5. We have a markedly over-populated planet, compared to the condition of the last highly-pathogenic influenza pandemic:

World Population
2006: 6.5 billion
1915: 1.8 billion

The source of this pandemic will once again be from Asia.  This region has dominated the world population for more than 2,000 years.  Between 1800 and 1900, the global population doubled, while the Asian population tripled. It would quadruple in the next 100 years (to the year 2000).

Humans have artificially increased in numbers when compared to historical population trends defined by childhood disease, and thus have reduced fitness for several reasons, chief among them less than stellar lifestyle choices in both developing and developed nations, and a marked over-dependence on medications to offset population-curbing infections.  Thus we have a novel change in infant and older adult mortality when compared to historical demographics, due to medical intervention over the last 90 years in many countries.  

This unnatural population pattern  predisposes these cohorts to increased risk - despite the unusual epidemiology of highly pathogenic influenza that favors adults.  Once the primary waves of pandemic pass, secondary infections that (for lack of a better term) "ripen" in the adult survivors will hit the ranks of the elderly and very young.  With exhausted drug supplies and an overtaxed medical care system, what do you think will happen?

Lastly, we have large numbers of individuals living in camps: refugees, the newly homeless and those who have been in camps for years, the result of displacement from civil war and genocide.  They form a pipeline of the most susceptible peoples, rising out of the worlds poorest places.

You have zero capacity to stop these places from breeding the very worst pathogen strains.  These people are war-stressed, depressed, malnourished, and disease ridden to start with.  How do you enforce 'social distancing' in these places?

The developing nations have learned from their Colonial masters, the art of shipping excess people abroad.  That mindset has become instilled in the places that will harbor and nurture the initial pandemic outbreaks.  It will virtually impossible to contain their numbers, and they will flee to places they believe will help them.

They will come here, to North America, in droves.  But before they will arrive, this pestilence will travel before them, as it has in past pandemics.

The risk of pandemic is virtually 100%.  The question is no longer "if", as we have ~80% of the top twenty most populace nations with endemic H5N1, and nearly half of them with evidence of human infection from this viral strain.

The question is now "when".  

A final comment:

"The 1918 pandemic swept through the world inexorably from continent to continent".

Nay madam, it was not an 'inexorably sweep'.  It came about in near lightning-bolt quickness, from the precursor wave in New York that originated in Europe in early Spring, to the rebound wave carried back from Spring illness in US and UK military training camps and troop debarkment points, to mid-summer outbreaks abroad ships - with near simultaneous outbreaks in the Far East (in China, as a matter of fact, where it probably started from French/British troops moving between Europe and the Far East, protecting key ports).

And what do we have now?

International movement of troops and men living in close quarters in camps.  They will be the second wave of fodder, after the refugee camps ignite - and they, too, will spread contagion rapidly, as they are demobilized from overseas and return home for national security.

Old patterns in the New Age.  


2005
An excellent overall assessment from the good Doctor.

How did he get from >80% Mortality.....

H5N1 is a strong candidate for a pandemic because it replicates within humans, producing severe pneumonias and cytokine reactions (in comparison to other avian viruses causing only mild and localized human infections eg conjunctivitis rather than systemic disease).  Despite the use of tamifu, the CFR in Indonesia is still >80%, although later in the speech he did say there seems to be some reduction in mortality in Egypt with the use of tamiflu.  Although 2007 was a relatively good year in terms of human cases, 2008 is getting off on a bad start.

to 2-3% mortality?

Some people see the main impact of a pandemic as on people's health, with maybe 30% people sick and 2-3% of them dying, healthcare overwhelmed etc.  but pandemics cause a lot more problems beyond health, including problems in systems of government, security systems, prison systems, police service, military.  Also in social and humanitarian needs, to satisfy populations' demands for food and other essential services.  There will be severe economic disruptions due to disturbance in trade and commerce, and breakdown in banking and other systems.

and keep in mind.....

Although 2007 was a relatively good year in terms of human cases, 2008 is getting off on a bad start.

So it's finally accepted that modern medicine won't help us.

social distancing measures as the first and most important strategy for mitigation

and that multiple species now carry the virus...

On H5N1 specifically, Nabarro calls it "the nastiest flu virus we've ever known, and I'm going to keep repeating that".  The virus is now in > 60 countries, and is being transmitted continuously among poultry in many of these countries, ie the virus is now enzootic.  In West Java, for example, the virus is entering the environment in large amounts, and has been isolated not just from poultry, but in the water, in fish, as well as in some mammals.  The presence of such large amounts of virus in the environment means the risk of human infection continues and is not going away, despite efforts at eradication in the past few years

And you'd better stockpile those supplies now because you wont have time.

The first part of the global strategy involves dealing with the initial outbreak.  The key is to get there quickly.  Nabarro says they have about 20 days to get there and work with local authorities, to try and contain it, otherwise containment will fail.   But if the initial outbreak is near an international airport, if people start traveling, etc then we won't have those 20 days.

Thank you dear Doc... i notice a turn in your communications. You seem to be telling it like it is now... rather than patting countries on the back for their cooperation. Maybe you are no longer hoping they will cooperate anymore. Maybe we will start to hear the truth from you now... that certain countries - any countries that have the virus in them, should share them with the WORLD WIDE body of scientists, researchers, educators, in the public and private sectors to find an answer to ...

This combination of the possibility of a global megadisaster with huge uncertainties bumping up against people's livelihood

So tell me Doc... how many humans will die if H5N1 is unleashed onto this unsuspecting planet's 6 billion plus population?

Tell the truth


on the 2-3% mortality
I think he was referring to the planning scenarios that countries use.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Hmmm ;-)
You seem to be telling it like it is now... rather than patting countries on the back for their cooperation.

He needs to do both.  That's the nature of his job.  It's not mutually exclusive anyhow.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
why 2005? n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
2007 - must be teh turnning point
Goju,

 Sigh I face that at work under the stark light of excell spread sheet and graph maild around the office to show "it is getting better"

 I agree with your post and add this condolence or advice.

 "It aint over till its over" - battle cry

 "Making prediction on the future based on teh past is like driving to work by only using the rear view mirror" - stock market advice book.

 "we made a great deal of really good plans, too bad disasters did not follow our plans."

 Cartoon showing a catapult throwing a technition into a castel wall with the caption "according to the manual it is working fine"

Kobie
"Noah built the ark when it was warm and sunny"
"Gather winter food during the warm lazy days of summer when all is well"


[ Parent ]
The idea of central planning is flawed at it's core
What Nabarro is promoting is more centralized planning, control and direction.  The idea that 'experts', 'properly prepared, organized and equipped' are going to succeed in preventing or even mitigating the impact of an influenza pandemic is a seductive but wholly flawed idea.

It won't work.  It hasn't worked in the past and it will NEVER work in the future.  I differentiate this from governmental education efforts, which have had a measurable ability to effect change in people's awareness of and reaction to various threats.

The only way to mitigate the impact of an influenza pandemic is to do what we are doing here-

-teach people about the risks;
-teach people about how to prepare;
-teach people how to be self sufficient.

Learning to think for yourself is a painful process but that is the ONLY treatment for a pandemic.  More "experts" and central planning will not move us in the needed direction.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


actually central planning is only in there
because he is the UN coordinator.  It is the most centrally-planned organization you can find.  As I see it, he is trying to get governments to adopt more adaptable and bottom-up approaches from his position at the center, and from his observations on the ground in his visits to affected communities.

In the Katrina meeting, he spent a long time on local community empowerment and how important it is to develop bottom-up strategies.

My sense is, the problems are so complex it's not possible to cover all aspects equally in one meeting, or in a 15 minute speech.  He has always been big on the humanitarian side, and he did spend a fair amount of time upfront on the suffering of the people with HIV/AIDS that I didn't write about.  

Later on in his talk, there was a more emphasis on reaching out to different sectors of society, engaging the public, communications etc.  But I didn't take as detailed notes then, cos I already got a lot of that in the previous meetings, which is why it may come across as emphasizing central planning!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I agree and disagree.
Central planning is flawed for what you said and because "one size does not fit all" Reliance on central sotres or help is to "put all your eggs in one basket"

 However

 1) Centralized reseach reduces forced duplicaiton - though ideas should be localy tested
 2) Centralized store house of information creates one stop shopping for answers - though ideas should be localy tested
 3) By acting as a cntral hub of communication you gain situational awareness

 To this end the fluwiki helps disseminate and express new ideas around a diverse population - ideas should be localy tested :o)

Kobie
Leaders inspire and then get out of the way so many can do more.


[ Parent ]
A truism:
Taken together, social, economic, governance and humanitarian consequences need to be treated with greater urgency than public health and clinical health problems.

In the U.S., this is exactly why the problem was moved over to DHS and out of the purview of CDC & public health, where it had languished for two years.  The loss of two years has bequeathed to  us the plans that we have today.  However, this is true not just for the U.S.  I don't see public health agencies in other countries working in particularly pro-active role.  From France to Australia, will there be any other choice left, in the absence of such pro-active planning, but to close borders and call out the military? Some major nations, such as China and Russia, have said nary a word about preparation for a pandemic (rather nerve wracking for such an enormous risk).  Everybody's populations should be prepared by now, at least to a baseline degree, but they aren't.  Now Nabarro feels the pressure of this virus' entry into West Bengal.  He probably knows the time for that sort of effort has been lost, that a certain baseline of preparedness for the world's populations will just not be met.  

Nabarro seems to understand that, as a consequence, everyone will close the barn door and "insulate themselves," from the individual to the national level.  He used to fight against this, but he seems to accept that it will be the reality now.  

Interestingly, his recommendations on what to do "next" now lack specifics on stockpiling PPE, antivirals, or basic provisions.  Nabarro's "what's next" plan is all about communications, coordination, and "management" of the inevitable problem.  That's very different than his prior emphasis on preparation.  He gives points to those who've pressed forward with mitigation strategies, but he undoubtedly knows they'll be unevenly applied, and in the greater scheme of things the pandemic will take its toll, regardless, and thus he acknowledges the great social and economic costs that will ensue.

Nabarro's put some emphasis on containment, and they are still hopeful about delaying the virus' reach.  Movememt restrictions from the affected area (with some maintenance of quality of life for those within), ring containment of the area (only those exposed will be given the now precious antivirals), and the rapid deployment of a vax to the affected locale, which he states won't happen because it won't exist, are still on the menu. Nabarro does acknowlege that his prior estimate of "20 days" of containment could be optimistic (no doubt he was affected, as we were, by the closeness of the call for the Long Island man connected with the Khyber Teaching Hospital cluster in Pakistan).  

This is Nabarro acknowledging realpolitik. It's Nabarro saying that it's going to happen, he acknowledges that it will probably be H5N1, and it will be bad.

I'm not surprised to hear he then said this:

Also, government and voluntary bodies have to get ready for large scale humanitarian relief.
 
I feel that the next thing we will begin to hear from these leaders is talk about how to begin the recovery.  They've mentally moved through the inevitability of a pandemic, they have clearly outlined just how bad it will be.  They know their containment efforts will ultimately fail.  I believe they're already thinking about what good they can do, at this point.  That may lie, in their minds, with pre-planning a roubust and vigorous rebuilding effort for the post-pandemic period.  Recovery planning, in the end, may, in fact, be the most important effort of all, and it needs to be done now, while things still hold together.  Watch for recovery planning to become the new emphasis.  

actually, it hasn't done that
In the U.S., this is exactly why the problem was moved over to DHS and out of the purview of CDC & public health, where it had languished for two years.

That's not so. The lead agency for this is HHS, through ASPR. At the same conference, the day after nabarro we heard FEMA (DHS) talk about the need for three days of food and water. very disappointing, but the all-hazards DHS message and the 2 week HHS message have yet to mind meld.

In many ways, HHS is ahead of DHS, in other ways it is the opposite.


[ Parent ]
in many ways
In many ways, HHS is ahead of DHS, in other ways it is the opposite.

HHS is ahead of DHS.  In other ways, HHS is unable to do certain things only because it is in the purview of DHS.  

As an example, the keynote speech given by Jeff Runge representing DHS, HIS #1 nightmare, he said is anthrax.  And he kept repeating that, anthrax is the biggest threat.  

I can't help noticing that that was not what he said in the AMA meeting mid 2007.  

We need to be aware of political realities that drive some agencies more than others.  Or political forces.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
a guy like Jeff Runge
speaking at an event like this.  His words represent official policy as far as his department is concerned.

And it's official.  Anthrax is the biggest threat.

Sleep well, everyone...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Anthrax?
Hogwash!

B. Anthracis is not readily communicable from an infected human to another, even pulmonary anthrax.  The big threat is from weaponized spores resulting in an acute pulmonary infection lethal in less than 48 hours in most cases.  For obvious reasons, I am not going to go into detail on this at all, but the statement that anthrax is a greater threat than a pandemic strain of influenza such as H5N1 is so grossly ridiculous it strains belief!

Now, influenza is not the only strategic biological threat out there.  Frankly, I am seriously concerned about the threat of smallpox, as it is also very infectious, and if any of the GM versions are as infectious they would be very nasty bugs indeed.  Both smallpox and influenza have the potential to be employed as strategic WMDs.  But anthrax?  That's a terror and tactical weapon, effective in the area of deployment only.  Not even in the same league as the major viral killers.

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
;-) see what I mean? n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what did he say in 2007?
If anthrax is DHS' Jeff Runge's biggest nightmare NOW, what did he say in 2007 at the AMA meeting?  

Did that problem get fixed?

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
Oh he didn't give a specific item of concern
Just general thoughts on integrated preparedness, end-to-end planning, shared responsibility, everyone has to use NIMS, etc.  And he gave a scenario of a nuclear devise in a city, but it wasn't presented as the main threat, just a scenario.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
another example
in one of the preconferences I went to, specifically on pandemic flu, the DHS guy talked about infrastructure continuity.  It was all happy talk, about how these companies are well aware of the problems and preparing for them, and, just like Jeff Runge, it was also about all the different documents/plans they have written.

At the end, I asked this question: to the extent that 85% of infrastructure is in private hands, and to the extent that their state of preparedness is proprietary information (his words not mine) is there any mechanism of compulsion, that the government can in any way ENSURE that they are preparing instead of just saying they are preparing.  If a company does a risk analysis, and decides that the cost of preparing is so high and their margin so thin, that the cost cannot be justified to their investors, that they might as well take a risk and not prepare.  Or even if they prepare, chances are a pandemic is going to be so bad and they will be affected by everyone else who hasn't prepared, that they might as well take their profits now and just fold in a pandemic, cos they are likely to fold anyway.

His answer?  Oh, they are preparing all right.  No there are no mechanisms for compulsion, but why wouldn't they prepare?  They have all these smart risk experts working for them, they know the risks and they all know what to do.  Do you have any idea how many smart people they employ?  (or something to that effect!)  Of course they are preparing.

Short summary?  DHS is saying trust the private companies to keep the infrastructure going because that is what they are telling us, despite the fact that we do not have any means of verifying whether they are doing what they are saying they are doing!!!

It's a looking glass world that they live in...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
in summary
I agree with Nabarro in principle, have always done so from day 1, on this

Taken together, social, economic, governance and humanitarian consequences need to be treated with greater urgency than public health and clinical health problems.

It's just that in the case of the US, the security (vs the health side) side of the government has been dysfunctional and almost non-functional since birth, for unfortunate reasons of history, and is likely to continue to be so for the foreseeable future.

Their insistence on terrorism as a bigger threat than pandemics is rearing its head again.  Watch that phenomenon and what it's likely to do for pandemic preparedness.  Watch the fight for direction in developing the SNS.  That will tell us which side is winning and where the money is going to go.

Money taken away from panflu, from HHS, if it were to go to DHS, is not going to be spent on panflu, is my current assessment.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
for background reading
To understand the issues, and how the pendulum is swinging, read this Transitions II diary especially my recent updated comments here



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
no mechanisms for compulsion
Susan, THANK YOU for asking that question.   Even if you don't get an answer you are looking for, the fact that you ask a question about "mechanisms for compulsion" at least brings it up among the other people present.  AND it kind of makes me wonder about them -- why aren't THEY asking those questions?

4

His answer? Oh, they are preparing all right.  No there are no mechanisms for compulsion, but why wouldn't they prepare?  They have all these smart risk experts working for them, they know the risks and they all know what to do.  Do you have any idea how many smart people they employ?  (or something to that effect!)  Of course they are preparing.

Well, just look at the recent report from the Department of Energy, where some 34% of Dept. of Energy's OWN agencies or entities, did NOT have a pandemic plan of any kind, and they said essentially, they didn't have one because no one required them to have one.

(discussed here:  
http://www.newfluwiki2.com/sho...

"The Continuity Program Manager asserted that he was unable to require all entities to develop a plan because there was no enforceable criterion, such as a DOE order....(snip)...
Further, we were also told by some entities that had not submitted a pandemic plan that they were waiting for a DOE order. Thus, we believe that it is important for there to be an enforceable requirement that all DOE entities have a pandemic plan."

Some of these entities that did not have a plan (ANY kind of a plan!) were electricity producing companies.   Like THIS ONE:


"The Bonneville Power Administration (BPA) is a U.S. self-financed federal agency which transmits and sells wholesale electricity in Washington, Oregon, Idaho, and western Montana. The BPA is part of the U.S. Department of Energy, and is headquartered in Portland, Oregon.

The BPA was created in 1937 to transmit and market the hydroelectricity generated from the Bonneville Dam and, later, the Grand Coulee Dam and other federal dams in the Pacific Northwest. As of 2006, BPA provided about 35% of the electricity used in the region."

 wikipedia



GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
oh but I DID get an answer
Even if you don't get an answer you are looking for,

It was not an ideal answer, but in one go it answered a LOT of my questions, gave me a lot more ability to assess the state of infrastructure resilience and preparedness, now and for the foreseeable future.

And it is NOT GOOD.  At all.

why aren't THEY asking those questions?

You know what?  Such WHY questions are really beyond me.  I will have to step into their shoes to figure them out, and frankly, when I do that?  Again, I don't find good answers at all.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
...
yeah...  can't really go there, tho, without offending alot of folks that mixed, drank, and sold the deregulation Kool-Aid.  for those folks - "eat, drink, and be merry" appears to be the mindset of choice...  it is only half the quote, but the deregulation folks were smoking crack anyway, so why bother with details (nobody wants a downer once they've achieved a good high)?  

the only way to ensure CI is maintained adequately, is to regulate it.  that will cost more, and it will be political suicide for whoever is in office.  


[ Parent ]
...
case in point, the telecom act of 96...
http://www.fcc.gov/telecom.html

open the market place, increase competition...  and along the way, drive any business that wants to survive to cut costs wherever possible, cutting resilience, staff, and forcing optimization of JIT supply chains.

the people got exactly what they asked for.  it will take leadership, education, and alot of time - to undo the damage.  we're weak because the people didn't want to pay for strong.


[ Parent ]
But you were answered
that they are asking those questions.  

We've just seen a total breakdown in a command-style centrally controlled, fully "publically owned," infrastructure in China as a result of a natural indicent - a snow storm.  

Where is the transparancy there that would allow us to evaluate that sort of system as better able to respond than the semi-private, or public-private partnership of the American infrastructure can be expected to respond?  I'm just not seeing any advantages in the recent demonstration of a centralized command/control system.  

Does the UK or any other nation you can think of have better answers to the questions you are asking?  Or, is everyone pretty much, from the U.S. to China to the U.K., assuming such answers are not for general circulation as they could be potentially considered matters of national security?

The lack of answers you are receiving does not worry me. I suppose that could be inferred if everyone else is answering those same questions, but I don't believe that's the case.


[ Parent ]
I'm not interested in comparing any country to any country
as you seem to be.  I have no knowledge except for that one question that I shared here.  For the purpose of informing the public.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
It's just that I often see
criticism of the U.S. systems and solutions, but don't notice a similar level of criticism leveled elsewhere. It seems to me there should be a better balance of that.  

Besides, it's not really possible to project what "should" be done here, without examining alternative efforts, and making some comparing against at least those standards (if there are no objective standards available).  If that's not done, analysis is done in a kind of a vaccuum, and the situation is, in reality, not being explored as fully as it might be (leading to perhaps lopsided conclusions).


[ Parent ]
I'm afraid you are confusing
It's just that I often see  criticism of the U.S. systems and solutions, but don't notice a similar level of criticism leveled elsewhere.

absence of evidence with evidence of absence.  If we apply your logic, does that mean that we are satisfied with everything under the sun that is not talked about on this forum?  Clearly that is not the case.

Just cos something is not mentioned, does not mean anything other than it is not mentioned, period.  All of us are of course free to express our opinions, or criticism (your word not mine), so you are certainly free to compare the US to whatever country you want.  But please do not make inferences on others (or to be precise my) comments where they do not exist.

There are many reasons why certain things are discussed more than others.  In this specific instance, it was because this was a US meeting that Dem and I attended, that we are reporting on, and that the question that I asked, was to an official of the US government.

I do and will report on other countries such as Europe as when they arise.    In fact, did you not read that I have just written a 13 page critique of public health measures for the EU?  You are certainly welcome to comment on those for comparison!!  I do and will comment/report on China or any other country as when the issues arise, but alas I have far less ability to access information due to the nature of that country, but I do share what I can when I can, such as giving the ad hoc translation when the Nanjing cases were breaking out.

it's not really possible to project what "should" be done here, without examining alternative efforts, and making some comparing against at least those standards

Really?  That may be your approach to problem solving, and that's fine.  It isn't mine.  Good alternative efforts may or may not exist out there.  There may not be any valid comparisons, particularly for a novel and mega disaster like a pandemic.  We are making it up as we go along.  To limit our thinking by doing comparisons to existing solutions (if they exist at all) is IMHO not going to dig us out from under the mess that a pandemic will cause.

Like I said, being just a little better than totally dead is not my goal, thank you very much!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Um, I don't know about that
The lack of answers you are receiving does not worry me. I suppose that could be inferred if everyone else is answering those same questions, but I don't believe that's the case.

It is cold comfort to know that everyone else is just as or even more screwed than you are, is how I think about this.  

A little bit less dead is just not good enough, but then that's just me.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
infrastructure continuity
re:"infrastructure continuity"-the context this is in really gets me as each little town, township, etc is in and of itself an infrastructure, a small to large business entity in its' own right depending on size.

My town has 40,000 residents-30 miles away is Philadelphia with 1.5 million residents.

Why not the forethought to tell towns they are the infrastructure that needs to plan its' own continuity??? This brings in local planning etc.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
National Response Framework, etc.
According to the National Reponse Framework, neither HHS nor FEMA have the lead.  DHS is clearly defined as the lead agency for "all domestic incidents requiring multiagency Federal response."  That would be a pandemic.
From the National Response Framework:  http://www.fema.gov/pdf/emerge...
Principal Federal Official (PFO). By law and by Presidential directive, the Secretary of Homeland Security is the principal Federal official responsible for coordination of all domestic incidents requiring multiagency Federal response. The Secretary may elect to designate a single individual to serve as his or her primary representative to ensure consistency of Federal support as well as the overall effectiveness of the Federal incident management.

So, does a pandemic qualify for such an incident manager, taking the problem out of the hands of FEMA (and HHS)? Yes, it does:
Congress has provided that, notwithstanding the general prohibition on appointing a PFO for Stafford Act incidents, "there may be instances in which FEMA should not be the lead agency in charge of the response, such as a pandemic outbreak or an Olympic event." In such cases, the Secretary may assign a PFO.

And what will the PFO do?
The Secretary will only appoint a PFO for catastrophic or unusually complex incidents that require extraordinary coordination. When appointed, the PFO interfaces with Federal, State, tribal, and local jurisdictional officials regarding the overall Federal incident management strategy and acts as the primary Federal spokesperson for coordinated media and public communications.

They will also help resolve any inter-agency bickering:
...the PFO promotes collaboration and, as possible, resolves any Federal interagency conflict that may arise. The PFO identifies and presents to the Secretary of Homeland Security any policy issues that require resolution.

Then, is this just a hypothetical that maybe will happen?  Nope.  It's already a done deal:  
Pre-Designated PFOs and FCOs. In certain scenarios, the Secretary of Homeland Security may pre-designate a PFO and/or FCO....For example, beginning in 2007, the Secretary pre-designated a national PFO and five regional PFOs together with a national FCO and regional FCOs, who will serve in the event of a nationwide outbreak of pandemic influenza or other similar nationwide biological event.

So, we already have a pre-selected "bird flu Czar" who will report directly to the Secretary of DHS.  Also pre-selected are 5 regional pandemic FCO's (who represent the FEMA administrator in the field).  So it appears their organizational plans are moving ahead, and that's probably a good thing.  It looks to me like the authority moves from the President to the Secretary of DHS to the PFO to the FCO's, with the PFO tasked with coordinating agency response.  So who is this Pandemic PFO?
Consistent with his role under Homeland Security Presidential Directive (HSPD) 5, Secretary Chertoff pre-designated Vice Admiral Crea, the Vice Commandant of the US Coast Guard, as the National Principal Federal Official (PFO) for pandemic influenza and has pre-designated five regional PFOs and 10 deputy PFOs. http://www.dhs.gov/xnews/testi...  

Dr. Jeff Runge testified as to which agency would be in the lead during a pandemic during his testimony to a Committee of the U.S. House of Representatives on 05/11/06: http://www.dhs.gov/xnews/testi...
As the domestic incident manager, the Secretary of DHS will coordinate the overall Federal response to a pandemic in order to ensure the continuity of our government, maintain civil order, preserve the functioning of society and mitigate the consequences of a pandemic. The Secretary of DHS serves as the principal Federal official for overall domestic incident management. In this role, during a pandemic outbreak, the Secretary of Homeland Security is responsible for the coordination of Federal operations and/or resources, establishment of reporting requirements, and conduct of ongoing communications with Federal, State, local, tribal, private sector, and nongovernmental organizations...

This need for coordination of our National instruments is part of the reason that DHS exists. A pandemic could threaten the ability of the health and medical sector to manage all the consequences, which could likewise threaten the functioning of society and the Nation's economy. It is the responsibility of DHS to coordinate the Federal response to manage those risks.


The lead medical voice also belongs to DHS, it seems:
In the event of a pandemic, a close, synchronous working relationship with HHS is essential. Our national Public Health and medical resources will unquestionably be taxed, probably beyond capacity, and DHS will do everything in its power to assist HHS with its mission to prevent illness and mitigate the consequences of the anticipated widespread morbidity and mortality. The DHS Chief Medical Officer is the primary point of interface with HHS and is responsible for advising the Secretary of DHS on all medical issues, including avian influenza.

The testimony of Dr. Til Jolly to another U.S. House of Representatives Subcommittee reiterated the pandemic command structure on 9/26/07:  http://www.dhs.gov/xnews/testi...
As outlined in the Implementation Plan DHS is responsible for the coordination of the overall domestic Federal response during an influenza pandemic, including implementation of policies that facilitate compliance with recommended social distancing measures, development of a common operating picture for all Federal departments and agencies, and ensuring the integrity of the Nation's infrastructure, domestic security and entry and exit screening for influenza at the borders

HHS is given a very specific role, and DHS recognizes it:
DHS recognizes the key role of HHS in its responsibilities to lead clinical disease surveillance and rapid detection during a pandemic, and, under Emergency Support Function (ESF)-8, to plan, prepare, mitigate and support the coordination of the public health and medical emergency response activities during a pandemic under ESF-8, including the deployment and distribution of vaccines and of antivirals and other life-saving medical countermeasures from the Strategic National Stockpile.

Dr. Tily then gives a similar polite nod to the expected contributions of the State Department and the USDA.

There are no doubt overlapping responsibilities that will be encountered in the real-world of pandemic (and I don't think they've run a national-level exercise since all this was hammered out, which might be a good idea). But I'm hearing in all of this that DHS has the lead, and that HHS is but one of the agencies working on assigned aspects of the pandemic, yet one of many agencies DHS is tasked with coordinating as lead agency.
 


[ Parent ]
no
in fact, all the testimony prior to Dec 2006 is null and void. DHS was scrambling to take the lead, but PAHPA took care of that. From a post I wrote  in Sept. 2007:

A flu pandemic, as a public health issue, would fall under ESF #8 - Public Health and Medical Services which includes:

  • Public health
  • Medical
  • Mental health services
  • Mortuary services
and would have Health and Human Services as lead agency (this was actually established by statute in 2006 by Congress because of confusion between DHS and HHS). The Pandemic and All-Hazards Preparedness Act (PAHPA)
created a lead federal official for public health and medical emergency preparedness and response within the HHS named The Assistant Secretary for Preparedness and Response (ASPR), currently RADM Craig Vanderwagen, a family physician with significant prior experience with the Indian Health Service, service in Iraq, and the HHS senior officer in the HHS responses during the 2005 Hurricane season and the Tsunami, serves as the lead official for Emergency Support Function #8, the Public Health and Medical Annex under the National Response Plan [to be replaced by the proposed National Response Framework with changes in the annexes].
GAO still wants further clarity, but what's supposed to happen is clear (HHS is lead agency by act of Congress). What does happen is anything but clear.

[ Parent ]
...
i didn't get that impression reading through the NRF core document issued January 2008; it appeared that DHS has lead for anything requiring federal response (i would expect HHS to know ESF 8 - anything else would seem outside their area of expertise).  i wouldn't expect HHS to know anything about ESF 12 resources or capabilities, but DHS would (and does).  i would expect DHS to grant HHS lead for the medical aspects, but not overall lead.

[ Parent ]
funny how DHS doesn't want to give anything up
Congress' intent and HHS' understanding is that HHS is the lead agency specifically for pandemics, and within the NRF, for ESF-8 (but not for DoD). See graphic from NRF site, where DHHS is coordinator for ESF-8:

In theory, it's HHS that distributes the Strategic National Stockpile of meds, though DHS may be responsible for the logistics.

Not that anyone in DC ever has turf battles (with terms like lead agency vs overall lead, how could that ever happen?). But when someone from DHS says, no, it's us, that does not make it so.


[ Parent ]
funny you should say that ;-)
funny how DHS doesn't want to give anything up

that is precisely the issue.  Pandemics is just one more item caught in a bigger turf-war.  The development of medical countermeasures for the Strategic National Stockpile is one battle-front.  http://www.newfluwiki2.com/sho...  The conflict is between those who believe they can run things by executive order vs authorities enshrined in legislation.  The PAHPA is very clear in giving ASPR the authority to direct the development of medical countermeasures and vaccines, which is what Bob Kadlec made the point of emphasizing, in his recent speech, in his reference to hspd 18.

This is part of an ongoing pattern, like the draft NRF that came out last September that caused such an uproar (and some resignations).  The role of FEMA vs DHS was fought over even though it had already been enshrined in legislation (the Post-Katrina Emergency Reform Act, enacted as part of the FY 2007 DHS Appropriations Act, P.L. 109-295.)  

The new NRF, the actual version that eventually got published, had to include an explicit reference to the legislation every time the role of the FEMA administrator was mentioned, to hammer home to DHS they need to comply with the LAW.

Another example, the new NRF has re-organized the 15 planning scenarios into 8 new categories, but in his talk, Jeff Runge was still referring to those old categories.  Can it be he didn't get the memo that they have been changed?  I don't think so.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
and we can't see his slides
cos they are 'too large to post'  http://www.emergencymanagement...

Other speakers either had slides included in the manual, or did not use slides, like Vanderwagen.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
...
HSPD 5 doesn't give DHS any room to give anything up, want or otherwise.  the responsibility flows through DHS to whatever lead they designate - and that designated lead runs with it.  if bad things happen in a COG scenario, tho, and the designated lead is no longer capable of handling the task for whatever reason, the task still must be handled - which means it would need to be re-assigned to another dept until the issues are resolved.  at that point, i'd expect DHS to re-assign ESF 8 to another entity - which one would depend on how much of govt remains operable.

if i'm reading it correctly, HHS is only granted lead for ESF 8 functions in a pandemic - which, while massive, will not be all that has to be handled.

i understand the turf war concerns - but there is a huge difference between just preparing for the ESF 8 aspects, and preparing for all aspects; ESF 8 doesn't cover all CI.

to my knowledge, DHS has lead for all events requiring federal response; in the case where that event is a pandemic, HHS has been designated to lead the ESF 8 response and support operations.

now....  that's just my understanding, and i've made mistakes before.. so...  ;-)


[ Parent ]
you are right
ESF 8 doesn't cover all CI.

DHS is in charge of CI, which is where the problems that I referred to above arise.

It's also my understanding that legislation takes precedence over presidential directives.  That said, much of hspd5 that set up DHS was also enshrined in legislation with the creation of the Department.

The whole process was complicated and fraught with problems from day 1.  Which is why I referred to it as dysfunctional from birth, or by birth.

Note also the CI issue causes problems for personal preparedness.  HHS as the public health response agency, cannot recommend preparedness based on assessment of how well or not critical infrastructure is going to hold up.  That is DHS's domain.  They can only make recommendations based on public health needs, ie voluntary home isolation and quarantine for families with infected people.  Ergo two weeks!

DHS has in a very clever sleight of hand, published this document called Pandemic Influenza: Best Practices and Model Protocols (April 2007) in which it refers to how the population may be asked to go into self quarantine for 90 days, and also how different EMS entities should make sure they have enough supplies for 90 days etc.  You would think this is an official policy document or guidance from DHS, but no, it isn't.  Not exactly.  Read the following very carefully and determine for yourself whether it is or is not GUIDANCE GIVEN BY DHS!

The purpose of this document is to provide guidance for developing best practices and model protocols for use by State, local, tribal, and territorial personnel in the development of pandemic influenza plans, preparedness activities, training, and exercises. The content contained herein is a synopsis of input received from Federal, State, local, territorial, and tribal emergency medical services (EMS), fire, emergency management, public works, and sector-specific participants during a three-day forum sponsored by the Department of Homeland Security (DHS) Chief Medical Officer and hosted by the U.S. Fire Administration on 23-25 February 2007. The results of this forum are being coordinated with the ongoing efforts of the Department of Transportation (DOT), the Department of Health and Human Services (HHS), and others.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
...
agree...  they put their seal all over it, but it's merely a synopsis of input received.  if they didn't agree with it, they wouldn't have put it out there, and certainly not with their seal.  which seems to make it an official unofficial document.  plausible deniability comes to mind - it can be claimed, or disclaimed..

[ Parent ]
precisely!
Jeff Runge in the AMA meeting was also very adamant, when I asked him, that DHS is in charge of personal preparedness.

If so, I haven't heard anything from his department telling the public to prepare, have you?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
...
not since the Ready.gov push back in the fall..  
http://www.dhs.gov/xprepresp/

i wouldn't call that pandemic prep, tho...  we need new words - the ones we have just don't scale.  and it's easy for folks to misunderstand what is being discussed, because they miss the difference in context.

a fatality in a wreck may be a tragedy, a tornado may be a disaster, a hurricane may be a catastrophe, a pandemic that goes on for 18 months...?


[ Parent ]
it's called a megadisaster!
It's a good word.  We gotta start using that, methinks!!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
agree with that
and your comments about DHS having 'greater function' than ESF-8. HHS is in charge of public health aspects and pandemic preparedness though ASPR, but not ALL aspects of same. ASPR, a part of HHS, is charged with coordinating with DHS.

However, the issue originally raised by Pixie


In the U.S., this is exactly why the problem was moved over to DHS and out of the purview of CDC & public health, where it had languished for two years.
which led to this side discussion is simply not so. The problem was not "moved over to DHS and away from CDC etc." HHS remains ESF-8 lead agency, unambiguously in charge. What's ambiguous is that anything that's not ESF-8 is DHS.

[ Parent ]
The quotes I used
to support that statement came from the most recent (and I believe final) word on how pandemic response will be structured:  The National Response Framework, dated January, 2008.  

Those direct quotations from the National Response Framework demonstrate that HHS is tasked with the medical response, but is not lead agency (which is critical for decision making).  Not for a pandemic, which has been singled out as a special circumstance.

HHS's role in a pandemic is strictly cubbyholed: "health and medical" response.  As I highlighted, that means vax, antivirals, SNS, etc.  That's a very specific, limited tasking. Overall lead, and consequently overall decision making - which was the topic of my initial point - has been handed to DHS.  The National Response Framework (1/08)states that clearly.  

Is there ambiguity on who will make some of the key medical decisions?  There might be some there.  The role of the DHS Chief Medical Officer, in the key advisory role to the DHS head, and the DHS chief (who has the ultimate decision making authority) may cause some confusion as to who makes some of the important decisions on even medical issues.  Overall, HHS has tasks to accomplish during a pandemic, but they will not be making the major decisions. (Realistically, they should run a simulation on the kind of monkey wrenches that could arise with any potentially overlapping areas of jurisdiction such as that between the DHS Chief Medical Officer & CDC's head, or potential differences of opinion between DHS' decision making authority on border protection vs. CDC's Quarantine Office viewpoints, well before TSHTF).  

I highlighted Runge's testimony to Congress on 5/11/06 and Tilly's testimony to Congress on 9/27/07 to point out that these roles have been defined for some time now, and the new National Response Framework (of 1/08) does not change them but rather clearly articulates them, very specifically, for a pandemic.


[ Parent ]
I'm sorry
I understand what you said, but with all due respect, I do not believe your interpretation is correct. DHS can write all the regulations for making itself paramount that it wants, but it does not have the force of law that PAHPA does.

PAHPA was passed in Dec '06. In Aug '07 GAO studied the lay of the land:

What GAO Found
An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics occur when a novel virus emerges that can easily be transmitted among humans who have little immunity. In 2005, the Homeland Security Council (HSC) issued a National Strategy for Pandemic Influenza and, in 2006, an Implementation Plan.

Congress and others are concerned about the federal government's preparedness to lead a response to an influenza pandemic. This report assesses how clearly federal leadership roles and responsibilities are defined and the extent to which the Strategy and Plan address six characteristics of an effective national strategy. To do this, GAO analyzed key emergency and pandemic-specific plans, interviewed agency officials, and compared the Strategy and Plan with the six characteristics GAO identified.

What GAO Recommends

GAO recommends that (1) DHS and HHS develop rigorous testing, training, and exercises for pandemic influenza to ensure that federal leadership roles and responsibilities are clearly defined, understood, and work effectively and (2) the HSC set a time frame to update the Plan, involve key nonfederal stakeholders, and more fully address the characteristics of an effective national strategy. DHS and HHS concurred with the report. HSC did not comment.

The executive branch has taken an active approach to help address this potential threat, including establishing an online information clearinghouse, developing planning guidance and checklists, awarding grants to accelerate development and production of new technologies for influenza vaccines within the United States, and assisting state and local government pandemic planning efforts. However, federal government leadership roles and responsibilities for preparing for and responding to a pandemic continue to evolve, and will require further clarification and testing before the relationships of the many leadership positions are well understood. The Strategy and Plan do not specify how the leadership roles and responsibilities will work in addressing the unique characteristics of an influenza pandemic, which could occur simultaneously in multiple locations and over a long period. A pandemic could extend well beyond health and medical boundaries, affecting critical infrastructure, the movement of goods and services across the nation and the globe, the economy, and security. Although the Department of Health and Human Services' (HHS) Secretary is to lead the public health and medical response and the Department of Homeland Security's (DHS) Secretary is to lead overall nonmedical support and response actions, the Plan does not clearly address these simultaneous responsibilities or how these roles are to work together, particularly over an extended period and at multiple locations across the country. In addition, the Secretary of DHS has predesignated a national Principal Federal Official (PFO) to facilitate pandemic coordination as well as five regional PFOs and five regional Federal Coordinating Officers. Most of these leadership roles and responsibilities have not been tested under pandemic scenarios, leaving it unclear how they will work. Because initial actions may help limit the spread of an influenza virus, the effective exercise of shared leadership roles and responsibilities could have substantial consequences. However, only one national multisector pandemic-related exercise has been held and that was prior to the issuance of the Plan.

from page 5:


The Strategy and Plan indicate that both the Secretary of Health and Human Services and the Secretary of Homeland Security will have leadership responsibilities that are consistent with the NRP - the former for leading the federal medical response to a pandemic and the latter for overall domestic incident management and federal coordination.

GAO and everyone outside of DHS does not give DHS the powers you say. This is clearly joint custody, and NRF does not change that. The decision making you cite, in fact, is HSC (i.e., the WH) and not DHS at all. That's why the hspds have such force, and while many of the hspds have to do with biologic weapons, not pandemic, hspd 21 incudes natural outbreaks and entirely concerns HHS and not DHS.

http://www.google.com/url?sa=t...


[ Parent ]
But again, HSPD-21
is a planning document, and one which puts the full force of the law behind compelling that planning of certain kinds be done by certain dates.  

Planning is very different from response, however, and its delineation as far as responsibilities go.  


[ Parent ]
hspd, ie presidential directives
But again, HSPD-21 is a planning document, and one which puts the full force of the law behind ....  

do not carry the full force of law.  They are executive directives, policy documents that the president writes for the various departments to implement.  Yes, the president has authority by the powers vested in his office, by him simply being president, to get his subordinates to do things, but still policy directives do not carry the same weight as legislation in that failure to comply or implement those directives or acting in violation of them is not an indictable offense, at least that is my understanding.

If the president tells Mike Leavitt to do something, for example, and Leavitt refuses, the worse that can happen is that he gets fired.  But he can't be prosecuted for it.  Again just my understanding.  For civilian matters of course.

In fact, historically sometimes presidential directives that are deemed to have violated some acts of congress are often the subject of potential impeachment discussions, such is the overarching power of the legislative over the executive.  AFAIK.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
see also
Building on the Public Health Service Act,3 PAHPA seeks to ensure that national authorities are organized and well equipped to respond to a catastrophic event. The act aspires to answer the question of "who is in charge" by squarely placing the Department of Health and Human Services (DHHS) as the lead agency for "federal public health and medical response[s] to public health emergencies covered by the National Response Plan,"2 which otherwise vests most emergency management functions in the Department of Homeland Security.4 This represents a significant shift of federal authority for the public health components of emergency responses.

http://www.pacercenter.org/pdf...

That could not be any clearer.


[ Parent ]
Except for pandemic
which is pulled out, into its own special category, in the new (published 1/08)  National Response Framework, which supersedes the National Response Plan (which will be defunct on March 22).

[ Parent ]
show me exactly where it says that, please?
PAHPA is law and NRF incorporates it. NRF is a guide, not a law. It also specifically says
The Incident Annexes describe the concept of operations to address specific contingency or hazard situations or an element of an incident requiring specialized application of the Framework. The overarching nature of functions described in these annexes frequently involves either support to or cooperation of all Federal departments and agencies involved in incident management efforts to ensure seamless integration of and transitions between preparedness, prevention, response, recovery, and mitigation activities.

The Incident Annexes published with the National Response Plan remain in effect


From page 90 of the NRF document Printable Version All Annexes (referring to and defining ESF-8):

The Secretary of Health and Human Services (HHS) leads all Federal public health and medical response to public health emergencies and incidents covered by the NRF. The response addresses medical needs and other functional needs of those in need of medical care, including assistance or support in maintaining independence, communicating, using transportation, and/or requiring supervision.

The Secretary of HHS shall assume operational control of Federal emergency public health and medical response assets, as necessary, in the event of a public health emergency, except for members of the Armed Forces, who remain under the authority and control of the Secretary of Defense.

http://www.fema.gov/pdf/emerge...

Where are you are getting the idea that HHS has had pandemic 'pulled out' from it, or that pandemic has been pulled out?  


[ Parent ]
see also this from ASTHO


[ Parent ]
here's the expert's view
from a presentation at the National Emergency Management Summit, by James G. Hodge, Jr., J.D., LL.M. Associate Professor, Johns Hopkins Bloomberg School of Public Health; Executive Director, Centers for Law & the Public's Health

Legal Considerations in Real-time During Disasters and Public Health Emergencies (slides available here)

Best summary of PAHPA I can find.

 



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
the paper I cited
in this comment is by James Hodge. ;-)

[ Parent ]
yeah, he's DA GUY
for all that legal stuff!  LOL!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Dem, two points
HHS has lead on all health-related incidents except for a pandemic, which is specifically exempted and given it's own response structure in the new National Response Framework (1/08).

Plus, the National Response Plan which you cite has been superseded.  It's old news.

National Response Plan:

The National Response Framework (NRF), successor to the National Response Plan, has been released and will become effective March 22, 2008. Until that time, the National Response Plan, last updated May 25, 2006 remains in effect. http://www.dhs.gov/xprepresp/c...


and:
The National Response Plan, last updated May 25, 2006, establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents. It forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents.  

The National Response Plan remains in effect until the National Response Framework becomes effective on March 22, 2008. http://www.dhs.gov/xprepresp/c...


So, if pandemic happens between now and March 22, you're right, and I stand corrected.  

If pandemic happens after March 22, the National Response Framework goes into effect and the roles, as noted, are re-defined.  


[ Parent ]
they are not superceded.
PAHPA supercedes the NRF.

That's exactly why congress passed the law.


[ Parent ]
I smell a turf war
and I have some idea who'll win.  ;-)

But really, they should be gaming this now.  


[ Parent ]
actually HSC and the WH
(Homeland Security Council), Rajeev Vankayya's old home, always wins.  ;-)

[ Parent ]
I just posted news about him
as a matter of fact.  ;-)

[ Parent ]
speak of the devil!
your comment is well taken about gaming; GAO says what's needed is exercises and field testing to clarify our discussion.

[ Parent ]
This is mindboggling! How are all our local authorities going to work their way
through this thicket of print and come up with anything useful before TSHTF?   Here we have intelligent people who are really concentrating, and they come to different conclusions.  Is it any wonder that our officials are letting it go until later?  After all, there will probably be a new set of books about this in 6 months, so "let's wait and let the next guy do it."   deep sigh.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
see GAO report
for the answer. ;-)

see comment here:

http://www.newfluwiki2.com/sho...

and it is exactly why we are raising this now and not during a pandemic.


[ Parent ]
yes and no
The officials that I've spoken to, feds as well as state ones, are pretty clear about the chain of command.  Yes there are some issues that need to be worked out but the major areas are pretty well defined.

For example, you can see the delineation of responsibility in this line-up of speakers in the recent conference, in the pandemic reconference http://www.emergencymanagement...


National Pandemic Influenza Medical Countermeasure Programs

Robin Robinson, PhD
Director, Influenza, Assistant Secretary for Preparedness & Responses Biomedical Advanced Research & Development Authority, U.S. Department of Health & Human Services, Washington, DC
Presentation Material (Acrobat)
Presentation Material (Powerpoint)

2:00 p.m. Implementing a Continuity of Operations Plan: Essential (COP-E) for Pandemic Influenza

Jim Caverly
Director of the Partnership and Outreach Division, Office of Infrastructure Protection, Department of Homeland Security, Washington, DC


2:45 p.m. Pandemic Influenza Checklists

Toby L. Merlin, MD
Director, Division of Public and Private Partnerships, National Center for Health Marketing, Coordinating Center for Health Information and Service, Centers for Disease Control and Prevention, Atlanta, GA
Presentation Material (Acrobat)
Presentation Material (Powerpoint)





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Talking about Congress is Wrong!
The Departments and Agencies you are talking about belong the the Executive branch of the Federal Government.  The Congress has only one item of involvement in the running of those agencies and departments.  It is funding.

Any resolution passed by Congress, but not signed into law by the President has NO SWAY in the running of or who is lead agency in a crises.  Only the President can make that call.

Remember how FEMA reacted during Katerina. They did just what they were required to due until the Governor(s) of each state asked for additional help/support.  Then it was given as needed.

RICH-FL

  No warning - no way to fight - no way to win!  
We need help in our local communities to survive. Remember that quote:    "...No man is an island..."


[ Parent ]
PAHPA was passed into law n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
National Response Framework=
...an All-Hazards approach to everything, except pandemic. The emphasis is on WMD, terrorism. Somehow we can take the template for anthrax for example and apply it to pandemic.

Like that'll work..... ;/

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
No, the National Response Framework
very specifically pulls "pandemic" out of the morass of threats, and gives it its own leadership, chain of command, etc.  

That's exactly the point.  Pandemic response has been singled out for special treatment in the new National Response Framework.  Nothing else has been treated in the same way, and all other hazards - biological or terrorist - are left in the same basket, except for pandemic.  


[ Parent ]
hmm....
All NRF refers to is the 2005 WH National Strategy for Pandemic Influenza, since amended. Everything else is in ESF-8. This is from the NRF "additional resources" section:

National Strategy for Pandemic Influenza guides our preparedness and response to an influenza pandemic, with the intent of (1) stopping, slowing or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic, and mitigating disease, suffering and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society.

I can't find any other reference to pandemic on the NRF site with all its documents, annexes, etc. and certainly nothing outside of ESF-8 that changes our discussion above about who is in charge of what, unless you know something else.


[ Parent ]
Letter to Gov.
After a long day of research and phone calls, I have drafted this letter to my governor:

Sir:

Pandemic planning-for the local/township level-seems to have 'fallen through the safety net' within New Jersey.

I am a volunteer member of the Winslow Township (Camden County) local board of health (non-enforcement). Along with another registered nurse, we have tried without success to have our town prepare for pandemic planning.

Neither the state nor the county have mandates to make a town plan for this specific hazard, which falls outside the All-Hazards approach to disaster planning and mitigation.

FEMA offers no specific mandates or grants, as counties do not include pandemics under "All Hazard Mitigan Plans"-these address natual diasters id floods, tornadoes.

DHS offers no mandate or funding-Camden County is not even under the UASI (Urban Area Security Inititative) funding (not enough population or infrastructure). Yet I live within a half-hour's drive of Philadelphia-a city with well over 1 million residents. The pandemic that impacts them will have a huge ripple effect for my town.

I doubt my town will do any type of serious planning without a mandate to do so, and probably funding. Where is this to come from?

Please provide some concrete help and guidance for my township, as well as the other small towns in New Jersey.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
good for you
and specifically ask for a response!

[ Parent ]
re letter
I will; my governor has been very good about getting back to me when I've called or emailed-although everything before this was related to patient issues at work.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
thank you
and best of luck to you!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
One question.

In a likely pandemic scenario with a highly pathogenic virus that spreads very quickly (controls aren't in place to stop the spread within a few weeks time), near mayhem at overloaded hospitals and clinics...and a relatively high mortality among patients..

How many volunteer medical people are going to step forward to risk their lives?

The government hinges a sizable chunk of its medical support response on volunteers, who will not be paid to risk their lives and who probably won't even see coin to offset personal costs of housing, supplies, food.

FEMA 'mass care' logic will not work for a pandemic.  Thank-you, Susan and others, for posting details behind Fed emergency response legislation and administration that most of us wouldn't otherwise hear about.


[ Parent ]
good question
How many volunteer medical people are going to step forward to risk their lives?

I've been asking that question for 2 years.  For the first year, I got ignored or laughed at.  For the second year, there were uneasy looks and silences.  Very recently, it is beginning to be talked about, as an 'acceptable' and no longer 'fringe' opinion.

It's hard work, and it takes forever, but some of them do slowly and steadily get there.  

All that, is only in the public health and medical professions.  Not in DHS and FEMA and emergency management professions yet.

FEMA 'mass care' logic will not work for a pandemic.

FEMA has congenital disabilities that it is trying very hard to overcome.  Heroically I might add, at times, but institutional cultures and political stresses take a heavy toll, so I don't expect magical happenings any time soon...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Goju posted this query
to professional nurses on a very large nurses discussion board sometime back.  Their bottom-line answer?  

They're not working if there's no PPE.  

CDC has not been overly active in stressing that public health officials and health care entities should be stocking up on these necessities while they are still available.  My health district of 30K people (no hospitals in it) has exactly 100 N95's on hand with which to greet the pandemic, and no plans to purchase more.  They're counting entirely on the SNS to meet all of their needs.  

The PPE won't be there.  If the PPPE is not there, the nurses won't work. If the nurses won't work, I doubt volunteers will feel confident in making a different choice.  


[ Parent ]
btw, as the GAO report makes clear
the PFO/FCO is clarification for FEMA (CFO) vs DHS (PFO). In oher words, FEMA is NOT the lead agency here. However, the PFO and FCO have (or can be be perceived as having) similar roles.

There's one important difference. The FCO (FEMA) gets to disburse funds. The PFO just gets to meet with Chertoff.

The above discussion has little to do with HHS.


[ Parent ]
doh!
The PFO just gets to meet with Chertoff.

You're funny!  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
he did mention them
Interestingly, his recommendations on what to do "next" now lack specifics on stockpiling PPE, antivirals, or basic provisions.

PPE and antivirals.  Again, I didn't take detailed notes only because they were pretty much the standard stuff.  

And his emphasis is more on being able to make some intelligent choice between different options such as antivirals as mitigation vs social distancing as mitigation.  It doesn't mean that he negates one over the other, it was more like he was emphasizing what he thinks countries are not paying enough attention to, eg social distancing as mitigation strategy applied deliberately vs antivirals and vaccines



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
unfortunately I believe we are not there yet
I feel that the next thing we will begin to hear from these leaders is talk about how to begin the recovery.  They've mentally moved through the inevitability of a pandemic, they have clearly outlined just how bad it will be.  They know their containment efforts will ultimately fail.  I believe they're already thinking about what good they can do, at this point.  That may lie, in their minds, with pre-planning a roubust and vigorous rebuilding effort for the post-pandemic period.  Recovery planning, in the end, may, in fact, be the most important effort of all, and it needs to be done now, while things still hold together.  Watch for recovery planning to become the new emphasis.  

I wish to god you are right, but the reality is Nabarro is a visionary.  He is leading the pack.  What he is saying is what he thinks countries need to do, not what he sees as already being done.  

Which means most countries are a lot further behind him both in their thinking and in their state of preparedness.  And most countries are not dealing with pandemic preparedness with the sense of urgency that we feel or that Nabarro feels.  In writing up responses to the ECDC, and next to the UK government, I got a lot more close-up look at the thinking in Europe, just as I did for the US.  I have to say they have made some progress, but it's agonizingly slow, and even things that we here have all taken for granted such as school closures, over there we are only beginning the battle for hearts and minds.

And Asia of course is even further behind, let alone Africa, etc.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
it takes time OR a kick in the head (a gentle one)


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
no, gentle ones won't do it
unfortunately.  Complacency and pig-headedness (which btw is a technical assessment) cannot be cured except by radical treatments.

;-(



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
except that radical treatments
sometimes can kill the patient.  That is the problem.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I just had an email communication
with a national level official in Europe, just yesterday, when I was reassured about the efficacy of telling people to cough and sneeze into tissues which are then to be disposed of properly.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
When you say
I wish to god you are right, but the reality is Nabarro is a visionary.

I don't think you understand me, or I don't believe you would wish I was right.  

My take on Nabarro's words is that he's beginning to "declare defeat," to some extent, on the subject of getting governments to prepare and with regard to the entire preparation movement.  The man's done about all he can.  A stalemate with regard to willingness to prepare seems to have been reached, globally.

It sounds like he's thinking that it might be prudent to leave that where it lies, and move on to the resolution of the last act of this play.  The visionary may intuit that it is best to work towards improving the lot of the next generation, if this one is lost.  That would mean, in practicality, moving on from the notion of preparedness to that of recovery (but not because we can declare victory on the preparedness portion of the assignment - quite the contrary, although not through lack of effort).  


[ Parent ]
I didn't get the impression he was giving up
from hearing him speak.

His presentation is here:

http://www.ehcca.com/presentat...


[ Parent ]
welll I'm with Dem on that one
I was there in the room, and I didn't get the impression he was declaring defeat at all.  Telling everyone what needs to be done and how hard, how much more work is needed, how hard it is to get consensus among 500-1000 parties, yes, but the man is very much the fighter!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
2005?
I was originally going to post about a speech I heard the good Doctor give in 2005 but then changed my message. Forgot to change the heading... but at that time he believed countries would NOT close their borders. Clearly his thinking has changed.

Tell the truth

about closing borders
He didn't mention anything about that, as far as I can tell.  His reference to people insulating themselves was in the context of individual avoidance behaviors, and leading from that the inference being there will be severe absenteeism and continuity issues.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I am not suprised. With so much to cover borader closings are a sensitive issue. n/t


[ Parent ]
Until...
While I applaud all the good work done on the international, national (US), and state levels, UNTIL someone, somewhere, in power and very believable speaks up in a very clear, very loud manner directly to LOCAL GOVERNMENTS local preparation will fail to materialize.

Three long, hard years grinding away locally with another nurse (and she has a Ph.D.!) have produced-nada. zip. zippo. nothing.

My local PTB think IF there is a pandemic threat that "the county and state will take care of us, tell us what to do" and "have warehouses loaded with medications to fight this thing." This is despite repeated talks,meetings with documented comments from WHO/CDC, DHHS.

It is better to look ahead and prepare than to look back and regret.


you know what?
On the local bit?  That is EXACTLY what the ReadyMoms project is about.  

There is close to zero will to take this to the people, to get local communities prepared.  Local government has no incentive to do much unless people are standing in front of townhalls asking them why they are not doing this and that.  People won't know to ask those questions unless SOMEONE goes out there and informs them.

That is the missing link.  Accountability from below.  From grassroots.

It doesn't have to be confrontational, but it does require an informed citizenry.  No one is out there doing it, folks.  It's us or no one else.

Think about it.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Hit or miss
I agree with and support your Ready Moms work.

However, the majority of local governmental leaders will be 'relaxed' on this subject no matter the pressure from grassroots because it is a grassroots movement. It's still too easy for us to be lumped into a 'they're slightly mad' category.

The only real hope for any solid movement will come when:

#1. The Pandemic is upon us

#2. A mandated preparation is pushed upon them, especially if it is funded.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
not really ;-)
It's still too easy for us to be lumped into a 'they're slightly mad' category.

There is a big difference between a one-on-one encounter with officials when it's easy for them to brush you off, and a public encounter with an audience where your case is solid AND there is enough people (just a small group) in the audience informed enough to KNOW that your case is solid.

It is about making it HARD for them to deny what you are saying.

That's the reason why you need a small but significant number of parents informed, especially moms.

Sometimes it just seems to me there's nothing that scares officials more than a group of determined moms with right on their side....Think Cindy Sheehan.

We need to get them mobilized.  First we need to get them informed.  That's the reason for the RM project.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Why aren't you pursuing the ReadyMom project in the UK
rather than here?  It would seem to be an easier project to undertake at home.  

[ Parent ]
because readymom was started in the US
I would dearly love for people from the UK to start doing this.  I looked around and I haven't found any yet.

Remember this is not my project, is a project built on existing and ongoing work done by various people.  The importance for me is proof of concept.  Personal preparedness is what the whole world needs.  It's very hard to sell, to get started.  The easiest way is to start where there already is some movement, however small, and help build that up for dissemination.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
also, the US government
is the only government with official recommendations for personal stockpiling.  That I have found.

The UK certainly hasn't done that yet.  I have been pushing them on that point, eg in the paper I wrote in response to their pandemic plans in May 07, available here, as well as in personal communications with senior officials including Lindsey Davies, National Director of Pandemic Influenza Preparedness.  She has some personal inclination towards that, but I suspect the political resistance is huge.  I will be writing again on that in the next round of consultations, due 22 Feb.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Hard to deny-not the issue here
It is a Catch-22 siutation; very few citizens around me will become involved or take a serious look at the issue if TPTB don't take it seriously; TPTB don't make a move without someone important at the top or MANY people from below putting pressure on them.

Given the # of issues facing most people today, this is at the bottom of their list.

The really sad part? RE: "It is about making it HARD for them to deny what you are saying"-they DON'T deny what I say! They say they are aware of it! Yet their behaviors don't match their words.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
not deny what you are saying
but deny the fact that your case is valid.  But that is only the first step.  Without more support, you are just one lone voice, and they can certainly ignore you.

The key, and the difficulty, lies in getting more citizens informed and involved.  Rather than just trying to change your local authorities on your own.  But as you said, it's a catch-22 situation.  People won't get involved until they are convinced, and they won't become convinced till the government makes it a priority.

Having said all that, and I know it's no comfort, the point is we all recognize how hard this is.  Why else would I or anyone else spend our precious time and resources butting the system?  It's precisely because it is hard that we need as many people as we can get working on it in as many ways as we possibly can.  Many of these ways will fail, but we won't know which ones might have some effect.

Saying the same things over and over again is tedious and discouraging I know, but you never know when there might be that one time when that one person who happens to hear you somehow got something from what you said that you never intended, that had some effect that you never intended, simply because you didn't know what challenges THEY have, and you happen to accidentally address something that turns a light on in their brains!

Yes, it's a high commitment and low return activity.  But what other option do we have?  And as TXNurse said, and as I have experienced from time to time, there ARE signs of progress.  Such progress only happened as a result of the work of various people.  It may not be you directly, or it may be you.  We will probably never find out exactly what each of us contributed to the process.  But somehow someone has to go out there and keep working at it.  

The problem is too big, the consequences too severe, for us to just walk away from it.  I'm not saying that's what you are suggesting, just expressing how I feel about this.  There's been so many times when the obstacles appear insurmountable, and all I see is walls, but when I take a bigger picture view (ie other than local) than things are moving.  We need to keep track of where they are headed, and make use of opportunities, however scant those are.  The upcoming opportunities WILL in the next year be at state and then local levels, for the US.  It will still be slow, but that is definitely where it's headed, as the ramifications of the PAHPA legislation filter down the system.

For Europe, it will be in the fight for the community mitigation measures.  We are about 1 year behind the US on that, and more in other areas.  And yet I still see so many opportunities to apply my efforts to the problem.  

After we get the EU onboard for NPI and stuff, then we can sell that to the rest of the world.  Much as I appreciate how important it is for your local community to be prepared, let me just conclude this by saying if you look at the sum total of what Nabarro is saying, plus what came out of the Global Risk report, and think for a minute about the ramifications of the state of globalization, you gotta realize that you are not safe unless the rest of the whole world is somewhat in a better place than they are right now.  If production lines in China or Mexico are stopped because workers in sweat shop factories are dropping like flies, do you think your local community, however well prepared, can be self-sustainable?  We TRULY are in this together, the whole world.

Just my 2 C.  Take it for what it's worth.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Catch 22 and us
I am still trying, but how long can 1-2 people keep this up? I prep continously for my family, and speak to anyone who will listen.


It is better to look ahead and prepare than to look back and regret.

[ Parent ]
I know, we just keep trying
there's usually just 1 or 2, in most places.  Which is why we hang out here, cos there's more, at least to commiserate with.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Fear not.
"majority of local governmental leaders will be 'relaxed' on this subject no matter the pressure from grassroots because it is a grassroots movement".

They are about to become 'un-relaxed'.  The problem is, that County government is used to having its emergency needs met by the State, and the State, in the most recent decade of unusual weather conditions/local natural disasters, has been trained to plea to the Feds (FEMA) for assistance.

Everyone is looking to the Feds for answers.  However, the Federal budget for disaster planning is, as Susan and others have pointedly commented, directed towards a rank-order of emergency response, centering on terrorist actions.

Governments outside of the hard-hit human- and fowl-casualty nations, choose to believe that this pandemic will not really materialize.  They are reactive - and they don't really want to put a lot of effort into pandemic readiness if the perceived risk is low.

Plus, you have an entrenched budget mentality in Congress and the White House:  war comes first, big business second, general social services third, and emergency non-miliary actions, come a distant fourth.

We have a war-driven economy, remember this fact.

If you want the Pentagon to shift it's priorities, you will have to convince them of the sheer magnitude of social and economic upheaval that will require the full attention of our government and armed forces, in civil response/policing.

YOU WANT THEIR ATTENTION.  Obviously, their present attention is directed elsewhere.  

Once the Feds are fully riveted on this pending crisis, the Word from On-High will be 'do it, or else' (meaning, funding freezes, the ONLY way to get the lackadaisical State and County government to shift their own priorities).

Everyone is waiting for the Word, that this is real and it's Going to Happen.


[ Parent ]
I'm even more cynical than that
if that is possible, LOL.

I believe that many do believe it's at least very likely and needs to be taken seriously, but PRECISELY because the scenarios are so dire, they would rather the great unwashed (the masses) do not know about it for fear of rocking the economic boat too soon.





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I agree, Susan
I keep coming back to why did Nero fiddle while Rome burned.

Logical answer is because he couldn't think of anything to do that would help the situation.

Sound familiar?


[ Parent ]
Agreed.

Sure, we have interesting analogies, too: long-over due large earthquakes in cities prone to seismic liquifaction (meaning building stabilization pylons seated on poorly cohesive fine grained sediments don't amount to a hill 'o beans, when the big shake happens), and volcanoes in critical areas also long overdue to a big blow.  In each case, geologists and engineers have warned the Powers That Be, of risk probabilities and consequences (in long, tedious, but very well constructed - and recent - reports). The problem is that a good scientist will be cautious and curb warnings with uncertainty estimates.  In geological terms, the plus/minus slop is enough such that politicians know it probably won't happen on their watch.

Not so with this pandemic.  Using our geological analogy, we have had the deep rumbles give way to significant tremors and larger minor shakes.  In our present economic predicament, you may be right - the the worst case scenarios are so dire, government officials presume that little can be done, because (1) they won't be believed if they give out these pronouncements, and (2) the system is so fragile, that there are insufficient bandaids to stop what happens - significant loss of life and at least temporary breakdown of society. The aftermath, as you have said, will be ugly.

But what if you could do something to avert the worst case scenarios?  It would take all of your spare time, most of your dollars, and 'unnaturally' rapid planning and deployment to do it.'

(the answer is  'yes', when the cause is 'just', as for example, in preparing to go to war, post 9/11).

But this pandemic is not seen as 'pending' and preparation as 'necessary and just'.  Nope. It's a remote possibility in most peoples minds, grass roots and leadership, alike.

WOULD THEY LISTEN?  Would they act?  Do they even care?

I think there is a certain mirroring of apathy among our leaders, just as their is among the voter constituency - the "don't fix it, if it ain't broke" mentality.

You would think those running for presidential candidacy nomination would be chewing the fat over this one.  

Nope.  Take that as a hint.  


[ Parent ]
Thanks Oracle
Re: "Everyone is waiting for the Word, that this is real and it's Going to Happen..."

Yes yes yes yes!!!

Why do it translate into why pay for it if someone above us can do it/pay for it instead.

No one (below DHHS) wants to pay for this or stick their collective necks out to say to local governments "DO THIS NOW!!"

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
Sorry for my poor grammar
I meant: 'Why do it' translates into 'why pay for it if someone above us can do it/pay for it instead'.  

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
Paralell Lives
I think Grace RN and myself are living the same life. Susan, I applaud what Readymoms are trying to do, I, like Grace have been working for > 3 years trying to make a difference on the grassroots level. Myself and another nurse in my town (she is the Health director for the school district) have relentlessly talked to the schools, churches, newspapers, local people, my hospital in the next town, we have given power point presentaions, numerous research articles, met with officials, not once but many times. All to no avail. 3 years ago my DON for the mid size hospital I work in was my patient one day (so I had a captive audience)and after trying to go through the "proper" channels unsuccessfully at my hospital, I gave the DON an earfull while she was my captive! 3 years later as I have stated in other earlier posts my hospital came to the conclusion that Avian Flu was the #1 risk factor to deal with so she assigned our infection control nurse the duty of making a pandemic plan and told her to recruit me. I was told this was #1 priority, we had ONE meeting last June 29th!!!!! She always states she is overwhelmed and we will get to it, all the info I give or ideas for the Hospital and local communities go in one ear and out the other. My nurse friend with the school district has been doing the same with the school superintendent and school board. She has had numerous meetings with the nurses who work under her...they all think she is wacko (like me!). Like Grace and EVERYONE else on the flu sites have said thousands of times, until our Gov. steps up to the plate and says this loud and clear the work we do falls on deaf ears. You say "think about it" sometimes its all I do, and I have not given up, I have "converted" maybe 9 - 10 people. And I do see some small changes, and I mean SMALL, recently I have seen some commercials on local Austin stations, 30 sec blurbs.....that unless you already have an idea about what they are talking about, the average person just ignores. The most common response we all get is "if there was really something to worry about our Government would be telling us" If I had a penny for every time I've heard this I would be sipping on my own private island with a few close friends!

[ Parent ]
well, yes
I've always said we need government to say it loud and clear, but a) they are not doing it on the public airwaves, but more importantly b) the diffusion of policy from top down to the bottom is a very slow process.  When I meet with all these emergency management people at conventions, they are only just STARTING to look at personal preparedness.

Sometimes when we do something and it doesn't work, there may be numerous reasons.  A couple of common ones come to mind,  One is the time was not right yet.  Think of the diffusion of innovation model.  For any innovation to take off, there are many requirements.  One of which is time (and momentum).

Take a look at this curve.

The very beginning of that S-curve, the increase is extremely small and imperceptible.  Most of us are literally so far ahead of the curve that it seems impossible that the idea will take off.  And yet let me just say that there were many things that I said that was scoffed at one year ago, such as HCW not coming to work (I was almost laughed out of the room!) which is now being taken seriously and being expressed by keynote speakers from the podium.

There are many challenges to adoption of innovation.  I haven't had time to write any more than part 1 of the marketing preparedness diary yet, but including all the sensory modalities, such as touching the prep items, is an important component.  Creating the experience of familiarity (similar to shopping, for example) is another.  Utilizing THEIR beliefs, values, and concerns, not ours is yet another.  

I could go on, but the point is, there are many ways to reaching a goal, and if at first something doesn't work, it doesn't mean that it will never work.  It may mean experimenting with many other ways of doing it.

Last I heard, Thomas Edison went through many lightbulbs before he made one that worked.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
YES I agree
Susan,
I agree, and I keep trying to open new lines of communication when the opportunity arises, recently I have seen a few more people actually coming to me with questions, which I have seen as promising, just not in the numbers I would like, but although I may sound negative I'm always trying to think of new ways to reach poeple.

[ Parent ]
there you go!
recently I have seen a few more people actually coming to me with questions, which I have seen as promising

People asking you questions is a sign that they have been THINKING, which is a critical requirement on the road to action!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Love ya' Txnurse!
Thank you, thank you, thank you! I had no idea we are living parallel lives- f you ever head to South Jersey will take you out to dinner and a gabfest!

My nurse friend (the one with the Ph.D.) is ready to give this up. I really thought that given her credentials TPTB here would take her more seriously than me-no such luck.

It's about funding to do this and a complete lack of triage at the state, county and local levels. There are alot of very serious issues out there-no debate there. A pandemic can't be scheduled, no predictable CAR,CFR....

Yes yes yes to "if there was really something to worry about our Government would be telling us". It's not just in Texas and New Jersey-this is nationwide thinking.

I seriously, and very sadly believe that is will only be an issue for the local PTB when it's on our shores and in our towns. Then they'll call us and say-what can we do?

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
Txnurse...
would you email me if you have the chance?

puub@comcast.net

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
the power from above
has done as much as they can possibly do, is my perception, in this department.  There is only so far they can reach, without the funds and the (political) mandate to do this properly.  They have just about reached the extent of their effectiveness IMO.  

Not that there won't be room for further improvements, but those will be minute and incremental.  There will not be quantum leaps, for a very long time into the future, I don't think.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
evolution in action
This will be one of those unpleasant instances where genetic evolution (of a virus) confronts memetic evolution (of human culture) resulting in a huge shift in both human genetics and memetics.  From a scientific standpoint, the outcome of the next pandemic will be fascinating to observe.

I wonder what Dawkins has to say about this?  SusanC or Dem, have either of you met him or discussed this with him?  I'd guess he'd be interested......

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
my thinking in this vein is
that if we cannot prevent the impact of a pandemic, at least we could study it and record the results for posterity....

KEEP THE GRID UP!
Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"


[ Parent ]
would love to meet Dawkins
but no I haven't had the honor/



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Powers from above
Strongly disagree with you here, Susan.

Because the next pandemic can't be precisely predicted ie date/time/country of origin, what the CAR, CFR will be, no one, no one who HAS the power will stick his/her neck out and directly tell LOCAL GOVERNMENTS to get their acts together and plan now.

Too risky in this darn over-P.C. world.

Where's Harry Truman when we need him?

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
I'm surprised you say that
no one, no one who HAS the power will stick his/her neck out and directly tell LOCAL GOVERNMENTS to get their acts together and plan now.

The REQUIREMENTS for pandemic planning, in order to get their federal funds, have been in place for a couple of years.  So far they only need to self-report on compliance.  From this coming October, there will increasingly be mandatory components and audits.  

The TELLING has been done.  It's a compliance issue.  That's why we need citizens to hold local government accountable.

Read the CDC cooperative agreements.  The new ones coming out next year will be even more detailed and have all the new provisions as per the PAHPA.  Unless local government wants to give up their federal grants, they will have to comply to a certain extent.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
state vs local governments
Susan, I think you are forgetting that the grants were given to state governments (state public health depts), not local governments.  While I could be wrong, I think that there were probably very few requirements tied to the money.  

Some of the states may have given small grants to local health depts, but it may be just to get them started with the planning process or to help them purchase PPE or other equipment, but it may not have been much money.  I know with our state, it was less than $10,000 for each local health dept. to set up their plan and purchase equipment.  Needless to say, it did not go far.

We also need to acknowledge that pandemic plans within the local county health depts. may be different than pandemic planning that is taking place within city, township, or rural communities.  As far as I am aware, there is nothing that dictates that these entities have to work on the same plan or to even have their plans similar to each other.  Hopefully the plans are and the health depts have good working relationships with those cities and towns they are responsible for in their counties/districts/cities, but it does not have to be.  Money for public health preparedness was not given to cities/towns for their individual planning process.


[ Parent ]
there IS money specifically designated for cities
under the Cities Readiness Initiative

I think you are forgetting that the grants were given to state governments (state public health depts), not local governments.  While I could be wrong, I think that there were probably very few requirements tied to the money.

No, the CDC cooperative agreement guidance for FY07 includes this paragraph that anticipates the changes that will come in next year as a result of implementation of PAHPA (page 3 of pdf).  The direction is there, the specifics and mandatory components will come in next year.

Integration with Local Partners
Language in the reauthorization of this program through the PAHPA strengthens the government's commitment to the principle that preparedness response is a local activity. Local health departments are to be engaged in and approve both the awardee's preparedness plan and the distribution of funding associated with it. CDC interprets this to include tribes located wholly or in part within the jurisdiction. In addition, public comment about the plan and its implementation must be sought, including a mechanism such as an advisory committee or similar to solicit and address comments from the public and stakeholders. This new emphasis on widespread local engagement is reflected in the required activities of the Budget Period 8 submission guidance.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Not funding for all
In your post, you bolded part of the statement "Local health departments are to be engaged in and approve both the awardee's preparedness plan and the distribution of funding associated with it. "

That would happen only if local health departments provided federal/state money for the planning process.  I can tell you that in the counties in my state, they did not give mini-grants to any cities/towns with their huge allotment of $10,000.  That means that the health depts do not have the right to approve or deny any preparedness plan if they did not provide the funding.

I had a chance to look at the list of cities included in the "Cities Readiness Initiative" and none of the cities listed are located in my state.  It also looks like they are not adding any new cities for funding.  So much for the states that are not included.  I had also heard that much of the pandemic funding had been cut from the budget.  Does anyone know if that money was left in?


[ Parent ]
can't answer your last question
and I'm not saying everyone gets funded.  But neither can states completely ignore local health departments either.  That is the point I'm making.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what I meant was
while the money may not be given to local health departments directly, the state is required to consult and get agreement from the local health departments, in how they use the money.  That I think is a very useful thing, however much or however little money they get.  It means they all HAVE TO sit round the table and thrash out the issues.  That's where resilience comes from!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Define..
By LOCAL most funding is meant COUNTY health departments, not towns, not small cities-and our county got a real pittance. 2008 funding was massively cut.

My mayor had repeatedly said-despite multiple meetings, emails, phone calls, presentations etc that the county will take care of 'us'. The county has directly told her they will not prepare a plan for us. Mayor still thinks the county HAS to do it-so why bother with the funding (Trust me-$$ is the biggest issue-who pays for what. Running a close second in issues is-no one has told 'us' this is a realy problem that needs to be planned for now).

My newest fav saying is "chance favors the prepared mind"

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
City Readiness Initiative
Cities are defined as metropolitan areas, not towns of ~40,000 people dsuch as mine.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
so, yes if there is no money
I'm sorry but what else is new?  I look at the UK, and the rest of the world, there is even less money.  

This is just one more of the list of the problems that need to be tackled.  If there is no political will, can we change that?  If congress does not approve the money, can you change that?

If not, what ELSE can you do?  What other creative ideas can citizens come up with?

Those are the questions that come to mind...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Lack of money is a non-excuse
I believe the 'lack of funding' is a lousy excuse for failing to do planning.

There would HAVE to be a way around that-mandate that department heads doing it during work hours, use volunteers (the few one could find) etc. look for grants...

But, given the 'ickiness' of the topic, not having funding is an easy way out.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
yeah, that's for sure ;-(
But, given the 'ickiness' of the topic, not having funding is an easy way out.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
slides from Dr Nabarro's presentation
available here

A good quote here:

H5N1 is clear and present danger.  NO CERTAINTY what it will do next.

and some important slides:








All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


also this one
(highlight mine)





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
What MY TOWN reads is...
"Local governments synchronized" = our local OEM person calls the county OEM person to find out what to do. Period. That easy.

I have been told this directly, and more than one, by the mayor AND our OEM person.

It is better to look ahead and prepare than to look back and regret.


[ Parent ]
What I would LOVE to see
What I would LOVE to see- Fluwiki listed as a member of:

The National Domestic Preparedness Consortium (NDPC)

https://cdp.dhs.gov/consortium...

It is better to look ahead and prepare than to look back and regret.


well
FEMA needs to move beyond 3 days.

[ Parent ]
Wow, I just so love this exchange!
Yes, they definitely need to catch up, to what we are doing.

LOL



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
NRF in, HHS pandemic plan out-it's all alphabet soup
I thought the old system was confusing-this is ridiculous!

It will be even easier to get local planning put off again and again due to the incredible confusion this new system creates, the upcoming changing of the guard, etc.

Is this being done specifically to create a logjam?

It is better to look ahead and prepare than to look back and regret.


Menu

Make a New Account

Username:

Password:



Forget your username or password?



Active Users
Currently 0 user(s) logged on.

Contact
  DemFromCT
  pogge (In Memorium)
  Bronco Bill
  SusanC (emeritus)
  Melanie (In Memoriam)

  Flu Wiki (active wiki resource)
  How To Add To Flu Wiki
  Get Pandemic Ready (How To Start Prepping)
  Citizen's Guide v 2.0
  Effect Measure
  Dude's FTP

Home
Powered by: SoapBlox