| The state issues with personnel mentioned yesterday have apparently been resolved, and screening/testing stations for incoming passengers in Hawaii, Puerto Rico, and Alaska have been or are being set up.
Strategic National Stockpile (SNS) antivirals are being deployed, though the states are still using them on a containment basis (identify and treat the cases, prophylax contacts) rather than a community strategy (where most of the antivirals will go for treatment only). The trigger for that switch will be similar to the trigger for school student dismissal... rapid increase in cases that are not linked epidemiologically.
As we enter the second day of the exercise (and the seventh day of the pandemic - see day I for more), CDC is feeling the calm before the storm. In fact, it's calm enough to start trying to anticipate what things will look like 3 days and 10 days from now. Well, anyway, the questions can be asked, but there's not enough data to hazard guesses other than it'll get worse, and there'll be shortages that are not apparent now.
And there's a new wrinkle thrown in for realism: two Arkansas teenagers have committed suicide while being treated for contact exposure to H5N1 with oseltamivir (tamiflu). [Did I mention that everywhere you look throughout the Emergency Operations Center and press room, there are signs in red capital letters that say EXERCISE?]
Does that change distribution plans? (No). Does it change warnings about use (No, but tracking data is requested from clinicians, and lots of questions about this new information are generated at the mock press conference).
Towards the ened of the briefing, there was a word from the Director, Dr. Gerberding , about the need to include new media in future information plans: "we need to be blogging", she told her chiefs. Well, maybe not exactly the way we do, and maybe not now, but recognition that in a new pandemic, different rules of engagement will need to apply. [And if we're asking them to think about it, we'll have to think about it on our part as well. Imagine how we would handle the information on tamiflu deaths, similar to when we were discussing the Japanese media reports of same].
Dr. Richard Besser, who is the Director, Coordinating Office for Terrorism Preparedness and Emergency Response (and a pediatrician) on the issues of SNS stockpiling and pediatric dosing and instructions, pointed out that pediatric dosing forms (liquids) don't always have the same shelf life as other formulations, and that once the SNS meds arrive and are taken by the state for distribution, state (and not federal) shelf life rules apply. With acknowledgment that more needs to be done for pediatric emergencies in general and panflu meds in particular, there will be ongoing work to do so in the coming months.
We also discussed with Dr. Besser the sometimes overlapping roles of CDC, ASPR and DHS, particularly when it comes to personal preparedness (there's nothing more discouraging than pandemicflu.gov recommendinging 2 weeks of prep and DHS saying three days) and advice on home care (ultimately that may be an ASPR function, with both agenices partnering with orgs like the Red Cross). Non-federal entities are more nimble here (see getpandemicready.org), and the ongoing need and challenges in keeping personal preparedness in the public forefront despite the known difficulties with the public's perception that this isn't a 'hot topic'.
All in all, this exercise (not yet over for them) should be, I think, a valuable tool for CDC. Role playing and testing and drilling logistics, and practicing the actions and information collection that would happen in a real scenario can help note gaps to close for the real thing. And anything that they can do to improve their response helps us, though it reinforces our own responsibilities to plan in advance for our own families, pets and selves and not wait for them. Hopefully, it will also identigy things done on day 7 that might just as well be done now (such as videos explaining how to use masks).
Today is a travel day, and I will be able to answer comments later this evening. Thanks for your comments, suggestions and readership.
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