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Reporting from the CDC Community Mitigation Meeting Dec 11-12 Atlanta #1

by: SusanC

Tue Dec 12, 2006 at 02:08:51 AM EST


UPDATE Dec 18 link.

White House announcement today on 6 month status report includes this on NPI:
Community-Wide Mitigation Strategies: We have focused unprecedented attention on the role of community-wide mitigation strategies, such as early school closure, cancellation of public gatherings, and other "social distancing" behaviors in reducing illness during a pandemic. Interim guidance on the ways communities can use these interventions most effectively will be released in January.

Things are moving.  Watch this space.

SusanC :: Reporting from the CDC Community Mitigation Meeting Dec 11-12 Atlanta #1
It is better to have approximate answers to the right question than to have the exact answer to the wrong one.

Irene Eckstrand, NIH-MIDAS

Here are selections from my notes and some of my thoughts on today.  A couple of overview points:

  • Today was mainly information gathering and presentation to the participants, who will get into groups tomorrow to work on the issues and come up with recommendations.

  • The focus is on non-pharmaceutical community mitigation interventions, and will not cover antivirals and vaccines, even though they were mentioned briefly.

  • A summary agenda can be found here

MARTY CETRON, CDC slides


Marty Cetron summarized the 3 main activities of this meeting:
  • Release of Institute of Medicine review of the evidence, historical data and mathematical modeling results

  • share preliminary results of the many listed activities over the last 6 months

  • Solicit input and opinions from participants to guide the development of interim federal guidance on community mitigation strategies

The interim guidance will be written up this month, NPI (non-pharmaceutical interventions) will be one of the chapters, but it will also include other components of community mitigation such as the use of antivirals.  This interim guidance will be circulated interagency to be rolled out early January (as I said before).  Notice this really is interim as it is very likely to be further revised down the line.

One scary piece – Cetron asked how many people in the room was taking part in meetings on community mitigation using NPI for the first time, ie where data and issues around NPI were presented and discussed, and fully 1/3 of the room raised their hands.  Some of the presentations were technically quite challenging, and I wonder how well tomorrow will run, for those for whom this is pretty much the first time they have considered these issues.  I think Marty was surprised too.  We'll see…

ARNOLD MONTO, U of Michigan slides

Arnold Monto did a review of the pandemic flu problem.  Some notable points:
  • The magnitude of a pandemic has to be put into equation in order to respond. - Monto

    That's what I've been saying, "You gotta work the numbers!" ;-)

  • risk group may change for a pandemic, policy needs to be adjusted according to information available, eg they are now vaccinating pregnant women because of the increased risk of severe disease slide #8 Monto(Hmm... didn’t know that one, gotta look that up) Flu Wiki link

  • scientists used to believe only in reassortment as mechanism for formation of pandemic virus, but that view was changed with the knowledge of the 1918 virus.

  • the 1918 W curve had a limitation in that it was based on deaths within an entire calendar year.  But data from the UK on age-specific influenza deaths in women by calendar quarter (slide #12) shows the changed pattern of mortality very clearly, further verifying the real increased fatality in the < 5 and young adults. (btw very elegant slide)

  • in 1918, deaths in civilians were mainly virologic, while in the military, might be some that were mainly bacterial

  • Philadelphia deaths: 140/1000 population at peak week! (slide #16)

  • still on 1918, median 9 days from hospitalization to death

  • 1957, started in China, seeded in the US in the summer, but big outbreaks began only after school started.  Also, the first wave was more lethal. 
    Lesson: You can't count on first wave being milder.

  • 1968, similar seeding in summer, peak November December.  So 1957, 68 we had some breathing space.  Now with more air travel, we don't know whether we will have that.

  • various things we are not sure of about H5N1, eg is human infection a disseminated disease?

  • on NPI - the experiences in 1918 etc tell us that school closure and social distancing etc will happen cos people will practise that without prompting from government.  It is a matter of whether we can do it systematically to reduce stress and chaos!

    This point was repeated by various other speakers, notably Carter Mecher of VA, and Kathy Gensheimer of Maine Dept of Human Services, plus myself.

  • key question about NPI - how to implement most appropriately.

RAJEEV VENKAYYA, White House slides

Rajeev Venkayya from the White House Homeland Security Council presented the policy perspective from the administration.  The significance of his presentation was not so much in the contents, cos we all know those already, but the fact that it is the view of the Bush administration.  I will list a few examples
  • H5N1 CFR is at 60%

  • 1918 is not the worst case scenario, we are using the figures for policymaking only

  • at 30% attack rate, in a 1918-like scenario, the death rate for those aged 1-19 would be 13 x the annual death rate

  • at 40% AR, it would be 20+ times (this is essentially the same as what we discussed previously on the old forum here )

  • what prompted the administration to take action was the realization that pandemics can have a broad spectrum of severity, and you need all the tools you can get

  • NPI is one prong of multi-prong strategies, including 'Manhattan-like' project on vaccines

  • the National Strategies Implementation Plan was just the 'first cut of the planning', now we need a 'roadmap'

  • Closing thought: 3 things needed: Leadership, Imagination, & Resilience.  There are lots of secondary and tertiary consequences.  PH officials may not be the best people to deal with them.

MATTHEW CARTTER, CSTE, Best Slide of the Day! slides

I’m going to skip ahead to the last session of the day, and take one point from Matt Cartter’s presentation.  The logic behind the totality of his presentation requires its own discussion to do it justice, and I hope to write that up some time later this week.  The point that I’m referring to is on his slides #22 onwards.

What Cartter is saying is that most people have difficulty conceptualizing the severity or implications of a pandemic, let alone the need to prepare.  But people understand hurricane warning categories, eg that a Cat 1 is mild, and a Cat 5 is like Katrina, so we can use those as analogies.  Essentially he translated the mild, moderate, and severe scenarios into Cat 1, 3, and 5 for that purpose, using total deaths of < 100K for Cat 1, >/= 1M for Cat 5, and Cat 3 would be in between.

These numbers are essentially the result of the combined effects of the attack rate (he uses illness rate for laymen, which I think is great) and CFR (he said we should probably just use mortality).  So he plotted those data sets that would result in the 3 different sets of death rates and came up with the charts on slides #22 onwards.  I understand Marty Cetron had a hand in that as well, and it was all done by hand. 

What is so brilliantly simple (and simply brilliant!) about this is now you have 3 different areas (4 if you count seasonal flu) within which any combination of AR and CFR could fall that would immediately classify the outbreak as Cat 1,3, or 5.

Now is that easy to understand or what?!

The job tomorrow is to fill in the measures for the 3 different scenarios...

___________

There are various other topics worth writing about from today, notably the really interesting new data from analysis of historical records from 1918 by Markel and Lipman, plus the discussion arising from the ASTHO consultations with Roger Bernier (not much new info, but good discussion) which I will post at another time. (slides added)
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To quibble,
they should probably use the word "fatality" instead of "mortality." 

"Mortality" is a word found only in insurance company charts these days.

"Fatality" is a word used all the time on those "CSI" shows and by teen video gamers. 

If they want the people to understand it, they should use "fatality." 


don't know, I'm 50/50 about that
That's an interesting point.  I might ask him tomorrow...



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


[ Parent ]
pandemic intensity - proportional response - ready at all levels
We're collectively getting there - or at least to somewhere in between.  Here's to hoping we have time.

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

Lipman's #8 means 70% lives saved
And of course 70% of a lot is, well, a lot.

We will be asking our fellow citizens to contribute their part to global R-naught.  We'd better get used to asking each other for such contributions.

Here's Lipman's presentation.  Download it, because you'll be using it a lot locally, I guess.  Print slide #8 for your networks.

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


Thanks lugon
He's done some great modeling work on that and you're right - it will be helpful in trying to get others to act.  Copies will be going to our local school boards right away.

[ Parent ]
Sounds like it has been a good conference
and thank you for updating us on your learning so far.  I know you must be beat!  I like the idea of a scale for telling people what the threat is, but will it duplicate and/or contradict WHO's?  You don't want anything contradictory because people will more likely latch onto to the "better"(less depressing/scary) piece of news.  After a while no one took the terrorist chart seriously because it wasn't all that clear and kept changing all the time.  Who will be the authority deciding - CDC?  It has to be credible.

If you can get copies of those other charts you saw that would be great.  I've found visual aids really help hammer home the threat to people I've been trying to get to prep.


no contradiction: closeness vs impact
WHO has created a scale that is about "how close we are to a pandemic".  No one knows what length of time we'd need to cover that distance.

The slides SusanC greatly writes about are about "how bad a pandemic was" (or might be), after all the cases and deaths are counted.  So it's size (or impact), not distance.

No contradiction, and no conflict.

And of course we're most worried about "soon and bad", even if we all know there are other alternatives.  It's just that we're less worried about those other alternatives.

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


[ Parent ]
Comparing Pandemic Severity to hurricane severity is brilliant!
I think what Matt Cartter did was excellent and will go a long way to making "the average person" instantly understand why we should prepare for a 1918-style (or frankly, worse) pandemic even if we aren't sure that's what's coming.  It is just like preparing to survive a Cat. 5 hurricane, even if doing so is overkill if all you really get is a Cat. 3 hurricane.

A lot of people will be able to understand that.

They will also be able to understand that we have different responses to a Cat. 3 hurricane (stay inside) and a Cat. 5 hurricane (evacuate) and that the responses to the more severe situation will be a lot more disruptive than for a less severe one.

At least some portion of people will be able to understand that preparation for a Cat 5 pandemic will need to take place at the local and family level.

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


I've added the relevant slide show to each speaker
Note that Martin Centron (CDC) has two slide presentations.

Dem, good links near names, thanks!


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

[ Parent ]
Bad link
SusanC---4th point under Rajeev Venkayya needs to be re-linked to old forum

"Rajeev Venkayya from the White House Homeland Security...."

at 40% AR, it would be 20+ times (this is essentially the same as what we discussed previously on the old forum here)


did the size of towns matter?
I've looked at some slides where towns get different results based on what they did to slow the pandemic down.

Did town size (number of people) make a difference?

We won't be able to act on that, but it might be an important factor.  Or, now that I think of it, we might want to create some borders within, if that has some effect and can be done/recomended in practice.

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


Using Hurricane verbage is good,, but something else could be better
This is why I do not like the new forum style...

It is easy to lose posts like this one from last Saturday.  And after thinking about it, it should be called the Pandemic Severity Scale, or PSS.

And as a modifier, as discussed below, I would go with

Class 1 Pandemic -

Class 2 Pandemic -

Class 3 Pandemic -

Class 4 Pandemic -

And stop.

The best descriptors would be modifications of the asteroid impact scale, referenced below.

From my earlier post...
http://www.newfluwik...

Pandemic Impact Index 
First of all,  Natural disaster risk have all been quantified and qualified.  The public has been educated in multiple severity indexes.  Tornado's have their Fujita scale http://www.tornadopr.... with F0 being the smallest up to F5 being the highest.  Most lay people can understand that you don't want to be in the way of an F5.
Other scales come to mind...  Hurricane scales such as the Saffir Simpson http://en.wikipedia....

With the Cat 1 to Cat 5 scale.  You want to avoid the class 5.

Earthquakes have their mag 1 - 9 scale, each one being logrithmically worse http://mistupid.com/...

Asteroid Impact scale  http://neo.jpl.nasa....

The nuclear war clock scale...  etc, etc...

Note that all of these have a unique modifier.  This helps lay people immediately differentiate from one scale to the next.  It is useful shorthand.  F, Cat, Mag,

So what's the point?  We can create our own Pandemic Impact Scale, give it some sexy name and modifier, say a Fluwiki 5 or FW5 or Impact 3 etc.

Create the parameters along the lines of the asteroid impact scale.

We can the declare that it is the "official" scale and begin to market it to the MSM.  MSM needs something that is already prepackaged for the lowest common denominator and can be easily shown with pretty pictures and or charts.

We CAN force the argument to talk about relative Pandemic Flu Risks.  By filling the media vacuum of possible pandemic scenarios, the designated Fluwiki spokesperson should be able to get inserted into the debate.

 

Just rolling along, making waves and causing trouble...


linking to your comment
is exactly why I do like the new forum. Easy to find... just look under your comments. In the old forum, it's lost forever.

we will not be competing with other govt./NGO entities in terms of an 'official' scale. But for teaching and commuynication purposes it has value.


[ Parent ]
thoughts on scales
The charts with CFR and AR give a two-dimensional picture.  From burials point of view, pandemic intensity is the same if we double CFR and cut AR in half.  Primary care folks will be more interested in AR intensity.  Not sure we can get a unique scale, but let's give it a try.

The point of view here (FluWiki) would be NPI, disruption, getting the point across about the need to prepare, or the need to prepare diferently ...

Ruminating a bit

Hang on.  Hurricanes are measured in terms of the strength of the wind, are they not?  Could there be a "wide" (or badly located) Cat3 costing more money and claiming more lives than a very "narrow" (or short lived) Cat5?  So maybe pandemic intensity is "final percentage of lives claimed".  I.e. "mortality".  The scale is simple: zero to a hundred.  And we can slice it using history as a reference: equal to or less than 1968, between 1968 and 1918, worse than 1918.

Is that simple enough?

OTOH, disruption (secondary trouble, deaths included) can be non-proportional to CFR.

Dunno.

Just thinking out loud.

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


[ Parent ]
a cat 3 in my town
is worse than a cat 5 over the atlantic. Unless you're there, of course.

even in worldwide pandemics, it hits differently (different impact) in different places. St L vs Phila is oft used as an expmple of mitigation (St L did better) but impact is different as well, regardless of reason.


[ Parent ]
pandemics hit people
and of course, killing the frail is not the same as killing the strong, etc.

Also, there's no cut-off point where things get suddenly different.  But we would do different things with a low CFR (spend all our antivirals with the weakest members of society) and with a high CFR (spend all our antivirals with the members who help others to go on living).  Not exactly sure I'm getting my priorities right, but you get the point: we'd do different things in different "stripes" of the spectrum.  So maybe we can work backwards: from what we'd do to the different stripes (as in "this individual disease should be treated with surgery, but if it's not so bad then we can treat it with pills").

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


[ Parent ]
The context of the post was important
The Pandemic Severity Index was in the thread about about creating a talking head that was non governmental, i.e. the common folk persona.

In order to get a seat at the table, MSM wants you to be two things.  One, your message must be a counterpoint to the other talking head that they have already lined up.  and two, you must have an easily understandable point.

I wanted to suggest in the previous thread that in order to get airtime, and fulfill the desire to change the public discussion away from 1918 pandemic planning models, that we need to create the conflict along the lines of ...

Moderator:  The Government says that they are preparing for a pandemic. That's good enough for me,  Isn't that good enough for you?

Fluwikiian:  That's where you may find yourself dead.  Look, the government is planning for a Class 3 Pandemic.  However, all of the data and scientists are seeing the potential for a class 5 Pandemic.  That's like preparing for Category 3 hurricane, when the radar and satellite pictures are showing a Category 5 bearing down on you. You may survive a Cat 3 if you hunker down.  But if that Cat 5 shows up, your dead if you don't prepare.  And that's what I am here to talk about. 

Moderator:  Are you saying we're going to have a Class 5 pandemic?

Fluwikiian:  I am saying that the forecast for a Pandemic is currently a Class 5, but who knows?  just like a hurricane, it may peter out before it gets here...  But it makes no sense to prepare for a Class 3 pandemic when all the signs point to a major blowout.....

Now in order to even have this conversation, FW has to create the Pandemic Severity Index, put out a press release, and start using and talk about it.

Then, offer up the Fluwikiian spokesmodel, I mean spokesperson, that will then hit the FW talking points:

1.  There are different levels or classes of Pandemics
2.  The one we are facing is a class 5 pandemic.
3.  The types of preperations are different for each pandemic.
4.  The government is preparing for the wrong pandemic.
5.  The average american doesn't even understand the yearly probability of occurance of each type of pandemic.
6.  The high negative impact of a class 5 pandemic coupled with its high probability of occurnace with H5N1 means that the time to plan is over, and it is time to prepare.
7.  And more.....

All of the other stuff, how much, what, etc, is better set up for the net.

 

Just rolling along, making waves and causing trouble...


[ Parent ]
Pandemic Path Scale - Building on Existing Discussion
It seems that when ever the influenza pandemics are discussed, three main factors come into play in one form or another:

Attack rate, mortality rate and mortality curve.

I am wondering if something using existing terminology, but the hurricane category structure would work. 

Pandemic Pathogenicity Scale (Path Scale or PPS)

Morbidity (Attack Rate) x Mortality (Case Fatality Rate) x Mortality Curve (Deaths<65 on a comparative scale)* = Path Score

Using the 20th Century Pandemics as rough models, we then create 5 buckets:

Path 1: Mild  (1968-69 Hong Kong)

Path 2: Moderate (Asian 1957: )

Path 3: Acute (1918: 20 million deaths est)

Path 4: Severe  (1918: 40 million deaths est) 
Path 5: Ultra  (1918: 90 million deaths est)

I have more detail, but there's a lot of different numbers for each pandemic that are bandied about for each of the elements I have included. Rather than include them and turn the discussion to that detail, I have just set out the barest outline to see if any of it makes sense.

*Or pegged to median age of illness and/or death

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
not all are sure closing schools explained lower mortality in 1918
Pixie caught this piece of news about the conference.  A skeptic's view.  Makes me wonder.

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

Random Comments on the Slides
MARTY CETRON, CDC slides:  Any word on when the state-based excercises on a state and community level will be rolled out? That will be an excellent time for advocating for citizen engagement and getting in some talking points on the side.

Venkaya slides:  The graphic of the base line and surge capacity line, when compared to either the projected demand and even the mitigated demand, was a bit of a shock - though I knew that surge demand would overwhelm surge capacity, I had not thought it would do so by such a large proportion. 

I think his comment about the uncertainty of effectiveness of community mitigation strategies is important to note.  Just because it works on paper (or in cyberspace) does not mean it will fly in the real world. It may be all we have, but its like my skills in the pool hall - shoot and hope you make it.

The slide dealing with consequences of community mitigation strategy was also enlightening.  Just as the kicking in of the body's immune system makes your body ache so badly during seasonal flu, so it is partly our own mitigation strategies that will cause some of the problems we often discuss and lay directly at the feet of the pandemic.

I also think his comment about 'spontaneous action by the public' nicely encompasses both constructive voluntary action and not-so-constructive action on the part of the public.

Thanks for reporting back.  Very interesting. 


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


more to come
and more slides to post.

[ Parent ]
Whan do you think?
I've gotten accustomed to SusanC's instant reporting -- do you think she took a night off?  (-:


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

[ Parent ]
continuous scale
I don't understand, why you all want levels.
Just use a continuous scale with probabilities and expectation values.
Or use both.
But don't hide behind the less informative one
to prevent commenting on the more informative one.

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


continuous and discrete scales not exclusive of each other
Reality gives us a continuous, multivariate scale, acting all over the planet.  And for each point we will respond with a continuous, multivariate scale, on each spot of the planet.  So reality is really a mess.

But we want action, and for each individual "action" is very much an ON/OFF proposition.  You either get surgery or you don't.  Ok, sometimes it makes sense to wait for further symptoms, or wait for the effect of drugs to take place.

We give names to colours, and we also have "reddish", "yellowish", etc.  We can have PF-0 until 100, and also PF-A until E.

In short, we can always go back to complexity, right after we've captured the attention of a number of people.

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


[ Parent ]
Quick reference - broad audience
A pandemic scale would be useful and not useful for the same reasons existing scales for natural disasters are.

They provide a quick refernce to describe severity and inform of the threat.

They provide (once popularized) a comparative measurement tool to allow uninformed members of the public a way to compartmentalize what is being discussed. 

For many, possibly most, the term "1918-like" means very little.  The terms 1957-like or 1968-like mean even less.

While inexact and admittedly simplified, they provide a useful starting point, especially for the broader audience.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
more phases
hurricane-scales and WHO-phases do this, but earthquake scales
or damage-costs are more informative since they use a continuous scale.

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


[ Parent ]
WHO Phase Measures Progress
Not severity.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Most Americans have little experience of earthquakes -
do we all understand that a 6 is 10 times a Richter 5? 

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

[ Parent ]
cat6 is 10 times as bad as 5 - same with pandemics, i would say
I'm just guessing, but I think there IS a cut-off point so that after that things are radically different.  We just don't know where that falls.  Call it "elasticity limit" if you wish.  Such a "limit" is bound to be multivariate - just like elasticity of some plastic may vary with temperature or whatever.

Thing is, we might have to frame it in terms of the response needed, not in terms of the intensity of the pandemic.  We would be talking about:

- level 1: "a pandemic that needs a health-care only response"
- level 2: "a pandemic that needs an essential-services mainly response"
- level 3: "a pandemic that doesn't let us think about it very usefully in a community level"

How that relates to CFR and "other variables we haven't grasped yet" is beyond me (yet).

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


[ Parent ]
what's the point of conferences ?
wouldn't it be much better and cheaper and faster and more comfortable,
if they presented their data on a webpage with discussion board ?

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


we're almost having both, if they listen
Ok, it could be better, I supose.

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

[ Parent ]
gs, that comment alone justifies your existence ;-)
if you didn't exist we'd have to invent you. ;-)

[ Parent ]
in the beginning was the logic (with 80% probability)
Dem wrote:

  >gs, that comment alone justifies your existence ;-)

and I thaught, our constitution already did this

  >if you didn't exist we'd have to invent you. ;-)

you can invent people ?
I pause to wonder what is here inferred...


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


[ Parent ]
this has to be repeated
> the view of the Bush administration [is,that]
  > 1918 is not the worst case scenario, we are using the figures
  > for policymaking only

why had they been hiding this view since now ?
will they now propagate this view more ?

and how did the prices of mortality-bonds react on this announcement ?

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


correction
oops, "until now" not "since now".
Unfortunately we can't edit comments here :-(

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


[ Parent ]
there is still no consensus
only opinions.

[ Parent ]
and part of the point of the meeting
remember your 'why meetings?" is to reach an 'interim'
  consensus. if that's possible. And it's not clear what that will be, or if it is possible.

[ Parent ]
consensus

consensus in meetings is based on social pressure
not reasonable weighting of arguments.

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


[ Parent ]
that's pure opinion on your part
sometimes it is, and sometimes it's not, based on fact. It's always based on persuasion regarding alternatives and consequences.

[ Parent ]
'interim' consensus
You mean like since we have different opinions and/or want differnt NPI's or the same NPI's at different times, or think different people should pay for the same stuff...if we are lucky, there might be an accidental period of time when we kinda all ended up in the same spot?

Measured in nanoseconds maybe?

.-)



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


[ Parent ]
Alert levels
If you have too many levels, you run the risk of people ignoring dangerous situations.

Every year I see people brush off Category 1,2, and 3 hurricanes as "small" because they focus on the higher numbers of 4 and 5.  This is true even after Wilma, which did terrible damage in Florida and was a Cat 1/2, I think.

I would stick with 3 levels for this reason.


Alert levels like hurricane cats???
I just looked at Matt Cartter's slides, and though I highly respect the effort at making information easier to relate to, I don't think the concept of hurricane categories applies very well to pan flu.  The slides don't flow that well, so I can only fill in the gaps from one to the next and "guess" what he was trying to convey.  So please forgive me if you disagree.

Just juggling the numbers on the slide, the ratings, 1, 3 and 5 appear to be based on total estimated deaths in the U.S.  cut-offs of 100K and 1M.  That looks completely arbitrary.  Arbitrary isn't always a bad thing, but there's a table where it looks like he suggests linking these alert levels with certain pandemic actions.  With the huge consequences of pulling the trigger, is arbitrary a good thing in this case? 

Why not just use estimated number of deaths, the number from which these levels seem to be based?  Isn't that something people can relate to, and actually less euphemistic and more to the point? 

Now with hurricanes, a hurricane category is based on the highest windspeed near the center of the storm.  A lot of statistics have gone into developing the scale.  Cat 5 is assigned to storms that are near the top end of physically (thermodynically) possible storms.  And there are certain local actions that are taken based on the intensity of the storm, and predicted landfall.  (Aside: The NHC talks to local authorities and advises them on what plans they should follow.  Why?  See next paragraph)  Are there enough statistics on past pandemics to really say that 1M dead is even a good cutoff for the highest category? 

Speaking of predicted landfall, places that end up affected by the storm, but are even a fairly short distance away from the immediate eyewall will likely see much lesser effects.  For instance, as you know, a cat 5 hurricane can come ashore, and 50 miles away from the hurricane's eye, the effects might be more like a cat 1.  The Nat'l Hurr. Center has gone to great lengths to make people aware that when they see a projected path of a hurricane, to not focus on the exact track.  The only reason I bring this up is that to me, it weakens the argument that this pandemic alert level is not analogous and can actually do some harm.  If a pandemic happens, everyone in the U.S. is in the middle of the 'projected track.'  To me, it's another thing I see to file under 'what's the point in modeling after hurricane categories?'  And in fact, it kind of undermines the Hurricane Center's efforts in warning people to pay attention to specific forecasts for their area, and not to stare at the specific track.  It is a big deal.

So I just don't see the point in doing the alert levels as I am surmising they are to be used.  Although well-meaning I'm sure, it's not a well-thought notion and isn't particularly meaningful.  JMHO.

Meteorologist in Florida!?!  Now we're talkin'!!!


Corr
"it weakens the argument that this pandemic alert level is not analogous and can actually do some harm."

meant to say:

it weakens the argument that this pandemic alert level is analogous and can actually do some harm." (remove 'not')

Meteorologist in Florida!?!  Now we're talkin'!!!


[ Parent ]
meteorologist?
There is no perfect system. It was argument by analogy, and a stretch.

You can't please everyone, obviously. ;-P


[ Parent ]
ha!
We are well-covered in fluwikie, aren't we?!?

Meteorologist in Florida!?!  Now we're talkin'!!!

[ Parent ]
we are!
we are the people. ;-)

[ Parent ]
A way to reach the public
We have been trying to find a way to show magnitude and intensity of a potential pandemic using natural disaster educational tools that already exist.  Of the ones that I can think of (tornado levels, hurricane categories, earthquake scales, tsunami warning - is still being worked on), the one that the public knows the best, even in the northern states, are the hurricane category warnings.

If an educational outreach program for the public is developed using a system similar to the hurricane warning categories (and I think it would be a good system to consider), you would need to use all of the categories (ie: don't use just 3 out of the 5 categories) so it would not confuse people.  For example, if you have a 3 category system and state it as 1,2,or 3, people might think of category 3 as a moderate level compared with hurricanes.  Even the terrorism threat levels are 5 levels and seem to mirror the hurricane levels so that people can understand them a little bit easier.

Should this system be used, people would need to understand that if a pandemic begins and our country is at a level (category) 5 risk, that risk level is for the entire country and not just in a single state.  Having different levels for different states would be too hard for people to keep track of.  IMHO, it would have to be an all or nothing deal for the whole country - the country would be a single level.

Again, we need to keep in mind that this would only be for educational purposes to get people prepared for a potential pandemic.  This is not for epidemiological tracking of cases once it starts.  It is not for marking some areas/states at higher levels if they have international travelers.  It is to make this very complex and confusing information easier for the general public to understand so they can follow through for themselves and their families.


[ Parent ]
Implementation
The problem I forsee is with implementation of such a scale at the practical level.

Will our authorities have enough courage to encourage our people NOT to wander about town as usual during a Cat. 5 pandemic hurricane?

This, to me, is the weakness of this scaled system.  If the danger is brief, then battening down the hatches and staying out of the storm - completely -  is the only logical response. 

In a prolonged event, will our officials, can our officials, tell everyone who is not a critical worker to "stay out of the storm?"  That will take courage. It is also a difficult message because you want the people who produce food, for example, to NOT be scared into not showing up for work.

Implementation of these warning systems is very tricky.  In NYC, we will never go above "orange" on the terrorist alert scale unless an event has already happened as "red" triggers the closure of all the tunnels and transportation.  Even moving from "yellow" is very difficult politically, so you try not to move to orange. It begins to be the "scale" that is evaluated, rather than the incipient threat itself in some of these instances (i.e. "we can't move to orange, or Level 5, or whatever because then X,Y,Z, will have to happen). 

We've seen the same thing happen with the WHO pandemic phase warnings.  If an actual action is required, or even suggested, by moving to a higher level, then it becomes the level system itself that can muck up the works and can also prevent the implied logical movement and timely actions that are needed.  The system itself, then, can become a very big problem.

Recently with that rumor of a case in Quebec I looked up the U.S. pandemic "levels," as I was fuzzy about their details.  One problem became evident immediately.  The way the levels were thought out refelcted the way that people a year or two ago (when the levels were created) thought about how H5N1 would arrive here.  Well, if you look at the chart, it is very clear that "the first human case in North America" puts us right at the equivalent of "Level 6" the way they have it (graphically and mentally and maybe legally) now.  No question that that would trigger some pre-set actions once a case is found anywhere in North America (and it was interesting that it was "North America," not simply the U.S.).  Would that pre-set equivalency to the WHO Level 6 make them less likely to reveal the first case (and the level change is made for a single case) of H5N1 in North America?  I think the answer is obvious. 

So, when we set these levels we sometimes set parameters (and sometimes straight jackets) for our later actions on this information too.  That's where the process seems to fail a bit.  In hindsight, for example, we now know that putting the first single human case the equivalent line on the chart with WHO Level 6 is probably a bit extreme, but that's with the benefit of hindsight from our position months after the chart was made.  Looking ahead on what to actually implement from these various pandemic levels and how, is a really difficult question.  More difficult than just figuring out what the velocity and severity of the storm itself should be awarded on the scale - that is the easy part. 


[ Parent ]
UPDATE
Hi everyone, apologies for being offline for so long.  Between a slow internet connection, a dying PC, and jet-lag it was kinda hard.  I finally got the machine and stuff running at 1am, but i was so tired that I would start sentences and not know how to finish them!  In the end I just had to give up.  This morning I realized I hadn't even taken out my contact lenses.

Anyway, I'm flying today.  I'm going to put up some info rather than discussion cos that needs more continuity.  But it's been a good meeting, everybody worked hard, the whole process was quite challenging, but I can see the benefits.  More later.

Here I'm going to backtrack a bit to give the framework of this meeting, the menu of NPI's being considered in the 2 days.  Again the purpose of the 2 day meeting was to summarize the findings from the different activities over the past 6 months (see Cetron's slide on CDC Activities) for the participants,  whose collective job was to come up with conclusions, recommendations, or suggestions so that the CDC/HHS can write up the interim guidance for state and local PH.  The paper has to go to the WH before Xmas, so it's a crazy deadline.  (Mine were not the only dark circles under the eyes, there were plenty to go round!)  It will also be circulated between agencies, after which it will go public in early January.

Those who are mathematically inclined will find this interesting:

Math models predict a synergistic effect when certain measures are used in combination This is because the initial upswing of an epidemic curve is exponential and interrupting an exponential process through the use of multiple interventions results in synergy when mapped on a linear scale.

Menu of NPI's

  • Voluntary isolation of cases
  • Voluntary quarantine of household contacts of cases.
  • Protective sequestration of children and adolescents, including by closing child care centers, schools, and universities and preventing these persons from congregating in the community
  • Interventions to reduce transmission in the non-health care workplace eg exclusion of ill workers, social distancing and hygiene measures
  • Interventions to increase social distance in the community eg cancellation of large public gatherings, closure of public places, measures to decrease crowding on public transport
  • Domestic travel precautions, advisories, and restrictions
  • Infection control measures in the home, community, and non-healthcare workplace
  • Measure with respect to healthcare delivery
  • Early antiviral treatment for cases and post-exposure prophylaxis for household contacts.




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


Also..
This document was “guidance for implementation independent of whether or not authorized jurisdictions choose to apply them in a compulsory manner”

"The measures suggested in this document are for implementation during a severe pandemic at a severity similar to or higher than the 1918 pandemic.  The implementation may commence once a pandemic has been recognized in the US.  A document that describes the usefulness of these measures in less severe scenarios is being developed separately."



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


Epidemiology assumptions for using these measures
  • Person to person spread, primarily by the respiratory route over short distances eg 3-6 feet and to some extent by contact with respiratory secretions such as on hands
  • Short incubation period – mean 2 days, range 1-4
  • Peak infectivity early in illness, correlated with fever and symptoms
  • Transmission from persons without symptoms (about 30% of those exposed) possible but much less likely
  • R0=1.9
  • Critical role of children in infection transmission
    • higher and longer duration of shedding virus when infected
    • Studies show flu typically introduced into household by children
    • High density and mixing in school
  • No assumptions about disease severity,
  • In most severe pandemics, duration of measures in community likely to include the full period of the outbreak eg 12 weeks




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


If I were
the President, I'd say:

"Ok, we'll tell them to stay at home if they're sick, stay at home if they're exposed, don't hang out in crowds, try not to travel, encourage good hygiene, and we'll advise them to close the schools."

"Now what?"

That's the response I get when I present this series of "measures" to the moms around me.  They don't need to see any computer modeling.  These things just make sense to them as moms.

The next question from them, as I will expect it will be from our President, is also invariably "yeah, ok, well that makes obvious sense - now what?

What do I need to do, have, buy, prepare, to make that feasible?

That's the complicated bit. 

The moms want to know how to be able to stay home.  They want to know how much stuff they'll need.  They want to know how to deal with their employers or their childcare. They want to know what to do if their own school district doesn't close early.  They want to know if there will be food in the stores.  The moms understand the results of the TLC meetings intuitively.  They need to know how to be able to do what their own common sense, and the experts at this meeting, recommend. 

The moms, in other words, are much more worried about how to implement these measures in the practical than they are about agreeing they are useful.  (In other words, we could have gotten a group of soccer moms together and pretty much reached the same conclusions). 

They, however, don't know how to begin to make it feasible for themselves or for anyone to actually DO what makes sense. 

I am hoping that the President will also quickly toss back the report and will also ask "ok, now what?" just as quickly as my local soccer moms have.


A "No Duh" Moment
The moms, in other words, are much more worried about how to implement these measures in the practical than they are about agreeing they are useful.  (In other words, we could have gotten a group of soccer moms together and pretty much reached the same conclusions).

That's funny, Pixie. It reminds me of an article I wrote when my oldest child was about three. There was a Harvard study released that declared very self-importantly: "There is violence in children's videos."

One of the points in my article was, "No duh. A random poll of moms hanging out with their kids at the local pool would have yielded the same findings."

Meanwhile, all the money spent on the Harvard study could have been used to help the homeless families on Harvard's own doorstep without a roof over their heads much less a VCR with which to watch said violent children's videos.

With a couple of exceptions, everyone I know who is seriously prepping has school-age kids. When I present the situation to them from the mom angle, they get it.



[ Parent ]
YOU GO, GIRL!
Pixie, you took the words right out of my mouth!  I was just getting there!

A very interesting thing happened in the afternoon.  Now remember the goal of this meeting was to analyse all the evidence available, and make recommendations that could be put out to State and Local PH. 

As we got into the discussions in the afternoon, we were really struggling with this task, the reason being that if you have to recommend certain measures that might save lives but cause secondary consequences to varying degrees and to various people, who may not even be the beneficiary of those measures, you better have a good case ie evidence, benefits outweigh cost, etc, and you better have fairly good consensus!

Since the IOM report was shall we say so 'balanced', it became useless as 'evidence'.  Plus you don't know how many lives you can save, you don't know how much it's going to cost, and who it's going to cost etc.  So that was a really difficult deal.

Halfway through the final session, Marty Cetron, bless his heart, threw some sparklies into the whole thing by asking those who had school-aged children (about 20-30), if we had a pandemic and there were cases in your community, how many would send their children to school. 

Nobody raise their hands!  It was amazing, and surreal.  Not only that, I had turned around and was watching the audience.  Apart from 1 person who was maybe uncertain for about 10 seconds, everyone else was completely sure.  It looked to me like this was not the first time they had thought about this and they had pretty much made up their mind.

I was gobsmarcked!  I had expected most parents to arrive at the same conclusions, but I did not expect 100%.

The same group of people, considering the same question, when acting as policymakers, had real problems arriving at conclusions or recommendations to any degree of conviction or consensus.  But when asked as parents, the response was certain, absolute, and had 100% consensus.

All this, after 6 months of activities by so many agencies, 2 days of hard work by 200+ experts/professionals...



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


[ Parent ]
Let's especially not forgot to throw in
the Los Alamos modeling.  ;-)

Next time we'll just have a picnic.  I'll make the sandwiches. 

The follow-on issues are not so easy.  Maybe that's why they want to stay with the ones here.  Who want's to volunteer for the follow-up committees?  Anyone?  Those will be the tough committees to be a part of, career-wise, emotional-wise.  Talk about being gobsmarcked...


[ Parent ]
What happened?
I have some theories but this immediately came to mind:

It is better to have approximate answers to the right question than to have the exact answer to the wrong one.

Irene Eckstrand, NIH-MIDAS

I have to catch a flight soon so I will give my short 2C here.

In the whole process, nobody had realized one thing.  Bottomline, school closure is the biggest intervention, and kids would be affected, either positively or negatively.

Kids have parents (or surrogate equivalents) who have the legal right to make the ultimate decision for the child.  Whether you like it or not, it's the parents' decision that is going to count.

Unless you want to use mandatory powers to take away parental rights, and nobody wants to do that, the way that parents make their decisions, their judgment of the whole situation, their risk assessment, is going to count far more than any expert in the room.

Somebody needs to go out and ask the parents.

I gotta go, more later.



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


[ Parent ]
The single most valuable piece
of information I have gotten anywhere so far is the news that you told me regarding the hypothesis that herd immunity will probably be reached in any given community when 30% to 35% of that population is infected. 

There is then an actionable choice that can be made there. 

Who in that community will be infected? 

Will it be the children? 

The parents need to be asked that.  It pretty much clarifies things for them quickly, and for most others as well.


[ Parent ]
Pixie
Scientists/PH officials need evidence.

Parents only need information, even if incomplete and with uncertainties.  They are used to dealing with uncertainties.  Making decisions based on insufficient evidence comes with the territory.

All they need is for the experts to give them the info, proven or not.



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


[ Parent ]
PH officials too
will need to become acustomed to working without the customary "net" of evidence.  It is just not going to be there, in that this is a once in a 100-year event we are talking about.  We may have already milled about as much as we can from what is out there. They are on new ground.  The time for insisting on customary rubrics in order to take (any) action is now very limited. 

[ Parent ]
Pixie you are so funny
and so spot on.  That's exactly how everyone will react - not just moms, but everybody.  We convince them of the problem, but with no direction of what to do next we'll have a lot of headless chickens running amok in Costco.

And everyone knows soccer moms are the smartest...;)


[ Parent ]
Breakout groups
The morning of the second day, participants broke up into groups, and did a process similar to the ASTHO public engagement exercise.  We worked on 5 interventions:
  • Voluntary isolation of cases
  • Voluntary quarantine of household contacts
  • School closure
  • Protective sequestration
  • Social distancing

figuring out benefits, challenges, mitigation strategies, etc.

Then we were asked to 'vote' for each of these measures as well as put down when we want the measures implemented:

  • when the disease was outside the US
  • just hit the US
  • in your state
  • in your region
  • in your community
  • many cases in community

There were quite a few CDC people in the room in my group, almost the same number as participants!  The discussions were quite interesting because you can really see people trying to come to grips with making the 'right' choice.  The voting took the form of putting different colored sticky labels on the measure. 

The fact that you had to do it in front of the whole group probably put some pressure on some people.n The upside was you could observe people's behavior as they try to come to grips with a problem that really, whatever you choose, is not going to be perfect nor painless!  I think one big learning probably was an awareness of how difficult this must be for those who actually had to make the real decisions f a pandemic happens.

After lunch, we got back to the big room and the various groups gave their findings and discussions.  I was in and out of the room so didn't catch all of the discussions.  Overall the votes were pretty consistent with the ASTHO exercise.  Which means that private citizens, stakeholders (Washington DC and this meeting), and PH professionals (this meeting) pretty much made similar choices.



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


Synergy works both ways; Closing schools is the first half - not toughest half of that NPI
Math models predict a synergistic effect when certain measures are used in combination. This is because the initial upswing of an epidemic curve is exponential and interrupting an exponential process through the use of multiple interventions results in synergy when mapped on a linear scale.

I would hope that they understand that the negative impacts of a pandemic on society, taken in their cumulative effect, operate under that same rule - to increase problems on a synergistic basis as they are added to the equation.

Menu of NPI's

...
Protective sequestration of children and adolescents, including by closing child care centers, schools, and universities and preventing these persons from congregating in the community
...

And if there is not someone home to keep them from congregating in the community, especially if the net is down or restricted, that will be a very interesting situation.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


Interesting point
Into the Woods - what an idea: tasking the best and the brightest we have to keep the internet up in order to keep our teens out of the malls and away from the Dunkin Doughnuts parking lots, hmmm. 

Who would have thought that the continuing health and well being of MySpace could become a vital national security matter, but I think you're absolutely right!  :-)


[ Parent ]
USINFO take on IOM meeting
On our government's website:

13 December 2006

Slowing Pandemic with Social Action Could Have Costs, Consequences

Institute of Medicine studies community interventions to stop influenza transmission

By Charlene Porter  USINFO Staff Writer  /  http://usinfo.state....

Washington – A prestigious U.S. nongovernmental scientific organization – the Institute of Medicine-- is urging caution about policies to close schools and workplaces if a serious influenza pandemic strikes a town and raising doubts about how effective so-called community interventions really are in slowing the spread of disease.

[snip]

In the 1918 influenza pandemic in the United States, some city and town officials took action to minimize social contacts to prevent further spread of the disease. They closed schools and theaters and prohibited worship services and community meetings, hoping the actions would keep infected people away from well people to limit the spread of the disease.

The Institute of Medicine (IOM) – part of the U.S. National Academy of Sciences – examined the implementation of these actions in the past,  theoretical models forecasting the implementation of social interventions, and the available science on the effectiveness of such actions. IOM is a private nongovernmental organization that often conducts studies for federal agencies.

The IOM report, released December 12, is not conclusive, but it recommends further study on the issues and suggests that some possible actions that might seem rooted in common sense could have unforeseen consequences.

[snip]

The report also makes a strong warning about the potential for the rights of the individual to be trampled in a community effort to control a pandemic’s spread.

“While imposition of costs on individuals can often be justified, care must be taken to ensure that individual sacrifices are only imposed when necessary to protect the public’s health,” the report says. “Balancing benefits and costs is particularly important in the event of a pandemic, where the stress and fear caused by an immediate threat of widespread morbidity and mortality can lead to ill-considered decisions.”

The committee had particular concerns about the proper balance between benefits and unforeseen costs if schools closed to prevent pandemic spread. The panel speculated about whether children might be exposed to more violence outside of the school environment, or whether parents would be able to provide proper nutrition and care when children are home from school unexpectedly.

The IOM panel also looked at historical analyses of actions taken by various communities across the United States as a deadly flu spread across the nation in 1918-1919.

“[C]ommunity interventions may have lowered the peak death rate and … proactive and early implementation were associated with flatter epidemic curves,” the panel said after reviewing historical records, “although there were examples of cities that implemented the strategies but still had severe epidemics.”

The IOM panel recommends further theoretical modeling of potential community interventions and their effects to include a greater array of possibilities than have been considered so far. [snip]

(USINFO is produced by the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state....)[snip]

Tell us what you think about this article.


They could have said kids will gain weight
eating too much pop corn, watching too much TV, so it is not a good public health measure to close schools at the early sign of pandemic.

The vested interests i.e. businesses want to keep the school open so employees will still go to work. If the ordinary people do not speak up, the outcome is not looking good. The final report will include many opt out clauses for counties to make their own decisions and the counties will be over run by business interests.

More missed opportunities.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.


[ Parent ]
life-threatening illnesses need aggressive treatments
The analogy that I make is the role of chemotherapy in treatment of cancers and the ethics behind that.  In the face of a life-threatening condition, modern medicine accepts that it is appropriate to offer treatments that carry potentially severe side-effects, including life-threatening ones. 

It is widely accepted as good clinical practice, in fact it is required (otherwise you get sued), to provide the treatment and use other measures to support or mitigate them.  Chemotherapy is now firmly established as standard treatment for many types of cancers, and have saved millions of lives.

For new treatments that do not carry sufficient clinical data to provide 'proof' to the level that science requires, you would still use it in selected cases where other options are either not available or have failed.  The key here is not just cost/benefit. 

A vital part of this equation is informed consent. 

If the patient, after being fully informed of the potential dangers, is willing to accept them, then it is appropriate and responsible to offer that treatment.

We need to give the public the opportunity to give the informed consent.

The problem is, in the case of school closure, since the adverse consequences may not necessarily fall on those who get the benefit aka the kids and their families, there arises some conflict of interest.  Cos why should people who don't have kids not be able to get food because the truck driver is home looking after his kids? 

The counter-argument to that is civilized society has already accepted the notion that there is some degree of collective responsibility to protect the most vulnerable, including children.  Warning labels on plastic bags is a good example.  Manufacturers have to take that extra step, with costs ultimately passed on to the consumer, in the interest of children in general.

The results from the ASTHO process, whether with the general public or with stakeholders or PH community, show a very consistent level of support for school closure.  (84% for citizens, 83% for stakeholders)  This is despite the widely expressed concerns about secondary consequences and the difficulty of mitigation, issues explored in those consultations before the votes were cast. 

One role that government can and should play is be the arbitrator.

Since even those who do not have young children often do accept that extra responsibility and cost, as these results show, we need to put the case to the public at large, and let the dialogue and debate, and, more importantly, the search for solutions to the consequences, start now.





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


[ Parent ]
Schools needed to protect children from their parents???
"The panel speculated about whether children might be exposed to more violence outside of the school environment, or whether parents would be able to provide proper nutrition and care when children are home from school unexpectedly."

Answer:  Don't make it unexpectedly.  Inform parents of the risks of a pandemic, and how to prepare to keep their kids at home (or to be sheltered with relatives), and how to prod their employers into taking their planned sheltering into account.


[ Parent ]
more violence when school is out?
The panel speculated about whether children might be exposed to more violence outside of the school environment

Current data from National Report on Juvenile Offenders and Victims does not support that.

This slide shows that there are more violent crimes by juveniles on school days than non-school days, while this one shows that shoplifting remains more-or-less the same.

Also, read this Kick Out The Kids, Bring In The Sales. A lot of malls already have this policy of banning kids and teens without adult supervision during certain hours. During a pandemic, they could very easily just expand that policy to cover all hours, so that only those kids with adult supervision and therefore consent can go to the mall.



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


[ Parent ]
what CFR ?
it all depends, how severe the pandemic is.
A lot of misunderstanding arises, because different commentators
have different scenarios in mind but usually don't specify
which.

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


[ Parent ]
You are so right gs!
It is very important to understand what CFR assumptions are being made in any given plan, or even speculation.

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

[ Parent ]
Who Will Feed the Children?
One of the problems with closing schools is every week day, over 27 million kids get free or very, very cheap lunch and (to a lesser extent) breakfast there.  So if we are going to close the schools (which I believe we must) not only do we need to figure out who will watch over them and prevent them from congregating outside of school, we must realize that they will be unfed, unless plans are made now to deal with this issue.
Unhappy Meals

Every weekday at lunch, courtesy of the federal government, more than 27 million schoolchildren sit down to the nation's largest mass feeding. ...

School Lunch and Breakfast Program

...The School Lunch Program subsidizes lunches (4.7 billion in fiscal year 2002) to children in about 6,000 RCCIs and almost all schools (93,000). During fiscal year 2002, average daily participation was 28 million students (57 percent of the children enrolled in participating schools and RCCIs); of these, 48 percent received free lunches, and 9 percent ate reduced-price lunches (Table 15-LUNCHANDBREAKFAST-1). The remainder were served full-price (but still subsidized) meals.
...

The School Breakfast Program serves far fewer students than does the School Lunch Program; about 1.4 billion breakfasts in 71,000 schools (and 6,000 RCCIs) were subsidized in fiscal year 2002. Average daily participation was 8.1 million children (21 percent of the 38 million students enrolled in participating schools and RCCIs). Unlike the School Lunch Program, the great majority received free or reduced-price meals: 74 percent received free meals, and 9 percent purchased reduced-price meals (Table 15-LUNCHANDBREAKFAST-2). ...



ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
feeding kids when schools are closed
This was discussed here http://www.newfluwik... and also  here http://www.fluwikie2... , which I will re-post:

On the subject of school meals, this is a good document for stats.  Food Assistance Landscape 2006 from the USDA.

About 30 million kids participate in the National School Lunch program, of whom 50% are eligible for free lunch.  That gives us 15 million kids.

However, according to the Blendon survey at the Harvard School of Public Health, of those who are eligible for free school meals, only 13% replied that they will have a major problem if schools are closed for 3 months, which is about 2 million kids.

Looking at it in a different way, perhaps we need to find out what these parents do to feed their kids during the summer vacation.  The Summer Food Service Program provides for that, and their figure, interestingly, is also 2 million.

I would assume that if schools are closed for extended periods in a pandemic, the number of school age kids that we need to figure out how to feed will be 2 million, and not 28 million.  2 million is still a big number, but in a country with 56 million kids, that works out at 1 in 28. 

Can the citizens of the US find ways to feed an extra 1/28 per child in a pandemic?  I would be very shocked if they can't!



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


[ Parent ]
keep the schools open and if the kids get sick and die
they won't have to worry about feeding them.

Parents might disagree with the officials' priorities though.
(Then, officials might have even more to worry about.)

Just tell the public; can't solve any of the problems by leaving the hundreds of millions of people out of the pandemic alert loop. They won't appreciate having been shielded from making better choices, after the govt decided citizens are on their own, but didn't really want to break the news to them; just keep collecting taxes and juggling the ponzi economy as long as possible. They will lose the public trust right when they hope to have it by having kept the public in the dark and fed them like a mushroom farm.

And not everyone who is eligible for lunch help chooses to take it;
lots of things people buy out there they don't need, but if one wants to feed their family first the lifestyle luxuries for the adults aren't missed.
Some, at least, could feed their own kids, if, the govt said, "life or death".

But not if they aren't told now;

think how much households could have stocked up bit by bit if public had been told being thrifty and resiliant was something to be proud of?
Was where real Homeland Security is?: Informed, educated, healthy, responsible citizens, getting ready in case of a pandemic influenza year?

We could have made a community-level preparedness gap by now (wouldn't that have excited tptb??) over other nations! ("Economic uncertainty! they'd stop buying stuff they don't need! They'd quit jobs they hate -or- that plan to risk their lives!" whatever tptb imagine why not to tell the public- Well, we know how certainly bad the economic future will be if we have an unmitigated influenza pandemic...)

A nation's children are its future.


[ Parent ]
They are kidding right?
Do I need more coffee to read that correctly?  I think I'll take the chance of my children accidentally seeing violence on TV at home vs dying.  Thanks USINFO for your opinions but I choose to ignore them.

[ Parent ]
the local/state people
are worried about what the teens will do and where they'll go if school's out.

Doesn't mean that's the definitive concern, but it's out there in officialdom.


[ Parent ]
Re: where they'll go if school's out
What do they in the summer when school's officially out? Most of 'em go to the mall, the movies, the beach (if there's one close by). In a pandemic, the mall will be closed, the theaters will be closed, and the beaches and lakes may be off-limits.
This puts the onus back onto the parents---if a family is prepped, and they know the consequences of socializing outside the home, then most likely the kids will be well aware of what's going on.
If the grid stays up, and the Internets stay up, them Instant Messaging, video messaging, emails, websites, etc. will be their playground.

This entire report makes it imperative that more and more people be made aware of the effects of the social changes that will be necessary in order to survive.


[ Parent ]
note that 'the malls will be closed'
who will close them? It is a voluntary thing. I hope that they'll be closed and kids won't go if they're open.

But...


[ Parent ]
what staff?what stock? what sales?
they may decide to close themselves

- or officials may say surprise; we had our eye on that building to give our responders some decompression space.


[ Parent ]
Agreed with crfullmoon
If...and that's a big word...if the authorities require social distancing, as was done in 1918, then the malls will have to close due to lack of business. It won't be the mall owners themselves, but the individual stores inside that will have to make that decision based on the lack of business. We know very well that the mall owners (mostly corporate entities) are going to want their lease and rent payments come He** or high water, but the businesses won't be able to pay. And that takes us into another whole discussion about business bankruptcies, etc...

There are a lot of malls across the US that are on their last legs in terms of their usefull age. They could be used for temporary housing for responders (I can hear it now: "Yep! I sleep at TJMaxx"), cold storage (some have private ice rinks), food and preps storage for the immediate areas...

I don't believe these things have been completely hashed out by the good folks who are putting the plans together that we all will ultimately have to live with...


[ Parent ]
(What ! Hash not ready yet !? Whadda they think we are; chopped liver?)
"don't believe these things have been completely hashed out by the good folks who are putting the plans together that we all will ultimately have to live with" ?

I'm shocked -shocked! BB !

If the feds do give the states some sort of report card in the Spring (if we're so lucky) what are the quizzes going to come back looking like but; more plans for more non-public planning, the "Not Started" boxes checked off for too many things, and, some of the most important preparations and problems not even asked about on the list??


[ Parent ]
Granted, my kids are younger...
but if I have to I will bungee cord them to their beds to keep them home and safe.  I know teens have their own agenda, but hopefully some will use common sense.  And if not much is open then there is less temptation to go out. 

[ Parent ]
pretty sad
It's pretty sad that the government/schools are worrying about what kind of trouble kids will get into if thier not at school.  What we need, even more than pandemic awareness, is for parents to stand up and be parents.  It's the parents job to make sure their kid isn't out causing trouble if schools are closed. 

Our children change our lives, whether they live or not.
www.misschildren.org


[ Parent ]
They see bigger problems
Seems the report is toying with the idea of keeping the schools open.  The idea of less violence is lame but illuminates their thinking that they don't want to discuss the real issues that make open schools attractive.

Perhaps they realize that the impact of closing the schools on spreading the disease may be more muted than school closures in 1918. Back then, if the schools closed, most kids went home to a non-working mother that could keep them in and fed.

Today, that may be much less likely and more difficult for many more heads of household:

From the U.S. Department of Labor, Women's Bureau http://tinyurl.com/v...

Of the 117 million women age 16 years and over in the U.S., 69 million were labor force participants—working or looking for work.

With a labor force participation rate of 59.3 percent, women represented 46 percent of the total U. S. labor force.

Labor force participation rates for women, by race, were: black, 61.6 percent; white, 58.9 percent; Asian, 58.2 percent; and Hispanic, 55.3 percent.

And from Women in the Workforce - Facts About Working Women, Center for Women and Work August 2002 http://tinyurl.com/w...

In 1900 women made up 18.4 percent of the working population. Today, women make up 46.4 percent of the labor force.
(It was approximately 20% in 1918)

62.1 percent of married women with spouse present, 65.3 percent of married women with absent spouses, 66.8 percent of never-married women and 74.5 percent of divorced women are currently participating in the labor force.

71.9 percent of women with children younger than 18, 77.9 percent of women with 6-to 17- year olds, 64.8 percent of women with children younger than 6, and 55 percent of women with infant children were in the labor force in 2000.

In 1999, 48 million children depended on the earnings of a single working mother.

Mothers were primarily responsible for the gains in women’s labor force participation rates throughout the 1990’s.

So it may be much more difficult to keep kids in if both parents or the head of household are working.  There will be a much higher likelihood of kids getting together and socializing without a parent home.  If working mothers do plan to stay home with the school-age children, then the impact to the economy will be much greater than when working mothers made similar decisions in 1918.  It may be that this is the greater fear the report is suggesting.

TPTB may believe the economic collateral damage will be much greater than many of us assume.


[ Parent ]
tptb may forget : dead people don't have economies
if one or both parents go out in pandemic and get sick
perhaps they will bring it home to their kids anyway;
does govt want traumatized orphans, or, whole families dead?
Their skills, and potential skills, erased?
(Or, bereaved parent/s that
have lost all their children suddenly? Nothing else to lose?)

Nothing like that sounds like a good prognosis for a post-pandemic economy, nor the current government, nor a healthy future.
Maybe the public needs to define "leadership" for their community, now.
(Maybe they'll have to make some for themselves.)
Educate the children about what their chances are of not having a future if they get panflu, and that it is contagious before symptoms. (And, that preganacy increases chances of death?)


[ Parent ]
It Comes Full Circle
We may be at risk of greater economic damage this time around as a result of considerably different family formation and female economic participation. 

Our social cohesion is much lower than 100 years ago, unfortunately.  Our society is made up of much smaller 'special interest groups'.  We are not identified as we were in the past; Italians, Poles, Russians, Catholics, Jews and Protestants, it is much more fractured.  This limits the appeals of leaders in these communities nowadays.  Even geographic identification is more unusual.  How many of us live with extended family nearby for even 2 generations?  America is 3 miles wide and 1 inch deep, as the saying goes.

Our advantage is electronic.  Whereas in the past it was more difficult to get comprehensive information of how the Spanish flu was unfolding, we could communicate more more often and in greater detail (not to mention interactively) using television, radio and especially the Internet (streaming video, localized content etc.).

Getting the 'soccer Mom' approach going and driving MSM is the trick.  Engaging community leaders to jump start a ground swell reaction is going to be less effective than continuing to work only at the grassroots level IMO.

I spoke with another 'senior manager' in my company today about this and his impression was that while he would look into it for his own family, the company won't likely do anything until the government tells them to because it will cost money.  People have a very durable preconceived view of the world and cracking that eggshell is much more difficult than I thought.  The Y2K fizzle is a big reason for this. 


[ Parent ]
I'm starting to think the eggshell cracked long ago
and we just can't put it together again...

(Why wouldn't the boss even tell his own employees unofficially; for they and their own families' sakes?!

Does the company expect them to show up, or will they just fold up the company and declare bankruptcy when pandemic starts??)

(And the Soccer Moms seem too busy - or too shocked if they start to listen - if the schools had shared the school checklists when they came out last March, and started community dialog, we'd be past some of the time-wasting adjustment reactions by now...)


[ Parent ]
Managers get promoted more easily by posing
Crfullmoon said: "(Why wouldn't the boss even tell his own employees unofficially; for they and their own families' sakes?!"

This boss prepared his family for Y2K and felt sheepish when it did not happen.  He (and many like him) see the PI risk in a similar light; they do not want 'egg on their face' if it is mild or does not happen soon.

Remember, managers are promoted by the impression they create as much as by their accomplishments.  Leadership is more risky, there is a much better payoff if you are a great leader, but the chances of that success are much lower.  So the average manager sticks with hitting a few singles and posing with the right people. 


[ Parent ]
this is why I never worked in a cubicle (and don't play well with bureaucracies)
Y2K was a human computer problem that was addressed and prevented and could have been fixed a bit late with not much real harm done to people.
Anyone who has been getting teased about that, well, tptb could have informed and framed that better, couldn't they; "They spent this much $$$$$$$$$ and fixed those human-made computer problems." They made the problems; they knew where they were, they knew the day the problems would start, too.
No infectious plague there.
(Y2K people who bought some flashlights and radios and had some food and cash at home, didn't freeze in the dark nor get stuck on a highway thinking they couldn't manage without french toast ingredients, the next couple blizzard-related power outtages either, I bet) (or whatever the "tropical-climate equivalent" scenario is).

- Totally different now; we have years of a "novel" virus gaining momentum, we have nations witholding info, we have mammal species who normally don't get influenza dropping dead from "unprecedented", virulent, H5N1, we have way too many human cases to say, "like the 1 case 'swine flu' alarm"; we also have reputable people saying pandemic is possible at H5N1's current fatality rate -what harm in telling, compared to getting blindsided by that?
"Pandemic insurance" doesn't go to waste.

I'd rather not feel like I see "dead people walking" because no one wants to show them the scary memos, because, "they can't handle the truth".
I'd rather not have people gasping for breath and dying with no way to stop it.
Or getting "triaged out" because they have existing medical conditions "that aren't expected to survive months of pandemic".
I'd rather have the community talking about what the heck could we do so we don't end up with heaps of blackening corpses and have to hope the army can come? and later, have to try to recover after every single surviving household has had at least one death.
Who wants to know they didn't try to warn families, and mitigate the loss of life and psychological trauma?
The outrage against govt, and, lack of young/childbearing/ working/experienced sectors will cause lasting future problems the survivors will have to deal with.
Don't the managers want to be among the survivors?
If the local health officials don't plan to be here to deal  post-pandemic, so they feel ok keeping the public in the dark, maybe they'd better say so now, so they can be replaced by people who want to give the public fair warning.

(I hate to pose.):-(


[ Parent ]
pandemic vs Y2K - wikipage
http://www.fluwikie....

I think we could start creating a FAQ (Frequently Asked Questions) page, with many questions we're hearing or that we see implied in the way people look at us).

Opinion.FAQ or where?

This should be a long page.

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


[ Parent ]
panflu vs Y2K - added to wikipage
http://www.fluwikie....

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

[ Parent ]
I really like that one:
crfullmoon on Y2K:

"...they knew the day the problems would start, too."

You say the greatest things.  :-)

Stealin' that one for my presentation (it wasn't in there anywhere...) as it's a jarringly simple and true thought.


[ Parent ]
pixie, i added that one to the wikipage
http://www.fluwikie....

So maybe you want this for a fuller presentation.

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


[ Parent ]
Thanks Lugon!
I guess we're all up tonight. ;-)

[ Parent ]
The Y2K fizzle is a big reason for this.
So many people don`t think,or don`t know, about the thousands of hours spent by the puter folks to make this a non-event.
  And, Y2K was a hardware problem, not a software(us) problem.

There is no pleasure in having nothing to do; the fun is in having lots to do and not doing it." -Mary Wilson Little

[ Parent ]
Agreed
I was at Telcordia then.  I saw what was going on to prepare.  But the average person was not aware of that or does not care.  In their mind, it still didn't happen and all that bucketed food made them look stupid to their coworkers (that secretly planned to come over if it was bad).  This is how many of the fence sitters older than 30 see this PI thing. 

There is also the adrenaline junkies among us that sully the message.  For example, in my church there is a woman that trumpets the risk of PI - and who also sends email to everyone  about the solar storm coming our way (READ ASAP !!!).  That hurts our credibility.

Also,  some have a view that it's a third world thing ('won't it really be only the dirty wogs???')

Critical thinking skills are inversely related to daily hours in front of the television.  So I do not think many will get it on their own, they need to be told on television by the President or Beyonce.


[ Parent ]
The bucks gotta stop, right now!
We won't truly know how many families will need help with childcare unless we roll this out as 'interim' policy now for State and Local PH to test-run.  I am 100% in support of the notion of 'beta-testing' whatever interventions are being considered.  It is only when a series of systematic drills have been done all over the country can we get back together to count the consequences and mitigations.

Nobody ever said it would be easy.  We can go round and round in circles searching for 'evidence', and there are those who will insist on that as 'best practice' who will keep searching all the way into the next pandemic and out the other end and there will still be not enough evidence.

Or we can take every kid's life as precious and every parent's intuition as probably telling us something valuable, test all interventions and parts of interventions to the point of failure.  Then we will know where the bugs are.  And whether the cost is too high and how we can manage that.

But, right now, State and Local PH will not do that without specific Federal instructions.  I didn't know this until it came out in the meeting.  They want someone to tell them to close schools, when to do it, how to do it, etc etc.

Since current data are all based on models or historical work, ie there are no 'properly conducted' epidemiological investigations of real pandemics, it is awfully hard to give specific instructions!

Everyone wants someone else to take the can.  If you say it, I will do it.  But if it doesn't work, or cause &%^()U, then be very clear that it was your fault, cos you wrote the guidance.

I say "Shame on them".

The bucks' gotta stop.  Right now.  Right here.  With every single official up and down the line.

If you knew enough to know that you will not be sending your child to school, then you already have whatever guidance you need inside of you.

Think about that.





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


[ Parent ]
Maybe the only way the Feds give instructions is receiving a Citizens Petition
Sadly, the Feds are followers, not leaders.  Citizens have to become leaders. The petition has to be loud and clear, so it can get onto public debate. Only then will the Feds have enough political support to give directions to the States.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
everyone has to take responsibility
for this whole process, is what I'm saying.

I'm all for people's voice, but in this specific instance, there isn't a clear line where the public stand on one side and TPTB stand on the other.  It is more like different elements of government are having to re-negotiate working relationships and chains of command and responsibility, to a larger degree.

for right now.



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


[ Parent ]
Depends on the CFR
If the CFR is high the malls will be desolate anyway. But the impact of a high CFR wont be apparent untill weeks into a outbreak. The first few weeks are where the NPI will reduce the spread.

mall closings
Most of the major mall developers require their retail tenants to carry 'business interruption' insurance which would cover the tenant and make funds available to continue to pay rent in the event of an insured 'peril' - disaster etc - while there might be some exclusions, hopefully not 'pandemic') this type of insurance would protect the Landlord's income stream and allow retail tenants to close if required to do so by govt edict. Might be a good idea for any small retailer/business wikians to look into getting 'business interruption' insurance.

I get mad everytime I read about this
All the reasons including kids getting into trouble/increased crime, kids not getting a school lunch, daycare on and on. Are inconsequential compared to death.

Do parents parent their children anymore???? Is school really a daycare center. How do parents feed watch and maintain conrtol of their children in the summer????

Closing schools saves lives period. How can the government seriously put economic intrests above the lives of the children in this country. What kind of monsters are they? This really ticks me off. This disscussion should not even have to happen in a civilised society [or so called one]


these all needed to be discussed
How can the government seriously put economic intrests above the lives of the children in this country.

The decision has not been taken yet.  This is consultation.  There was some responsibility in discussing every aspect IMO.  Especially addressing the objections and/or secondary consequences.

But the fact that the officials would personally not send their kids to school speaks volumes, and will not have gone unnoticed.  I fail to see how they can possibly ignore this.



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


[ Parent ]
you lack imagination
the fact that the officials would personally not send their kids to school speaks volumes, and will not have gone unnoticed.  I fail to see how they can possibly ignore this.

See subject. :-)

Seriously.  We shouldn't let them ignore a number of things.  Put the right pressure on the right side.  The question is how.

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


[ Parent ]
How we manage it
I think the question of "how" can be answered fairly easily.

We share the same information that those officials saw with those who make the decisions.  And, to make sure those who make the decisions make the right decision, we share that same information with those that push those officials who make the decisions. 

Put simply:  we share the data - cold, hard, and worst case scenario, with the PTA's and the teachers. 

They'll push the administrations, and the boards of ed. 

If they see the same data that those officials saw, I believe they'll come to the same conclusions. They'll shape the agenda.  And I, for one, believe they have the right to see it.


[ Parent ]
Conflict of Interest?
Pixie said; "Put simply:  we share the data - cold, hard, and worst case scenario, with the PTA's and the teachers. "

There may be cascading implications of closing schools beyond the impact to health.  For example, each school district receives federal matching funds for every kid enrolled in your local school.  Ten years ago it was about $5,000 a child.  The district will not get that money if the school year fails to run a certain amount of days (180 days??).  I'll bet many administrators and union reps are giving that loss some consideration.  Loss of those funds may hammer a district's budget.

I know a 'blown budget' pales in comparison to additional sickness and death, my point is that it will be part of the calculus involved in the decision.  This may be why schools are not banging the drum for additional preps right now.  They take a wait and see attitude. This is one of many economic impacts prepping and planning will have to face.

It is very interesting that many teachers on fluwikie have already said they won't show up even if the schools remain open.  Once they feel the risk is overwhelming, they'll disappear and SIP.  That may close the schools from the bottom up.

Our objective is to create awareness among stakeholders that are not subject to as many conflicts of interest.  This type of person will more readily demand action or a seat at the table. So instead of going to the PTA and school board, it may make more sense to go to myspace.com and push awareness through kids to the parents. Schools do this type of thing now by focusing issues oriented political messages at the kids and telling them to 'tell your parents!!!'- especially around elections.  It is an effective, proven tool we can use to our benefit. 

Kids and parents do not suffer from nearly as many conflicts of interest!


[ Parent ]
there's an assumption that
the schools will close whether it's official or not. And why would management send their kids or show up themselves if the teachers won't? And why would the unions not support the teachers who don't go if they are in the majority?

You raise excellent pooints but if this is Fed/WH policy, none of these are insurmountable barriers.


[ Parent ]
If the data shows that closing schools will save lives, the Federal govt. should pay the schools the matching funds
to gain compliance with Targeted Layered Containment.  Either the order can be given nationally under DHS in a pandemic or the feds have to strongly suggest compliance, under local control -  as in normal times.  Where the federal govt. gets the money will have to be faced later.  Our schools have to close to save the children, and their families, and localities had better get the message.  Having preparation ideas on www.pandemic.gov was never enough:  hungry people going to empty markets as individuals is different from closed schools in every state.  Wasn't there a song, "...people get ready....."?

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

[ Parent ]
I've had better luck....
talking with parents and a few board members I know individually vs going through the board/superintendent.  When officials start looking at the numbers as PEOPLE not OFFICIALS, the numbers start to impact them personally.  Talking with teachers and PTA heads is another good way to put pressure on administrators to do something.

[ Parent ]
One good thing
about going through the Board of Ed officially, though, is that any data you offer can be hard copy filed into the permanent record (then they can't say they didn't know).  Also, many times reporters are in attendance at these meetings and are always looking for interesting things to write about. 

It's similar with PTA meetings.  If you are recognized and speak, you end up in the formal record, a summary of which usually goes out to everyone in the school at some point.


[ Parent ]
common sense
I can go to any HS dropout and ask him/her if closing schools in a pandemic is what needs to be done. It would take about 5 seconds for even an uneducated person to figure this out.

Now explain to me why many people with lots of letters behind their names have to hold confrences produce charts spend monies and argure over the impacts [which anyone with a 8th grade education could figure out]. Closing schools is pure common sense. They did it in 1918 without studying the impacts. Those who didnt close schools and other venues because of econmic reasons paid in a higher death toll. Duh!

KISS if you dont close the schools children and adults will sicken and die needlessly. Why TPTB have to argue debate and hold confrences over this is beyond me. If they cant figure something as simple as this out quickly and without debate what does this say in regards to TPTB ability to react in the intrest of the public in more complex issues. We shouldnt have to push them to do what is so clearly right. 

Susan brought up a very telling point. The people argueing over this wont send their own children to school, why would they even consider sending other peoples children. Are they worth less than theirs???? 


it's good to consider all the ramifications
and the guys with the degrees aren't the enemy. nontetheless, your point is well taken.

see the next installment.

http://www.newfluwik...

If they need the charts to agree with you, fine. here are the charts.


[ Parent ]
TPTB are learning too, as everyone runs like mad
Susan brought up a very telling point. The people argueing over this wont send their own children to school, why would they even consider sending other peoples children. Are they worth less than theirs????

I don't think, before that question was raised publicly, that people were actively thinking like that.  It was a great revelation to everyone, like opening their eyes to what they are dealing with.  You could feel the power of that collective revelation.

The disconnect, unconscious before that moment, was made obvious to all, that PH officials and scientists thinking in policy terms have forgotten to connect with that part of themselves that was still part of the people.

In response to exhortations of "Above all do no harm", a woman from a school board said "The hottest fires in hell are reserved for those who remaim neutral in times of crises."

I loved it.



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


[ Parent ]
And then...
SusanC, now that you have had time to consider the events of the meeting, how do you think the participants will react professionally to that collective revelation? 

My suspicion is that nothing will change.  It sounds like many of TPTB are implementers, not leaders - especially locally.

As this thread has developed, I have thought of a guideline that has driven some of my preparation.  I became aware late last year that there were insufficient foodstuffs in America to allow everyone to prep for 2, 4 or 6 months.  But that became part of my goal as I read more of the fluwikie.  So until I had a good part of my food stored, I spoke of PI only to those I knew well.  Part of my reasoning was that I wanted to get what was needed for my family before there was a crush of shoppers at the stores.  Once I had it, I became more aggressive with the message.  Some may feel that is selfish but it isn't really; I am personally responsible for my families' safety first, once they are secured, and I have the opportunity to help others, I am obligated to assist them.  I have made that commitment explicit to one other family.

Perhaps that motivates some of TPTB.

Perhaps there is an invisible hand guiding most of TPTB. None of us know what it is, it seems.  Finding that 'invisible hand' is a waste of time at this point IMO.  Your work at a national/international level is very important, but I think more of us need to get involved with the 'Soccer Mom' ideas.  I have a few more people to see about PI this week.


[ Parent ]
this needs to be both top-down and bottom-up
and the soccer mom/dad idea really needs to be pursued.

[ Parent ]
What's a Soccer Mom/Dad approach? n/t


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

[ Parent ]
citizen activism? n/t




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


[ Parent ]
start asking your locla officials where we are at
do we have a pandemic task force? who is on it? when is the report ready? What's the plan?

perhaps that's easier after a Fed announce ment of an interim guideline in january, but then, now, or tomorrow, those questions have to be asked.


[ Parent ]
Do as I say, not as I do?
SusanC, now that you have had time to consider the events of the meeting, how do you think the participants will react professionally to that collective revelation?

I don't know, it's a little hard cos whatever we want to think, professional instincts can be very powerful. On top of that the normal machinations of government would work like they would normally work (and probably rightly so). 

OTOH, it was a powerful experience for people, particularly coming at the end of a really strenuous 2 days of working at the problem.  It is possible that there are some senior people who are actively considering the implications of these revelations.

For example, how would this be interpreted by the public, assuming the public get to know about this widely, if TPTB comes up with policies that are against even their own parental inclinations, having been made fully aware of those inclinations, even if the final decision of whether to send their kids to school has not been made?

How hypocritical would that be?  What would that mean?  That their kids are worth more than yours?

They need to give these parental instincts the proper right of place.  Parents who lose kids in the next pandemic will not forgive officials who know what they know now, including their own personal feelings as parents, and still choose to keep other parents in the dark.



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


[ Parent ]
You got that right
Parents who lose kids in the next pandemic will not forgive officials who know what they know now, including their own personal feelings as parents, and still choose to keep other parents in the dark.

[ Parent ]
You got that right
.
.
Parents who lose kids in the next pandemic will not forgive officials
who know what they know now,
including their own personal feelings as parents,
and still choose to keep other parents in the dark.

(That would make a great billboard ! ;-)
Just needs a few govt pandemic website addresses under it.)


[ Parent ]
Or Petition before they make it official or too late
We are not here to bash TPTB.  We are here to help them succeed in spite of themselves.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
then that's it
This revelation can be a powerful catalyst or force multiplier to public communication because it represents a Sword of Damocles to professional careers.

When I discuss PI with people I'll be sure to end with a recounting of that moment.  It would also be a good idea to include it in letters to newspapers or government officials.


[ Parent ]
UPDATE Dec 18
http://www.newfluwik...

White House announcement today on 6 month status report includes this on NPI:

Dem the link isn't working.  Thanks


RE: whitehouse
That sounds very promising, and is good to see. Gives one some hope. But I thought bird flu isn't going to happen?
(yes I'm being sarcastic)

United we stand: Divided we fall
www.flunewsnetwork.com


[ Parent ]
6 months
Well, now we know why so many states put out all the papers. They were trying to get their stuff in at the last minute.lol

There is no pleasure in having nothing to do; the fun is in having lots to do and not doing it." -Mary Wilson Little

[ Parent ]
yes deadlines do work, sometimes ;-) n/t




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


[ Parent ]
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