A Major Clue
Excellent catch PCViking !
"Influenza Pandemic Simulation Reveals Challenges in Delivering Essential Services During Widespread Outbreak
Thursday April 27, 9:00 am ET
Exercise by the World Economic Forum and Booz Allen Hamilton Finds Potential Strains on Healthcare and Telecommunications Infrastructure
Advance Planning and Public-Private Partnerships Needed for Effective Response"
"Exercise by the World Economic Forum and Booz Allen", two Big Players and
a major Clue.
This must be the basis, for the Washington Post article, Sunday, April 16, 2006
Sic Semper Tryannis,
U.S. Plan For Flu Pandemic Revealed
Multi-Agency Proposal Awaits Bush's Approval
By Ceci Connolly
Washington Post Staff Writer
Sunday, April 16, 2006; A01
President Bush is expected to approve soon a national
pandemic influenza response plan that identifies more than
300 specific tasks for federal agencies, including
determining which frontline workers should be the first
vaccinated and expanding Internet capacity to handle what
would probably be a flood of people working from their home
computers.
The Treasury Department is poised to sign agreements with
other nations to produce currency if U.S. mints cannot
operate. The Pentagon, anticipating difficulties acquiring
supplies from the Far East, is considering stockpiling
millions of latex gloves. And the Department of Veterans
Affairs has developed a drive-through medical exam to
quickly assess patients who suspect they have been infected.
The document is the first attempt to spell out in some
detail how the government would detect and respond to an
outbreak, and continue functioning through what could be an
18-month crisis, which in a worst-case scenario could kill
1.9 million Americans. Bush was briefed on a draft of the
implementation plan on March 17. He is expected to approve
the plan within the week, but it continues to evolve, said
several administration officials who have been working on
it.
Still reeling from the ineffectual response to Hurricane
Katrina, the White House is eager to show it could manage
the medical, security and economic fallout of a major
outbreak. In response to questions posed to several federal
agencies, White House officials offered a briefing on the
near-final version of its 240-page plan. When it is issued,
officials intend to announce several vaccine manufacturing
contracts to jump-start an industry that has declined in the
past few decades.
The background briefing and on-the-record interviews with
experts in and out of government reveal that some agencies
are far along in preparing for a deadly outbreak. Others
have yet to resolve basic questions, such as who is
designated an essential employee and how the agency would
cope if that person were out of commission.
"Most of the federal government right now is as ill-prepared
as any part of society," said Michael Osterholm, director of
the Center for Infectious Disease Research and Policy at the
University of Minnesota. Osterholm said the administration
has made progress but is nowhere near prepared for what he
compared to a worldwide "12- to 18-month blizzard."
Many critical decisions remain to be made. Administration
scientists are debating how much vaccine would be needed to
immunize against a new strain of avian influenza, and they
are weighing data that may alter their strategy on who
should have priority for antiviral drugs such as Tamiflu and
Relenza.
The new analysis, published in Proceedings of the National
Academy of Sciences, suggests that instead of giving
medicine to first responders and health-care workers, as
currently planned, it might be wiser to give the drugs to
every person with symptoms and others in the same household,
one senior administration official said.
The approach offers "some real hope for communities to put a
dent in the amount of illness and death, if we go with that
strategy," a White House official said.
Each year, about 36,000 Americans die from seasonal
influenza. A worldwide outbreak, or pandemic, occurs when a
potent new, highly contagious strain of the virus emerges.
It is a far greater threat than annual flu because everyone
is susceptible, and it would take as much as six months to
develop a vaccine. The 1918 pandemic flu, the worst of the
20th century, is estimated to have killed more than 50
million people worldwide.
Alarm has risen because of the emergence of the most
dangerous strain to appear in decades -- the H5N1 avian flu.
It has primarily struck birds, but about 200 people
worldwide have contracted the disease, and half have died.
Experts project that the next pandemic -- depending on
severity and countermeasures -- could kill 210,000 to 1.9
million Americans.
To keep the 1.8 million federal workers healthy and
productive through a pandemic, the Bush administration would
tap into its secure stash of medications, cancel large
gatherings, encourage schools to close and shift air traffic
controllers to the busier hubs -- probably where flu had not
yet struck. Retired federal employees would be summoned back
to work, and National Guard troops could be dispatched to
cities facing possible "insurrection," said Jeffrey W.
Runge, chief medical officer at the Department of Homeland
Security.
The administration hopes to help contain the first cases
overseas by rushing in medical teams and supplies. "If there
is a small outbreak in a country, it may behoove us to
introduce travel restrictions," Runge said, "to help stamp
out that spark."
However, even an effective containment effort would merely
postpone the inevitable, said Ellen P. Embrey, deputy
assistant secretary for force health preparedness and
readiness at the Pentagon. "Unfortunately, we believe the
forest fire will burn before we are able to contain it
overseas, and it will arrive on our shores in multiple
locations," she said.
As Katrina illustrated, a central issue would be "who is
ultimately in charge and how the agencies will be
coordinated," said former assistant surgeon general Susan
Blumenthal. The Department of Health and Human Services
would take the lead on medical aspects, but Homeland
Security would have overall authority, she noted. "How are
those authorities going to come together?"
Essentially, the president would be in charge, the White
House official replied. Bush is expected to adopt
post-Katrina recommendations that a new interagency task
force coordinate the federal response and a high-level
Disaster Response Group resolve disputes among agencies or
states. Neither entity has been created.
Analysts at the Government Accountability Office found that
earlier efforts by the administration to plan for disasters
were overly broad or simply sat on a shelf.
"Our biggest concern is whether an agency has a clear idea
of what it absolutely has to do, no matter what," said Linda
Koontz, director of information management issues at the
GAO. "Some had three and some had 400 essential functions.
We raised questions about whether 400 were really
essential."
In several cases, agencies never trained for or rehearsed
emergency plans, she said, causing concern that when
disaster strikes, "people will be sitting there with a
500-page book in front of them."
The federal government -- as well as private businesses --
should expect as much as 40 percent of its workforce to be
out during a pandemic, said Bruce Gellin, director of the
National Vaccine Program Office at HHS. Some will be sick or
dead; others could be depressed, or caring for a loved one
or staying at home to prevent spread of the virus. "The
problem is, you never know which 40 percent will be out," he
said.
The Agriculture Department, with 4 million square feet of
office space in metropolitan Washington alone, would likely
stagger shifts, close cafeterias and cancel face-to-face
meetings, said Peter Thomas, the acting assistant secretary
for administration.
The department has bought masks, gloves and hand sanitizers,
and has hired extra nurses and compiled a list of retired
employees who could be temporarily rehired, he said. A
24-hour employee hotline would provide medical advice and
work updates. And as it did during Katrina, Agriculture has
contingency plans for meeting the payrolls of several
federal departments totaling 600,000 people.
Similarly, the Commerce Department has identified its eight
priority functions, including the ability to assign
emergency communication frequencies, and how those could be
run with 60 percent of its normal staff.
Operating the largest health-care organization in the
nation, the VA has directed its 153 hospitals to stock up on
other medications, equipment, food and water, said chief
public health officer Lawrence Deyton. "But it's a few days'
worth, not enough to last months," he added.
Anticipating that some nurses may be home caring for family
members -- and to reduce the number of patients descending
on its hospitals -- the VA intends to put nurses on its
toll-free hotline to help veterans decide whether they need
professional medical care. At many VA hospitals, nurses and
doctors would stand in the parking lots armed with
thermometers and laptop computers to do drive-through exams.
Modeled after its successful drive-through vaccination
program last fall, the parking-lot triage is intended to
keep the flow of patients moving rapidly, Deyton said.
Much of the federal government's plan relies on quick
distribution of medications and vaccine. The Strategic
National Stockpile has 5.1 million courses of Tamiflu on
hand. The goal is to secure 21 million doses of Tamiflu and
4 million doses of Relenza by the end of this year, and a
total of 51 million by late 2008.
In addition, the administration will pay one-quarter of the
cost of antivirals bought by states. The Pentagon, VA, USDA
and Transportation Department have their own stockpiles --
and most intend to buy more as it becomes available.
Blumenthal, the former assistant surgeon general, questioned
why two years after Congress approved a $5.6 billion
BioShield program to develop new drugs and vaccines, so
little progress has been made.
Homeland Security's Runge has a different concern: "One of
the scariest thoughts is, if this country has successfully
developed a vaccine within six months of an outbreak or our
supply of antivirals is greater, there may be a rush into
the United States for those things."
And even if those fears do not materialize, officials have
warned that the federal preparations go only so far. Much is
left to the states, communities and even individuals.
"Any community that fails to prepare -- with the expectation
that the federal government can come to the rescue -- will
be tragically wrong," HHS Secretary Mike Leavitt said in a
speech April 10. The administration is posting information
on the Internet at
http://www.pandemicflu.gov .
© 2006 The Washington Post Company
