[Mb-civic] U.S. Plan For Flu Pandemic Revealed - Washington Post

[William Swiggard]

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 .

http://www.washingtonpost.com/wp-dyn/content/article/2006/04/15/AR2006041500901.html?referrer=email
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://www.islandlists.com/pipermail/mb-civic/attachments/20060416/4cda122d/attachment.htm