U.S. Plan For Flu Pandemic Revealed

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[Zepps_News] U.S. Plan For Flu Pandemic Revealed

 

 

 

 

http://www.washingtonpost.com/wp-dyn/content/article/2006/04/15/AR2006041500901_\

pf.html

 

*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

 

--

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talking about wiretap, it requires -- a wiretap requires a court

order. Nothing has changed, by the way. When we're talking about

chasing down terrorists, we're talking about getting a court order

before we do so "

-George W. Bush, April 20, 2004

 

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