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Preparing for a Natural Disaster of Pandemic Proportions

Since September 11th, and even before, the federal government has run war games. These drills have been designed to prepare for the eventuality of another attack, whether another airplane hijacking, a suicide bombing, or a CBRN attack. Mostly our focus and attention has been on these types of incidents.

Homeland Security includes the efforts of first responders, public safety and of critical infrastructure organizations. Importantly, it addresses a range of hazards and disasters, both natural and manmade. At the heart of the homeland security process is the understanding of anticipation, indications and warning, mitigation, response and recovery.

Last week, another type of war game was held, one that was intended to help prepare the country for a global outbreak of a highly transmissible strain of influenza -- a pandemic. While admittedly such outbreaks have occurred infrequently in history, their occurrences are also unpredictable. This war game is described in Agency Uses Mock Outbreak to Prepare for Disaster

A 22-year-old Georgetown University swim team member just back from Indonesia eats dinner with his teammates but then develops a fever and doesn't accompany them to a meet in New York. That is how a flu pandemic in the United States started.

Unfortunately, a winter storm created a public safety issue and caused the CDC to abort the war game midway through the program, postponing the conclusion of the exercise until April.

The question of how to deal with a possible outbreak of pandemic flu, likely to be a strain of the much publicized H5N1 bird flu, in the United States has been controversial. There has been an on-going debate over whether the fears of a pandemic outbreak of H5N1, or avian flu, was a real risk, or if the crossover of the disease from poultry to humans was possible. This question was back in the news this week, and raised to a new level of awareness and concern that at least at the Center for Disease Control, the possibility is all too real. In addition to the war game, the CDC issued new guidelines in preparation for a flu pandemic.

Probably one of the more scary observations is that if an outbreak were to occur, it is likely that it would take four to six months to prepare a vaccine to protect against a pandemic flu, the guidelines are considered critical to restricting the virus in the interim.

Among other things, these new guidelines have created a scale of 1 to 5, with five representing the most severe outbreak. As expressed in the CDC news release :
"The threat of a pandemic continues to be real. We need to continue helping state and local decision-makers determine some of the specific actions they could take during the course of a pandemic to reduce illness and save lives," said HHS Secretary Mike Leavitt. "An important consideration for action is the severity of a pandemic once it emerges. The new CDC guidelines are a step forward in that direction."

Among the recommended actions in case of a pandemic outbreak are:

1. Asking ill persons to remain at home or not go to work until they are no longer contagious (seven to 10 days). Ill persons will be treated with antiviral medication if drugs are available and effective against the pandemic strain.

2. Asking household members of ill persons to stay at home for seven days

3. Dismissing students from schools and closing child care programs for up to three months for the most severe pandemics, and reducing contact among kids and teens in the community

4. Recommending social distancing of adults in the community and at work, which may include closing large public gatherings, changing workplace environments and shifting work schedules without disrupting essential services.

The actual (and lengthy) plan document can be found here . The CDC’s pandemic flu page is found here .

Why is all of this so important, and how does it relate to homeland security? The answers start with this from the Washington Post article:

The H5N1 strain of avian influenza, or bird flu, has killed millions of birds and 164 people, mostly in Asia, since 2003. It does not pass from person to person efficiently. But it is highly lethal and still evolving; many experts believe it has the potential to cause a pandemic.

Further, the response to an outbreak of a pandemic flu, if it happened, would come under the heading of “All Hazards” Crisis Management that is governed by HSPD-8. HSPD-8:

"...establishes policies to strengthen the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies by requiring a national domestic all-hazards preparedness goal, establishing mechanisms for improved delivery of Federal preparedness assistance to State and local governments, and outlining actions to strengthen preparedness capabilities of Federal, State, and local entities."

How real is the threat from H5N1 and how possible is it for the “bird flu” to spread to humans? Two articles highlight the most recent outbreaks of the “flu” in poultry.

Deadly Bird Flu Virus Found in Britain and First case of bird flu found on British farm

Simply, these two articles talk about the gassing of 159,000 turkeys from Europe’s largest poultry producer that were infected with H5N1 while in a sealer shed. The question of transmission is raised. The Washington Post article includes this:

Bird flu has killed or prompted the slaughter of millions of birds worldwide since late 2003. It has killed at least 164 people worldwide, but remains difficult for humans to catch. Experts fear it could mutate into a form that spreads easily among people, potentially sparking a global pandemic. So far, most human cases have been traced to contact with sick birds.

The final point for now, and one that underscores the potential threat is this, Pandemic flu may be only two mutations away (a biologically technical piece):

The difference between a flu virus that kills millions, and one that kills only a few comes down to just two amino acid changes, researchers say.

Knowing the mutations required to convert H5N1 into a flu pandemic threatening humans is an important finding that may permit scientists to remain ahead of the spread of the virus. It is ironic, though perhaps not, that the CDC war game was aborted by something that could well help stem the spread of an H5N1 pandemic flu outbreak it if occurred…a major winter storm that paralyzes a city and keeps everyone indoors and out of contact from others for the duration of the incubation period.