I am in the process of updating the panflu plans for all the US states. As I do so, I’ll be scanning them to look for interesting factoids.
Sorry if this is seen as parochial, but I live in the States. I think it would be great if someone were to start updating the plans of other countries as well.
Cordon sanitaire is in the Federal guidance, but the Arizonans don’t like it much. They don’t think it will work. Nonetheless, erection of physical barriers to keep people in their communities is mentioned. The key document is supplement 8, Community Disease Control and Prevention.
btw, the state plans can be found here.
The great state of Texas Last Updated: Wednesday, October 26, 2005. (rolling eyes)
However, in yesterday’s news… the director of health in Lufkin (town about mid way between Houston and Dallas) is taking the bull-by-the-horns and has devolped a “plan” to start preparing her county (it will be first, she said). Her plan is being incorporated by region 4 & 5, which includes 35 counties.
All I can say is, thank God for this ladies moxy!
EnoughAlready – at 23:48
Maybe by the time I get to the “T’s” they will have another update.
Florida’s plan is dated March of 2004, but I have to say that upon reviewing it a few months ago, it seemed to be fairly on target, with the exception of specific details of exactly HOW things would get done. (Perhaps Gov. Bush had already gotten the inside track from his brother back then.)
I was told by our local health dept., however, that they were waiting for an updated version from the state any time now. If I hear more, I will let you know.
California’s plan was finalized in July 2006, with this on page 133 of 166:
If the Governor has not already proclaimed a state of emergency, CDHS (California Dept. of Health Services) will recommend one before implementing non-pharmaceutical measures with widespread public health and societal impact. Absent a Governor’s proclamation of emergency, California Health and Safety Code gives CDHS the legal authority to “require strict or modified isolation, or quarantine, for any case of contagious, infectious, or communicable disease, when this action is necessary for the protection of the public health…” (Health and Safety Code § 120145) or to “take measures as are necessary to ascertain the nature of the [contagious, infectious, or communicable disease] disease and prevent its spread” (Health and Safety Code § 120125). The Governor’s Office of Emergency Services will coordinate implementation of activities and resources for measures that involve multiple agencies.
Italics mine
Monotreme - considering the “size of Texas” and the size of several of it’s major cities, and the fact there are some world reknown medical centers/facilities in the state… I hope they get going by the time you get to the T’s. This firecracker in Lufkin is apparently gonna give them a run for their money! (Go, girl, go!!)
Monotreme—You are right about the AL plan. I am in AL. C. Lesinger, the AL State Contact for Pandemic Flu (sub-chief of the AL Dept of Public HEalth Division of Immunization, or something similar) has indicated that the State sees the potential panflu threat as “all emergencies are local emergencies” and state has therefore charged all of the counties within the state with coming up with plans (how’s that for passing the buck?). These county-wide plans were supposed to have been completed in August 2006 and posted for public review and discussion September 2006. There were no publicly announced meetings WRT the planning process, no publicly announced information on the AL Dept of Public Health Website regarding the county-specific planning process, and approaching halfway through Sept. no counties have posted plans for public review and input. In a word, I believe that AL is not planning at all. No one has any information, and each person shuttles requests for information to someone else. The 2005 “draft” plan for AL primarily focuses on fantasy vaccine scenarios.
Arkansas updated their plan in August 2006.
Assumptions: 30% attack rate, 2% CFR. I think these are the recommended CDC assumptions, currently. Not all states seem to know that.
The Arkansas plan is heavy on medical procedures. Not much consideration of infrastructure that I noticed in my quick read. It has legal documents, starting on page 108, for quarantining. This includes area quarantine. Cordon sanitare is definitely an option but not preferred. No mention of stockpiling in the plan, but it there is a page on their panflu site describing food and water storage. It’s pretty detailed, but only recommends 3 days of water storage and provides a 3 day menu.
Kentucky created a draft of a pandemic plan in 2001 (or maybe 2002 - hard to tell; 2001 data is cited) and is in the process of updating it. I haven’t the faintest idea when this update began or when it is scheduled to be complete. You can find the draft here. Much of it has to do with planning surveillance and for the distribution and anti-virals and vaccines, though vaccines are assumed not to be available at the outset of a pandemic. Estimates for possible deaths do not reflect the virulence of H5N1. Planning for the preservation of infrastructure doesn’t seem to figure. Hope the update is an overhaul.
At Kentucky’s pandemic web page, Kentuckians are urged to have food, water, and supplies for up to a week and to be prepared for power outtages.
Monotreme at 23:48
do know of any links/references for a CDC recommendation for a 2 % CFR for planning purposes? (I’m thinking of writing a letter to the editor….) (-:
ACM, sorry, I don’t think the CDC recommendations are publicly available. At least I haven’t been able to find them. I am inferring what the CDC is recommending to the states based on how the states that have recently updated their plans are changing their assumptions. They all seem to define a severe pandemic as one with a 30% attack rate and a 2% CFR. The impression I get is that states are now being urged to plan for this level of pandemic. I don’t think that was true a year ago, but this is just my opinion.
For your letter, you could use some other state’s planning recommendations. May not be as good as having the CDC recommendations, but better than nothing.
17 September 2006 InKy – at 10:07 WROTE:
At Kentucky’s pandemic web page, Kentuckians are urged to have food, water, and supplies for up to a week and to be prepared for power outtages.
SCWAZ: Kind of counterdictory isn’t it, that you only need a week of supplies, yet they plan on having power outages. Would these outages only last one week. . . Something’s not being thought thru here. . .
The California Plan was updated on September 8 2006. Very disappointing. They are considering the possibility of a moderate pandemic, less than 1918, but clearly expect a mild pandemic, based on the very limited planning that has been done. It’s a plan to plan. Doesn’t look operational. Just standard infection control procedures. No consideration of infrastructure. No consideration of SIP. No recommendation to stockpile, even for 3 days. Total reliance on WHO for triggering even the limited measures they may implement. Not reassuring.
I must say, I don’t understand what kind of a message the CDC is sending to the states. Is California being given a different message than Arkansas? Or is the CDC saying: “We have no clue what you should plan for, here are three options, mild, moderate and severe (1918 type), take your pick”. This is really bizarre. Talk about bad risk communication. You’d think there would be a consistent recommendation given to the states as to what to plan for.
I did not read the entire Kentucky plan. As far as I can tell this plan was designed by various district health departments. It addresses the pandemic from their roles as public health providers. Back in the spring, meetings were scheduled in all the districts. The old plan focused almost entirely on the distribution of vaccines; a selection process to determine who got the vaccine and in what order. As far as I know there was no effort made to involve members of the community other than health providers in the pandemic plan. I think all counties were encouraged to have local meetings to plan. My county has not done that. There are, they say, too many other immediate problems to address much less addressing something “which might” happen.
If you you live in Kentucky, be prepared to be on your own from the onset.
Regarding Kentucky - the lack of planning scares me; the lack of public awareness and preparation scares me more. I do know KY put in an order for Tamiflu.
You can forget about NJ.My grandaughter came home from her first day of school with a booklet, from NJ homeland security. It was pretty general in scope. A small section on a three day emergency kit.Not a single word about bird flu!We still haven’t heard anything concerning school closings from local officals.The school system does have plans for various emergencies.The only thing that is being done is monitoring the bird population in a local park.Its’an outrage considering there are poultry farms in my locale.I’m just so frustrated! I am redoubling my prepping, going on prep runs at least 3 times a week.Good luck to us all!!!
Some of the annexes are new. They suggest that a quarantine may be applied on a geographical basis, but suggest snow days would work just as well.
There is a pandemic flu brochere which is OK. It points out that people may need to stay home for days or weeks and suggests storing food but doesn’t give a recommended amount.
Monotreme - The Colorado state plan is pathetic and so is the leadership from our state medical director. Thanks to him, Colorado did not order its full allotment of Tamiflu from the feds. The only counties that are showing strong leadership, such as Larimer County, have really intelligent staff who are blazing their own trail. Others are waiting for the state to give them guidance, and we all know how that goes.
Nightowl, thanks for pointing out Larimer County’s efforts. I’ll add them to the Colorado page. They even have a Wiki! It’s a little sparse right now, but maybe the Colorodans can take a look.
Here is a better link to the Larimer County PanFlu Wiki.
Thanks, Momotreme, I didn’t even realize it was a wiki! I should move to that county.
Monotreme -
The Georgia plan has not been updated since October 2005, and is geared towards a mild pandemic (“in the United States alone,…between 89,000 and 207,000 people will die”). While there are plans to develop a scheme (when the CDC puts out its recommendations) to prioritize persons who may receive anti-virals and vaccines, Georgia has not chosen to purchase any tamiflu/antivirals beyond what the Federal Government has set aside for the State.
There are planning documents on the site that date from June 2006, and they appear to be more serious - however, they also appear incomplete, and put the responsibility for planning for a pandemic on the shoulders of the counties.
My favorite quote from the Master Planning Kit: “It is critical that every individual in Georgia know about the possibility of a pandemic, what to do to prepare themselves and their family, and what to do when the pandemic arrives. A well informed public can help to slow the spread of the pandemic. Materials are being developed by CDC and GDPH to inform the public about the pandemic threat.”
So, here in Georgia, we are just waiting on the CDC to get around to making some policy - and passing the buck down to the County Governments.
Oh wait, I jumped the gun. (Conn, Del, & Fla are next). Sorry.
It would be interesting to see if there are regional differences in the plans.
amt,
I think most states are waiting for a clear signal from the CDC that preparing for a severe pandemic is very important. I don’t think most states have been given this message. Either that, or most states are ignoring the warning.
Either that, or most states are ignoring the warning.
The message has been given. Soem listen, some don’t.
Dem,
I beg to differ. Several large states are planning on an attack rate <=25%, with 1/2 of those needing ANY form of medical care (includign outpatient), about 2% of cases needing hospitalization, and about a 0.5% or less CFR. They aren’t pulling these numbers out of nowhere. They are getting them from federal authorities IMO. No one seems to want to reveal or explain on what it is that they are basing their planning assumptions.
The issue, as I see it, is a political one. The CDC can issue dire warnings, but Georgia is waiting for concrete direction and policy setting on specific issues from the CDC. Its possible that the Governor’s Office does not want to waste political capital going over and above the Federal Guidelines on difficult issues such as personal preparedness to vaccine distribution. Building a public consensus on these issues, in our State alone, before the event is politically costly, however necessary.
The following statement is typical of many of the most difficult policy decisions in the GA State Plan:
“The CDC should identify priority groups who shall be eligible to receive these agents (antivirals). If CDC does not make recommendations for priority groups for antivirals, ultimately the State Health Officer in consultation with Epidemiology, Immunization, Pharmacy, Nursing, and District Health Offices will make the recommendations.”
Throughout the documents, there are quite a few references like this, deferring the ultimate decisions on high stakes political issues to the CDC.
Now, I am alarmed and disappointed by this state of affairs, and I think both parties are to blame. We, as a people, should know what the plans are and be able to participate in building a consensus.
DemFromCT – at 13:42
The message has been given. Soem listen, some don’t.
Could you expand on this? Here’s my problem. Every Doc, local health official and PTP I know takes whatever the CDC says as gospel. We can discuss whether that’s a good idea or not, but that’s what I have observed. If the CDC gave a strong message like:
“Although we don’t know for sure what the CFR will be, the available evidence says a 1918-like pandemic is a real possibility and you should plan accordingly.”
I would have hard time imagining a State public health official telling them to piss off, they’re going to plan for a moderate or mild pandemic. To me, a more likely possibility is that the CDC gave a wishy-washy message like:
“We hope you plan for a 1918 pandemic, but if you don’t, we’re cool with that.”
In support of my hypothesis I present the California plan, which pays lip service to planning for a moderate pandemic but clearly is doing nothing more than you would do for a mild pandemic.
The CDC could at least point out that California was ignoring their advice, but they don’t.
amt – at 21:25
I agree with your post. States very deferential to the CDC and the WHO. They make it very clear in their plans that everything they do will be contingent on recommedations from these two sources.
Personally, I think the CDC gets their directions from the WHO and the WHO gets their directions from China, at least with regard to pandemic flu. Hence, our almost total lack of preparedness.
Hmmm.
…I found this review of Southern Pandemic Plans Plans from 2005. Interesting in how the plans are similar, and how they vary. It seems that Federal input figures largely in the State planning.
Also found this comment from the GDPH Director:
Q. Do you recommend that people start stockpiling food and other supplies, just in case?
A. In any emergency, individual accountability and preparedness is a big part of a successful response to a disaster. We would recommend that individuals and families ensure that they have stockpiled enough food, water and any other supplies they may need [radios with batteries, flashlights, maintenance medication] to sustain themselves for anywhere from one day to three weeks. However, the local pandemic planning committees throughout the state will in the future also be making specific recommendations locally.
The three week recommendation is good, but they are pushing the ultimate responsibility to the local level.
Sorry, I forgot the link for the quote in the last post. Q&A with GDPH
Next up…
Plan last updated February 2006. The scope is limited, just health care, no consideration of infrastructure. Lots on ethics and prioritization. Uses WHO phases. They state a wide range of CFR possible depending on the virulence, but the most likely CFR is .27%. Unbelievable. Literally. So did the CDC tell them use 2.5% for planning purposes and CT public health commissioners said no? Or did the CDC present a range of possible CFRs and let CT pick whichever one it wanted to use as the most likely? Planning in CT is clearly based on a mild pandemic and would fail completely in case of a 1918 style pandemic or worse.
Here’s the Connecticut Pandemic Influenza Plan
at the panflu site, they have a link to emergency supplies: standard emergency instructions, at least 3 days water, etc.
About CDC-
All I have to say to CDC is: Remember AIDs? The movie, The Band Played On, pretty well sums up how and why CDC gets bottlenecked.
According to my state (Louisiana), the CDC told them the worst case would be nation wide 70% infection rate with a .25 CFR… That’s 200,000,000 infected only 500,000 deaths… These numbers make no sense what so ever… And my state is only planning for these… only planning for health care concerns relating to quarintine & vacine distribution
Are the assumptions (infection rate/CFR)that are being given by the CDC to states for planning purpose top-secret information? I don’t mean to be asking a stupid questino. I don’t know how these things work. But is there some way to actually find out what states are being told? And why they are being told it? And what they are choosing to do with that information?
This is from Louisiana plan… I copied & pasted this part…”Because of the high degree of infectiousness and contagiousness of pandemic influenza, the number of persons affected in the United States will be high, and is estimated by the Centers for Disease Control and Prevention (CDC) that o Up to 200 million persons will be infected o Between 38 million and 89 million persons will be clinically ill o Between 18 million and 50 million persons will require outpatient care o Up to 2,000,000 persons will be hospitalized o Between 100,000 and 500,000 person will die”… So maybe they are telling different states different things LOL.. Or more likely my state tells it’s people whatever it feels like
ACM and anonymous, you both hit on an important question. What is the CDC telling States to prepare for? Are all the States being told the same thing? If they are, then why not put that in the public domain on the CDC website?
Monotreme - I had read CT’s before and was completely unimpressed. Reminded me of those corporate “development” seminars I used to have to attend: walked away with a HUGE binder of papers, but nothing usefull to my job at all.
The state’s plan is consistent with its residents: anywhere I’ve gone I’ve seen virtually no one “prepping.” I’ve tried to bring it up in general conversations - change the topic. Gave friends and neighbors information sheets - got a few converts (3 or 4 maybe), the other 95+ - nothing. Without state citizen’s pushing their concerns to local, county or state officials, not much will ever get done. If TSHTF, CT can say “look, we have a plan!” Too bad it’s usueless. Sounds like many other states are the same.
Sorry, I don’t exactly agree. If a 1918-style plan hits, we are screwed whatever prep the state does. Flu Aid and Flu Surge have been provided to all the states with a 1918-style tour by Leavitt to each state. I heard him in CT and read about what he said elsewhere - if you didn’t hear the message it’s because you weren’t listening.
What local folks decide to plug into is a local issue and a local choice. In CT, it’ll be review of health facilities to teach the local hospitals what they can’t handle (and the hospitals are aware they’ll be overwhelmed), and money set aside to supplement the Fed stockpile of tamiflu (if you believe in that).
CA at the county level also has better planning than most, as does WA.
What people have to understand (govt and citizen) is that having a plan in a binder doesn’t help much. The planning process, meeting people face to face and opening channels, is much more helpful.
The dismissive attitude that most of the posters at Flu Wiki have toward official attempts is a double edged sword to anyone trying to get anything substantive done. We are very helpful and honest in picking up on what’s not been done and what won’t work, and completely dismissive of people really attempting to roll stones uphill, which takes time. Not every realization on the part of state officials has made it to paper - and that’s why there’s us ;-)
But expecting something radically different than CDC dogma is really highly unrealistic.
EnoughAlready – at 00:35
About CDC-Remember AIDs? The movie, The Band Played On, pretty well sums up how and why CDC gets bottlenecked.
Although conventional wisdom tries to blame the Reagan administration, Jesse Helms, and government inaction for the AIDS epidemic….the truth is that it was rabid political correctness that allowed that to to explode. No one had the guts to come out and take control of the situation. They could have contained that epidemic in the early years with quarantines, but no one wanted to offend gay people or drug addicts. Heck, as that book pointed out, the gay folks didn’t want to even curtail their behavior at all. If someone had tried to round them up along with the drug addicts we proabably would’ve had riots…but AIDS would probably be just a memory by now.
Let’s hope there won’t be wimpy people in charge when the next pandemic starts.
“Hope is not a plan”
Dem - that’s my point. I think the reason why CT’s plan is a bit lacking (as are most others) is that there isn’t a group of people pushing up from the grass roots level. I don’t know what part of CT you’re in, but in much of Fairfield county where I am, many are too self-abosrbed to notice what is going on around them. And I don’t blame my local officials - many of them are volunteers anyway and it’s a thankless job. Needless to say they may not be the best qualified but their hearts are in the right place. My next plan of attack is to approach the Board of Ed (they’re all parents - get them frightened) and the local paper. It’s not much of a rag but EVERYONE in town reads it, mostly to see who got pulled over for a DUI or “what the house on Fulton street sold for.” I’m tired of that “deer in the headlights” look when I try to talk to people individually so I’m trying another approach.
DemFromCT – at 13:07
If a 1918-style plan hits, we are screwed whatever prep the state does.
I don’t agree. I think there is alot a state can do to plan for a 1918 or worse pandemic. Obviously medical care will be severely limited, but infrastructure concerns can should be addressed. CT’s plan doesn’t consider these at all.
Flu Aid and Flu Surge have been provided to all the states with a 1918-style tour by Leavitt to each state. I heard him in CT and read about what he said elsewhere - if you didn’t hear the message it’s because you weren’t listening.
So, if I understand you correctly, public health authorities in CT have disregarded a recommendation to prepare for a 1918-style pandemic? If so, CT citizens should be writing letters to the editor and their governor.
CA at the county level also has better planning than most, as does WA.
Agree.
But expecting something radically different than CDC dogma is really highly unrealistic.
Agree. But that raises the question again - What exactly is the CDC message? Have they recommended that every state plan for a 1918-style pandemic, Yes or No? We can’t seem to get a clear-cut answer to this question.
They a have pretty good plan. It’s very terse, but is well-organized and packed with information. Pretty comprehensive. In their assumptions, they provide info for both a moderat and a 1918-style pandemic. They mention snow days, travel restrictions in Delaware may be necessary. Voluntary is preferred.
They don’t mention SIP or stockpiling but have the link to the pandemicflu.gov site for individuals, businesses, etc.
They need a Delaware brochure recommending stockpiling food, water and meds for 6 weeks.
Not really a plan at all. More like a few notes jotted down on an envelope from a meeting. The worst so far.
Wow, I hit paydirt with Florida’s plan. The most interesting part of the plan is the assumptions. They have two sets of assumptions. The first set really surprised me - an attack rate of 35% and a CFR of 5%. Estimated dead in Florida- 320,000. This is 3% above the 1918 pandemic. This 5% number came from the HHS Pandemic Influenza Tabletop Exercise Package 2006. It is *not* in the HHS plan.
The second set of assumptions comes from the CDC’s Fluaid. The most likely CFR using this software is assumed to be .3%. This is a hugely different number from the HHS Tabletop Package estimate.
I’ll now speculate that states that are expecting a mild to moderate pandemic are using the CDC’s Fluaid software. States that are making preparations for a severe pandemic must have seen the HHS tabletop package and are influenced by it.
So the question now is: Has every state seen the 5% CFR number? If so, it sounds like each state can decide for themselves which CFR they want to prepare for - 5% or .3%. This makes no sense. Because of JIT, no state is an island. If the Energy or Food states don’t prepare properly, then the other states are doomed no matter how well they prepare.
Another interesting tidbit: one of the activation triggers is 10% of clusters with 4th generation of cases. Karo was H2H2H - 3 generations. We’re close.
Jeb Bush, Governor of Florida, George Bush’s brother. Better information?
Hi. I’ve been lurking for a few months but this is my first post.
Florida is pretty good when it comes to disaster preparedness in general because we have to be, and Jeb Bush does a terrific job in that area. Maybe he does have inside info, but it’s just as likely that he’s accustomed to dealing with disaster preps and he understands that it IS possible. It seems like a lot of states aren’t grasping that a pandemic is a distinct possibility.
Hurricane states do have a leg up compared to those who haven’t done that level of prep.
Meserole in FL – at 23:52 Welcome!! Somebody in your state has it right! Congrats!
We call our flu preps “hurricane preps on steroids!” If we somehow manage to dodge the pandemic bullet, we will be well prepared for next hurricane season. The most worrisome aspect is losing electricity. I worry that people who aren’t accustomed to being without power will not be able to cope. We were out for a week with Wilma, and it was just plain awful. Many lost both water & power - some for months. It’s not a pleasant thought.
Georgia is interesting for a couple of reasons. First, the CDC is located in Atanta, so we might expect that the Georgia plan gives the clearest indication of what the CDC thinks. Second, Georgia actually has two plans posted on their site. The original Pandemic Influenza Plan (Oct 2005) which is still identified as the plan and a new plan which was written in June 2006 which is called Georgia Pandemic Influenza Standard Operating Guide and is relatively hard to find on the department of health’s website.
The old plan assumes a mild or moderate pandemic. The new plan assumes a moderate or severe pandemic. The old plan is entirely medical and gives no consideration to infrastructure. The new plan assumes many community groups and businesses will be affected. The new plan is much more serious and includes the possibility of travel restrictions into and out of Georgia.
The master planning template indicates that a 1918 style pandemic is possible. Advocates caching supplies like masks and alcohol handwash. Emphasizes social distancing. Not much emphasis on SIP.
A very detailed County planning kit is also available.
Georgia has clearly moved in the right direction, but not far enough or fast enough, imo.
BUMP while lots of you sleep..
bump. Monotrememe this review of plans you are providing is incredibly valuable. Thank you. (For everything.)
Most of the plans are prepared by the public health agencies, and are heavy on measures that are within the public health agencies’ mandate (surveillance, vaccines and so forth). However, they typically don’t address critical infrastructure maintenance, which is outside their primary mission. It’s not their specialty.
Likewise, I find many ordinary people believe that a moderate/severe pandemic is possible, but do not think that critical infrastructure or supply chains would break down. (Now, I personally follow the pandemic story, specifically because I do believe critical systems could break down without adequate trained people to run them. )
I think its easier to convince people that a pandemic is likely, than to convince them that it could push our economy (and therefore our society) into a state of partial or total collapse. It’s the infrastructure part of the equation that is missing in these plans.
BUMP
ACM, you’re welcome.
amt – at 15:22
I think there are stages of pandemic preparedness at the State level. The first stage is a purely medical response by health departments assuming a mild pandemic. The second stage links the medical response to generic state emergency preparedness groups assuming a moderate pandemic. The third stage is a comprehensive plan directed by the Governor’s office assuming a severe pandemic.
I think many Governors will move to third stage planning if they are given clear messages regarding the risk of a severe pandemic.
Hawaii’s plan was last updated in December 2005.
It is tightly linked to the WHO staging system. Declaration of phase 4 triggers a number of actions including confiscation of antivirals from pharamacies. Community quarantine is possible. Work quarantine for essential workers (SARS in Toronto as the model). Reasonable force authorized for non-compliant people. Restricted movement of sections of the community. Restriction on use of private vehicles and closure of roads possible.
The plan is relatively serious. What’s interesting is that all this is based on a mild pandemic with a .3% CFR. This CFR was recommended by the CDC Pandemic Influenza Planning Conference held in Denver Colorado in February 2005.
So, it appears that the official CDC recommendation to States is to prepare for a mild pandemic. This is built into the Flu-Surge program that states are encouraged to use for planning purposes. In contrast, another group with HHS has created a Pandemic Influenza Tabletop Exercise Package in 2006 that encourages planning for a CFR of 5%. Obviously states that use the Flu-Surge program will be much less prepared for a severe pandemic than states the use the HHS Tabletop Package. What I wonder is: Do all state governors know about the 5% figure from the HHS Tabletop Package? If they do, why aren’t they urgently updating their plans?
Meserole in FL – at 00:21
We call our flu preps “hurricane preps on steroids!” LOL! That’s cute, and funny! I live in a hurricane area too.
From the US gvoernment Pandemic Planning Assumptions
1.1.5. The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios. Two scenarios are presented based on extrapolation of past pandemic experience (Table 1). Planning should include the more severe scenario.
[Number of deaths in the US indicated for a severe (1918-like) pandemic: 1,903,000]
Comment
I think the defaults for the Flu-Surge program for the States are set wrong. They are still set for mild pandemic and HHS now wants the states to plan for a severe pandemic. Either the CDC somewhow doesn’t know this, or they forgot to tell the states to change the settings or some States have decided to disregard the advice of the federal government. In a severe pandemic, how many people will die because of this? People in the States that are ignoring HHS directives should ask their governors: Why?
Monotreme,
A most excellent question. I have long been dismayed at the planning assumptions being made, vis’a’vis the CFR. The state folks aren’t stupid, they well understand the parameters and inputs for the Flu-Surge models.
Again, I am forced to conclude that they are planning for a pandemic that they think they can handle, not the worst-case scenario - which they have concluded ab initio that they cannot. The danger then is that if the worst case does materialize, they will be paralyzed and all systems will be on auto-pilot, i.e. flown into the ground.
IMO they are conceding that the battle is lost before it has begun. Not a nice thought. Sun Tzu would be pleased with our non-sentient little friend.
The Sarge-You know it would be a shame if H5N1 just decides to “nuke” us, instead of engaging us in a battle that we might have a chance of winning. But, of course, it doesn’t care about our prospective valor, ingenuity, and the post-mortem reviews in the hoped-for history books.
Bump -(and why not bump this thread to the mailboxes of your local journalists and politicians, while we’re at it?)
The Sarge – at 18:56
I think you are giving various public health officials way too much credit. The CDC is an absolute mess. It’s in midst of a meltdown with senior scientists leaving as fast as they can get out the door. It’s entirely possible that they forgot to tell the states to change the parameters of Flu-Surge when the threat level went up (as I’m sure it did about 10 months ago). Many of the state and city public health officials have only a rudimentary understanding of science. They are completely unqualified to evaluate the risk of a severe pandemic. Many have no clue about possible infrastructure collapse. When the CDC sendt them a software package for planning and Secretary Leavitt sent them Planning Assumptions that conflicted, many simply picked one and went with it, I suspect.
crfullmoon – at 20:52
You’re absolutely right. The only way to fix this mess is to shine a very bright light on the conflict between the Flu-Surge default parameters and the HHS Pandemic Planning Assumptions.
Time to flood governors in states that are not planning for a severe pandemic with input from their constituents about the horrendous mistake their public health officials have made with their pandemic plans. It would also be helpful if Fluwikians were to attend conferences in these states and bring a printout of the HHS planning assumptions and ask public health officials point blank: “Why are you ignoring federal guidelines on pandemic planning?”.
http://www.nunatsiaqnews.com/news/nunavik/60929_04.html
KUUJJUAQ - Nunavik’s regional health board has a plan on how the region can cope during a pandemic – a worldwide outbreak of illness that could kill billions of people. A summary of the plan, which was presented to the recent meeting of the Kativik Regional Government council, paints a grim picture of such a pandemic’s effect on Nunavik.
…one in three people in southern Quebec could fall ill or die, and more than seven in nine in Nunavik could be hit by the pandemic.
A region-wide quarantine would be one way to limit the northward spread of a pandemic to Nunavik, health officials told the regional council. This lock-down would continue until the first wave of the illness ended, and a vaccine could be manufactured. The first wave of illness would strike over two or three months; the second would follow in three to nine months. Under this worst-case scenario, food destined for a quarantined Nunavik would be dropped off at airports and pilots would not go outside the aircraft, and patients needing special care would go to Chibougamou instead of Montreal.
Monotreme,
I just wanted to add my thanks to you for reviewing our state plans. I had looked at mine (FL’s) when I first came to the Wiki a year ago. I didn’t really appreciate all of the info at that time, however. I have just reread every word, thanks to you.
Hopefully, I am now a more informed consumer/citizen. Part of our state plan states, “Educate the local community in advance of a pandemic.” I haven’t seen the DOH do that yet in this vicinity. Methinks NOW is “in advance.”
Planning is one thing, implementation is another…
Galt – at 09:21
Went to the local Health DEpartment in Mobile, AL and asked if they had any pamphlets etc. in regards to Bird Flu, the woman asked me “Verbatim”, “What, BIRTH FLU, hold on, let me check the CDC site”, can you believe this?
Unfortunately, yes. That, and chickening out on the, “Educate the local community *in advanc* of a pandemic.” part, still seems like “We’re screwed”.
Monotreme, if I take time to go through the state plans, I will look for the devilish details of the “mass fatality management” sort of factoids…
Need some bright light of public scrutiny and better plans and preps now for all that as well..
nsthesia – at 11:25
You are welcome.
One of the things that Flu Wiki does really well is to educate the public. Every state should put a link to this site on their panflu page. Of course, they may not always like what they read, especially on this page ;-)
crfullmoon – at 14:20
if I take time to go through the state plans, I will look for the devilish details of the “mass fatality management” sort of factoids…
When I finish all the states, I was planning on creating a Wiki page with table comparing all the states on a variety of variables. You are welcome to the gruesome factoid section. It’s something I try not to think about.
The Idaho plan was updated March 2006. They claim to be using the CDC Flu Aid Program which assumes a 25% attack rate and .23% CFR. This would seem to indicate that they disregarded HHS’s directive to plan for a severe pandemic.
Yet…
Examination of the plan indicates an expectation of severe social disruption. Once the pandemic begins, the Governor will declare a State of Emergency and the Military Division will activate the Idaho Emergency Operations Center. There is a heavy focus on keeping infrastructure up, including providing food to citizens. There will be substantial invovlement of the military.
All this for a mild pandemic? Color me skeptical. A cynic might suggest that they are planning for a very severe pandemic but giving the public mild pandemic numbers because they don’t think they can handle the truth.
Monotreme, I already had enough stuff in my head anyway, even before I read, a couple of years ago, experts were losing sleep over H5N1. I don’t mind looking through it, so other don’t have to.
I would rather plans on paper were discussed publically and improved, and prepped against, rather than have things go down the way they look to at present levels of “what to do with the dead” preparedness. Need to use some daylight offline, (I need household staff -and don’t want any) but maybe I’ll start reviewing Mass Fatality Plans tonight. Anyone else can chip in, or start the thread before then, if they wish.
Last updated March 17, 2006. In some ways it is a 3rd generation, comprehensive plan. The response will be run out of the governor’s office. It is noted that he will be Commander-in-Chief of the National Guard. There are contingency plans for critical infrastructure (although details are not provided). However, the planning assumptions are all over the map. On page 13, it is indicated that 9,000 dead is the worst case they are planning for, which translates to a .2% CFR. However, on page 78, the maximum deaths are put at 47,462, which translates to a 1% CFR. The latter figure is used for Fatality Management. Both figures are supposedly from the CDC. Both violate the directives of the HHS which are to plan for a 2% CFR. The CDC is part of the HHS. Talk about bad risk communication. Could it be any worse?
Some other observations. The state government will have the power to appropriate private property for public use including: vehicles, fuel, food and medicine. The section on fatality management is very detailed. It suggests that temporary morgues be removed from public view and that sensitive sites like schools not be used. A bioethics committee will be convened if mass burial is considered necessary.
No recommendations for individual prepping on any of the Illinois pages. There is a link to the HHS planning checklist for individuals and families. This site recommends 2 weeks of supplies. I doubt very many people in Illinois know that they should be doing even this much.
Monotreme, I exchanged e-mails with our state’s DHHS commissioner last week. He has asked me to contact our state epidemiologist with my questions and concerns. I would love to have your thoughts on our state’s plan. Any chance I can entice you to skip ahead to NH’s plan anytime soon? I have my own thoughts on the plan, but I haven’t reviewed others, so don’t have a context or benchmark to measure against.
Edna Mode – at 22:42
I’ll do it tomorrow night.
Monotreme - at least Illinois is saying two weeks. I was just putting together a packet of printed info for a friend, and checked on printing something from Ready.gov to give the balanced view including govt. advice. And the first thing I find on make a kit is “three days” water and food. Argggg! That’ll get us Ready, won’t it? I’m ready to move to Seattle or Ft Wayne. I’m only one & half driving time from Ft Wayne, but centuries away in community prep awareness. Thanks for doing the States. Fun to see which is doing “something” and which ones are duds.
(tell the public “days” is governmentese for “months?)
Monotreme – at 23:22
Thanks a bunch!
A certain “Mari from Hawaii” has suggested, as a comment in Bellagio’s posts at Effect Measure, that gov should print out stamps so the poor may stock up a little just when the pandemic starts. This would send a message to the rich.
It is here.
I copy it in full:
MRK…no plan yet, but I arrive in So Cal tomorrow evening and will do my best to ensure they have a good one in place before I fly back to Hawaii a week later. In the meantime, I spent the day writing FEMA officials, congresspeople and newspapers with the proposition that, among other things, the US govt should create emergency supply cards (like USDA food stamp cards, only good for a whole list of emergency supplies at stores) and give these out NOW to all low income families, with the understanding that the cards will only be activated and usable if and when the WHO decides that a pandemic is imminent. That at least would make it possible for the poor to gather up necessary survival supplies a bit ahead of the game. It would be a very low expense to the government if the flu fails to materialize, but could save hundreds of thousands of lives if a pandemic hits and people are already prepared. Plus by putting these cards out it sends the message - low key, but clear - to the rest of the populace that it might be prudent to take this threat a little more seriously and prepare themselves. The other key thing I suggested was that the government set up in every community a place in which bottles of drinking water could begin to be stockpiled well ahead of any emergency. It’s not like it’s going to go bad, and without adequate drinking water no one can survive for very long, so ensuring everyone has drinking water is a top priority. This is particularly important in areas where there is not much rainfall (So Cal, Arizona, Nevada, New Mexico etc.) I don’t see the point in even mentioning medical care, it’s just not going to happen. I’ve also posited the idea to my charter school network group, suggesting that our schools step up to the plate and act as the focal points to spearhead community flu preparedness efforts. I’ll work on this more when I get back from California. You’re right about how history - or simply our own consciences - will judge us regarding how we helped one another during and after this. I’m working on it now, as I really hate the feeling of guilt.
Monotreme:
So many of the state plans seems to rely on versions of martial law. How effective do you think it will be? It seems to me the larger cities will be placed under ML and the rest left to their YOYO scenario. Govt supplies or medicines will come to and from (if anything is left) areas of where the martial law is—almost like creating conflict between cities and rural towns. The ML enforcers will go to YOYO areas to procure food/water for the cities, but in all likihood will not be able to share medicines etc with the smaller towns. Am I the only one seeing this? Those small town folks aren’t going to allow that for very long. Have you changed your views on the scenario developments for the mega cities?
mj – at 01:16
You’re welcome.
Leo7 – at 13:53
So many of the state plans seems to rely on versions of martial law. How effective do you think it will be?
It depends on whether essential services are being provided. If the GRID is up, water is flowing and people have food, I think most people will obey orders to remain in their homes. Knock out food or water, and martial law will fail.
Have you changed your views on the scenario developments for the mega cities?
No. There is no evidence that any of the Meagacities are preparing, with the exception of Seattle. Meanwhile, small to medium size cities are starting to ramp up their preps. The disparity is getting even greater.
Note
In my next post, I will skip ahead to New Hampshire at the request of Edna Mode.
The best thing about the New Hampshire plan is the background. It is well-written and largely accurate. Other than that, New Hampshire has a standard first-generation plan. It’s mostly a medical response to a mild pandemic. Very heavy on surveillance. It has a color-coded alert system that is wildly optimistic. After the pandemic begins, New Hampshire will be at green. They don’t go to red until people are dying in the building. Really. They present the chart from HHS showing the severe pandemic projections for the US, but ignore them for New Hampshire. They use a 25% attack rate and .2% CFR instead of the HHS recommendations of 30% attack rate and 2% CFR. Recall that HHS has recommended that all states plan for a severe pandemic. New Hampshire has, instead, utilized CDC recommendations to plan for a mild pandemic.
Edna Mode, and anyone else from New Hampshire, if you talk to the state epidemiologist, can you ask them why they are not planning for a severe pandemic, as recommended by the HHS? Did they receive specific instructions from the CDC to use the mild pandemic parameters or did they just use the default parameters in Flu-Surge and/or Flu-Aid? Thanks.
Thank you for skipping ahead, Monotreme. I will absolutely ask your question to the epidemiologist. Your analysis basically confirmed my worst thoughts about the plan. I have many friends that work at the state DHHS, and the lack of basic information and interest in pandemic planning is shocking. Thanks again. I’ll let you know what, if anything, I hear back from the big wigs.
Edna Mode – at 12:43
You’re welcome. Looking forward to hearing more about the motivation for using mild pandemic numbers.
Closed and continued here.