Forum: UK Preppers to Action

I’m off work this week so my attention is back to BF. I have been on the department of health web site where they openly admit that hospital will not be able to cope and that chains of supply will be interrupted, yet, do they tell people to prep? NOOOOOOOOOOOOOOOOOOOO!!!!!!

I know Anon 22 has done extensive work on this. I wonder if it would be an idea for all of us in the UK to meet and talk about what skillos we have collectably that may enable the word to get out.

My thought are:

If the government wont listen, will the media? Can we get our message on a talk show, Richard and Judy maybe?????

Anon 22- Have you been down this road already????????

We need to get the people in the media on our side….I think….Does any one have any ideas?????

Anon 22 - what has your experience been and is there anything we can do or should we just admit defeat, buy a farm collectably and bug out during the pandemic?

Richard and Judy is a good call. Richard was into Y2k and prepped for that. I am sure this would be up his street. I have the email address for somebody who works on the program as an a producer. I would not be able to contact them personally for professional reasons, but could email it to you if you wanted?

No, I’m not admitting defeat. I do however think the obstacles are huge. I have several ideas which I’m not ready to write about here just yet simply cos they are not well-formed. I’m keen on your idea of getting together for a brainstorming session, It’s not enough IMO to just approach the media. It isn’t that they don’t understand this, I’ve spoken to some of them. It’s that the higher level folks in the media business don’t want to take a lead. Whether it is political interference I don’t know. But I do want to for example gather together representatives of patient support groups and discuss with them what will happen to chronic patients when the supply chains don’t work and the NHS has crashed. I don’t have the capability of putting things together cos I’m too stretched at the moment all the way till christmas, but I’m perfectly willing to throw my energy into good plans if we can come up with them.

London Boy, Anon 22 has my email and her’s is in the profiles. Do you both fancy meeting in town to see what ideas you have? I’m off this entire week but on Monday life will get back to its normal frantic pace so for me, this week is best.

I would love to meet Anon 22 as she’s one of the brightest people I have EVER come across and it would be a real honor for me.

Crazy American Lady in the Village – at 12:00

Can you email me again, I’m not sure I still have your email address, sorry, too many computer re-installs recently!

This is from ‘Hospital Doctor’

Pandemic plan ‘dilemma’

By Lisa Hitchen

The Government’s faith in its stockpile of antiviral drugs to combat pandemic flu has been criticised by public health experts at Hospital Doctor’s conference this week.

Civil unrest could result from a public desperate to receive their share of the 14.6 million courses stockpiled if a pandemic were to strike within three years as predicted.

Prof John Oxford, professor of virology at Barts and the London NHS Trust, advised that antivirals should be given to the families of anyone diagnosed with pandemic flu, but with only enough for 25 per cent of the population it would be impossible. ‘This is a dilemma,’ he said.

‘’‘Dr Hilary Pickles, director of public health for Hillingdon Primary Care Trust told delegates that ‘we are currently planning for an experiment in mass therapy, with little time for feedback on side effects’.

‘There are also uncertain delivery mechanisms, which risk violence and resentment because oseltamivir is seen as a wonder drug with not enough to go round,’ she said.’‘’

But the Government’s flu planning tsar hit back at critics, saying that resources had to be distributed carefully and that the high profile of pandemic flu could help get important public health messages across to the public.

Prof Lindsey Davies, natio-nal director of pandemic flu preparedness, said: ‘We have got to be realistic about how much funds and what trained personnel are likely to be available. That is one of the things we have got to consider amongst all the other priorities,’ she said.

The DoH plans a publicity campaign on hygiene this autumn, but it has yet to resolve issues such as who should get antivirals during a pandemic and how they should be given.

A revised pandemic flu plan is currently being developed, but Prof Davies could not confirm if extra funding for critical care contingency planning would be included.

Crazy American Lady in the Village - please contact me at lugon at singtomeohmuse the-usual-dot com

Anon 22 - Right, so at least they’ve come clean….so why are they not telling people to prepare! Sigh….

Why they are not telling people to prepare?

• They don’t know that preparing is needed, i.e., would be beneficial.
• They don’t know that preparing can be done.

There are other things they don’t know.

Some things are more difficult to imagine than others.

I know.

Lugon and Anon 22 -I’ve emailed you, off to teach right now so will be offline for a while

Have been off line for several days, but I think that there are some good ideas forming here, and I am willing to find some time to assist if it will help. This is written in hast and off the top of my head so I hope it makes sense.

I beleive the problem is twofold - the EU took a planning lead as part of its moves to produces EU harmonised health policies, with only some aspects left at marketing state level. This whole initiative then fell down when individual states were not willing to sign up to what was asked of them. However, individual country plans were not updated in light of this development to encompass a more holistic look at the problems, combined with (I think) those ‘powers that be’ preferring to listen to advisors who do not/ did not beleive that H5N1 would become a pandmeic within a 10 year time scale. i.e leave it to industry.

Food supply has not been adequately considered, in that it is assumed that free movement of goods across borders will continue uninterrupted. I have not seen considerations of impacts on food production collated and considered from each EU food producer, let alone considerations of critical goods (eg oil supply, imports, chlorine for water purification etc etc) to assess an EU wide impact. It does not mean it has not been done however, but given political damage and failure that was caused by not reaching EU consensus, politicians and EU beaurocrats are not willing to risk further career damage and stick their necks out, let alone take a lead. But my concerns are that if EU Marketing States cannot work out rationing and sharing arrangements for anti viral medicines in the event of a pandemic at this time, then I dont hold out much hope for any of these essential requirements being adequately shared, transported etc - i.e the single market will collapse as each EU state struggles to meet its own domestic needs.

At UK level, the belief that a vaccine will be developed and the govt pledge to provide vaccine to every man woman and child ceased debate within the media - or perhaps they were asked to keep quiet to maintain domestic economic stability and confidence. Economic stability and continuity is everything - especially where elctions are looming: Bird flu is ot perceived as enough of a problem and it certainly isnt a vote winner.

It is thought in the UK senior levels of government that the stockpile, this vaccine pledge, combined with large company continuity planning - using a set of planning assumptions that require a consideration fo a 68 style pandemic to an upper end of a 1918 style pandemic - are enough. The set of planning assumptions that are provided include such things as assume up to 35 % of the workforce is absent from work, and have recently been updated to ask inclusion of the impact of possible school closures on absenteeism rates. It is left to each individual planning organisation / local uathority to guess at and deduce what the practical implications might be. This requires knowledge and expertise of the H5N1 risks that just isn’t there. Only if a mortality rate of 2.5% is breached will emergency powers be invoked, which then means that army and police could be used. Health planning has been left to the NHS, and is divorced from issues such as other essential goods supplies.

At a business level, planning has been the domain of the buisiness continuity planners. I have read elsewhere that certain oil producers in the US plan to simply shut facilities. Some organisations have stockpiled their own tamiflu and are planning lock ins. What has not happenned is consideration fo the knock on effects of adding all these plans together, on related and dependent buisnesses. What has not happened is that these industry plans - from power producers to water companies to food haulage and transportation - have not been collated, anywhere to look at the wholistic picture. Because the media has been silent, buisnesses large, medium and small think the threat has receded.

WHAT NEEDS TO HAPPEN

Having had governmental contacts, my experience suggests that the media are THE outfit we have to get involved. Difficult questions have to be asked in the right places to apply pressure on the political system to take a lead and to take responsibility.

so..Let’s identify 1. all the key UK reporters and media that are in a position of respect and authority who can report and ask questions. 2. all the key UK and EU politicians and beaurocrats who should be repsonsible and take a lead on pandemic planning 3. and brainstorm a list of pertinent and relevant questions that should be being asked of these persons e.g.

If food supply from overseas is disrupted, what UK strategic reserves are held?

If vaccines cannot be provided in a timely fashion, how exactly do the govt intend to keep essential services running? Will they mobilise the army? What if 50% of health workers are absent and IV drips etc run out? What plans are made to ration these? Distribute these?

Do local authorites i.e county councils hold copies of all key infrastructure providers pandemic plans for their areas eg food supply, water supply, power supply, transport etc for their area to collate a local impact report (Tesco, Sainsburys,etc plus British gas etc etc to provide details of what their plans are for each county). If companies have not made adquate plans nor secured adequate essential supplies to keep them running, what powers do govt have to make them do so? If they can’t what is govt doing to make sure that these essential services keep running?

If county plans exist where are these county plans published? Have they been made locally available/ distributed so local buisnesses that rely on these services can consider impacts on their own continuity planning? Have these been sent to govt department x for collation at a national level to determine where our national vulnerabilities lie, and so that govt can form its own conintuity plans?

Have local NHS plans been co-ordinated within these county plans?

Has a vulnerability assessmenet been made on disruption in supply of overseas imports, and have these been made by each of these critical service suppliers in their pandmeci plans? If they dont know, why dont they?

Has the EU carried out a collation of impacts across the EU and determined how such supplies could be guaranteed? If there are going to be national shortages do we still have food mountains strategic reserves?

What about medicines supplies? Can the pharmaceutical companies provide information on safety stock reserves of critical non-pandemic drugs? Insulin, heart drugs, etc etc. How vulnerable is pharmaceutical manufacture if overseas supplies became disrupted?

How will we maintan our oil supply? Can the UK sequester all remaining North Sea Oil production if it is needed?

I am sure there are many more that you can all think of. We then need to get reporters asking these questions, and, even if these are not published in media articles per se, if we can get to evaluate and pick holes in the answers, and feed back these analyses to reporters, they just might begin to feel it is thier duty to start reporting and getting the UK to follow US style prep advice.

A better way to phrase the questions, and perhaps to prompt ideas.

1. It is known that the UK is not self sufficient in food production and is highly dependent on imports. Whilst UK planning may have considered these issues, we are reliant on the adequacy of planning by businesses and governments overseas, and elsewhere in Europe. Therefore, what steps have governemnt undertaken to ensure that imported supplies and production of those supplies will not be disrupted? If the measures that the UK can take are limited, what domestic arrangements have been made to ensure continuity of these essential supplies through the peak of a pandemic wave?

2. Please can government confirm what the UK domestic annual vaccine production capability is? Therefore, once a suitable pandemic vaccine has been developed, how long will it take for government to fulfil its pledge of vaccinating every UK citizen?

3. (Assumption - pledge 2 could not be filled within 18 months. 6 months for develoment and 12 months minimum for adequate production, assuming that NO vaccine supplies go out of the UK) If the pandemic presents itself in waves of infection, has there been any planning assumptions considering the recurring impacts of disruptions on essential goods and supplies of later waves? Has consideration been given to estimated recovery times of individual services sectors, and thier subsequent ability to respond to a later wave of infection?

4. How robust is UK energy supply, and how dependent is it on imported raw materials such as oil, coal or gas? Has the government examined the pandemic plans of these suppliers to ensure that they are robust? If such supplies are vulnerable to disruption, what domestic provisions have been made?

And so on.

Additional questions as I think of them - but I will stop if everyone thinks I am on the wrong tack! Please let me know.

5. What measures have the government taken to ensure continuity of supply for essential medications during a pandemic that are not directly assoiciated with the pandemic? This includes essential prescription medications such as Insulin, antibiotics, IV drugs for critical care, Intravenous equipment, surgical and other masks to limit the spread of infection etc. If this is being left to individual health trusts to plan, what measures has the government taken to ensure that trusts have stockpiled adequate reserves and supplies? Is this being co-ordinated at a national level? Is additional funding being provided to ensure that such reserves can be acquired? What is the situation with respect to health trusts that are in budget deficit?

Crazy Lady, I am potentially interested in meeting up to kick around some ideas. I don’t know how much I can promise to give, in terms of time, in the long run as I am about to get stupidly busy with work, but if you want to email me on mrdbuckleyatgmaildotcom , we can talk about what we can do.

Flumonitor - I think these questions are right on track and need to be asked by the media, how do you envisage getting the media to ask them? I think a big thing that needs to be asked is how will any panic / rioting be dealt with and how is the NHS planning to cope with the massive over subscription that is inevetable?

Londonboy at 12.17 ‘how do you envisage getting the media to ask them?’

If we know who the key reporters are in the UK we hold a press briefing - a fluwiki press briefing, if we are allowed. A hotel lobby would do, unless someone could donate the use of an office or similar. We invite them to a location (to be arranged) in London and present our concerns and what we feel they should be asking/ doing. We give them press infomration packs - properly researched and referenced, covering each of the issues and concerns, and we ask them to go and start asking the right questions of the people we have identified at UK and EU level.

If we can, we ask John Oxford or any other known concerned experts to give their opinion and give a title to the briefing that has enough sound bites to attract thier interest and headlines. We give them the proviso not to report on the briefing per se, but to go and ask the questions and to report a full analysis of the answers that they are given - whereafter they can use those ‘personalities’ at such a briefing for provision of authorised quotes to voice the concerns that we have, and the shortcomings there are in UK planning and general interest levels.

May be a long shot but worth a try?

flumonitor,

You’ve raised many good points. One of the biggest difficulty in the UK is still proving the case, connecting the dots to make a convincing case, and not look like a nutjob. If you or anyone want to go to the media, in order to make a difference, you will encounter huge opposition. The obstacles are not insurmountable, but you need to be so well prepared with figures and references and numbers, and be able to defend every aspect of your case. Remember its the same as what Goju said when he started initially, that everytime you make a move, you need to assume that you’ve got one shot only. If you mess it up, you can’t undo it. I’m not trying to discourage anyone, but there is a big difference between here and the US in that the government here goes around reassuring the public that they’ve got everything in hand, whereas the US has decided to take the stance that “you’re on your own”. Don’t underestimate the enormity of the difference here.

BTW John Oxford, thinks that UK has a great set of plans and we’re one of the best prepared countries. Just so you know. And I also think that we should move away from ‘plans’ and do ‘scenarios’, cos the govt is so good at writing plans, but someone needs to point out to the public the fallacy of these plans, and where they will fall apart.

Please email me and we can discuss this in greater detail. There’s a lot that I am not ready to mention yet on a public forum.

Flu monitor - Wow that is certainly an ambitious plan. My concern would be that it would require a lot of work and ultimately nobody turns up because no media outlet would care. It is clear that the British MSM does not see H5N1 as being a valid news story, so why would they even bother turning up to a press conference?

I do not mean to be critical, rather more I am asking the questions, I could very well be wrong.

Ok this is all off the top of my head:

Perhaps sending out a press release would be a better way to go initially and seeing how much it gets picked up, although I don’t know how to go about this,a nyone any ideas?

I think Richard and Judy that Crazy American Lady suggested is a good call, but we would have to find a suitable expert willing to go on, also I know their new series doesn’t start till the New Year. The other option is putting together an email with the salient facts and then emailing them to Radio stations seeing if they would like to do an interview with our expert about an approaching pandemic.

Hmmmm seems to me we definately need to need an expert, or at least a spokesperson who can pimp themselves around, maybe on behalf of an impressive sounding group that is actually just us. The UK Pandemic Foundation perhaps?

Press releases need to be directed to the correct individual and usually are shaped so that they can be aready to print story with topping and tailing by the journalist - so we need to know who to send them to. Additionally, they need to be short - if necessary accompanied by fully referenced briefing and background documents. They then need to be sold in - a call to say the release is coming, a call to check that they got it and discuss, and get a verdict or concerns. Its actually also a lot of work, and sometimes more than a brieifng - and yes there is a risk of a no-show, which is why the release needs to be punchy and leverage an aspect of the subject that is of interest to them. We dont necessarily want them to go half baked on reports either though or we will rapidly lose both crdibility and interest - anon_22 is quite right on this. We need them to ask the right questions in the right places and do a good bit of investigative journalism to see how weak certain aspects of UK preparation and planning are - and then report on that. It needs to be a campaign of sorts - all in it will be no small undertaking from any of us. And we need to be 100% accurate in the facts we present them without too much in the way of opinion. Journalists have to also relate to the issues personally - in that it is themselves and their families who will be just as vulnerable as the rest of us.

Personally, the biggest front that the government is putting up is tamiflu. They are trying to make the case that they have enough for 25% of the population which is approximately how many will get sick, so we are fine.

Their plan is to set up phone lines so that people who get sick will call. The calls will be answered by trained personnel (these have not been identified, resource has not been allocated) who will follow an ‘algorithm’, presumably a set of questions to determine whether the person is actually suffering from the pandemic virus. If the answer is yes, then they will appoint one member of the family to go to a local area (no specifics yet) to pick up the tamiflu. The aim being to get the meds to the patient within 12–24 hours of onset of symptoms.

Here are a few big problems, just off the top of my head: 1) What are the chances of correct diagnosis? If we look at the experience from Indonesia, reported here at 22:07 the clinical presentations of normal seasonal flu and H5N1 infection are indistinguishable until Day 5 when shortness of breathe starts. The phone operators are being asked to do an impossible job.

2) If the phone operator decides that the caller is not suffering from the pandemic virus, how likely is it that they will successfully reassure and persuade the person to hang up? Wouldn’t it be reasonable to assume that people will want to know why? And if let’s say they are told that it’s because they don’t have symptom X, well, it could be that they called so soon that symptom X has not started yet, in which case by the time symptom X starts, they might have missed the optimal treatment time. Or the caller can decide to hang up and then call under a different name and just make up symptom X. The whole system is so open to abuse that I can boldly predict that it will fall apart in less than a week, with bogus ‘patients’ getting their hands on tamiflu while law-abiding (or clueless, depending on how you look at it) people will miss out, assuming the phone system can stay functional for that long.

3) Ethics: If it is difficult in the hospital setting (see above Indonesian experience) with patients under 24 hours observation to tell whether they have the virus, how can one safely and ethically reassure anyone on the phone that they don’t have it?

4) What percentage of the national stockpile is earmarked to be used in this way? How much is saved for GP’s to prescribe, and how much for hospital patients? Have they worked it out yet?

5) All this is assuming that the standard dose ie 75mg twice daily for 5 days will work. All current evidence tells us that it won’t work for H5N1 patients. We need AT LEAST twice the dose and twice the duration. If we use the standard dose, repeated nationwide, we may be doing the world the disfavor of producing the most lethal bioweapon the world has known, namely a NA-inhibitor resistant pandemic H5N1 virus.

6) If we use the higher dose, well, then there is enough for only 1 in 4 of people who get sick. If we add the issues of distribution failure, wastage due to incorrect diagnosis, hoarding, theft, how much do we have left for treatment?

7) How much do we need to save for the purpose of treating hospital patients? We need to have sufficient to cover all in-patients including suspected cases, if we don’t want hospitals to be major foci of outbreaks. Which means even more will be wasted. But if we don’t do that, hospitals will be deathtraps for HCW’s, who will either get sick or go AWOL.

8) They are using a figure of 3.7% hospitalization for a CFR of 2.5%, meaning that 2 out of 3 hospitalized patients will die, assuming that nobody dies at home. If we assume half of those who die will do so outside of the hospital, which is a pretty gruesome scenario, we are still faced with the assumption that 1 out of 3 hospitalized patients will die. Now we know that the biggest problem that will require hospital care will be breathing difficulties. Some but not all of those with breathing difficulties will go into ARDS. That is, for every patient with ARDS, we expect that there will be at least several with varying degrees of breathing problems. We know that in optimal conditions including ICU care and ventilators, ARDS patients have 40–60% mortality. Does that mean that we will be only admitting patients who are in frank or imminent ARDS? Does that mean that everyone else who are experiencing breathing difficulties will have to heck it out (excuse the bad pun) at home? In the GP’s surgery? Where exactly are those who have breathing difficulties but might have a good chance of survival supposed to go?

9) If we are not admitting to hospital those with breathing difficulties but have a better chance of survival than those with ARDS, and only admitting those who are most likely to die, and if we do not have enough tamiflu to treat the patients and/or insufficient PPE to protect staff, why should HCW’s risk their lives to save those who are likely to die anyway? The experience from SARS was that no matter how stringent infection control measures were, HCW’s still got infected. The only thing that eventually stopped that from happening was the use of PAPR (powered respirators) for close nursing or at minimum during high risk procedures such as intubation. After the first few heroic HCW infections and deaths, how many are willing to continue to intubate patients without PAPR? If they are not willing to do that, we might as well not have ventilators, unless we run really fast now and buy a lot of face-masks and machines suitable for NIPPV (non-invasive ventilation) and train a lot of people on their use. None of these very complicated issues have been addressed.

Like I said, that’s just off the top of my head. There is a strong case against what the government is doing. The problem is presenting it coherently in few enough words so as not to try the patience of editors.

I’ll work on it some more.

In the meantime, anybody who can find links to any UK plans, updates, local information, please either post them here or in the wiki on the country page. I will look at all resources put up but I don’t have enough time to do more searches.

Richard and Judy are a good place to start. They often follow the lead of Oprah - eg the book club.

If you can get a few celebs interested in a pandemic then they might be asked onto similar shows to talk about their fears/thoughts. We need a bit of momentum.

Approaching potential converts as a group might have more impact than as individuals. We won’t seem quite so much like lone loonies. Most of the people I’ve met who are concerned about bird flu are intelligent, well educated people so we shouldn’t come across as too way out.

Plying people with food and alcohol has also had success in getting people to listen to you in the first place.

Anon_22. Good points. I will see about posting everything I have (that is not already linked to) tomorrow as cannot do more this pm.

Probably not what you’re looking for but:-

This is a link to the Cheshire, Local Resilience Forum, it shows risk assessments for local hazards

http://tinyurl.com/rcssg

As a document, it says very little, but on it a bird flu pandemic is the most severe risk they list. If this is the most severe risk the region faces, what are they doing about it?

I’d also tie up all those references to us being on our own in a pandemic, all the hospitals being over run, and the recommendations that medical staff all wear masks. If we’ll be looking after our own sick, why aren’t they recommending masks for all?

Anon_22 - quick questions I have thought to consider before I sign off that you may have thoughts on. What is bed space availability versus the numbers of expected patients, over a six week pandemic wave. What plans have been made for field hospitals (IF ANY) as I remember this number of expected hospitalisations greatly exceeds national capacity. What provisions for staffing these? What is the present average time of hospitalisation of a patient to recovery or death, and therefore how quickly will hospitals be overwhelmed if this pattern (seen elsewhere at present) is maintained? If early discharge is planned, what provisions are planned for local care and equipment provision? Has this factor been included in PCT plans and planning?

More tomorrow and thanks for your insights.

flumonitor,

All good questions.

As my kids will say “Ha Ha very Ha!”

I have some of the information but not all. I need help in finding normal operating capacity etc. Links to NHS statistics. It would be useful if we pick 1 or 2 typical primary care trust and/or NHS hospital and work through actual numbers.

uk bird – at 13:59

Thanks. It IS what we want. This is highly significant.

Because notice they put under ‘impact’ - catastrophic, for a pandemic with 25% attack rate and 1–3% mortality.

You would think that people should be told about this!

Sorry for my absence, but been involved in other matters, I’am always ready to help in any way I can.I note that some of you have each others email address. Not sure how that can be sorted, please advise if you want to discuss this issue further.

Alan, if you email me at anon_22 AT hotmail DOT co DOT uk I can maybe get started talking to each other. Someone who knows how to set up yahoo groups or other chatrooms can co-ordinate some more. In the meantime, this might be a good place for everyone to post information, news, whatever you can find. We don’t know what is useful until we can look at what there is to find!

For example, the link that uk bird gave, to Cheshire’s Local Resilience forum, gave the following risk assessment:

• Outcome description: Pandemic in two waves, 3–9 months apart at 12 weeks each duration. Quarter of population affected. 500 to 100k consultations per week overwhelming health services. Clinical attack rat e of 25% with mortality of 1–3% of those infected.
• Likelihood: possible
• Impact: Catastrophic
• Risk Rating: Very High

And it referenced UK Resilience as source for the rating grid. So when I go to the UK Resilience site , I found this document Risk Grid which contained this risk grid

which gives a very good visual illustration of the degree of risk they are talking about. Now my question is, therefore, that if the risk is very high, a) why do they keep reassuring the public, and b) why is there no extra funding for this risk, apart from spending on tamiflu and maybe vaccines?

Now I don’t think Cheshire came up with the risk assessment themselves, rather this came from the central government. We need to find the actual document that acknowledges that.

This risk grid was also shown in the Cheshire document as this:

The reason why I put up both slides is to show that the grid from the Cheshire document is actually from the Cabinet Office. It would then beg the question of whether the assessment of ‘catastrophic’ also came from the Cabinet Office.

That’s the kind of thing we need to find to take to the public.

I just googled for “pandemic exercise europe”, and this pops up:

• Pandemic Influenza: Commission publishes evaluators’ report on simulation exercise
• crisis simulation
• crisis solutions
• report on first link
• another report on same
• eurosurveillance
• cidrap on Europe

http://europepanflu.blogspot.com

I read about but couldn’t find reference to an exercise in the UK called SHARED GOAL. If anyone can find it please post. Also, their next exercise will be in February named WINTER WILLOW

“WINTER WILLOW is to be the full national exercise of our response to a flu pandemic, building on the more limited coverage of the recent SHARED GOAL. It is intended to cover all 3 layers in the structure; national, regional and local. The scheduled dates are Fri 16 to Wed 21 February 2007

http://www.gos.gov.uk/gose/docs/264757/vssgMinutesFeb06.pdf

HPA Pandemic Influenza Contingency Plan http://tinyurl.com/zxdrl UK Health Depts Contingency Plan (Scotland) http://tinyurl.com/f87rm Reasonable review of 2005 Contingency Plan http://tinyurl.com/e4ut2 HSE Considerations re: Pandemic http://tinyurl.com/lx26z UKNIPC meinutes http://tinyurl.com/nunob UKNIPC Home http://www.advisorybodies.doh.gov.uk/uknipc/index.htm Welsh NHPS Co-ordination centre plan http://tinyurl.com/lk45t

More later - please give feedback on usefulness. It will help me refine the library!

Sorry - I have not worked out the formatting just yet!

Europepanflu, thanks for reminding us about http://europepanflu.blogspot.com !

There was news there about a conversation among UK top people … just a minute … nay, can’t find it right now, but I found these:

• http://europepanflu.blogspot.com/2006/03/every-man-for-himself-in-europes-bird.html
• http://news.scotsman.com/topics.cfm?tid=161&id=495232006 (Scottish hospitals would not cope)
• http://europepanflu.blogspot.com/2006/05/uk-preparing-for-supply-meltdown.html
• http://europepanflu.blogspot.com/2006/03/hospitals-would-not-cope-if-bird-flu.html

The conversation I’m half remembering included people from maybe the House of Lords or something of that sort. They actually discussed things and the whole conversation was written down in a PDF file.

lugon digs

http://tinyurl.com/zdaqc this is the best reference to the SHARED GOAL document I could find.

So that anon_22 is not burdened with e-mail documents, can someone advise me how to load up documents?

Flumonitor, you can write to demfromct or dude or lugon at singtomeohmuse dot com - i can’t upload things myself but i’ll gladly follow up. Or if the document can be wikified then that I can do.

Critical Analysis of the HPA Pandemic Influenza Contngency Plan.

Plans are only as good as the assmuptions on which they are based, and therefore I choose to start here. http://tinyurl.com/zxdrl for full document.

1. Assumption are based on the known experience of the last three pandemics and their characteristics, and assume that the profile we presently see for H5N1 will mitigate to the levels of H5N1. This is not necessarily unreasonable, but, given what has been seen in charactristic terms of the H5N1 virus, there is no scenario that considers a higher level of CFR.

2.Infection control assumptions for pandemic influenza are based on current knowledge about seasonal influenza viruses • Person-person spread of human influenza viruses is well established ACCEPTED

• The patterns of transmission observed during nosocomial outbreaks of influenza suggest that large droplets and contact (direct and indirect) are the most important and most likely routes of spread ACCEPTED BUT DOES NOT TAKE ACCOUNT OF BLOOD BOURNE VIRUS NOR POTENTIAL FOR INFECTION THROUGH BODILY SECRETIONS. THIS IS A KNOWN PROBLEM WITH H5N1

• Airborne or fine droplet spread may occur in some settings (e.g. during the performance of aerosol generating procedures in healthcare settings)SEE POINT ABOVE: NO MEASURES ARE CONSIDERED FOR SARS-LIKE TRANSMISSION POTENTIAL

• The incubation period of human influenza ranges from 1–4 days (typically 2–3)ACCEPTED

• Infectivity is proportional to symptom severity and maximal just after the onset of symptoms ACCEPTED • The period of communicability is typically up to 5 days after symptom onset in adults and 7 days in children, although longer periods of virus shedding have been documented in a small proportion of children. CLINICAL EVIDENCE FROM INFECTED INIDVIDUALS SHOW THAT INFECTIOUS PERIODS, AT LEAST FROM PRESENCE OF VIRUS WITHIN BLOOD AND OTHER TISSUES MAY BE CONSIDERABLY LONGER THAN THIS

• Virus excretion may be considerably prolonged in immunocompromised patients ACCEPTED: NB AIDS PATIENTS • Virus may be recovered from infected but pre-symptomatic persons, but there is little published evidence to support person-person transmission of influenza from a presymptomatic individual to a susceptible host. ACCEPTED, BUT NO EVIDENCE TO SUGGEST THIS IS NOT THE CASE HERE EITHER. PRECAUTIONARY PRINCIPLE.

• Seasonal influenza viruses can survive on environmental surfaces, especially so on hard non-porous materials (up to 48h)EVIDENCE THAT SHOWS THAT H5N1 VIRUS SURVIVES UP TO 30 DAYS IN THESE CIRCUMSTANCES AND IS EXCEPTIONALLY HARDY (Reference not to hand but will find later unless someone has it to hand quickly) VIRUS ALSO VIABLE IN WATER, WITH LONG TERM VIABILITY IN ICE AND AT 0 DEGREES, AND UNKOWN DURATION AT SUB ZERO TEMPERATURES (180 DAYS PLUS)

• Influenza viruses are easily deactivated by washing with soap and water, alcohol based hand sanitizers, and cleaning with normal household detergents and cleaners. ACCEPTED

As a consequence of these basic failures in assumptions, all control measures planned below will be inadequate.

3. Pandemic infection control measures in all general settings will be based around: • Persons with symptoms staying in their own homes • Persons who develop symptoms at work or whilst away from home, returning to home as quickly as reasonably possible • Good respiratory hygiene practiced by all • Frequent hand-washing practiced by all • Appropriate cleaning of frequently touched hard surfaces in the home and in public places • Avoidance of unnecessary contact with others and unnecessary overcrowding (reduction of contact rates) • Rapid access to antiviral treatment for symptomatic persons (reduction in transmissibility) In health and communal care settings, additional measures will include: • Prompt recognition (and treatment) of staff with influenza • Exclusion of staff with respiratory symptoms • Segregation of staff into those dealing with influenza patients and those not (with exceptions) • Maintaining physical and/or temporal separation between ‘flu’ and ‘non-flu’ patients/clients • Standard Infection Control Principles • Droplet Precautions • Personal Protective Equipment according to risk of exposure • Environmental cleaning and disinfection

There is no condiseration of sick persons visiting doctors surgeries or other premises, with virus settling on carpets. are all surgeries, pharmacies to be disinfected (carpets) on a daly or twice daily basis? Hoovering will stir up infectious particles for example, that will still be viable unless treated. Surgeries do not possess this sort of equipment. In a hospital setting SARS like precautions,as well as masks need to be employed if we are to protect HCW for drips, injections and other interventions.

This is just for starters. More later. Comments (and help with the references) welcome.

‘will mitigate to the levels of H5N1’ should have read ‘will mitigate to the levels of H1N1 at the very least’ More haste and less speed so I apologise for the typos.

Assumptions that are missing: First pass.

1. That supply lines for essential goods e.g PPR, non pandmeic related medical supplies eg drips, nebuliser, non-anti viral prescriptions may be disrupted (almost all imported from far east), and necessary measures to ensure continuity.

2. Provision for GP surgeries and field based care, beyond anti-viral medications. Limitations of patient visits to GPs/ surgery access for basic provisions such as prescriptions.

3. An assumed time period between pandemic waves, and consideration of manpower resources which may be seriously depleted. Redeployment is frequently referred to - but who and from where? If HCW are inadequately protected, what contingencies?

4. There is no assumption of a period that would be required for either hospitalisation nor how long people who became sick would be unable to work. Present experience indicates that this may be weeks or months, and 1918 reports refer to 3 month absences frequently being necessary.

5. No assumption based on the period of time that adequate testing goods and materials should be held for, no for the time allocation before which restock and resupply may be necessary.

6. Given that there is widespread consensus that we should be at Alert level 4 now, stocking of additional PCR tests and other measures does not occur until level 4 plus is reached. We may only have 30 days to level 6.3, which is insufficient time for manufacturers to make and supply, especially if there is transport disruption and these are made overseas. Therefore we are likely to have inadequate supplies of these when a pandemic arrives.

On re-reading this I need to rewrite it and clarify when there is proper time to do so - apologies if the points are not very clear at the moment. I will have another go.

uk bird, can you email me at anon_22 AT hotmail DOT co DOT uk. I have a message for you.

I have a question for everyone. Which is going to look bad coming from a Mod, but whatever. Is anyone in the UK doing anything with Pandemic Flu Awarenss Week? I haven’t done anything in this regard simply because I just have no time, and also I don’t see a lot of UK folks ready to go out and give out ribbons. Or maybe I’m mistaken. If so, I apologise.

But if nothing is happening anyway, do you think we should at least modify the press release and send out one version excluding the whole volunteers giving out ribbons business, and just present it as an online effort?

could work for europe as a whole - if it is a whole

on the other hand - how do we know if a number of people are ready? ah, ok, by sending it as a pdf through email networks, right? would p2p (peer to peer) work?

IMPORTANT - please help

I am adapting the press release for the UK, as the current one will not go down well here at all. It’s almost done. It is 7am here and I have to go catch some sleep. It would help me greatly if some folks can find the links to media press submission pages and post them so that I can get the press release out as soon as I have finished this afternoon.

anon_22 in case you read fluwikie before email (hehe!) i consider your adaptation to be just perfect.

Who is ready to send to other European countries?

anon_22 : I’ll start now and email you.

I’ll start with the Times, Mail, Sun, Telegraph, etc.

Find a name of a jouranlist first to increase the chances of success - a phone number too if you can, becasue a quick call and a chat will improve the outcomes vastly. This is an aspect of something I do for a living - if we cant, anything is better than nothing and I have use of an automated system (no names though) that can get a release out quickly. Its a bit like throwing mud at the wall and seeing if it will stick though - first route is best. Between us all if we could do a few calls each it may not be too much of a burden - but we would need to have an agreed ‘conversation points’ guide so that the output is clear and consistent.

“Find a name of a jouranlist first”

I suggest someone googles for “site:thetimes.com (or whatever it is) pandemic” to look for articles, then find the name of those who have written about it.

I got the order wrong. It should be “pandemic” and then “site:whatever”. Example: google “pandemic site:http://www.timesonline.co.uk”.

This lets us get at “Tim Reid in Washington”, “Nigel Hawkes, Health Editor”, “Mark Henderson, Science Correspondent”, “Philippe Naughton, Times Online”, “Angus Macleod, Scottish Political Editor”, “Sam Lister” and probably others in other pages.

Mr Hawkes might be the person to talk to, judging by what I read.

Someone please replicate the process with other papers?

AND look for email addresses of whoever is the “target journalist”.

The Times (Mark Henderson) on “statins”!!!!!

uk bird, thanks for the lead - i must be off-line for some time now - good luck!

House of Lords Science and Technology Committee Report on Pandemic Influenza (PDF) - 212 pages

Thanks, anonymous – at 08:25

Reading some random pages:

Page 53:

Q145 Lord Howie of Troon: Do you mean to be rationed in some way?

Professor Zambon: Clearly if you have two million doses and you have 50 million people who want a vaccine then there will have to be some degree of rationing applied to it.

Lord Howie of Troon: Are the House of Lords a priority?

Lord May of Oxford: At least they come under the age category!

It goes on. Q147 and 148 are good, too.

It’s good that this has been published. Adjustment reactions all the way forward, I supose.

I have started a new thread for Pandemic Flu Awareness Week UK and Europe for visibility.

There’s work to do. Go help. Please.

A couple of uk links that are an worth a look

Catholic church policy on bird flu http://tinyurl.com/nb3ga

An interesting presentation on bird flu in the uk. http://tinyurl.com/r33o6

The Catholic church policy is indeed interesting.

There is a free buisness continuity planning tool available from http://crisis-solutions.com/pandemic.htm which claims to be used by the UK governmnet for assessing pandemic impacts and feeding inot strategic plans.

Worth taking a look at their assumptions to see if they are vaild or flawed and if so, how this may affect overall attitudes of UK govt etc.