Forum: The Role of Local Public Health Officials

Summary: there are high level meetings which are focused and uplifting. Reality on the ground shows there’s a chasm between those meetings and what local public health officials are doing (or able to do). How to close that chasm is the purpose of this thread.

Over at Forum.WhatIsTLC, Pixie – at 22:11 wrote (my emphasis):

anon_22: “I agree there’s a lot of work to be done. That’s why we need to get people educated, informed, here, and then go and talk to these local officials. That’s what I’m doing. :-) “

I think the problem here is that there is a huge chasm between the people you just met with at the meeting which discussed Targeted Layered Containment and the people tasked with managing pandemic preparation (including containment) at our local and state levels. They don’t think it is needed.

There is a chasm.

Goju, crullfullmoon, and I have been doing the rounds of the local officials in the NY to Boston corridor. The level of interest and motivation generated in the meeting you just attended is, I assure you (as Goju and crullfullmooon already have), completely absent at the practical level.

What we are saying is that we are, in fact, already doing what is proposed. We are taking the information we have learned here and all along this long road, and are attempting to implement action at the local level. At this point, we don’t, I think, care which action it is (apart from assurances of mystical visions of a non-existent vax and miraculous Tamiflu), as long as there is some action. Those of us willing to step out and engage at this level are meeting a brick wall. We are not alone. You do not hear of Fluwikians reporting back about successes with their local governments - anywhere. Ever. Reports of local governments being prepared, or at least on their way towards preparation, are nearly non-existent.

Some of us, like you, have spent time in high level meetings that are well focused, engaged in problem solving, and full of people facing the reality of what needs to be done. Those meetings are not only informative, but uplifting and energizing.

But we have chosen a dual role. We have one foot planted over there, but we also have one foot planted firmly in front of those charged with the public health and welfare of our citizens at our state and local levels. When we plant the other foot in that arena, we have entered another world entirely. This disconnect is severe.

The chasm between those meetings, where everyone understands the level of problem we are potentially facing, and the meetings those of us who have actually ventured out on the local level have had, is gigantic. We are talking Mars and Venus here. Without some very real attempt to bring those two sides and outlooks together, one side will continue to talk and intellectualize, and one side will continue to stubbornly do, in reality, nothing or less than nothing.

I expect the tension between what we see happening in the most serious way now at the highest level, and the continuing stubborn inaction at the local level, will continue to grow. My state, and many local public health officials, apparently believe that they can wait until the 11th hour and then make a heroic end-run at this issue. We know that effort will tragically fail. The words “too little, too late” will have meaning as they never have before. The TLC planning assumptions have a weakness - they assume engagement, and preferably early engagement. We don’t have that engagement. Not yet we don’t, and we need to think of some ways to get it, again preferably now rather than later.

Crfullmoon and Goju speak of wanting to pursue the problem by utilizing various gardening tools and kitchen implements. I won’t add my suggestions. We are frustrated, yes, but it does not ruin our day. We are right back here seeking further strategies that will produce actual and measurable practical progress. Those at the top can talk all day. We here can talk all day (and we do). But it is all for naught if we cannot turn the talk into action.

We could take the path of least resistance, I mean hypothetically at least. We could just hang out here, and talk to each other and the many like minded people who share our views. And, it’s always affriming to attend the meetings where everyone is on the same page and we’re preaching to the choir (they usually provide a nice lunch to boot).

Instead, we have perhaps chosen the path of most resistance. We are your canaries in the coal mines, and the inaction we are finding out there is gut wrenching. But our hypothetical choice to continue is really not a choice. In short, as Goju said, we see dead people. We know too much. There is no choice.

We all work out our ideas here. Goju started the thread the other day about just this subject, although at that time I think the subject was more amorphous, and not so well defined. He noted the increase in high level meetings and other seemingly tense and anticipatory actions at one level, and the nearly complete and utter dismissal of the entire issue at the more local level. The disconnect was nearly complete, and I saw it too. I’ve seen others comment on it recently as well, such as Bird Guano and our nurses. Fourty-eight hours of ruminating about it and listening to input from the Fluwikian hive mind has led me to the conclusion that we have a problem. We have a chasm. Now the question is what to do about it. IMHO, the people who hold the key to reaching our community leaders are our public health officers. They need to be reached. That chasm has to be bridged. If not, we really will be faced with a situation full of dichotomy: the few key leaders who have been consistently urging preparation themselves will be well prepared, and the public health officials who somehow did not get the message will be standing around asking “why didn’t anyone tell me this was serious?”

How do we bridge this? How do we bring about enough engagement to even begin to proceed with TLC or any other meaningful actions? TLC is a pro-active, rather than a reactive, strategy. Without engagement and engaged advance planning, TLC is unworkable, no matter how effective it may be in theory. TLC is not 11th hour stuff.

Goju – at 23:09

Maybe some pressure on these folks?

http://www.apha.org/

OK folks - Here is the place to go to work

http://www.getreadyforflu.blogspot.com/

post to the comments to get the ball rolloing

Goju – at 23:36

OK Fluwikians - we need your help.

As Pixie pointed out on the TLC thread, there is a major disconnect between the higher Government warnings and the local Public Health Officers who often control our town’s reponses to health concerns - in this case Panflu preparedness.

I found the American Public Health Associations website at http://www.apha.org

They have a Panflu section. It is woefully in need of our expertise.

I also found their Panflu blog … it is here:

http://www.getreadyforflu.blogspot.com/

I have sent a comment already and hopefully they will post it.

Please go there and post your comments. The more they hear from us, the sooner they may respond by telling their members - your local Health Officer - what they need to DO to get everyone they are responsible for ready for Panflu.

30 October 2006

Average Concerned Mom – at 07:40

Pixie at 22:11

Are you able to articulate what is the root of this “disconnect” on behalf of local public health officials?

Is it a lack of the sense of imminence or urgency? Or lack of a sense of how fast thing will move once they get started? I.E. you say that they seem to have a feeling that there will be time later to get ready, once things look more sure?

Or is it simply being overwhelmed by having had this additional huge, complicated health issue thrown on their plate with no reduction of other duties?

Or — all of the above?

Pixie – at 07:47

Average Concderned Mom - at 7:40

Those are really good questions, and figuring out what the “root” of the disconnect is is a really, really, good issue to focus on.

Like crfullmoon, I need to pour a large pot of tea before I tackle those questions since they really are that good. And, they are the crux of the matter.

lugon – at 08:53

(…) Please look at a current threat assessment and look for “lugon – at 08:17″. This is part of what would convince them that “this virus is moving”.

Well, I guess I will take a stab at answering this one. There is not any single answer - in fact it is a combination of several issues and none are quickly and easily fixed. IMHO, some of the reasons why local public health staff may be “disconnected” are:

(1) Lack of funding and staff for BF preparedness - For example, our county got $10,000 for BF preparedness from the state. That money is to be used for anything BF related - including preparedness meetings, PPE for staff, lab testing of any birds, creating and printing educational materials, creating websites, etc. As you can see, that money will not go far. That also does not include staff time. Many public health depts. have had their staff cut in recent years to save money. It is very difficult to add more work for the remaining staff people to do (and not have overtime costs).

(2) Delays in getting timely and accurate information about BF. Many health officers I have talked with get their information from CDC and WHO website sources. I have not seen many updates from the state to the locals. As we all know, this information from WHO and CDC is very dated and is not entirely accurate/transparent. The HO’s do not have the time to sift through all of the overseas news to find out what is happening today. Quite frankly, we are more aware of current avian flu news than they are. If at this point you think that by personally providing them with articles or websites, IMHO, I do not think it will do any good. I do not think the HO’s will see you as credible unless they know you and you are a part of their inner circle. I also do not think they will see newspaper articles as credible information either. With this said, this might be why they do not see this issue as one that should take the front burner - if WHO and CDC do not come out and really start educating the public and state this potential pandemic could be a major catastrophe, why should they do so?

(3) I want to make it clear that this final one is more my opinion, but could also be an important potential block as well. What would you do if you knew a large earthquake has struck, the potential for a huge tsunami being created is high, and you live on a relatively flat island? What do you tell the people? Where can they go? You do not have the boats to save them and you only have a couple of tall buildings to put a few people in. Do you issue a tsunami warning to the people? What can you do? Maybe the tsunami won’t come or it will be small and will not affect much and you will have created a panic needlessly. With avian flu, it might be something similar. If the CFR is high enough where they see potential utility and infrastructure breakdowns, do you sound an early warning to the people? There will be no place for these people to escape. As a health officer, you do not have the power to allocate resources to feed or protect these people. You do not have funding to buy medical supplies to take care of them. You will get backlash from businesses and possibly elected officials who may cut your already meager budget for speaking out.

None of this is a good situation and there are no perfect solutions. I am also not saying that we should sit around and do nothing. I think we need to keep in mind that health officers are not always free to act the way they may want to (for political, economic, or other reasons).

As a health officer, you do not have the power to allocate resources to feed or protect these people.

I think we need to keep in mind that health officers are not always free to act the way they may want to (for political, economic, or other reasons).

Other blocks? How do we get past these ones?

From the other thread:

Goju – at 09:58

Average Concderned Mom

I think the PHO are stuck between a rock and a hard place…

Lets say for instance that PHO Mr. S of SmallTown reads our indo thread and the lightening bolt of understanding hits him square between the eyes. He then starts reading as much as he can to educate himself about Panflu and its effects on the community… takes some time and realizes that he it’s his job to save the lives of the children in his community.

What does he do next? If I were him, I’d go to the WHO, CDC, Fed Government and State Gov Panflu websites.

And what is the message he comes away with? Confusion I’d say. Prep spreads from 3 days to 3 months and longer. CFR’s from .5% to 79%. When/not if but dont know when…

His number one job, which takes all of his time, is not Panflu. So he slowly puts a plan of action together and has to squeeze it into his already hectic schedule… and has to present it to his “bosses” in a way that is believable and doable.

He has to also be “right” or he risks losing his job…. which may be his number one concern.

So our PHO disconnect is not really a disconnect, but confusion as to how to move to what next step.

If he acts boldly, he will either be the hero (if pandemic happens) or a fool (if pandemic doesn’t happen). If he acts not at all, he will either be blamed for many deaths or left alone to do his job as he has always done it. - no risk.

What would you do if you were in his shoes?

anon for now – at 10:06

Maybe (s)he prefers to keep the job in order to be of help when it happens?

POLITICS. IGNORANCE. DISBELIEF. COMPLETE DEPENDENCE ON ‘TPTB’ TO SAVE THEM. Pick a reason.

I work on a local DOH and on a good day, it’s like pulling teeth. If you can get a completely independent task force made up that answers to the least number of higher powers as possible, and comprised of as many ‘hand’s on’ people as possible.

Trust me. I am there right now. Tied up in committee procedural BS.

Viruses mutate a heck of alot faster than politics moves.

The first thing to do is to assess the situation in each locale. Often, public health directors jobs are political sinecures given out to loyal campaign supporters, and there is only a vague (or no) professional connection. Others, especially in small towns, are appointed simply because they are the least unqualified person for the job and someone has to do it. Some of the more honest directors will acknowledge their lack of knowledge, and those will be surprisingly receptive to suggestions for improvement and preparations AS LONG AS they do not threaten the budget or require unusual spending, do not require expenditure of political capital, or any significant amount of actual work.

Probably the best overall course of action would be to try to get access to the director and then use that access to persuade him to let you make a presentation to the local governing authorities. by doing it this way, he expends minimal political capital at minimal risk.

LMwatBullRun – at 10:18:

Ok, but riddle me this.

We are sometimes finding that the entire city planning team can be pretty much on board - except for the public health guy. They’re ready to move, and he says “no, not really needed IMO.”

What to do about that?

(1) Lack of funding and staff ; All I asked, back in Oct 2005 was that the health dept honcho tell the citizens the federal government (and the WHO!) have a pandemic flu website and to take a look at it. Plenty of low-cost low staff ways to accomplish that.

(See Peter Sandman for officials’ irrational fear of “panic” in the public. “that doesn’t listen to us anyway about smoking and seatbelts” “telling the public now about pandemic would have a bad outcome” “this is like Swine Flu and Y2K (his ignorance was showing!)and if I warn them and it doesn’t happen they won’t listen next time” Out very educated town would be shocked to hear how foolish and stupid they are thought of in general. Patronize them, and, don’t tell they and they are in a game of “russian roulette”.)

When peoples’ lives are at stake they are usually willing to volunteer their time, either to educate themselves or prepare or both. We have community organizations, and, people with many skills, but, they weren’t told we needed to start working on this -‘not even after our Feb.2005 state pandemic influenza summit. Nothing was said about it in the financial requests at Town Meeting two months later.

(2) Delays in getting timely and accurate information about BF. Evidently, they don’t want it, as they do not want the responsibility of bringing the public bad news’….”Quite frankly, we are more aware of current avian flu news than they are. If at this point you think that by personally providing them with articles or websites, IMHO, I do not think it will do any good. I do not think the HO’s will see you as credible unless they know you and you are a part of their inner circle”…

Officials not up to this should have requested a position - a volunteer committee if necessary- been formed just to focus on pandemic influenza year preparation ; “all-hazards approach” averages out too short. One if those hazards is too unlike all the others.

(3)”Do you issue a tsunami warning to the people?” Yes I do What can you do? Maybe the tsunami won’t come or it will be small and will not affect much and you will have created a panic needlessly” What is panic? If we live on a flat island at risk of tsunami (or storm surge) we need to all know that and be talking about what we’d do ahead of time. And, listening to scientists that say we need to build farther away from the coast, replant mangrove trees that were removed, and, scrape up money for a tsunami monitoring/warning system

So, some jobsworth keeps his job until catastrophe. Then, what sort of shape is the rest of their life in? Most of the public will come up with attempts at rational solutions given honesty and education and ethical leadership.

No top-down solution? Then tell the grassroots you’re very sorry but they’re going to on their own in a natural disaster and let’s do our best and then work together for recovery.

Meanwhile let’s keep trying to show anyone you think needs to know what the current human cases/countries/crf off the Main Wiki are, and govt documents that have assumptions for officials - they don’t say we are guaranteed months of warning, nor antivirals and vaccines, nor outside food and medical aid, and pandemics can play out over years.

Public mistakenly thinks if it was important they would keep hearing about it. The current economy/status quo has been considered more important than long-term resiliance.

First, they wanted to “hope it won’t even happen” then, they went right to, “if it’s that bad there’s nothing we can do so we really can’t tell the public, now”

“Maybe (s)he prefers to keep the job in order to be of help when it happens?”

What “help”? They will be totally useless for an unprepped population, that is unready for home nursing and DIY hospice, unready for mass fatality surges (and ones including children), unready for local hazards, uncoordinated between local businesses, faith communities, institutions, non-profits, unready medical and psychological health care providers, ect.

I’d be more use if I told, even if I had to find another day job for the duration. Being someone on a phone list so they can keep track of how many are sick, how many hospitals have any staff, how many dead? I’m not cut out to be a bean counter, nor someone who’ll have to staff a pandemic mental health hotline, nor the “media relations” person who’ll have to deliver agreed-upon messages to the public every day of the pandemic! “Sorry, you’re so out of luck! You really had months and months of warning but I didn’t tell you to start getting ready and that, ok-it’s pandemic now, here’s what you have to do” stuff really didn’t work the way I hoped it would.”

Telling; if people were too scared to believe it could happen, at least I tried to warn them. Some will listen and act, and are glad to have the chance to do so. Who am I think I am; to decide no one should know, knowing people are going to die?

We need to tell the world that the most up-to-date information can be found on this forum.

Forum, not the wiki side, cos it takes time for someone to re-write the stuff to the wiki.

I’m re-posting this from the TLC thread.

Goju,

I think you’ve hit the nail on the head. That the small town PH official is really caught between the rock and a hard place. Hopefully the latest research findings will help him some. But Pixie is also right in that there is a big disconnect, and I see that as the crucial task ahead of us in the next couple of months.

I think for the US, this is the time to take the most credible messages that we are getting from the scientists, and bring them to the attention of local PH officials. To say to them, its not just me saying it, but this is the advice that the highest level of government is getting. It hasn’t filtered down to you yet, but if we have a pandemic soon, you won’t have time to wait for that.

If you don’t want to have to change your plans every 2 months cos of what will filter down later on, you better pay attention to this and start altering your plans in that direction. Start getting people on board, cos you will have your job cut out doing that, and you won’t have enough time.

If and when TSHTF, the public will not forgive you for saying you didn’t have enough time to implement things, cos all they will see is that the information was available by November 2006, so why haven’t you done anything with it.

On the subject of keeping their jobs, the small town PH official needs to know that what’s at stake is more than that. As I said to the IOM Committee, losing a child is the biggest trauma that can happen to people. Bereaved parents will want to find fault, and when they know that there were recommendations by credible scientists for early school closure, and the local PH official didn’t do that, the anger is likely to be directed towards these officials personally.

You wouldn’t want to be living in a town where a group of such angry parents think you responsible for their children being dead.

Pixie: “We are sometimes finding that the entire city planning team can be pretty much on board - except for the public health guy. They’re ready to move, and he says “no, not really needed IMO.” What to do about that? “

How about a volunteer committee if necessary- form to focus on pandemic influenza year preparation; work outside the box. Can we ask for help from the state level, if some would like to be excused and go back to their regular jobs; let some other body take on their authority for pandemic mitigation community preparation?

http://pandemicflu.gov/plan/states/statelocalchecklist.html

“ Establish a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens) and that is accountable for articulating strategic priorities and overseeing the development and execution of the jurisdiction’s operational pandemic plan.”

Did this not happen everywhere, not just my town? (Meeting on the quiet, “Emergency planning” committees; “all-hazards”, no private, faith, business, involvement -not a large group involved at all -not called a “Pandemic Preparedness Coordinating Committee” -doesn’t count.)

Or, did everyone’s “operational pandemic plan” just think so much about vaccine distribution they forget to get the public stocking up for disruptions and figuring out how to cope with being sick for 6 to 8 months on their own, locally?

Or do they just not believe they they won’t get mutual aid, state nat’l guard, state stockpiles, extra state police, federal DMORT teams, all sorts of federal emergency help, ect, when we need it, despite getting told over and over, not for a pandemic influenza year you won’t! ?

I absolutely agree that there is a disconnect between the committee meetings in government offices and what is know in the neighborhood (“street wisdom”) For my part, the best use of my time is to get the word out to my neighborhood of 9,000 (that’s how many live on my Washington peninsula). I think it has to be as grass roots as possible — the same way you get word out that the local church is holding a raffle to raise money for a needed roof.

Here’s what I’m working on sending out. I think the humor and wee brush with naughtiness are vitally important to getting it circulated:

Can you handle a YOYO? Nah, not the doohickey on a string. YOYO stands for “You’re On Your Own.” Public health authorities are concerned that this might be a bad flu season. Whether it’s pandemic flu, earthquake or a bad winter storm, there are times when services and supplies are disrupted. Let’s see how ready you are to handle a YOYO event. Test yourself: ___ I have two weeks supplies of food and water. (TWO WEEKS?? Yeah. Sobering, isn’t it? Think about it though. Katrina victims had a horrible storm and then there were major obstacles to getting supplies delivered. If we did have a flu pandemic, wouldn’t you rather be home with your soup cans than in line behind someone sneezing?) ___ I have the medicines I’ll need (prescriptions, ibuprofen, first aid kit). ___ I have a way to keep warm if the power is out. (Wood stove and firewood or at least a sleeping bag and warm cap). ___I have a flashlight, extra batteries and a camp stove and fuel. I also have matches and a manual can opener. ___ I have specific supplies for my household, such as pet food and a pet carrier for Barkey the dog and Hairball the cat. FOR ADULTS ONLY. (If you’re under 21, close your eyes when you read this): ___ I won’t be on the roads to fetch booze, tobacco, chocolate or birth control because I’ve got that figured out. I’ll plan so I don’t add a “cold turkey” experience to an emergency.

It has to be door to door, on every store counter, in every newspaper slot.

Forgot to add this to my 11:05 post:

<CAVEAT: this message needs to be delivered to every PH official, but, for legal reasons, delivered in a way so its not a threat or intimidation.>

crfullmoon - at 10:36: “this is like Swine Flu and Y2K”

Well, when they say that, we should completly agree.

Y2K

That statement is a big opening to tell them that yes, maybe it is like Y2K. During Y2K, all the guys who had the responsibility for the health and welfare of the computer systems in their companies had devoted ENORMOUS resources - time, money, hands-on labor - to preventing the problem. There really was a problem - miles of coding had to be rewritten, systems that were interdependent had to be checked and double checked for bugs. The first people who became aware of a potential Y2K problem did have to “sell” the idea to thier higher-ups. But when the potential magnitude of the problem was understood, those enormous resources were approved and unleashed and the probelm was worked on in every major corporation in America - for years.

Here, it’s the “years” part that we just don’t have. We have a virus with a 79% fatality rate already circulating, it’s picked up polymorphisms for greater transmisibility in both Turkey and Egypt, and now we are hearing that India somehow cheerfully avoided disaster by applying a Tamiflu blanket. If it were 1995, and we were looking at a Y2K-like problem in 2000 and had 5 years with full agreement to start work on the problem everywhere, right now, then we’d maybe have a chance. But we likely don’t have the time, and we most definitely don’t have that agreement.

The public health officers are in the same position that the corporate information officers were before Y2K. Will they go down in history as being as proactive as their counterparts in the private sector? Are they leading teams of people right now in the same way that the corporate information officers were prior to 2000 in order to avert disaster? We are just not seeing that kind of energy or dedication to the problem.

Swine Flu

On the subject of the Swine Flu comparision, there are parallels and then there aren’t. The Swine Flu hadn’t seeded itself to the degree that H5N1 has, and there are many other differences. But the area which may end up being unfortunately similar in outcome to the swine flu situation is that of the problem with new vaccines. More people were injured during the Swine Flu outbreak by the vaccines meant to combat it than were injured by the flu itself, and yet public health officials continue to hope for a vaccine that will solve this problem. Some local doctors are attempting to run practice pandemic vaccine clinics, but as soon as children begin to have bad reactions to the new vax, people will indeed remember the other part of the Swine Flu debacle and will ask their public health guys why they hadn’t thougth of that part, and maybe given them some alternatives, like encouraging their citizens to SIP with enough forethought and planning to enable them to do so.

So yes, the lessons from Y2K and the Swine Flu are clear:

1. Get to work early and hard if you want to avoid clear disaster, and 2. Don’t count on a vax to solve your problems for you (it may cause more problems than you already had).

(Olymom, maybe add, “fire extinguishers I know how to use” and “battery-operated smoke and carbon monoxide detectors” in there, after the sleeping bag and hat somewhere?)

anon 22, what about “What’s the societal outrage going to be like when bereaved parents or orphaned children find out how long ago how much warning was out there? “ Does that look ok?

(Where are all those pandmeic planning quotes about how transparency and honesty are important for gaining and retaining the public’s trust in government…? )

made new page http://www.fluwikie.com/pmwiki.php?n=Resources.PublicHealth

Currently it only has a link to US state departments of public health. Looks like there is a need for more content from threads like this to be added.

anon_22 - at “You wouldn’t want to be living in a town where a group of such angry parents think you responsible for their children being dead.”

Honestly, anon_22, I don’t know if I would really want to remain in that job of public health officer if I felt that I was facing a “100-year event” of this magnitude. Maybe that is part of their reticence, and the human part of them is just hoping beyond hope that the projections are all wrong, and it will just go away.

But if they do choose to remain in that job, and if they make that choice, then they really are ethically obligated to do what they can now to avert as much misery as possible later.

Olymom’s idea of beginning citizen-run pandemic committees is the only alternative we will have if we cannot get these public health officials on board. Right now, we are all tring like heck to work with them, rather than around them. They are the most direct avenue to practical and meaningful action if - if - we have their ear and their commitment. If not, then we really will have no choice but to take the matter in hand and begin moving down an alternate path. It would be more effective if we could all work together.

If not, though, I know that my town is small and I have already mapped out in my mind exactly who I want doing the various jobs that will remain unassigned if TPTB do not assign them. I’m ready to move down that alternate path, if needed. But to be most effective, and to make the best use of the time we have (the “God-given time” Nabarro talked about), it would be a whole lot better for the present mechanisms we already have in place locally for health and safety to be utilized instead, and not left lying on the side of the road like medieval anachronisms.

I would like to tell you what I have tried to do in my community and see if you have any ideas.

I started writing to the DOH in June about preparations in our county and I asked specific questions concerning, power(we don’t have our own power plant), water supplies and chlorination( our little village has it’s own water company and no plan), SIP, etc. Basically I received a reply that there is no pandemic yet and not one question was answered either. My letter and the DOH answer was posted on our county’s community web site on 6/19 as of today there have been 50 views. Did my letter help anyone? I could not say as I have not one reply. I also wrote to the Infection Control Practitioner & BT Coordinator at the hospital our county is co-ordinating with since we don’t have a hospital either. He sent me their rough draft and fortunately they will be going into action at the first sign of a human case in the US, which makes me feel better. Personally through the help of this site I hope to have a better heads up before then but this answer was the only positive one I have received. Our county’s website still says 3 days of food with 2 weeks in () next to it. I emailed them and let them know that their link for more information on Pandemic Flu didn’t work. It did get fixed and the information is available and also states that there may be a 6 month disruption of services but yet on the main emergency preparedness tab it still indicates the 3 days etc. I would like to point this contradiction out. I also copied and canvassed our county seat with Inky’s flier. I wrote TAKE ONE PLEASE across them all, I hope this helped to inform someone. There has not been an article in our paper on this subject since May 2006 as well.

Frankly I am at a loss as what to do if anything. The DOH is offering a preparedness course and honestly I hesitate to take it as I am so aggravated with their attitude I may make a mistake and say the wrong thing. I don’t feel I need it either as we are well prepped here for 1 year. I thought if anything I could use it to get a foot in the door and get more information to them. I have talked to as many people that I can that I know on a level where we can discuss this subject. I have met one who is preparing and that one is also the person who told me about this site in fact. What else should I try to do? A follow up letter perhaps? Nothing as some information is on their site? Any suggestions at all would be greatly appreciated.

Sorry if this isn’t the proper place for this post. I cannot tell you how aggravating informing others or getting questions answered has been around here, I just didn’t want to give up on them yet. Thank you

crfullmoon - Did this not happen everywhere, not just my town? (Meeting on the quiet, “Emergency planning” committees; “all-hazards”, no private, faith, business, involvement -not a large group involved at all -not called a “Pandemic Preparedness Coordinating Committee” -doesn’t count.)

Or, did everyone’s “operational pandemic plan” just think so much about vaccine distribution they forget to get the public stocking up for disruptions and figuring out how to cope with being sick for 6 to 8 months on their own, locally?

Exactly what is happening. You know, we have a “all hazards committee” with no faith based leaders, busines leaders, citizens, etc. We are also just planning for the vaccinations.

Discusting!

Every county HO is answerable to a state HO and every state DOH has its corresponding legislative oversight committee. This might be a place to start. Perhaps a well-written letter with figures included would get a response. If not, send it a second time as an open letter, to the head of the oversight committee, to be published in your newspaper.

Most PHO offices are woefully underfunded and understaffed. Anything you can bring to the table that can make their jobs easier would help. In many instances they are part-timers who IRL are doctors, etc. with practices they have to keep going as well (I’m talking about town-level PHO, not state or even county). The few I’ve encountered do genuiniely care about their jobs and communities. Town level politics can get ridiculous, and if town officials aren’t on board then not much will happen. PHO’s are definitely caught between the proverbial rock…That’s why I have tried to do a multi-pronged effort by addressing school officials, board of ed, parents, 1st selectman and the media. It will take a confuencefo different groups pressing for action to get something to happen.

pixie at 10:28-

the answer to the appeal to erroneous authority is simple: Drag out more and better qualified authorities. Webster and Osterholm come immediately to mind. It’s better to finesse this by introducing this topic early, to prevent bruised egos.

As in-

“One of the reasons I am interested in this issue is because of Dr. Osterholm’s assessment that this next pandemic is coming and that it has the pontential to be very severe. We here in East Podunk are going to be affected; Dr. Osterholm, who advises DHS, says it could be all over the US within Days.”

Keep in mind the Iron Law…….

don’t forget poop runs downhill

if the state DOH doesn’t pressure the county DOH who in turn don’t pressure the local DOH to get with the program then folks- ain’t nuthin’ happening.

On A Current Threat Assessment VII at 13:30, Bird Guano posted a matrix entitled Federal Security Risk Management.

It listed Impact of Event on one side and Vulnerability (which I interpret as “how likely is this event to happen” on the other, and showed actions to take for each cell on the matrix.

I wuld put it up here but I do not know how.

Do you think this matrix could be useful in dealing with public health officials?

I’m thinking at least a part of the disconnect may be with the feeling that “There’s no pandemic NOW so we have to think about things that are happening NOW.” But the matrix shows that when the Impact of the event would be catastrophic, you actually start spending the money when the Vulnerability is relatively low.

The commonsense analogy I use with my own group of mom-friends is, even if I am 100% sure my child has been exposed to the common cold virus, I don’t really take action against it (a little decongestion, but some Kleenex) until he actually is showing symptoms. (mild Impact, High Vulnerability). But if my child has accidentally been stuck by a needle that might have been used by a drug user, no matter how low the chance of infection, I’d want him on some prophylactic meds against developing HIV. (Severe Impact, don’t know what the vulnerability would be.)

I believe that CDC and WHO need a stronger voice, but due to the political atmosphere today, I do not know if this will occur.

There are some other resources for local health officers that could help with the planning process. The first is the National Association of County and City Health Officials (NACCHO). This link (sorry, I still have not mastered the tinylink yet!) is to their website that has a 60 page guide that is intended for use by local health depts. for pandemic planning. http://www.naccho.org/topics/infectious/influenza/LHDPanFluGuide.cfm

The second resource is the Association of State and Territorial Health Officials (ASTHO). Their site also has resources regarding avian flu. http://www.astho.org/templates/display_pub.php?pub_id=1383&admin=1

It is my hope that NACCHO and ASTHO start being more vocal and providing more information to local health officials. These organizations are seen as credible and carry weight with federal organizations (ie CDC). To a lesser extent, the Council for State and Territorial Epidemiologists (CSTE) may also provide some education to the state health depts. as well as providing some pressure at the federal levels to get local health depts ready.

Sniffles – at 10:04 wrote:

“Well, I guess I will take a stab at answering this one. There is not any single answer - in fact it is a combination of several issues and none are quickly and easily fixed.”

Sniffles makes a good point. The reality is, infinite expectations and finite resources. Our response can only be predicated by our individual circumstances. Tins of Tuna under the bed, or do we wait for the cavalry ? I think Leavitt addressed this already.

I just e-mailed our local health official after attending an avian influenza presentation put on by her department at a rotary club luncheon. Folks, this presentation unnerved me (and that’s hard to do).

Firstly, she disspelled any possibility that the next pandemic will be “light”. Her whole presentation was based on 1918 all over again. Secondly, she said we as the public are not hearing the whole story because of politics (it’s an election season). This is one topic that the seasoned politicians just don’t want to touch. Thirdly, this virus is much more widespread in different animals than I thought (and I thought I’d been keeping up quite well). Apparently, I’d missed the memo on how much it is affecting the seal populations right now. She said it is easily transmitted from seal to seal. She said that marine mammals are really getting hit with it.

Then she made several errors (on purpose?) when answering my questions. I asked her if our county was putting back N-95 masks for our first-line responders. She said there was a three-month delay in getting those right now. I told her she could go down to Home Depot and find them on just about any aisle. She said the department was looking for several different kinds so that they would fit different faces better (maybe, but wouldn’t it be better to have some that don’t fit exactly right in the meantime? Anyway, I e-mailed her department and suggested they could always use nylon from stockings over the head to get the masks to cling to the face better). Then the granddaddy of them all: she said our county is not stockpiling Tamiflu because it has a short shelf life (really, she said this). In the e-mail to our health dept. admin. (since I didn’t want to argue with the presenter), I said that the shelf life of Tamiflu was good for several years past the expiration, according to my doctor and to studies that I’ve read. But this one seems like a cop-out. I think our county doesn’t really have the money to stockpile Tamiflu, hence the excuse. I’m really beginning to see where the first line responders just won’t show up to work. The ones I know aren’t dumb. Maybe part of their pandemic plan will be to replace the smart EMTs with dumb ones.

De Jure:

Lol! By the time this thing hits there won’t be any dumb EMT’s. People on the front line are awake, but they are waiting for some type of organization and guidance. People on the front lines aren’t used to developing the plans, they enact the plans. Everyone is waiting for what I’ve come to think of as “The Great Health Mandate.” I believe this sucker is in the background being worked on, but it won’t dance till after the elections and probably the holidays—you know, the economy thing again. Did you do any more research on the aquatic wildlife? I’m still mourning the shrimp.

Leo7: Actually, I was hoping TomDVM would comment on the marine life infections. Tom, have you heard anything lately about an increase in H5N1 infections among seals and whales? Anything in those trade journal magazines that you get, you know, the ones you place next to the commode?

De jure,

As far as I know, and someone please correct me if I’m wrong, there is no data on H5N1 in seals. If she was definitely saying seal to seal, please email her and ask for the references. That will tell you whether the stuff she was saying was, well, BS.

Influenza Pandemic – Overcoming the 4 stages of Denial

I have found a great deal of success when I have approached the topic differently…. In the past I have given a power point presentation regarding the history of the H5N1 virus, the current status, potential impact etc. Very little or no response, even among co-workers, close friends and family members.

So, I changed my presentation approach. I now start off in the following manner:

I realize that it is difficult for anyone here in this room to want to prepare for something we all hope and pray will never happen. We don’t have a sufficient budget, we don’t have the time, and we don’t want to prepare for something we don’t really believe will happen. However the reality is that we are currently monitoring an influenza pandemic that we need to begin preparations for immediately.

The reasons why we don’t believe that an influenza pandemic will happen are because we are in one of the following 4 stages of denial: 1. We do not believe the credibility of the presenter or we don’t believe the presenters message. (Why haven’t we heard this before from someone else?) 2. We don’t believe that such an event can happen. We have plans for earthquakes, floods, fires, etc. but not for a pandemic. Why not? When was the last time an earthquake happened in this area? 4,000 to 6,000 years ago? When was the last time anyone in this meeting has been in an earthquake? …….. NOW, When was the last time an influenza pandemic hit? 1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide. 1957 influenza pandemic caused about 70,000 U.S. deaths and 1 to 2 million deaths worldwide, 1918 influenza pandemic caused at least 675,000 U.S. deaths and up to 50 million deaths worldwide. 3. Even if it does happen, it won’t affect me? (I don’t raise any chickens, I don’t live in Asia or close to an infected country) 4. I knew it all along, but there’s nothing that I could do to prepare for it. Is there?

I then proceed to answer all of the concerns in the four states of denial and then proceed to warn people that as they leave and tell their co-workers, family members, and friends about this, they will also need to go through these stages before they will realize the priority and begin to prepare.

I am crestfallen, I have had two incounters in the past few days which have ‘rocked me timbers’. I met with a very top doctor at one of the best hospitals in the world, we have known each other for years, and he told me I should be worrying about “real threats, we have so many real and present dangers in the world and BF is NOT one of them.” He was smiling broadly and for him, he was laughing. The other was my local Health Dept. who instilled absolutely no confidence , although I was told not to worry, they had it under control. I was waiting for her to tell me that they would be giving out the vaccine at the local schools…that is how bad it was… OMG, YIKES!!!!

I live in a town with a huge community of grey seals and some harbor seals. I have not heard any reports of their bodies washing up on our beaches. Occasionally, we will have strandings of large numbers of pilot whales and Ripley turtles and very ocassionally a sick seal, but if the seals were dying, I think the news would be all over town. Perhaps they are just carrying the virus?

A while back I think Frenchiegirl mentioned something about anticipating answers from studies on contagion in cetaceans (dolphins and whales).

I’ve been trying for a year now to get our township’s administration to get real with making a pandemic plan.

After the presentation by our county’s BOH the mayor thinks they’re storing warehouses of Cipro and Doxycycline for the bird flu. Nope-those are the meds for a bioterrorism attack with anthrax. I have asked her multiple times for an independent task force to work on panflu planning. results-Nada.

The governing body’s liason to the local Board of Health (BOH) is really the only person on the governing body who ‘gets it’; in our town, no panflu plan could move forward without her. That said, the local board of health is still moving waaay too slow and not really addressing anything but the need for panflu education. A very important need yes, but it has to be done concurrently with all the other planning components. It needed to have been started last year, IMHO.

I am really frustrated. This type of process is so slow that I think if ‘IT’ arrives within the next 5 years we still won’t be ready.

And in our county, we are the only town doing ANY pandemic planning. There are 518,249 (in 2005) people living in our county-and our borders stretch from Philadelphia to 1/2 way to Atlantic City. Population of our county-518,249 in 2005. Size-about 222 square miles.

All these people. And the time bomb of the century is ticking as the bureaucratic process lumbers on. I could just scream.

lugon at 0903

re: “But we have chosen a dual role. We have one foot planted over there, but we also have one foot planted firmly in front of those charged with the public health and welfare of our citizens at our state and local levels. When we plant the other foot in that arena, we have entered another world entirely. This disconnect is severe.”

Exceptionally well said. I can add that at the local level, ain’t much happening where I live.

Do I rock the boat and try to make the process move faster, but at what risk?

Do I shut up and keep doing what the local level has been doing since 1/06? Exceptionally slow, but at least something?

I just did a quick ‘google’ on seal deaths and couldnt find any recent info - in the late 1980s there was a big die off in the Caspian sea - which they attributed to canine distemper virus apparently. http://tinyurl.com/uaptz

p.s. Did e know this already? Wikipedia has a GREAT page on global spread of H5N1 - with graphs and predictions etc - current to Oct 16!! http://tinyurl.com/yy8v7w

e = we lousy typing!!

Grace RN – at 20:55 lugon at 0903 - re: “But we have chosen a dual role. We have one foot planted over there, but we also have one foot planted firmly in front of those charged with the public health and welfare of our citizens at our state and local levels. When we plant the other foot in that arena, we have entered another world entirely. This disconnect is severe.”

It was Pixie who wrote that, Grace RN. Compliments to whom they are due. :)

gharris, Re http://en.wikipedia.org/wiki/Global_spread_of_H5N1 (not a long URL so I don’t use tinyurl - fwiw). It’s interesting to note that they keep countries in alphabetical order - maybe we should add a link to our own “cases” page? My own experience with wikipedia is that they want “facts only”. They don’t wildly speculate. Maybe we need to collect all their resources and link to them? Just go to wikipedia.org and search for “pandemic”, “H5N1”, “influenza” and then grab 5–10 links?

Little Kahuna – at 17:39 Influenza Pandemic – Overcoming the 4 stages of Denial

Please, Little Kahuna, could I have a look at your presentation? If you could send it to lugon at singtomeohmuse dot com I’d be grateful.

Quite a few presentations have been “anonymised” and then uploaded to the ftp site (see also the large files project). This only if you want to, of course.

The reason I ask is because I’m having similar problems at home. It’s a mix of denial and quite possibly difficulty (on my side) explaining a complex issue. Maybe there’s need to have a clear first step and then build on that. Dunno.

Show them the risk matrix.

Most people, especially doctors even health officials, probably do not have any experience thinking about truly catastrophic events. They can not imagine planning for something that is not yet a fact, but would be truly catastrophic. That’s where the comments are coming from — we have actual, real threat we need to plan for and be concerned with.

The idea that you start planning — and actually spending money, implementing plans — for something when the risk is only “moderate” has to be a big step; a paradigm shift if you will.

Average Concerned Mom – at 07:05 Show them the risk matrix.

You mean Forum.ACurrentThreatAssessmentVII BirdGuano – at 13:30 or anon_22 – at 14:45 or both or neither? Not sure how to use them myself. Will take a deeper look. Need to turn that into a conversation.

Thanks!

What it comes down to is what we in Europe would call ‘the precautionary principle’. That there are times when action needs to be taken despite insufficient evidence, cos the consequences are so catastrophic and so pervasive that by the time you’ve got the evidence, it will be too late.

The key is to give them numbers, not lots of them, but enough to make them sit up. Like the one that I gave about 2 decades of deaths in one season.

lugon — thanks for the link, yes I meant the matrix Bird Guano put up.

I expect local health officials like everywhere else have very little money, a lot on their plates; and run around putting out health emergencies as opposed to spending time and money on “preventative care” so to speak. Our whole American culture of health care right now focuses on the immediate, only; we are so stretched thin, we can only spend time on treating symptoms not addressing underlying issues.

Just the idea that you should take the time to think about something that isn’t actually happening yet, must be a huge paradigm shift.

The idea of taking action despite having insufficient evidence — has to be even more of a paradigm shift.

Someone somewhere needs something official, some document — not sure if the “Federal Security Risk Management” matrix is that official document, but surely there must be others out there — to give public health officials some of the impetus to make that paradigm shift. “It is OK and even NECESSARY to spend time energy and money on something that we aren’t sure will happen.” At the very least it provides a way to talk about things with the people they work for.

And how long to think about it, and who with, and (gasp!) a deadline. I mean, this is too open!

“every state DOH has its corresponding legislative oversight committee”

Shall we just start phoning them and asking

when the public is going to be told to prepare for the disruptions on the federal website they haven’t been told exists or been shown the checklists of yet, or

why we have no

Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens that was the first task on the federal checklist for state and local planning?

ACM @ 0908

re: “I expect local health officials like everywhere else have very little money, a lot on their plates; and run around putting out health emergencies as opposed to spending time and money on “preventative care” so to speak.”

In many towns the local BOH is ‘window dressing’ so to speak, especially smaller towns. Out local BOH plans a heart walk and a local health fair and that’s about it for a year.The liason to the BOH (oversees the committee and is a member of the town’s governing body) has no real prior health experience other than what she learned on the job over the years. It has the potential to be very politically motivated; and our BOH has a microscopic budget. Our local BOH has relied on the county BOH-where there are educated epidemiologists, people with degrees in public health- to do all the heavy hitting work.

Yet it’s the local BOH that is really left with pandemic planning as no county will do each township’s planning for them.

Hence, the lack of impetus for a local BOH to do what no one on the board is really educated to do. And yet, it must be done.

One of things I have learned in a number of years of dealing with bureaucracies is that you are almost always better off not making any enemies if you can possibly avoid it. If you offer to “assist them in meeting their obligations under the Federal guidelines for pandemic preparation” even to the point of handing them a draft plan with some blanks to be filled in, that would probably go a lot farther.

Grace RN, Lugon and all, just a quick thank you for continually working on this and staying tuned in. I am in lala land with grandchildren who don’t even know about the bogeyman yet, much less this monster. Here’s to your clear heads and grand efforts.

(LMWatBullRun – at 16:19 DOH! I’m too soon old and too late smart…) Offer to assist the public (including essential workers) in getting looking at the Flu Wiki and preparing and thinking about making community contingency plans is about as far as I get lately. We’ll see…

Enjoy your grandchildren, Lorelle. :-) We’re trying to make sure as many people as possible get old and get to enjoy grandchildren. Grandchildren sound like one of the best parts of life…

http://www.naccho.org/topics/infectious/influenza/LHDPanFluGuide.cfm

NACCHO’s Local Health Department Guide to Pandemic Influenza Planning

Click here to download the guide

Intended for use by local health departments (LHDs) as part of a multi-sector effort to coordinate planning for and response to a pandemic influenza outbreak, this 60-page guide offers the following:

An overview of key issues that should be considered for inclusion in a local jurisdiction’s pandemic influenza plan. An examination within each issue area of questions that should be asked, ideas on where to find information that may be needed, and partners that could be consulted to address those topics within the plan. Examples of ways in which other jurisdictions have addressed the topics described in the guide. Links to information that can be used to further investigate the topics or resources that can be used to customize tools for individual jurisdictions. At the core of this guide are plans developed by departments that host two of NACCHO’s Advanced Practice Centers, cutting-edge learning laboratories that develop and test tools that help other LHDs tackle all-hazards preparedness. Santa Clara County, California and Seattle-King County, Washington, have both produced notably comprehensive, but very different, plans addressing pandemic influenza that serve as the foundation of this document’s findings.

Grace RN

Probably a really uninformed question — but — what is the purpose of a local BOH, exactly? Where I live we only have a County Dept. of Health as far as I know — our small incorportaed towns (mine has about 6,000 inhabitants) have a mayor and our own small police dept., but no health officer. Not that I’m at all thrilled with our County Health Department.

But I am having a hard time imagining what the responsibilities would be of someone at a lower level — sounds like not that much? (Not meaning to be critical or condescending — just that if thay have no budget, the expectation must be, their job isn’t all that vital?)

ACM-

In West Virginia, one of the key things that they do is issue septic system permits and do septic inspections. Commonly they also license restaurants, bars, funeral parlors ( an historic source of ‘extra income’ for the health official) and in Nevada I believe that they also used to license and oversee brothels. Duties vary considerably from state to state; usually in most states there is enabling state legislation that takes precedence over city regs, but NYC and Boston among others had health officials that predate the US Constitution, I believe. You might just call the county and ask them what the duties are….

Average Concerned Mom – at 20:15

re: “…what is the purpose of a local BOH, exactly?… Where I live we only have a County Dept. of Health as far as I know ..But I am having a hard time imagining what the responsibilities would be of someone at a lower level..if thay have no budget, the expectation must be, their job isn’t all that vital?”

I think it varies town to town state to state. Our township of 36,000 people has an approx 9 member volunteer no-enforcement duties BOH. We have absolutely no enforcement powers so even if we crafted the best pandemic plan on the planet we have no way of making anyone actually comply. It would be more like a suggestion that they do something. Some towns in our county have no local BOH.

Yet if you look at the Federal pandemic planning form, it outlines what LOCAL people should be doing; these local committees may have little to no experience with any healthcare issues.

And look at this email I received from someone at my township-I had asked for a list of businesses so we can do a mailing advising them of the need to plan for a pandemic. How’s this for bureaucratic ****

re: business listings for mailings..”Make sure this is approved by the Board of Health prior to mailing, and also keep in mind that the cost for postage, and copies when discussing this with the BOH members. They should be made aware of spending/costs.”

I’d rather pay for it myself than have to wait around.

Imagine trying to do just this one little tiny component of planning and have to get a vote for each little step. Sure, we might get done in 10 years, considering we meet on a monthly basis- and that’s an accelerated scheduled as the BOH used to meet just 4 times a year.

And consider we’re the only township out of 37 in our county that doing anything at all. For 36,000 people out of over 500,000 in the county.

This is the face of real planning at the local level.

I do believe that if you are a public official and don’t rock the boat than you should go a shore and let someone stronger ride the waves while you support them on the sidelines. It is no excuse when nothing gets done because only so many meetings are held per month. Shouldn’t it be in the emergency planning to have as many meetings as it takes to get the job done? Go to your township meetings and get on the floor under new business, go ahead and offer to head the commitee. Keep the ball in your court, go armed with you [are the comitee] to the local Health dept, to the emergency planning, to all of the Home Health organizations and the Red Cross. You who have all of us are never alone.You are a commitee {like the army] of one.

Maid in Michigan@21:21 I agree starting too far up the ladder will do no good, the local level is where we have much more influence. The locals are you nieghbors who will be prepared or knocking on your door because you are.

Local health dept. have had there budgets cut for years they are asked to do more and more with less and less. Some of these officials are just trying to cope with problems in the here and now they dont have the time to devote to what may or may not happen. Frankly most of th local HD are overwhelmed with what they already have to do just to keep the boat upright daily. We are asking them to devote precious resources and time to something that isnt here.

Maid in Michigan – at 21:21

“Shouldn’t it be in the emergency planning to have as many meetings as it takes to get the job done”

I don’t have the authority to call a meeting; I am a subordinate on thiscommittee along for the ride along a road someone else picks out.

I did go many times last year to public township meetings and speak out. Multiple times I strongly urged the formation of an indepednent task force. Result-it was given to the local BOH to do and I was picked to work on the local BOH.

I get the feeling they’re looking for a potential ‘scape-goat’. All I can think to do now is every month work on one portion of the pandemic plan then eventually hand it all back to the mayor and governing body and say here’s our padnemic plan now you enforce it.

I am working on personally educated as many as I can within my immediate neighborhood.

Little Kahuna – at 17:39 -that sounds very good!

Grace RN, I’m about thinking we’ll have to make person-to-person, internet, church, chamber of commerce, flashmob, anything- kind of announcements saying, we’ve been in a pandemic alert period the past year, time for preparation is running out, we were supposed to be having a real Pandemic Preparedness Coordinating Committee as defined in the pandemicflu.gove state/local checklist. Let’s just start talking together as unofficial groups, and use the Flu Wiki resources rather than reinvent the wheel from scratch. People can’t get in trouble from their jobs for freely associating as private citizens right, even if some may be police, fire, EMTS, work in offices, schools, ect?

My city is planning to close its Health Department and turn over its duties to the 2 local hospitals and the county health department, to save money. They think the hospitals should have to earn their tax exemptions by doing more for the poor. Also some towns in Cook County don’t have a health department, so why should we? This seems like a really poor idea now, just when we need a robust system.

I think the public should hear “they are going to be on their own during an influenza pandemic”.

It is not here yet, but no one who has a clue says it looks to go away.

Especially since pandemic preparedness planning looked to be too big a job for local health depts a year ago; they should have admitted so to the public, rather than “hope it doesn’t happen”, or now, insist it’s’ll be so bad if it happens, there’s nothing the public could do now but panic anyway, so, don’t tell.

article on WHO Report …”A group of eminent influenza scientists gathered by the WHO last month concluded there is no reason to believe that the virus, which kills roughly 60 per cent of people who become infected, would become any milder if it evolves to become a pandemic strain.

The report, based on that meeting, cautions governments against spending a lot of money to stockpile existing H5N1 vaccines.”…

Where are our journalists? Or how about journalism students, who don’t have jobs to lose yet?? Why aren’t members of the press asking about local pandemic preparedness after all those summits said it is a local responsibility?

“Sow the wind, reap the whirlwind.”

“those who do not study History are doomed to repeat it.”

I am reminded of Barry’s description of what happened in Philadelphia. It would be much better if the Citizen’s Health Committee started public meetings NOW instead of after the pandemic had started…. I should think the local Elk’s lodge or Masonic hall would donate some meeting space…..

GraceRN, Maybe I missed it above,…. but who is leading this 9 member local Board of Health? And if there is a County Health Department, why are they not taking the lead? This has to be at the least, a County effort. The County receives money from the State, from the CDC, and I don’t know who all else is donating, but evidently there are many.

I would check your State plan. It may have desinated who is suppose to lead in the development of a pandemic response and plan. Just a thought…….

We have a really good public health official — she’s doing what she can — but her staff still have HIV, obesity/diabetes, restaurant inspections, pregnancy nutrition help, food cards, and all the rest to do. There weren’t enough hours in the day BEFORE H5N1 rolled along.

I truly believe the way to go is grassroots. Start with the already identified do-gooders: fire departments, Brownie troops, church Bible study groups and the like (include what one wag calls the “animal” groups: Elks & Lions). Don’t forget VFW, Masons, the local union hall — all of these groups already see the validity of educating the public on a wide variety of issues. Get the blessings of any one of these, and you are no longer an individual nut case. “Will your church please distribute this flyer from the fire department to your members?” “St. Tabitha’s is distributing this flyer to its members, could you at First Church of the xxx do the same?” and so on. Your local public health official will bless you — just stick with the facts (they are scary enough) — and, truthfully, all the preps/awareness for H5N1 makes one better prepared for earthquakes, storms, bio terrorism attack or whatever else.

The point I’m makin is DON’T ask someone else to do it. You will just make yourself one more nutcase with an agenda screaming invective at the public meeting of the whatever board (and they get 2 to 3 agenda driven folks every month) — start the ball rolling yourself.

Let’s keep “fighting the long defeat”.

Ask local officials what they think the public’s pandemic reaction is going to be when they find out how long ago the WHO, HHS, Dr.Webster, Dr. Nabarro, Dr.Osterholm, and others, warned about the impacts.

It’s in the records; the testimony to Congress, the CBO report, when their state’s pandemic “summit” was, (reports from experts in the field warning current mass fatality preparations are inadequate),

and when hungry and grieving people find out they had had advance warning and time to prepare (over a year has gone by already) and make local contingency plans, but the local officials knew, and chose not to tell the public in a way that was transparent and honest, what do these local officials imagining happening next?

Lorelle – at 16:34

Grace RN, Lugon and all, just a quick thank you for continually working on this and staying tuned in.

Thank you- and keep up the good work at your end!

LMWatBullRun – at 16:19

re:”If you offer to “assist them in meeting their obligations under the Federal guidelines for pandemic preparation” ..

That’s an excellent suggestion andI thank you for the concept. I will present it at the next meeting 11/13/06.

By chance do you live in Winslow Township Camden County NJ? If so, sure could use your help…

Olymom – at 23:31

“Will your church please distribute this flyer from the fire department to your members?” “St. Tabitha’s is distributing this flyer to its members, could you at First Church of the xxx do the same?” and so on. Your local public health official will bless you — just stick with the facts (they are scary enough) — and, truthfully, all the preps/awareness for H5N1 makes one better prepared for earthquakes, storms, bio terrorism attack or whatever else.

Excellent idea, Olymom, and this is the direction I think we need to move in too.

Can we here prepare a pandemic preparation & informational brochure that we can all print out, very similar to the terrific “Pandemic Flu Awareness Week” brochure?

That would be incredibly helpful.

It would take only a few tweaks to the “Awareness” brochure, and I for one would love to see the title changed from “Awareness” to “Preparation” now. The media will be used by TPTB to create general awareness once all the info fed to them in all these current meetings and community summits is digested. People will then be looking for practical information about what to do. Some may even be looking for that information now. I think that if we deposited brochures at churches, etc., as Olymom suggests, that they would be picked up by many people and reprints would be needed forthwith.

People out there want this information, they just are not getting it and are lost as to where to find it. Can the Fluwiki mind work together on creating these brochures then distribute them, as was done so successfully for the “Pandemic Flu Awareness Week” (which went so quickly!), and make it easier for them?

No one wants to hear me. They walk away. I post things on the walls around my desk. I just get a weird reputation. I use the best sources I can, journal articles, WHO press releases etc. I really think it is going to take an official government statement. Otherwise, I’m just some wacko.

We experience so much vivid fantasy in our lives via the media, especially television, that most people have a hard time getting a true grip on reality.

We in the West live in a “pretend” world with “pretend” intensions augmented by committee directives that implement nominal preparations.

“Going through the motions” will get you killed/defeated in War or Pestilence.

We need some obsessive compulsive REALISTS to grab this bull by the horns before it fatally gores us.

Let’s ask HHS Sec. Leavitt to request the media use his Minnesota pandemic flu summit

Any state, any community, or for that matter any citizen that failed to prepare - assuming that the federal government could take care of them during a pandemic - would be tragically wrong quote as a PSA, once a day…

http://directory.psc.gov/os/52.html

In my western state there are small county public health offices that operate under the jurisdiction of the state DOH and local county government. I am the manager (RN) of one of these PH agencies. I have two offices in my county that are 100 miles apart. I drive back and forth between them every two weeks to support my total staff of 5 nurses, two secretaries, and two PH Response Coordinators. We have a County Health Officer in one town and a deputy CHO at the other end of the county. Both are young family practice physicians who work fulltime for the two local 16 bed hospitals. My county covers 6,000 square miles and has a population of 16,000 in nine small towns. My PH offices offer 34 PH programs that include among others: Maternal Child Health programs, communicable disease prevention and follow-up, substance abuse, STD and HIV/Aids testing and counseling, chronic disease education and support groups, child and adult Immunizations, physical assessments for long term care placement, case management, environmental issues and of course health emergency planning and response. We participate with several human resource councils, conduct community health education, draw blood for local health fairs, and work with our Department of Family Services and law enforcement on child protection teams. Since the attacks of 9/11 we have been considered part of the first responder community. That’s not totally alien as in small towns many of us wear many hats. Some of us have been volunteer firefighters, EMT’s, ER nurses, etc. In the past few years we’ve been asked to prepare for terrorist attacks, CBRNE, and other natural disasters. We started addressing pandemic flu well over a year ago. As you can see, there’s not much the ten of us would be able to do during a pandemic to directly help the public. We have plans for what actions we will take as the event unfolds. (We’ve been told that we 10 must figure out a way to vaccinate our 16,000 residents in 48 hours and I bet we will.) But we came to the conclusion long ago that the best way to prepare the county was to encourage everyone to become as well prepared to be self sufficient as possible. Because we live in a frontier type setting, most of our folks are familiar with the concept. So we’ve been trying to educate the public about the threat for several months. We’ve been recommending that everyone prepare to be able to self quarantine for several weeks (months if you can afford it). We’ve been stressing the importance of handwashing, good respiratory hygiene, staying home if sick, etc. to minimize exposure. We are designing a home study course to teach home care of the sick in a disaster. We’ve put articles in our local papers for several months and are sending out an insert with prepping tips in the papers this month. The managers of our two grocery stores are supportive of our efforts and are stocking case lots. We’ve taken presentations to over 1000 people by way of civic organizations, local government agencies, churchs, clubs, etc. And we’ve organized local Community Pandemic Flu Planning Committees made up of reps from local government, utilities, law enforcement, emergency management, health care providers, schools, and others. Our hospitals are aware of the threat and are working with us. With limited resources and staff they do the best they can. The plans we make are not too complex. We’ll focus on NPI for the most part following the examples of the small towns that survived the 1918 pandemic.

It’s a challenge to present the threat in a clear, balanced way. We were once asked to prepare for smallpox, or some other bioterrorist attack and since those have not yet happened, it’s important that we share our message in such a way that we do not lose credibility. I always tell people any preparations we make for a pandemic won’t be wasted. It’s a good idea to be prepared for any out of the ordinary event be it a disaster or just loss of a job. It’s not important what people may think of the messenger - it’s important that I do my job. And that’s looking out for the welfare of the people of my county. I don’t know how many will follow our advice - but hopefully many will and we can say we did the best we could.

I would advise checking with your local PH office - offer to help. I’d be delighted to give you a job to do!! If not enough is being done - perhaps your concern will prompt more action. Do bear in mind though that our PH infrastructure has been stretched to the limit for years, many of us walk around in a daze as we are asked to do more and more as budgets are being cut. We do recieve some funds from the CDC but as those funds filter down to the counties they shrink considerably.(We got $8,000 this year for pandemic flu planning.)

I read fluwiki everyday and get great ideas and information. I have no doubt I’ll learn about the start of a pandemic here before any another source! Keep up the good work you’re doing to prepare and thanks so much for all you share.

Good for you! Frontier RN, I wish you could get the pandemic chair and talk to my fellow citizens; you’d give them credit for being adults and handling the truth and send them to go become more self-reliant for a pandemic year.

This turned out to be an interesting thread. I admire everyone putting their a—on the line for education, but I see no way out. Two weeks ago the doctor who heads up the BOH in my county was asked by a newsreporter about the clinics set up in food stores like WalMart. She thought she was going to get a positive response. But what he said, was “What idiot dreamed that up?” He went on to say he e-mailed the State person over him to ask who was in charge of the public health threat these clinics in foodstores created?

Answer, Public Health wasn’t consulted when the idiot or whoever dreamed up health clinics in food stores. This is the the problem in public health, they’ve lost their clout, and they’re not even consulted. He wrote the companies putting in the clinics and asked them to set them up in a seperate building outside of where the food is located, but he didn’t get responses.

My county is the second largest in the state and the Dr. of the local board of health wasn’t consulted. This is clearly the reason you aren’t reaching the base. There are too many fingers in the pie and most of them don’t have a basic concept of public health or public health regulations. I was glad to hear the Medical Director of our BOH stood up and said this clinic in foodstores was a public health threat. I for one stated on the wicki weeks ago I wouldn’t buy food at a place that combined the two, too me, as a HCW, this is plainly stupid, and I don’t understand why this is being done.

Bottom line when people who are aware and give opinions on this wicki, and then go to these clinics in food stores as several confessed they did, there is more than a public health disconnect. The concept of Public Health is basically gone with the wind. In other words, your message was doomed before you even got started unless you intend to first start a local revolution in the importance of public health.

Right now, the majority of people think their local Board of Health is where all the poor people go for vaccines or where you have to go to get a license to work in a restaurant. That needs to change.

Goju and crfullmoon: I am located in the corridor that you speak of. I am running into a brick wall!

This is what I have done and it seems to be making some headway. I created a town specific forum. It is located at Monson Plans (I am not sure that I formatted that link correctly)

Even with all this there is still resistance. We do seem to have some movement.

As far as budgeting for town preps. We have been told by TPTB that local governments are “on their own”. People within those towns need to be told that they are on their own too.

There is no way that a city or town can provide food, water and medicine for all of its citizens. A community effort to stock the food pantries is about the only way that this can be achieved. The kindness of strangers cannot be dismissed. Just my opinion.

(2beans: I owe you an apology, I think that I formatted your profile…)