This forum/conference was supported by the Association of State and Territorial Health Officials (ASTHO) & The Keystone Center.
Presenters:
Roger H Bernier, PhD, MPH, Senior Advisor for Scientific Strategy and Innovation, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC)
Jeff Duchin, M.D. Chief, Communicable Disease Control, Epidemiology & Immunization Section Public Health – Seattle & King County
I must state that I am paraphrasing everything that was said. There is no way I can write this down exactly word for word. If I have made a mistake somewhere, I apologize. I think I have recorded this pretty accurately.
Roger Bernier started the session by laying the groundwork of what we would be discussing and deciding today. He stated that we would:
1. learn facts about influenza viruses
2. discuss 5 different control measures that could be implemented for a pandemic flu
3. discuss the pros and cons of the consequences of each of these control measures
4. decide whether those control measures should be implemented
5. discuss what we could do to decrease the consequences and increase compliance with each of the control measures
All in all, he said we would be deciding if the pain of the control measures would be worth the gain.
Then Dr Duchin went through a slide series describing what influenza is, how it spreads, symptoms, seasonal versus pandemic flu, the impact of a pandemic, and ways to decrease spread. H5N1 was discussed. He stated that basically it was a flu in birds mostly at this point, and not many humans. The CFR was stated as 60%, but then he stated that it would come way down if efficient human to human spread occurs. He emphasized that it was not a pandemic at this time. Mild pandemics were discussed (1957, 1968). A severe pandemic today was described in the 1918 terms of :
90 million ill, 10 million hospitalizations (nearly), 2 million dead (nearly)
The topic of what is needed to limit the spread of a pandemic. The whole idea is to reduce contact between infected and uninfected people. Necessary points are:
1. Must act early before disease becomes widespread.
2. No single measure will be foolproof. Multiple measures must be used at the same time to maximize benefit (staying home for 7 days if you are infected, wearing masks, etc).
3. Ideally, communities implement control measures together.
Then there was a Q & A session for Dr Duchin:
Q. You discussed staying at home for 7 days with influenza. You can infect others for a longer period of time, so why did you state 7 days?
Basically that this was just used for discussion purposes, and you could certainly make a case for a longer period of time.
Q. There was a NYT article discussing the use of surgical masks.
This article has not been reviewed, but surgical masks could certainly be a help.
Q. When will there be a vaccine available?
It will take 6 – 9 months for the first doses of a vaccine to be ready.
Q. How will a test be done to see if a person has the seasonal flu or H5N1? Is there a test?
There are specific teats that can be done. The results can be known in a few hours.
Q. Is there Tamiflu available for the residents of Seattle, and how much?
There is a stockpile of Tamiflu that will cover 25% of the residents of Seattle (at one course per person = 10 pills).
Q. JV stated that the CFR for 2006 is 67% right now for H5N1. WHO met in September in Geneva and made the statement that there is no scientific reason why the CFR has to decrease if it starts to spread H2H and develop into a pandemic. The CFR might decrease, but there is no scientific reason why it has to decrease.
Dr Duchin agreed with my statement. He indicated that we all hope the CFR decreases.
Q. In reference to the priority for the vaccine, is it possibility that the priorities will change at all over time?
The priorities might change. It just depends on how the virus acts, and who is more at risk.
Q. Will it be difficult to diagnose the difference between seasonal and pandemic flu?
If it starts elsewhere, we will all be vigilant and be watching, monitoring, and testing for it. If the first case starts right here, it will be a bit harder to diagnose at first, and then the decision as to when or how fast to implement control measures will be quite important.
Q. For many people, it has been difficult to figure out how to stockpile any prescription meds in case those people will be strictly staying at home, and can’t get out to get them. What is being done about that?
Insurance providers are presently discussing allowing stockpiling of at least a months extra of meds (maybe more than one month…the decision has not been made).
Q. Will boarders be closed?
You can’t even identify people who can spread the flu virus but are asymtomatic. So, you can’t stop them. If 99% of all the traffic across boarders is stopped, it would only stop the flu from arriving by one month. There will always be traffic across boarders. We can’t stop that. Therefore, there is no decision to close boarders at this point.
Q. What will happen if we have a pandemic like 1918, and people need extra food and necessities?
That is a good question, and we will be trying to decide some of that today.
Roger Bernier then discussed a handout we received. This was the scenario (not real present-day facts) we all worked with today to make decisions as to what control measures should be used. This is the hypothetical scenario:
Scenario for Public Engagement On Community Control Measures Against Pandemic Influenza At Home, School, Work, & Play
The World health Organization has confirmed ongoing human-to-human transfer of a dangerous influenza virus in several countries and has determined that an influenza pandemic is underway.
Impact of Disease: The Centers for Disease Control and Prevention has advised that the pandemic influenza virus is likely to reach one or more of the contiguous 48 states within 30 days and is expected to be affecting communities across the country within several weeks. Community outbreaks will last 6–8 weeks and about 30% of the community will develop illness. The pandemic is being judged as a severe one and may come up to two million deaths and ten million hospitalizations in the US. A second pandemic wave will occur three months after the first wave.
Vaccine, Drugs, and other Materials: The Department of Health and Human Services is funding the development of a vaccine against the pandemic influenza virus and intends to acquire enough for all US citizens. However, the first lots of this vaccine are not expected to be available for 4–6 months. Antiviral drugs will be in short supply and will likely be kept for treatment of ill persons and certain front line emergency workers. Face masks may be recommended for some situations, but supply is uncertain and should not be counted on for general use.
Control Measures: Communities are advised to consider various strategies (also called community control, community containment and social distancing measures) that might help slow the spread of the influenza pandemic since at this time we cannot rely on other measures for this purpose. Experts are not certain how effective these control measures would be, but it is possible that used early, and in combination, they could significantly reduce and/or delay the number of cases. The five-part community control measures being proposed for implementation are:
1. Encouraging people sick with influenza to voluntarily atsy at home until well, at least for a week (self-isolation)
2. Encouraging the non-ill household contacts of people with influenza to also voluntarily stay at home (self-quarantine) for at least 7 days
3. Canceling large public gatherings
4. Closing schools and day care facilities for up to 12 weeks or for the duration of the local epidemic, and keeping young children and teenagers from gathering in large groups elsewhere
5. Encouraging people to voluntarily work from home or take leave
Impact of Control Measures: The consequences of implementing this five part package of control measures are expected to be substantial, including loss of wages or income from business, disruption of services at hospitals, banks, stores and other facilities, loss of work for parents and guardians of school age children, and restraints on people’s freedom of movement and freedom to gather. These types of effects, or more severe ones, might be seen eventually even if the control measures are not implemented.
Decision: Leaders must weigh the benefits as well as the negative consequences of implementing the control measures before deciding whether or not to implement 1) all, 2) some, or 3) none of the proposed control measures. What option should they choose? If the choice is to implement one or more of the control measures, what problems must be addressed or lessened to assure successful implementation? When is best to implement control measures?
Roger Bernier then took a question:
Q. How well did social distancing do in 1918?
If you look at St. Louis, there was aggressive social distancing. This did lower the curve for infections. But, this and other situations are anecdotal.
At this point a break was begun. I went straight to Dr Bernier and asked him why he didn’t discuss modeling and how significant different measures (like TLC) could definitely decrease the attack rate. He indicated that for this situation where they are trying to get the general public to evaluate different measures to be implemented, they did not want to go into the technical details of modeling. He felt that was too much to discuss…too much technical info to explain to the general public.
Dr Bernier stated that they are waiting for the IMO to make a statement as to what measures actually work. I indicated that I had read all the info on all the slides from the IOM conference. I told him that I felt there were certain points agreed upon like school closures which made the most significant effect, especially if done quite early. He indicated that the IMO would come out with statements/recommendation in the near future, and they would wait for that info. Also, with the IMO recommendations, and the information from these forums, there would be new recommendations made by the government in early 1/2007.
For the discussion today, people were only supposed to rely on the statement “Experts are not certain how effective these control measures would be, but it is possible that used early, and in combination, they could significantly reduce and/or delay the number of cases.”
Then I went to Dr Duchin and asked about what was being done re helping people to possibly stockpile for 8 weeks (grocery store planning or informing people re the need to prep). He indicated they did not feel the need to urge people to stockpile for 8 weeks. He indicated that they are not suggesting that people stop working (in general). He stated that people would need to go to work, although some can choose to stay home, and that is OK.
We then took a break and went into small group discussions.
I will post more in a little bit. I have a LOT to post. This was a good conference in the end. A lot of good discussion to come! I got all my points out I wanted to make!
We then all broke into small group discussions. Each table had about 8 people plus a facilitator. We were to discuss each of the 5 community control measures, and decide what challenges there would be for the general public for each measure.
The following is a listing of items we all came up with in my group for each of these categories:
1. Challenges for: Encouraging people sick with influenza to voluntarily stay at home until well, at least for a week (self-isolation)
Done
2. Challenges for: Encouraging the non-ill household contacts of people with influenza to also voluntarily stay at home (self-quarantine) for at least 7 days
3. Challenges for: Canceling large public gatherings (most in my group felt this would be the easiest measure to do)
4. Challenges for: Closing schools and day care facilities for up to 12 weeks or for the duration of the local epidemic, and keeping young children and teenagers from gathering in large groups elsewhere. (I did make the comment early on that children are very infectious, 1.5 times more than adults. Therefore, in closing schools there would be a large decrease in the spread of the virus. There is a large density/closeness of kids on buses and in schools, and they share the bathrooms at school and are not careful with hand washing etc. Then they can also come home and infect others)
5. Challenges for: Encouraging people to voluntarily work from home or take leave
Then we were asked (in small groups) to go over all of the above 5 measures and discuss problems with compliance with each measure. This is a listing for my group:
1. Compliance problems for: Encouraging people sick with influenza to voluntarily stay at home until well, at least for a week (self-isolation)
2. Compliance problems for: Encouraging the non-ill household contacts of people with influenza to also voluntarily stay at home (self-quarantine) for at least 7 days
3. Compliance problems for: Canceling large public gatherings
4. Compliance problems for: Closing schools and day care facilities for up to 12 weeks or for the duration of the local epidemic, and keeping young children and teenagers from gathering in large groups elsewhere
5. Compliance problems for: Encouraging people to voluntarily work from home or take leave
I will post more in a moment
In small groups, again, we were asked to discuss and list different measures that could build trust on a state level. Here is my small group list:
Then we were to evaluate how many of the measures (1–5) we would want instituted (felt should be instituted) if a pandemic was announced in different places. Not which ones, but how many of them. There were 7 people in my group at this time.
1. A pandemic has been announced elsewhere in the world (like Indonesia)
All group members agreed that none of these measures should be instituted, but education for compliance should be ongoing.
2. A pandemic has been announced in the US, but far away (New York)
1. 2
2. 1
3. 1
4. 3
5. 0
3. A pandemic has been announced in Washington State, but far away (Spokane)
1. 2
2. 0
3. 0
4. 1
5. 4
4. A pandemic has been announced in your community (Seattle)
1. 0
2. 0
3. 0
4. 0
5. 7
5. Others have become ill from the pandemic in your community (Seattle)
Answers same as above (all 5 measures)
Considering how much difficulty people in my group felt that others would have with staying home sick and school closures, etc, I was very surprised that as soon as the pandemic was identified in Seattle (meaning even one person was ill in Seattle), everyone in my group voted for all 5 measures to be instituted (if not already). This surprised me, but it is GREAT!
Under:
“2. A pandemic has been announced in the US, but far away (New York),” the next line should read:
# of measures (out of 5) that should be instituted, voted on by people in my group
A number of comments/statements were then taken from the entire group of 90–100 people attending:
1. The government needs to tell people the truth. We need leadership. We all need to be on the same page. Then people will be more willing to comply.
2. There is going to be a huge problem with implementing these measures if 99% compliance is necessary for them to work.
Dr Duchin answered this by saying that 99% compliance is not necessary. These measures will work, especially if a number are used together, and a lower compliance rate will still work.
3. I WILL CHOOSE WHEN TO GIVE UP MY CIVIL RIGHTS. NOBODY ELSE WILL DO THAT FOR ME. (This was said in a very forceful manner) Also, businesses have to work out plans to help employees.
4. The government must either help its citizens or the economy. The government must make a decision.
JV then made the following statements (5–8):
5. When discussing all of these measures to be implemented, what we should all keep in mind is the children. This is a deadly pandemic we are discussing. The worst psychological trauma a parent can ever endure is the loss of a child. These measures we are talking about will help save our children.
6. If you look at the number of deaths from all causes for ages 0–24 during one year, and then compare that to the number of deaths that would occur if there was a pandemic like 1918, the deaths in the pandemic would equal 20 times the number of deaths from all causes for those aged 0–24. The pandemic deaths would equal two decades accumulations of deaths from all causes (for ages 0–24).
7. So far, for H5N1, 80% of all of the deaths have been age 30 or under. 50% of all of the deaths have been age 20 or below.
8. Children are the most infectious, 1.5 times more than adults. There will be a high rate of infections in schools, and then they will bring those infections home. This is why very early school closure is the most effective measure to implement.
All 90–100 of us then participated in electronic voting. We all simultaneously used small “clickers” to answer the following questions:
Given the consequences of the measures 1–5 that we have discussed, which would you support?
1. Encouraging people sick with influenza to voluntarily stay at home until well, at least for a week (self-isolation)
Yes--−96%
2. Encouraging the non-ill household contacts of people with influenza to also voluntarily stay at home (self-quarantine) for at least 7 days
Yes--−77%
3. Canceling large (no magic number given for large) public gatherings
Yes--−79%
4. Closing schools (K-12) and day care facilities for up to 12 weeks or for the duration of the local epidemic, and keeping young children and teenagers from gathering in large groups elsewhere
Yes--−78%
5. Encouraging people to voluntarily work from home or take leave
Yes--−93%
Comment: Here, I was surprised that the answer to # 4 re school closures was not higher. Possibly if the group was given more info on this subject, the number would have been higher. However, in my small group, many felt that closing the schools would create lots of problems for parents having to stay home.
Next we electronically answered more questions:
If a pandemic had started in another country (not in the US), and would be in the US in 30 days, what control measures (the above 5) would you support implementing now? You can only pick one of the three choices below.
1. All control measures
Yes--−30%
2. Some control measures
Yes--−61%
3. No control measures
Yes--−9%
At what point do you support beginning to implement control measures? You can only answer yes to one of the below. (This adds up to 101%, so I don’t know what happened with that)
1. No time
2%
2. Pandemic has started in another country
25%
3. Pandemic has started somewhere is the US
45%
4. Pandemic is in your community
27%
5. Only after someone has become ill in your community
2%
Absolutely Fantastic report.
The best news is that most understand and want to act early to slow the spread.
This was the last session of the day. We were all again given a chance to make comments that could help those planning control measures to figure out how to approach the subject and work towards compliance.
1. JV stated: Pandemic education must be started early so that people can prep/stockpile and network. These things can’t be done in three days. It takes time to figure out what to do and buy. It takes time to talk with others in your community and come up with good ideas. That cannot be done in three days. Weeks or even much longer are needed to sort all this out.
2. JV stated: In reference to the control measures discussed, the government must get those ideas out ASAP. People need to mull over those concepts. They need to think about them and the consequences. Networking can be done to figure out how to cope with these measures. But this takes time. Many questions need to be asked an answered.
3. JV stated: Trust will only come after honest complete information is explained by the government.
4. If there is white washing, and everything is just done for the economy, that won’t work!
5. We need the feeling we have individual rights.
6. We need the government to tell us the truth. None of that will go to waste. Prepping is win/win.
7. Trust comes from candor. We can accept some ambiguity. If the answer is, “We don’t know right now,” we can accept that if that is the truth.
8. The government needs to help with resources.
9. Protecting the public from panic is hooey! Tell us the truth!
10. The scientific community needs to change to tell us what they know. Don’t hide the truth.
11. Explain how and why decisions are made. Be transparent.
12. JV stated: We have all talked about needing multiple forms of media for education. One thing we absolutely need is the MSM covering this news. My husband and my friends are not stupid. Yet, when I try to explain that a pandemic could happen, they don’t believe me. They say, “It’s just in the birds! If there really was a problem, it would be in the MSM. There is basically nothing worrisome in the MSM.” Someone in authority need to get on primetime news, get people’s attention, and explain in understandable terms about what we are facing and what we should do. This is where the average person expects to find serious news items. Everybody is not going to the CDC web site! This is a study in psychology as to how to do this.
13. People should be informed about the 1918 flu. What happened then, and what could happen now.
14. Different community leaders will understand how to connect with their communities. They should do the education.
15. We need irritating commercials like the one for “Head On.” Then people would remember what was said.
16. Maybe The Great Influenza should be required reading in school.
17. We need to get to different group (ages, races, low income, etc) in different manners.
18. Schools could distribute handouts explaining a pandemic and possible school closures.
19. Maybe some of the comedians like Leno and Letterman could discuss the pandemic. That would get people’s attention.
20. Maybe a DVD could be made discussing the 1918 flu.
This ended the forum and discussion for the day. I tried to accurately relate everything I heard. I couldn’t get every word down exactly as it was said. So basically everything should be considered paraphrased.
I should note that before the session started today, we were all given surveys to take which asked questions about our knowledge of influenza, pandemics, and possible use of control measures. After the conference was over, we took another survey of the same type of questions.
We were also asked if we would consent to further survey questions in the future (via telephone or otherwise). It was optional.
I was told that eventually a summary of this conference/forum will be on the web site: http://tinyurl.com/mb5jj
I did meet another great Fluwikian at the conference. Also, when asked if some followed Fluwiki, a number raised their hands. We were all told that news of this conference would probably show up on Fluwiki…that they could check later on!
JV, well done! Thank you!
Even if there might be some self-selection in that the audience is more aware and maybe slightly better informed than the general public, the extent to which they appear to understand the implications is better than my expectations.
The percentage for school closure is encouraging, it shows a compromise between parents concern for their kids, and the problems that they encounter with keeping them at home. But there’s a lot more education needed plus real measures to help people with the overcome the challenges.
Goju -
Yes, I was pleased with the general understanding from the group. I was quite happy that they all seemed to want to start control measures early. However, support for all the measures was not 100%. I was disappointed that there was not more support for these measures, especially for school closures. More support may come with more education and therefore more understanding.
I can’t figure out where the sidescroll is coming from :-(
anon_22 -
Yes, I am happy with the basic understanding.
You can probably see from the comments that there seemed to be a number of people who felt the government had not been honest with them. Many people continuously asked that the government be honet, open, transparent, and not hide anything. I was a little surprised at that.
The other frequent comment was that education was needed in mutiple forms, and soon.
I wonder if Europe is paying attention.
JV, thanks for you transcription and comments!
It’s good that a few fluwikians were there. What was your precise question and their answers? More like “who has read fluwikie more than once” or “who here is a compulsive fluwikie reader”?
It’s also good that most people were not fluwikians and yet understood things and responded as you say.
And of course it’s great (ok, at least better than zero) that the US is doing what they are doing. A number of non US citizens are watching. anon for now, but we don’t know about TPTB.
We may have a chance?
Thank you, all who attended, asked those questions, and, conveyed the info to the Flu Wiki.
I wish they had been less misleading - more open and honest in what was presented;
H5N1 is in birds and an unprecedented number of mammal species
should have explained the WHO Ten things you need to know about pandemic influenza and US federal websites went up Oct.2005 and could have started passing the information from those sources then, but were afraid to. (I think that was a mistake; ‘fess up and say, Sorry you’re a year behind, that’s our fault, but, you need to catch up now, this is serious.)
Should have only said what the WHO is currently saying about fatality rates may not go down, (they also should have said that cfr is with hospital care, vents and antivirals, which will not be available in a pandemic,
and, shown the IOM slides - we sure already could look at them, and no one had to get paid to go to the effort to do so, because it is so important)and,
implying that we will know and have 30 days before pandemic gets in the US is just not believable on the face of it.
Why was there no mention of deaths, funerals, burials/cremations, (yes, I know “why not”, but ----!) When mentioning cancelling large public gatherings, next bullet point could be not holding public funerals, and mention surges will mean changes will have to be made in how bodies are processed after death, even if you’d “pre-arranged”, whether that is the dubious current plans of storing them somehow for eventual processing by normal channels, or, an expedited process involving deputizing more classes of workers to do the legal paperwork, and sending the id’ body for immediate burial, (in pre-excavated “collective” burials with volunteers by hand digging if necessary), after the immediate family gets to say goodbye. Could ask them if they’d be ok once the coffins run out, just buried in body bags or shrouds? Can local people and resources be put to making caskets? (Hey, they’ll be taking you seriously, and go home and stock up- isn’t that what you want? Sigh.)
Other questions I had from looking over the thread;
Specific tests for H5N1; and how many do they currently have, for what % of the population, and where are they positioned? Is that really going to be helpful, past the first week or so?
Why use misleading lengths of time “for discussion purposes” if the public is just now trying to be educated and get the facts? They will assume people will recover in less than 7 days if you say they have to stay home; as if they’d be able to get out of bed and go. Also, if children or those with compromised immune systems can infect others for a longer time it should have been stated; the public is trying to learn. (I’d go so far as to say “survivors” need to stay quarantined until x ammount of time has passed, but people tell me I go so far it’s “too far”. I still disagree; shielding the public from the truth is wrong when they are the ones who will be suffering the consequences.)
Public worried about teen isolation compliance, or unplanned pregnancy? Make sure the teens see the fatality rates for their age groups, understand medical care will be overwhelmed or in a tent or superdome somewhere, and, go over the fatality rate for pregnant women and fetuses in the 1918 pandemic. Still time for birth-control options, too.
Anything expecting money from the federal government or state, has to remember everyplace wants that’ and, HHS Sec Leavitt spent time (and taxpayers money) having every state have a pandemic summit - that should have been publicized, and local forums started immediately afterwards. Leavitt: “May I suggest to you that local preparedness for the reasons that I have described is the foundation of pandemic preparedness.
If there is one message on pandemic preparedness that I could leave today that you would remember, it would be this: Any community that fails to prepare with the expectation that the federal government or for that matter the state government will be able to step forward and come to their rescue at the final hour will be tragically wrong, not because government will lack a will, not because we lack a collective wallet, but because there is no way that you can respond to every hometown in America at the same time.”
Also misleading; …for up to 12 weeks or for the duration of the local epidemic…It’s a pandemic; other areas will be affected at the same time and be unable to help. “for up to 12 weeks” Doesn’t match with what I’ve read about waves, possible overlapping strains and waves, and IMHO the public needs to hear they need to be helping shape local contingency planning for a pandemic influenza year.
Thank you JV.
Some simple & clear lessons on compliance with community control measures are found here. People agreed such measures are wise, and most stated they would be willing to comply. In terms of implementation, then, that implies:
What I hope those running this exercise have learned is that the fear TBTB are so worried about will be lessened, and both the willingness and practical ability to comply with community control measures will be much greater if as many people are as prepared in advance as possible. Again, not rocket science and they are preaching to the choir here, but it is good to hear they are thinking about this and may act on this information.
JV - i am interested what your feelings and thoughts will be later in the week after you’ve had a chance to digest what you experienced.
I know I had a major reaction days after the conference I attended.
lugon -
A moderator (not I) asked something like, “Do any of you here read Fluwiki?” (not about complusive readers, etc). I was writing something down at the moment, and then looked up to see maybe 5 hands go up in the room. Someone else then stated that there were other sites to read too like CE.
Pixie -
Yes, your two points are the two main ones people kept repeating over and over:
1. The government must be open, honest, transparent, and explain to us exactly what the facts are (starting NOW), as they are know or understood (not months later). Then the public will have trust in them and this will foster compliance. People were adamant about this point. Many sounded angry or irritated when they stated this point.
2. Education NOW in multiple media forms, and on the MSM, re the H5N1 pandemic covering:
I attended the conference too, and to be quite frank, it was like watching a train wreck. Jeff Duchin, the Chief of Communicable Disease Control in Seattle, after being called on using a 1918 CFR rate for planning, responded that he ‘hoped’ the CFR would go down. Hope is not a plan, Mr Duchin.
As I listened to my group talk, and after a private chat with Roger H Bernier, PhD, MPH, Senior Advisor for Scientific Strategy and Innovation, I came to realize one very important point. These city meetings are being used as cover for public officials to say that this is what the public recommends we do. However, typical of any well organized meeting, we were never really given any choices on the agenda, we only were allowed to comment on what TPTB have already decided as possible control measures. Specifically, and here is the real deal, they ‘will not’ recommend any mandatory anything. Period.
When I proposed to Roger that it would be an interesting experiment that in one city out of the four, instead of using the verbiage 2. Encouraging the non-ill household contacts of people with influenza to also voluntarily stay at home (self-quarantine) for at least 7 days., to substitute the word quarantine, his face developed a look of horror and his entire body language changed. His reply was that all of the control measures were ‘voluntary’, and quarantine means mandatory. No way were they going to require anyone to do anything, at least on a CDC recommendation level.
This makes me sad. Where is the leadership? Where are the hard choices? Is this what we get when we emasculate the American public? Even someone in a public leadership position has to be a bureaucrat first, leader second. I am reminded of some of the WWII histories that discussed what happened at the start of WWII in the American Military. It takes a different type of man to rise in the ranks during the period of piece, an effective bureaucrat. However, once action occurred many of these men were unable to make the hard choices, and had to be replaced by those who knew how to do what was necessary. And now? History repeats itself. I just hope we have enough time to make the replacements once action starts.
None of these “so called” control measures are worth the paper they are written on if they are voluntary. The only one that is non voluntary is # 4, Closing schools.
And what about the cancel large public gatherings #3? When questioned from the audience what the meaning of large was, an acqward series of glances between the staff occured. It seems that that question is under debate, and for now, large means pro football games. But it it still under discussion.
Some great comments here! And there’s so much more that needs to be done. I for one think it seems a good start since they had a specific goal of consulting and polling the participants about the 5 specific measures. They probably needed to stay within a prescribed format for the poll data to be valid! <groan about statistics>
I hope most people went home with many new things to think about, that this will trigger one idea after another.
Thanks again to JV and pablo and any others who attended and shared with us here.
pablo escobar - at 10:50:
No way were they going to require anyone to do anything, at least on a CDC recommendation level.
You are right, that’s how they are proceeding - it’s all “voluntary” measures being spoken about now. But if they don’t get moving on this, and get those recommendations out to communities, their leaders, and their public health officials for actual implementation, the entire subject will be removed from their hands.
If they fail here to persuade our community leaders and the public to utilize these “voluntary” methods of prevention and infection control, that is precisely when the military and other police authorities will be called in to do it for us. That’s why we need to act now to get these “voluntary” measures accepted by our leaders and our communities. I don’t want to see my neighbors finding that they are looking into the eyes of a 19-yo kid manning a National Guard post who is tasked with isolating them “non-voluntarily” while they attempt to seek out food and medicines for their family members. But if we don’t want to be there, we have to act now (not just talk about it all, but act).
Those New Orleans families at the Superdome and on the bridge had not prepared. We saw the consequences - their “quarantine” and isolation was not voluntary after a certain point.
Goju -
Here are some of my reactions so far:
1. I was surprised that so many had a good general knowledge of what has been happening with the H5N1 virus.
2. I was surprised there were quite a few health care professionals present (nurses, doctors, etc)
3. Although I completely agreed with the two major points that were repeated (the need for the government to be honest, and the need for education, now), I was actually surprised to see so many other people voice exactly what I felt. That felt good!
4. I was heartened by the fact that most people felt starting control measures early was the best idea (72% believed before it even got to your community). But, I was unhappy that there was not better support for individual measures. If there had been scientific support (like using the modeling studies), I assume more people would have given suppport.
6. Repeatedly, in my small group, different people indicated that although it might be important to stay home (because they are sick or exposed), there are so many reasons a person would feel the need to “just get out.” My small group discussed the fact that if people are hearing (or were given the education) that to go out would bring exposure (and then exposing family) and possible death, then the decision to go out might change! I guess because I understand this virus so well, and the CFR, and consequences of illness, I was surprised that the discussion kept going back to the “need to get out” for some reason (one extra supply, go to church, etc). I had the feeling that the understanding for compliance for the control measures was based sometimes on feeling this was seasonal flu and sometimes on a pandemic flu with a high CFR. Therefore, to “just get out” would not have a deadly consequence. This is where massive education is needed (re control measue efficacy and the flu in general)!
7. In my small group, I kept feeling like I wanted to tell them everything I knew. Periodically, I did quote a fact, etc, but I was not the expert that they were there to listen to. I could not sit there and preach to them. That was not my position. My small group’s job was to use the specific info we were given to come up with decisions as to challenges and compliance problems with the control measures as stated to us. Also we then had to discuss if we supported these measures and when they should be instituted.
8. The specific point of this whole forum was to take people who DID NOT yet have the knowledge of the conclusions of the IOM, and have them look at different measures to see where challenges and compliance problems would be. I believe the government is on a fast track to come out with new recommendations (and education) as to what control measures (TLC) should be used in the US. They need the gut feeling from all over America as to how the public would respond to these measures, so they will be ready with education, answers, and solutions. I feel this is really happening quickly now.
9. General reactions from the audience (including anger at the government not being honest, and a cry for education) are helpful to decide on how to address the citizens. However, this was not the precise point of this forum. The precise information needed is as stated under # 8. I do understand exactly why they structured the forum as they did. They know that a pandemic can have a higher CFR, and they know the results of the IOM. They will have to factor this all in appropriately when they form their new plans. Otherwise this is all for nothing! They know the scenario they presented to us is only hypothetical. They must be feeling a 1918 scenario is the BEST case scenario. If they discussed the worst case scenario (CFR 60 - 80%), I think they would not have been able to concentrate on the control measures. People would have been screaming about, “Everybody will die…what are we to do?” Then the discussion re the control measures would be lost.
JV,
all good observations.
I was surprised that so many had a good general knowledge of what has been happening with the H5N1 virus.
Did you get a sense whether the officials were surprised or relieved? Were they calibrating or watching the audience response carefully?
I agree with pablo that the discussion re the control measures was only stated as voluntary. Any time anyone brought up the word required or mandatory, this was denied (except re school closing). I assume they all understand that to only discuss voluntary, much different reactions will be found. Again, if we were discussing mandatory measures, the discussion would have suddenly gone over to taking away people’s rights.
I believe I understand why they stated their scenario as they did, and keeping the discussion to just voluntary. People would be screaming about a high CFR or mandatory control measures, and they would not be able to just discuss challenges and compliance problems with the control measures. They certainly may end up making specific meausures mandatory, but right now, they left that out of the discussion.
In the end, when final plans are drawn up, the results of this forum will be viewed as the the public’s reaction to a 1918 pandemic (possibly/probably much milder than what H5N1 will bring), and discussing voluntary measures. This has to be factored into what they will propose. Considering they know the CFR could be quite high, we may be seeing some mandatory measures.
JV – at 11:32:
You are so right - so much in their future planned communication depends on how they communicate about the CFR.
Geez, even I would probably give in to the “need to get out” and just slap on a surgical mask and go shopping in a pandemic with a >2% CFR. (Ok, maybe I wouldn’t really, but I’d at least think about it, particularly if it went on for a long time). I’ve spoken to a lot of my friends and neighbors and they are pretty clear that they would risk normal life and work if the CFR was that low. Most believe that if the CFR is that low, they would be expected to show up at work and most of life would continue on normally (as it did in 1918) apart from maybe the postponement of big public gatherings.
But tell them that the CFR could be 35% or 60% or that it is currently 79% and they start asking about what kinds of food they should stockpile in their basement.
There is also a very big difference in people’s reactions between telling them that this will be a 3-week event and telling them that this will be a 3-month or an intermitent year-long event.
I worry that the parameters your groups were using were not just selected for discussion purposes only, but were selected because they are the only parameters that decision makers will allow themselves to think about. If so, the information gathered in these meetings will be highly flawed and potentially not very useful. Only the best and most accurate of inputs will get you the best and most accurate of outputs. Inaccurate inputs can dangerously jeopardize the process, and lead to very misleading conclusions.
My impression from reading about this is there is a general sense that mandatory measures hardly ever provide additional benefits to justify the far bigger problems, than voluntary ones.
The benefits obtained from any intervention increase with compliance, of course, but beyond a certain point, the increments are minimal and costs great. ie it is a case of diminishing returns. That’s why the general wisdom is to use voluntary measures and use public education and support to improve compliance.
I meant to say a pandemic with a <2% CFR
But tell them that the CFR could be 35% or 60% or that it is currently 79% and they start asking about what kinds of food they should stockpile in their basement.
LOL
so true!
anon_22
Yes, the theory is sound - very sound. But mandatory measures are implemented in a crisis atmosphere, after the theory has already failed in some jurisdiction. You are right that mandatory measures don’t often provide additional benefits, and those in the New Orleans Superdome and on the bridge who were lacking in food and medicines would agree and would tell you that the mandatory measures there did not bring them additional benefits in the form of the needed food and medicines. Sometimes which benefits, exactly, are desired and desirable becomes lost in a crisis.
If they don’t use public education now to make sure people CAN voluntarily comply, and those people ignore the (possibly much too mild?) warnings and run out of food, water, and medicines, the mandatory measures won’t provide additional benefits to those people but they will be used, nevertheless. This time, though, it will be the wealthy citizens of towns like Goju’s that find themselves on the bridge, angry and hungry, not just the less fortunate citizens of New Orleans. And the folks in Goju’s town will be yelling “why didn’t you tell us?”
I have observed that the biggest ground shaker for people not the CFR alone. When you couple it with the ages affected and make it personal… their kids, you can feel the ground move.
JV Thanks for covering this so well. Let it sink in afew more days…
anon_22 -
I got the sense that the officials sometimes felt a little on the defensive. A few statements that officials made were contradicted by members of the audience (like the CFR will come down in a pandemic). The only time I felt there was just a little hostility was when one of the officials (after many people kept saying the government was hiding info, not being honest) stated something like, “I would like people to stop saying we are hiding information. We have all of this information on the CDC web site. Much information has been made available.”
I also felt that the audience had very good and accurate comments. The audience was a bit reactive if anything. I think that the officials were probably a bit surprised by the audience’s general knowledge and their somewhat adverse reactions to the government. I would have to say that the officials handled themselves well in answering the audience’s questions (considering why this forum was set up).
Again, this forum was not set up for people to come together and just vent. This forum was set up to find out the public’s reaction to a specific scenario and control measures.
Statements made by officials were somewhat calibrated. Again, I refer back to the CFR having to go down as a pandemic happens. Again, I would say that the officials did not set up this forum to discuss other issues other than what they set out for us. If we had gone into exactly how well a N95 mask would work in a pandemic, that would eat up time. They had to get down to the public’s reactions to the scenario they set out. We started at 9 AM, had maybe 3 break of about 5 minutes, and even worked in our small groups while we ate lunch. They did not have a lot of extra time to discuss topics like masks, boarder closures, how many weeks to prep for, etc.
I do think the officials were watching the audience carefully. When there were discussions in groups (large or small), every comment was written down on large standing pads of paper on “A” frames (paper was something like 2′ X 3′). Our facilitator did this in our small group, and a designated official did this in the large group discussions. Multiple microphones were passed around in the large group discussions, and they tried to be careful to let everyone have a chance to talk. Interestingly, after someone from the audience spoke in the large group, the moderator frequently stated what a good point that was.
(I think we’re seeing the officials struggling with their own panicky adjustment reactions and avoidance of conflict by not telling the public - that “band-aid” should have been “pulled all the way off” a long time ago- I’m afraid at this rate, they’ll still be quietly dropping baby shoes in front of study groups when pandemic will start busting out all over; then it won’t matter what stuff they had “good intentions” to plan to tell officials to tell the public 6 months out, will it?)
Doubt people would have been actually screaming. (Have ‘em breathe into a paper bag; was there a mental health Dr. in the house?) I’d rather they lost appetite for breakfast, got upset even, and get it out of their systems now, and get taking rational preparation actions going locally.
Rather have it hit most people at once during the first wave; that there really are not enough vacines nor antivirals nor vents, nor good outcomes, nor a Deus ex machina rescue, and then, they’ll be out, screaming, while the army is finally able to come around to collect bodies onto a truck or something?
They could have told the participants more, modelled how to agree it is very frightening, and go on to what we can be doing. Then, those people could go do the same thing for those they communicate with outside the workshop, especially if state and local officals will get the media repeating the messages to prepare already out there from federal and state officials.
(signed, a very frustrated “INFJ”)
i think i got the sidescroll.
You are so right, Goju. The physcian I met last week who was unfamiliar with the H5N1 pandemic possibilities was very surprised to hear about the high current CFR - that was new news to her, and that had her interest. But she seemed to clutch a bit when I corrected her thinking about this flu being like the ordinary flu - she thought it would be riskiest for the elderly and infant populations. I told her that no, it hit the age group that both her and my children are in the hardest. She seemed to really react to that. I could not continue and tell her about the cytokine storms, etc., because at that point I was panicing inside a bit, thinking “this doctor is so good, so sharp, and she just doesn’t know” followed by a sinking “we’re so done for (using more creative language).” I’ll follow up with her later, and will provide her with some further information on the age breakdowns and the manifestations of the virus in young people (I think that will ensure her continued interest and maybe spur her involvement in the issue) but at the time I pretty much had my head in my hands.
Pixie at 11:55 -
“Only the best and most accurate of inputs will get you the best and most accurate of outputs. Inaccurate inputs can dangerously jeopardize the process, and lead to very misleading conclusions.”
I absolutely agree.
I wish the CFR was stated a little higher, yet, as I stated above, I can see that people might get in a very reactionary mode and only talk about the death rate etc. This group was a mixture of people with differing knowledge bases. I think this scenario was very calculated so that a simple discussion of challenges to and compliance with different measures could be evaluated. These issues would basically be the same if the CFR was 70%, but the compliance hopefully would be better, because the understanding (after education at that point) would be that not to comply might result in death. The need to just get out is not so acute when one understand the CFR is 70%.
JV – at 12:34
The need to just get out is not so acute when one understand the CFR is 70%.
Yeah, unless the “need” is for food, water, and lifesaving medicines.
I know that’s not what they were talking about, but still…..
Thanks again for such great work summarizing the proceedings - I still can’t figure out how you were able to write that fast!
Pixie -
I tell you, I think the officials may have figured out that I was going to go back somewhre (Fluwiki, etc) and report on this, because I was the only person in the room constantly writing on a tablet everything that was said (other than an official). The scenario was typed up on a piece of paper, so I had that to copy from.
Three scenarios:
I hope there is advance warning. But in #2 then maybe “low CFR” is the best you can get.
Let’s hope this is not the last frame in the movie. Our question to convenors is: Now what?
I mean - we fluwikians have had the mixed luxury of having plenty of time for our adjustment reactions, no?
But without any warning at all, people would, hmm, just get very upset, with nothing rational at all.
So these conferences had to go for something of “tolerable intensity”. I guess.
One other note on my one on one discussion with Roger. I asked him about what was the goal of the control measures? Really. He pointed out on the handout, specifically, …Experts are not certain how effective these control measures would be, but it is possible that used early, and in combination, they could significantly reduce and/or delay the number of cases…
Really, i said, why? Roger said he didn’t know if they were going to be able to reduce the total infected, just spread it out to be able to manage it better. I pointed out that if that is the goal, then the government had better think about quick and sharp, and get it over with, rather than spread it out over a longer period, and further damaging the economy. He surprised me saying that that is a discussion point that needs to be addressed, namely which scenario allows for the best recovery post pandemic.
I have come to the conclusion, that the government has hit upon the best strategy by default. Do nothing, and get it over with. The longer they stretch it out, the worst the post pandemic recovery period will be. You know kind of like Iraq, Katrina, and other disasters that did not have a viable post event plan in place.
pablo escobar – at 13:02
From a sheer individual survival standpoint, for each of us it’s best for any particular individual if some OTHER community lets it rampage through and gets it over with, while our OWN particular community does what it can to shelter from the storm.
That brings up some serious ethical inequalities though, but that is in effect what may happen during an actual pandemic if we use this hit-and-miss communication/education program and do not give everyone the message equally. And that will cause other (have they imagined them?) post-pandemic problems.
I want to add one more thing. I think we have some really courageous people here, and I’m not just talking about talking in public, but like Pixie talking with the doc, and being terrified inside for all the different things, but still staying with it and making sure that the message brought across is at the right level to ensure interest/concern but not freak them out. And this is just one example.
pablo escobar – at 13:02
I have come to the conclusion, that the government has hit upon the best strategy by default. Do nothing, and get it over with. The longer they stretch it out, the worst the post pandemic recovery period will be. You know kind of like Iraq, Katrina, and other disasters that did not have a viable post event plan in place.
You may be right, but I have a different take on the situation, see what you think.
These are people who have been told to test out citizen’s response to a very tight set of measures, and since no official recommendation is out (or even decided yet), they can’t really tell you whether short and sharp or flattening the curve is better. Not because they don’t know for themselves, they probably have at least an opinion, but they are not allowed to say that until the studies are done and results evaluated.
I do know that this particular series of meeting results will be analysed and used as part of the material to make the ultimate policies. So chances are the guy is just not allowed to say which is better, not at the moment.
The timeframe on the slides that I’ve seen is decision by end December, I think.
I hope this is useful info.
I think the fast, keep on as normal until they drop get it over with, unmitigated spike will be too depopulating, and lose (or premanently impact) too many brains/experienced essential civilians and it will affect critical infrastructure, permanently. Economies require functioning populaces.
Not having a viable post-event plan is still the problem,
unless the officials have some sort of delusion; get to be “dictator for life” under martial law, or, live in Dr.Strangelove’s mineshaft bunker idea ?
Post-pandemic recovery will require the consent of the governed, and I don’t think public trust will ever be regained if it were to happen now. Putting info on websites and then not putting it in front of the public by telling the media it was required PSAs for national security ? Could have done so, with ethics and leadership. Should have said, have to mention Local NPI Pandemic Preparedness for every time the words terror/terrorists, ect, was uttered by a politician.
Worse than “a woman scorned” is a “bereaved parent who was unwarned”. When you ain’t got nothin’, you got nothin’ to lose.
crfullmoon at 13:33
The models keep saying the same thing. social distancing does not mitigate the effects, only stretches them out. In a sense, if your kids are going to die, they are going to die. The question is when During the first month of a pandemic? or during the sixth month?. But the law of unintended consequences kicks into gear. Does stretching out the infection period of a pandemic cause more mortalities due to secondary social unrest? Does stretching out the infection period give the virus even more opportunity to mutate into an extemely high lethal rate? Remember, it was the second 1918 wave that was the worst, not the first.
Your comment on bereaved parent is dead on. Fear the taliban? Better fear the healthy good-ol-boy father with a dying child in their car. No guardsman alive will stop him from his path.
The models keep saying the same thing. social distancing does not mitigate the effects, only stretches them out.
That’s not my understanding after looking at the slides of the conference anon_22 went to and reported about.
More healthy people taking care of less people ill makes sense.
We need to prepare for that, of course.
So three scenarios:
No?
Greetings! I’ve never posted here before, but have been hanging out at the CE Flu Clinic for about a year. Several of us from CE were also at the King County Flu Forum yesterday, and there’s a thread at CE on this same subject (plus some notes from the Atlanta Forum) that you may want to read for the sake of variety.
http://www.curevents.com/vb/showthread.php?t=61130&page=3
I do think that, for better or for worse, we “flu-nerds” may have outnumbered regular less-informed folk at the Seattle gathering.
Kris (MomCares)
A little dose of bias can do no harm, against the huge bias of silence.
Social distancing (NPI or TLC without medicines) might be used to drastically reduce illness and deaths. There is a great article about communities that reported very few cases in 1918: http://tinyurl.com/hu264 Also, in many of these places, the roads into and out of the town were shut down. This will be basically impossible in a large city, but it could work in a small community. This article is inconclusive, yet interesting.
Here are excerpts from that article:
“Ultimately, we selected seven communities that reported relatively few if any cases of influenza, and no more than one influenza-related death while NPI were enforced during the second wave of the 1918–1920 influenza pandemic: San Francisco Naval Training Station, Yerba Buena Island, California; Gunnison, Colorado; Princeton University, Princeton, New Jersey; Western Pennsylvania Institution for the Blind (WPIB), Pittsburgh, Pennsylvania; Trudeau Tuberculosis Sanatorium, Saranac Lake, New York; Bryn Mawr College, Bryn Mawr, Pennsylvania; and Fletcher, Vermont. Because of the apparently reduced morbidity and low mortality these communities experienced during the second wave of the pandemic, we have labeled them “provisional influenza escape communities.” “Provisional” means that we cannot definitively determine on the basis of the historical evidence available to us if these communities sustained their low morbidity and mortality rates because of policy decisions made by their community leaders and public health officials, because the virus skipped some communities altogether and varied in its behavior in other communities (viral normalization patterns), or because of other factors such as population density, geography, and good fortune. Although ultimately it proved to have experienced significant numbers of influenza cases and deaths and was therefore not deemed a “provisional escape community,” we have included Camp Crane, Allentown, Pennsylvania on this website because of its unusual circumstances and the strong menu of NPI enacted.
Limited by the quantity and quality of data, we nevertheless ultimately concluded that protective sequestration (the shielding of a defined and still healthy group of people from the risk of infection from outsiders), if enacted early enough in the pandemic, crafted so as to encourage the compliance of the population involved without draconian enforcement measures, and continued for the lengthy period of time at which the area is at risk, stands the best chance of protection against infection. We also found that available data from the second wave of the 1918–1920 influenza pandemic fail to show that any other NPI (apart from protective sequestration) was, or was not, effective in helping to contain the spread of the virus. American communities engaged in virtually the same menu of measures. Despite these measures, most communities sustained significant illness and death; whether these NPI lessened what might have been even higher rates had these measures not been in place is impossible to say on the basis of available historical data.
However inconclusive are the data from 1918, the collective experiences of American communities from the pandemic are truly noteworthy, especially in light of the fact that faced with a pandemic today we would likely rely on many of these same NPI to attempt to contain the spread of the infection until pharmacological supplies of vaccine and antivirals were available.”
welcome to FW MomCares
Thanks, Goju! I probably won’t be able to visit often, as I already spend too much time on FC!
JV - I’m in awe of your note taking yesterday!
Btw… I read the above-mentioned article when it was published. The conclusions about the effectiveness of social distancing aren’t scientific (as I recall the authors acknowledged this), as they didn’t look at the many towns that tried the exact same social distancing measures and were still whalloped in 1918. Some obvious examples are the twon which totally isolated itself, but with the mail delivery came the virus… or San Francisco which was perhaps the most aggressive major city in the US with social distancing, and managed to largely dodge the deadly second wave, only to be blasted by the thrid wave, resulting in the highest death rates for any city on the west coast.
Don’t get me wrong — I’m in favor of social distancing and have prepped and plan to keep our family confined for the duration if a severe pandemic materializes. I just don’t hold out much hope that be wildly successfully (especially after hearing the remarks from the folks in my small group at yesterday’s Flu Forum.
Kris (MomCares)
p.s. I’m not sure I can exist without a spell-checker…
Thanks for going to the forum, MomCares !
Thanks for the warm welcome, crfullmoon. I see there are lots of familar “faces” here at the Wiki!
Unfortunately, as I re-read my post above it becomes increasingly clear that between my rotten typing and inability to spell, I may be incapable of expressing a coherent thought here. Understand that I mean well in spite of my shortcomings :-)
Kris (MomCares)
MomCares -
Re the article I mentioned, I understand it is not scientific, but I think it mayshow that sometimes 100% compliance with appropiate social distancing will work. I guess I am hoping this could be an example that it is possible to avoid this virus. I know, I know, it is not scientific.
Re my note taking, I tried to write absolutely everything down. But, every so often, I found that I just zoned out with someone’s comment, and did not write it down. I wanted to prsent the conference as best I could to Fluwiki, so those who could not go, would feel like they were there. Were you there? Could you tell who I was (the only one constantly writing on a tablet)? Do you think I did a good job of writing exactly what was said, and the flavor of the conference? Do you have differing views than mine of the conference?
JV - I did the same as you at my conference - tried to just write as fast as i could not changing what was said. It is recommended to anyone going to one of these so we all can share and discuss what was actually said.
I did however scribble questions as I wrote. If the question wasnt answered by the time it came for Q&A, I raised my hand.
For all going to conferences… pick a seat in the line of sight of the moderator to speakers. they will be looking in your direction when they open the floor to questions and will pick you first. If your questions are to the points discussed and are good, they will cal on you again. I got to ask most of the questions in the NYC conference.
anon_22 – at 13:17 These are people who have been told to test out citizen’s response to a very tight set of measures…
Yup. In marketing circles, it’s called a focus group.
Traditionally, focus groups have been used by makers of consumer products to gather qualitative data from target groups of consumers. They are often used in the new product development process, for example, to test consumer reaction to new product concepts and prototypes. Focus groups are also used to test marketing programs, as they can provide an indication of how consumers will react to specific advertising messages and other types of marketing communications. In this way, focus groups can help advertising and promotion managers position a particular product, service, or institution with respect to their target audience.
When you boil it down, pandemic influenza is a product that the government needs to figure out how to pitch to the public.
JV - Yes, I attended the conference and I think your notes are remarkable!
Hi Edna Mode! — I worked in new product marketing for many years and conducted MANY focus groups. The difference here was that those conducting the forums are identified and present, while in most product focus groups I was involved with the participants never knew who was conducting the research (we were behind mirrors). Not to mention that these forums involve 100 participants at once, which would never have been done in a traditional focus group. The process used in these gatherings is referred to as a Policy Analysis Collaborative. It is openly admitted that ONE of the objectives of this process is to “help build public support for whatever guidance is finally adopted”.
After the forum there was a slightly more traditional focus group, but Roger Bernier (CDC) and other “customers” of the research were again openly present and identified.
I do agree that they are primarily seeking qualitative feedback about planned policies for social distancing during a pandemic so that they’ll be better able to “sell” the programs to the public. IMHO, that’s not a bad thing, as such policies could only be effective if there were a high level of voluntary compliance. In other words, marketing WILL be needed.
I suppose if one believes these programs are overtly wrong-headed, they weren’t seeking truly seeking creative alternatives through this format. Rather, they were testing prefered strategies. Personally, I haven’t thought of anything much better than what they propose given that there would be extreme resistance to mandatory quarantine.
Kris (MomCares)
Spent the evening reading the FW,
Began my Prep list (prep map) and Instructions to family how to use them, and final prep moves when the pandemic begins. Reminder for me and a “just in case” something happens to me first.
1/2 skimmed … 1/2 read Doc. Woosdon’s book. good book. The medical treatment for BF is invaluable.
Started Doc. Greger’s book… made my eyes cross.
Then came back to FW and read this entire thread - it really brought it all home. It made me sick to my stomach.
Edna Mode – at 22:54 anon_22 – at 13:17 These are people who have been told to test out citizen’s response to a very tight set of measures…
Yup. In marketing circles, it’s called a focus group.
When you boil it down, pandemic influenza is a product that the government needs to figure out how to pitch to the public.
I want to clarify this just because I DO know what this process is, from talking to the many experts and officials at the IOM meeting.
This is part of the same process as the IOM meeting, which collected evidence from scientists in front a committee of experts, but in the presence of the public so they can add their input as well, which I did.
The other part of the process, this series of public engagement meetings, was partly to assess public understanding and response, and partly to gather opinions about what would work and what might not work. Opinions will also be taken, presumably by other processes, from business, education, health, and other sectors. Then all these opinions will be gathered together and reviewed in their totality, to come up with the best (or least bad) recommendations as guidelines for public health officials.
So, at least at this stage, it’s not about pitching it to the public, not yet. Somewhere down the line, when they have taken the decisions, they will have to pitch those to the public for sure.
> So, at least at this stage, it’s not about pitching it to the public, not yet. Somewhere down the line, when they have taken the decisions, they will have to pitch those to the public for sure.
I didn’t hear anyone impying it was about pitching it to the public NOW, but rather that it was about learning HOW to effectively pitch it to the public when/if the time comes.
Kris (MomCares)
On further reflection I realized something fundamental.
The policies being tested at these forums are based on the premise that PEOPLE SHOULD KEEP WORKING UNTIL THEY ARE ILL OR KNOW THEY’VE ALREADY BEEN EXPOSED.
The personal social distancing they suggest (stay home for 7 days after you’ve fallen ill or been exposed) is all about preventing you from infecting others while you stay home and either die or live, NOT about preventing you from getting ill in the first place.
In other words, they’ve already made the choice that continued business functioning is more important than staying healthy.
Perhaps this is the only viable choice, as they won’t suggest that WELL, UNEXPOSED PEOPLE hide out in their homes until the threat has passed, yet that’s really the only form of social distancing that worked in a few small towns that largely avoided the 1918 flu. HEALTHY people totally holed up in confined “clean” place where there was NO virus… either a small town or a home.
Under these policies, my DH is to continue to work until he knows he has been exposed, THEN bring his germs home to the family and stay home.
I wish I had fully grasped this during the forum.
Kris (MomCares)
p.s. I just posted this at CE FC, but decided to also put it hear in case it promotes discussion. In the future I won’t duplicate posts as I know many/most of you also hang out at FC.
MomCares, that’s why I am so angry and frustrated, and will never trust government or local officals/politicians farther than I can throw them again.
OT: I guess it is true our election system has been corrupted and now only selects for Narcissists (…”The condition becomes pathological, and diagnosable as a personality disorder, when it significantly impairs social functioning. An individual with narcissistic personality disorder tends to harbor an exaggerated sense of … own self-importance and uniqueness. .. is often excessively occupied with fantasies about his own attributes and potential for success, and usually depends upon others for reinforcement of … self-image. A narcissist tends to have difficulties maintaining healthy interpersonal relationships, stemming largely from a lack of empathy and a propensity for taking advantage of others in the interest of self-aggrandizement. It is often found in combination with antisocial personality disorder.”) That, and the “Iron Law” about bureaucrats taking over the originally-valued goals of any organization, and only pursing the goal of continuing to be bureaucrats…
They will not have enough populace left after all the waves to have any sort of modern economy or democracy.
Officials. politicians, and people in public trust like health care or school administration, think they are ok with deciding who gets an informed chance to try and live, (which includes themselves and their families) and who will just get blindsided.
They chose, and continue to choose, not to tell the public what the WHO thought they needed to know 13 months ago. Shame on them.
Momcares - at 8:57
The problem with their theory, then, is that it will be impossible for anyone to really know if they have been exposed.
If I attend a business meeting, or meet with a client at their company headquarters, or if I wait on clients at my grocery store, there is no way that I will ever know if these relative strangers have become ill with pandemic flu. Locating me and informing me that someone I might have had contact with came down with the flu 3 days later is something that is just not going to happen.
I agree with you, Momcares, that the gist of their meeting seems to imply what you noted. If we just get a nasty strain of flu (low CFR between 1918 & 1968, for example) the approach they have under consideration might work - keeping the wheels of commerce moving while inconveniencing some people. If we get a really deadly strain of flu with the current demographics, the advice to work until you are sick will ensure that you’ve already spread a deadly contagion to others, and will ensure that you bring it home to your kids, as you point out.
Public policies, and public education, all hinge on the CFR and a clear understanding of who it affects - policies written with bad assumptions on this point will prove confusing and may do more harm than good.
In thinking about this from a policy standpoint, the best principle to go with would be to be totally honest with the public. That is what their focus groups seem to have stated and restated as their - the public’s -preference. Hopefully they are listening to that.
The policy makers would say that the problem with presenting educational materials, PSA’s, and guidance about the pan-flu CFR is that, (and to be fair it’s true), they really don’t know what it will be. But if that is the case, then they have to say that they don’t know and give the public perhaps two alternate scenarios.
In the first scenario, we wlil see a nasty and dangerous 1968/1918 level flu which will impact us, but will still allow for much of normal life to continue as it did during those two pandemics. They seem to have well considered this scenario, and have input that thesis into their planning assumptions for guidance and public education, but they cannot simply stop there.
They must also admit to the public that the CFR and the impact could be much greater, and then quote the official WHO findings that the current hellacious CFR may not decrease greatly. They need to present to the public a “Plan B,” along with strategems for how to handle it, at the same time that they present their “Plan A.”
Saying “we can’t handle it, so we might as just go home now” is not an option for these policy makers, IMHO. I criticized other highly centralized entities the other day for not having a “Plan B” because they are often too self-confident about their ability to “manage” the problem. When and if the problem becomes unmanageable, we need to make sure we don’t fall into that same trap. We need to have had, and to have communicated, our “Plan B” to our citizens. If policy makers make allowances for only a relatively mild pandemic, and comunicate to the public using that as as their only assumption, with all of what we already know now, history will have their heads.
Agreed Pixie - consequences of a severe pandemic need to be made public.
MomCares @ 8:57 -
“The policies being tested at these forums are based on the premise that PEOPLE SHOULD KEEP WORKING UNTIL THEY ARE ILL OR KNOW THEY’VE ALREADY BEEN EXPOSED.
The personal social distancing they suggest (stay home for 7 days after you’ve fallen ill or been exposed) is all about preventing you from infecting others while you stay home and either die or live, NOT about preventing you from getting ill in the first place.
In other words, they’ve already made the choice that continued business functioning is more important than staying healthy.”
I agree. They never discussed people choosing to SIP. They never discussed needing to alert people to stockpile for 8 weeks. They never remotely discussed the need to alert people early so they could network, prep, and stockpile.
This I posted above:
“Then I went to Dr Duchin and asked about what was being done re helping people to possibly stockpile for 8 weeks (grocery store planning or informing people re the need to prep). He indicated they did not feel the need to urge people to stockpile for 8 weeks. He indicated that they are not suggesting that people stop working (in general). He stated that people would need to go to work, although some can choose to stay home, and that is OK.”
I must say that I was taken aback with these statements by Dr Duchin. I had/have the impression that he and the other officials felt there is no extreme worry about the population working. I felt he (and probably most of the others at the conference) expected that people would (in general) work and keep the economy going. They did discuss working from home, closing schools, and avoiding large gatherings, but there was no feeling of urgency/pressure to keep people unexposed by SIP. There were no statements remotely suggesting, “OMG, this is going to be one hell of a plague coming our way. The CFR could be 60%. We will all need to prep. for 2 months or more, network, and SIP! Maybe we should all prep for 6 months at least, because there could be a lot more waves and collapse of the infrastructure.” Nothing like this was touched on.
Yes I’m repeating myself, but, Groucho Marx:
…”What happens? Nothing. Not even ice cream.
The gods look down and laugh “
( perhaps The Gods of the Copybook Headlines.. )
Well, planning for a mild pandemic wherein everybody tends to business as usual assumes somebody has looked at the science and is formulating more than a wild-ass guess as to how things will turn out. I think people need to not be sheep and turn off their thinking caps, and need to instead ask those holding the conference hard questions about their underlying assumptions and the science behind them.
I could hold a community conversation on what will happen if & when the big meteor hits, but unless I have some science and sound theory behind my assumptions of where it will hit & how big the impact will be (I assume it would be hurtling toward us at the time of the meeting), my meteor conference will be a big waste of time for everyone involved. Will we just assume if the meteor hits that everybody will put on their suit and tie and go to work as usual? Some kind of scientific criteria & substantiating data would be demanded even in that crazy scenario. Why are we holding those embarking on pandemic flu conferences to any different standard?
It alarms me that Dr. Duchin is not closely examining the assumptions he was hired to work with. I hope that he is at least doing so in private. If anyone else goes to the next round of meetings, I’d be curious to see someone ask him (or whoever is running the meeting that day) what science has been given to support the base assumptions of the mild pandemic that they seem to be working with. Will they be running future conferences that have, as their underlying assumption, a pandemic with a CFR of 30% or 60% too? (Rhetorical question, but I’d like to hear that someone asks it at the upcoming meetings if anyone is going).
That was me, of course. Sorry - I cleared my cookies.
I think the bottom line in pitching this to the public, and them going along with social distancing, will be the ultimate CFR of the emerging pandemic. If people think they have a less than 2% chance of dying from it, they won’t think that the odds are so great that they should completely disrupt their lives, financial security, etc. for such a “low probability”. Its a matter of risk analysis for them. Maybe folks with children wouldn’t risk it, but older folks or those without kids may not feel it necessary until it is on their doorstep, if then. Forcing them to comply with someone else’s risk analysis, and consequently “destroy” their lives for nothing (if they feel it is Y2K-ish) will result in rebellion to the idea.
However, if the CFR rate is upwards of 50% in the best case scenarios, you may very well see much higher adherence to public requests for quarantine, whether voluntary or mandatory (at first). Fatalists, or those highly religious folks that feel that whatever they do is “God’s will” so they will let God care for them, and thusly take no additional actions whatsoever, will be the only ones that won’t comply as long as they are economically able to (at first).
BUT, if the government (federal or local) does not start a strong education blitz early, that includes informing the public of a possible range of 2% CFR OR UP TO 50%+ CFR possibility, admitting it is yet unknown, then many will not have the time to even think this out or properly prepare. The gov’t needs to include information in fixed income checks given to elderly, welfare and disability payments to inform of what help, if any, they can offer these populations in helping to secure extra supplies to prep. -or at least indicate now (early) that they are on their own and need to consider these issues NOW.
If the gov’t doesn’t start taking this seriously and ACTING, nobody will really start taking this seriously beyond lip service - if that.
Personally, as a human with a survival instinct, I would hope for a fast-moving pandemic that clears right through and affects the masses that don’t take the necessary precautions in time quickly. That will translate to fewer encounters I would have to worry about and more supplies on the other side with less competition. It would also mean that “normalcy” could begin to develop sooner -whatever that may prove to be. If more people SIP and the pandemic is extended for a longer period of time, it would ultimately affect a greater number of people in our western world do to supply shortages and there would be more secondary deaths beyond those the disease would have ever taken.
The only reason to SIP is to hope that a cure could be developed while you were in hiding, and that you could get some of it when it was available, and not get infected in the process of getting to it. If the reality is that it couldn’t be developed and distributed by the time the flu ravaged through your area (multiple times?), what would be the use of SIPing at all? Ultimately you have to catch the flu to have immunity to it or else “wait it out” until it hopefully gets weaker so you stand a better chance of surviving it. Only those that are willing and able to SIP for the 6 months plus that it would take to develop a vaccine would even have a fighting chance.
When the gov’t puts that bit of info out there, or people come to that conclusion themselves, you will have a small part of the population that does manage to be able to prepare enough for that time frame and then there will be the rest that give in to the fact that they just can’t economically do that. That goup will then resort to living their lives as best as they can and hope for the best if they do have to work, or go out for supplies, or whatever. -so ultimately you will not realistically get total adherence to any voluntary or involuntary measures when “reality hits” in the event of a high CFR. When things get difficult, this end group, who the majority will probably fall into, will do what they can to survive and still try to enjoy life as it used to be, once they get through their “weeks worth of supplies” and the pandemic is still 2 states away. By the time they NEED to be SIPed in their community, there won’t be any supplies left to do so with. that’s when things will start getting bad in the event of a high CFR. -I predict it will be within 3 weeks of the pandemic hitting within any given community. That will result in the start of the civil unrest and panic the gov’t is so worried about.
Sorry Mr. President, in a high CFR situation, it will be inevitable. Pray for a fast moving pandemic, since it will happen anyway. Let’s hope it ends fast too.
Stay the current course: 2 weeks of pandemic until civil unrest, maybe 2 years until recovery.
How can honesty, transparency, and household and community preparation be worse “outcomes” than that?
TreasureIslandGal – at 11:47: Ultimately you have to catch the flu to have immunity to it or else “wait it out” until it hopefully gets weaker so you stand a better chance of surviving it.
Unfortunately, in 1918 catching one round of the flu did not necessarily protect you from the next rounds (many people got sick more than once).
And, the second and third waves were sometimes much more virulent than the previous waves (San Francisco did well and avoided the first wave in its area, but sucumbed to the harsher subsequent wave).
I don’t envy those trying to communicate all this. But the strategy of urging (healthy) populations affected by a wave to SIP, and ensuring they have lots of supplies on hand to enable them to do so, seems to be the only rational and viable answer any of us here have come up with after pondering all the potential facets of the problem (that is, if they want to have any rational and viable population left).
Lets make the assumption that TPTB have all the same information we here on Fluwiki have. Then follow the discourse on this thread. The conclusion I come to is TPTB have made the decision to control information and downplay the situation. This keeps the general public uninformed so they can’t make personal decisions aka think on their own. TPTB want the general, uninformed public to “take one for the team” so that social and economic disruption is put off for as long as possible. TPTB don’t want to deal with the fallout of full disclosure. TPTB want to retain their positions of authority before, during and after a Pandemic.
Heck, it may never happen anyway. Even if historically they happen on a regular somewhat predictable basis. :(
We have received confirmation this morning that we can attend the Lincoln summit on November 18, 2006. I’ve started a file of potential comments and questions. Please keep them coming. I am willing to say or ask anything that will convey the depth of the valuable research and perspective conducted on this site. I’m an excellent speaker and note taker and open to any and all suggestions. My sincere gratitude to each and everyone of you.
Q Are TPTB that want the general, uninformed public to “take one for the team” with a 70% cfr in people under age 20 with hospital care, still in positions of power?”
(sorry I’m in the mood to virtually kick something)
crfullmoon 12:27
If they are I bet they are prepped to the hilt. What sane person with all the facts wouldn’t prep to SIP? Nabarro has, Osterholm has, Webster has. . . :(
Guess I meant, “ask if they are still making descisions” in such a way the audience hears that TPTB want the general, uninformed public to “take one for the team” with a 70% cfr in people under age 20 with hospital care’…
Dr.Nabarro, Dr.Osterholm and Dr.Webster have been much more honest than anyone people in my town ever usually read, or hear from. The locals are culpalble, in my book.
which needs a typist, who spellchecks
I have
I’ve met Nabarro. He appears to be a man of sincere integrity. I’m glad to know he is prepping. If my impression is correct, (and it isn’t always) the world will need people with his base of knowledge and honesty. Your question is at the top of my list crfullmoon. Thanks for the help.
How about,
Why are people who think The Public Can’t Handle the Truth and There’s Nothing They Can Do Anyway So Don’t Tell Them To Prep still in charge?
(Get the silicone mitts; think I’m burnt out)
I felt the atmosphere of the conference format and the emotions of the officials was analytical. I went to this forum understanding that they were probably not going to touch on a high CFR. That was true, and it did not make me and others happy. Many comments from the participants reflected that this pandemic could be much worse with a high CFR, and that they felt the government had been hiding that fact and related truths. Also there was a repeated outcry to infrom the pubic on all these issues. I made statements on those topics also. The officials had to have gotten these points. What they will do with them is another question.
I kept coming back to basic the reason for the forum. The reason was to get the average citizen’s response to 5 control measures if there was a pandemic the severity of 1918. Now, a 1918 pandemic is not mild. However, I did feel that many just did not get it re the consequences of that CFR. The consequences of the 1918 flu were not discussed in depth at all. The classic slide was shown of many people sick in beds that were all lined up in rows. The statement was made that 50,000,000 or more died worldwide, 500,000 - 675,000 in the US, and this is the worst pandemic the world has known. The statement was made that the average life expectancy statistic decreased 10 years in 1918. This was presented in an analytical, unemotional fashion. There was no discussion of the suffering and shortages that occurred. There was no emotion connected with the 1918 flu like, “OMG, the pain and suffering was unbelieveable! The dead had to be piled up. People starved. Illness was everywhere. Frequently families lost many menbers.”
Even though those statements re 1918 CFR and statistics are bad enough, I still felt many people looked at the 1918 flu as something they could cope with, like a “bad” flu. Many of the people in my group kept giving excuses or reasons to go out (have to work, go to church, help someone, etc) other than the need for supplies. There was a disconnect there with many. If the officials had just related their deep emotions re the deaths and destruction of the 1918 flu, I think many more would have wanted to SIP.
The scenario we were given to evaluate was the 1918 flu. Many didn’t even take that seriously. Others were outraged that a higher CFR was not used. I understood they need to get reactions to the 5 control measures. Challenges and problems with compliance would really be the same no matter what CFR. But, people would not be as concerned with complying with these measures if the CFR was higher. The concerns would then change to how can I prep and network so I can SIP, and also how can I get compensated for my lost work time.
Well, the responses have been collected from the Seattle conference. What they do with these responses is up to them. They know they gave a low CFR, and that many didn’t even understand the consequences for that CFR.
MY MESSAGES TO THE GOVERNMENT OFFICIALS:
Education using multiple media forms (including primetime TV) must occur SOON covering:
Now, this is a lot of education! However, for the government to be honest and transparent, all of this needs to be covered…NOW.
When all this education is started, I imagine the stock market will fall. This is one reason I feel this education is not being done. A pandemic will bring economic disaster. But, the higher the CFR, the larger the economic disaster will be. The government has the opportunity to decrease the CFR with honest education NOW.
My best advice to all is to try and prep for as long as you can. When you are comfy with that amount, try and prep extra cash to try and satisfy some of the bill collectors that will try to keep callign until they have no viable staff to do so any longer.
Hope that a vaccine comes along with a broad ability to protect against numerous strains or at least an ability to make a new one that comes along survivable for you. Hopefully we’ll have moments when we can come out of our holes and restock if there are any stocks to do so with in between waves.
Hopefully there won’t be Mad Max style self-serving militias or gangs running about making things even worse for any survivors.
I used to think that not being able to have kids was a curse, but now maybe I understand the reason for that… and that maybe it was a true blessing with what we may need to face in the near future.
The Government:honest? Oxymoron. Short-term $tatus quo vs. risk of depopulating event, with multiple essential brains dead> single-point-failures> long-term economic Depressions?
“The government has the opportunity to decrease the CFR with honest education NOW.” I don’t see “leaders” as being capable of doing this.
(Get the silicone mitts; think I’m burnt out)
I know that it’s hard to believe anything other than the worst about governments on most days, however, in this specific instance, I think we may need to give at least some of them the benefit of the doubt.
The reason why I say that is because recently, I have had so many questions and requests for clarification about stuff that we write about here, and so much positive feedback, that I genuinely think at least a small but important group are trying very hard to catch up with us. Yes, I say catch up, cos we are farther ahead than they are, in certain things like how people should prep, in my not so humble opinion. :-)
Which is bad and good. The bad you have already mentioned, the good is better now than never, and better that they want to listen to us than not.
JV: Your documentation of your attendance is comprehensive to the max. It will be a huge help when I attend. Anon: your ability to see all sides is consistantly a calming influence for me. No matter the challenges each of us may face now or when a pandemic hits, we have to keep moving forward, despite how difficult or frustrating it may seem. On an hourly basis the pain of not being able to get my message across intensifies. Simultaneously, the work done here at fluwiki is affecting all types of people. The work which ALL of you have done and are doing is not and will not be in vain.
crfullmoon @ 13:44 -
If the government:
1. WANTS to protect it’s people (lower the CFR) with the massive education as I listed above
2. will take the time and effort to educate honestly and properly
3. will therefore accept an economic reaction to the education (stock market fall etc)
4. will accept an outcry from the public re presumed shortages or inability to obtain needed items, loss of income
Then the government will potentially save millions of lives.
If they do not educate as I outlined above, the population will eventually find out that they decided preventing the economic reaction to honest, appropriate education is more important than saving lives. If no panademic arrives before early 1/2007, we will find out what the government has decided. If their decision is not to openly educate, the population will find out they had the information, but hid it. If that is the case, when a pandemic comes, there will be a massive backlash against the government, I fear, when that is made public.
I have always been a hopeful person, and I still hold out hope that the government will weigh the option to educate honestly or not, and decide on the former. We will find out at least by early 1/2007 if the pandemic has not arrived by then.
crfullmoon, you may be right that the leaders are incapable of doing this. I so hope you are wrong!
talk about burnout..i’m getting fed up with the BS excuses too….
re:”Why are people who think The Public Can’t Handle the Truth and There’s Nothing They Can Do Anyway So Don’t Tell Them To Prep still in charge?”
Because it’s true. People ignore the threat even with warnings- to them it’s: (pick an excuse, any excuse)
hey it’s 2006! [that’s 1918 + 88 years. and that proves what?]
someone will figure it all out…[they have and you still aren’t listening to their warnings]
it’s not my job to..[save your own life? :/ ]
who can afford to prep [someone who can afford to die]
it’s no use whatever will happen will happen [maybe, if you want to watch your kids starve to death before you do]
not everyone will die-I’ll live [good you can help dig the graves then]
MomCares – at 08:50 I didn’t hear anyone impying it was about pitching it to the public NOW, but rather that it was about learning HOW to effectively pitch it to the public when/if the time comes.
Yes. And no matter how you slice and dice it, whether you call it focus group or policy analysis collaborative, whether it’s 10 participants or 100, it’s all about taking the pulse of the people and figuring out what the public will swallow. I wish they’d hurry the hell up, figure it out, and get on with the messaging. Although, given the U.S. State Department’s warning today to US citizens living in Hong Kong to prep for three months, it appears someone somewhere has figured something out.
lifeisgreat, and others going to the next forums -
I have a suggestion for when you go to the next forum. IF the officials do not go into any more depth re the consequences, struggles, deaths, shortages, etc during the 1918 flu, maybe you could stand up and explain vividly, and with a bit of emotion, about the symptoms of gasping and bleeding from the mouth, mounting piles of dead, innumerable hardships and suffering, and unbelieveable shortages of everything. Give examples of everything. Take your time doing this too. It takes a little time to sink in! It would be best if the officials actually showed numerous slides of these situations, and were not just analytical, but they probably will not (since they did not in Seattle). Here in Seattle, many of the participants did not grasp the depth of the problem in 1918 with a 2% CFR. So, I imagine that will be the same at any forum. With a greater depth of understanding of the human suffering during the 1918 flu, maybe not as many participants will say, “I’d just like to go out sometime, and not have to stay at home during a pandemic.” Maybe they will then accept the control meaures and decide that the more TLC the better…and comply!
Consider it done; vividly, citing documented occurances and with emotion.
lifeisgreat -
Excellent! It is too bad you can’t also show some slides!
Will they allow me to hold up photos? The anwser I’m guessing is no. In which case the words must be all the more effective.
Fluwikians are far up the stairs. If the other person is a ready adult our best advice will be “jump up here!”. If the other person is a not so ready adult, or a child, we may want to step down just a bit and help them walk up the stairs. Notice I said “may” and “just a bit”; not sure about how.
We may need to give both messages at once. Maybe the full message is: “you need to come up here, either in one leap or in tiny steps, but do start now and keep in mind you’ll have to cover the full distance”.
The tiniest step may be, what?
Tiniest step may be… learning Pandemics with high death rates are still an escapable fact of life on the planet? Not the least because we already have a health care system “Scotty” would describe by exclaiming, “Captain, she canna take much morrre!” ? Let alone 30 to 40% of the population getting sick, for months?
JV – at 01:09 Where’s that quote someone posted from the person writing after pandemic- the one we wondered what he’d say if he could be here today? It was so traumatic he could barely write about it, -and he knew everyone knew what he was talking about because they had suffered losses, but he did write about it….was it CT? That’d be worth printing out and reading aloud if you get a chance…
Saw an opinion piece recently about Ft.Devens when it was Ground Zero in a pandemic; did I put it in the MA thread? That’s sort of near us. We do have a ( very quietly “publicized” ) “bird flu and you forum” coming up this week; I can sit in the audience, (and I am trying not to blow it) (nor have a stroke).
lugon — I’m thinking a lot about what is that tiniest step. And I think crfullmoon is right — it is just believing — allowing yourself to believe — that this actually could happen.
The other small first step is getting that we may lose utilities — i.e. storing water for more than 3 days. I think that move is a huge step. People who will store water for 2 weeks are ready to contemplate other steps.
Water is simple. And bulky.
Making room is one of the first steps.
lugon — yup! That’s the first thing people say to me when I suggest storing water. “Where will I put it? I have no room for it.”
Unless you have a reason to believe there will actually be a problem, you have no incentive to find room for all the stuff.
Once you actually allow yourself to believe it could happen, it is simple to find the space — though different for every household or apartment, of course.
lifeisgreat -
Unfortunately, I don’t think holding up photos would be very effective.
Every time they asked for comments or questions, about 5 microphones were handed out so different people could speak around the room. Most people just spoke for 10–15 sec asking a question, or making a comment. Few people took as long as a minute. I think you will have to choose your words carefully, and try not to go much over 90 sec. Talk slowly, so your words can sink in…but make sure every word counts. I don’t think they would ever give you anything like 5 min. I suppose if you wanted to bring a book showing pictures of the 1918 pandemic, you could tell others they could come look at it at a break if they wished. I believe it is true that a number of participants just did not understand at all what really happened in 1918.
They are watching the time closely, and don’t really want individual people to talk too long. It would work out well if more than one person covered this topic. If tow or three people talked 60–90 sec each, that would be great.
This is a very fast-paced 6 hour forum, because they have so much to cover. We had a break to fill our lunch plates, and then we came back to our tables and worked in our small groups while we ate lunch. We had two other 5–10 min breaks.
I must say that they did seem to really want to hear what everyone had to say. They recorded every statement made. It appeared they wanted to take our pulse. What they will do with it is yet to be seen.
wonder if anyone has anything to report?
Too late. I hit the post button and realize it’s not Nov 18 yet in the US.
lol
For those who are going, good luck and please do post afterwards, even if you didn’t take notes and just want to share your thoughts.
I agree with anon_22. I would love to hear what went on at the other forums! Please do post!
JV where was the thread that you wrote up your report? Since you are here, it will save me a few minutes trying to find it. thanks!
Did anyone attend in Syracuse yesterday?
I attended. As soon as the Syracuse meeting was concluded, I had to go directly to Boston for another event and I have just at this moment gotten home, so if you can give me a little time to reorganize and summarize my notes, I’ll put up a summary. It was a very interesting meeting, and I felt a very productive one.
Somebody else from FW also attended - who was the nice lady in the redish jacket? She stood up at meeting’s end and suggested FW as a great place for everyone to find further information. :-) I meant to introduce myself but she got away before I could get the chance. My fellow Fluwikian asked a great question about HK, and I was the one who asked about the CFR estimate used for the exercise.
Should we continue the discussion here on the ASTHO Seattle meeting thread for continuity, or should we open a new thread for the Syracuse (and perhaps Nebraska) meeting?