From Flu Wiki 2

Forum: IMPORTANT Post Your Views for the IOM Review of Pandemic Mitigation Strategies

16 October 2006

anon_22 – at 19:16

If you have opinions and ideas about pandemic mitigation that you think TPTB should consider, now is the time to act.

I am opening this new thread to gather your views, for this specific purpose. Please read the links carefully and post here. As of this moment, I’m making plans to go. I will do my best to represent the most important points made here, subject to my own interpretation and opinion, of course. Even if I don’t go, you bet someone is reading what you are writing, so now’s the time to go for it.

Since everybody who is anybody working on this is absolutely maxed out in their time commitments, it would help if posts are well thought out, concise, and constructive. We have a whole week, so take your time. Sit down with a notebook, make a pot of coffee, write, think, re-write. When you’re satisfied you’ve said what you want to say to TPTB, post. Then check back to see if I have a question for you.

I will read and consider everything. I promise. Even if I won’t act on everything.

If you are not sure about something and want some discussion, start a different thread for discussion, to save my time and my sanity. When you’ve gotten as clear as you can in your mind, which may still not be perfect, just post anyway.

Good Luck!


The Institute of Medicine (IOM) is conducting an expedited review of the role of community-based mitigation strategies during an influenza pandemic. A workshop on this topic will be held on Wednesday, October 25 & Thursday, October 26, 2006 and will be open to the public. The meeting will be held at the PAHO Building, Room A, 525 23rd Street, NW, Washington, DC 20037. This workshop is part of the information gathering process of the IOM committee reviewing this issue.

The committee will prepare a report based primarily on information from the workshop that will include conclusions and recommendations, based upon available evidence, regarding:

Read their statement of task

The policies to be considered are those to be used in the United States. The workshop will be open to the public and attendance will be sought broadly. The workshop format will allow for dialogue among workshop presenters, the committee, and the audience.

DemFromCTat 19:52

My short list of things the Feds should be more open about reporting/discussing:

DemFromCTat 20:04

bump

INFOMASS – at 20:05

How about Tom DVM’s points about stockpiling regular antibiotics and IV/rehyration fluids to contain secondary infections and complications? (Could some of these be purchased and held legally by individuals who had gone through a training course?) Or developing a remote diagnosis protocol (over the telephone?) so that scarce skills could be stretched? Or delivering packs of food to homes that have run out, assuming that there were stores of food and people willing to drop them off? I think the best way to avoid panic and violence is to have SOME way to help the sick and hungry, and to develop systems so that social distancing w/o social breakdown is feasible.

Anon_451 – at 20:10

To Dems List I would like to add:

Responsibility of the FEDS to insure that the Power Grid stays up to reduce secondary illness, and possible death.

Responsibility of the FED to insure the proper delivery of potable water to homes to protect against secondary illness, and possible death and to assist in the home health care by average citizens.

Development of Flu baggies (brown paper bags of medications) that could be used by the average citizen to reduce the effects of the flu for the more minor cases, reserving critical medical personnel for only the most critical.

More active involvement of NGO’s in planning and education NOW before the flu hits not “when it happens”.

2beans – at 20:29

Neighborhood centers, areas of 10–15 square blocks or self-identified neighborhoods. The centers could serve as a pre-positioned cache of food, water, Anon 451′s Flu baggies, as well as reliable communication devices, to be kept staffed and guarded in the event of an outbreak. In this way, you could provide basic services for those without them and have at least minimum force already there in case of civil disorder and which would also serve as a deterrent.

lugon – at 20:32
Anon_451 – at 20:36

Anon_451 – at 20:10 Sorry that did not format right:

Responsibility of the FEDS to insure that the Power Grid stays up to reduce secondary illness, and possible death:

Responsibility of the FED to insure the proper delivery of potable water to homes to protect against secondary illness, and possible death and to assist in the home health care by average citizens:

Development of Flu baggies (brown paper bags of medications) that could be used by the average citizen to reduce the effects of the flu for the more minor cases, reserving critical medical personnel for only the most critical:

More active involvement of NGO’s in planning and education NOW before the flu hits not “when it happens”.

2beans – at 21:29

The neighborhood centers could be fabricated at a remote area in a POD configuration, self-contained and ready to be delivered and staffed as needed. If freight can be containerized, why not essential goods?

LauraBat 21:41

Early school closures, cancelled public gatherings, etc. See CDC graphs comparing St. Louis, where teh mayor did such things, and Philadelphia where they didn’t know how bad it was until it was too late. Social distancing saves lives.

JV – at 22:02

The one thing above all else that will help with mitigating a pandemic is:

1. INFORMING THE PUBLIC that a dire pandemic may happen at any time, and prepping for 8 weeks is necessary.

2. THEN, with that knowledge, the public can prep as best they can. Many people may buy extra for neighbors. Communities can start to network to provide for this disaster. Trust will be built up between the government and the people.

3. THEN, when a pandemic hits, chaos will not HAVE be the order of the day. There will not be as much of a need for food and water distribution from the government. Many more communities will be self-sufficient. Many people will have somehow figured out what to do re stockpiling many other items. People will have been planning how to help each other in emergencies. People will be able to SIP at a moment’s notice without running around creating chaos. How can you possibly SIP if suddenly you are told that a pandemic flu will be in your area in three days? Thousands will not have to die from social disruption or lack of food, water, and heat. A national emergency can create exponential havoc just simply on the basis of being unexpected!

If the government decides to hide the truth of how bad this pandemic could be, the citizens will find out eventually, and then there will be no trust. This happened in 1918. The government must come forward and carefully explain the situation, and the need to prepare. Otherwise, a Katrina situation, simply because of lack of knowledge and therefore lack of preparation, may easily develop. This does not have to happen. Thousands of lives can be saved simply by the proper information given out in a timly fashion…NOW.

Knowledge is power. Together they will shape our future.

The government dispensing accurate information NOW is the best way to mitigate deaths from a pandemic.

Jane – at 22:49

JV, that’s a wonderful expression of the first priority. Pessimism or fear regarding big cities may be silencing TPTB right now, but that’s cowardly and will take us all down the tubes. Without a clear message to urge action in every sphere of citizens’ lives (home, job, school, neighborhood), most of our people will be unprepared.

KimTat 23:09

More media involvement. Do the reverse of what was done in 1918. Patriotic duty to protect and prepare its citizens to be self reliant and not get caught with our pants down. Matter of national security spin.

Every major paper, news site should have a dedicated URL link on their web site. A column in printed media with link to the URL. My newspaper had sections of the paper for different parts of the city, this could be used to identify locations of emergency pick up of supplies, where to go for medical care, medicines…

Already established neighborhood organizations, watch groups begin with planning on what to do at the local level. Smaller local groups should be approached now to begin planning for security, drop off points, drive-walk up soup kitchens at churches, community centers.

How much of the money that was given to states for pandemic preparedness was used for Tamiflu stockpiles? Do the states still have money? Stockpile of food and water and heat/cooking source-rations created now in each community seems a better use since stockpiles of Tamiflu seem iffy at best depending on possible resistance, a bigger percentage of the population will never see them but will need basics.

If there is a quarantine,school and business closures… can payments of bills be deferred without fear of eviction, utilities being shut off. (if the grid stays up) How about withdrawal of retirements accounts, 401k…penalties be forgiven in case of national security so bills can be paid by some or a combination of financial strategies. Volunteers receive credits vouchers for hours worked to be used for current or future necessities?

17 October 2006

Fiddlerdave – at 00:51

As a minimum, the national electrical power delivery system should be immediately nationalised and revamped on an EMERGENCY basis for crisis-handling capabilities, much like Air traffic control systems or missile defense. Normally, Power generation by public and private utilities can utilize the national grid on a peer to peer basis (Generator A sells to Customer B and simply utilizes this grid to ship the power)or sell to the centralised market as is done now, but the core function of this grid is critical to our national interest and must be maintained in a way to sustain its operation under all conditions possible, for both equipment and personnel. Large centralization of populations in cities make this critical, and essential for saving millions of lives for even relatively short term failures.

Prepare a plan for handling the fast collapse of for-profit hospitals (and financially support non-profit hospitals) when our health-payment system collapses. Insurance companies have no way to handle a much greater than average illness rate, and payment levels to these entities will tremendously reduce as the health insurance fails to pay. For-profit hospitals should be returned to non-profit status as they are abandoned, then subsidized. Governments should pay for the hospitals to stockpile a larger-than-needed supplies of essentials, especially overseas manufactured supplies (almost everything), and operate a central reserve of 3 months minimum (like National Petroleum Reserve). This should be a year, which still would not be enough time to rebuild our own industries to do this if pandemic or war.

heddiecalifornia – at 02:55

More information needs to be put out to the public at large on useful efforts to clean, sanitize, and decontaminate areas where flu might be spread. Use of detergent, water, soaps, sanitizers, solutions, salt, vinegar and other methods of removal. Best practices for maintaining public and private facilities. So far, there is little information out on the actual life of avian flu virus on various types of surfaces, whether it is easily killed with sunlight or ultraviolet light, what temperatures are sufficient to remove it from clothing, mail, shoes, and so on. Use of masks. Just how is it spread? in the air, droplets, humidity, temperatures. What kind of air filters (ozonation, ultraviolet, filtration) are sufficient to remove it.

fredness – at 03:04

Excellent points made by all.

I have long hoped for newspapers to include a link to pandemicflu.gov above the fold, every day (not just a special section on preparedness once every six months). Post it on city buses. We know it is coming and we need some classes to become educated. Isn’t this message more important than 99% of the things broadcast on television? There is a good amount of information on the US gov’t site but I never see them promote it. We have a great deal of knowledge but little utilization.

Alfred Crosby wrote in his book “America’s Forgotten Pandemic” p. 49 “The organ of the public government primarily responsible for maintaining the levees againt infectious disease was the United States Public Health Service, but it wasn’t ready for danger of this magnitude…it was called upon to to a job which had been created in theory, but for which it had never been prepared in reality. The lack of solid information was an immediate problem. First, the USPHS had to have the latest news about the progress of the pandemic in order to make the most efficient distribution of its forces…Second, the fullest information about influenza and the pandemic had to be broadcast around the country because neither physician nor laymen knew more than a few scary rumors Spanish influenza, providing a perfect climate for confusion, panic, and proliferation of quack remedies. Posters were printed and sent out all over the country by means of the Red Cross, the Federal Railroad Administration, and the Post Office Department. Six million copies of the pamphlet, … a full explaination for the medical community and authorities in general were printed and sent out under the Surgeon General’s name… The most difficult problem was organization, not publicity. Public health departments and bureaus existed nearly everywhere in the country in some form or other but never had been organized for a unified effort… And, such is the inertia of society, the war and matters associated with it continued to occupy center stage.”

We have greater means of publicity today but where is the organization? How far have we come in 90 years?

lugon – at 05:34

not talking to each other but in anon_22′s direction

We have greater means of publicity today but where is the organization? How far have we come in 90 years?

I think it’s “self-organisation” that matters. Not all fish in the pond have the same size, of course. I think Feds are to:

It looks like one of us will be creating a wiki page to help anon_22 digest all this input, no? :-)

Mari – at 05:57

Provide incentives to encourage more self-sufficiency. Examples: discounted seeds and materials for building raised beds to encourage growing food locally, discounts on water barrels for rainwater harvesting, subsidized courses on home health care.

Develop scenarios that could be used by local governments to impose phased restrictions on the use of potable water for non-drinking purposes; e.g., when to forbid landscape watering. Technology for real-time measurement of water usage rather than manually reading a meter every few months (necessary to go beyond the honor system for water conservation).

Develop ideas for how to even out power/gas consumption during the day, given the local industrial/farming/residential mix. What are recommended priorities for different types of facilities in getting power/gas? If the power/gas is off for an extended period of time and comes back on on a limited basis, what is the priority order for starting up facilities and neighborhoods? The community and the power/gas company would need to work together to figure these out.

lugon – at 06:51

This outline summary may serve as a “memory aid” in looking at this complex situation in “sectors” (think the face of a clock).

The more graphically oriented among us may want to use mind maps and even do them cooperatively with neighbours. Central question provided by anon_22 above: community-based mitigation strategies.

Branch out. Harvest what’s important and bring it here.

Watching in Texas – at 07:57

1. Early school closings are going to be key in minimizing the death rate in children.

2. Make plans to try and keep the grid up, and start talking conservation now, not later.

3. Communicate to the public now that the threat is real and that 3 days of supplies will not be enough. Do this until people actually understand this - we’re not talking about one small article hidden in the back of the newspaper.

Dennis in Colorado – at 08:56

Fiddlerdave – at 00:51 As a minimum, the national electrical power delivery system should be immediately nationalised and revamped on an EMERGENCY basis for crisis-handling capabilities

That is a fine Socialist plan but
1. The 10th amendment to the Constitution prohibits it, and
2. There is no federal agency capable of doing it, even if it was constitutional (surely no one would suggest turning over the grid to FEMA…).

JR – at 09:25

1. Federal, State and Local authorities should sync up on their recommendations for how many days of supplies people need to arrange for themselves. I’ve heard 3 days, 2 weeks, 1 month, 3 months, etc., all from credible authorities, and it’s very confusing.

2. For those who can’t afford to prep, allow a one-time-only opportunity to make a penalty-free withdrawal from their medical savings account, 401K, or similar savings instrument to purchase supplies. If abuse of this opportunity is of concern, perhaps a fixed amount per person in each household could be set, and receipts for supply purchases could be required.

3. For those below a certain income level, allow a one-time-only opportunity to apply for food stamps equivalent to the amount needed to prepare for each person in their household.

4. Even though it can’t be said for certain that a pandemic will happen at all, give a date certain for when people should be prepared with x-weeks of supplies. Otherwise, many (and perhaps most) will procrastinate.

5. Use public access cable channels to educate people about BF and how to prepare for it.

6. This won’t be possible in every community, but where it is feasible, designate a standalone BF medical center. A place of last resort only for those with critical flu symptoms. Figure out in advance how to consolidate other critical care patients in another location. All other patients should be directed to separate facilities (possibly of a makeshift nature inside of schools if necessary) that should be prepositioned, prestocked and ready to go at a moment’s notice.

7. If phones are working, set up a hotline for people seeking information. This could be manned on a volunteer basis, from home, by those in the community with expertise on BF-related topics (i.e. people like us). There will be millions of questions, which if left unanswered (such as how to treat water, for example) could result in unnecessary suffering, or worse.

barn owl – at 09:41

H5N1 in humans leads frequently results in immediate secondary bacterial pneumonia. Doesn’t the secondary pneumonia cause a lot of the complications requiring hospitalization

If you can hold off the secondary pneumonia, then hospitals may not be so overwhelmed.

Should pneumonia vaccination be encouraged before this goes pandemic?

crfullmoon – at 09:59

Best mitigation strategy would be to get out to the public now, on TV, on local government letterhead, busses and subways, ect, all those old memos such as;

The WHO’s Ten things they thought you needed to know about pandemic influenza back in Oct, 2005 (add note explaining the Jan. 2006 rapid response policy update; they now respond to threats without raising the alert level first)

The 3 flu terms from pandemicflu.gov: Seasonal, Avian, and Pandemic, but, add note that though currently there is no pandemic flu it could break out at any time and impact everyone for months at a time, so the time to prepare is now. (Wish former presidents HW Bush and Clinton could do this one as a PSA.) (Maybe with Oprah; to make a trio more age groups would recognize.)

The state Pandemic Influenza Summits did not get on the public nor local politicians’ radars enough when they occurred. Can they be rebroadcast on tv as a public service?

(Stop worrying about what this will do to elections and political careers; we need an informed, prepared populace. Homeland security begins at home with an educated, healthy, functioning people; better suited for hard times and recovery.)

Mitigate the death tolls by being honest now. More of the public can handle the truth than you think. There are things communities can do now that would make a pandemic influenza year less horrible, (even if some think “nothing will help, so” let the public get blindsided). (The public/municipalities would also be better prepared for smaller disasters or economic uncertainties they do not prepare for now.)

The historical record seems to show mass fatality management becomes a logistical and psychological problem. It looks like we are less set up to deal with this than our ancestors. (Especially when the power grid and fuel delivery is impacted.)

If the public gets the information about a possible deadly pandemic, with possible double-digit mortality rates and collateral deaths, they will then understand why they need to prepare their homes and communities, and, see the real need to make better plans for handling all the steps when people die and need id, legally pronounced and death certificates made, next-of-kin involved in burial in ways that let them see the person is dead but do not involve disease risk from mingling mourners.

(The community’s mental health professionals and faith community leaders are not currently ready, and would themselves be severely impacted during a pandemic, but they are, on paper, needed resources.)

Current plans are better suited to small local disasters; don’t plan to stockpile bodies in ice rinks and refrig. trucks and have minimal staff process them all somehow. (Then, expect DMORT teams to be able to help everywhere at once; they can’t.) Deputize on the local level many more who will be qualified to handle all the legalities locally, in the field.

Please go re-read lugon – at 20:32 and JV – at 22:02 and fredness – at 03:04 and, Thank you.

History Lover – at 15:56

Dennis in Colorado - You have as usual brought up one of the most pertinent issues of this entire discussion. Where would power inhere -with the states as promised in the Tenth Amendment, “the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people,” or will Article I, Section 8 (the so-called Elastic Clause) prevail? This article gives the federal government the right to “make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.” In other words, the issue will be the historic one of federal rights versus states rights. Will the crisis create nationalization of utilities and public services such as occurred in World War I - telephone, telegraph and railroad? Or will local utilities retain control? What do you think?

Olymom – at 17:16

Work with school boards/districts to 1) have pregnant staff go home immediately 2) close schools EARLY in pandemic — and educate parents that a school closure for pandemic is different than school closure for a snow day — sounds dumb, but I can guarantee that kids will be on the telephone asking “Can Mandy come over and spend the night?”

Figure out NOW what the policy is for paying staff who are not at work (such as a teacher when the school is closed) — are they using up sick days? vacation days? These will be early questions and should be addressed.

Jane – at 17:38

If the water and sewage collection/treatment systems fail, people will need substitutes. Sickness will result if people aren’t prepared with sanitation ideas and supplies. Depending on population density, it could get really nasty, very soon. [And of course, simultaneously, people will be looking for drinking water.] Government-subsidized (or at least tax write-offs for families and businesses) buckets and plastic bags for toilets could help minimize illness.

Dennis in Colorado – at 17:50

History Lover – at 15:56
I agree, it will be an issue of federal powers versus state & individual rights.
However, for Article 1, Section 8 to apply, the issue must be one “of the foregoing powers” or must be one vested by the Constitution in the Government of the United States. That gives Congress the authority to make laws regarding Post Roads, coining of money, the raising of an army and a navy, and laws concerning treason & piracy on the high seas.
The only way around that is to declare an emergency of the highest order and suspend certain elements of the Constitution (as Lincoln did).
I’m not quite ready for that, though I suspect others are.

LMWatBullRunat 18:42

I respectfully suggest that CRFullMoon has touched on a MAJOR problem that is not being recognized most places- What do we do with the potentially infectious dead bodies that will abound during a severe pandemic? CDC and DHS could do a lot of good by issuing recommendations to the states and localities for what to do about death certificates and field-expedient handling of dead bodies. If there is a severe pandemic we will lose more people in 6 weeks than we normally lose in a year or two. One way or another, this problem will be dealt with, if not by the local authorities then by the local people or by Nature. Best if there is a reasonable set of suggestions put forth by the Feds on how to handle this.

It will certainly serve as a wakeup call for the rest of the sheeple……

Wolf – at 19:31

Lots of great ideas here. Have little to add except that while we’re possibly facing a unique situation, we don’t have to reinvent the wheel. The military, for one, has a great deal of experience dealing with massive logistical challenges. Even though they’re a bit busy at the moment, there has got to be a wealth of information out there. (As I recall from my Army days you could learn to do just about anything from a Training Manual) Another source is Doctors Without Borders for expertise in dealing with emergency medical situations in a primitive field situation. Again, while they will no doubt be overwhelmed, any sort of literature or SOP’s would be useful to provide to HCW. Refugee agencies familiar with issues of mass populations with few resources would be source of info for sanitation issues. These are ideas that have probably already been addressed, but I just haven’t seen the info. If it’s available, make it accessible. If not - let’s go get it.

anon_22 – at 22:45

bump

DemFromCTat 23:00

Another issue is licensing. If NY docs want to help in CT (or nurses), can they? Can lay people be elevated to do simple tasks usually done by licensed people? Is it state by state (a morass)? What’s the role of the Feds in setting policy? What about malpractice insurance for these good samaritans? Who pays?

anon_22 – at 23:10

Dem,

I have a different thought. What about getting out of the licensing debate for now? (Or at least conduct that as an adminstrative not a policy issue.) What about starting to look at teaching ordinary people simple home nursing skills, but doing that in massive numbers?

These are not mutually exclusive avenues, but I have a concern that every time this comes up, we may quickly get bogged down in licensing issues which will go way over the heads of ordinary people, who will be getting the meta-message that this has nothing to do with them and ‘those professionals’ will find a solutions.

Also, I think there’s a real risk that some volunteers’ concerns about putting their names on registers of any kind, for fear that they may be compelled to act, may stop them coming forwards.

OTOH, basic courses for everyone, with no certificate or license at the end of it, will both create an egalitarian and pragmatic mood, as well as (hopefully) make people more aware that they need to depend on their own resources.

Just thinking out loud…

Tom DVM – at 23:37

Dem and anon. If I was in charge of developing a pandemic medical system, I would first set some assumptions and the two most important to me would be 1) no standard healthcare system and most definitely no hospitals and 2) the requirements for pharmaceuticals will be many multiples (1000′s) of the demand today…

…if we have no pharmaceuticals then the rest of the argument really doesn’t matter…does it?

If we assume the drugs are avaliable then a few healthcare workers in a secure area on the telephone can service a great number of very worried or panicked care givers.

Those care givers could drive up to a neighbourhood MacDonalds take out window and pick up the number of recquired care packages for their family…as told to the person using standard take-out communications. The packages would included antibiotics antifever drugs, oral electrolytes and yes, in my case, prednisolone…and there would be a manual of instructions to go with it to help allay fears.

For the more serious cases, if possible, we could arrange for roving groups of healthcare workers although I’m not sure they would remain functional in an all out pandemic with 1918-like illness.

However, this system would maximize limited resources and ensure that our healthcare workers giving advice would not get influenza from directly contacting sick patients…computers could also be used in the same way.

Thanks.

senegal1 – at 23:40

My comments: Local communities have to be networked officially to a hospital in their area. So in a pandemic I know that my area hospital is X. Then each hospital needs a hotline that can be answered by a nurse or doctor who can answer from home and each local person needs to know what it is. Then each community needs to stock pile CPAP and Bi-PAP machines (as well as the brown bag of medicine mentioned above). If you read the literature on these — in the early stages of ARDS (a typical complication), these machines work better than O2 and ventilators with fewer complications. And they are made for HOME USE. Besides no hospital has enough money for more ventilators but they can buy many many CPAP machines for the cost of one ventilator. Also some of these machines now come with batteries. These machines can be dropped off at local homes with an instruction card along with the idea from above of the brown bag of medicine. An alternative would be to have these in an adjunct center to the hospital if the idea of home use is too bothersome for some local communities. Individuals can also call the hotline to a Respiratory Nurse for help setting it up. As a front line effort this could be effective in saving a fair number of people. However the liability issues might be too large to overcome.

Also in ARDs there are number of things which can be done from positioning the person in a certain way so that it`s still possible to breathe to feeding a solution high in essential fatty acids to taking statins (don`t without a doctor recommendation). We need to have some experts look over the literature and give us an opinion about non-medicine remedies — maybe something like “worth a try”, “dangerous”, “don`t try without a doctor`s advice” so on. Such things as essential fatty acids, vitamin D supplementation, etc. Those that are worth a try should be stockpiled for local communities.

Also it is unacceptable for the US Government to simply negate the role it has to play in getting poorer segments of the population prepared. If you have money you can stockpile food if not — well too bad. I think the food stamp idea above is an excellent one but would have to be put in place months before not at the last second. Unfortunately, some people will just sell the extra food stamps for more money that month so you would have build around that.

Finally, we need real communication. We need all the gene sequences that any public group in the US has released immediately. We need the US government to refuse to provide Tamiflu stockpiles or money to any government that won`t release the sequences and we need sanctions for those that continue to hoard. We also need a government website with real scientific information on it that is updated daily about the actual state of the science of the virus.

Okieman – at 23:55

anon_22,

Jane – at 17:38 adressed an issue that has been in the back of my mind for some time. It is not a matter of the actual failure of the wastewater collection and treatment systems per se, but rather the potential lack of manpower to operate them due to sickness contracted on the job or elsewhere. H5N1 has already been shown to be present in human waste. It will take real heroism on the part of sewage treatment plant operators simply to go to work.

This health problem for the wastewater system operators has additional implications to the water system. This is due to the fact that for many smaller towns, one or two people operate both the water and wastewater systems. If they get sick trying to keep a lift station up and running, then their sickness will likely impact the continued operation of the water system. This was not so much an issue back in 1918 because many households had their own well, and also still used outhouses. But today, I would say this issue is a nightmare. It is extremely important to maintain the health of these workers.

In addition, as has been noted elsewhere, if/when sewers start backing up, health problems begin to multiply. Contaminated neighborhoods. Contaminated streams and lakes. If this occured during freezing conditions the virus contaminated wastewater would linger and pose a risk until warmer temperatures prevailed. (If my memory serves me correctly, H5N1 has been shown to last indefinitely in freezing conditions.)

Here are two links which addresses H5N1 in water and wastewater:

http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf

http://www.who.int/foodsafety/micro/avian/en/index1.html#section%202

18 October 2006

Posie – at 00:23

JR, this is brilliant!

>> 2. For those who can’t afford to prep, allow a one-time-only opportunity to make a penalty-free withdrawal from their medical savings account, 401K, or similar savings instrument to purchase supplies. If abuse of this opportunity is of concern, perhaps a fixed amount per person in each household could be set, and receipts for supply purchases could be required.>>

i mean, i particularly love this part…

>>3. For those below a certain income level, allow a one-time-only opportunity to apply for food stamps equivalent to the amount needed to prepare for each person in their household. >>

only not sure about the “one time only”. certainly the benefits would need be associated with risk communication and preparedness classes.

as an aside, there do seem to already be plans for hotlines.

great brainstorming, all! good luck, anon_22!

mpb – at 02:31

1) the other major governmental body which isn’t addressed but which also ISN’T included in state and municipality planning is tribal governments. It isn’t simply an oversight. If tribal governments are not specifically included, they are specifically excluded (for example, environmental laws do not apply. Laws which specifically include “reservations” do not include any Oklahoma tribes; only 3 of NM 23 tribes, and only 1 of 300 something tribes in Alaska. Laws which apply to American Indians specifically exclude Yup’ik and Inupiat Eskimos and Aleuts (Unangan). For many regions in the US, the tribal governments are the governing body for evacuations routes, police and firefighter backup (for example, nuclear weapons labs), cell towers, health clinics, food commodities, senior servcies, etc which are needed by non-tribal members and governments.

2) we already have instances where the federal pandemic response has been implemented. For example, in Alaska, the state and tribal and Federal agencies were broadcasting there was no bird flu in North America, after the test results were publicly released elsewhere that we (our birds) did have LPAI H5N1. Why hasn’t the leading edge, the initial focus of US efforts, of bird flu prep, not been successful? It’s still early and of a small enough scale to analyze what happened and what the implications are for other parts of the country and for later in the pandemic response. Also, 2/3 of the state regularly get cut off from “civilization” but never for more than a week at a time (9/11) — what can and cannot be restored or made operational solely by local resources could probably indicate what would benefit or be disastrous on a larger scale.

lugon – at 04:31

It looks like one of us will be creating a wiki page to help anon_22 digest all this input, no? :-)

Here it is. The idea for a wiki-page at this stage is that we may harvest what’s been written in the thread. Harvest may mean:

Personally I intend to print out this thread and, as anon_22 suggests, take our time. Sit down with a notebook, make a pot of coffee, write, think, re-write. When you’re satisfied you’ve said what you want to say to TPTB, post.

2beans – at 08:32

Re: sewage and waste water contaminants. Read effect measure this a.m. I wonder if there is some sort of additive for sewage that could possibly turn this situation into an asset (so to speak). i.e., Tamiflu will pass into waste systems undeteriorated.

Bluebonnet – at 09:04

I agree with JR. My biggest concerns are:

  1. Nursing home residents. What is the plan? They were left to die in NO.
  2. Undocumented workers. Right now this portion of the US is cut off from most information. Here in Houston this community is very, very wary of governmental authorities. There have been roundups. Folks will be very suspicious of activities related to pandemic flu. Are plans underway to address this very thorny issue?
  3. Food pantries. Plans need to be implemented immediately to keep food pantries stocked. Too many Americans rely on this “emergency” food as it is.
  4. Homeless folks. What is the plan for them?

I think JR’s plan to issue additional food stamps for prepping is a wonderful idea. I also would like to see the State and/or Federal authorities lift sales taxes on prepping items just like they do in Texas for back-to-school and in Florida for hurricane preparedness.

History Lover – at 11:30

Dennis in Colorado - I agree with you completely. Who knows what will happen? Will local governments take control of various issues only to be superceded by federal authority (after telling us we’re on our own)? Nationalization of critical goods, services and manpower is certainly a possibility, but it will also most certainly create tremendous conflict. Living in a city with one of the nation’s largest military posts, I do consider the implications of this. Your thoughts on this subject are always welcome.

mpb - You are also right on the money. As usual, Indian tribes will be one of our most vulnerable groups. Those who are under federal jurisdiction may receive no help from local communities, because they are considered “non-taxpayers.” Those who are not under federal jurisdiction may also receive no help, because everyone assumes Indian tribes are self-sufficient. And you are so right to point out that tribes contribute so much not only to their own people but to local communities. In World War II the Roosevelt administration declared American Indians to be a “natural war resource”. This enabled the government to draft Indians into the work force and more importantly, to utilize all natural resources on the reservations.

If you know of anyone in Congress or government we could contact and ask about their plans concerning Indian tribes, I would like to have that information. The only one I know who is on the Senate Committee on Indian Affairs is John McCain.

If it’s not too personal, I am curious as to whether or not you are an American Indian. If I’m prying, I apologize.

senegal1 – at 12:17

I posted this in the thread on the VA, MD, Washington DC Get Together but it bears repeating here. One key thing lacking as far as I can see now is horizontal communication bewteen services within a community. I see lots of vertical knowledge — school principals know other principals for example — but they don`t know the business leaders of some of the main stores in their communities. Ditto for the store owners, etc. We need communication information based upon geographical location — horizontal information — as well as a chain of command up the county government line.

2beans – at 12:44

Bluebonnet: the mergency food stamp program is already in effect. After Katrina, affected state employees were also allowed to tap into 401k without penalty. As part of south Louisiana’s hurrican damage mitigation plan, supplies have been pre-positioned in various locations for disaster relief WORKERS, along with sophosticated communication equipment, in POD form, presumably for delivery by airlift.

One of my biggest concerns is about the homeless. Consideration needs to be given to all “outsider” groups- foreign language speakers, including sign language, the Vietnamese community, etc. Mzny of these groups have a strong church or organization affinity. The homeless are another matter. I hate to keep returning to the example of Katrina, but it really is the best template. In Katrina’s aftermath, my area was awash with newly re-located homeless - well, people whose ties with society were severed long ago - alcoholics, the mentally ill, drug addicts. They do not have the ability to find a food stamp office nor, in many cases, to use the food stamps. I’m afraid that plan would just make them more exposed to abuse by hoodlums. What they DO have is an affinity for a particular street corner and the store nearest to it. This is why I bring up the idea of PODS. Supplies can be tailored to areas served. In inner city corridors, they could be stocked with food as well as medical supplies, perhaps to be staffed by people familiar enough with the immediate area to at least recognize the faces. In more prosperous areas, maybe basic medical supplies would be enough.

The plan and technology are already there and need only be somewhat expanded in scope and tailored in application by location.

Timber – at 13:02

As long as we’re at it:

Is anyone considering the foreign policy implications of a pandemic? What if our allies are hit first, and hit hard? Will we send them aid? Will we deploy personnel to help quell civil disturbances in, for example, Great Britain?

If TSHTF in, say, Indonesia and Iraq, will we be ready to respond to the inevitable claims that the pandemic is an anti-Islamic plot engineered by the US? Anti-US sentiment will explode, and with it the possibility of terrorist acts.

It now appears possible that oil-producing regions in Africa and Asia will be among the first hit. What if the pandemic is raging in the Middle East, but we are somehow able to minimize the contagion here? Oil will stop flowing, but demand will remain high. Do we have a plan, or are we just going to muddle through?

In my experience, questions such as these are most likely to get the attention of the people who really control things. Has anyone slapped them upside the head with a pandemic two-by-four? These questions might be the way to get them to act to protect and provide for us all…

anonymous – at 13:56
ConnectRNat 14:15

The public will be looking to local government (mayor, county executive, commissioners, managers, etc.)to take the lead during a pandemic. We need to make sure that they buy in to the potential for a pandemic. As a local health official I can have all the plans I want, but without the backing and support of local government my efforts may be for naught. Most of the authority granted to a town/city/county, under a governors declaration of an emergency is wielded by your local elected officials, not public health. Some will meet the challenge, others will falter. HHS has held statewide meetings on pandemic preparations over the last year all across the nation, but the message has been embraced by few, and ignored by many. The IOM must ensure that local government is part of the solution, not part of the problem.

JR – at 14:40

2beans, I like your idea about PODS for dealing with homeless, addicts, etc., and I agree that very creative strategies will be needed to assist the most vulnerable in our society during a pandemic. However, when I mentioned the food stamp idea, I had a different segment of the population in mind - and it wasn’t exclusively those who already rely on food stamps (though they should definately be included).

I was thinking more along the lines of what percentage of the American public can actually afford to prep - even if they took BF seriously and were desperate to do so. I suppose the answer would depend heavily on the length of time for which SIP preps were needed, but let’s say, for the sake of the discussion, that the length of time is closer to 3 months than it is to 2 weeks. How many people can afford to do that?

Prepping for a family of four for three months has run me into the thousands of dollars. I’m reasonably comfortable financially, but shelling out several grand has nevertheless…hurt. I fear that a significant number of families who’ve never been on food stamps (and who couldn’t imagine ever needing them) would find it simply impossible to afford to prep for that period of SIP. Hence, even if the govt. hollered from the rooftops about the need to prep, what difference would it make for these folks? I don’t have any hard data, of course, but it wouldn’t suprise me at all if half the population couldn’t come up with the money to even set themselves up with water (storage containers and filtration systems being as outrageously expensive as they are). Most of these people wouldn’t qualify for today’s emergency food stamp program, and if we wait until a pandemic to qualify them, it will be too late.

Maybe the term “food stamp” conjures up the wrong image of the people I’m thinking about. Maybe a “disaster planning credit” for those below a certain income makes more sense.

EnoughAlreadyat 15:07

Potable water and waste management HAVE to be addressed. These are the very basic, bottom-line “emergency” preparation mitigations.

Electricity has to be available, even if rationed. It is imperative to the most basic “health” standards. (Hygiene, sanitation, temperature regulations, etc.)

If food is even considered as a “possible” scarcity, which it must be or they wouldn’t be telling us to stock-up for whatever the “time” is now, then there is a paramount need for state and local governments to prepare food banks. MILK for infants is an absolute that has to be a prioritized fundamental preparation. In fact, it would be prudent, IMHO, to be having an outright breastfeeding campaign. WIC, extension agencies, Red Cross, etc, need to be having classes offered at the community level dealing with food safety, food preparation, management, budgetting, caretaker roles, etc. For example, ORS formula’s need to be available at low literacy level and at nominal cost. Client/citizens need to be trained in such procedures, including understanding of why they are used and when.

School districts need to have clearly defined plans for closing and opening of classes. This can’t happen too late, or resume too early. Parents/caregivers need some guage of what to expect with helpful information concerning this flu. Additionally, many parents/caregivers will need information and helpful resources (age appropriate) to continue educational studies.

Essential workers need to be identified, targeted and prepared. Foremost, they must be protected.

Grace RN – at 16:17

This horrible thought has been nagging me. In 1918 there were a huge number of orphaned and single parent families created because of the pandemic.

In today’s society-as opposed to that of 1918-there is a huge number of single parent families. Usually the mother is head of the household, and needs to work to maintain the family.

A moderate to severe pandemic now, IMHO, would drastically-terribly-increase the number of orphaned children who will need care, physically and mentally.

With the low priority placed on today’s childcare and sick leave (USA), honestly I have no ideas on how to address this.

It’s such a painful thing to even contemplate, yet, are we

Bluebonnet – at 16:39

As to the PODS - see below from another site I read:

“Was told today to Immediately start executing state Pandemic flu plans as of Nov 1st. Put the phase 1 plans in motion and get the positions filled and trained. All to be done and reported back by end of November of the positions, disciplines, and persons. All resource typing to be finished, and NIMS positions in order.”

Answers question regarding “immediately” “Just implementing the plans. Assigning the shelters, personel positions in place, NIMS requirments done, MOU’s completed. Also, making sure shelters are stocked with required supplies. Preparation for storage of the POD distributions. Who will have security level to be present when POD arrives and items stored.

Which funeral homes will handle the dead. Just the intial stages of the plan. “Start putting it in motion from step A” as it was said.

I dont know what information, may just be that winter season is coming up. I cannot say, just following orders.”

JR - OHHHHH I like your Disaster Planning Credit. If FEMA can distribute AFTER a disaster why not before?

Grace - I too worry about the orphans. I think I worry the most about the most vunerable of our folks. I also worry about prisoners (including juvenile offenders) and the mentally ill/disabled. What happens to them?

In short - WHAT ARE THE PLANS, STAN? Sorry to shout like that but I am really, really, really getting tired of not knowing the PLAN!!! Or lack of one. Just TELL us already!

JR – at 17:16

Hey Bluebonnet, you and I must be traveling down some of the same roads. I caught that info you mentioned about PODS myself.

When it comes to the orphans and other unfortunates, even a Disaster Planning Credit won’t be of any use - especially if 90% of the rest of the population isn’t even squared away. I simply can’t imagine a scenario which protects these people in the event of a sudden pandemic - unless it’s been planned out in advance on the local level somehow. Which, if 90% of the general population can’t even be persuaded to do for themselves…just won’t ever happen. The only real chance for the most vulnerable, is if the majority are prepared enough to extend a helping hand.

History Lover – at 17:25

Enough Already - You described everything succinctly and reasonably. It’s just too bad you’re not in charge of FEMA. OTOH you’re obviously overqualified.

lugon – at 17:37

are we being useful for anon_22′s purpose? I hope so!

2beans – at 18:33

JR: Although I see your point about advance food stamp eligibility for prepping, I have grave doubts as to whether the feds would approve due to the massive amount of fraud turned up post-Katrina (there’s that word again). What I CAN see happening is advance stocking of food banks and pantries, or PODS throughout a given area. The distribution must be of sufficient locus frequency, i.e., maybe 1 mile between centers, so that limitations on travel can still be reasonably observed and security maintained. This is where something along the lines of block captains, or street corner social workers - people who know the people in the area - would enter the equation. I admit I,m sort of thinking out loud, but neighborhoods ARE basically self-identified and it seems to me this factor should be used for organizational advantage. Another possibility is USDA-run counters in grocery stores and eligible families applying for and being issued “scrip” type currency, usable only for storable food. That might be feasible.

2beans – at 18:46

Bluebonnet: can you source your information from that other site? Our state plan specifies that the supplies cached pre-event are reserved for disaster workers only. Also, I’m familiar with the NIMS, had to complete them, but what are the MOUs?

Grace: I’m assuming (well, hoping) Social Services will step in where children are left orphaned. The weak link I see is appointing a party responsible for notification. And believe me, folks - and I meant to add this to my earlier post - we want the responsible party to be the personal “us”, not the federal or NGO “them”. The biggest single F-Up factor in Katrina was that “them” would not get out of the way for “us” to put our small boats into the water and save people. Fortunately, “us” knew of many other put-in points that “them” couldn’t find. Of course, “them” also couldn’t find their butts with both hands. Did I just say that? Why yes I did!

Edna Mode – at 20:35

Cannot emphasize enough the essential need for early school and public venue closures.

Equally important: Require insurance companies NOW to authorize and reimburse a one-time, three-month stockpile of all maintenance prescription medications

No funds for supplemental food stamps. These funds should instead be used to stock community food banks and emergency shelters.

Communication needs to begin now to reinforce the idea that it is necessary and OK to stay home during pandemic:

The government at its highest levels (GWB) needs to begin communicating now in the most public forums (televised address to the nation) to all corporate and private citizens that resources will be available, including…

Tax-free/penalty-free access to retirement funds to aid in post-pandemic economic recovery.

Grace periods on secured and revolving debt payments for duration of pandemic and for at least three to six months post-pandemic. The corporations that underwrite this debt have ample time NOW to insure and reinsure their exposure in the event of pandemic.

Family Medical Leave during pandemic no questions asked (no hassles over leave paperwork having not been submitted beforehand, etc.). The government should enact emergency legislation NOW to require employer compliance.

Broad and liberal interpretation of other leave policies (sick, vacation, bereavement) during pandemic to ensure that sick people stay home without fear of job/income loss.

Anon_451 – at 20:43

Edna Mode – at 20:35 Go to http://www.opm.gov/pandemic/ Feds already have it in place.

Edna Mode – at 20:44

anon_22 - at 19:16 Since everybody who is anybody working on this is absolutely maxed out in their time commitments, it would help if posts are well thought out, concise, and constructive.

lugon ¨C at 17:37 are we being useful for anon_22¡äs purpose? I hope so!

Points taken, anon_22 and lugon.

People, Anon_22 has enough to do without wading through lots of discussion. Please make your points succinctly, and, if a topic has arisen in the course of this thread that you feel deserves fuller discussion, start a separate thread.

But here, in this thread, let’s try to stay on task. Keep the posts short, sweet, sage, and decorous.

This is a great opportunity. Perhaps one of the best we’ve had to potentially influence the broader public conversation. Let’s not blow it.

19 October 2006

fredness – at 07:36

Life globe facing a common threat. Humans are working instinctively to protect themselves. Many are individuals and groups are working very hard on various aspects of this. We will reap the greatest benefit if we coordinate our time and energies. We must recognize the importance of using existing data and be aware of the benefits and costs of redundant efforts. One way of doing this is for organizations to utilize a commonly available means of sharing information. Traditionally this would be provided in a press release and the public is dependant on the discretion of news editors to include the news. They also publish study results in non-profit sources of information like the National Library of Medicine’s PubMed, the Proceedings of the National Acadamy of Science and the Public Library of Science. The FluWiki serves to facilitate sharing this information. I am certain we could benefit from the various organizations preparing for a pandemic would greatly increase the return on time and energy invested if they (as individuals and groups) participated in posting resources here on the FluWiki. Through coordinated efforts adding information into the knowledgebase we will all benefit and can minimize the loss of life. That would be the best “Community Based Mitigation Strategy” I can think of.

1- the quality of existing models about a potential influenza pandemic and their utility for predicting the effects of various community containment policies on disease mitigation.

I remember reading in the news that IBM was about to start a model of their Global Pandemic Initiative (link to their press release and point of contact). It appears to focus on disease outbreaks and “elements will be shared with the open source community”. Another part called Project Checkmate will study viral evolution and immune response with Scripps Clinic.

Another large modeling effort is Modeling of Infectious Disease Agent Study (MIDAS), a collaborative network of scientists, leads in researching the use of computation and mathematical models that will prepare the nation to respond to outbreaks of infectious diseases. press release and graphic simulation

There was a similar study titled If Smallpox Strike Portland also by Los Alamos National Laboratory. See also Effects of behavioral changes in a smallpox attack model

We have some information about models here (which could be more complete by using info from this post).

lugon – at 08:32

Big picture …

I’ve napkin-mapped a few global challenges: pandemic flu, peak-oil, peak-food, global warming, disruption by massive terrorism, and maybe a few others. They feed on each other, they have some things in common, and they also have quite a few differences.

Local self-reliance, which would probably need global facilitation to be effective and fast, plays a role in most if not all of them:

All in all, pandemic flu is unique in that it will be sudden and simultaneous, will affect humans directly (not the hardware or the software, but the wetware), and will induce some level of “fear to help”. And some pandemic-flu specific things are needed, such as masks, home-treatment (including inmunomodulators and good old rehydratation), and even, while we’re at it, maybe some antivirals and some few-and-late vaccines.

But in any case local self-reliance is a must, as is communication so that we may learn cooperatively what works and what doesn’t work. (If you’re the second town to be affected, wouldn’t you love to know what worked in the first town?)

Now, the thing is we’ve actively walked away from self-reliance. Things were inevitably local back in 1918, just because food or drugs couldn’t possibly travel thousands of miles from farm to table; they had to be local. Now we need to run forward to a new kind of chosen, globally sustained, self-reliance. I don’t mind buying globalised pipes to irrigate my local crops, but crops must be local. (And this is from an urbanite who can’t tell lettuces from baobabs - at least not without googleing for them.)

So: self-reliance in food, water, energy and communications. Globally facilitated self-reliance.

This is not to say that we have zero self-reliance now. If we measure it on a 0–100 scale, we may be at some point between 20 and 30, by my guesstimate. We need to push, facilitate, beg, borrow, squeeze our brains, sleep less (or more), all until we reach say 60 or 70 on that scale. Globally and locally. In as many places of the world as possible. In a couple of years or less. Starting with whatever is easiest, makes immediate sense and/or has lots of help if we let it happen (perhaps reviewing regulation of self-supplied energy will change the rules so that people will spend their own money - just an example).

Thanks for letting me rant about this. Thing is, what bothers me more about the next flu pandemic and all of the other things is: darn, we can do it!

Anyway - what’s the Federal role in this? I don’t know. :-)

Grace RN – at 09:00

2beans – at 18:46

regarding current social work status and dealing with newly oprhaned kids during and post panflu

As of right now 10/19/06, social work agencies can’t cope with what they have to deal with now. Crack/HIV/AIDS is predating panflu re: a slew of orphans and abused/neglected kids.

lugon – at 09:19

Grace RN - “Social work agencies can’t cope”.

It looks like we’re in a “can’t cope” world. Maybe it can’t be business as usual or more of the same any more.

Bluebonnet – at 09:34

2beans- don’t know what MOUs are. Go to www.terminusreality.com and check out the 9103 weekly discussion thread. He posts each week (usually) and seems to have some inside info on pandemic flu and other natural disasters. Is he right? Can’t tell you that - but he has been right on a lot of things. Each person needs to make up his/her mind about what he is saying.

I, too, gather that the PODs he mentions are for disaster workers.

lugon- you hit my frustation as to no info right on the head.

Anon22 - can you somehow convey to TPTB at the conference the frustation folks are feeling right now with the lack of information?

fredness – at 10:14

2- Conclusions that can be drawn from the historical record and available science, gaps in current knowledge, and approaches that would narrow these gaps.

In order to minimize redundancy it is important to clarfiy what we already know and what we don’t know. There is a lot of information here on the FluWiki index from many authoritative sources. Lugon has a good idea with mind mapping the outline summary.

There are 43.000 references to pandemic on PubMed. There are 47 on Public Library Of Science, 166 on Proceedings of the National Acadamy of Science.

Why re-invent the wheel? I have often felt administration is important in all areas of life. See who is doing something well and learn from their model.

nsthesia – at 10:46

Suggestions for Panflu Mitigation:

Utilize the media to inform citizens of threat.

Encourage education channels to create and air programs on influenza and pandemic flu.

Encourage media to increase information on preparation for panflu.

Encourage airing of PSAs (facts, preps, home care, etc.), increasing in intensity as situation develops.

Initiate a National Awareness Campaign (cough etiquette, crowd avoidance, handwashing, school monitoring, etc.), involving individuals, businesses, schools, military, etc.

Encourage/Develop programs of 30 min. increments educate about: Prepping, Sheltering in Place, Personal Protective Equipment, Home Care of Patient, etc.

Mari – at 12:16

If we focus on individual communities (towns, cities, up to states), community-based strategies are needed for the following:

  1. How to prevent people from getting sick from the virus (e.g., processes for vaccination, anti-virals, social distancing, closing schools)
  2. How to treat people sick from the virus to minimize deaths (e.g., special wing of hospital, home nursing, nursing hotline)
  3. How to keep healthy people from getting sick or dying from other things (e.g., treatment of non-flu illnesses/injuries, home delivery of babies, provision for food/water/power, arrangements for children & vulnerable populations, filling prescriptions)
  4. How to fill in for workers who are sick or tending for the sick (e.g., mobilization of retirees, cross-training)

Each community will have a different set of vulnerabilities and priorities for addressing them. I thought about my own community, and came up with major categories for possible vulnerabilities of:

Some strategies that my community could implement to mitigate effects of a pandemic:

2beans – at 14:55

Grace at 9:00 - You don’t need to tell me about the shortcomings of Social Services. We’re chronically understaffed. The feds are very good at mobilization of large amounts of forces and goods; at micromanagement - not so hot. Let them do what they do best then get out of the way. I think care for orphened kids may best be handled by folks nearby who already know the kids. This is not ideal but at least a certain amount of comfort and good will may already exist between kids and neighbors.

Bump – at 23:16

20 October 2006

lugon – at 06:31

Utilize the media to inform citizens of threat.

Maybe govs can’t or won’t do that directly, but they can foster open meetings in which “experts” (see Forum.WhoIsQualifiedToAssessTheConsequencesOfAPandemic thread) assess things. Such meetings should be both national and local. They would include some basic information (a power point presentation about the virus, pandemics in general, and little else), with a set of parameters that define a pandemic (“pandemic wave in a spreadsheet”, “lenght of disease”, “absentism rates in essential workers and in HCW”, and possibly other things), and then “off you go!”.

lugon – at 06:36

So, the “experts” would be police officers, supermarket owners, etc.

2beans – at 06:50

Bluebonnet:

Found it - MOU = Memorandum of Understanding, as between two agencies or jurisdictions, or division of responsiblities. States may have MOUs with the USGS regarding primary functions of each after a natural disaster.

anon_22 – at 09:13

Just a quick note to thank everyone for such wonderful inputs. I’m on the road with an increasingly unreliable laptop :-( so I may not be able to respond as much as I would want. Trying to decide whether to re-install Windows without access to another PC (and risk the whole thing becoming completely unusable for the next few days) or muddle along (and risk the whole thing crashing completely at any moment) is a hard choice.

I guess if I were to triage :-) this I would go for the latter option.

Still I can read your inputs, even if it means downloading and printing it off of hotel computers!

lugon – at 10:02

anon_22: Maybe get yourself a linux live-CD such as http://www.damnsmalllinux.org or http://puppyos.com/cd-puppy.htm … if that particular “brand” of linux sees your modem, then you can use it to surf the net even if your old Windows is broken.

Either that, or your two options.

fredness – at 15:30

anon_22: Plan to buy a Lenovo or ThinkPad. First do a backup if at all possible. Pay a shop if you must because losing data is terrible. A good pc shop can also perform a “repair in place” on winxp. If you are tech savy you can try it yourself, instructions are here (at a glance it looks good but I cannot vouch for the author). Official Microsoft info is here

Please excuse the thread drift. We now return to our regularly scheduled Pandemic Mitigation Strategies.

anon_22 – at 22:02

fredness – at 15:30

anon_22: Plan to buy a Lenovo or ThinkPad.

Erm…I am using a lenovo, dammit!

It seems to be ok tonight. Temperamental.

anon_22 – at 22:23

Actually, its not.

Bad day, overall.,

:-(

21 October 2006

Dizzy – at 18:32

A thought from the UK, where secretiveness is and has always been the order of the day.

Place some control in the hands of the people. Most folks given responsibility rise to the challlenge. Nationwide delivery of information packs on such things as:

If our governments can’t help us they can at least give us comprehensive information on how to help ourselves.

There is a website called Skillswap which appears to be in it’s infancy. Pushing such websites would be a good thing.

25 October 2006

crfullmoon – at 19:04

“A workshop on this topic will be held on Wednesday, October 25 & Thursday, October 26, 2006″

News to look forward to!

anon_22 – at 19:57

Just got back from Day 1 of the IOM workshop. The agenda was about evaluating the different models for non-pharmaceutical interventions, to figure out how much evidence there is, where are the gaps etc.

It was pretty good, and I’ll write about it definitely tonight. Right now I gotta go eat.

I’ll start a new thread for that.

senegal1 – at 22:58

Very interested in hearing about it and hope it was better than the one on Monday. Thanks for changing your schedule to stay for it.

I hope that they talked about the importance of open communication and creating trust in dealing with folks. I am getting the feeling more and more that the “authorities” tend to want to move directly to models using force to gain compliance. As we saw in some of the presentations on Monday — that doesn`t work. I suggest that all communities have a document that each potential decision maker must sign which states our goals for the ethics underlying the decisions that they will have to make.

Pixie – at 23:36

anon22 -

I think that the single most effective change that could be made right now by the kinds of people you are seeing at your meeting would be to encourage them to begin to move decisively to involve the public health officers of this country fully in pandemic flu preparation.

The public health officers are the link between state and federal goverment and the individual decision makers running our cities and towns. However, in my experience, the public health community has been slow to become enthused about encouraging their communities, and the decision makers they report to, to prepare for a pandemic. Their reticence is not without merrit - if they are wrong, and the pandemic threat eventually evaporates, they fear that their jobs and professional reputations may evaporate also.

How can public health officers be encouraged to move beyond these valid fears? How can they become engaged and be motivated to take the threat of a pandemic seriously, and to advise the leaders of their communities to do the same?

A typical town mayor cannot wear all hats, and must delegate questions of public health to those with that title. This is working against us, at the moment, because most public health officers do not seem to be leading the pandemic preparedness movement. However, it seems to me that if we can manage to effect change in this one area, that it’s reach would be felt in many, many, mayor’s offices in this country. And that, in the end, is where the ultimate local decisions are made, where the funding is allocated, and where plans to prepare for pandemic influenza will either receive a “go” or “no-go” decision. If as many public health officials as possible could be encouraged to urge the decision makers they advise to move towards a “go” decision), action will happen, organization will happen, and lives may be saved. Without the impetus of their public health officials clear advise, though, most local officials will see no problem in continuing to ignore a threat that they have been advised does not really exist on a level that should worry them, and will instead, on that advise, choose to do nothing.

As Revere pointed out recently in an Effect Measure post, there is quite a difference between individual/family preparation and community preparation. A vigorous and effective effort to reach the public health officials of this nation and to encourage them to lead the effort to prepare their communities for pandemic influenza could be a simple and yet highly effective strategy.

26 October 2006

Fiddlerdave – at 02:28

Dennis in Colorado – at 08:56 “That is a fine Socialist plan but 1. The 10th amendment to the Constitution prohibits it” I find the argument of constitutionality of an emergency preparation - like making a power grid that would be adequate to keep our country from becoming a 3rd world nation overnight - kind of amusing less than a week after the suspension of Habeus Corpus, which makes all other constitutional rights a sham (along with numerous other federal butts in state’s issues). However, in the wake of a terrorist threat that has precipitated the immediate buildup of a huge federal agency (Homeland Security), allegedly protecting us from internal and external dangers, can we not wrap our minds and national security around nationally protecting electrical power, whether from terrorist ,pandemic or other system-wide failure (just from is own miserable condition), whatever the means? I suggest nationalization simply because there is no time (in my view) to build it from scratch (a highly preferable solution), nor do I suggest anyone else be prohibited from building their own power grid (generators can be private) with the generous payments I am sure they would get for their current holdings. But with the huge piece of the federal budget going to the “socialist” military defense system (why does no one suggest the feds are too incompetent for that - let’s contract the entire defense out to Halliburton! or that we each should own our own household nuclear devices), protecting our buildings from bombs or attacks is meaningless when simply depriving them of power makes them uninhabitable or useable, for living or for manufacturing goods, services, or defense materials. Our interstate highwy system would be a good model (once again for this purpose the grid could be managed by the states but there is no time to wait for each state to figure it out), and an example of the enormous value of cooperative effort for the survival, and incidentally the advancement, of our country. Our current choice of not being “socialist” in THIS national, essential, survival arena means we are just going to do without power and sacrifice 20 to 60% of the population and even more of our industrial capacity, and THAT industrial capacity, I assure you, the survivors are going to miss dearly.

29 October 2006

lugon – at 12:11

looking at the site of the organisers of this conference - will they publish slides somewhere?

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