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  •  The Brits have a more active plan (none)
    The federal role in such a pandemic would be largely policy-oriented and advisory, Libbey and local health officials explain. The Centers for Disease Control and Prevention would issue technical advice to health care workers, such as what symptoms to watch for in the population, how to administer a vaccine or an antiviral, and which groups of patients should receive treatment first.

    Health and Human Services Department, for instance, would undoubtedly tap its emergency stockpiles of medical supplies that are pre-positioned in secret locations across the United States.

    According to this article in today's Sunday Independent 'Armed police to guard bird flu drugs' they have gotten hold of a detailed plan to deal with a pandemic in Britain:

    Armed police are to guard stocks of drugs used to fight bird flu as part of emergency measures if a pandemic hits Britain, The Independent on Sunday can reveal.

    The drugs will be handed out at chemists and specialist walk-in centres to prevent doctors being overwhelmed by demand.

    The new measures, contained in Department of Health documents, follow a realisation that the health service will be unable to cope as the virus sweeps through the country.

    The disclosure comes as the body of an imported parrot, which died in quarantine from flu, was being tested last night to see if it had the deadly H5N1 strain of the disease which has killed 60 people in Asia. The World Health Organisation fears the strain may mutate to cause a worldwide pandemic, which could kill up to 150 million people.

    Ministers believe a quarter of Britons would catch the disease within three months of it arriving in the country and are preparing for 50,000-750,000 deaths.

    They are stockpiling 14.6 million doses of the antiviral drug Tamiflu, which lessens the effects of the disease and, it is hoped, would save many lives. But they expect GP surgeries to be overwhelmed and panic-stricken people to try to raid supplies.

    Armed police will be ready to guard stocks of the drugs, though the Army will not be called in. "We do not put troops on the street in this country," said one senior source.

    Chemists will be authorised to dispense the drugs and special centres will be set up.

    Experts working for the Department of Health say just half the required number of intensive care beds could be provided if bird flu struck today. Professor David Menon, of the Intensive Care Society, has told a Lords committee that "current ICU resources would be overwhelmed" if just 15 per cent of patients required high-level care.

    Hospital managers have been told to start working on plans to convert operating theatres into makeshift wards to cope with up to 6,000 cases a day.

    A minister said the Government was considering dispatching supplies of the drugs to poultry workers as a preventative measure. "We need to be careful not to provoke panic or hurt industry unnecessarily, but we won't let commercial considerations affect our actions," said one government figure.

    But the Government is poised to reject a plea at an emergency meeting of health ministers in Ottawa tomorrow from Canada and Mexico that each country should donate a tenth of its stockpiles to developing countries to head off the emergence of a pandemic.


    Of course in large part this represents a difference between they way police and medical services are organized in Britain vs. those in the United States.  But one of the disadvantages of our decentralized system in the case of a pandemic is that if there were news, or even false reports, that anti-viral drugs were available in some areas of the US  that were not available in others it could cause people to travel to the hardest hit areas in hopes of getting drugs not available in their area.

    •  the advantage of a decentralized system is that (none)
      local health experts are likely better positioned to deal with this than the CDC, or DHS, and it doesn't put Michael Brown in charge.

      But now is the time to shake out local services, get everyone talking to each other and fire the political appointees (or hire them experienced assistants) NOW, not after the fact.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Oct 23, 2005 at 05:59:17 AM PDT

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      •  And the disadvantages of a decentralized system (none)
        local health experts are likely better positioned to deal with this than the CDC, or DHS,

        Well that is the idea, but there are lots and lots of "experts" out there and we are talking about a situation where it would be important to have a certain amount of nationwide uniformity given the instant communication available and the highly mobile nature of our society.

        But now is the time to shake out local services, get everyone talking to each other

        Well but who is to do that?  And are we talking about state governments, city governments, or the policies of various hospitals?  Who decides that?  And how does anyone find out exactly what has been decided? 

        I see real problems with just waiting for the CDC to just issue some general suggestions on how local organizations and professionals should deal with things.  In particular there is the problem of the national Tamiflu stockpile that the Feds will control.  What will be the strategy on that?  Will it be used for prevention or will it be saved for those who become ill?  Who will decide?   When will they decide? How will that be implemented?  The British plan at least suggests that this has been looked at in a centralized way.  It looks to me like the US government is just passing the buck to "local authorities" in situations where that really does not work.

        •  ah... (none)
          Well but who is to do that?  And are we talking about state governments, city governments, or the policies of various hospitals?  Who decides that?  And how does anyone find out exactly what has been decided?

          It's happening now. The CDC and your state health people have been meeting to finalize the CDC plan... your local hospital and regional disaster preparedness committees have been setting themselves up since 9/11 to deal with bioterror... that system will provide a framework to build on.

          What hasn't happened yet is the drill-down to hospital staffs and your own MD so that everyone knows the plan. That'll take time, too. The CDC plan will be published, then the states will be charged with getting that done.

          How will you find out? Through your state health department web site, probably. But the non-health issues (preparing businesses for personnel and material shortages) has not been done.

          That's where Flu wiki and other local initiatives are needed.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Oct 23, 2005 at 06:56:15 AM PDT

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          •  You know what it all comes down to (none)
            is that conservatives would generally play odds that any possible tragedy might not be so bad and opt for not spending money on preparations while democrats were at one time very motivated when it came to creating the "safety nets" in advance.

            I happen to know some of the people who are working closely with the White House on this one and I think we are all just lucky that they were big GOP contributors and that their businesses will benefit greatly from any spending prior to the pandemic arriving in this country.

            I think the gross ommission from conservative governing at the federal level is not setting up systems that can be utilized by the states.  Think about these preparations like you would the interstate system of highway transport and then one can understand that a federal role is key in helping states.  Think about the "bridge to no where" in Alaska and one can see how the federal role can go so terribly wrong.

        •  This is like Y2K. (4.00)
          No, I'm not about to repeat the canard that Y2K was a false alarm. It wasn't -- it was a serious threat that was successfully dealt with so that it didn't cause the disaster that would certainly have ensued if no action had been taken.

          Bird flu is like Y2K... in that it requires parallel actions by a huge number of separate independent entities that are not used to co-operating with each other or sharing plans.

          The huge PR effort that was needed to persuade businesses small and large that they needed to spend a lot of money examining their old software and either patching it so it wouldn't crash or replacing it or figuring out how to do without it -- or they would be hit with a huge problem when the calendar rolled over, a problem they wouldn't have the time to fix... that effort is now being regarded as "hype".

          Why? Because it worked, that's why. Businesses did, by and large, do what needed to be done. When 2000 arrived, the Y2K bugs that did bite were few enough in number that they could be dealt with by normal troubleshooting procedures.

          Because the actions required were so extremely decentralized, nobody could really know until the time arrived whether enough businesses had done enough of the necessary work. That's why midnight on New Year's Eve, 2000 was such a tense nail-biting moment.

          The arrival of bird flu will be the same sort of moment. The only difference is that there isn't a precisely scheduled moment on the clock when the virus will mutate to cause a pandemic. Oh wait, there's one other difference -- the threat is not to the survival of the organizations that need to take action, but to the survival of their "customers", that is, the general public.

          Still... the same sort of strategy may work to prod them into action.

          Folly is fractal: the closer you look at it, the more of it there is. - TNH

          by Canadian Reader on Sun Oct 23, 2005 at 09:35:56 AM PDT

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          •  Long lead time (none)

            It helped that a lot of programmers knew that Y2K had, by its nature, a long lead time -- the date January 1, 2000 would arrive on was much easier to predict than the first human-to-human transmission of bird flu.  Many of us, in the course of making other software changes during the 1980s and 1990s, threw in code to handle the Y2K transition since we knew it was coming.  It also helped that Y2K problems began popping up in 1997 when people started getting credit cards that expired in January 2000 and systems started having problems.  

            The minute-to-minute operations of power facilities and factories were one area of panic-peddling -- never mind that the software charged with such operations rarely cared about the date, let alone 0000 GMT 1 Jan 2000.  

            Fun fact:  In the minutes after midnight New Zealand time, the international phone lines to New Zealand were overwhelmed because Australians were making sure that the Y2K disaster did not start there.  

      •  PS I'm not defending the system (none)
        since the public health system in the US is in atrocious shape.

        I'm just telling you what to expect.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Oct 23, 2005 at 06:58:59 AM PDT

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