A Journey Through The World of Pandemic Influenza

Truth and Flublogia

Truth can be a peculiar thing. Something that always exists, even if elusive or hidden. It exists even if uncovering it is beyond our ability. A "hidden truth" doesn't preclude its existence, just reminds us of our limitations, or at least should remind us.

Depending on a person's philosophical bent, it can be viewed as relative or absolute, but that is more a reflection of the person as opposed to the truth of a matter. Some "truths", in reality, are nothing more than opinions, subjective perspectives: warm vs. cool, difficult vs. easy, etc.

The oft-quoted last lines from Keats' Ode to a Grecian Urn are not even very truthful:

 

"Beauty is truth, truth beauty," - that is all
        Ye know on earth, and all ye need to know.

 

Sometimes truth can be downright ugly, frightening, hurtful, and/or emotionally traumatizing. There is no "beauty" in that sort of truth, yet, it is still "the truth".

 

There is a lot of truth to search for when someone either comes to the issue of pandemic influenza or becomes involved on an ongoing basis, as the netizens of Flublogia (the cyber flu community, and those who [virtually] inhabit it) have. There are scientific, political, sociological, psychological, economic, and legal issues, to name but the "major players". Thus far, none of them have been particularly beautiful, actually just the opposite – ugly they are – at least when viewing from the vantage point of a severe category PanFlu event.

Flublogia does one thing really, really, well: search for the truth. We don't always find it for varying reasons; it may be beyond our technical means, a lack of insider information, an inability to discern private motivations, or wrestling with an event not yet a reality. But even in our failures Flublogia shines brightest when it is engaged in a strenuous search for an elusive truth.

 

I frequently mention "Flublogia", and generally just parenthetically state "the cyber flu community", but what, exactly, is Flublogia? It is the totality of the cyber resources dedicated to all things Pandemic Influenza, almost exclusively directed at the H5N1 strain. That encompasses the blogs, the authoritative with expert/professional authors, the news oriented, and the analysis – opinion oriented (not "hard" lines of demarcation, as we all have occasional forays into each area), and then there are the Flu Forums.

It is on the forums that the real "grunt work" is performed. Issues and unfolding events are picked apart with a thoroughness that would rival that of any obsessive/compulsive. The netizens who frequent them range from doctors, lawyers, and engineers, to homemakers, and retired grandparents, with everything in between (including snarky ex-cops). Collectively it is an evolving demonstration of co-intelligence narrowly focused but expansive enough to be inclusive of everyone who pulls up a virtual chair.

I have had the pleasure and privilege to meet in the world of brick and mortar a goodly number of Flubies (the flu obsessed). My most recent encounter was when I participated at the IDSA Pandemic Influenza conference where six other Flubies either participants or attended as a means of furthering their own understanding. It was a genuine pleasure to meet people who share the same concerns and driven by the same motivations: become informed, learn, prepare, and help others to do the same.

Each flu forum has its own distinctive "flavor" and "core" participants, although many participate on more than one. Aside from the active posters there are many who are referred to as "lurkers", those who read what is posted but don't participate in the conversations, the silent far outnumbering the "vocal".

Although each flu forum has a genuine sense of "community" about it, I can be found periodically throughout the day, and most nights, participating at P4P. When searching for information finding a place that not only has helpful folk, but also a simple and well labeled structure, can mean the difference between success and failure, and P4P has that handily over many of the other flu forums. What good is information if it is too difficult to ferret out?

However, it is probably P4P's honoring of two things that are very near and dear to my heart that recommend it the most (at least for me): The greatest latitude for freedom of speech, and the highest (IMO) ratio of objective over subjective "truth". The latter artfully balanced (mostly) with the former, and opinion is clearly and unambiguously labeled as such.

This is especially important when attempting to "vet" information: are there implications that we should concern ourselves over, if so, how and why they are meaningful. Because, although I am a person who tends to be the sort that seeks a "core dump" of data, at the very core of that core dump is the "why" of why I am digging through the data: What effect does or doesn't this have on me and mine.

In the harsh realities of "truth", we must be ever vigilant for what Francis Bacon knew well in the 17^th century but we, in our time, fail to either appreciate or never even realize:

The human understanding is no dry light, but receives an infusion from the will and affections; whence proceed sciences which may be called "sciences as one would." For what a man had rather were true he more readily believes. Therefore he rejects difficult things from impatience of research; sober things, because they narrow hope; the deeper things of nature, from superstition; the light of experience, from arrogance and pride, lest his mind should seem to be occupied with things mean and transitory; things not commonly believed, out of deference to the opinion of the vulgar. Numberless, in short, are the ways, and sometimes imperceptible, in which the affections color and infect the understanding.

 

In closing, I will draw upon another favorite quote of mine:

The truth is out there…. And so, that's where I can be found – seeking. And, occasionally, even being reminded that what I find too ugly to believe doesn't necessarily mean it can't happen, or isn't true, or potentially so.

 

SZ

Law Enforcement and PanFlu

According the US Department of Justice [2004] there are more than 800,000 full time sworn law enforcement officers in the US [link]. 2004 being the latest statistics I could find.

Summary findings In 2004 there were more than 800,000 full-time sworn law enforcement officers in the United States

 

Type of agency	Number of agencies	Number of full-time sworn officers
Total		836,787
All State and local	17,876	731,903
Local police	12,766	446,974
Sheriff	3,067	175,018
Primary State	49	58,190
Special jurisdiction	1,481	49,398
Constable/Marshal	513	2,323
Federal*		104,884
Note: Special jurisdiction category includes both State-level and local-level agencies. Consolidated police-sheriffs are included under local police category. Agency counts exclude those operating on a part-time basis. *Non-military federal officers authorized to carry firearms and make arrests.

What these statistics don't show is that roughly half of the total are employed by departments of less than 100 officers, or that only about half of the state and local sworn officers are in positions where they respond to calls for service [LEMAS2000].

Also from LEMAS2000, the latest published survey:

• On average, larger municipal police departments employed 22 full-time sworn personnel per 10,000 residents.
• County police departments and sheriffs' offices employed an average of 11 and 10 officers per 10,000 residents, respectively.
• State law enforcement agencies employed an average of 2 officers per 10,000 residents.

A breakdown of personnel is found on page 16 should curiosity inspire a slightly more informative breakdown. When considering police officers one must account for the twenty-four hour nature of law enforcement as well as days off.

When I speak about our LEOs (Law Enforcement Officers) during a time of severe pandemic influenza I assume operations at an emergency response footing, i.e., 12 hours on – 12 hours off, no days off, shift staffing. But even with that it's easy to see there are not a lot of spare LEOs on average to go around.

Furthermore, as a general rule most departments have sworn officers unfit to perform "street duty", whether due to advancing age, declining health, or service related injury. Under normal operations they fill the slots that don't require physical aptitude but still need to be filled. During an emergency being a "sworn officer" does not equal "being deployable on the streets" since potential physical demands will be even higher than they are normally.

Additionally, one only need do an internet search for "police staffing shortages" to get a glimpse of the depth and breadth of the problem of recruitment and retention departments all across the US are facing (examples: here and here, contrarian: here).

You may be asking yourself Why would all of this relative minutia be of interest to someone other than a "numbers kinda gal"? Simply: When we need or want a police response, we need or want one.

During an influenza pandemic planning assumptions focus on 30 – 50% staffing shortages across all sectors and segments of society due to illness, family illness, or fear of infection. There is no reason to assume the statistic will be much different for our police. Conversely, there is reason to believe it may be worse, my more thorough analysis of the underlying issues can be found here.

 

A severe pandemic defined by the US Centers for Disease Control (CDC) as 30% of the population falling ill and 2% or more of those having fatal outcomes. Should the world experience a severe influenza pandemic our Law Enforcement agencies will be tasked with not only their traditional roles, but new ones as well, driven by the health emergency.

 

The prospect of responding during a time of civil crisis with a chronically understaffed force, suffering the same (or worse) attrition as the general workforce, is one I find disturbing. Our police have a fiduciary responsibility to the community they serve, but that community has a reciprocal responsibility to give them the means to accomplish theirs.

Lest you view me as an overwrought alarmist here is a snip from The role of Law Enforcement in Public Health Emergencies (2006) [pdf link], a joint effort of The U.S. Department of Justice, Office of Justice Programs' Bureau of Justice Assistance (BJA) and the Police Executive Research Forum (PERF):

In a large-scale incident, such as a pandemic, law enforcement resources will quickly become overwhelmed, and law enforcement officials will have to balance their resources and efforts between these new responsibilities and everyday service demands. All of this may have to be accomplished with a greatly diminished workforce, as officers and their families may become infected and ill, and some personnel may determine that the risk of continuing to report to work is just too great to themselves or their families. A department's ability to respond effectively to any emergency—public health or otherwise—greatly depends on its preparedness, and this is directly linked to the law enforcement agency's planning and its partnerships. [Emphasis added]

One of those "partners" is the public, and the public should demand that even during a pandemic all means to ensure an effective police response are in place since only the pre-pandemic phase affords the opportunity to properly prepare – during is too late, way too late. Because, after all, when we need or want a police response we need or want that response, and excuses for inability to provide one are not only hollow but also carry potentially human life price tags.

Of course as the mother of a patrol officer for a small city, I have a very selfish reason to advocate for PanFlu prep by our law enforcement agencies: my only child's ability to perform his fiduciary responsibility without it costing him life or limb unnecessarily. That means he must be adequately supplied with Personal Protective Equipment (PPE), such as disposable infectious disease barriers (masks, rubber gloves) and copious amounts of alcohol based sanitation gels to last the length of the pandemic. It also means that his department must not assume more roles than they can perform, and have adequate staff to perform those that they will perform.

I would love to be able to report that his department meets those criteria, unfortunately I cannot. Sadly, I don't anticipate ever being able to report their attaining those three items. So I would suggest that if/when a severe pandemic strikes you not call your local police… you wouldn't want to hear their excuses and the phone might just go unanswered anyway.

 

SZ

Reprised -Mixed Messages: Thermometers and Mass Graves

I originally posted this back on April 18th but since I have been on such a rant about "The Message" I thought I would recycle it - just to make my point on the communications the public is being offered. My indignation has not lessened over these few months.

[Previously posted 18Apr08]

There are times when I find it difficult to remain gracefully dispassionate, especially when I come across something that I believe to be not only egregiously ignorant, but also a danger to the public. What makes today's topic so angering is the latest on the Influenza Pandemic front out of Ireland.

From IrishMedicalNews.com:

Flu medication stock-up advise

For all Ireland's high profile stocking up on antiretrovirals, each household will be urged to have the humble thermometer and paracetamol or ibuprofen in the event of a flu pandemic, according to a new Government handbook.

An introductory handbook on the Government's emergency planning plan, distributed recently to households across the country, says that while there will be more worldwide flu pandemics, the time and severity of their occurrence and the age groups on which their impact will be most severe cannot be predicted.

However, every household in the country will receive a leaflet before the pandemic reaches Ireland advising the measures including stocking up on a thermometer, paracetamol/ibuprofen, that should be taken. The Government will advise citizens to begin these preparations if and when the WHO confirms that a pandemic is imminent.

The guide also advises buying enough food and other supplies in advance of the pandemic to last "you and your household for at least one week", and advises awareness of hygiene measures to prevent infection.

Under the plan, the handbook says it is essential that people with flu symptoms stay at home while the indications persist, unless they receive other advice from a telephone hotline, which will be set up to provide advice and support, or from official Government announcements through the media.

The PDF of the handbook may be found here for those who wish to verify, as I did, that this is not a misquote but what is really being said.

Advising action only after the WHO declares an Alert Level Four pandemic threat will no doubt ensure that just about every household in Ireland will be out trying to purchase supplies at exactly the same time. As someone who is threatened with hurricanes on a regular basis I can attest to what it is like when many people attempt to buy the exact same supplies at exactly the same time. There just isn't enough supply to meet demand.

However, the entire timing strategy could prove to be naively misguided as publicly Ireland's Office of Emergency Planning is telling everyone that there will be time for everyone to become prepared (buy that thermometer and fever reducer). What if there's not?

What if an influenza pandemic bursts upon the world much as SARS did in 2003? Not an unreasonable question as influenza spreads much easier from person to person than SARS did, and we could find ourselves in the grips of said pandemic even before WHO has time to verify and announce its arrival.

Well actually, Ireland does have plans in place to deal with an unprepared public should a severe pandemic befall the world. This from NewsLetter.co.uk February 9, 2007:

Straw poll on grave crisis

A straw poll among district councils across Northern Ireland
yesterday revealed they are planning for at least 20,000 extra
graves to cope with a possible flu pandemic. Ian Starrett, Johnny Caldwell, Laura Murphy and Philip Bradfield report on how different councils are managing.

Continues….

Since the advice given to the Irish people, diligently mailed to every household, is so meager, and by any logic ridiculously inadequate, it's a good thing the district councils have planned to bury so many.

But it begs the question: Why is the official assumption that they will need those mass graves and yet the only advice they are giving their citizens is to purchase a thermometer and fever reducer? Would it not be wiser to advise people to stock up on a few more weeks of food so they don't have to be out and about possibly becoming infected, and a few more medical home treatment items?

Could it be that Ireland's Office of Emergency Planning has decided that the only effective action any citizen can effect is to depend on the Office of Emergency Planning? And that when they are exhausted and depleted it's just easier to toss the flu victims into those well thought out mass graves? Do the planners in the Office of Emergency Planning think their constituents are that stupid and personally incapable as to have no need of genuine guidance and advice? It certainly appears that way to me.

Officials are preparing for the range of severity of a potential pandemic, from mild-to-severe; meanwhile they are telling the public it will be little more than an inconvenient case of "the flu". Well, OK, they are not saying that explicitly, but it is what their message implies.

I would suggest that the citizens of Ireland politely suggest where the Office of Emergency Planning can stuff those thermometers.

SZ

Yet another lesson from history

Today is the Fourth of July, the day Americans celebrate the anniversary of our declaration of independence from Britain in 1776. Even though I'm not much for holidays, the 4^th is a holiday that never fails to inspire and awe. As a casual student of history the time surrounding America's founding holds special fascination, the entire world in flux, often violently so.

We have the Founding Fathers to look to as the astutely adept leaders and nurturers of America's nascency. Fascinating in themselves, brilliant, erudite, complex and far from perfect. I often look around wondering where are our modern equivalents to Washington, Jefferson, Franklin, Payne, Adams, – well, you get the point. For the record: I'm fairly confident that I probably made a post such as this last 4^th of July, yet I've still not found them.

Where are our leaders who believe such as this:

I love the man that can smile in trouble, that can gather strength from distress, and grow brave by reflection. 'Tis the business of little minds to shrink; but he whose heart is firm, and whose conscience approves his conduct, will pursue his principles unto death.

Thomas Paine, The American Crisis, No. 1, December 19, 1776

Our leaders today not only don't believe such as the above, they would find the concept threateningly alien. No, today our leaders, at every level, only wish to preserve themselves and hope the house of cards doesn't come down while they are tucked up under its roof. Most of our leaders shrink from committing their names and office of authority to making the public unambiguously aware of the potential threat of pandemic influenza and what we should do (minimally) to educate and prepare ourselves, after all, it may not happen, or may not happen too soon, or may not be too bad….

These leaders make a gamble that the pandemic will hold off long enough to occur during someone else's term. That would be fair enough, and I wouldn't grouse, if their inaction and failure to uphold their public obligations only affected themselves and their families. However a pandemic, by its very nature and definition affects the entire world, and that includes every person – every man, woman and child – within the confines of their jurisdictions.

It's not like those on the federal level have no experience with those further down the food chain and their proclivity for intransigence, self-serving myopic policies, and ignorance over how what happens locally (or at the state level) can, and sometimes does, affect, or place at risk, the entire nation. No, there's our entire history as a nation of experience with it.

This snip from Lance Banning's From Confederation to Constitution: The Revolutionary Context of the Great Convention [pdf here, and a recommended read in general]

Liberty in Peril During the 1780s, in other words, the feeling grew that liberty was once

again in peril. Alarm was most intense among the men whose duties, education, or experience encouraged them to pin their patriotic feelings on the continent as a whole: certain members of Congress; most of the best-known revolutionary thinkers; most of the former officers of the continental army; many merchants, public creditors, and other men of wealth. Men of social standing were distressed with the way in which the revolutionary principles of liberty and equality seemed to shade into a popular contempt for talent or distinction. Too often, to their minds, the best men lost elections in the states to self-serving, scrambling demagogues, and the revolutionary constitutions made it far too easy for these demagogues to set an ill considered course or even to oppress the propertied minority in order to secure the people's favor. Continued confiscations of the property of people who had sympathized with Britain and continued use of paper money, which threatened men's investments and their right to hold their property secure, were grievances of particular importance to those who had investments and positions to defend.

 

And yet the sense of fading hopes and failing visions was not exclusively confined to men of wealth. Anyone whose life had been immersed in revolutionary expectations might share in the concern. Every state seemed full of quarrels. Every individual seemed to be on the scrape for himself. No one seemed to have a real regard for common interests, a willingness to recognize that selfish interests must be limited by some consideration for the good of all. Public virtue, to use the phrase the revolutionaries used, seemed to be in danger of completely disappearing as every man and every social group sought private goods at the expense of harmony and other people's rights. But virtue, revolutionaries thought, was the indispensable foundation for republics, without which they could not survive. If public virtue was collapsing, then the Revolution was about to fail. It would degenerate into a kind of chaos, from which a tyrant might emerge, or else the people, in disgust, might eventually prefer to return to hereditary rule. So, at least, did many fear. Guided by the same ideas that had impelled them into independence, they saw a second crisis, as dangerous to liberty as the crisis that had led them into Revolution. As they had done in 1776, they blamed their discontents on governments that lacked the character to mold a virtuous people and fit them for their special role. Once more, they turned to constitutional reform. They saw in the problems of the Confederation government not merely difficulties that would have to be corrected, but an opportunity that might be seized for even greater ends, an opportunity to rescue revolutionary hopes from their decay.

 

I would hazard the guess that there probably isn't a Flubie in Flublogia that wouldn't recognize those words as they relate to PanFlu. And how apropos that a piece from today decries a generalized lack of vision and passionately felt resolve:

 

Bootstrap resolve 
By Michael F. Raczko 
Special to Toledo Free Press 

As Americans ask more and more, "Is everything spinning out of control?" perhaps it is time to discuss "resolve" … how we grabbed it, what were some of the incredible accomplishments we achieved because of it, and are we experiencing a "national lack of resolve"? 

 

[snip]

 

What Halted Our Resolve? 

The resolve to place men on the moon was probably the last large-scale focus that jump-charged the American everyman. Even in the 1960s, as the Apollo spacemen practiced their drills, our focus was clouding. A long war in southeast Asia, campus unrest, the assassination of some of our best and brightest leaders, national scandals…..all were brought into our homes with instant 24/7 news and analysis. Almost overnight, the actions of celebrities became more important than reducing the national debt or providing an effective health care ystem. Resolve came to mean filling the jails with casual drug users or introducing complex regulations that prohibit the quick (and virtually invisible) one-second look at an entertainer's exposed breast. Resolve is still a part of America, but it has been scattered to and embraced by fringe groups that inhabit both sides of the political aisle. 

Bootstrap Resolve 

Are we spinning out of control? Can the American spinning be slowed…..maybe even stopped? What will it take to re-ignite resolve? Will it take a major international incident, another 9-11, a killer pandemic? Perhaps that resolve can come from leaders who inspire and motivate…..leadership spawned from the business world, the academic world, the world of those who govern. 

And most importantly, do we have it in us to personally grab "bootstrap resolve" and carry it toward a brighter future? A future that is not spinning out of control. 

 

 

We are an era in desperate need of leaders such as Jefferson, Payne, Franklin, and Adams. Will America's upcoming elections prove to be fortuitous in both timing and benefit or just more of the same?

 

 

Time – the coin of the politician's wager: It will not happen on my watch! Let the sucker who follows expose their neck to the risk of the unknown and unquantifiable that requires the public to actually take responsibility for themselves.

 

That's the unambiguous message: The government (at whatever level) can't make us safe, and they can't take care of us should a pandemic happen. We must shoulder that responsibility ourselves. But, that would be a very unpopular message indeed.

 

Although the threat message does trickle out, it is usually sugarcoated with announcements of plans and plans to formulate a plan for what they are going to do. The next sap can tell us what we must do. At least tell those who are cognitively biased with a need to be told – with specificity. Since there is no way to know who operates with those biases that means everyone must be told. And that means that every person who occupies a position of public leadership must deliver the message.

 

 

No more hiding under the house of cards, that stack of coins might well be nearing an end, and some bets are just ignorantly foolhardy.

 

 

SZ

What’s right with this picture?

There is a major cyber conversation going on at FluWiki about the failure of message that is pandemic influenza. Aside from the fact that message delivery is of interest to all those who take the message forward, it is interesting to me because I find the concept unpinning the various statements to be interesting in itself.

Everyone looks for someone to blame when things don't go the way we would wish them. That's only human nature. But fortunately for us humans, generally there is someone who has earned the right to bear the blame, even if it's only ourselves, though rarely will we point our finger there. Of course, that too is only human nature.

I have found fault with just about every segment involved in the PanFlu message arena in most of my recent posts, because I think there is blame to be spread around.

The difference with the FluWiki diary is that, in one of the few instances I can specifically reference, the people pointing the finger of blame are also the ones working tirelessly (even if not as successfully as hoped for) to remedy the problem(s), shortcoming(s), and complete failure(s). And that is decidedly not human nature.

I may not agree with everything said but important points are being made, even the ones I'm not in total agreement with.

 

Flublogia is an infinitesimally small segment of the internet, with a shrinking population of netizens. Of this intrepid few even fewer actively strive for the "greater good" instead of being absorbed in personal motivations or the Flubie [a flu obsessed netizen] equivalent of voyeurism.

One of the posts directly invokes the spirit of my nation's founding (celebrated tomorrow, and my all time favorite holiday) and I was strongly reminded of something from Joseph Ellis's Founding Brothers:

[…]The politics of the 1790's was a truly cacophonous affair. Previous historians have labeled it "the Age of Passion" for good reason, for in terms of shrill accusatory rhetoric, flamboyant displays of ideological intransigence, intense personal rivalries, and hyperbolic claims of imminent catastrophe, it has no equal in American history. The political dialogue within the highest echelon of the revolutionary generation was a decade-long shouting match.

Proof that a group of smart, dedicated, passionate, audacious people, though small in number, can accomplish what prevailing wisdom said was a fool's mission, even with a bit of ideology and hyperbole tossed in – which might explain all those Flubie voyeurs out there.

 

SZ <on the eve of America's Birthday: hat tip to ya Ol' Gal>

Credibility and Cognitive Biases

Significant news on the PanFlu and H5N1 front has been rather slow, mostly just more of the same. More plans coming out, more plans to plan, more chickens and ducks dying, more statements of "we've made progress but there's much left to do", and Indonesia's Health Minister Supari is still being most frustratingly obstinate.

Most of the news of note has been about everything but PanFlu or H5N1. Floods, soaring fuel costs, scarcity of food, politics, the US Supreme Court's ruling on the Second Amendment, the findings coming in from the Mars lander Phoenix, an ice-free Arctic this summer. On and on.

The world is a busy, busy place with many important things, some crucially so, intruding upon our limited time and attention spans.

My own life has once again taken an unexpected turn. This past Monday I assumed the Accounting Manager's position as it again became vacant. It has taken a bit of "extra attention" this week as the department undergoes some rather significant reorganization. Since we do not have to hunt a replacement, nor suffer as we train them, this transition, the third this year, is going quite smooth and already showing very positive results – even if I say so myself.

Just as I seemed to be unable to escape taking on a role that I did not want, nor seek, I have been unable to escape a recurring theme of late:

Credibility.

The credibility of our public officials. How the public perceives the credibility of those who advocate on the PanFlu issue. The credibility of the message itself. Who has credibility to parlay into results. Who lacks credibility. Who risks their credibility by speaking up in ways counter to the officially sanctioned public message.

What struck me very recently – no, what knocked me square in the solar plexus, was the realization that those who professed concern for credibility didn't express the same, or for that matter – any – concern for truth or intellectual rigor.

When I made the choice to become actively involved in the pandemic issue I chose to view the public as capable of accepting that a range of potentials existed. Ambiguity, a dearth of hard facts, and evolving knowledge notwithstanding, I believed, and still do, that what we do know deserves to be openly discussed and dissected, and doubly so for what we don't know.

[…]In some cases, people can exert direct personal control over the risks they face (e.g., through diet or driving habits). In other cases, they can only act indirectly, by influencing social processes (e.g., the allocation of law enforcement funds, the enactment of environmental legislation, the siting of hazard facilities). In all cases, they need a diverse set of cognitive, social, and emotional skills in order to understand the information that they receive, interpret its relevance for their lives and communities, and articulate their views to others. They can acquire those skills through formal education, self-study, and personal experience. However, as diligent as they might be, individuals are helpless without trustworthy, comprehensible information about specific risks.

[…]Effective risk communications require authoritative and trustworthy sources. If communicators are perceived as having a vested interest, then recipients may not know what to believe. They may accept the message at face value or reinterpret it in ways that attempt to undo perceived biases. As a result, the impact of communications will be blurred, and the communication process further complicated. Not knowing whom or what to believe can make risk decisions seem intractable (Fischhoff, 1992). Such confusion and suspicion can erode relations between experts and the public, as well as open the door to less credible sources. Such failures of communication can be deliberate, as when communicators attempt to manipulate the public or simply fail to take their duty to inform seriously. However, they can also be inadvertent, as when communicators fail to realize the complexity of their task or the opportunities for failure.

[all emphasis added]

Risk Communication: A Mental Models Approach Morgan, Fischhoff, Bostrom and Atman

 

We all understand that credibility is crucial, whether we are the recipients or the deliverers of an important (potentially life effecting message), but how do we measure it? Do we trust those whose job it is to inform us? Do we trust those with letters trailing their names? Do we trust what a famous celebrity tells us? Do we trust a snarky ex-cop-cum-accountant?

I've chosen whom I view as credible and knowledgeable, and yet even with the information they provide I always – always—run it through my own logic filters. Most times that serves me quite well. On occasion, however, my logic filters don't perform as well as I would like or assume, since like other human beings I have cognitive biases. And, yes, the last I checked I really was a human being.

As I have journeyed I have recently had to come to grips with the cognitive biases I am prone to, even if only in hindsight. Since I have become hyper-aware of how my own shape and inform me, I have also become watchful for them in others.

Being alert to the things that underpin words, I have become aware of a disturbing tendency:

When people begin to spout off about their credibility or the perceived credibility of the PanFlu threat that consistently translates: "I've watered the message down so I'm not judged a scaremonger, my credibility is more important than the truth. Besides, the public is too stupid to effectively handle it so why should I risk my own credibility?"

I don't view the public as stupid, incapable of understanding the myriad facets of all a severe influenza pandemic would likely entail. I have believed most have made conscious choices on the threat of a potential near future severe influenza pandemic. Just as I have made conscious choices on the issue; choices of what and who to believe, what and who to dismiss. But, ya'll out there have cognitive biases as well, so maybe the choices weren't so "conscious" after all, or at least to the degree that I generally go on about (latest here).

This communication thing is far more complicated than I ever knew and I'm learning fascinating things as I feverishly try to address my own naive communication skill-sets. As I've come to understand it I am a "core-dump" person when it comes to information assimilation. That means I want "The facts, all the facts, and nothing but the facts". Which, not surprisingly, shows up in what I have posted over the course of this blog's couple of years of existence.

And that brings me back to credibility: Given my "core-dump" mentality I don't view a "fact" as having credibility – it's a fact after all. And when it's not a "fact", that means it's an assumption, presumption, hypothesis, supposition, extrapolation, or out-and-out guess. Of course, I am assuming the information is promulgated in good faith thus no need to account for lies, falsehoods, half-truths, and anything deliberately misleading.

It's unfortunate that much about what a future influenza pandemic has in store for us resides in the "other than fact" column of the ledger. As a result, the weight we give "other than facts" is highly informed by our perceptions of the credibility of the person making the claims. That is not a bad thing, in fact, that is a very useful and serviceable "logic filter" in and of itself.

I am quite comfortable in "the land of presumption" given my years in law enforcement. In court proceedings things are often presumed factual until proved not: a rebuttable presumption. The most well known example is a defendant's presumption of innocence until proved guilty.

Science has something of an equivalent:

[…] Scientific realists acknowledge (in fact they insist) that scientific knowledge is always provisional, always subject to revision if better evidence is discovered, and most of them have no quarrel with the thought that social factors and extraneous agendas can shape priorities, lines of enquiry, funding, education, and the like.

Why Truth Matters (Benson, Stangroom 2006)

 

I do not find fact and presumption (or hypothesis, logical assumption, inference) untenable dichotomies, even with a "core-dump" mentality, but rather necessary correlates in our search for understanding. Perhaps this also explains why I have no "credibility issues" when I post and discuss what we do know versus what we think we know. To me "being wrong and willing to be proven so" is a wonderful part of the process – it protects us – allowing us (hopefully) to get past the ego to continually search for more perfect understanding, and on those rare occasions to go from postulate to indisputable fact.

But what happens when the person informing us of something so heavily burdened with "other than facts" is also quite consciously guarding their credibility?

We get silence.

Many can't admit, even to themselves, that the watered down message, or outright silence, is self-serving. No, instead, they blame the audience: The public is too stupid to understand, much less channel that understanding into anything other than blind panic.

I'm not certain about anyone else but I tend to be insulted when someone thinks I'm stupid. Even if it's only an ego-protective self-serving cognitive bias on their part.

Personal Preparedness

This blog is pretty much all about the potential threat of a severe influenza pandemic as I see it, and the "why" behind my belief. I don't write a lot about preparedness, only that we need to be prepared.

You see, the way my brain is wired, if I am threatened I take action, which, in the case of PanFlu, meant educate myself on the issues and stock my family's needs for several months of self-sufficiency. To me becoming personally prepared was axiomatic.

Oh, and yes, I said "several months of self-sufficiency".

 

I recently had a discussion with a Fellow Flubie (we, the Flu Obsessed) and I made the off-hand comment that I was not a "prepper", (someone who believes in self-sufficiency against life's unfortunate vagaries, as a way of life), and further that "prepping" didn't hold any fascination for me. This person looked at me as if I had suddenly morphed into an alien being. You see, this person knows the level of preparedness I have attained and my words didn't match up (in their mind) to my known actions.

Am I "quibbling" over a label? I don't think so. I don't view "being prepared" as a way of life, I view it as a positive action in the face of a quantifiable threat to my life and wellbeing, and, more importantly, to that of those I love and cherish.

That doesn't make me a "prepper", and that sure doesn't make me a survivalist as some might be tempted to label me. It makes me a responsible member of my community.

As someone who will not be attempting to gain access to food and services which may be very limited and strained, if not totally depleted, I and my family will not be contributors to a public crisis.

Since I will not be occupying my time with attempting to find food and water during a time of likely supply chain disruptions I will not be out risking infection and bringing that infection back among my family.

By not having to be out in public to secure life sustaining supplies and using up my supply of personal protection equipment (PPE) as I attempt to guard myself from infection, I will, should the need arise, be free to help those around me and in my community, better utilizing that limited supply of PPE I have stashed.

Since I am a trained First Responder, though many years stale, there may be a small but critical role I could perform, thus freeing up the more current and valuable personnel. In times of crisis there are parts we all must play: sometimes that's just staying out of the way, and sometimes it's contributing in whatever small way we are capable.

That is what personal preparedness means to me, and that doesn't make me a "prepper". It makes me a responsible citizen.

Pandemic vs. All Hazards preparedness

I make no secret of the fact that I feel including the threat of a severe influenza pandemic in the All Hazards approach to preparedness to be short-sighted and egregiously ill-informed. To say nothing of intellectually lazy and criminally negligent.

First is the obvious, at least to me: a severe influenza pandemic will be like no other disaster this country, my country, the United States of America, will face. There are unique issues and unique problems not inherent in any other known threat save a general and widespread nuclear attack.

Instead of preparing for a severe influenza pandemic and thus ensuring a strengthened response to any other disaster we could face, we have strengthened our capacity to respond to other disasters and lumped a severe influenza pandemic among them.

Now, I am inspired to say that most people might not see the problem there. After all, being prepared is being prepared, no? To that I say: No. Emphatically.

Glad you are asking why…

As I stated above, only a general nuclear attack would cripple the entire country like a severe influenza pandemic will. Every other disaster or threat would be far more localized, even if resulting in a vast number of casualties/fatalities. The region specific crisis would allow other parts of the country to lend assistance and so the region in need would only have to hold out until help and material arrived (officially 24 – 96 hours). During a severe pandemic there would be no help from outside our respective regions, perhaps not even from outside our own communities.

All other disasters and threats are not only "finite in space" but also much more "finite in time". A pandemic, on the other hand, may affect a community anywhere from eight weeks up to two years, although at varying degrees of overall community threat and crisis. It's why the personal preparedness message geared toward All Hazards carries a general "two weeks of food and water". That is the official assumption of the time frame a person/family would potentially need to be self sufficient during times of disaster recovery. And for every other disaster that is generally good advice.

During the pandemic of 1918 the vast majority of death and illness was concentrated in one 12 week stretch; the rest of the eighteen months saw vastly lower levels. But even if we only considered the 12 weeks to be our personal and community's "threat window" how does being self sufficient for two weeks prepare us for those twelve? What, exactly, are we to do for the other ten?

Those touting the two week recommendations may have some explaining to do on the other side of a pandemic if it happens sometime in the near term and it happens to be severe. Let me rephrase that: Those touting two weeks will have some explaining to do.

 

My second issue with the inclusion of a severe pandemic in All Hazards is a bit more complicated but I feel the more important.

As stated above a severe influenza pandemic presents unique challenges and unique threats. It is also a complicated issue because so much is unknown and much is unknowable until the time comes that we find ourselves existing within the pandemic.

The first thing that one must come to grips with is the stark reality that we may face a pandemic even worse than that of 1918, the last severe human pandemic. Much debate is ongoing about whether H5N1 must attenuate its current virulence in order to attain sustained human-to-human transmission capability. Granted, a pandemic worse than 1918 is not the most likely, or so our best minds tell us. But as I often say: Not likely doesn't equal impossible.

Within that issue we have embedded the issues of how rapidly the virus would lose virulence once it began circulating in humans, given that humans are not the natural host, wild waterfowl are. How many will become ill? Planning assumes approximately 30% of the population will acquire symptomatic illness (have symptoms of illness), but that may be wildly optimistic in an unmitigated pandemic, and may even be on the optimistic side for one that is.

These issues are critical to planning and preparations and it takes tackling at least some science to arrive at reasoned answers.

 

One need only glance over these charts (here and here) from the report Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations (found here) published by the journal Chest to begin to see that a severe pandemic is inherently different. Please note the times estimated for critical care and mechanical ventilation, as well as the length of time before outside assistance could be expected to arrive on scene. Then, for a truly eye-opening read I recommend the report itself. It is a report that I would make mandatory for anyone involved in any official level of pandemic planning.

 

Which brings me to the crux of my issue #2 with the All Hazards approach to pandemic influenza preparation:

By including a severe pandemic with all the other threats we may be at risk from we have allowed our public officials to not put in the time to educate themselves on the myriad and interwoven unique issues. We have allowed them to not make the tough and expensive and concrete choices that would be morally demanded of them if a severe influenza pandemic were an issue that stood on its own threat merits.

We have allowed them to do just enough so they can say they did something, all the little "somethings" that don't require sticking their tender necks out by specifically committing funds and actions toward what is (currently) labeled a low probability/high impact event.

 

I will again quote (slightly out of context) HHS Secretary Leavitt's Pandemic Planning Update V:

Since our last Update, we have entered a new phase in our preparations. The milestones are farther apart but no less significant. We are now tackling some challenging issues that can only be resolved with the collaboration of the full range of stakeholders — State and local officials, public health and medical professionals, religious leaders and ethicists, the business community, organized labor, non-governmental organizations, and individuals from all walks of life.

This quote is out of context because he is referring to the need for further planning, and I say it's time to start tackling and addressing the issues themselves. It's time for that proverbial rubber to meet the roads. In order for that to happen the pandemic issue must be extricated from All Hazards and addressed with the specificity it requires.

Secretary Leavitt closes his update:

We don't know if the H5N1 virus will spark the next pandemic, but we know that it's just a matter of time before something does. There is simply no reason to believe that this century will be different than any past century. The difference now is that we better understand the threat, so we can increase our preparedness for a pandemic before it comes, in order to diminish its potential impact.

The Federal government cannot mount an effective response to the threats that we face as a nation without partners at every level of government and throughout society. It is every American's continued commitment that will make our country a safer and a healthier place.

That last sentence brought a chuckle (albeit a cynical one). Sure couldn't prove that by our demands for actions from our officials and leaders thus far. And since we, the "every American", are quiet, our officials and leaders are happy to be just as quiet and inattentive. We have, after all, given them our permission to be so.

 

SZ

We all make choices

There are generally only five groups of people who trumpet the potential threat of a severe influenza pandemic that H5N1 poses. Those are governments, some scientists, the media, the World Health Organization (WHO), and the cyber flu community, otherwise known as "the flu obsessed" or "Flubies".

Interestingly, those groups encompass three important segments of a society: government, media, and the citizenry.

I get into degrees of "snit" when I read someone's post on one of the flu forums that bemoans "people not being told" about the threat of a severe influenza pandemic and the requisite actions required to be prepared to meet that threat. Depending on how operative my very small supply of patience is that day is reflective of how bad the snit is.

People are exposed to "the message" nearly every day, and in 2006 it was many times a day in nearly every communication medium and venue in existence, at least in the US.

The message consists of the possibility that we will experience a pandemic in humans of H5N1 avian influenza, and that the pandemic may be severe. Severe is officially defined as a pandemic with approximately 30% of the population falling ill and 2% or more of those dying. In the U.S. those figures 30%/2% translate to 1.9 million deaths.

It is because the message carries ambiguity that people tend to not "hear" it, it's not because they aren't being told in the first place. The message must contain the high level of ambiguity that it does because we don't know if H5N1 will cause the next pandemic (it may be some other pathogen) and we don't know how severe the next pandemic will be if and when it arrives.

We, those that concern themselves with the issue of an influenza pandemic, can only deliver the message; we have no control over whether folk choose to "hear" that message. An example from today is found on the UK's Timesonline :

 

Armed Forces could not help civilians in flu pandemic

June 14, 2008 Michael Evans

The Armed Forces would struggle to cope if the country was hit by a pandemic flu, with more than 50 per cent of military personnel laid low, an internal Ministry of Defence document indicates.

The Royal Navy, Army and RAF would be so badly hit in the "worst-case scenario" because of their close working environment, particularly on warships, that no military personnel would be available to help the civil authorities, the study says.

"The priority ... will be maintaining critical military operations with little or no spare resource to provide military assistance to the civil authorities," says the internal MoD document, which is in the form of a guide for defence personnel.

In past crises, ranging from floods and foot-and-mouth disease to national strikes by firemen and petrol tanker drivers, the Armed Forces have played a key role in assisting the civil authorities.

However, with dire predictions of heavy flu casualties - up to 750,000 deaths and more than one million people needing hospital treatment - it is accepted officially that the Armed Forces would have to spend all their time ensuring that there were sufficient personnel to carry out basic military tasks and maintain operations abroad.

Experts have predicted the inevitabiity [sic] of another flu pandemic - there have been three global outbreaks in the past 100 years - and that it might come in several waves of three to six months over two years.

    [All emphasis added]

There is absolutely no way that I accept the premise that people are not being told of the potential threat. I cannot, not with the evidence my own eyes see every single day, and have seen for several years now. Those that believe "the message" is being withheld from "the public" not only believe the withholding to be fact, but, sadly, and embarrassingly, they believe it is being withheld for a reason.

The reasons posited generally run "we don't want to panic the sheeple", or "let's not upset the economic status quo", or "it would cause financial markets to suffer". Since I argue that the message is not being withheld, I don't feel it necessary to refute the reasons given for such withholding.

 

Of course, people are free to believe what they believe. It's true for those who believe the message that a potential severe influenza pandemic is a genuine threat and it's true for those who choose to believe there is no threat. But make no mistake—it's a choice. Some have made that choice with conscious deliberation and some have not, instead they make something akin to an intuitive leap of belief—or disbelief—without any intellectual rigor or analysis. That is their right as free-thinking (or not) sentient beings.

But let's not assign fault or malfeasance to others for the choices made by those we, the flu obsessed, would want to believe as we believe: that a future severe influenza pandemic is possible, the threat doesn't necessarily exist in the remote future, and there are concrete things we ourselves can do to mitigate the severity on a community as well as personal level.

To state it plainly: should a severe pandemic happen it's all about your community and your personal situation. They are intimately and inextricably intertwined.

 

 

Choices—we all make them.

 

SZ

It’s the Community Stupid

It would be easy to assume we know all there is to know about "the flu". The reality though is we don't. In fact, some of what we thought we knew has proven to be wrong or partially wrong, and with every new finding we also find new questions that need to be answered.

Our ignorance is also demonstrated in our attempts to prepare to meet the real challenges a severe pandemic would present. It's understandable that we don't know what would be the best thing to do (known as best practices) very few alive have experienced a severe pandemic since the last one began in 1918.

 

This blog carries a quote from Health and Human Services Secretary Michael Leavitt from the early part of 2006: "Any community that fails to prepare with the expectation that the federal government will come to the rescue will be tragically wrong". That was over two years ago. Since then the amount of time spent just wrangling over what will be needed and who will be responsible for said "whats" is staggering. And that wrangling is still ongoing.

This from A Report from Secretary Michael O. Leavitt March 17, 2008

[snip]

State and Local Preparedness

 HHS has stressed repeatedly in State pandemic influenza summits with governors and in numerous other meetings that preparedness for pandemic influenza must be a shared responsibility among governments at all levels, the private sector, and individuals. To the extent that potential partners refuse to apply their talents and assets unless the Federal government foots the bill, they are abdicating their responsibility and thereby placing their communities at higher risk than need be.

Since 1999, HHS has provided funding to State and local public health departments to enhance their preparedness for naturally occurring, accidental, or terrorist-induced emergencies. This has included strengthening relationships with public safety and emergency management agencies. Since 2002, HHS has provided all States and territories as well as four major urban areas with some $2 billion to enhance surge capacity in hospitals and other healthcare entities.

HHS is also leading an effort involving eight cabinet departments of the Federal government to help States refine their plans for countering pandemic influenza. The primary focus of the planning guidance, technical assistance, and readiness assessments is to help all agencies of State governments — not just health departments — understand what they can do to help mitigate and otherwise counter an influenza pandemic.

This involves State public health departments looking inward to do what is necessary to continue their respective operations. But it also involves looking outward to establish and test partnerships with other agencies of State governments, local governments and the private sector — including both for-profit and not-for-profit entities. State-based partnerships are one of the most promising ways to prepare for pandemic influenza.

[all emphasis added]

 

I have been peripherally witness to the efforts of two highly informed and intelligent Flubies (what those involved in the cyber flu community frequently call ourselves) that could not be more different in their approaches and philosophies. One believes we must find the means and message that will move the federal government to more direct and specific actions and the other the same at the local level.

 

As I am a rather frequent and vociferous participant in the cyber flu community I often find myself defending the federal government. Those who know me know that I get in a bit of a snit when the government, at any level, intrudes upon my life, or picks my pocket. I find "government" onerous, and those who are employed to interfere with my self determination to range from a mildly annoying to barely tolerable. I am, at heart, a Libertarian. I believe in the principle of Individual Sovereignty, Locke's state of perfect freedom, minus the religiosity of course.

Given these philosophical beliefs one would be tempted to ask why I, staunch Libertarian that I am, continually seem to defend The Government and their pandemic preparations (or lack thereof).

The answers are quite simple: The federal government cannot do it all. The federal government cannot pay for it all. The federal government cannot make anyone else do what logically needs to be done. That said, it will not prevent the federal government from bearing the blame for the myriad failures and resultant deaths, because as human beings we always need someone to blame, and as human beings that is rarely, if ever ourselves.

 

Personally, I am so disgusted and so discouraged that I can't help but sit here and say—yet again—why bother. Until we as a nation can take personal responsibility for our own well being and that of our own communities we will face a pandemic ill prepared at best, and probably not prepared at all in reality.

To paraphrase James Carville: It's the community stupid. But we will not learn that lesson until we view it with hind sight.

 

SZ