A Journey Through The World of Pandemic Influenza

Royal Mounted Canadian Police

Some days just seem to have a motif; today is one such day. Today it's running from the computer, screaming as I gouge my eyes from their sockets. My day job was one of those days that reduce me to wondering if I really do like to eat regularly and have a roof over my head.

As I was chomping on my lunch buzzing through FluWikie's News Diary for today I came across a post that got my blood pumping with (good) excitement. A snip from a larger piece was prefaced by "Royal Canadian Mounted Police Get It":

In addition to operational readiness, one of the key messages that emergency planners are sending to employees is to be personally prepared.

Large-scale emergencies pose unique psychological, social and physical challenges even for experienced first responders. Because many employees live in the same communities in which they serve, there is a good chance they will be personally affected when disaster strikes. This could result in not reporting for work or being distracted out of concern for their families or their own personal safety.

"Workforce resilience is the underpinning of everything that we do," says Neily. "If our people are not personally prepared to be at work with the comfort that their loved ones are being taken care of, then we are going to have a challenge."

 

I was totally deflated when I got home and read the entire piece.

The first paragraph from the RCMP Gazette cover story:

Preparing for a pandemic

National plan starts with individual readiness

By Katherine Aldred

The estimates speak for themselves. According to the Public Health Agency of Canada (PHAC), over the course of an influenza pandemic, up to 70 per cent of the population will become infected and between 15 and 35 per cent will become clinically ill and miss work. If antivirals are not available, 1 per cent of the ill will be hospitalized and 0.4 per cent will die.

 

Reading that paragraph I just wanted to scream and toss my laptop across the room—and then gouge out my eyes. Yes, I truly was that upset.

This was the official information two years ago. Two years ago—before we had scientific findings, computer models, and reassessments of both.

OK, sure, the next pandemic could be this mild. My problem is the presentation of these figures as a foregone conclusion—that it won't and can't be worse.

[snip]

"We don't know when a pandemic will occur, what the cause will be, how severe it will be or who will be hardest hit," says Dr. Arlene King, director general for Pandemic Preparedness at  PHAC. "We do know one thing: when any emergency hits, it's too late to be doing the planning. The structures, processes and tools have to be in place."

Police agencies involved in responding to a pandemic must be prepared not only to deal with the complex requirements of a public health emergency but to carry on their normal day-to-day operations with a greatly diminished workforce. The challenge is getting ready.

They say the right (scripted) words.

[snip]

According to Neily, the RCMP could be called in to provide a number of different functions during a pandemic such as enforcing public health orders like quarantines and travel restrictions, limiting access to areas deemed out of bounds, transporting and protecting medical equipment or medications, protecting certain types of facilities and, in a worst-case scenario, controlling crowds.

And like any operational response, police must be prepared for the conditions — in this case, a contagious disease.

[snip]

"From a health point of view, our preparedness plan outmatches anything out there," says Legault. "One of the greatest challenges will be trying to assist with public order and containment measures to prevent the spread of the virus while a vaccine is being developed. We may also be enforcing social distancing measures and there are always people who do not want to follow that."

 

Although they are saying the right things about preparing for a pandemic, they are quite probably preparing for the wrong pandemic. The mild pandemic they are preparing for is one as happened in 1957, what the US CDC (the Centers for Disease Control) has quantified as a category 2 pandemic.

A category 2 on the pandemic severity scale will only occur if the influenza strain (whether H5N1 or not) is not a wholly avian strain of influenza, instead it would require that the avian strain swaps genes with a human influenza virus. Sure, it could happen, but why plan for it to happen that way when there is no guarantee that it will?

 

Planning for a mild pandemic and being socked with a severe one will cost lives, many lives, many RCMP lives. Planning for a severe pandemic and only having to deal with a mild one costs nothing but a bit more money and a few more brain cells.

 

Perhaps they will get a clue before it is too late to act upon it.

 

SZ

 

 

The Military and PanFlu: Part I

I have a deep and abiding love for our men and women who serve our country in uniform.  Most of my minority was spent as a Navy Brat and I am married to a man who did his requisite stint during the Vietnam Era, also in the Navy.  Of course, each branch of the military thinks they are the best, the special, the chosen, but the Marines… well… they are Special. 

Never have I met a current, or former Marine (some say there is no such thing as a former Marine), that I didn't instantly peg him as being such.  Sorry ladies, I have never met a woman who served in the Marines. 

I often dwell on the Military's role during a severe pandemic, in my mind, on the forums, and in this blog.  The men and women in uniform will be the biggest chunk of the Federal Government's response to the societal and humanitarian issues that will likely arise.  The concept is a sound one, after all, no other organization, in the world, is better able or better equipped to address those issues.

The problem, the huge, insurmountable, ignored problem, is that there is just not enough military to go around.

In total, the men and women under uniform, or readily made so, comprise no more than 1% of the American population.  That's in total. 

I have read references over this past year to the government's commitments to the idea of providing assistance to other nations during a severe pandemic.  When I read them I have always experienced this split personality, one  part wanted to laugh, hysterically, and the other wanted to scream in despair… and then slap someone up-side the head (as we say here in the South) for blatant stupidity on a grand scale.

There is little doubt that much of our critical infrastructure will be strained, under-provisioned, and under staffed, perhaps to the point of collapse. 

Should our power generation and water systems fail US citizens will be looking to the military to make it better.  Should our food deliveries significantly slow, or stop, US citizens will be looking to the military to make it better.  Should social order break down US citizens will be looking to the military to make it better.  On and on and on, in every sector of critical need of a modern society we will be looking to our military men and women to make it better.

We will be looking to one percent to save the other ninety-nine percent of us.  I will readdress the fallacy of even that one percent in another post of this planned series, but for now, it suits for illustration purposes anyway.

 

The inspiration for this post and those that will follow in the series was this piece from The Stars and Stripes...

III MEF ready to respond if avian flu pandemic hits 
By David Allen, Stars and Stripes
Pacific edition, Monday, April 9, 2007

CAMP COURTNEY, Okinawa — If the avian flu becomes a real pandemic threat to humans, especially in the Western Pacific, the III Marine Expeditionary Force will be ready.

During a recent humanitarian relief deployment to the Philippines, MEF corpsmen tested technology a Portsmouth, N.H., firm developed for almost instant tracking of vital information that in the past would take days or even weeks to analyze.

And a team of Marines and sailors has developed a detailed pandemic influenza response plan for Okinawa.

Global Relief Technologies was awarded a $3.5 million contract last fall to provide about 120 PDAs — hand-held computer devices — to the Marine Corps, which at any time has personnel scattered on deployments throughout Southeast Asia. The region is considered ground zero for the bird flu that could one day mutate and become the next great human pandemic.

The equipment, along with accompanying computers and satellite hookups, was delivered to the 3rd Medical Battalion before they deployed last month for a humanitarian mission to southeast Luzon, the Philippines island where some 15,000 people lived in camps after being displaced following a series of natural disasters in December.

"This initiative is driven by the need to collect and record data for tracking the avian flu — and any other humanitarian crisis — quickly and accurately," said Navy Capt. David Lane, Force Surgeon for the III MEF. "It worked exceedingly well."

Continues at link….

 

Bless the Marines.

Bless the Marines, and slap their leaders upside the head.  Just what are they thinking? 

 

These are men and women who are presumed to have the highest risk of death from H5N1 solely because of their age bracket.  These are men and women who, if left in their OCONUS duty assignments, will be left in crumbling countries with little or no infrastructure remaining, with little or no government left standing,  with no advanced medical treatment facilities, and little or no resupply, and quite possibly sick and dying.

They will be on foreign soil, attempting to Band Aide a hopeless situation, meanwhile their fellow citizens will have their own hopeless situation(s) that will be in desperate need of those very Band Aides.

Bless the Marines.  They don't understand the phrase "hopeless situation".  And for those responsible for this action plan… consider yourselves slapped up-side the head by a Southern Mother.

 

SZ

Pandemic Planning and the Courts (if they say so...)

The Guidelines for Pandemic Emergency Preparedness Planning: A Road Map for Courts dated March 2007 had been made public and the 32 page PDF can be found here.  It was put together by the Task Force of Pandemic Preparedness Planning for the Courts. 

An open letter from Chief Judge of the Maryland Court of Appeals addresses the intent of the plan.

 

One of the fundamental things I define myself by is being a Strict Constitutionalist.  I believe that the US Constitution and The Bill of Rights are nothing less than Sacred Documents, sanctified by the very blood men and women have spilled for over two and a quarter centuries in defense of them.  Given the level of involvement in Law Enforcement that I have both historically and currently, it would be safe to assume that I take the concept of the Rule of Law very seriously indeed. That said, my first reaction after my initial skim of this report was literally not knowing whether to laugh hysterically or beat my head against the wall until it was a Bloody Pulp.

My second reaction, upon reading it in a more deliberative manner, could only be described as a break with reality.  This report came on the heals of my finishing the HCWs in a CMI entry found here, and the two papers mixing and merging in my mind made me feel like I had either fallen into that proverbial Rabbit Hole or frantically looking around for it to dive into.

 

On February 1, 2007, the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) issued guidance on several nonpharmaceutical measures that might be taken to reduce the harm caused by an influenza pandemic. The guidance introduced, for the first time, a Pandemic Severity Index, which uses a case fatality ratio as the critical factor in categorizing a pandemic’s severity. The index, available at www.cdc.gov/od/oc/media/pdf/MitigationSlides.pdf, is modeled after the five levels of severity used for hurricanes and designed to help officials determine whether to take steps such as advising employers to promote telework, closing schools, or limiting public gatherings. It ranks the severity of a pandemic by the number of fatalities it causes, ranging from a Category One pandemic (90,000 deaths) to a Category Five pandemic (1.8 million deaths).

As the chart from the CDC that this plan draws upon clearly shows the attack rate (% of population that will become infected) is set at 30%, although they were intellectually honest enough to state it was an assumption.  Also, in fairness, the Category 5 CFR (Case Fatality Ratio) starts at 2%, since they use the greater than or equal to symbol.  The problem comes in when plans use these figures as the Worst Case Scenario, not the base parameter of Worse Case.  This is important because it could be magnitudes worse.

What the Courts plan fails to address is if a PanFlu event is worse than the 30% attack rate with a 2% mortality.

 

The Task Force was charged with creating a framework that could be used by courts in each state to develop pandemic emergency plans. In response, the Task Force’s planning process has been approached from four perspectives: (1) preserving the continuity, integrity, and independence of the judicial process (i.e., the rule of law) during a pandemic emergency; (2) substantive legal issues that will likely arise; (3) interagency relationships and coordination that will be needed, particularly among the courts and state and local public health agencies; and (4) the court as a workplace.

There will (potentially) be a point where the courts will be rendered inoperable and this plan so many words on paper.  Should the CFR present at much above 5% society will begin to crumble and the courts along with it. A Pandemic Plan for the courts would have been much better served had it also addressed issues outside of maintaining status quo. 

 

5. Courts During a State of Emergency

The constitution and implementing legislation in most states require that the court system operate on an ongoing basis. Only recently have a few states authorized the temporary closure of a local court in an emergency; in those instances the closure has been contemplated as temporary and of very brief duration. Most court COOP planning has included the identification of mission-critical functions (i.e., functions that the court is constitutionally and/or statutorily required to perform) and the timeframe for their performance. For example, such planning would include the mission-critical functions, in priority order, that must be performed given a disruption of 1 day, a disruption of more than 1 day but less than 1 week, and a disruption of more than 1 week but less than 1 month. Similar to COOP planning, a pandemic entails identifying how mission-critical functions of the court can be performed. However, it also requires that the court be able to address the issues that arise as a result of the pandemic, taking into consideration the potential protracted period of disruption.
As a start, judicial system officials should address the following:

􀂾 What are the requirements under the state constitution and the state statutes for declaring a state of emergency?
􀂾 What effect does a declaration of emergency have on court operations?
􀂾 What are the immunities of government actors during an emergency?

 

Well, enough for today, I will pick this back up again, so much to say that it's better to split it into digestible chucks.

Pandemic Dominoes: HCW's Stand at the Apex

Yesterday Fla_Medic called attention to a piece that was released in JEMS:The Journal of Emergency Medical Services titled "Will emergency health care providers respond to mass casualty incidents?". Having my curiosity shot off the scale I spent roughly an hour tracking down the paper the JEMS article referred to and purchased it straight away. 

Before I dig into the very disturbing findings of this paper I would like to lay some ground work. 

I have been involved with the Cyber Flu Community for two years now in one way or another.  We are an interesting, eclectic group comprising professionals and laymen, deeply involved to casually informed.  When the issue of workers reporting to their jobs comes up two things have always been cited, the SARS response and the presumed illness attack rate.  The two figures mesh nicely, both pointing to a roughly 30% absenteeism rate at the height of a "severe" PanFlu event.  A thirty percent staff reduction in any industry or service would be extremely difficult to work around, but assumed not impossible. 

The thirty percent absenteeism in all Essential Services sectors is supposed to be one of the major points that their respective Influenza Pandemic Plans are to address... and that's assuming they actually have formalized plans... a BIG assumption because many are still stuck at the "Plan to Plan" stage.  This paper points to the possibility that the 30% assumption may be grossly optimistic. 

As some who have read my Blog for awhile will know, I am acutely interested in PanFlu from an LEO's (Law Enforcement Officer) perspective.  My only child is a street officer on a small city PD who has every intention of working during the PanFlu, should one materialize.  During a moderate to severe PanFlu police will be stretched as thin as HCW's as they will be operating in situations that will facilitate infection, and at the same time not having adequate means of personal protection.  And, just as the Health Care System can not operate at 18-30% staffing levels, neither can Law Enforcement, so with that in mind, I will now introduce the actual paper this entry addresses. 

WILL EMERGENCY HEALTH CARE PROVIDERS RESPOND TO MASS CASUALTY INCIDENTS?

James I. Syrett, MD, MBA, John G, Benitez, MD, MPH, William H. Livingston III, MD, Eric A. Davis, MD 

ABSTRACT 

Introduction: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. Hypothesis. Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. Methods. Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. Results. A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest immitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers’ family members led to decreases in commitment rate, as did agents identified to be transmissible. Conclusions. As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers’ family increases commitment to work. These factors should be considered in emergency planning. Key words: emergency preparedness; disaster response; mass casualty incident. PREHOSPITAL EMERGENCY CARE 2007;11:49–54

Even though the abstract states: Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. What the body of the paper states is: 

The scenarios differed in two aspects. In the first scenario, there was an effective pro­phylaxis or treatment available, and the agent was iden­tified as being nontransmissible. In the second scenario, there was only an unproven experimental prophylaxis or treatment available and the agent was identified as being person-to-person transmissible. The final ques­tion in each scenario concentrated on specific methods of prophylaxis/treatment dissemination

So, as can plainly be seen, at no time does the survey ask the respondents if they would report to their assigned duties if there were no treatment available.  Since it is reasonably assumed that roughly two weeks into a severe PanFlu event there will be no supplies left to treat anyone this question would have been useful to have seen addressed.  In fairness, the survey seems to have been put together prior to the SARS HCW debacle or the general awareness of an Avian Influenza Pandemic.

One of the more disturbing aspects of this survey is the fact that it was administered at a hospital that had up to date training in response to a terrorist's attack involving mass casualties since it is a designated decontamination and treatment facility.  The authors speculated that being informed on a higher level of the likely issues involved may have motivated some of the responses, on the negative side.

 

After reading the paper twice in its entirety I was deeply disheartened.  While no one can say with any certitude how they will or will not respond in any given situation of the magnitude of a severe PanFlu it is, I feel it is helpful to understand the thought processes of those we will be depending on, and how they will potentially play out.

Since it is safe to assume that any person who is dedicated enough, some might say stupid enough, to report to work during a situation such as is my focus will likely find themselves needing medical attention themselves at some point in the crisis how soon should we expect to see the drop off of Emergency Services personnel reporting?  I would venture to guess pretty quickly.

Will police, even those dedicated to their mission, risk reporting in a crisis situation, where the chances of injury and/or infection, are great knowing that there will be no treatment for them should they become injured or ill?  What if an officer has an auto accident while responding to someone's urgent call for help and there is no EMS to transport him/her to the (unstaffed) Emergency Room?  The exact same scenario question could be posed for Truck Drivers as well.  Will they report knowing that if they become infected or injured there will be no one to treat them?  What happens if they don't report?

 

Essential Services are called that because that's what they are... ESSENTIAL.

 

I am not pointing an accusatory finger at Emergency Room doctors, nurses or EMS, EMS crews are "Brothers/Sisters in Blue" and as such I consider them equally members of my very extended "family", but I do feel obligated to point out... shout really... the nightmare cascade of consequences should the people that stand at the pinnacle refuse to "stand."  And I feel that I only addressed the superficial surface of the issues this paper brings to mind.

It would be prudent for Hospital... and County/City... Administrators to sit up and take note of this paper.  The problems it identifies could be blunted by bringing in a reasonable amount of PPEs (Personal Protection Equipment), planning to give priority treatment to the Emergency Responders... AND THEIR FAMILIES, and actually demonstrating that they care about the health and welfare of those they depend upon to perform these very important and ESSENTIAL functions.

Canadian SARS Commission Final Report

The final part of the Canadian SARS Commission report was released to the public and the pdf may be found here.  The entire report is just over 1200 pages long, broken into two files. I admit, I am taking the easy and expedient route for the time being and only dealing with the 70 page Executive Summary.

I watched the SARS saga unfold, having caught its explosion out of China because I regularly checked up on H5N1's doings.  No, not as I do now, but I would check it once or twice a week just to make sure that I was "current" on any new findings.  So, I do find this report of immense personal interest, in and of itself, but its lessons are applicable to what we may face with an a pandemic strain of influenza, and was one of the driving reasons for the commission, thus grist for this Blog.

 

Hospitals closed; cancer treatments and heart surgery were postponed. Patients were denied visitors. The sick and the dying suffered without the consolation of their families.  The dead were disposed of quickly and in the absence of family and friends. The wider impact of SARS through canceled heart surgery and delayed cancer treatments will never be known. And SARS was also an economic disaster for the country, the province and the GTA in particular.

Things happened that should never have happened: deaths, unspeakable loss, untold suffering.Where should we direct our outrage, our anger?

The evidence discloses no scapegoats. This was a system failure. The lack of preparation against infectious disease, the decline of public health, the failure of systems that should protect nurses and paramedics and others from infection at work – all these declines and failures went on through three successive governments of different political stripes. So too, in a sense, we as citizens failed ourselves because we did not insist that these governments protect us better.

SARS taught us lessons that can help us redeem our failures. If we do not learn the lessons to be taken from SARS, however, and if we do not make present governments fix the problems that remain, we will pay a terrible price in the face of future outbreaks of virulent disease.

Why was Ontario so unprepared for SARS? Our public health and emergency infrastructures were in a sorry state of decay, starved for resources by governments of all three political parties. The health system’s capacity to protect its workers was in a state of neglect: what little existed was badly malnourished. There was no system in place to prevent SARS or to stop it in its tracks. The only thing that saved us from a worse disaster was the courage and sacrifice and personal initiative of those who stepped up – the nurses, the doctors, the paramedics and all the others – sometimes at great personal risk, to get us through a crisis that never should have happened. Underlying all their work was the magnificent response of the public at large: patient, cooperative, supportive.

It is commonly theorized that SARS was easy to stop because the serial interval, average time between primary and secondary cases, was slightly over eight days, and that a person was not infectious until symptoms were obvious.  Of course, I should qualify my "easy to stop" statement with: once it was realized they had a new infectious disease on their hands.

There will be major differences with a pandemic strain of influenza.  The serial interval is expected to be roughly half, potentially doubling case count, and the virus may be spread by an infected individual prior to the onset of visible symptoms.

It gets messy when the R0 (R Naught, attack rate) is compared between SARS and influenza.  While SARS is officially said to have an R0 of 3 (each infected individual will infect, on average, three other individuals) that figure doesn't account for the two identified Super-Spreaders and the 300 cases from the Hong Kong apartment complex with faulty plumbing.  These three anomalies accounted for many secondary cases and those secondary cases are used to determine the overall R0 of SARS.  The atypical is probably statistically skewing our picture of the typical.

It is commonly stated that a pandemic strain of influenza will have a smaller R0 than SARS, and when a pandemic strain is known to be circulating within a community protective measures will be readily taken, thus the lower R0 makes sense.

In the end though, it is assumed that an pandemic influenza strain will be far more straining on a community's resources than SARS and it nearly crippled the communities it struck and overwhelmed the local health care.

[snip]

The Commission has not heard of any country or any health system that foresaw SARS. No one foresaw the sudden emergence of an invisible unknown disease with no diagnostic test, no diagnostic criteria, uncertain symptoms, an unknown clinical course, an unknown incubation period, an unknown duration of infectivity, an unknown virulence of infectivity, an unknown method of transmission, an unknown attack rate, an unknown death rate, an unknown infectious agent and origin, no known treatment and no known vaccine.

We will be luckier with a PanFlu, by the time it is here the Monster will be known.  Knowing what you face takes some of the fear out of it.  Our HCW's didn't have that luxury during most of the SARS episode, they bravely faced the unknown, and many paid the price for it, in illness and in death.

[snip]

SARS taught us that we must be ready for the unseen. That is one of the most important lessons of SARS. Although no one did foresee and perhaps no one could foresee the unique convergence of factors that made SARS a perfect storm, we know now that new microbial threats like SARS have happened and can happen again.  However, there is no longer any excuse for governments and hospitals to be caught off guard and no longer any excuse for health workers not to have available the maximum level of protection through appropriate equipment and training.

The last sentence says it all.  There is no longer any excuse.  Sadly, we hear excuses, and fervent denial of the threat, everyday.

 

SZ

Will Police Report for Duty During a Pandemic

A concept has been floated on the Flu Forums that police should be assigned to the geographical areas that they live in the event of a severe pandemic, my definition: a 10% CFR (Case Fatality Ratio) or higher.

At first blush, this makes a lot of sense.  Less gas consumed, and officers would have a vested interest in the local area where they live.  It is even a model that my county's Sheriff's Department utilizes during a Category 2 or above hurricane landfall.  Stay home, come out as soon as is possible, be responsible for calls in your area.  It works for hurricanes because personnel are fairly well dispersed and roadways are often rendered impassible anyway, and the Sheriff's Deputies have county wide jurisdiction.  Reality is though many police live in a jurisdiction different from where they work

During a moderate to severe pandemic two areas where policing would be thin are the two ends of the socioeconomic spectrum, the bottom and the top.  Not many police live in the worst or best neighborhoods.

But, as one astute Flubie pointed out, exactly how vested and committed will a police officer, or department, be to areas where they consistently suffer abuse, denigration, and even verbal, physical and legal attacks?  A tough question.

Surprisingly, it is the same two areas as lack of residential representation put at risk.  While physical attacks may not be common in the upper socioeconomic neighborhoods, the other maltreatment categories surprisingly are.  The very first time I was spat upon was by a woman in one of the best neighborhood's of my city.

It brings the phenomena of "There's Blue and then there's every body else", or the variant, "There's Blue and then there's you" to light.  Police and the community at large are often at odds, viewing each other with less than friendly gazes.

Unfortunately there appears to be the very real possibility that we, society at large, will be asking our law enforcement officials to serve and protect us in a totally unprotected state.  No PPE (Personal Protective Equipment) such as masks, gloves and hand sanitizer. 

Expert assumption (yeah, there's that word again) has it that PPE will probably be totally depleted in about two to four weeks, even in the most well prepared organizations and hospitals.  Our First Responders, Police, Fire, EMS will be expected to perform their duties unprotected.  A callused position could be taken that the threat to life and limb are integral to their jobs and a risk was, de facto, accepted.  It's what they get paid for, right?

In a word: NO.

Although the risk of life and limb is a fact of life for our police, it is something that a great deal of training, continuing education, and money are expended to minimize.  And, while they accept the fact that every time they pin the badge on may be their last, giving their life is not part of the contract.

You see, there is a distinction.  Giving one's life is an act of conscious volition, with full understanding that death will be or likely will be the final outcome.  Having one's life taken is an act or circumstance, that while possibly foreseeable, every action was taken to prevent.

There's the rub.

...EVERY ACTION WAS TAKEN TO PREVENT.

So, there are two, diametrically opposed, factors effecting motivation to report in a probable life threatening and crisis situation, a strong sense of duty and an "Us vs Them" mentality.  Sitting smack in the middle of those two polar opposites is the will to live.  The more connected to a community an officer is the more likely he/she will be to report to duty, even at great danger to themselves.

How will a community ensure that their police tilt toward the "sense of duty" side of the line?  At the risk of stating the obvious, ensuring that they have sufficient PPE would be a good start.  Since a sufficient supply of PPE is probably not a goal that can be accomplished, at least a honest effort to get in place what can be gotten would go a long way.  A community that cares for its cops will have cops that care about the community.

During a moderate to severe pandemic everything will contract down to the community level.  Ensuring that as many public service employees are vested in the community only makes sense.  The purchase of adequate PPE for the police is cheap considering the alternatives.  Communities must not find themselves in the position of having to ask their police to give their lives protecting those who failed to do everything within reason to protect them.

Community planners should also be aware that those they depend on to police their streets, put out their fires and respond to medical emergencies may be a pandemic resource that their communities of residence may compete for.  Since police are commonly viewed as an enemy, or at best, an intruder by the communities they police, they may be easily convinced to contribute their talents and skills where they feel more "at home."

Ripples, Waves, or Tsunami

When I think about pandemic issues (like I STOP thinking about them) I tend to become overwhelmed.  Terms like "Domino Effect", "Ripple Effect", and my personal favorite, "Cascade" quickly come into play. 

I try to read all the published data on the latest Table Top exercises and all the various and sundry expert opinions on the likely effects of a pandemic.  Unfortunately there are few that offer a Grand Overview.  One of the latest and perhaps one of the best to date is the BoozAllen Simulation which can be found here. I encourage any who have not read this yet to do so at the first opportunity.

The Response in the Simulation

Participants recognized that their world had changed--it was not business as usual, and the decisions they faced were both complex and morally difficult. (Emphasis mine)

The team found that the telecommunication infrastructure would likely shut down sometime in the first week of a pandemic and thus the telecommuting we hear touted so frequently would not be an option for the average citizen.  Calling for a prioritization scheme for key organizations and individuals to avert an overload of the Internet.  That means you and I will be locked out.  Does that make you sit up and scratch your head?  It did me.

I have counted on the government busting their butts to keep the Internet up and accessable so that we can stay informed and proactive in our responses to a pandemic.  I am not even sure how the Internet would or could be restricted.  I suppose if you shut down all the civilian ISP's that would work.  But, as you can guess, I have a vested interest in hoping for continued civilian access to the Internet.  Our forum and this blog, to say nothing of the fact that I am a total new junkie.  I can't even begin to imagine the withdrawal I would suffer cut off from the information flow.

Federalizing of food, fuel and health care was also mentioned.  Now, those were no surprise and I can only hope that it will happen early on so that we are not faced with a Katrina type debacle where the government comes in after everything has been destroyed and attempts to put the pieces back in functioning condition.  Notice please I didn't say back in order, just up and running, there is a world of difference.

An interesting section is included quoting Dr. Nabarro called "Ten Things I learned"

1. The response needs to be both strategic and opportunistic.

2. Emphasis has to be as much on the people as on the virus.

3. Quite likely by Day 28 all systems will have fallen apart-It is essential and perhaps the most important factor of all.

4. Engaging business from the start is not a luxury-it is essential and perhaps the most important factor of all.

5. Media s an essential part of the response and you need to learn to work with them.

6. Encourage joint work by government, business, and community organizations at all levels.

7. Martial law is not an end but a means, and you need to understand the end state you are working toward when using it-people are precious-martial law should be used to protect the people.

8. We need to define a pandemic state and how business and government will work in that state - must do this now.

9. “Flu-casters” - need to dashboard to track flu statistics and progress around the world.

10. Military must be involved in the response to help keep the peace and deliver essential goods and services.

And then there's the closing...

The economic, health, and social consequences of an influenza pandemic could be devastating if effective and coordinated preparedness activities and timely response actions are not undertaken.  Governments and businesses will face tough, practical, moral, and ethical decisions as they enter a world where not all sections of society are equal, where infrastructure is debilitated, and where irresponsible behavior may emerge as a consequence.

The report also addresses the interesting concept of forced conscription of people who have recovered from a bout of H5N1.  What they fail to mention is that most, all though not all, of recovered H5N1 patients take weeks and months to become functional again.  Children seem to suffer less lasting effects than adults, but it is the adults that will be looked to for conscription, not five year olds.

Martial Law

If you are an American citizen the thought of martial law sends you into screaming fits of hysteria.  We just don’t like the idea of troops on our streets, weapons trained on us with the intent of controlling our freedom of movement.  It also doesn’t help that the dramatizations of what a BF (Bird Flu) pandemic may look like almost always show an overwhelmed and frightened soldier shooting some civilian in the back.

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What will be the likely truth of martial law in America?  While I don’t have a crystal ball I would like to hazard a few guesses.

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First and foremost, please remember that the troops will be Americans.  Our sons, brothers, husbands, daughters, wives, sisters.  And even our fathers, mothers, grand fathers and grand mothers given the military’s reliance on the Reserves.  They also take an oath, sworn or affirmed to uphold the Constitution of the United States and defend her against all enemies both foreign and domestic.  Get that last bit?  AND DOMESTIC.  That means they are charged to protect us from any megalomaniac who may want to play fast and loose with the tenants of the Constitution.  We can argue how much of the Constitution will remain in place later.

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Troops deployed in our cities and on our streets are not our enemies. And as much as the whole concept is anathema, when you are in a crisis situation, YOU will be glad to see them.  I know, I’ve been there.  1989 Hurricane Hugo.  I wanted to run up and kiss the first National Guardsmen I saw roll into the city, but I will also admit that I was really glad to see them leave when they had us back on our feet.  Troops on city streets… bad ju ju, but sometimes they are the only ones that can save us.

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Another glaring example is,of course, New Orleans.  It took the US Military and the selfless men and women who put their own safety on the line to rescue literally thousands who may have perished without their intervention.  These men and women were professional, skilled and singularly dedicated to their mission of saving lives in conditions that were hellish by any American’s standards.

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Second, there simply won’t be enough of them to be standing on every street corner waiting to shoot unwary citizens in the back at the first opportunity.  America is a nation of 300 million +/- souls occupying roughly 354,000 square miles.  As a comparison, Iraq has a population of approximately 27 million populating about 172,000 square miles . American troops are doing all they can to maintain law and order in that country.  See my point?  There will only be enough troops deployed to cover the major population centers and within those, the critical infrastructure, hospitals, supply depots, power stations, fuel depots, vaccine distribution points.

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If pandemic happens and you are LUCKY enough to have a soldier or guardsman on your corner, smile at them (behind your N95 mask of course), thank them, and remember, they are probably just as scared and disconcerted as you are.

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SophiaZoe

Electricity during a pandemic

Will we be able to count on our electricity during a pandemic?

That probably depends a great deal on where you are located geographically.  Why?  Because I believe that the greatest risk to our electricity supply is not so much supply, but maintenance of the power lines and the items to affect repairs.

What puts our power lines at risk?  The same things that damage them everyday.  Wind, hurricanes, tornadoes, ice, trees falling on them, vehicle accidents.

Experts estimate that all work staffs will suffer an approximate 40% absenteeism.  This figure represents "best guess" of course, but it encompasses rates for illness, caring for ill family member(s), death, and simple failure to show.  This rate will be exacerbated if we suffer social unrest where it would be dangerous, or perceived to be so, to travel the roadways and/or leave family unguarded.

As I will state over and over again when dealing with staffing levels, all businesses and most governments are staffed at current assessed need levels.  Staffing levels are not figured to cover an absenteeism above 5%.  So, if damage to lines occur, who will repair them?  What if damage is fairly wide spread, as occurs during ice storms, tornado out breaks, or hurricanes and tropical storms?  In situations of wide spread damage crews come from surrounding areas and even surrounding states in a compact of mutual aid.  Needless to say, during a pandemic there will be no mutual aid coming into an area of power line infrastructure damage.

The good news is that there should be a considerable reduction in demand.  Factories, Malls, Schools, Car Dealerships, etc will likely be closed or operating at very limited levels, therefore the electrical demand from the commercial and manufacturing sectors will be minimal allowing more to be dedicated to residential usage.  I am of the hope that the shift will minimize any potential capacity problems due to fuel availability, lower demand = less fuel consumption.

So, at best, I assume intermittent service, at worst, total break down of the grid.  In planning for electrical needs I have one largish and one small portable gas generator.  We also have a 55 gallon drum with pump for fuel.  Since we live in hurricane country, these are also standard hurricane prep items.  Double duty...it's a beautiful thing.

I would also like to share with you links to information from members of Plan For Pandemic who have addressed the issue with a bit more creativity and know-how.

Solar Power for the do-it-yourselfer  A page on Plan For Pandemic authored by Member Spoon, a member of the "gang of four".

Basic Pedal Generator A page on Plan For Pandemic by member Enumclaw, wa

I actually hope to have time to gather the supplies for the solar and pedal power and convince son and hubby to put them together.  At worst... it will be fun to do, at best... they just might come in real handy.

SophiaZoe