Stockpiling: No Single ApproachIn reviewing the blog postings I note there are many questions about personal and family stockpiles. These questions include: Should I stockpile food, water, medications? How long should a stockpile be designed to last? What are the Government’s recommendations for personal and family stockpiles? There can be no single approach to family and personal stockpiling that is perfect for everyone. Each family and individual must analyze their unique situation and needs and design a stockpile that works for them. Below I offer some simple advice that should help strengthen your family and individual pandemic preparedness plan with regards to stockpiling, but before I begin let me lay out some important overarching preparedness principles not specific to a pandemic: 1. Preparedness should not be aimed exclusively at one hazard or the other. A stockpile should be able to support its owner through a pandemic, a hurricane, a blizzard, an earthquake….or any other circumstance that might require the owner to be self sufficient for a period of time until outside support can be reestablished. A good preparedness plan is one designed to be useful in all sorts of emergencies. 2. For a family or individual to be prepared, they must have planned and practiced the ability to be self sufficient for the period of time it might take to get outside assistance in an emergency. 3. One should be aware that the resources of a stockpile may need to be used at home, in a shelter or on the road during an evacuation. 4. Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time. Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely. This is because in most emergencies, help is likely to arrive within days not weeks even if delayed. In rare situations where help cannot be expected immediately, evacuation to more supportive settings or the identification of alternative sources of support locally can usually be achieved within days of an emergency event. Pandemics offer a unique challenge because they ultimately affect every community. Additionally, at the height of a severe pandemic there may well be nationwide disruptions in the production and distribution of certain services and goods. Fortunately, unlike an earthquake that strikes suddenly or a blizzard that whips up over the course of 48 hours, in a pandemic there will likely be some advanced warning. Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies. In mild pandemics there may well be no disruptions. It is also important to note that even where there are disruptions in services and supplies, they are likely to be temporary and sporadic. They will not occur in every community simultaneously, nor will they affect all goods or services at the same time or to the same extent. Home quarantines for those exposed and home isolation for the sick are situations in which a person might need to avoid any contact with the outside world requiring a period of self sufficiency. Rarely will these periods extend beyond 10 to 14 days. After that period of time most people will be non-infectious because they have either recovered fully or have been shown not to have been infected by an exposure. Every family should conduct an inventory of their needs and dependencies. The stockpile for a family with a bottle fed infant will be very different from the stockpile needed to support an elderly couple with chronic illness. It is important to list those services, goods and medications for which your family is particularly reliant on outside sources. Home oxygen supplies, medications and special diets might all experience disruptions in availability during a severe pandemic. Stockpiles can be accumulated in small increments over time. As the stockpiles ages the oldest items in the home stockpile can be used and replaced with newer items before they expire. The American Public Health Association advises that every family should have at least a three day home stockpile of food water and medication. This basic stockpile would likely be able to support a family through the most commonly seen emergencies. The US Department of Health and Human Services has advised that during a pandemic, families might need as much as two weeks worth of supplies in their stockpile. This size stockpile would be sufficient to support a family through a home quarantine and through the peak of an outbreak in their community during which sporadic temporary disruptions in availability of some products and services may occur. It is important to note that the size of any given home stockpile might need to be larger for families that live in more rural areas served by relatively fewer sources of those essential needs identified for a family’s stockpile. For example: A family with only one source of prescription medication within a 100 mile radius should probably maintain on hand a longer supply of that medication than an individual with four different sources within one mile of their home. For individuals living abroad, stockpiles designed to last months may be necessary. Depending on where exactly around the world you live, disruptions in availability of supplies might be more severe than in the US due to inherent weaknesses in distribution systems and relatively poor preparedness systems. Access to outside support and aide might be more delayed than it will be for individuals living in the US and the ability to return home may be temporarily disrupted as a result of a pandemic or other emergency.
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Posted by
Admiral John O. Agwunobi
MD, MBA, MPH; Assistant Secretary for Health, U.S. Department of Health and Human Services:
“4. Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time. Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely. This is because in most emergencies, help is likely to arrive within days not weeks even if delayed. In rare situations where help cannot be expected immediately, evacuation to more supportive settings or the identification of alternative sources of support locally can usually be achieved within days of an emergency event.”
Posted by
Edna Mode,
Daughter, sister, mother, aunt, pandemic planner, and ticked off U.S. taxpayer:
Apparently, Admiral John O. Agwunobi, you’ve never read the U.S. Government’s Pandemic Planning Assumptions found on the federal pandemic preparedness site here:
www.pandemicflu.gov/…
Posted by
Admiral John O. Agwunobi
MD, MBA, MPH; Assistant Secretary for Health, U.S. Department of Health and Human Services:
“Fortunately, unlike an earthquake that strikes suddenly or a blizzard that whips up over the course of 48 hours, in a pandemic there will likely be some advanced warning. Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies.”
Posted by
Edna Mode,
Daughter, sister, mother, aunt, pandemic planner, and ticked off U.S. taxpayer:
I live within an hour of a two airports that serve international flights. No one in my community will have a month or two before a pandemic begins interrupting supply chains if Patient Zero steps off a flight–infected with the next pandemic flu virus but asymptomatic–and circulates in our communities for days before becoming sick. Remember, one size doesn’t fit all, Admiral John O. Agwunobi.
Posted by
Admiral John O. Agwunobi
MD, MBA, MPH; Assistant Secretary for Health, U.S. Department of Health and Human Services:
“In mild pandemics there may well be no disruptions. It is also important to note that even where there are disruptions in services and supplies, they are likely to be temporary and sporadic. They will not occur in every community simultaneously, nor will they affect all goods or services at the same time or to the same extent.”
Posted by
Edna Mode,
Daughter, sister, mother, aunt, pandemic planner, and ticked off U.S. taxpayer:
Apparently, Admiral John O. Agwunobi, you’ve never seen your boss’s interview on the Charlie Rose Show seen here:
www.youtube.com/watc…
Posted by
Edna Mode,
Daughter, sister, mother, aunt, pandemic planner, and ticked off U.S. taxpayer:
I am Edna Mode. I am not only a daughter, a sister, a mother, an aunt, a pandemic planner, and a ticked off U.S. taxpayer; I am also a survivor of the 1968 pandemic and am married to a man who survived both the 1957 and 1968 pandemics.
I know pandemics can be mild and pass without ruffling barely a feather.
I also know that at present the H5N1 virus has achieved all but one of the World Health Organization’s criteria for sparking the next pandemic and that the current case fatality rate in Indonesia, the hotbed of H5N1 activity at the moment, is as of today 87%.
If H5N1 starts the next pandemic, which there is no guarantee it will but which is looking mighty likely at this point in time, your advice for a three day or two week stockpile will send many innocent people to their deaths.
Shame on you, Admiral John O. Agwunobi.
Posted June 6th, 2007 at 5:36 pmAdmiral John O. Agwunobi,
Thank you for addressing the issue of prescriptions. I have many drugstores near me but only one carries my sons medicine.
Stockpiling is one part. Avoiding the microwave incase power is out or the microwave breaks. Cooking skills are also essential.
The point about having supplies that can be used at home as well as on the road is taken. Since other disasters like hurricanes will happen during a pandemic. It would be bad to have to decide between evacuating or leaving supplies behind.
Stockpiling food, water and medicine is just one part. Batteries, lights, air filters and other supplies that may become expensive during a pandemic because of scarcity.
I look forward to other peoples input.
Regards,
Posted June 6th, 2007 at 5:57 pmKobie
Admiral, I am so thankful to read your blog!
As a mom of 2 young children, I am quite concerned about the possibility of a severe pandemic, and about how I can prepare my family, and my community, for it.
Frankly, preparing a simple, 2-week “flu kit” would be a lot easier, than the alternative, such as a family pantry of 12 weeks’ supply.
However, after reading the DHS “Pandemic Influenza: Best Practices and Model Protocols” guidelines to emergency responders and public agencies, linked here: www.usfa.dhs.gov/dow… of course you can understand why I became a bit concerned that my 2 week “flu kit” (chicken soup and Kleenex-brand tissues, also good for other emergencies such as earthquakes and hurricanes) might not be sufficient.
Naturally, as you realize, the planning assumption that “The population may be directed to remain in their homes under self-quarantine for up to 90 days per wave of the outbreak to support social distancing practices” got my attention.
In addition, the questions arising as to “How will citizens get food, supplies, fuel, and access to healthcare services? Will the supply chain be able to maintain the stock of essential consumables and supplies?
Will control measures be implemented to prevent price-gouging? Will family financial concerns influence the ability or willingness of families to self-quarantine? Will control measures be implemented to cover those that are income dependent for purchasing essential items on a weekly basis?
Will financial institutions forego strict adherence to financial policies and contractual requirements during a pandemic? Will foreclosures or repossessions occur during the outbreak?
Will vigilantes develop in neighborhoods or communities?
Will society experience a breakdown?
Will a black market develop?
Will the theft of resources surface in an illegal distribution market?
Will counterfeit prophylaxis and/or PPE surface?
Will healthcare facilities and citizens become victims?
How will local government react to these potential problems?”
I am sincerely grateful to my government — in the form of DHS — for having the willingness to confront this situation dead on, and ask these tough questions, and I am glad to have the heads up, that the next pandemic may … just possibly … not be mild.
But frankly, the idea of preparing for a pandemic at times is overwhelming to me. I’d rather just ignore it completely. I’d like to not think about it and go about my life. So I’d be extraordinarily grateful to you, if you could make me some personal guarantees.
1) Can you, Admiral, personally guarantee me (and my community) that our next pandemic will be a mild one, with no interuption of essential services or grocery deliveries?
2) Can you, Admiral, personally guarantee me (and my community) that if we do have a severe pandemic, we will get at least one month’s warning and possibly two? And with that month’s warning, can you assure me that I will have enough money in my checking account at that point, to stock up on any needed supplies, if it turns out 12 weeks self-quarantine is what will at that point be needed?
3) Can I have your personal assurance that my chidren will be fed, no matter what? I live in the state of Maryland, right outside of DC, so I assume things will be fine, right? If we have any type of pandemic, from mild to severe, can you assure me that 2-weeks worth of food and water will be all that is needed, and that other than that, the Giant and Safeway around here will be supplied with some kind of food, my little kids can eat? (They do have allergies, as many American kids these days do…)
4) If worse comes to worst, and the pandemic comes soon and is severe — can you assure me that the government will alert me in a timely manner? Can you promise me that if my 2 weeks of chicken soup and Kleenex “flu kit” will see me through, and after that, the state of Maryland will alert Target-Giant-Walmart-Safeway-FEMA-Red Cross-someone that my children are in need of food and medicine? They are stockpiling, just in case, aren’t they? And it isn’t peanut butter, is it? Because my kids can’t eat peanut butter.
Can you promise me that these businesses and agencies will be delivering food and medicine to my doorstep, if we need to self-quarantine? Or if we are allowed out, can you promise me that all the lines of supply will be open, and that beyond my two-week supply, stores will be open, my husband will still be employed, and I will still have money available to me to purchase the things my children need?
5) Can you assure me that there will be no price gouging? No civil unrest? Truckes will continue to make deliveries on time and, though some shortages may occur, mostly all will be well?
6) Finally, may I have your personal assurance that NO ONE in the federal government is receiving any different advice, from the advice you have given us, your public? May I have your assurance that we are receiving the very best advice you have to give, based on science, not politics? And that “those in the know” are not being told to stockpile at least 12 weeks of food, medicine, water and PPE such as N95 respirators?
I will believe you if you tell me so, and I will stop worrying about this pandemic and the related secondary consequences of mitigation.
I desperately want to believe all of the above will happen, and that a 2- week “flu kit” is sufficient for the majority of the American people to get them safely through a pandemic.
Thank you for your time and attention to this matter.
Posted June 6th, 2007 at 5:59 pmDr. Agwunobi, welcome to the discussion. I am troubled by some of your statements; they stand in stark contrast to some of the other information produced by the government.
Regarding the time available for a warning to prepare for an avian flu pandemic, the simulations produced by the Los Almos National Laboratory seems to contradict that assertion:
www.lanl.gov/news/im…
The conclusions one can gain from the Dark Winter smallpox simulation are equally grim.
Even the pandemicflu.gov site warns there may be prolonged disruptions in supply lines and essential services. A pandemic is simply like no other emergency: everywhere, all at once.
Regarding the advice that preparing is only necessary for a short time until relief arrives stands in contrast the the Department of Homeland Security pandemic best practices manual that recommends 90 days of supplies for essential service workers and the recommendation on the Warden system to Embassy staffs to stockpile food and water sufficient for 12 weeks.
I don’t think there is a family in America who does not feel their members are absolutely essential to them. I look at my children and know they are absoutely essential to my life and well-being. I think we all deserve the same advice.
Posted June 6th, 2007 at 6:00 pmDear Admiral:
I beg your pardon??? Surely you misplaced this:
[quote]April, 2007:
Homeland Security, Pandemic Influenza ‘Best Practices and Model Protocols’
Page 7:
The population may be directed to remain in their homes under self-quarantine for up to 90 days per wave of the outbreak to support social distancing.”[/quote]
June 6,2007:
Admiral John O. Agwunobi,Assistant Secretary for Health, U.S.
[quote]Home quarantines for those exposed and home isolation for the sick are situations in which a person might need to avoid any contact with the outside world requiring a period of self sufficiency. Rarely will these periods extend beyond 10 to 14 days.[quote]
Posted June 6th, 2007 at 6:04 pmAdmiral John O. Agwunobi
Would you care to explain why any U.S. city is much different than Toronto or Ottawa, in terms of how long disruption to supplies may last during a possible pandemic?
toronto.usconsulate….
Why would a U.S. citizen living in Toronto or Ottawa need 2 - 12 weeks supplies, and would need 3 days to two weeks in New York City or any other U.S. city?
Have you seen evidence, or even table top exercise, that can be published to convince the public the government at various levels across the country can guarantee food, water and other supplies will be delivered in sufficient quantities? What happens if 40% of truck drivers get sick? What happens if international shipments from a pandemic inflicted country stops? How would you do to MAKE them deliver?
Thank you.
Posted June 6th, 2007 at 6:13 pmAre we reading the same blog? Can you point out one single post asking the questions you listed? Have you even read any of the postings, or the publications of your own agency? I realize you’re probably a very busy person, and maybe this is a pre-packaged response, but before you advise people on matters of life and death, I would recommend that you find out what they’re really asking, and that you give accurate information.
Posted June 6th, 2007 at 7:29 pmAdmiral Agwunobi,
Thank you for your input into this debate. I am a little unclear on a technical matter.
Quoting from your post:
and
Can I ask you to please clarify for us whether the ‘advice’ you are giving here are your current personal opinion only? Or do them form the answer to the first question and are, in fact, official US government recommendation for personal and family stockpiling?
Put in another way, has HHS already made up its mind about what recommendations would be given to the public for personal preparedness, ahead of the leadership summit?
It would help us greatly in understanding the purpose and the progress of the summit if you can clarify this issue!
Thank you and I look forward to your early reply.
Susan Chu MD
Posted June 6th, 2007 at 7:34 pmEditor
Flu Wiki
Dear Admiral Agwunobi Sir
Pardon me, but, you have got to be kidding. 2 weeks, 4 weeks, stockpiling? You all need a reality check. What you are saying is fine if you make at least 40k a year. However…
The low to very low income people; the disabled; elderly; the single parent; the low wage hourly working families do not have the resources to stockpile anything.
If they do, and their social worker finds out, they could loose their food stamps, even their medical coverage, not to mention they will get trapped in endless paperwork trying to explain how they managed to stockpile.
Then there are those in low-income housing, using that term broadly to cover the many types, who are not allowed to store or stockpile anything. The authorities call it Hazardous.
These people live from month to month. I watch them trying to share and combine their resources as it is. I really think our planners need to make a few trips to these places and ask them what would be needed in their type of community: The needs be will different depending on their location. What kind of help can grassroots community leader like myself get to help those we have dedicated our lives to?
So far, 100% of the people living in low-income conditions, that I have talked to, assume that some authority is going to save them. I am starting to wonder if local authorities want it that way.
Posted June 6th, 2007 at 8:03 pmWhile the last couple of weeks has shown us that our questions will not be answered, I still would like to post one for the Admiral, for the record.
Is the information stated in this blog your own personal opinion or does it represent your professional position as an officer and higly placed official with HHS? There seems to be some confusion on the flu boards about this so a clarification might be in order.
Posted June 6th, 2007 at 8:17 pmAdmiral,
As a business person and as a citizen, I find myself somewhat concerned by your post. It suggests a lack of understanding of the scope and complexity of pandemics and pandemic response, as well as the realities of the critical inter-dependicies between industries, the global just-in-time supply chain, or the shear scope of international travel and the speed of human movement. The fundamentals of your response differ greatly from the guidelines posted by your own agency as well as the CDC and guidance posted on the US government’s own website. We need to be encouraging greater self-reliance not less.
Your comment “Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies” is a complete fallacy — I work with government agencies and business planning for pandemic everyday and in 2 years I have never heard anyone say this. We can hope we have notice, a heads up, but very smart modeling suggests that it is equally likely we will have none at all.
Your comment that 3 days of preparedness is simply no longer supported or recommended as sufficient by emergency managers or the Red Cross — Katrina taught us that.
As far as isolation and quaratine, 10-14 days is not the limit. In fact, these conditions will be set by local public health officials and jurisdictions and the guide is up to 2.5 times the period of potential contagion.
Finally, the tone of your post suggests a “don’t worry, the government will be there to help you in a few days”. The Secretary of DHHS as well as other officials have routinely and regularly emphasized the exact opposite.
You do make one important point in that the specific solution for each family should be unique to that household based on their own circumstances –beyond that, I think you post raises some real questions.
Posted June 6th, 2007 at 8:41 pmDr. Agwunobi, people in high positions and with stellar credentials such as yourself have a responsibility to the general public. Please, please reconsider your statements. The Federal Govt. and State Govt. has already made it abundantly clear that they will not be coming to the rescue. They can’t. Those of us who are ordinary citizens who have followed and carefully researched the evolving pandemic flu situation understand that the magnitude of a severe pandemic is beyond govt.’s ability to be everywhere for everyone. Statements such as you have made here will lead those who have not done the research and who are not well educated on this topic to think a pandemic is a relatively minor event like a blizzard or a hurricane where help will arrive within a couple days. Leading people to think the impact of a major pandemic is minimal and for very short duration will result in many many people dying needlessly. Please sir, give people a more realistic assessment of what a severe pandemic may be. There is much that the govt. can’t do as concerns a pandemic but you can give people good advice.
Posted June 6th, 2007 at 8:57 pmPreparedness should not be aimed exclusively at one hazard or the other. A stockpile should be able to support its owner through a pandemic, a hurricane, a blizzard, an earthquake….or any other circumstance that might require the owner to be self sufficient for a period of time until outside support can be reestablished. A good preparedness plan is one designed to be useful in all sorts of emergencies.
For a family or individual to be prepared, they must have planned and practiced the ability to be self sufficient for the period of time it might take to get outside assistance in an emergency.
Tell me how long does it take to be self sufficient for the period of time it could take to receive assistance?
Should we not begin now so that people have time to drill?
This is a GREAT IDEA. Lets begin a nationwide campaign to tell the people they should prepare and stock up in case of a pandemic for a minimum twelve weeks, yes I know that people should also be prepared for other emergencies as well as tornadoes, hurricanes, forest fires, earth quakes, snowstorms and god forbid bombs of any kind. If you have enough supplies for at least twelve weeks, this would get people through until help arrives except if you need to leave your home.
One should be aware that the resources of a stockpile may need to be used at home, in a shelter or on the road during an evacuation.
Bug out bags are also a great idea (Good Job!)and could be very useful in many of these scenarios–but not a pandemic unless a person has a safe house to go to already because being around others that our potentially infectious would only cause more problems. Don’t you agree?
Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time. Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely. This is because in most emergencies, help is likely to arrive within days not weeks even if delayed. In rare situations where help cannot be expected immediately, evacuation to more supportive settings or the identification of alternative sources of support locally can usually be achieved within days of an emergency event.
That would be great if true, I know people that were hit with snowstorms this past winter and many went weeks without help of any kind. That’s ok. They handled the situation with out government help because they were prepared and lived in the Midwest on farms. Hate to keep bringing up Katrina..but the government didn’t do a bang up job on that now did they? There are still people without the needed help. Timely, I don’t think so. Please quit giving out the message that you (government will ride to the rescue) Americans are supposed to be strong not dependent.
Just tell the people, to prepare and don’t expect government rescue. Do the math. How many government employees vs how many citizens in the United State. It’s a no brainer. And since there is currently no real vaccine, not enough Tamiflu I am going to assume that a few people might call in sick. Don’t you think so?
Pandemics offer a unique challenge because they ultimately affect every community. Additionally, at the height of a severe pandemic there may well be nationwide disruptions in the production and distribution of certain services and goods.
I’ll agree with that above.
Fortunately, unlike an earthquake that strikes suddenly or a blizzard that whips up over the course of 48 hours, in a pandemic there will likely be some advanced warning. Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies. In mild pandemics there may well be no disruptions. It is also important to note that even where there are disruptions in services and supplies, they are likely to be temporary and sporadic. They will not occur in every community simultaneously, nor will they affect all goods or services at the same time or to the same extent.
This one I disagree with.
UN-Fortunately unlike an earthquake that strikes suddenly or a blizzard…a pandemic takes time to plan for. 48 hours is no big deal for just about anyone, uncomfortable-yes. Most people can survive a few days without going to a fast food joint. I don’t believe that we will get warning.
Could I be wrong?
Sure.
So could you.
If I am wrong-no biggie. I and others have extra supplies.
If you are wrong. Devastation.
You’re not dealing with a bunch of newbie flubies here.
I do know the facts, the risks, the odds.
I do understand the science as well as any non-scientist can understand it.
I know what the current CFR is and I am aware of CAR, RO…and the different possibilities as numbers go up and down.
I and no one else knows when or where it will start, it could simmer for awhile yet or explode tomorrow.
…I respectfully disagree that you can guarantee you can give us several months notice and even if you could what good will it do the people who are currently not aware of the potential-they will be like a deer staring into the oncoming headlights.
Preparing takes time if you are to do it right and I very strongly suspect you “normally” expect yourself and others around you to be right, to plan right-your posture, uniform and rank says it all. And your message confuses me. It doesn’t sound or feel right. Why?
Home quarantines for those exposed and home isolation for the sick are situations in which a person might need to avoid any contact with the outside world requiring a period of self sufficiency. Rarely will these periods extend beyond 10 to 14 days. After that period of time most people will be non-infectious because they have either recovered fully or have been shown not to have been infected by an exposure.
Disagree. 10 to 14 days, you are an optimist Sir! Those that have actually survived so far have taken months before they were out and about again. And there have not really been a lot of survivors to date–more then half have died if we are talking about H5N1 virus going pandemic.
A normal flu year-ok.
During the 1918 pandemic, with a lower RO and CFR then the current H5N1 people were taking a very long time to recover and many had long term health problems afterwards.
Every family should conduct an inventory of their needs and dependencies. The stockpile for a family with a bottle fed infant will be very different from the stockpile needed to support an elderly couple with chronic illness. It is important to list those services, goods and medications for which your family is particularly reliant on outside sources. Home oxygen supplies, medications and special diets might all experience disruptions in availability during a severe pandemic. Stockpiles can be accumulated in small increments over time. As the stockpiles ages the oldest items in the home stockpile can be used and replaced with newer items before they expire.
In general, Agree with the above but I’m sure we could disagree about–if the utilities will stay up to provide oxygen, getting doctors to prescribe….
The American Public Health Association advises that every family should have at least a three day home stockpile of food water and medication.
I disagree with the public health advise, not good for even a very mild flu year. I know. Unless you want to go to the store while sick to pick up meds, that you now have to stand in line for and sign your life away, not to mention your not allowed to get more then one or at the most two packages of cold and flu medications at a time. What if you have 7 people in your family and your all sick and all different ages ( you give babies, small children, teens, adults and elderly different types and need a lot more then two packages? We will so be SOL. Not to mention having enough food, drinks…for everyone with out going out and spreading the illness.
This basic stockpile would likely be able to support a family through the most commonly seen emergencies. The US Department of Health and Human Services has advised that during a pandemic, families might need as much as two weeks worth of supplies in their stockpile. This size stockpile would be sufficient to support a family through a home quarantine and through the peak of an outbreak in their community during which sporadic temporary disruptions in availability of some products and services may occur.
Still disagree but not as vehemently. If you are even a tiny bit wrong on what you suspect (or want or hope for) the case attack rate, cfr and ro it won’t be near enough. I know I’m right and you do too, because it’s logical to plan for the worse and hope for the best. And being the strong intelligent man that you are–you understand logic if not emotions.
It is important to note that the size of any given home stockpile might need to be larger for families that live in more rural areas served by relatively fewer sources of those essential needs identified for a family’s stockpile.
For example: A family with only one source of prescription medication within a 100 mile radius should probably maintain on hand a longer supply of that medication than an individual with four different sources within one mile of their home.
This really makes very little sense. First the doctors and insurance companies have to allow us to have a larger stockpile of meds and considering that a large percentage of our life saving medication are made overseas..well that is problematic, isn’t it? And I don’t know about you but even living in the city with lots of pharmaceutical options-they still run out of medications in a normal flu year. Out is out.
For individuals living abroad, stockpiles designed to last months may be necessary. Depending on where exactly around the world you live, disruptions in availability of supplies might be more severe than in the US due to inherent weaknesses in distribution systems and relatively poor preparedness systems. Access to outside support and aide might be more delayed than it will be for individuals living in the US and the ability to return home may be temporarily disrupted as a result of a pandemic or other emergency.
Partially agree with you. Yes Americans overseas in other countries are going to be up a creek because it has already been mentioned that American embassies will not provide help to its citizens. That should be explained in-depth to travelers before they leave the states.
A lot of our food, supplies and medicines come from overseas/other countries–I betcha a few flubies could give you numbers on that-that’s not a strong point-but I know a German guy that is really, really good with numbers.
As to America being stronger in the distribution area….maybe-again it will depend.
Still sounds like your hoping for the best and planning for the best case scenario and don’t get me wrong, that can be a good thing but not in this case. I was one of the first people to hear of and buy the movie the Secret, I am an optimistic person with a can do attitude. (between you and I we need more people in government with that attitude.)
Again, IMO, depending on what the cfr, ro and case attack rate end up being, TELLING people to plan for only two weeks is not only misleading but dangerous to our national security and could allow our country to be weakened further in a potential time of great need.
With Respect
KimT,
Posted June 6th, 2007 at 9:06 pmMom, Grandma, American, CMT, Ex. Account Executive, Community volunteer…bottle washer, grocery shopper, driver and currently a driver instructor to my 15 year old (that is at high risk of dying in a pandemic)
Greg Ewert –
Although your question (post #9) was addressed to Admiral Agwunobi, I would like to take a stab at answering it, if I may.
In my opinion, there are many facts about a future pandemic that we just don’t have, but one thing we know is that our poorest citizens will suffer more than any — unless we all take the responsibility for helping them.
Responsibility starts with knowledge, and the knowledge that Preparedness is Power.
I do not call for anyone to “stockpile” anything, rather, those of us who can (and that means most people) should build more resiliancy into our lives at all levels — more savings, better stocked cupboards and pantries, more medication on hand.
With enough time — a year or more — and proper motivation — a FIRM, CLEAR warning and urging to do so from the government — many people could and would try to have a more serious “family pantry” to get them through hard times, including supply shortages as well as periods of unemployment due to economic disruption caused by pandemic flu, or any other hazard or disaster.
The poorest citizens, the ones who already rely on food stamps and food banks, church kitchens, free/reduced school breakfast and lunch for their kids — will need the help of their communities. There’s no doubt in my mind.
Our message must be: Prepare Now To Help Your Neighbor.
If 80% of our citizens are prepared for a long-term emergency, the government and faith and community-based agencies can help the remaining 20% who cannot help themselves.
If 0% prepare for a long-term emergency, then the government and volunteer agencies will be stuck trying to help all 100% — not to mention themselves. In such a situation, I fear our poorest and least able citizens will be the lowest priority.
We must prepare now, because the stakes are so high.
We must have grown-up pantries (not “kits”) to see us through and to give us options and resources, and to be able to help those in more need.
Posted June 6th, 2007 at 9:19 pmTo Greg:
You said “If they do, and their social worker finds out, they could loose their food stamps, even their medical coverage, not to mention they will get trapped in endless paperwork trying to explain how they managed to stockpile.
Then there are those in low-income housing, using that term broadly to cover the many types, who are not allowed to store or stockpile anything. The authorities call it Hazardous.”
Good point. If the government is serious about a pandemic (we are watching, government, ARE you serious??) then the first thing that needs to be done away with is limits on stockpiling food. In fact, the government should be ENCOURAGING it.
I would say, however, that the majority of people in the US are not in these programs.
And even still, the reality of pandemic preparedness needs to be stated clearly, not managed for this group or that.
We CANNOT be politically correct–it will not aid those who need it, just add more to their numbers if a pandemic hits, diluting the meager resources.
First of all, fact should not be mitigated–if the best guess of a pandemic is that it would be best to have 8 weeks of stocks, then people need to know that. Not telling people that because some cannot prepare that much is not helpful.
No, it is not at all helpful to condemn those who could because there are those who cannot.
INSTEAD we alert everyone, get everyone doing whatever they can (be it large or small or not at all) and THEN we focus our energies on those who cannot help themselves.
Doesn’t it make much more sense in the idea of pandemic survival to say “Everyone, it might be necessary to shelter in place for 90 days and a pandemic lasts for 12-18 months. Prepare as much as you can as soon as you can. And those who can, please consider donating GENEROUSLY to your local pandemic food bank to take care of those who cannot help themselves. Your donations WILL save lives.”.
Isn’t that better? That way the government does not have to bail out ALL of us when our “two weeks” run out, but rather can concentrate on those who need them the most AND will have extra stores from donations to do so.
Again, let’s not dilute the aid that the poorest citizens will need because those who COULD have prepared were not told to, or were low-balled.
Posted June 6th, 2007 at 9:23 pm4. Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time. Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely. This is because in most emergencies, help is likely to arrive within days not weeks even if delayed. In rare situations where help cannot be expected immediately, evacuation to more supportive settings or the identification of alternative sources of support locally can usually be achieved within days of an emergency event.
A pandemic will occur simultaneously everywhere. Secretary of Health and Human Services has gone to every state to tell them that “You’re on your own” and do not expect to be rescued by the government. The disruptions will be unpredictable as to duration and as to which items on your personal needs list.
Also, the idea of being evacuated to a central location during a pandemic horrifies me. I sincerely hope that such evacuations are not included in any government plans.
Pandemics offer a unique challenge because they ultimately affect every community. Additionally, at the height of a severe pandemic there may well be nationwide disruptions in the production and distribution of certain services and goods.
Speaking of services, water and power are crucial services, but if their workers are at home sick or caring for family, those services may fail. If the crisis last 2 or 3 days, even in winter a family can get by. But if the crisis lasts for weeks or months (or if, say, an ice storm downs lines or cryptosporidium contaminates the water supply) a three-day supply of food and water will not suffice.
Pandemic has been the focus of my attention since January 2005, and I have learned that the more one thinks about what could happen, the more one has to plan for the worst case, in order to have some piece of mind. If only planning for pandemic were in the public consciousness…then I could talk to neighbors and help them instead of being afraid to bring up the subject.
Your job title mentions “Health” so perhaps you could do something to encourage communities to offer courses in home nursing, as it’s likely that our overloaded hospitals will be unable to take in all pandemic patients. Today most vents are in use already, so people shouldn’t expect 21st-century health care during a pandemic. (It’s unfortunate that news about pandemic too often discusses vaccines, which will not be available for most people until far into a pandemic, while not describing the cascade of problems that are likely to occur.)
Posted June 6th, 2007 at 9:28 pmAdmiral,
Sir, I sincerely hope that you do not seriously believe what you have espoused here. If you have only prepared for a couple of weeks, then you will most assuredly be in for a large surprise.
Posted June 6th, 2007 at 10:23 pmLet’s get real. I believe that the nation can handle it. We have survived depression, recession, war, and stock market collapse. But we could really be helped by a little advance warning and something more important than that…..the TRUTH!!!!!!
I believe the Admiral can be dismissed from this discussion.
He obviously is not familiar with H5N1 nor the consequences of a severe pandemic.
His statement is outdated.
Posted June 6th, 2007 at 10:48 pmAdmiral, with all due respect, your blog is a textbook example of what is wrong with the state of pandemic preparedness in America today. The government is giving a very mixed message. The left hand (you) doesn’t know what the right hand (Michael Leavitt) is doing! (I’m going to assume that we’re not the unwitting victims of a Good Cop-Bad Cop routine.)
You claim that 3-14 days worth of supplies is sufficient because help will be on the way. Your boss has been warning the nation - loud and clear - that help will NOT be on the way and we’ll be on our own because the logistics are impossible. In light of the widely divergent advice, I think it’s fair to ask: which one of you is right? (My money is on your boss.)
If people take YOUR advice to heart, it may in the end cost them their lives, and/or the lives of their friends and families.
It cannot be stressed enough: AN ALL-HAZARDS APPROACH IS COMPLETELY INAPPROPRIATE when planning for the possibility of an H5N1 pandemic with a fatality rate that has been well over 50% all along - more than 10x the fatality rate of the 1918 pandemic.
As for the idea that we will have two month’s worth of notice, I am dumbfounded! Pretend for a minute that the TB-carrier bridegroom (sorry - I forgot his name) was actually an asymptomatic H5N1 carrier. How many flights did he take? How many countries was he in over the course of a week or two? How many people did he come into contact with - and how many people did THEY in turn come into contact with? I’ve done the math and it’s not pretty. Two months notice??!! Not even close.
I can only hope that you composed and posted your blog before you had a chance to do your homework. I also hope that you will revise your advice ASAP, before too much damage can be done.
Posted June 6th, 2007 at 10:55 pmAdmiral John O. Agwunobi
Thank you for you post, I’m glad to see that a much smaller SIP inventory is justified. I’m glad to finally find out help will be on the way within a couple of weeks. My family will sleep with less worry tonight. Could you tell me which agency I should contact if this goes beyond my two weeks of preps? I couldn’t find that on the PandemicFlu.gov site.
Posted June 7th, 2007 at 12:51 amThanks,
Aeolus
First of all, thank you for taking the time to address this issue.
You do make several good points regarding preparing. However, I am concerned with some of the discrepancies in several of your points.
The first point that is this:
“Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time.”
I find…problems in your argument. First of all, the “support” that citizens will be “reconnecting to” WILL be neighbors, friends, family, community. Being self sufficient means being well enough able to take care of one’s family AND any of the needy around them. Being self sufficient is to be part of the SOLUTION. Being self sufficient means that I do not need a hand up, I can OFFER one.
For ADULTS, self sufficiency should be one of the FIRST things that is expected of us, not one of the things that the government would warn against “too much of”.
Not only that, but self sufficiency also aids people individually in their own lives. How much money would the government save if people would gradually become a little more responsible for themselves and less dependent on the government? For example, my self sufficient friend had stored for an emergency that came in the form of job loss. For 11 months until they got a job, they had more than enough food.
I must wonder why there is such a squeamishness in portions of the government regarding being self sufficient for longer than “3 days to two weeks”? Why exactly is “self sufficiency” a bad thing? Rich in America are (or can be) “self sufficient”. Farmers on the plains are “self sufficient”. Isolated tribes in the Amazon are “self sufficient”. Amish are “self sufficient”. Why is it acceptable for some selective people to be self sufficient, but for mainstream America self sufficiency is a no-no, a disturbing idea to be discounted and downplayed? Why?
Next:
“Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely.”
Again, I would ask “why discourage self sufficiency”? It is the ability to take care of oneself and those around them—the HEIGHT of maturity and responsibility.
I would then ask how long is “prolonged”? If it is more than two weeks (which is NOT prolonged in my book, having been through storms, hurricanes, and even St. Helens), then the recommendations are terribly inadequate.
I would also like the admiral to address how one is to survive with two weeks of food *IF* the Department of Homeland Security has already stated that a pandemic might require a home quarantine of 90 days PER WAVE. Also, as waves of a pandemic last around 6-8 weeks, how would are we to stretch out the two week food supply? Will the DHS be running food deliveries for every community that is in the midst of a quarantine?
“Preparedness should not be aimed exclusively at one hazard or the other. A stockpile should be able to support its owner through a pandemic, a hurricane, a blizzard, an earthquake…or any other circumstance that might require the owner to be self sufficient for a period of time until outside support can be reestablished.”
I would like to offer your words back—that GENERAL preparedness is good in many ways. I would also like to offer that one crisis that almost every family faces is job loss, not hurricane, not blizzard, and not pandemic. I would also like to offer that VERY rarely are people out of work for less than two weeks.
So if we are going with an all hazards approach, then we need more than two weeks. If we go with the most common crisis, again we STILL need more than two weeks. If we go with anything but the most mild of pandemics, we will STILL NEED MORE THAN TWO WEEKS. So I am afraid that again, encouraging longer than two weeks provisions is the way to go. Why encourage people to depend on others when they can learn to depend on themselves?
Next:
“…in a pandemic there will likely be some advanced warning. Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies.”
Sir, I am curious to know how you are basing your conclusions–and I do not mean that in the least bit ugly. I honestly have not seen anything that would support your conclusion in the years that I have been studying the idea of a pandemic.
First of all, consider the fact that the pandemic COULD start on our side of the world. That would greatly reduce the “at least one to two months’ heads up” if the pandemic started in, say, Kansas, with the way we travel.
Also consider that the pandemic can get a foothold in less advanced regions of the world where it would not be recognized until it had traveled far and wide. How many times has H5N1, for example (though that is not the only possibility for a pandemic) been misdiagnosed as dengue, “atypical pneumonia” and others?
Consider SARS and the speed of its travel, even though it is not contagious until symptoms appear. From my understanding and reading, one person can be on the other side of the world in less than 24 hours. People have been known to travel with the flu, or be incubating and then feel the hammer come down on them on the plane–WELL within the contagious period. ONE person with the wrong timing can start a chain that infects the world in MUCH less than one or two months.
Also, consider that the idea of a pandemic generally suggests an exponential growth in cases. An excellent graphic that shows the speed that influenza can travel (1918) can be found here
www.pbs.org/wgbh/ame…
Even if we saw the index cases appear, you are in government, you know that countries (especially the one where the pandemic starts) are going to INSIST on waiting until the last possible moment, until they KNOW with 100% certainty because no one wants to cry wolf or risk economic loss or loss of face. In fact, some countries might wait until it ALSO appears in a different country so that they will not be the ones blamed, the ones holding the bag, the only ones to bear the brunt of “ground zero”.
I would also like to ask which would logically be easier for our delivery system to support: a gradual building over a year of people buying supplies? Or a mad rush of nearly the entire population panic buying in a month?
I would also offer that many of us are on budgets. How are people supposed to find enough money to buy a stockpile with only a month’s leeway, if that? Even if we desire to, we might not have the time or money to in only a month.
Lastly, you mentioned that it would be a month or two before there were DISRUPTIONS OF SERVICE…however, we are not only talking about disruptions, but of the need to reduce the spread of the virus, possibly via home quarantine.
Then:
“In rare situations where help cannot be expected immediately, evacuation to more supportive settings or the identification of alternative sources of support locally can usually be achieved within days of an emergency event.”
You are suggesting relocating people during a pandemic? Take people from their homes and put them with a bunch of others who may or may not be carrying the disease? I do not believe that will work in either a logistical, psychological or even just plain LOGICAL sense.
First of all, as a doctor, surely you must agree that putting well people together with sick people is NOT the way to limit a pandemic. This plan would nearly GUARANTEE disruptions of service. As a military man, you know that more resources are spent on the wounded, not the dead. Even a mild pandemic, where there are more wounded and few dead, this would INCREASE the number of ill and, subsequently, an increase in disruption of services. Without people, goods are not grown, harvested, trucked, processed, boxed, trucked again, stocked, or sold.
Plus, we have seen how “successful” an “evacuation to more supportive settings” was in Katrina. While the evacuees faced imminent physical threat of death from a hurricane and flooding, the alternative was to be holed up in the Superdome where rapes, murders and other atrocities reigned.
Psychologically, people do not WANT to leave home, especially if they are sick or in danger. They will also be EXTREMELY distrustful as they feel that the government dropped the ball (which it would have if it did not warn people adequately).
Logistically which is more feasible? Encouraging people to have a GOOD stockpile in their own homes, giving them the information they need to take care of their own and those around them, putting a strong government message of “Go feather your nest, it will be the best place you can be. Buy food and supplies. Reach out to neighbors and family members. You CAN and will have to take care of yourself and each other, this is how…”
*OR*
Try to uproot large portions of communities out of their homes and gather the sick and the healthy together with no psychological support and very little physical support, requiring the National Guard to stand watch as masses of people have a simultaneous adjustment reaction to what they are experiencing?
Logically what is more reasonable—breaking down the task of caring for the nation among the CITIZENS of the nation with admonitions of preparing NOW, or trying to be father/doctor/grocer to everyone when a pandemic hits?
Let us say that we look to communities for that help…where are they to get the supplies in the midst of a pandemic? Most communities are unprepared as well. Communities, halfway between government and citizen, are suffering the problems of both: ignorance like the individual citizen and the inertia of the government. People do not know because the government will not tell. The government will not tell because “hope” seems to be a key factor in the government response plan. Remember, it is “Hope for the best BUT PREPARE FOR THE WORST”.
Local support will probably be via family and friends. Again, the more preps they have, the more support they can give. People might not be able to share their last cup of sugar with you if they have children to feed, but they will mostly likely give you two cups if they have a full bag in the cupboard.
We cannot afford to refuse to work the problems now with advanced and thorough preparations on ALL levels, and instead go with: “do the mins, and if something big happens, exacerbate the problem with evacuation, crowding, etc”.
“Home quarantines for those exposed and home isolation for the sick are situations in which a person might need to avoid any contact with the outside world requiring a period of self sufficiency. Rarely will these periods extend beyond 10 to 14 days.”
Again, I must disagree. Home quarantine is also to PREVENT sickness in a community stricken with a disease. The idea is “if there is a bear outside the door, do not go outside until it is safe”. That is why the DHS said that there might be a 90 day quarantine period. People might actually need to stay home so they do not get sick or get others sick.
But let’s say that 14 days is the max that someone would have to quarantine (though I strongly disagree), that is still cutting it a BIT close with the stockpile.
Then suppose someone in the household comes down with something during the quarantine? The quarantine is then extended. Suppose that house’s quarantine ends as the wave is peaking in the community—those people might want to wait inside a bit longer. Again, I find it short sighted to say “What is the LEAST we can do?”.
I do not mean to be impertinent, but sometimes a COLD lasts longer than 10 days. Seasonal influenza takes a long time to recover from, and a novel influenza will probably be much longer. If a family of four gets sick in a staggered, typical “1-3 days of incubation” with a novel influenza, you are looking at a lot longer than 10-14 days.
“After that period of time most people will be non-infectious because they have either recovered fully or have been shown not to have been infected by an exposure.”
Perhaps…until the sequence changes. Which it most likely will. As you know, influenza is very prolific and sloppy, changing and mutating constantly. Hence, having to re-do the vaccine every year. We will ramp up meager vaccine production for the first strain….but what about the second or third?
“The American Public Health Association advises that every family should have at least a three day home stockpile of food water and medication. This basic stockpile would likely be able to support a family through the most commonly seen emergencies.”
I puzzle at the choice of this organization out of all the major organizations that are out there. Most major organizations are recommending at least 1-2 weeks. Frankly 3 days would not see people through much of any emergency. Hurricanes, snow storms, job loss, unexpected car payments, pandemics, even the most minor personal illness generally lasts longer than this!
“The US Department of Health and Human Services has advised that during a pandemic, families might need as much as two weeks worth of supplies in their stockpile.”
Again, extremely shortsighted. And again I must ask why the APHA’s recommendation was offered if the HHS has a longer timeframe to stockpile?
Understand that if a person has extra, they can help those around them. They can donate to a food bank to take care of the portion of the society who cannot stockpile AT ALL. They can support a neighboring family who is down on their luck, or in the midst of a pandemic. They can support themselves in the event of a more severe pandemic, or they can use that food to see them through their own personal hardships. There is not ONE reason to lowball stockpiling and a dozen reasons why the recommendations should be longer.
Sir, I believe that your intent may be sincere, I just do not follow your reasoning. If you truly believe that a pandemic will be wholly foreseeable, minor, transient, and relatively benign, then please tell us WHY. What are the facts that led you to your conclusions?
I am MOST interested, honestly and seriously, to see what facts brought you to the conclusion that this is nearly a non-event, something that, even at its worst, will be easily manageable with two weeks of supplies at the most, and the government coming in to save the day.
What FACTS have you seen that we have not? I guarantee that most of us would greatly appreciate hearing any SCIENCE (not belief or ideals or policy) that lead you to your conclusion. Thank you very much for your time.
Posted June 7th, 2007 at 2:16 amAdmiral John O. Agwunobi
Posted June 7th, 2007 at 2:48 amWell your’s is certainly the most interesting post I’ve read on this site to date. In light of Secy Leavitt stating “your on your own”, how can you in conscience suggest that 2 weeks of preps would be sufficient to SIP for a pandemic wave that has been suggested by both the CDC and the DHHS to last 8 to 12 weeks?
Thanks,
Aeolus
Thank you for your article.
I’ve been spending a while trying to figure out why the presented advice kind of, erm, clashes with what I feel is my current worldview.
You’ve probably felt the same when talking with someone you know is intelligent, has lots of information, but, for some reason, seems to speak a different language.
I felt the same when reading your post, and I don’t like feeling that way. After all, here we are: humans trying to do whatever makes best sense in the face of whatever the future may bring.
We need a better understanding of what each other thinks, if only because then there will be actions that will hopefully prove more effective in the face of reality. It’s all talk until there’s no more talk.
I feel one key point might be in the sentence you offer:
Let me be upfront about it: that’s not my current perception at all.
I’ll tell you what my perception was initially. I computed the numbers, and if 30% of the population are bound to be ill at some point in the pandemic, then the worst few weeks maybe 2-5% of the population will fall ill simultaneously. That’s one in twenty, and if we add an extra person to take care of the ill, then society still has 90% of the players moving across the field and, after all, winning the game. It can’t be that bad, I thought.
Thing is, pandemic flu is not seasonal flu. When people are ill they are more severely ill than what we usually see. There’s a whole range of posibilities, of course, but if we asume people are ill (or recovering) for 2 weeks instead of one, then our 10% (ill plus carers) becomes 20% at the height of the pandemic. Even a not-too deadly one.
And if people don’t want to see their children into a situation that would multiply their chances of dying by 5 to 70 times or more (I certainly wouldn’t want that, so I wouldn’t say anything different to my extended family, neighbours, coworkers, etc), then I’ll pull them out of school, soon and for as long as needed (4 to 12 weeks is the current assumption), in all except very minor pandemics (which, granted, have happened too). And that will add to absentee rates because there’s no way I’ll leave my kids alone at home for 4 to 12 weeks. All of that, because children’s lives are, erm, more important than other things. (I’m trying not to show my more intense feelings. After all, we’re not into a pandemic yet.)
And we’re not yet counting the huge numbers in the “service industry” (everyone cuts each other’s hair or sells fancy articles at malls, these days). I guess that’s why the World Bank expects recession (meassured in .5% or even 4% of the world’s GDP), even in a not-too-deadly pandemic (that would be .5% GDP).
So it’s quite posible that absentee rates will be over 20% (some say 30%, 40%, or maybe more in some instances) for several weeks in each wave, which will probably disrupt some things, even some important things, for more than 3 days. Still, 20-30% looks like summer holidays, and the world doesn’t break down because of that, right?
Things are made worse because it will be happening in many places at once, and illness weeks can’t be scheduled or amicably discussed among co-workers, as in ok, I’ll fall ill days 1-7 and you fall ill days 8-14, call it a deal?. (Some people think “simultaneously all over the world” is too dramatic. Ok, let’s leave it at that.) So the supply chain for just about anything may be disrupted in several places, because it’s a long chain, with many failure points. How many steps from farm to kitchen (farmers, truck drivers, border officers, more truck drivers, supermarket employees)? And they will indeed be “failure points” and not “holiday points”, if many people who work closely together fall ill at the same time. It’s more like going on strike. All over the world. In simultaneous or rapidly sequential, unplannable waves.
The posibility that there will be some uncomfortable to hellish months is clear. Even in a pandemic that’s not very deadly.
All over the world. Our smooth-running, “all things just-in-time” world. No outside to wait for support from! Rather, we preppers will be the support for (a few) others! (I say “a few” because I may be able to help some in my close family. No more than that, sorry. Every family needs a few preppers!) Part of the solution, not part of the problem. The task ahead is rather big, and we’ve already started.
I honestly don’t think 3 days or two weeks will cut it. Let’s start with two weeks and build upwards from that.
Now, what’s your view of how a pandemic will unfold?
I await your reply. Thanks!
Posted June 7th, 2007 at 5:29 amAdmiral Agwunobi
Thank you for taking the time to post. The purpose and function of this blog and June 13th conference are stated on the About page:
No doubt, the blog function is being fulfilled here, and I hope the conversation on the 13th of June will be equally dynamic.
To be fair, your post was divided into non-pandemic and pandemic preparedness sections, and much of the consternation from your readers is based on the message your post gives that stockpiling should be lean and portable in case of evacuation. It suggests that an ‘all-hazards’ approach should be weighted toward the mild end of preparation. That does not fit well with the Congressional Budget Office:
or DHS
which review the contingency of a more severe pandemic than 1968. Dr Raub, in the Secretary’s piece, was clear and correct that we can’t use previous pandemics to predict the next one; the message there is that we cannot predict a mild 1968-style event and must prepare for mild, moderate and severe events.
For that purpose, Secretary Leavitt engaged all the states in a series of summits. The Secretary’s opening remarks for each state are here. In my home state of CT, I heard this message about 1918 from the Secretary:
And so it will. Now, Secretary Leavitt did not give a 50 state tour focusing on 1968. there is a reason for that. He wanted the message about the need, the potential and the risk of a pandemic more significant than 1968 to be heard, and CDC in their table top exercises that I have participated, clearly projects through the use of simulated TV reports a much more urgent scenario than the one you describe here.
Given the pandemicflu.gov and the American Red Cross message of two weeks of food and water (not less), the above government authoritative links from DHS, CBO and HHS, the excellent work of historians studying 1918, the other posts by participating bloggers (including mine) and the insightful observation by Nedra Weinreich
I am not surprised about the comments left here. Knowledge of the current situation in Indonesia is not reassuring, nor is the recent XDRTB case, and these commenters are well aware of it.
Hopefully, the June 13th conference can be used to reconcile some of these different perceptions of message so that when community leaders assist HHS and the public to assist themselves, the message is clear and not cloudy.
In the meantime, the public health service needs to recognize that the point of view of the public has validity and substance. I hope you read these comments, therefore, in that spirit, since these are the local community leaders who will help prepare for the next pandemic.
Thank you for your time, and I look forward to more dialogue.
Posted June 7th, 2007 at 7:51 amAdmiral, obviously your comments have caused a bit of a stir. How are we, the public, to decide which government `voice’ to listen to on the subject of stockpiling food, water, and medicine? There have been many conflicting pieces of advice offered.
I call your attention to the following from last year.
U.S. Department of State
Bureau of International Information Programs
Washington, D.C.
March 9, 2006
PUBLIC HEALTH AND HEALTH CARE DELIVERY: PLANNING FOR A PANDEMIC
“Families should stock cupboards with enough nonperishable and prepackaged food products to last four weeks to five weeks. Supplies should include bottled water, canned meats, fruits, vegetables, soups, protein or fruit bars, dry cereal, granola and fruit bars, crackers, peanut butter or nuts, canned juices, canned or jarred baby food and formula, and pet food.”
tinyurl.com/l5omx
On June 1st,2006 the AP carried this report.
Little Rock (AP) - Arkansas public health officials say it’s a good idea to stockpile two months of food, water and medicines in case of an outbreak of pandemic flu or any other emergency that could lead to shortages.
And on the same date, this appeared in Vermont.
“State and local police, emergency medical services, firefighters, selectmen, trustees, state officials, and health care and hospital officials gathered for the first time in one room to learn what they needed to know in the event of a pandemic. . . . “We need to prepare and have some goods in our homes … be prepared for six or 12 weeks.”
These are just a few examples. In my own state, one county advised 40 days worth of supplies. I wouldn’t want you to think that those who have commented thus far on the 2-week debate are alone in their views.
The truth is, we’ve heard everything from 3 days to 12 weeks from `official’ sources. As you can understand, this makes a 2-week recommendation difficult to reconcile.
Posted June 7th, 2007 at 8:30 amDr. Agwunobi,
For the record, I think that in your blog you say things which you should know are not true. For example, you said:
“Even in the most extreme emergency circumstances the need for prolonged periods of self-sufficiency is very unlikely. This is because in most emergencies, help is likely to arrive within days not weeks even if delayed.”
Tell that to the Katrina victims.
All the top flu experts say that H5N1 may go pandemic with its current kill rate of over 50%. Most models assume over 30% of the population will be infected. If this occurs, do you honestly believe that help will be coming? From whom will the help be coming?
One more question: Does your post reflect official HHS policy?
Posted June 7th, 2007 at 8:46 amAdmiral John O. Agwunobi,
It seems the posters here and myself think your pandemic out look is a bit rosy.
If you could please let us know your thoughts.
What plan ‘B’ is in case things do not go well. Since our food, oil adn such comes from other countries “re connecting with supplies” seems more doubtful to us.
What plan ‘C’ is incase the unthinkable happens. Back in ‘65 a light bulb with a virus was dropped on a N.Y. subway track to see judge the spread of virus. There are several “Low Tech, High Concept” nightmares I hope the powers that be have planned for such a night mare. My fear is that without more supplies the average person would not be able to respond to such plans. I could be wrong.
Drilling is part of training because there is a huge difference between “I have done that” and “I have never done that, but they mentioned it in class.” Firemen drill, police drill, public utility workers drill, doctors and nurses have drills, even kids - scouts - are drilled to test their skills. Some states have tornado drills, fire drills. Why have a pandemic drill if there is no pandemic?
Sir, I look forward to your thoughts as you are privy to information and meetings we are not.
Average Concerned Mom - I agree with you, Lugon and others. May we prep, may we drill.
Regards,
Posted June 7th, 2007 at 8:50 amKobie
Admiral,
In a pandemic, every mile that separates us from the source of our food or any other essential is a mile of vulnerability. A subsistence farmer in a poor country is less vulnerable than the apartment dweller in the city or the family in the suburbs, whose food must travel hundreds of miles to reach the table.
In a pandemic, the family in a $500,000 home may freeze to death in winter, whereas a family in a cabin with a wood stove will stay warm.
In a pandemic, a city dweller sweltering in airless rooms may succumb to summer heat, while a family sitting out under a shade tree hundreds of miles nearer the equator finds refuge.
To the extent that we are dependent on our long and tenuous supply chains for the essentials of our lives, we are vulnerable.
To the extent that we are dependent on an aging and rickety infrastructure to supply power, fuel, warmth, cooling, and clean water, we are vulnerable.
To the extent that the next harvest depends on fuels and fertilizer, big machines, processing plants, refrigeration, and long-distance transport, we are vulnerable, not only during a severe pandemic, but perhaps afterwards.
To the extent that we know less than our grandparents did about how to lead self-sufficient lives, we are vulnerable.
To the extent that our neighbors remain unaware, unconvinced and under-prepared, we are vulnerable.
To the extent that our National Guard forces and their equipment are now deployed overseas, we are rendered more vulnerable than we might otherwise be.
The belief that we will suffer less because we live in a privileged and modern nation is as flawed as the notion that the Titanic could not sink. Our only life rafts are likely to be the ones we fashion ourselves in our homes and local communities.
The belief that the government can help everyone at once is as much a fantasy as a child’s faith that Santa can bring toys to every boy and girl the world over in just one night.
In a severe pandemic, there is no “outside world” to resupply us because a pandemic will be everywhere at once. So we’ve been told. To prepare for only two weeks’ disruption is to bet our lives on the mildest of pandemics, even as the most virulent flu virus the world has ever seen continues to infect and kill, edging the world ever nearer to possible catastrophe.
You may tell me and my neighbors to begin by preparing a stockpile sufficient for two weeks, but in good conscience, you must not imply that two weeks will be enough.
Posted June 7th, 2007 at 9:07 amIn April, 2006 Admiral John O. Agwunobi
attended the National Conference of State Legislatures’ Spring Forum. According to the article at this website
www.ncsl.org/program…
The following statements were made:
“Any community that fails to prepare because it thinks the federal government will rush to its aid will be tragically mistaken,” Agwunobi said. “It’s not because we don’t want to. It’s impossible. How could we be in every community simultaneously? The federal government, fortunately, is not that big.”
He also pointed out that while Hurricane Katrina strained emergency management for perhaps several weeks, a flu pandemic could last as long as 18 months. It won’t stop, he explained, until 30 percent of the population is either infected or vaccinated.
“It’s better,” Agwunobi said, “to prepare too much and deal with a minor event than to prepare too little and deal with a major event.”
In Secretary Leavitt’s last blog post he made this statement:
When preparing the public for a pandemic, leaders struggle with a constant dilemma. Everything they say before a pandemic starts sounds alarmist. However, once a pandemic starts—no matter how much has been done, preparation will seem inadequate.
My comment: I believe Admiral John O. Agwunobi is knowledgeable about the potential effects of severe flu pandemic. I also believe there is a good chance he is one of those leaders struggling with that “constant dilemma” Secretary Leavitt mentions concerning sounding alarmist. Finally, I believe his blog post is representative of his attempt to find a “middle of the road” warning. What motivates his stance? Your guess is as good as mine.
I’m not defending him. I reckon he is capable of coming on-line and defending himself.
(Personally, I think it is prudent to prepare to “shelter in place” for 3 months or longer. This so a family can avoid infection if a severe flu pandemic were to occur.)
Posted June 7th, 2007 at 9:52 amDr. Agwunobi, you hypothesize, “at the height of a severe pandemic there may well be nationwide disruptions in the production and distribution of certain services and goods”.
May I suggest you test your hypothesis by a simple, short telephonic interview with teamsters (not their stewards) and independent truckers across the USA. A good sample would be 1000 people.
Please post the answer to your survey question which I suggest be: “Will you continue to drive when you know there is a pandemic in which 5% of those infected will die, in which 1 out of 3 will become infected, and exposure to others is the way this pandemic virus spreads? Or will you park or quit and wait it out?”
Based on the answer to this one question, your hypothesis will stand or be invalid.
I’ve done this survey informally, and I’ve raised a further question after receiving their answers, “Do you think you have a social responsibility to continue to drive, when so many people are dependent on you?”
The answer I believe you will find is the same as that given by the laundryroom workers at Bellevue Hospital in the City of New York during the 1918 Spanish Flu, as reported concurrent with the event, in the NY Times. Every single worker walked off the job. They quit out of fear for their own lives.
The element imo you have failed to weigh fully is the response of “fear”, fear of the unknown and fear of exaggerated risk.
Even more damaging at the time of severe pandemic, your credibility will be challenged because your statements made now will be held up by the press and by those who record and remember. That loss of credibility will endanger the entire population of the USA because there will be no replacement for you and no reason to believe you further.
As I’ve said above, please conduct that survey and report the results here. It will take no more than a few days. I look forward to our mutual edification.
Posted June 7th, 2007 at 10:01 amWe all have to plan as we see fit. It is all based upon the underlying assumptions.
We now have a “new strategy” nationally being put in place based upon “mitigation.” It will change the assumptions. If effective, it might extend the duration of a pandemic event in a given area while delaying the outbreak peak. It is said that it will “decompress” the peak burden in infrastructures by spreading it out over time.
With no “mitigation” interventions, it is assumed you will have the highest percentages of the population infected in a shorter period of time causing a more extreme and sharp breakdown of societal infrastructures (that will not recover as fast as one thinks in a Just In Time [JIT] world) and a resulting NEED to prepare for the worst case scenario (e.g. stockpiling).
If you accept the assumptions inherent in the new “mitigation” strategy, then we just might not have the feared breakdown that led to previous recommendations for longer periods and the Admiral’s ideas might have more merit. Remember, this is IF you accept the new assumptions and that this “mitigation” strategy will work.
If you extrapolate, then you have to alter your planning somewhat. We all know that individuals that survive infection will be “immune” from infection for the possible second and third waves and will need to be recruited for future waves.
If you are extending the duration of the first wave, then perhaps systems need to be put into place to “gather up” these individuals as soon as possible after recovery to further minimize the impact on societal infrastructures. I haven’t seen any emphasis on this, but these kinds of things need to happen so even if people do NOT prepare or stockpile enough, there will still be a fabric of society insuring that enough materiel gets through to keep people alive.
Preparing for a worst case scenario could involve years worth of stockpiling ala “nuclear holocost.” Or least case, a couple of weeks. Everyone has to make their choices.
How will the new strategy change things, or will it? Even if it works in some areas and not in others, then we may be able to re-access the old assumptions about natural disasters and the possibility of “re-supply” from areas not or less affected to those areas more affected where it does not work or is not put in place or is done poorly. All will occur.
Katrina does not instill me with confidence, but what do we assume?
Posted June 7th, 2007 at 10:06 amAdmiral John O. Agwunobi,
Posted June 7th, 2007 at 10:11 amIn other words Admiral, you have managed to set back this entire effort by either not comprehending the situation or if you do comprehend, overtly misrepresenting it.
Admiral, Seems you have caused a bit of a cytokine storm here.
By now, if you are reading, you should realize that your approach just won’t cut the mustard on this blog.
Even worse, if you project this approach of yours to the public at large, many folks may suffer and die because of it if a severe pandemic occurs.
I am hoping that what you have written is your personal opinion alone.
I think now would be a good time for the Secretary to let us all know if your views represent HHS policy.
Posted June 7th, 2007 at 10:14 amI have to agree with comment #1 and #3, What a relief!! I can stop stockpiling? I don’t know what I’m going to do with all this extra food. Maybe I can give it away because it doesn’t sound like I will need it.
Posted June 7th, 2007 at 10:26 amI wish you were right Admiral, but by stating what you have and by giving people a false sense of security you have only put more people in danger.
It’s this kind of attitude and uninformed comments that make the public wonder if the government is taking any of this serious, and who’s safty they have in mind????
It’s a good thing to be part of this blog but PLEASE know your facts and be honest.
Even in the most severe pandemics we can expect at least a month or two between the identification of initial pandemic cases (and warning of the public) before the numbers of cases begin to result in disruptions to services and supplies.
Sorry, Admiral, if this comes off as sounding rude — but what planet are you living on? What about international air travel? This isn’t 1347 you know. The whole Andrew Speaker episode clearly illustrates that most of us could very well be at risk within hours or days of an outbreak somewhere.
Please, don’t insult our intelligence.
Posted June 7th, 2007 at 11:10 amAdmiral Agwunobi, thank you for your interesting blog, it’s certainly given us flubies something to get our teeth into
Now, if you had posted such blog at any other time or nearly any other place, it would have been the perfect blend of concern and common sense. Your advice seems eminently reasonable, designed to encourage people to see the wisdom of preparing for all hazards, including a potential pandemic. Certainly worthy of a brightly colored pamphlet in the doctor’s office.
However, this is not any other time, this is H5N1 time and this is the Pandemic Flu Leaders Blog. OK, we certainly don’t know that H5N1 will ever spawn a pandemic, but let’s face it, we’re all here because of it. Pandemics wouldn’t be on our personal and public horizons if it wasn’t for H5N1. Even XDR-TB doesn’t have the power to wake us up to our vulnerability to global disease. Yes, some cleaver people would point out the facts about how damaging even a ‘mild’ pandemic would be, but it doesn’t concentrate the mind like the global killer H5N1 could be.
Of course, perhaps you’ve got insider information, perhaps you know that the chance of H5N1 becoming a pandemic is so small as to be insignificant. Perhaps all the world’s health organizations are using it to stir up a bit of interest in communicable diseases, especially influenza. Tell us, are we wasting our time worrying about H5N1?
If you can’t answer that question, you have to accept that the nightmare scenarios of an H5N1 pandemic are possible. How valuable your blog then?
You can’t make the decision for the public on how much to stockpile. You need each and every one of us (who can) to make that decision for ourselves. To do that we need the truth, even if that truth is ‘we don’t know’.
Share the responsibilty for pandemic preparedness. That way, if we get it wrong, it will be our fault, not your’s.
Posted June 7th, 2007 at 11:24 amEven in 1918 the Spanish Flu covered all of America in four weeks!
That was in “horse and buggy” days!
Now we have fast trains, cars, helicopters and planes.
I shudder to think how fast pestilence and death could spead.
The current case fatality rate of 87% in Indonesia does not offer us any reassurance either.
There is an inadequate supply of antiviral medicine - there is not yet an effective vaccine - and it kills children and teenagers rather than the weak and the elderly!
Are we really both talking about H5N1?
Posted June 7th, 2007 at 11:59 amLadies and Gentlemen: Please put your pencils down. The time is up. The Admiral’s test is over.
You all passed with flying colors. You answered correctly.
Admiral … your next test posting is….?
Posted June 7th, 2007 at 12:01 pmI must ask again, as many of us are hoping for an answer - does your post represent current HHS policy? If so, how is it possible to reconcile its contents with the statements previously made by Michael Leavitt that appear contradictory to your stated position?
Further, how is it possible to even consider telling people on one hand that they may be detained within their homes for possibly multiple 90 day periods while not simultaneously reminding them that if they cannot leave their homes for 3 months, then they should have stocked provisions in advance of that directive? Is there some government plan to provide food, water, medicine, etc., to all Americans during what might be two or three or even four 90 day periods of which we are unaware? I’m sure many of us would be greatly relieved to find that such a plan exists.
On another front, do the existant plans take into consideration how to deal with the disposition of possibly millions of bodies within a relatively short period of time? I’m sure you are aware that the recent cases in Indonesia show that almost 9 of 10 victims have died. Even if you presume a relatively low rate of infection, if close to 90% of those infected die, there will be an enormous problem in dealing with all the corpses.
Again I ask . . . and I believe we have the right to know . . . do your statements reflect current HHS policy?
Posted June 7th, 2007 at 12:22 pmThank you very much for your blog. It is very insightful to see what a difference a year makes. I am particularly interested in what events have happened that have led you to change your beliefs/talking points over the past year per Okieman’s citation above in comment #29. I would like that information to be made pulic so that we informed citizens may make our own decisions regarding the individual need to prep.
Posted June 7th, 2007 at 12:31 pmI would like to make one point here regarding feeling vs fact.
Our society is very much geared to “Do what you FEEL you need to. We do not want to cause bad FEELINGS….we do not want scare, alarm, anger, irritate. We want people to FEEL their way through xyz. Let’s not say this because it might make people FEEL bad”. VERY much short term gain for long term loss.
The fact is that a pandemic will be what it is. It might be severe, it might be mild. Could be MUCH worse than 1918, or barely a sniffle.
We do not know it WILL be, but we do know what it COULD be. We can see how long people are suffering with it now. We can see the tabletop exercises that are done, and we can see what DHS is expecting and what has happened in 1918.
The only RATIONAL thing to do is to prepare for what it could be. If we are wrong, we are safe. If we are RIGHT we are safe.
Feelings will not change fact. Period. I do not feel like having a pandemic AT ALL, but that does not mean there will not be one. I know people who do not feel like preparing at all. However, they would if they were told “Hey, YOUR preparing is what you are going to have to depend on with a pandemic that is probably going to happen sooner rather than later.”.
So to offer to society “Do what you FEEL you need to do” without giving them as many facts as you can, is dishonorable and unutterably cruel. That is like saying “Do what you feel you need to to keep yourself safe” without telling me there is an armed gunman two doors down from me or a snake at my feet.
If a person “feels” that the government will come to them immediately, but that is probably not possible, then that person is in danger because he worked off of feelings, not facts. We saw that with Katrina. We WILL see it again if things are not changed.
Warm fuzzy feelings do NOT feed us. Rhetoric does NOT keep one warm. “Do what you think you need to” without any fact is NOT NOT NOT empowering, it is condemning one to suffering.
And one might counter “Well, they have to look at their own situation, their own needs”. Hooey–EVERYONE needs to eat. Period.
If the government came out with “This is EVERYTHING we know. This is what we strongly recommend. These are the policies that might have to be implemented. This is what we can do for you, and this is what you will probably have to do for yourself. If it is mild then we have lost nothing. If it is bad, this might save your life and the lives of your children.”, then that at least would give people a fighting chance.
Honesty, clarity, transparency is SO refreshing to see in government officials. Please take advantage of it.
To KM
“If you extrapolate, then you have to alter your planning somewhat. We all know that individuals that survive infection will be “immune” from infection for the possible second and third waves and will need to be recruited for future waves.
If you are extending the duration of the first wave, then perhaps systems need to be put into place to “gather up” these individuals as soon as possible after recovery to further minimize the impact on societal infrastructures.”
It is possible that people will NOT be immune for second and third waves. It is possible that the virus will change enough that it can be “recaught”.
I cannot disagree more with the “gather up the survivors”. People are not going to want to leave their families, and many will have to take care of family members and friends. Any system that “gathers up” people away from their families is not going to go over well at all.
No, if you want survivors to help, it is probably best to appeal to them now, not round them up later. I do not believe a “system” of gathering the recovered will go over well. But we can say “If you are recovered you are probably safe. Go to your local pandemic office and offer your services if you can.”.
Just a thought.
Posted June 7th, 2007 at 12:58 pmTierra23 is wondering “what events have happened…”
Read the new Mitigation guidance on the pan flu site. This is the major change I see. That interrim guidance may cause a shift if you extrapolate out from its goals which will likely evolve into assumptions. These are different than the past and will shift planning efforts and “if they work” they will shift expected and projected outcomes.
I am not addressing my personal beliefs regarding them here, but if you read the mitigation guidance and more importantly, the presentations from the Institute of Medicine Conference on this and resulting paper last Oct. And even more importantly, the journal articles from the presenters and others and W.H.O. both prior to the IOM conference and since, you can see the evolving approach.
It appears there will be some differences. One of the first, for example, is the concept of school “dismissal” vs “closure.” How is is different? It means you keep the school kitchens running, for example. It is a tactical distinction, but within the context of the new strategy, you begin to see systems alter not to prepare for the worst, but to plan to keep the fabric of society from ripping apart and instead stretching to its max…
And yes, it might mean that government has to change what it has been telling you for a couple of years… In this particular case that could actually be a good thing. Govt is still working on the transparency thing espoused in their own crisis communications plans though. Or maybe it’s not even clear yet in their minds???
This is my take. Once again, if you extrapolate, the changes could very likely be ones where the “worst case scenario” still exists, but it is less likely, changes its form a bit and is explicitly not quite as bad. Not quite…still very bad and perhaps just as many people die, but collapse MAY not occur. And remember, we are talking about worst case here. The new strategy allows for less than this with a hurricane level type of approach to assessing threat.
Posted June 7th, 2007 at 1:31 pmMonotreme notes that “All the top flu experts say that H5N1 may go pandemic with its current kill rate of over 50%. Most models assume over 30% of the population will be infected.”
Sources for statements such as this can be found in numerous other responses to these blogs.
It would be truly useful for HHS to address the “truth” of these propositions. If they are “false”, show us why…so we can go back to living and dreaming.
Posted June 7th, 2007 at 1:48 pmwww.ncsl.org/program…
Admiral: I wish your words here matched those in this quote. They do not and by failing to do so you add to the existing inconsistency in the ‘official’ message and decrease the likelihood that the public will prepare at all.
Your position and experience obviously give you access to information that allows a more informed view, so why would you choose to approach this blog opportunity in the way you did?
Given your position and previous involvement in pandemic preparedness, I must assume (hope) that in many of your assumptions you have intentionally chosen to downplay many serious risks and over-estimate the system capacity and resilience due to some outside factor that you believe requires such an approach.
You acknowledge that
(emphasis added)
But then you immediately undercut this warning with an assurance that everyone will have plenty of time to prepare, ignoring the serious risk that we may be surprised by its speed:
www.usmedicine.com/a…
And if there is a risk that a buying surge today would create shortages, what will happen if we postpone that buying surge to the time of maximum stress and minimum ability to recover? I cannot imagine the consequences of an entire population trying to cram its personal preparation into 30-60 days (to say nothing of 2-3 weeks.)
Do you honestly believe that this kind of over-assurance will convince people to prepare? Or that mixing discussion of a multiple hazards approach is the best way to either persuade people to prepare or educate them on how to prepare for a pandemic? (Evidence so far shows that approach not working terribly well.)
I wonder whether you are one of those public officials that has so little faith in the general public that you feel they must be treated like children so as to not ‘panic’ them.
www.usmedicine.com/a…
If so, I hope you take the time to read the following diary and the excellent discussion that followed: Panic and the Vision of Collective Incompetence.
www.newfluwiki2.com/…
Either through an unjustified fear of panic or for some other reason, it seems that the science/assumptions here are being twisted to support the pre-determined message of a 3-day to 2-week preparation period.
The frustrating thing is that you could have given the same recommendation on starting with a 2-week stockpile, without so obviously underplaying all the assumptions.
So why choose this approach?
Posted June 7th, 2007 at 2:22 pmDr. Agwunobi, I agree with most of the above comments. It seems counterproductive to undermine Secretary Leavitt’s message that we are on our own and not to expect much help in the event of a pandemic. I will be looking for his response to your post. Hopefully this will all get hashed out at the June meeting and we will get some clarity.
Posted June 7th, 2007 at 2:33 pmAdmiral
Posted June 7th, 2007 at 2:34 pmI am not a flubie or a blogger. I’m a 61 year old grandmother of 7 and one great grandchild on the way. I was only aware of this venue thru a family member,as to my knowledge it has not been advertised to the public where I live.
It would seem to me that in one short post you have set back the effort to ready the public in a very dangerous way.
If this is indeed the view of the HHS why was this forum even started? In one breath we are told to get ready,prepare and in the next we are told be happy don’t worry. Well, I for one am worried when we the public receive such mixed messages from our leaders. I think it’s time our leaders shoot square with us. WE can take it, the truth that is!
American’s are truly remarkable people when given the chance to work together.
Kmilhon post #42
I believe strongly that the non-pharmeceutical intervenions listed in the CDCs interim guidelines for community-based mitigation (I hope I got all that correct) could work well, IF people knew about them and were prepared for them ahead of time.
But even for these strategies to work (especially “dismiss the schools and keep kids at home for 12 weeks”) many, many families should be prepared for them, and that means having cash on hand (to help pay the bills when you are out of work) and in addition, full, “family pantries” — NOT a “flu kit” but actual bona fide food, supplies, and medicine at home to be able to better weather all sorts of contingencies… not able to eat out, not able to have home-delivered meals, whatever.
The most important thing in using the “close the schools” and other strategies is early implementation. The better people, especially families, are prepared for this NOW, the faster they will be able to comply with sensible, moral and ethical requests or emergency directives later.
And I promise you every mother in this country will be grateful she had the warning NOW and the time to prepare for this emergency, even if supplies are not terribly disrupted because the mitigation strategies worked, and even if only, say, one tenth as many children die as was forecast, because the mitigation strategies worked so well.
No mother I know would complain that she had prepared too much.
Posted June 7th, 2007 at 3:18 pmAdmiral Agwunobi,
As you we have put our cards out on the table. In response to Okieman’s (post#29) Tierra23 (Post#40) and others please let us know your thoughts.
Sir there are a vast spread of preparedness levels. Those with deep bunkers in the woods full of food, medicine and ammo - sites for government officials like The Greenbrier in West Virginia. To vulnerable home sites having less than three days food and water at home - most of us.
I agree with your over arching principals - to be prepared for multiple things. The small time limits to prepare for bother me. 30 days, not two weeks.
If people stockpile more - is that is ok? Many of us are looking way, way beyond two weeks. Why? even if supplies are available - scarcity and fear may drive the prices up. Tuna at $28 a can is not an available item for me. Why? The median family income is still well below fifty thousand dollars a year ($46,326 29Aug2006 source:http://www.whitehouse.gov/fsbr/income.html) - below that using 2002 U.S. government numbers (source: www.census.gov/prod/…) Income has not changed much and is not projected to change much.
Since stockpiling is only part - should we stockpile books for the kids to read, spare air filters, cloths, etc?
Sir, please do not think we do not spread doom and gloom for doom’s sake. We are genuinely chilled to the bone at the facts we see. We talk to each other about cooking, making water, health etc. Now we wish to hear you.
People seem to believe things will be harsh, much harsher than your post seems to state.
Regards,
Posted June 7th, 2007 at 3:34 pmKobie
Admiral:
The CDC and border patrol cannot properly educate, stop, hold or even safely fly one well-educated, mobile American male with XDR TB.
So please forgive me if I do not believe you when you say you could stop a pandemic form of flu within a city.
Posted June 7th, 2007 at 3:43 pmWhat a shame. Admiral, your post along with the science advisors post have done tremendous damage to the spirit of pandemic preparedness.
People I sent here have now told me there is nothing to worry about. Flublogia’s voice has been undercut by the “official word”.
I offer anyone who has gotten this far reading this thread to feel free to continue their education of H5N1 and Pandemic preparations by visiting any of the following websites. The people who have built these sites and the information contained are concerned with one thing only - the survival of their families through a severe H5N1 Pandemic.
www.singtomeohmuse.c…
Posted June 7th, 2007 at 3:50 pmwww.newfluwiki2.com/…
www.flutrackers.com/…
planforpandemic.com/
planforpandemic.com/
avianflutalk.com/
www.recombinomics.co…
web.mac.com/monotrem…
www.scienceblogs.com…
www.wilsoncenter.org…
www.msnbc.msn.com/id…
Science Teacher wrote: “Admiral, Seems you have caused a bit of a cytokine storm here.”
No, Science Teacher, the Admiral did not cause a cytokine storm. A cytokine storm by definition is an overreation. The reaction to the disinformation contained in the good Admiral’s post is entirely proportional.
See you back at PFI, Science Teacher. This will be my last post here.
Posted June 7th, 2007 at 4:21 pmI think what we are criticizing here is either a communications strategy, lack thereof or failure to follow one.
The change in national strategy is occurring as we speak. Perhaps this blog is a “trial balloon” for the new concepts??? Trial balloons that are perceived to be contradictory to previous positions are a good way of getting feedback on where people stand as is evidenced by the comments here.
Perhaps simply saying, hey we are making progress and here is how we are adapting might be a better approach As I noted before, the gov is still working on the transparency portion of their communications plan and trying to find the “balance” in their messages. Many in public health have felt that the initial messages have been…kind of out there, but that is second guessing. They have gotten attention. But now how do you shift? Perhaps we are watching that occur.
Real changes are occurring but how they are being communicated could possibly be improved upon.
Another example of the changes occurring are the recommendations for use of masks/respirators in community settings. This one
www.pandemicflu.gov/…
is only about two weeks old and relates directly to personal preparedness. I’m surprised it wasn’t mentioned in the blog. It is a subtle, but relatively dramatic shift from the (generalization) “masks don’t work so don’t bother” message to one of “here is how you use them…” This is a real change.
This is another example of mitigation functioning from the standpoint that something is better than nothing and we are dealing with populations not individuals(core public health concept).
Acknowledging that the reality is that there might be circumstances where individuals HAVE to congregate in a bad pandemic (perhaps to go to the schools where the kitchens are open for food???) means you have to provide the people with something that reduces the odds in a given person for contracting disease. In the whole, you have mitigated the impact of the pandemic locally…
I will have to admit that my own personal plan prior to about January of this year involved a certain element of placing my head firmly between my knees when it hit the fan, but now I really see something that might work. The jury is out still, but it is substantially better than the sky is falling approach we have been preparing for.
HHS should actually be crowing a little about this while gently integrating the change AND acknowledging that change into our societal approach. That takes very skilled communications. There seems to be a dearth of that. But it is also not an easy task. As the Chief Medical Officer of Australia stated, (oh and they seem to have their stuff together better than most of the rest of the world) “The competing temptations are “it won’t happen here complacency, “there’s nothing we can do” fatalism, or “no precaution is too great” alarmism…Even so, it’s hard to discuss potential disasters outside of people’s ordinary experience without generating the sort of lurid headlines which make some scoff and others panic. It’s important not to over-react to potential threats. On the other hand, people and governments need to take credible threats seriously and take reasonable and proportionate precautions against them.”
He’s good. Perhaps there is a lesson there.
It might be asked here, “Perhaps we were a little…disproportionate…in our initial approach to this??? huh maybe? OK, now what? How do we move back toward proportionate?”
Many of the people in public health are still trying to recover from the threat of national quarantine enforced by the military provided a couple of years ago. Was that proportionate? It sure got everyone’s attention.
And what is proportionate? The Admiral goes at that issue and its individual nature early in his blog. We all have to make choices for ourselves and our families. The government needs to communicate clearly and transparently and not assume anything…
Oh, I would like to note that the Admiral’s messge is NOT necessarily contradictory to the Secretary’s message. “On your own” and resiliency (another blog here) can mean that local communities … comprised of individuals, that can be self sufficient in a bad situation are going to be better off than those that are counting upon the government to save them. The same holds true for individuals.
In some ways, this is an implicit acknowledgement that a highly centralized high level government directed approach might not work. Katrina provided an object lesson. Did you know that the government in that situation “directed” “from the top” all long term care facilities have a contract with a transportation company to get people out. So everyone got their contracts done, checked that box off the list, and went on their merry ways. But there were hundreds of nursing homes and only three transportation companys… But the box was checked off so all was good.
The govt is learning and adapting, and realizing the solution may not be government but locals and individuals who know their situation and if given the chance and good technical assistance, they can solve the problems on their own and the big govt can find its role to support the people.
Now let’s hope they work on the communications part…but even here they are at least sticking it out there in these blogs. That takes a certain amount of guts.
Posted June 7th, 2007 at 4:41 pmDepartment of Homeland Security
Best Practices and Protocol
April 2007
www.usfa.dhs.gov/dow…
Guidance for developing best practices and model protocols for use by State, local, tribal, and territorial personnel in the development of pandemic influenza plans, preparedness activities, training, and exercises.
Summary:
www.newfluwiki2.com/…
Anyone developing their own individual or family pandemic influenza plans, preparedness activities, training and excercises would do well to take note of these recent guidelines, the assumptions used in that document, the assumptions referenced in the May 2006 U.S. Implementation Plan for the National Strategy for Pandemic Influenza
www.whitehouse.gov/h…
and the potential issues referenced in the Individual and Family Planning checklist on the official US pandemic preparedness website here:
Posted June 7th, 2007 at 4:59 pmwww.pandemicflu.gov/…
Kobie:
Got directions for The Greenbrier facility?
If our 2 weeks of supplies run out, those directions might come in handy.
n/k
Posted June 7th, 2007 at 5:03 pmThank you, Doctor, for your thoughtful and informative entry. From the number of responses, it is evident that the idea of stockpiling in preparation for a pandemic touches a raw nerve.
I’m old enough to remember when some people built bomb shelters, stockpiling blankets, transistor radios, water, saltines and toilet paper, among other necessities.
The writer who commented that the poor will not be able to do this is so right. Too many people in our society live hand-to-mouth, only buying food and supplies as they can afford them.
A topic for another blog is “who gets vaccinated first?” That question presumes that there would be a vaccine and that it would be available in a “reasonable” amount of time.
The reason that I raise the question is that it seems to me that long-haul truck drivers should be innoculated even before many health care workers. They are the ones who travel across country and supply food to the population. The reality of pandemic will challenge many of our deeply held convinctions about who gets innoculated, how soon and why. Very few persons in our society are self-sufficient. We have to rely upon one another in the event of what for many is an unimaginable event.
Posted June 7th, 2007 at 6:25 pmSister Talone:
In support of your recent post - When Trucks Stop, America Stops
Posted June 7th, 2007 at 6:51 pmwww.truckline.com/NR…
Sister Talone, you bring up a great point about vaccinating our truckers.
Just in case Dr. Agwunobi will not respond to your question, I hope I can make a stab at it.
I have discussed this topic here in case you or anyone else is interested:
www.singtomeohmuse.c…
This was a report by the National Infrastructure Advisory Council: The Prioritization of Critical Infrastructure for a Pandemic Outbreak in the United States.
www.dhs.gov/xlibrary…
January 16th 2007
129 pages and extremely interesting.
Without a doubt, Department of Homeland Security is thinking about these things. DHS is aware that we are planning for a pandemic, I believe.
Tier 1 Essential Employees are in the process of/or have been identified to see which workers are absolutely essential to maintaining a bare minimum of services for our country. This most certainly includes transportation workers such as truckers. They will and in my opinion rightly should be given priority for a prepandemic vaccine, because as I am sure you are well aware, no actual pandemic vaccine can – at the moment – be made until a pandemic strain breaks out; at with present processing capacity it could take perhaps 4 to 6 months to make enough, just for our most essential workers. (I am sure someone will correct me if I am wrong here.)
Unfortunately, as I am sure you are also aware, the current prepandemic vaccine we have stockpiled appears to not be so effective. I think in trials it only generated a protective response in 45% of the subjects in which it was tested. Not too good, and worse than last year’s attempt.
www.cidrap.umn.edu/c…
“Disease experts have expressed concern about the large dose the vaccine requires, in the face of the world’s very limited vaccine production capacity. The two-dose course (180 mcg) used in the study is 12 times the standard 15-mcg dose used for each flu strain in the seasonal flu vaccine. If the world’s entire flu vaccine production capacity for trivalent vaccine, which currently stands at about 350 million doses annually, were devoted solely to making the new H5N1 vaccine, it would yield enough for only a tiny percentage of the world’s population, experts have said.
HHS, in its most recent pandemic preparedness update, acknowledged some of the H5N1 vaccine’s limitations. “It is, for now, the best vaccine defense we have, and so we are stockpiling it,” the agency said in the Nov 2006 update.“
I’m just a mom, and an elementary school teacher; no medical expert, but even I can see that we have at the moment an extremely limited amount of this prepandemic vaccine for our essential workers – including our truckers, and our migrant workers who harvest our crops (and deserve to be protected), and our food processors and factory workers who turn raw food into edible products.
What prepandemic vaccine we do have, is probably effective only half of the time, if that. If we do have a pandemic in the next year or so – how will that all work out for us? Can our essential workers rely upon a vaccine to keep them alive, if they don’t know if they are in the 45% for whom it is effective?
Will our essential workers be willing to show up for work, knowing that the vaccine they have been given isn’t even effective half the time? Will they succumb to a virulent flu, if that’s the kind we happen to get?
We have a serious problem if our defense against the secondary consequences of a pandemic is relying upon a prepandemic vaccine. And don’t get me started on the Tamiflu defense.
We have a more serious problem if our elected officials will not level with the public about our lack of defenses.
We must prepare NOW to help our NEIGHBORS. The vast majority of the American public will help each other and we will help those who cannot help themselves, but we must be given enough time to do so.
I have no problem if our elected and appointed officals will assure me that they have the situation completely under control, and that the information they are giving the moms and dads, the poor, the average citizens is exactly the same as the information they are giving the corporate executives, the heads of news agencies, the utilities and heads of critical infrastructure. The same in tone, the same in urgency, the same in facts. If we are not at all concerned about H5N1 turning pandemic at a fatality rate of greater than 2% — and if everyone understands that it will not be a problem – then fine.
But if it turns out that some citizens, right now, are being told that to survive a virulent pandemic, they must begin NOW to stockpile 12 weeks of food, water, PPE such as N-95 masks, and medications so that they can avoid exposure, while other, less well-connected folks, are being given a different message completely – well, I would have a problem with that.
And I hope everyone else would, too.
Posted June 7th, 2007 at 7:35 pm#52 Kmilhon Says:
QUOTE
I think what we are criticizing here is either a communications strategy, lack thereof or failure to follow one.
END QUOTE
No, Kmilhon.
The Content of the Admiral’s post is the issue. It suggests a culture of don’t worry the government will look after you. The outcome can only be one of discouraging the public to prepare.
The Admiral knows very well that the calvary is not coming to rescue all across the country, that disruption in service and infrastructure is fully expected, that there are simply not enough resources to respond to local needs, by definition, during a PAN-demic.
Citizens want clear and factual information, not SPIN.
Posted June 7th, 2007 at 7:41 pmKm (I am not picking at you, I just see some ideas that I might be misunderstanding, but if I am not, need to be addressed …)
km said:
“As I noted before, the gov is still working on the transparency portion of their communications plan and trying to find the “balance” in their messages.”
You know, we were taught “If you always tell the truth, you do not have to worry about keeping your story straight”.
There should be no need for brilliant men and women, well educated men and women, to have to muddle through the concept of “transparency”. This is not nuclear physics or quantum mechanics. Transparency is EASY–just talk.
But just in case here is what we are looking for in transparency: “Say what you know that might impact MY life. Give me the data. NOW, not later. If there is a generally recognized problem, sit down and work it….but for crying out loud, keep the “managing” and the “tempering” and the politics out of it. You may enjoy politics, but you are not allowed to play them with my kids’ lives.”
I wish for a moment that those who are in the know would be able to experience what is like to be a parent who can see that there is a threat, but is NOT in the know. To see others say “Hmmm….yes I know what is going on….but I am not sure if you can handle it….and I want you to keep doing xyz….so what should I tell you? Hmmmm…..welll maybe in a little while I will tell you….”.
That is not going over so well.
They do not need to find balance in the message, they just have to say what they know.
That does NOT mean not tell us, or gradually rachet up the message like a frog in a pot in such subtle manners (like the masks) that very few people know what is going on.
No, that means tell us the problem then offer suggestions on how to prepare for it. REALISTIC suggestions based on the FACTS of the matter, not the politics of the matter or the feelings of the matter.
Posted June 7th, 2007 at 8:38 pmAtropine #59
QUOTE
That does NOT mean not tell us, or gradually rachet up the message like a frog in a pot in such subtle manners (like the masks) that very few people know what is going on.
END QUOTE
We in Flubloglia are keenly aware of the trained complacency of the frog, sitting in a pan of water with gradually rising temperature until he’s cooked. In the case of a transition to a pandemic strain, we get used to sporadic outbreaks, even human deaths, until all of a sudden a novel bird flu virus finds the final key to open up the Pandora’s box, except unfortunately we the people are the frogs. So sending graduated messages, sugar coated, softened, will simply build up societal complacency, and results in disastrous inaction.
Posted June 7th, 2007 at 9:29 pmOne of my concerns with the Admiral’s post among others, is the timing.
“Jun 7, 2007 (CIDRAP Source Weekly Briefing)–Pandemic influenza preparedness lost out when President George W. Bush signed an emergency spending bill on May 25…”
preview.tinyurl.com/…
Are we about to see the current Administration ‘back down’ on pandemic planning? If so, perhaps someone should present this, also from CIDRAP, dated June 6, 2007:
“Officials from Indonesia’s avian flu commission said today that the H5N1 avian influenza virus may have mutated in a way that makes it more transmissible from birds to humans..” (WHO has not yet confirmed this report, but then again, Indonesia is not exactly forthcoming with H5N1 isolates)
preview.tinyurl.com/…
Folks, this is not the time to become complacent…..
Posted June 7th, 2007 at 9:46 pmSome quotes from John M. Barry’s The Great Influenza:
“As terrifying as the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read. Uncertainty follows distrust, fear follows uncertainty, and, under conditions such as these, terror follows fear.”
“In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They could not control it because every true report had been diluted with lies. And the more the officials and newspapers reassured, the more they said There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death.”
“Despite that effort, whoever held power, whether a city government or some private gathering of the locals, they generally failed to keep the community together. They failed because they lost trust. They lost trust because they lied.”
When Americans know there’s a need, we usually step up. I was in East Texas not long after Hurricane Rita, and people there told me that federal officials had been very surprised when local people brought out their own chain saws to clear trees from the roads. Most Americans are self-sufficient; we don’t wait around to be given what bureaucrats think we should have, and we certainly won’t bet our children’s lives on an insane evacuation scheme after watching the Katrina debacle.
However, people have to be told the truth by an authoritative source about the range of possibilities for which to be prepared. Does your car insurance cover only your tires in a wreck, or does it cover the whole car? Does your house insurance cover just your kitchen, or the whole house? Yes, it’s possible that a wreck will only damage your tires, or that a fire will only destroy your kitchen, but you still insure the whole car and the whole house. In your post, you’re telling people to only insure their tires; pandemic insurance needs to cover the whole car.
Having pandemic insurance means being told the whole truth about what has already happened, and what could happen, and what the unknown variables are. It means using that information to decide for ourselves what level of preparedness we’re willing and able to achieve. It means thinking now about what we can do to protect our families and our communities.
If the very people we pay to protect the public health are telling us to have the bare minimum on hand and to wait our turn for further instructions, soon people will not trust what they read. Uncertainty will follow distrust, fear will follow uncertainty, and terror will follow fear.
Posted June 7th, 2007 at 10:02 pmIt is abundantly clear to me that soft-peddling the truth about the likely upcoming - perhaps imminent - pandemic has been a big mistake. The whispers have been summarily dismissed and/or ignored by the vast majority of the population. It is past time to use the bullhorn. I had hoped that this blog was an honest attempt to begin to speak in a louder, more authoritative voice, but my hopes were dashed by the Admiral’s blog. WHERE are our real leaders?
#52 Kmilhon wrote: I think what we are criticizing here is either a communications strategy, lack thereof or failure to follow one.
I am criticizing a blog that was patronizing, badly informed, and on certain points, factually incorrect. And this from someone who should have all of his ducks in a row.
Admiral: as I was reading your blog, I kept replaying in my head the scene from “As Good as it Gets,” when Jack Nicholson screams in frustration: “I’m drowning here, and you’re describing the water!”
Please - enough of the PR nonsense! Just level with the American public and be done with it, and never mind about the “communications strategy,” as though we’re a bunch of ninnies who can’t handle the truth. Then we can finally get on with the enormous task at hand. We have a LOT of work to do.
The clock is ticking and we don’t have the luxury of prevaricating any longer. We’re squandering precious preparation time.
Posted June 7th, 2007 at 10:08 pmIn my opinion, this blog does not encourage a Preparedness Movement. On the contrary, it is the perfect vehicle for teaching complacent behavior.
Where are our leaders?
Posted June 7th, 2007 at 10:37 pmGood evening Admiral,
I have read with great interest your post on the recommended amount of days to stockpile.
I have read your bio posted in the health and human services website and it states you “confronted many public health challenges including leading the state’s public health and medical response to the unprecedented four major hurricanes that struck Florida in 2004.”
A pandemic is not a hurricane, it will be far worse and for a longer duration. I am sure it would be like nothing we can imagine.
Can you tell me that all the people who endured those hurricanes only needed 2 - 3 days supplies while waiting for help from the US government?
Can you tell me how many days worth of food, supplies, masks, etc. you have personally stocked for your family?
I would venture to guess that you have more than 2 - 3 days if you followed the recommendations of any policy in existance today in preparing for an avian flu pandemic with such a high fatality rate. why take a chance with your loved ones and not provide for more? It doesn’t cost a heck of a lot for someone in your position.
But here you are recommending to me that I only have 2 - 3 days. Heck I have two teenagers, they could go through that in a good snowstorm.
Why would you want to put millions of peoples lives at stake by your recommendations? These are peoples babies, children, mothers, fathers, brothers and sisters. These are the people we live and breath for.
I am sure you would do anything you could to protect your loved ones, why arn’t you giving everyone that chance?
Please change your recommendations and tell people the truth. We can handle it you know.
Posted June 7th, 2007 at 10:45 pmMichael Coston had said:
>
>U.S. Department of State
>Bureau of International Information Programs
>Washington, D.C.
>March 9, 2006
>PUBLIC HEALTH AND HEALTH CARE DELIVERY: PLANNING FOR A PANDEMIC
>
>>Families should stock cupboards with enough nonperishable and
>>prepackaged food products to last four weeks to five weeks.
>>tinyurl.com/l5omx
this is not the HHS but the State-Department. It is addressed
at US-institutions abroad, you find 3 links to that document
with google : usinfo.state.gov,london.usembassy.gov,www.usembassy.at
The document says:
>For additional information, see Checklist for Influenza Pandemic
>Preparedness Planning (PDF, 39 pages) on the WHO Web site.
>PUBLIC HEALTH INTERVENTIONS BEFORE AND DURING A PANDEMIC
>
and links to a document which has the 2-weeks recommendation.
>On June 1st,2006 the AP carried this report.
>Little Rock (AP) - Arkansas public health officials say it
>is a good idea to stockpile two months of food, water and medicines
>in case of an outbreak of pandemic flu or any other emergency
>that could lead to shortages.
“it is a good idea” is not an official recommendation
>And on the same date, this appeared in Vermont.
>
>>State and local police, emergency medical services, firefighters,
>>selectmen, trustees, state officials, and health care and hospital
>>officials gathered for the first time in one room to learn what they
>>needed to know in the event of a pandemic. … >We need to prepare
>>and have some goods in our homes be prepared for six or 12 weeks.
this is jus addressed to those groups, not the general public.
>These are just a few examples. In my own state,
…which you should say is Florida
>one county advised
>40 days worth of supplies.
link ? Is it a hurricane-recommendation or a panflu-recommendation
or a recommendation for possible hurricanes during panflu ?
>I would not want you to think that those
>who have commented thus far on the 2-week debate are alone in their views.
>
>The truth is, we have heard everything from 3 days to 12 weeks from
>official sources.
the truth is most of these are not official recommendations for
the general public issued by HHS.
>As you can understand, this makes a 2-week
Posted June 8th, 2007 at 1:51 am>recommendation difficult to reconcile.
>Posted June 7th, 2007 at 8:30 am
gs — you make a good point as always.
There can be no one definitive recommendation to any American family as to what to prepare and how to prepare for pandemic flu.
Just let us moms of little babies know exactly what is being said and heard by top corporate executives; by heads of utility companies; by executives of news agencies; by pandemic planners; and by continuity of operations officials.
Let moms of little babies know what is being said by the Department of Homeland Secuirity with regards to the possible length of time frame we have the potential to expect. (90 days of self-quarantine) and let us know which federal, state or local agency will be tasked with providing for us, if for some reason we are unable to provide for ourselves, if indeed it comes to that.
Let us know the very best science on H5N1 and other potential pandemic flu virii there are out there — do not sugar coat anything; tell us exactly what is being said to the highest officials. Tell us under OATH that this is the best science you have to offer us. Tell us under OATH what defenses we have against pandemic flu and share with us under OATH that you are sure (or not sure) that these defenses (such as pre-pandemic vaccine and Tamiflu) are going to be any good.
Let moms of little babies (and everyone else) decide if, given these possibilities, we feel it is in our best interests to prepare (just inc ase all these safeguards do not work) and to what extent we wish to prepare our selves, our families, and our pantries.
gs — moms of little babies do not need certainty about anything in order to want to prepare. We do want to be getting the same information that those higher up are getting.
Posted June 8th, 2007 at 7:04 amWe’re all waiting for answers. Silence is an answer.
Posted June 8th, 2007 at 7:39 amThank you to come forth with Courage Admiral.
I have been aware of Northcom preparedness of the last 4 years. It has evolved and adapt to a Social Reality impacted by disaters.
As seen in many of the above posts, it is more of the same, the medics knows whats good for ya.
I have to say that in face of social dislocation, the security forces will do whats good for the society as a whole.
No the military will not provide cheese sauce for the vegetable in your plate, no they will not provide redwine sauce for your filet mignon, but they certainly provide you what you need to survive, ain’t that what is important?
Most of people are not veterans or have not lived in poor countries so they have not realised that survival in food is not a 5 services meal.
As for your statements concerning the delays, the time, etc… again people do not realise that these matters are not the business of the military, the military rightly so, IMO, adopt some workable parameters and walk the talk.
One last thing, do not underestimate the plans of management of disrupt society adopt by the military and do not expect it to be scream on roofs.
Again thank you Admiral to have come forward and felt the heat.
I do understand the heated reactions of the community towards your comment, and if we step back, take a deep breath, not much more could have been publicly state by you.
Snowy Owl
Posted June 8th, 2007 at 8:31 amanon.yyz (Post#58, #60 et al )
I agree. Because H5N1 could hit everyone from the Joint chiefs on down to whom ever we are fighting that week. It could hit the CEO of starbucks all the way down to Juan Valdez and those who pick the coffee. I would like to know why we can count on outside help.
Unlike 1918 not only are city folk further separated from where food is grown but there is more processing, less canning, and more centralization. In 1918 closing a butcher shop affected hundreds. Today closing a processing plant affects tens of thousands.
In 1918 people lived closer to work. A thirty min. commute was a walk - not by gas driven car. People did not live in Pennsylvania and work in DC. There where not frozen foods. Hence a long term electrical outage was a not as critical. People still generated their own power although the Niagra power station proved you could transmit power more that 20 Miles!!!!
Finally - the frog in the pot. Well put. Teachers know “keep the students above their comfort level and below their frustration level. Set hard tasks up for success. Do not pander to trivial wastes of time.” I hope I quoted that right.
Most kids and adults will say “I am not sure I can do that, I have not done it before.” it is outside their comfort zone. Yes, comfort levels vary all over the map. To this I fall back on one who lived and fought through 1918 and quote “Fun with a purpose” - Sir Baden Powell.
Many young men and parents are horrified at axes, fire, cooking with hot oil or grease, long treks in the woods without a cell phone or GPS, discussions of character and church. Only after completing these and many other tasks do they see just how high the human spirit can rise above ever increasing obstacles. How many times they will opt to go back and help another instead of basking in their own glory.
“A man or woman is never so tall as when thy stoop to help another.” the Shriners.
Regards,
Posted June 8th, 2007 at 9:05 amKobie
P.S. Average Concerned Mom Post#67 has a good point. Since fathers day is comming up let the dads know too. “A house divided against itself can not stand” - Pres A. Lincoln This is a team effort.
Regarding Kmilhon, Post #42. Thank you very much for the advice to read the Interim Guidance from the CDC on community mitigation strategies. I am intimately aware of that document and find the information proposed in it to be one of the few ways that we, as a populace, will be able to weather even a mild pandemic. However, I must confess, that it was actually this document which prompted me to personally prepare for more than 30 days of disruption. Prior to this document (and its very good, in my opinion, strategies)
Posted June 8th, 2007 at 9:26 amI believed that when a pandemic would hit, it would course through each area over the course of several weeks and then we would have time to regroup before the next wave– That those several weeks would in effect be like snow days where everything shuts down due to extreme illness, or heaven forbid, deaths, viewings and funerals. But, after reading the commonsense approach in the community mitigation plan, I came to the conclusion that instead of having a shortened wave where services were completely overwhelmed for a few weeks but then we could regroup, instead, we would have a much longer time period when services would only be a moderately overwhelmed, a much longer time period that the virus would be circulating looking for new hosts (not to anthropomorphize the virus too much), a much longer time period where supply lines may be disrupted, a much longer time period where first responders, HCWs, grid workers were going to need support for themselves and their families, a much longer time period where the poorest of people were going to need help with basic substinence, a much longer time period where we as a public would be stretched so thin, we thought we were going to break, all of this due to the lengthening of the time under the bell curve. No where in that document does it say that the government is going to save each and every one of us after 10-14 days.
However, all of that would be worth it, the failing economy, the struggling for bare survival, the rationing, the planting our own gardens, the supporting our neighbors who were less fortunate, and supporting our neighbors are essential employees, all of that would be worth it, for however long it took, because in the end, we will have saved lives.
So, with those conclusions, I decided that we the populace, who are able to prepare, those of us who have the money for cable t.v. and to get our nails done and professional haircuts, those of us who can afford a round of golf or tickets to an nfl game, those of whose children have cell phones and the latest brand name clothes, those of us who have the money to fill up our vehicles with 90 worth of gas to go on a trip, have an obligation to be prepared for that much longer time period under that bell curve which may extend for months with overlapping waves. There is an obligation to prepare for ourselves and our families. There is an obligation to prepare for the first responders and HCW’s and grid workers and transportation workers and farmworkers. There is an obligation to NOT expect the government to ride in on the calvary and save us. It is only prudent.
For those of us who live on more meager means, we are obligated to prepare for ourselves and our families. We are obligated to invest in our future because our lives depend on it. I strongly believe that most families in America, given the whole truth (Yes, we can handle it), can find the wherewithal to plan for extended disruptions for their families.
And for those of us who are unable to prepare (not because we do not want to, but because we are physically, fiscally, or psychologically impaired), we are obligated to let someone know that we exist, to let them know that we need help. We are obligated to assure that we are part of the pandemic plans.
It seems to me that stressing, as the original poster did, that the government is going to come in and save the day after 10-14 days, will do a great disservice to the CDC’s mitigation plan. I think that the plan depends on a large portion of the population being able to take care of themselves for the length of time it takes for effective vaccines to be developed, and last time I checked that is 4-6 months. Hence my original question, what has changed in the past 12 months? Are there secret vaccine plants online ready to go using new technology so we won’t have to wait 4-6 months? Has a variation of a pandemic version of H5N1 already been secured so the vaccine process has already been begun? Does the government have food, water, and medicine stockpiled for the entire populace? Does the government have sufficient tamiflu for prophylaxis along with PPE for all of the first responders, HCWs, transportation workers, grid workers, farm workers and others who work in the critical infrastructures (including their entry level workers and all of their extended families?). Has all of this changed in the last 12 months? Has any of this changed in the last 12 months which would cause the original poster to change his tune? If so, please let the public know, with all due respect.
Anon.yyz and Atropine. I was obtuse. I agree with both of you. As far as gathering up, I put quotes around it. I mean “asking” them to help not forcibly requiring them to. Gather is a gentle term meaning “To cause to come together: Convene” (Websters)
Atropine you note, “if you want survivors to help, it is probably best to appeal to them now… …But we can say “If you are recovered you are probably safe. Go to your local pandemic office and offer your services if you can.”
Exactly
Tierra, excellent thoughtful post. You extrapolated where I have yet to go personally. We all need to do more of this.
Posted June 8th, 2007 at 10:26 amSnowy Owl - Medicine Man Post#69
Dietary needs are vast. From diabetics, to low sodium, those that are tube fed to those who can not swallow and eat only jello.
Beans, rice and water will keep one alive but in planning - why not go whole hog and look at what a world wide disruption in food brings - particualy for area’s like Alaska, Hawaii, Guam, Azores and Puerto Richo.
If half the truckers call in sick - how does that affect people?
I thought the DOD already had full time job? During a pandemic when other people are moving around they may be a little busy.
Piracy along Malasia and Somalia is on the increase now - what will happen when they start to starve?
Regards,
Posted June 8th, 2007 at 11:24 amKobie
Snowy Owl (post #69), I’m puzzled. Are you saying that you expect security forces to provide basic food and water to all the people, but we shouldn’t expect it to be fancy or to our tastes?
–No the military will not provide cheese sauce for the vegetable in your plate, no they will not provide redwine sauce for your filet mignon, but they certainly provide you what you need to survive, ain’t that what is important?–
I don’t expect to see security forces in neighborhoods at all. I expect them to be fully occupied at warehouses until emptied, at pharmacies and groceries (ditto), and at hospitals, if we’re lucky. In other words, I don’t expect them to have any supplies to hand out, only to enforce order in a limited number of places.
Posted June 8th, 2007 at 11:41 amKobie and Jane,
I have been promoting preparedness for four years, so I am quite aware of the medicinal lack of resources, of disruption in delivery and production.
Click on the link of my above name and see for yourself.
My point is yes we must prepare, yes we must stock medicine and know about their alternatives, at the same time yes the military will do what has to be done to keep up society.
As stated by the Admiral, rural and remote regions have different needs.
Remotes and rural regions will have to give a hand to urban cities, there is no doubt about it.
As for the transportation and dropping points, they have been identified a long time ago.
No Northcom have not just sit on their they have made many drills and have done what has to be done, but do not expect them to breach security imperatives just to comfort you.
We must all prepare but if you have a yaear of preps, be cautious cause some people will need and get it.
We have to be reasonnable and prep.
Posted June 8th, 2007 at 1:39 pmJMHO
Admiral,
On Promed mail today, regarding a young man in Oregon who returned from Japan and developed measles:
“Local health authorities have been working around the clock to contact
hundreds of people who may have come into contact with the 2 men, Meredith
said. Although nurses told the 2nd man to stay at home because he could
spread the disease, he went to public places, Hendrickson said. Officials
said the man went to:
WOW Hall, last Tuesday, Brother Ali concert, 10 pm;
Jameson’s Bar, last Wednesday, from midnight to 2 am;
Sushi Station, last Wednesday, between 6 and 7 pm.”
So what’s all this talk about isolation, quarantine and the like?
Let’s get real-whatever flu virus causes the next pandemic, people are not too likely to cooperate with Public Health mandates to stay home -especially if they have not been warned to prepare.
People will expect to be provided for if they are told to isolate. Who will provide that? You?
Anyone who depends on their town/county/state/federal government is deluding themselves.
Posted June 8th, 2007 at 2:03 pmSnowy Owl (Post#75)
I do not expect the DoD to be there. They have full time jobs as well as dependets to take care of.
We the people should be prepping so we are not a burden but a help to others. Well as many of us that are able to. Here the deaf and blind will be willing hands but harder to use. I say that based on working with both the deaf and hearing.
While I am glad to hear the vulnerable points have been identified, I can not find anything that makes me feel secure. That the Panama canal will work as it always does.
That a hurricane during a pandemic will not spread disease further.
Working with diabetics who take good care of themselves are are still in and out of the ER several times a year.
Snowy Owl - two questions:
Will people in the lower 48 along with islands like Hawaii, guam and places like Alaska continue to get all they need so food and gas prices do not double during a pandemic?
Do we have enough medical supplies to give everyone who gets sick modern levels of health care?
Regards,
Posted June 8th, 2007 at 4:05 pmKobie
Admiral Agwunobi:
I think it’s true (as you wrote) that pandemic influenza should not be the sine qua non prerequisite for preparedness. However, I also think that it’s easier to motivate people to begin preparedness measures if they begin preparing for something specific rather than for something general.
The Sixth Century B.C. military strategist, Sun Tzu, wrote of how important specifics really are when it comes to preparation. A good military leader, he writes, will exploit this difference to weaken the enemy by denying the enemy foreknowledge of battle location or time. Without this kind of focus,
“the enemy will have to prepare against a possible attack at several different points; and his forces being thus distributed in many directions . . . For should the enemy strengthen his van, he will weaken his rear; should he strengthen his rear, he will weaken his van; should he strengthen his left, he will weaken his right; should he strengthen his right, he will weaken his left. If he sends reinforcements everywhere, he will everywhere be weak.”
Creating a crude psychological metaphor of Sun Tzu’s words, we could consider that although general preparation for disasters is the wiser move, some people will find this kind of large project cognitively akin to, “preparing against a possible attack at several different points,” and possibly become overwhelmed and discouraged. It may be that that the most successful road to general preparedness is from specific to general, and not vice versa.
Consider that it is much easier to follow simple directions than general directions, mainly because we have an idea of when “the job is complete.” This is not to say that general directions are inappropriate, but rather that when it comes time to speak those whom we serve, we should combine our general directions with detailed directions on how to accomplish them. Along with asserting that unique situations require unique preparedness, we should (in the same breath, if possible) give the public specific directions. Tell them, for example, that on their state health department’s web site there is a checklist that, when completed, means they are generally pretty prepared for most of what we expect. If we give the people specifics, they’ll know how to be ready.
Posted June 8th, 2007 at 6:14 pmAs pandemia is international, I apprise the Admiral:
Hong Kong Standard, June 7, 20007
To ignore that palpable fear will surface and can be met only with trustworthy facts and trusted prior action is to have guaranteed chaos.
People will be reckless when life is so severely and abruptly threatened. The social fabric will rent quickly because starvation is not fed with news blurbs or future promises.
When the public can eat words, a 2 week stock of food should be more than ample.
Many of us recognize the poor will starve, the unprepared will die, the medically unfit will be lost, all due to a lack of communication between the leadership and the citizenry.
I am profoundly disappointed that the Admiral’s position does not place the loss of life, a mere consequence of failure to prepare for even one fourth of the current CFR, is a position even thinkable by DHHS leadership.
Posted June 8th, 2007 at 8:00 pmYou wanted to hear from us? Well here it is Doc. It seems to me that the entire reason for this blog by the HHS was to connect with the people to help in identifying weaknesses where Pandemic Planning and awareness are concerned. (A total lack of repeated informational PSA’s is a biggie). But after reading this blog on preparation it seems quite apparent that little Edna Mode is more up to speed on this than the HHS assistant Secretary is.
I also believe that Edna is likely to be preparing more realistically for worst a case scenario than Dr. Admiral John Agwunobi is. What’s up Doc? I’ve been following this panflu potential for years now and I can tell you that Edna is right on the money. You on the other hand, who I’m assuming it’s your job to know these things, seem to be minimizing the potential for danger to the point where it sounds like more misinformation than enlightenment.
Why do I say such a thing? Because by the American Public Health Associations idea of prepping for three days and even your own departments suggestion that people only need to be prepared for two weeks… I believe you’re all misleading the people into preparing inadequately. Do not forget Doc, that the one major thing that they had in 1918 that helped minimize the deaths that we don’t have, was a food pantry in every home stocked with basics like flour, sugar, rice, and even food that they canned themselves. They did not live in a just in time economy. If you’re wrong the store shelves, if there’s elec., will still be empty when their three day supply runs out and until the next harvest, and the shelves won’t get refilled at all if the processing plant is out of beans, corn, or tomato’s. And whatever food is left on the shelf may cost a fortune.
“The US Department of Health and Human Services has advised that during a pandemic, families might need as much as two weeks worth of supplies in their stockpile. This size stockpile would be sufficient to support a family through a home quarantine and through the peak of an outbreak in their community during which sporadic temporary disruptions in availability of some products and services may occur.”
The reason I feel so strongly about this is that I have a TV, and on my TV I watched how long it took to get Ray Nagin’s Chocolate City of New Orleans back to normal after the government stepped in to help in the aftermath of Katrina (they still aren’t back to normal and have since become the murder capital of the United States with only half of the population they had pre-Katrina).
New Orleans was but one city in America and many people had fled in time so they weren’t concerned with how to dispose of bodies as they might be post panflu. Our government put forth a concentrated effort towards that one city - and still we were lacking so that we had to accept help from the Mexican Military inside our borders to help control our streets and the Mexican Navy and medical teams to assist in medicines and food distribution.
Now compare that to perhaps the entire East Coast of the US simultaneously suffering from a pandemic flu like in 1918. We’ve already heard by many experts to expect disruptions in basic services such as electricity for one. So how long do you think it will be before the government reaches us here in the little town of Mims, Florida with essentials like electric, food, water, or security, when perhaps NYC, Philly, Boston, Orlando, Charlotte, Pittsburgh, Baltimore, DC, Raleigh, Atlanta, Jacksonville… may be under siege by thugs who see opportunities to get away with murder.
At least if you tell people to listen to Edna and prepare for longer than two weeks, if things don’t get that bad at least she might have extra to offer to a starving neighbor. No offense, but be more realistic Doc, and either lead or get out of the way so EDNA can tell it like it is or may be.
Posted June 12th, 2007 at 12:48 pm