Message from the SecretaryIn the fall of 2005, the President mobilized the Nation to prepare for a pandemic. In response, I traveled to almost every state and territory to hold planning summits. At every level of government, plans were developed and resources were allocated. Today, we are better prepared, but there is still much to do. There is the danger that as avian flu slips from the head lines, people will believe the threat is no longer real. While the media buzz may have died down, the H5N1 virus has not. The disease is highly pathogenic, and it continues to spread. While we cannot be certain H5N1 will spark a pandemic, we can be sure that pandemics happen. They have happened in the past and they will happen in the future. Preparedness is a shared responsibility and must involve every level of government, every business, every church, every civic organization, every family and every individual. And leaders from every sector have a role to play in communicating the critical need for preparedness at home, within the workplace and in our communities. On June 13, I am convening a leadership forum in Washington, DC on pandemic preparedness. This interactive forum will bring together highly influential leaders from the business, faith, civic and healthcare sectors to participate in dynamic discussions to help Americans become more prepared for a possible influenza pandemic. In order to extend the value of this one-day conference, the Department of Health and Human Services is also hosting this blog summit as part of an ongoing effort by the Department to help Americans become more prepared. While the comments made on this blog may not always represent the views of the Department of Health and Human Services, we think there is value is having an open dialogue about this very important issue. Government alone can’t prepare the nation for a pandemic. This challenge requires your leadership. We have an opportunity to become the first generation in history to be prepared for a pandemic. Let’s continue to work toward that goal. Michael O. Leavitt
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Posted May 22nd, 2007 at 9:25 amestimate of the probability that there will be an influenza pandemic in the next 5 years ?
Please give a number.
I was recruited by HHS/OPHEP in 2005 for a special initiative involving respiratory therapists. The plan was to have a “cadre” of RTs (nationally, about 200) specially trained for Mass Casualty Care/Mechanical Ventilation. I received training on the SNS ventilators last year. I am technically on the federal payroll on an “as needed” basis. So far, I (and many other RTs who volunteered) have heard nothing from HHS and received no further training. Since there are no RTs in the USPHS Commisioned Corps, how will HHS/ASPR and Admiral Vanderwagen provide or coordinate these services?
Posted May 22nd, 2007 at 9:50 amHistory has shown us that effective response to disasters comes at a local level. Due to the explosiveness of a viral pandemic and the impact it could have nationally, any direct support from the Federal Government may be marginal at best.
It will be up to the individual and their communities to effectively prepare themselves for the reality of the potential to go it on their own.
The need to prepare for the inevitability of a pandemic by stockpiling foodstuffs and getting involved in your local community Emergency Response abilities cannot be stressed enough.
Thank you for taking this to issue task.
Posted May 22nd, 2007 at 10:11 amI live in a small rural city in Iowa.
I recently asked a town council member if the city had a disaster preparedness plan especially about pandemic flu.
I was met with a wide-eyed surprised look by the council member. He had never heard of it. He told me that if I got the flu, to go to the doctor.
Mr. Secretary, the message is not reaching the local level.
Posted May 22nd, 2007 at 10:14 amAre there plans for Senators and Congress members to hold town meetings across their states?
“Government alone can’t prepare the nation for a pandemic. This challenge requires your leadership. We have an opportunity to become the first generation in history to be prepared for a pandemic. Let’s continue to work toward that goal.”
In the spirit of working together toward these goals, would it be practical and useful for the US government to share the genetic information (sequence data) it has collected on the low pathogenic variety of H5N1 detected in the United States in the same way that we have urged other countries to share their data? The ability for a wide variety of people throughout the US to share in such information with our government and discuss its implications in monitoring the source and evolution of this avian virus would seem to enhance our confidence in this system of cooperation. If there are national security concerns with such sharing, it might be worth publicly stating that. Otherwise, withholding of information and data causes unwarranted suspicion and concern, where none should exist.
Posted May 22nd, 2007 at 10:40 amMr. Secretary … I second the response/concerns of ‘Katie in Iowa’ (please see my post in “The Need For Personal And Community Preparedness” blog). There is NO LOCAL informative presentations that are successfully getting to the public. It is all at the discretion of the local officials.
If they ‘believe’ … then they inform. If they do NOT ‘belive’ then that community is screwed (sorry … there IS a need to be blunt here!) You spent MONTHS and MONTHS going to each and every state to heed the warning and sound the alarm. From there the filtered information has drained all importance from your message. The local officials seem to think that it is THEIR decision whether this is a pending threat. We need help. The local citizenry should NOT be shouldering the responsibility and expense (yes … it costs $$ to print those fliers, send those brochures, rent those meeting halls) to get the word out to their neighbors and friends. Your words of concern, Sir, have been lost in the communicational chain of command!
THE LOCAL LEVEL IS NOT GETTING IT!
Posted May 22nd, 2007 at 10:43 amMr. Secretary,
Thank you for your contribution to the effort. I am especially grateful that you left the comfort and security of your office and took this message all over the country and delivered it to what may have been a skeptical audience at times.
However, I am concerned that this current effort may, in effect, be ‘preaching to the choir…’. Outside of the on-line flu community, does anyone else know this blog event is occuring?
I remember the night U.S. Astronauts first walked on the moon. Everyone, everywhere was glued to a TV set. We need that kind of audience attention in order to generate an adequate response to an event that will be just as historic and will surely be infamous.
If there are any plans to ‘raise the rhetoric’, so to speak, I encourange you to do so today, all concerns about creating panic aside.
Posted May 22nd, 2007 at 10:53 amSecretary Leavitt,
Thank-you for your blog and your efforts in preparing the nation for a pandemic.
I have a few questions.
1. Are there any plans for a mass media campaign to educate the public as to what they need to do to prepare for a pandemic? I realise that there is a Public Service Announcement that has been running occassionally on TV, but it doesn’t provide detailed information on how to prepare and few people have seen it.
2. Why do the current HHS recommendations at the pandemicflu. gov site suggest that people stockpile food and other supplies for 2 weeks (www.pandemicflu.gov/…
individual/checklist.html)?
As you know, flu outbreaks typically last at least 6 weeks. If people only stockpile for 2 weeks, they will have to come out of their homes to find food in the middle of an outbreak and risk exposure to a potentially deadly virus.
3. Are there any contingency plans for dealing with an H5N1 virus that does not decrease in lethality from it’s current kill rate of over 50%? Although we all hope that if/when H5N1 becomes a pandemic strain the case fatality rate decreases from 50% to 2% or less, at this point we cannot be sure that it will. Most of the plans I have seen assume a worst case scenario of only a 2% case fatality rate. Yet, the top flu scientists in the world have indicated that H5N1 may become easily transmissible between humans with its current fatality rate. References in next post.
Posted May 22nd, 2007 at 10:55 amMr. Secretary,
I am concerned that the incident command system (ICS) will not be effective to provide help when the pandemic hits the local level. Is there a way to make the IS 700 or a hybrid unified command training course available and accessible on the pedestrian level?
Will there be a mandatory “call up” of current and past Disaster Medical Team Unit(DMAT) members when this hits?
Posted May 22nd, 2007 at 10:59 amHere are some excerpts from two references to support my previous post.
From H5N1 Outbreaks and Enzootic Influenza by Robert G. Webster, Malik Peiris, Honglin Chen, and Yi Guan. Published by Emerging Infectious Diseases (www.cdc.gov/ncidod/E…):
“The H5N1 virus continues to evolve and spread, with additional human infections occurring in Vietnam, Cambodia, Indonesian, China, and Thailand. If this virus acquires human-to-human transmissibility with its present fatality rate of 50%, the resulting pandemic would be akin to a global tsunami. If it killed those infected at even a fraction of this rate, the results would be catastrophic.”
[snip]
“We cannot afford simply to hope that human-to-human spread of H5N1 will not happen and that, if it does, the pathogenicity of the virus will attenuate. Notably, the precursor of the severe acute respiratory syndrome (SARS)-associated coronavirus repeatedly crossed species barriers, probably for many years, before it finally acquired the capacity for human-to-human transmission, and its pathogenicity to humans was not attenuated.”
[snip]
“SARS was interrupted by early case detection and isolation, but influenza is transmissible early in the course of the disease and cannot be controlled by similar means.”
From the World Health Organisation Working Group, September 21-22, 2006,
(www.who.int/csr/reso…):
“One especially important question that was discussed is whether the H5N1 virus is likely to retain its present high lethality should it acquire an ability to spread easily from person to person, and thus start a pandemic. Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic.”
Thank-you for reading this. I look forward to reading your response.
Posted May 22nd, 2007 at 10:59 amKJensen: there is an internet course on the ISO 700 available. It’s here:
Posted May 22nd, 2007 at 11:11 amwww.learningservices…
Dear Mr. Secretary,
In your letter, you write that Americans “have
an opportunity to become the first generation
in history to be prepared for a pandemic.”
You are right.
But please consider that the last time a pandemic
struck America it was 1968, and despite our
complete lack of preparations, “the episode
was not significantly deadlier than a typical bad
flu season. Few people who lived through it even
knew it occurred.” (The quote is of historian
John Barry, Time Magazine, Oct 9, 2005)
America is supposed to be a country where we have
flourishing debates on matters of great importance.
While you are bringing together experts to discuss
pandemic influenza, have you included those with
skeptical or dissenting views? Science requires
rigorous debate, I believe, and any government
expenditure of billions of dollars demands it as
well.
Sincerely,
Peter Doshi
PS. If you are interested in my analysis, please see
the following:
Selling ‘pandemic flu’ through a language of fear
Christian Science Monitor, March 21, 2006, p.9
www.csmonitor.com/20…
Are US flu death figures more PR than science?
Posted May 22nd, 2007 at 11:35 amBritish Medical Journal, Dec 10, 2005, v331, p.1412.
www.bmj.com/cgi/cont…
If you cannot ensure the cooperation of countries that are currently hoarding H5N1 (the primary candidate for an influenza pandemic, of course) isolates, then you will be ignoring an essential component of preparation…research. You cannot conduct research on something that you don’t have access to, obviously.
Indonesia and Çhina are the chief impediments to conducting real-time research on H5N1; if an H5N1 variant were to emerge from either of these two countries, with a capacity for human-to-human transmissibility coupled with high infectivity, the resulting pandemic would likely be catastrophic.
Until this matter is effectively addressed we will continue to remain in the dark, with respect to the current status, and nature, of our likely adversary.
If we fail to get appropriate compliance from the various conties that have physical access to the accelerating number of H5N1 strains, then I cannot see how we can possibly maintain that we are taking this threat seriously.
Posted May 22nd, 2007 at 11:40 amLooking from the outside in, it appears that the Federal Government is relying on a trickle-down approach to pandemic risk communication and planning. HHS held conferences in each state a year ago, but it is not until next month that the PA Dept. of Health will hold a conference in my local County. When I speak to my local township, they are oblivious to the risk.
It would appear that a hypervirulent avian flu pandemic would cause such widespread disruption of communicatons and supplies, and result in so much social anarchy, that even County government might not be able to respond effectively. (In Pennsylvania, state resources would almost certainly be directed to problems in Pittsburgh and Philadelphia, with little of anything left over for the other communities.) Under these circumstances, it appears that planning and prepartaion needs to be occuring at the township or even local precinct level.
What can the Federal Government do to more adequately provide awareness at the local level? We understand that the risk of a catastrophic pandemic flu is only one of many issues of concern for local governments to deal with, but the probability and severity of such an event has clearly not reached the local level. More frequent public announcements by the President would be one approach, but a better approach would be to ensure that local governments are fully engaged through direct engagement with them by the Federal Government.
Posted May 22nd, 2007 at 11:57 amSecretary Leavitt,
Have you secured Tamiflu for your family and for what length of time have you prepared your family to SIP, shelter in place during an outbreak?
Thanks,
Posted May 22nd, 2007 at 12:48 pmAeolus
Dear Secretary Leavitt,
I am just an ordinary private citizen, who happens to have been following H5N1 news for over two years; I’m a curious sort interested in health.
I became convinced of the serious threat of H5N1 becoming a pandemic after much indepth reading, including the transcripts of the CFR symposium more than a year and a half ago.
Most people that think that people like me are fear mongers, “tinfoil hat wearers” (i.e. paranoid conspiracry followers), or otherwise foolish or chicken littles.
Unless and until all levels of government, starting with the top, give people the same message - that the danger of a flu pandemic is real, and that all levels must prepare for it, then the status quo (as mentioned by many of those commenting so far) will continue.
Either the government thinks there is danger ahead that everyone should prepare for, or not. Which is it? When people hear mixed messages, they assume that the message saying “there’s danger ahead” is the wrong one, and the message saying “nothing to fear” is the one they should listen to.
The saying “there is nothing to fear except fear itself” is a nice slogan but it is not really true. Ignorance of the very real dangers will fuel panic and fear; knowledge of the danger will motivate realistic planning and other appropriate actions.
Thank you for your time,
Posted May 22nd, 2007 at 2:06 pmP.K.
Thank you very much for this opportunity.
We can agree that we all want to minimize death, illness, loss of economy and loss of infrastructure.
However, the government is being penny wise but pound foolish at this moment, it seems.
One of the main problems, as I see it, is political correctness, self-preservation, and worry about “panicking” people. I appreciate the government looking out for my “anxiety/panic level” but I would rather have them work harder on telling me how to save my family during a pandemic.
No one is stepping out and calling this, so no one knows what to say.
Do not forget, people will forgive “We warned you but thankfully the problem did not happen” but NOT “We chose NOT to warn you much at all and the problem DID happen”. I know that people want to be sure so that they do not look foolish, but the only way to call a pandemic with certainty is in the middle of one, and by then it is too late to prepare.
These are the messages the public is getting…this illustrates the problem clearly:
“Don’t panic. Yes it is bad but it probably will get almost as mild as regular flu. Kills 75% but we want you to be planning for less than 2%. Buy for two weeks but do NOT stockpile even though waves last for 6-8 and pandemics last for about 12 months to 2 years and we are assuming there will be interruptions in our local/national and global production and delivery systems. We might quarantine, but do not buy enough to be in your home now while the supply system CAN handle it because we do not want shortages now. You will want to avoid crowds if the pandemic hits, but you will need food (which means large gatherings at stores, etc). Large depots of materials are ripe for looting, but we do not want individuals to have what they need beforehand. It will be Katrina in every city, so do NOT come to us, BUT do not SERIOUSLY prepare for a pandemic…two weeks should do it. A small percentage of Americans cannot prepare, so we are keeping the preparation number low, even though a good 80% CAN prepare for longer but are waiting for us to tell them to because we have worked on a system where the government walks people through nearly everything and many have come to depend on the government.
“There is little to no survival without tamiflu so you will need tamiflu, but doctors do NOT prescribe tamiflu for people to keep at home because we need to have enough for xyz, even though Roche is slowing down their production for lack of orders. You will need to go in to your doc for tamiflu during the pandemic, but the health system will be overwhelmed and we are trying to figure out how to keep HCW’s on the job, and there will be interrupted deliveries. We have tamiflu ORDERED for a small part of the population, but it will take at least double the dose. Health care workers will need to stay on the job, but we are not mandating that hospitals have policies to protect them. Get the flu shot, but it will not help. Masks can help but do not buy them. We do not encourage people to buy masks, gloves, etc because we do not want to “create panic” and we want those available for HCW’s, even though you can get those things at home improvement stores and hospitals cannot/will not stock them.
“7 Amino acids away from efficient human-to-human transmission…now 5…now two…now one, but “we don’t know when”, so we are still at the planning about preparing stage. This could happen at any time, but we are not sounding the alarm. Do not sound the alarm because “there is no need to be alarmist”, even though pandemics are natural occurances and we are due. Local governments, work with your people, but we are not committing to anything, so just tell them to prepare for two weeks, sneeze into their sleeve and be careful not to cause panic. The facts *ARE* there, but you have to be in “flublogia” to find them. “When, not if” but we do not know when, so there is not any alert. No human-to-human transmission….except for several clusters in different countries. H5N1 is rapidly adjusting to humans, but it is pretty much only in birds, so don’t worry. We hold press briefings but the questions are softball and there is a lot of talking about talking. Our experts are not 100% so they will not say “this is our best guess”.”.
You see the problem? No wonder people are not preparing. The message is SO counched to “not create panic” that there is no message at all.
Panic comes when the threat is HERE and people are unprepared and kids are starving or ill…NOT when we are being warned ahead of time, even if that warning is loud.
Either this is probably a big threat or it is definitely not. Government, it is up to YOU to tweet or get off the twig. If this is a serious threat, then stop the pc talk and start being frank. If it is NOT a serious threat then SAY SO and say why.
Hoping for the best is NOT a pandemic mitigation strategy.
One way to ease the feeling of being “overwhelmed” is to mention that pandemics END. It will probably be VERY bad for 12-24 months, then it will END. Most people can handle a short term, intense crisis, especially when they have time to plan for it.
People work on very basic principles: if it feels good, do it, if it does not feel good, do not. People will prepare when their fear of being unprepared during ANY emergency overrides their reticence to think about “bad things”. BUT the message has to be clear and loud and easy.
Also, the government, through well intentioned, but detrimental policies of “We know what is best for you…let ius handle responsibility for your lives”, has created an entire society of people who say “the government knows best….they will take care of us”. The government will have to overcome that to get people preparing. The message will have to be STRONG and LOUD—remember, you are competing with “American Idol”.
HHS, go to one of the pandemic flu forums…You can find the information you are looking for. You have a cadre of THINKING people there who have come up with ideas and solutions.
Remember, just because there is not a PERFECT solution, does not mean that we need to reject many GOOD solutions.
Thank you.
Posted May 22nd, 2007 at 2:15 pmMr.Secretary,
What would it cost to install a wood stove or vented propane heater, in the homes of people on Energy Assistance, who have no fireplace or alternative source of heat? What would two winters supply of wood or propane cost per household?
How many people will freeze to death if this is not addressed?
Is it possible to ramp up the low income food Commodities program? Things like long term storage foods, water barrels, bleach, small propane heaters and other supplies could be distributed this way. Information about the pandemic and how to prepare could also be distributed through this program.
Will the government be instructing the insurance companies who run Medicare to allow Medicare recipients to get an extra three months of medications?
Since Tamiflu production is being cut back because demand is lower, will the state medical boards stop pressuring doctors not to write presciptions for Tamilfu and allow people on Medicare to get a needed supply of this medication?
Could Medicare coverage be extended to masks, gloves, hand sanitizer and other supplies needed for the home care of flu patients?
Posted May 22nd, 2007 at 2:21 pmSec. Leavitt,
We hear that Roche has decided to cut back on Tamiflu production, citing fulfillment of orders from governments around the world and no new demand in place.
How is this possible?
Why is the U.S. not placing new orders for more Tamiflu with Roche? Switzerland claims to have on hand enough for 100% of its populace. Why are U.S. citizens not receiving that kind of commitment?
Are you aware that there are reports out of Asia (Thailand, Indonesia) indicating that successful treatment of patients infected with H5N1 already showing signs of acute disease require treatment with MORE than the usual dosage and for longer duration? Clinical research is being conducted right now. What if the results show that indeed more Tamiflu is needed?
At that point, the U.S. “stockpile” of Tamiflu for 25% of population becomes enough for fewer than 10%, possibly. Is anyone at CDC and HHS tracking this situation, and are you prepared to order and take delivery on more Tamiflu if it’s found to be prudent?
Also, about Tamiflu, is it feasible to encourage or direct doctors in this country to prescribe Tamiflu for their patients to have on hand at home, along with instructions on when and how to use it? As most people become sick and will be taken care of at home, wouldn’t it be better to already have the only medicine that is known to help (so far)already widely distributed?
Posted May 22nd, 2007 at 2:28 pmHi Dr. Leavitt. It’s an honor to be a part of this discussion. You are a hero to those of us that are *prepping* and we thank you for your help. Although the Gov’t says that it won’t be able to help much in a Panflu, we appreciate the fact that your going above and beyond the call of duty by holding the forum for the public and us little people LOL. The prepping community (your fan club) also post messages on another online discussion board that is dedicated to issues about the Panflu threat and we would all be honored some day if you could post a message of encouragement for the troops. The forum is at www.Avianflutalk.com
Thank you sir and God Bless,
Posted May 22nd, 2007 at 3:00 pmJasper
Secretary Levitt,
Posted May 22nd, 2007 at 3:30 pmI agree with the earlier post by C Mundy, I strongly agree that this blog is preaching to the “already convinced” choir. The posts and comments I have read so far are names I’m very familiar with from other forums. Our Government has a duty to correctly inform the public about pandemic flu…and I think we all have a pretty good idea we are most likely talking about H5N1, any good article I read always ends up dismissing a pandemic as “we don’t know when, we don’t know which virus” and that is where we lose even the mildly interested. I’m an ICU nurse now for many years, and have been doing epidemiology research for more than 10 years, I have published articles and written reports for business continuity, I also spoke at a large Supply Chain Convention last October. The follow up I receive mostly is “if this was really serious our goverment would be telling us this”. It is very hard to convince anyone, any business…even my own family.. regarding the scientific data. For most people this is not even on their radar, nor will it ever be unless our government stands up and becomes accountable. Believe me we are not a nation to panic easily, and given information that is truthful, and timely, those who can prepare will hopefully prepare. Those who need help to prepare will hopefully be helped by our government. The ramifications of the government having to be accountable after the fact, without proper notification to the public, in my opinion will be devastating both in human lives and financial instability.
As I stated above I’m a critical care nurse. My hospital has not had one pandemic meeting, nor have they stockpiled any PPE’s for HCW. In the worst case senario (not 1918 statistics)this is for me a non-issue, as most hospitals will succumb to closure in the first several weeks, and most HCW’s will not come to work because there has been very little planning. I have read many articles recently regarding ventilator triage….how much money has been wasted on these studies??? We have very few vents across the US, and even fewer qualified nurses to staff these units, forget ventilators!! We need to have basic training availble on TV now to educate the public on caring for the sick at home. We need REALISTIC guidelines on how long people will need to have food & water stockpiled in their homes. The time to do this is now, and very public, not on this blog that has the same people reading it, who already are educated regarding pandemic flu. If our Government waits until Joe Public has his children and other family members dying of flu or starving, I think the outcome will be catastrophic, and beyond any means of control. The Citizens of the US are a pretty smart group of people and should be treated as such.
May I heartily second what Atropine has posted above? That is exactly my experience, too.
PLEASE get on message, give the message over and over again, get consistent, and
do it now. Not after the virus makes another little shift and we have a spreading catastrophe on our hands.
No one will listen to flu-trackers in flublogia, whether we have advanced degress and experience in health care or not, IF YOU all in government do not have your act together. Start providing information and messages to back us up. I am tired of my friends and neighbors thinking I’m nuts.
Posted May 22nd, 2007 at 4:08 pmWeek 1 topic of discussion: “Why is it critical for each of us to prepare for the threat of pandemic influenza?”
Answer: Because you have already told us that when the pandemic hits we are going to be on our own.
Question: If you believe that it is critical for each of us to prepare for the threat of pandemic influenza, then why are there not PSA’s on TV in primetime on network stations (during American Idol, maybe) directing Americans to the pandemicflu.gov website for information regarding the threat and how to prepare?!
I look forward to your response, thank you in advance.
UTR
Posted May 22nd, 2007 at 5:04 pmQuick response comes at the local level. Why have we lost CD (civil defense) and how can we get it back so help is local, not way off in Washington DC or stored in some mountain bunker in Montana. We did it before. Our great-great grandparents survived pandemics without the internet, vaccines or the world health organization. We should be able to do a much better job putting their efforts to shame. Not out of disrespect, we just have far better tools.
Of course the government can not prepare us for a pandemic anymore than the government should rebuild homes destroyed by fire or tornado. Besides - pandemic is a world wide event so where will we go?
Why is American Idol more popular than American Survival? Hmm? Because American Idol is fun and people feel they have an input. My niece feels she can do more about global warming than the pandemic. Sad but true. She can change her habits and use energy efficient lights but does not see how she can stop a pandemic. She can not stop a pandemic, but she is learning to survive one.
Here is a fact: Sir Baden Powell said “Fun with a purpose” Make the lesson fun. Bill Cosby said the same thing oh his show “Fat Albert.” Make the lesson fun like “School House Rock” to show and people they have an impact. They may not stop a pandemic but they can help themselves. How? prepping saves them money for they buy food in bulk which is cheaper.
Is this a good cause? If you are prepared for a pandemic you are also prepared for a snow storm, hurricane, black out, short job loss and family coming in for a week. Many would say that is a good thing.
Are people interested. Look at the TV show “Survivor”, “Survival Man” and “Man v.s. Wild” along with “Asteroid Impact” and “Mayan end of days.” People are curious.
So when does casting for “American Survival” start? or a reality TV show where four families prep for pandemic and then stay in the same house for five weeks dealing with sickness and cabin fever?
“Be prepared”
Posted May 22nd, 2007 at 5:22 pmDear Secretary Leavitt,
Thank you for all you have done in raising Pandemic Influenza Awareness.I appreciate all of your excellent meetings held at the state level. You started the ball rolling and now it has sadly slowed down (through no fault of yours).
Many of us have worked hard in our local communities in an effort to make people aware of what a pandemic will mean to them. We have tried to teach people how to prepare and even educate our local government officials.
Some of the activities I have been involved in for the last 2 years include designing and printing my own pandemic awareness materials and passing them out at garage sales, sporting events, stores, libraries, public gatherings, phampleting cars, etc.
I have been a speaker at my local library and began the Red Ribbon Pandemic Awareness Campaign. At my own expense I had business size cards printed with the government sites and several flu forums listed.
I attended the ASTHO Community Mitigation meeting in Syracuse and I am currently a moderator at the PFI online forum.
I’ve also been to visit my local Town Supervisor who knew very little about a possible pandemic. He referred
me to my county for a pandemic plan and they referred me to the state pandemic plan. No one seems interested in finding answers to my questions let alone allow me to participate in planning as I am not a health professional (just a teacher who knows a heck of a lot about Pandemic planning and H5N1. ASTHO gave me a chance to participate actively.
There are lots of folks out there just like me that are willing to volunteer in sharing our knowledge (just visit the flu forums). The more people who are prepared the safer we will all be.
Fear driven panic just doesn’t come into this for most of us on the flu boards except perhaps initially when we first became aware of H5N1. It took time for most of us to work through our adjustment reactions. This is time that all Americans could have if we level with them now. The American public can handle more information. We on the flu boards have proven that.
We could sure use your help in getting real information to the average Joe. Information that would let people know exactly what provisions they should have stored and for what length of time. Two weeks of food and water just doesn’t cut it. Multiple waves and a JIT economy will require much, much more. (I tell foks to start at 3 months worth of preps.)
Please tell folks what a CFR is and that their is no scientific research proving that it will lower from where it is now in Indonesia which is staggeringly high, around 70%.
I think we would all feel far less frustrated if more information were released to the public. Information that would make my town officials sit up and listen and my neighbors to prepare.
We sure could use MSM and PSA’s now, rather then later.
If our population waits until time has run out and the pandemic is at our door then it will be too late for individuals to prepare.
Our public needs information; Information that might just save a lot more lives.
Posted May 22nd, 2007 at 5:33 pmThank you, Secretary Leavitt, for providing the opportunity for someone with no particular status, an average citizen like me, a voice. How many nations provide this for their citizens?
I took my concerns to both my local board of selectmen and my local board of health. I had one somewhat medical member of the BOH laugh and say “y2k all over again. Relax I don’t believe it will happen.” One selectman that, at one time showed some interest is now focusing on other crises which seem to be more pressing.
I was successful in reaching some of the community as a private individual but mostly now I am avoided as the pandemic nut. My neighbors laugh if I tell them to prepare. My own family members think it’s a joke. To some extent I blame myself for telling them too soon but then again I am still not prepared myself.
When I sensed the “storm” coming ever closer I pulled back. Whether that was out of self protection or futility I am not sure but I was honestly at a loss as to how to proceed or even if I should. Some folks around here just don’t have the resources to prepare. Some just do not see this as enough of a threat to postpone their other needs in favor of preparing.
When I posted on a local newspaper’s forum about the need to prepare for a pandemic, the post was removed and for a short time I was banned from any further posting. I had followed the rules of the forum.
On a local level, the budget crisis in my town is blinding everyone to the coming storm. Their focus is elsewhere. When local officials aren’t stepping up to the plate, how far should a citizen responsibly take matters?
I created an all-hazards approach to preparing for local television. It has never played.
I have created a forum that is advertised on our emergency services page. This is my last bastion of strength and the niche where I hope to help anyone who may seek some answers.
I try to be a good American. That is one of my primary goals. I know in years past, with other crises that our country has faced, that people have had to sacrifice for the greater good.
What is the greater good here and which sacrifices should we be looking at making?
I am also aware that a time such as this may cause this nation to become destabilized. In fact, each nation that this touches will have their security as an issue while a wave is hitting them. How can we, as citizens, help our nation?
I pray for our nation’s strength and ability to weather this, and I pray each citizen finds the strength of character to seek the best interests of all.
Posted May 22nd, 2007 at 5:34 pmMr. Secretary,
I have followed, as many here, Avian Flu for many years. It was, in part, your Mission in visiting all 50 states of the Union that validated my personal concern and moved me from watchfulness to action. However, to make that step still required me to take an intuitive leap as to the implications of your actions.
As a member of the online community of forum members who has followed the genesis of the Avian Flu, the topic of the difficulty of trying to get others, friends, family and community to understand the nature of this threat and prepare often comes up. While the government has been providing information and resources, it is agreed by almost all that this information and the resources provided are too limited to spark a sufficient degree of interest in the average person. There is not a great enough degree of concern evidenced by the government to move people out of the concerns of their day-to-day lives.
In part, I believe that it is the very nature of the threat itself which contributes to this, because, relatively speaking, not many people actually get even the “common” flu, though the term is very loosely often applied.
Therefore, conceptually, few have an actual grasp of just how devastating even the “common” flu is. I know that I am restating information that you are aware of, but “common” flu puts a person down for 7-10 days and their lungs are not right for another 2-3 weeks. 36,000 people a year die from it.
However, all winter long, in my capacity as a healthcare provider, I hear my patients say such things as, “Oh, I was out a day from work last week with a touch of the flu” or, that their kids were out of school for 2 days with “the flu”.
The misapprehension of what constitutes a common minor viral illness as opposed to Influenza is so common as to almost be Universal.
Therefore, not only our citizens, but also our members of the media, have, I believe, a difficult time wrapping their minds around the concept that the Avian Flu could be so devastating. They believe that they already *have* a concept of what “flu” is and it’s not really so bad. I believe that if it weren’t for the example of 1918, that the press would not be able to muster up even the tepid response that they have thus far.
SARS, Legionnaires, these make headlines because they are or were catchy, unknown illnesses, full of mystery and death that came out of no where. Dramatic.
But…. flu? “Yeah, I had that last week”.
I have seen you describe, in many interviews, the difficulty in trying to balance the responsibility of promoting the message to prepare against the responsibility of keeping the message appropriate to the level of currently known (or unknown) probability. The challenge of being proactive but not over-reactive.
Perhaps the answer is for the government to begin to work towards a paradigm shift, overall, to a more self-reliant mentality amongst *all* citizens?
It’s been noted here in Mr. Costen’s commentary, as well as many places elsewhere, that citizens today do not have the same mentality regarding self reliance and preparedness in general that they had 80 years ago. If Homeland Security and/or HHS were to begin more proactively urging and educating Americans to have a reasonable amount of supplies on-hand, as a matter of fact central to “good citizenry”, then maybe the issues of trying to educate people to this particular threat of Avian Flu, becomes both less critical and more accomplishable.
I think that there is something of a universal agreement that Security in the United States is not something we can take for granted anymore, but is something that must be monitored and managed. Perhaps, by agressively focusing on the concept of Preparedness itself, something that can be agreed upon as valuable by many, more citizens can be motivated to act.
The question is: do we have the luxury of time for this approach? That is the gamble. The average citizen is playing in the local “pool” while the government has the “line” in Vegas, so to speak. Can we afford the time and effort to create a paradigm shift or does there need to be a more effective and agressive public service campaign by the government *now*?
At some point, the citizenry is at the mercy of the government, that it will, when the odds shift far enough unfavorably, to being more aggressive in their message on Avian Flu, in “e”, print and air-wave media.
Right now, the reliance on people getting to pandemicflu.gov is inadequate. From the perspective of an average citizen, almost two years since you started visiting our States, what I have seen is that many local agencies and State agencies are themselves unequipped and unable to grasp the implications of an Avian Flu pandemic. Rather than promoting your message of “You’re on your own” and the message that each citizen needs to take personal responsibility and prepare, they are, instead, stepping into the role that the Federal Government has said is not tenable. They propose plans which do *not* stress individual responsbility and self-reliance but make it seem like they, the State or the local authorities *WILL* be able to handle the crisis, when and if it occurs. It is your message corrupted and co-opted.
I believe that this blog project is a step in the right direction. BUT, many here are likely to already be “up” on the subject.
At the end of the next several weeks, culminating with your leadership forum, how will that forum and this blog effect the lives of the average citizen?
Will the government “step up” and reach out to the people? Will we hear or see commercials or public service announcements on radio and TV? I still know that “Only you can prevent Forest Fires” and “Don’t cross in the middle, in the middle, in the middle of the block”. Will the average citizen, whom this will most greatly effect, actually be reached in a manner that they can hear?
For, without an effort by the Federal Government to more aggressively, beyond the level of the internet, reach out educate our citizens and thereby validate and support these highly influential leaders from the business, faith, civic and healthcare sectors whom you have called to this leadership forum, I do not believe that they, alone, can bring this critical message to action.
Thank you for this opportunity and your unceasing efforts.
JD
Posted May 22nd, 2007 at 5:36 pmMr. Leavitt,
Posted May 22nd, 2007 at 5:45 pmI have followed H5N1 for 2 years. I am a single mom and grandma. I am trying to put away supplies for those I love. Your message is not reaching the people. Is it just supposed to reach the select few that our government wants to survive?
First, why did I begin to prepare?
Like many Americans, I had most of the elements of a basic 3-day emergency kit scattered around the house and thus mistakenly counted myself as ‘prepared’. And like some of my fellow Americans, I had a vague suspicion that the pandemic publicity was nothing more than ‘wag the bird’.
But as I looked into it, I became convinced first of the immense destructive potential of a pandemic and then aware that the scientific and medical community was watching with great concern a recently circulating and highly virulent strain of flu virus that was attacking birds. These evidence-based watchers, with little political axe to grind, were raising the alarm of a small but very real possibility that H5N1 could become an easily transmitted human disease that could result in the next pandemic – and that such a pandemic could rival or exceed the impact of the great pandemic of 1918.
I found that both governments and global business interests were taking those alarms very seriously. If it was serious to them, it was serious to me. It is critical that we become aware of the threat we face.
So I started looking at what I could do to become more prepared to weather a pandemic. I quickly realized that my so-called “preparations” represented no more than a band-aid and cup-o-soup on which my family would could not afford to depend. If we chose (or were asked) to lay low and keep to ourselves to lessen the impact of the pandemic, it would not be for days, but weeks – potentially months. If the pandemic impact disrupted the cost-effective, but somewhat brittle international supply lines on which we all depend, my family would need to be not just willing but also capable of riding out those disruptions. If the local pandemic toll on people and systems was large enough or long enough, even the official government web sites were warning that the basics of food, water, heat and light might not be consistently available from our usual sources – so we had better make sure we could provide for ourselves. It is critical that we know the difference between feeling prepared and being prepared.
So the lists lengthened of what I needed to buy, store, and rotate. The piles deepened with what I needed to read, learn and understand. And the frustration mounted with how much I needed to know and do and how little I actually knew or had done.
Which is when I asked this same question: Why is it critical that I prepare?
Preparing for a potential pandemic on our own seemed at many times like being asked to kill the Hydra with a pen knife and bic lighter. (We understood the concept, but had serious doubts about our tools.) We have better things, more important and more urgent things to do with our money and our time.
And besides, a pandemic with severe impact may not happen tomorrow or even in our lifetime. (But it may.) If it does, it may not be that bad. (But it may and if it is H5N1 – well then ‘bad’ may not quite cover it.) If it is that bad, it probably won’t be that bad here. (If it is bad ‘there’ it will almost certainly be bad ‘here’.) Even if it is that bad here, the government will handle it. (They won’t. They can’t. They have clearly said so.) It is critical that we understand how to prepare and that while it takes time and commitment to accomplish this goal – each of us is capable of improving our preparedness.
So why is preparing so critical if the chance of a pandemic happening soon is so small?
It is critical because while housekeeping and maintenance are both very important, you cannot sweep the floor or repair the roof on a house that has burned to the ground.
There are risks whose potential threat of damage is so life-changing that we cannot afford to ignore them. This is why we have fire insurance on our houses – not because such a fire is likely, but because we cannot afford to ignore a risk that great even if the risk is not that high.
So we prepared. Starting with the things we will use in our daily lives (like extra food and critical medicines and medical supplies), moving on to the things we would likely use in a variety of possible emergency situations (like alternative sources of power, heat, light and drinkable water) and finally adding the things that would likely only be necessary in a pandemic (like N-95 masks, nitrile gloves, and other pandemic-specific preparations.) We started with 2 weeks of each category and built up over time to our current level of 2-3 months.
But why does it really matter? Why not just let whatever happens, happen?
My father carried a card in his wallet that I found recently after he passed away. It said it does not matter how much you know or how much you have. What matters is how much you care.
Of the things we care about most, few can be preserved on our own. If we care about protecting ourselves, if we care about protecting others and the things that are truly important, it is critical that we each prepare. Each person, each family, each community must prepare if we hope to preserve what we have and more importantly preserve who we are.
If a pandemic turns from threat to reality it will present an almost unprecedented challenge to each of us to stay true to our better selves. At the root of meeting that challenge must be the preservation of hope. And there can be no hope without responsibility – caring enough to fight for what you value most and preparing for that fight.
Posted May 22nd, 2007 at 6:05 pmI second Atropine’s post (17). The few things I’ve done quietly to encourage preparation for a pandemic have had little effect, because the government hasn’t said it’s important. (Having a website without pushing people to it and delivering its message in alternate ways doesn’t do the job.) I cannot make myself a target in my town by publicly talking up the risks of pandemic all by my lonesome. In the absence of steady government encouragement at all levels, it’s a wasted effort and too frightening to me to become known as a person with an odd mania now and a person-with-a-full-pantry later. Please get this issue into public awareness. When pandemic self-reliance goes mainstream, I’ll be happy to help locally.
By the way, recommending a 2-weeks supply of food is not enough. At least mention that some experts call for 2 months or more.
Thank you for opening the conversation.
Posted May 22nd, 2007 at 6:41 pmI strongly agree with TXnurse in post #20 about what is needed to prepare the public. If we can not depend on hospitals, then the people need to know this.
[snip]
We need to have basic training availble on TV now to educate the public on caring for the sick at home. We need REALISTIC guidelines on how long people will need to have food & water stockpiled in their homes. The time to do this is now, and very public…
[snip]
I have been posting to my fellow nurses for one year now on pandemic flu information on threads such as: allnurses.com/forums…. I can tell you very clearly that my colleagues are not prepared, and not informed. There has been very little training available, and in most cases none at all regarding pandemic influenza. As Txnurse has said, we do not have PPE. How can we do the job? Many nurses do not work in Joint Commission certified facilities if that is the agency tasked with preparing us. That leaves our state health departments in the role of educator, and this is not happening. Will no one take on the responsibility of talking to nursing and the other HCW that will be needed to get us through this? We need someone in authority to address us, and prepare us for this coming crisis. We need leadership.
Posted May 22nd, 2007 at 7:08 pmSo, here today among the 3 blogs we have learned that:
1) nurses by and large are not informed, not trained, and not supplied with PPE or prophylactic medication to face pandemic flu
2) police officers by and large are not informed, not trained, and not supplied with PPE or prophylactic medication to be be able to do their jobs during pandemic flu.
And folks in government wonder why participants in the flu web-sites are losing patience.
Posted May 22nd, 2007 at 7:40 pmNo Tamiflu and no PEE’s equals no work for nurses. We are not going to die because some bean counters decided it was not worth the money to protect us.
FYI forget forcing us to work we will hide run and resist.
Spent the money to protect us, if you want us on the job saving lives. Otherwise live with the fact the many more will die because of your inaction.
Nurses are even now making plans to fade away. Safe houses are being set up. We take this threat to our lives very seriously.
The public needs to be informed now so they can prepare. A consistant, honest, strong message needs to come directly from the federal government, otherwise it will fade off the radar.
This administration has very little credability. If you are planning on having the cooperation of the public during a pandemic you better start building trust now. Frankly I dont trust the lot of you any farther than I could spit, and Im not alone. Cruise the flu boards, see how your viewed. Katrina is still fresh in our minds.
Posted May 22nd, 2007 at 8:35 pmMy grandma needs to buy her Diabetes medication 90 days in advance and her insurance won’t cover it. It doesnt matter anyways because docotors haven’t been told the importence of Panflu prepping so they wont write any prescriptions in advance so their patients can buy emergency meds ahead of time in case of emergencies. They sure is heck wont let people buy emergency antobiotics in advance. So how in the heck can we prepare if the med community wont help in any way? they don’t even know what emergency preparedness is! sorry.
Posted May 22nd, 2007 at 9:32 pmIt seems to me that the people who have posted have made it very clear what we want from government. We don’t expect government to fill our pantries, to buy our Tamiflu and N95 masks, or to teach us how to take care of ourselves. We are perfectly willing to do those things for ourselves. Those of us posting here have gone the extra mile to educate ourselves about this virus and what to do to survive a pandemic. What we do want is for the government to send a clear, emphatic message to our fellow citizens so that they take this potential crisis as seriously as we do. That is the one thing that we cannot seem to accomplish. This part of the issue really is your responsibility.
Jefferson said that it was the duty of government to keep its citizens from harming each other. To deny the truth about H5N1 and the necessity for substantial prepping is tantamount to creating a harmful environment. Don’t forsake your duty. Send the message now, send it often, send it forcefully.
Posted May 22nd, 2007 at 10:39 pmSir, first off, I’d like to thank you for your service to our nation.
Given the fact that I am in agreement with all of the comments and responses of the previous contributors, I have very little to add along those lines. Having been preparing for H5N1 or it’s like for several years, I have found it to be, and consigned myself, that it’s a futile exercise to attempt to engage anyone in an attempt to motivate them to prepare for themselves. Having pretty much given up any hope of success, and without official leadership, no matter how well intentioned our actions in the community are…they are doomed to failure. Your support is required…
My biggest concerns now lie not with preparing , but the country itself (USA) and the direction we may be headed in the advent of a severe pandemic. Would the secretary entertain the idea that this may be a border changing event? Or even more so…a political event of such magnitude that the constitution itself could be suspended or even abolished?
Posted May 22nd, 2007 at 11:19 pmIf a Pandemic happens between now and Sept 2008, and it is severe enough to cause widespread disruption of society as many have predicted, will we still have a Presidential election?
Posted May 22nd, 2007 at 11:35 pmThank you Sir for all the work you have done to help prepare for a pandemic. I have been following avian flu for over a year.
The question; The Need to Prepare
Why is it critical for each of us to prepare for the threat of pandemic influenza?
I prepare for my family,my children and my grandchildren, my neighbors, friends and their families.
I prepare to keep America Strong, the future is our children. I prepare because I love my kids and grandchildren and I want to keep them safe.
I prepare because I understand the JIT delivery systems and I will not watch my children starve. I will not watch them freeze to death during a harsh winter.
There are millions and millions of reasons to prepare. People.
This is personal to me and even if I can manage to keep my friends and family from harm it will still be personal as I watch and hear about others that die from collateral deaths that can be prevented.
Doctors need to prescribe tamiflu and other needed meds now with clear instructions on how and when they can/should be used. Secondary infections will need to be treated too.
Regular prescription drugs. Allow the people to stock up on at least a three month supply that will keep them alive.
Tell the people how to best take care of their loved ones at home.
Basic food and water storage for longer then two weeks. The waves are projected to last much longer and with a large percentage of people not working during a pandemic, going to the grocery store will probably not be an option.
Are the Utilities preparing?
We know there are no guarentees for any of the plans you make and will deal with it. But tell the people this so they can make contingency plans themselves.
We need continual,loud messages via prime time tv, newspapers, internet, doctors offices, news stations, radio spots…to get the message to the people.
We are a strong country, A Strong Nation. We the people can help, but only if we are given the truth, the opportunity and the knowledge to take care of ourselves and our neighbors.
With Respect
Posted May 23rd, 2007 at 12:32 amIf we have a severe Pandemic does the Government have the right to declare Martial Law and enforce non voluntary quarantines?
What can we do to prevent that from happening?
If it did happen, how would the Government care for the population?
Posted May 23rd, 2007 at 12:37 amI echo the frustration of earlier posters in talking to family and friends about being prepared for a pandemic. Some of the responses have been “If you cook your chicken well-done, you won’t get it,” and “If it were really a problem, the government would be telling us about it.” If I’m hearing this two years after the “President mobilized the Nation,” something is very, very wrong.
There are many messages sent by the government that are only important to a small audience – the probability of pandemic influenza isn’t one of them. There are many problems that are too complex to be solved by average Americans – being prepared isn’t one of them. There are many things the government can’t and shouldn’t do for our citizens – making sure we all understand this threat isn’t one of them.
Mr. Secretary, I realize that yours has been one of the few official voices speaking out about the dangers of a pandemic, and I appreciate your efforts, but if the government is truly serious about mitigating the effects of a pandemic, the voices must be many, and they must be heard now.
Posted May 23rd, 2007 at 1:21 amSir,
Just like most people, I’m not a US citizen. The US population is about 1/21th of the whole World’s, which means that for every US citizen there are another 20 people in different countries. Well, I’m one of your personal 20, and glad and honoured to meet you in cyberspace, Sir.
May I tell you I’m personally grateful for your Centre for Disease Control’s interim recomendations about when to close schools for up to 12 weeks, and keep children and student-aged people from roaming in huge numbers on the streets and malls, if the next pandemic (come when may) happens to be lethal enough.
Being a father, I KNOW all of that will slow things down and so help us cope better with the inevitable. Trouble is, we need to be able to DO it and that means we need to prepare, not for a deadly virus, but for doing what we will desperately WANT to do in such a situation.
You’re now taking yet another step in engaging community leaders in a conversation that’s growing in wider and wider circles. Your own citizens urge you to speak loud and clear to the people in your own country, so that they will start taking many practical steps in order to be better prepared.
Not so in Europe.
How much of your economy depends on Europe (just as much as we all depend on each other)?
And what about the rest of the World?
So please consider this idea: you’re only as prepared as the next country. And in today’s world that means much more than geographical vicinity.
So, please, share your concerns and your (incomplete and interim as they may be) solutions across national borders.
Tell OUR leaders too.
Here are a few specific ideas just in case:
- I don’t know about international politics so I wouldn’t know what to suggest regarding talking to other countries’ politicians. Your territory! But if you’re personally stocking up on basic items, then tell them about it. And also tell them they don’t want “a nation of bereaved parents”. They will not be forgiven for not showing the way out and doing what they must. But, as I said, it’s your territory. Best wishes from the ground!
- You can host *international* conferences about non-pharmaceutical interventions (NPI) and post them on the web (please subtitle them so that many folks who use English as a second language will be able to get more of what’s said). We would read them and pass the links over to our fellow citizens in many other countries.
- You can go to conferences all over the world and sit on our tables to talk about NPI (you have done the maths) and community engagement (you have the experience).
- You can ask US based organisations (NGOs and businesses and not just embassies) to prepare and tell their environment to prepare. Set up strong communication channels (reliable video) so that the word may get out FAST to whole countries as to when to close schools etc. If schools are closed in far away countries, and if their societies do better in the next pandemic, might it not be the case that you will have less disruption in the US too?
- You can tell your immigrants (from Mexico or elsewhere) to prepare and to tell the people in their countries to do the same.
- Finally, you can lead in the area of self-sufficiency all over the world, in food, water, energy and basic medicines. Tell Hollywood or its modern equivalent (maybe that’s the internet for some, but not for all) to show how to be 21st century people. Foster sharing of information and make it a national security priority to have *basic* stuff sorted out (yes, you can still get toys from China -just an example-, but not your breakfast). Create the vision and take practical steps to make it workable.
Thanks for your time.
Posted May 23rd, 2007 at 4:44 amMr Secretary,
Thank you for your leadership in this initiative.
I have a couple of specific questions that I have not been able to find answers to. Since, as one of the editors of Flu Wiki, part of my job is to help inform the American public, I would really appreciate your assistance in this matter.
Do you have an estimate, and can you share with us, how many Americans will die 2 weeks after they run out of the prescription medications that they are currently taking?
Current advice from the government to individuals include
and
May I ask what plans the government has, if any, to ensure that Americans have both the ability and the right to stockpile, not just 2 weeks of food and water, but also at least 2 weeks of extra prescription drugs they are currently taking?
Thank you. I wish you every success in your endeavor.
Susan Chu, MD
Posted May 23rd, 2007 at 6:44 amEditor, Flu Wiki
Mr Secretary,
Let me second Just Another European’s proposals for spreading the word on NPI’s.
For the purpose of the general readership, let me share something that I learnt from my American colleagues at the CDC,
To slow down and reduce the impact of a pandemic,
Imagine a world where leaders from many countries gather together to share how they can best protect their young as well as keep the infrastructure running.
Would you say that is a worthwhile endeavor?
Thanks again for your time.
Posted May 23rd, 2007 at 6:58 amI am so glad to see the efforts you are making to tell people about the risks of pandemic flu.
As I live in England I just wish something like this would happen here.
Most people are convinced the disease only affects birds and that it is harder to catch bird flu than to win the lottery.
If I try to warn anyone about this they tell me that if it was likely to happen then the information would be in newspapers, radio and t.v. and they would have been told this clearly.
In this country we are also discouraged from obtaining more than a month’s worth of prescription medication.
It makes no difference that my prescription is essential and is on a special list that is supplied free of charge - bureacracy has spoken!
Thank you for all your efforts to enlighten people about the threat.
Posted May 23rd, 2007 at 8:29 amMr. Secretary,
Over the past couple of years, I have been working diligently on preparing my family to shelter in place for an extended period of time. As a means of organizing my efforts, I have written a document that has helped me to remain focused. I call it “Becoming Self-Sufficient for Six Months”. Although this document is available as a .pdf at Pandemic Flu Information and Flu Wiki, I regularly distribute hard copies to friends, family, neighbors, colleagues, business acquaintences, airline flight crews, and total strangers. At a mere 19 pages, it is neither definitve nor exhaustive, but it can provide some rudimentary pandemic planning guidance to help the average family cope with supply chain disruptions and the intermittent failure of utilities. I hope you will have an opportunity to peruse it and assess its applicability for your domestic situation.
After reading my pandemic planning document, please sit back and ask yourself the following question:
“If, hypothetically, the pandemic were to begin next week, and I only had the opportunity to top off my supplies, how long could my family effectively shelter in place?”
I do not expect you to post your answer here, but after you have addressed this question for your personal situation, you need to ask that question on behalf of everyone who resides in the United States. Right now, they may not be capable of getting by for more than a week or two; however, given both opporunity and leadership, they can prepare for just about anything.
The opportunity is still here and we are counting on you to provide us with the leadership. Please help us to get the American public as prepared as they can possibly be.
Posted May 23rd, 2007 at 8:46 amDr Dave, if I had the resources to print this out and distribute it I would. I don’t. As a private citizen acting on my own, I would stand in front of the local grocery and hand brochures out to everyone who walks by. I would do this tirelessly and unceasingly if I had about 10,000 copies AND I knew that it was the right thing to do for the greater good.
To me this is the heart of preparedness, EVERYONE being prepared for whatever the emergency. My heart would sing with joy if I could get this message across to everyone I can!
Posted May 23rd, 2007 at 9:01 amSecretary Leavitt,
I am a nurse at a small community hospital in Florida. We are the only hospital in our County and serve a large population. I am also a member of our county’s pandemic planning committee. I appreciate the efforts and progress you have help to engineer, but I am extremely troubled with the lack of awareness and / or concern displayed by both State and Federal government officials. Planning for a pandemic (or any other emergency) takes guidance and funding. The scope of planning for a pandemic encompasses so many areas of life that it is difficult for many individuals to think they actually can make an impact on anything.
Recent studies and headlines have shown how our health care infrastructure is perilously stretched thin. Managing the care of patients is difficult in normal everyday operations due in part to funding. For the last decade, Congress has sought to decrease payments to hospitals, yet the costs of caring for patients continue to rise. There is no funding for expansion of hospital services, or the hiring of additional staff. In a county of 72,000, our surge capacity will be 68 people. We are preparing our community through working with the Public Health Department, and Emergency Operations, but providing care during a pandemic will be a challenge that many cannot fathom.
The EMTALA Law changes posted in the (recent) Federal register will help, but needs to be stressed that the States adopt a reform in EMTALA Laws during an emergency, so we can triage appropriately, in different venues.
Tamiflu, which is a recommended treatment by the WHO and CDC, is not going to be available in Florida through the state. We will not be practicing “best practice” guidelines because of this. Communication from the Federal government in all Departments need to understand, if they are going to charge the local level governments and Health Care entities to make their own plans, we need the tools which are needed to be successful.
I firmly believe if people are exposed to truth, they will react accordingly. If members of Congress and State governments were properly informed, they too, would support this initiative.
Until the federal government treats this as a priority, no one else will treat it as a priority. Can we not be pro-active on this?
Thank you for creating a venue where we can voice our concerns.
Posted May 23rd, 2007 at 9:25 amMr. Secretary …. you have an awful lot of mail here. I’m curious as to WHEN we will hear a reply from you on ANY of the items of concern that are above.
I can only assume that as the inquiries and concerns mount, many are going to get lost in the shuffle. -k
Posted May 23rd, 2007 at 9:36 amDear Mr. Secretary,
I want to thank you and your staff for all of the hard work and effort you have done in regard to pandemic preparedness. The reason I decided to post my comments here is that as a public health professional who does not work for a governmental agency/body anymore, I am at greater liberty to speak compared with other public health colleagues.
The reason I have prepared is because I see myself and my family at risk for becoming ill and potentially dying. Health professionals (of all types) understand that people do not change their behavior until they see themselves at risk for becoming injured, developing a disease, dying, or even experiencing discomfort/pain. That is why people wear seatbelts, change their diets, get their children and themselves vaccinated, go for regular medical and dental check-ups, and taking medications. That is why during drivers education we show car accident scenes so new drivers can see what could happen to them if they do not drive appropriately and wear their seatbelts/helmets. If people do not think they are at risk, they will not do anything to reduce their risk. The same principles can be used with a pandemic. Right now, there has been almost nonexistant education about the situation. Because of this, people see their risk at zero and have no incentive to change their behaviors and to start to prepare.
I have talked with many people about preparation (local and statewide) and even with my background and experience, my success rate has not been very good. The two main reasons that come up are “if there was a problem, it would be in the newspaper or on TV” and “if it were this bad, the government would have said something about it”. I had hoped when you visited my state that the media would have really picked up on your message. Instead, the opportunity was used as an unveiling of a new research facility and the number of jobs it could create - very little of your message to prepare was conveyed to the public.
Last fall, I attended a general emergency management meeting and had an opportunity to talk with representatives of several of the major hospitals of my state. When asked about pandemic planning, they said they had things all under control and had been working on their plans for a long time. I asked them if they had ever talked to the physicians to see if they were planning to show up to treat patients at their facilities (physician are hired/paid by local clinics, not by the hospitals). They all had looks of shock on their faces. They had never bothered to find out. I then asked if they had space/food/water/PPE/personal supplies for staff who may need to stay at their facilities due to transportation disruptions or fear of spreading the virus to their families. They all said that they would not have enough space for patients - how would they possibly have space/supplies for staff? I told them bluntly that if they did not have these things available, how did they honestly expect staff to stay and work for them? Their mouths dropped to the floor.
I have talked with funeral home society last fall - they thought pandemic flu was seasonal flu. I was told they were not involved in the planning process at any level and said that the state plan section regarding handling of the deceased would not work. I told them to demand to be a part of the planning committee and that their voices needed to be heard. I believe this has now happened.
I have found that many public health staff professionals are not personally preparing and do not feel that pandemic preparedness is a priority for them or the people they serve (ie: I am busy and this is just another thing I have to do…… It will never happen and is just hype). This is very frustrating for me. The message will not get out to the communities if it is being deliberately stopped or minimized to the point where it is worthless.
Schools are not getting the message. Public health and educational departments within states and at county levels may not have established working relationships or guidelines on responsibilities. Our local school has done nothing for pandemic planning. My county health officer stated she would shut the school after 20% of the students are ill. That is not good enough - by then, it will be too late. To me, it seems that schools and public health officials believe that the responsibility for school planning lies with someone else, not them. Therefore, nothing gets done.
To prepare the nation and its people is a monumental task, as you well know. Clear messages about the potential risk of a pandemic need to be quickly provided to the public. Do not be afraid of inciting panic. I remember not too many years ago that cancer patients were not told by their physicians they had a terminal illness because “they would not be able to handle” the information. Family members were told to lie to the patients and say they were going to get better. This did not help the patients or their families at all and the practice was eventually ended. Patients are now allowed to know estimates regarding how long they may have to live so they can get their affairs in order. This information has benefitted patients and their families, not hurt them. I feel the same thing will happen with pandemic planning. Providing truthful information in a way that people can understand it will help everyone in the long run. Not providing this information in a timely manner prior to a pandemic will create a backlash of anger toward all levels of government that we have never seen before.
Thank you very much for your time.
Posted May 23rd, 2007 at 10:58 amFirstly, my thanks for what you’ve done and what you are doing towards pandemic preparedness. I appreciate anyone who is prepared to stick their neck out on a subject that is so uncertain.
Now for my view point. My pandemic plan is to stay ahead of the crowd. While 99.9% of the population are blissfully unconcerned by a pandemic I know that I can get my prepping done ahead of my fellow citizens. I don’t have to stock up now, I can do it all in the days before a widespread panic ensues. And even though I’ve got several months worth of food right now, I’ll still be stripping the shelves at the last minute… because I can and because I’d be a fool not to. Don’t expect me to be a humanitarian on this, let others get their share, my life and that of my family may depend upon my selfishness.
Does this make me bad? Maybe, but I’d be willing to bet that a lot of well informed people (perhaps yourself?) have the same plan, at the back of their minds. For those who have access to Tamiflu, masks, vaccines and security guards, there’s not the same supply problem that there is for the average Joe. Information gives you a head start.
However, if I thought that everyone else was as aware of the pandemic threat and as concerned as the good people here, I’d have a different plan. I wouldn’t leave prepping until society was on the brink of disaster.
Go on, change my plan, make me part of the solution, not part of the problem.
Posted May 23rd, 2007 at 12:05 pmI would like to add one more reason for the government to STRESS the importance of prepping: to assist themselves in the disaster.
Recently I read that the issues of “quarantine” were discussed, including “how do you make people stay in quarantine?”.
I counter that the problem is NOT how to MAKE them stay at home, but rather “how do you make them *WANT* to stay at home?”.
There is a difference between a castle and a temporary shelter. Most people, when any tragedy hits, want to “get home”. So work with that bit of human psychology!
*BUT* they will not stay there if their home has no food or water or medicine….THAT is where the government needs to start working harder on the preparedness message.
If people are not prepared in their homes, they will come looking for the two things that they have been taught WILL help them: crime and the government.
Human psychology is pretty basic in many ways–keep the good feelings, avoid the bad.
Sending out STRONG, LOUD, CONTINUOUS messages of “Home is safe, home is good…Feather your nest with food and water…You can weather the storm if you are prepared, tucked safely in your home.” would work WITH human nature, not against it.
Adults (and children for that matter) do NOT like being told “You can’t”. No amount of force or rationality is going to stop panic. The “National Guard” would NOT be able to hold the tide of thousands of people who are desperate for food and all having adjustment reactions at the same time. THIS is why preparedness is key…so we have time to adjust.
Remember: a starving man has no ears.
PLEASE do not forget the refrain that we ALL keep hearing “The government will tell us what to do….”. They are right to think that because of the way society and the goverment have become in recent generations. The government even tells us what kind of TOILET we can buy (I remember stories of people wanting to smuggle in high flow toilets when low flows were mandated)!
So for something as important as a pandemic, society expects that the government will be LOUD, if it is actually going to happen.
Also remember, preparing does NOT have to be pandemic specific. The government is currently working on many different possible catastrophes that might hit us….there is not ONE where prepping would be a bad thing that I have found.
I would once again like to challenge the “two weeks” policy. I got to thinking that, while some officials say “Well, people cannot prepare for more”….they were not thinking of time, they were just picking an arbitrary number. The more time that passes, the more people can prepare, *IF* they are shown how and given reason to do so.
Thank you again for this forum. I deeply appreciate your work.
Posted May 23rd, 2007 at 12:12 pmTo All,
It seems the blog “is preaching to the choir.” We understand to prepare.
One point is people feel they are not informed. Both KimT/CMT (Post#38), TXNurse(post#21), SusanC(post #43), Kim Crady RN (#46) echo similar concerns. They brought up some concerns about how can utilities, hospitals and public safety say they are prepared when they are not informed. My pharmacist, pediatrician, neighbors, bank are not informed, except for the papers I drop off, how can they be prepared.
DrDave(post#44) has an in depth paper. It may not be exhaustive but it is extensive eye opener. I’ve seen several articles and heard from those in the IT (computer) industry. They are taking it seriously but people are dependent on the community. So if that fails then
I doubt business and hospitals are prepared. Places of worship and some citizens seem to be prepared but most mid to large companies do not seem to be.
What I am worried about is sewage departments breaking down. The lights, food and water can be shut off and people / hospitals will continue to make sewage. Millions of gallons of it per day. With out lift pumps, raw sewage will collect in the pipes till it flows in the streets making a bad situation worse. Without treatment plants, raw sewage will flow into streams and bays polluting the water source of the town or the other towns downstream.
One fear is any supplies I have will be taken “for the common good.” Without legal protection of one’s supplies and goods, why should one prepare?
Posted May 23rd, 2007 at 1:20 pmIt is critical for each of us to prepare because this is a life or death situation. Period. Either we prepare to save our kids and grandkids, or they will most certainly die. Horribly. This flu has a 70% death rate WITH massive doses of Tamiflu and WITH ventilators IN hospitals. Without? I shudder to think.
I started preparing in 2003 when I first read an article on the internet by (or citing) Robert Webster from St. Jude’s Hospital about Pandemic Influenza.
It frightened me to my core. Then I started gathering supplies. My family thought I was crazy. Then I stopped. I wasn’t one of those “crazy paranoid survivalists”. I was an intelligent, educated mother of 7 and grandmother of 6. Then I spent several months just thinking about what would be needed for our family to survive something like this. It was mind boggling because I had to invent/reinvent/the wheel. Okay, maybe I am one of those. The only information available to me at that time was from survival groups on-line. So, I swallowed my pride, searched the sites, and continued to prepare.
I was thrilled when President Bush made his preparedness speech in late 2005. Hey! Maybe now information will be easier to find, and everyone will jump on board. But this didn’t happen. The US government websites were saying foolish things like Prepare For Two Weeks. Riiiiiight. Prepare supplies for 2 weeks when the Spanish Flu epidemic had three waves of 6-8 weeks? That’s crazy! Then I found information that the SAME US government on different websites were telling US citizens overseas to prepare for 12 weeks. Okay - obviously some government officials were more informed than others.
Because we are such a fractured society, we need all of the sectors of government and business working together to get out the message of personal, neighborhood, town, city, and state preparedness for each and every individual and business. The old rules of “That’s not my department” need to be discarded. Public health, Emergency Preparedness, the Military, the Public Library, local and national newspapers, radio, and TV need to all send the same message clearly, concisely, and positively. The message about making your home a safe refuge needs to get out as fully and quickly as this coming pandemic will.
No one seems to know this danger is coming. Because many people don’t have access to the internet, I decided to research the old-fashioned way. I called my local library.
I asked if they had received any queries about preparing for sheltering in place during a pandemic flu. Then I asked if they had received any questions about how much food, water, and medicines people should store. I talked the two of the three clerks who answer the phones. The answer was a resounding NO. Not only had they received no questions from the public, neither person had the slightest idea what I was talking about. One vaguely remembered seeing something from the state, but they had no leaflets, no websites listed, and no general information.
Libraries need to be a major player in disseminating this information. Perhaps brochures could be printed up and distributed. The summer reading program (already in place in much of America) could be used to give out information to both parents and kids.
We need to get the word out. Because Mr. Secretary, your kids are in danger of dying. And so are mine.
Posted May 23rd, 2007 at 2:17 pmre:”Katie in Iowa Says: …
I recently asked a town council member if the city had a disaster preparedness plan especially about pandemic flu….He told me that if I got the flu, to go to the doctor.
Mr. Secretary, the message is not reaching the local level.”
Mr. Secretary-ditto for my town-who have heard of it-from me-but don’t feel it’s necessary to prepare-they think the county,state and federal agencies will assist them. And I live in New Jersey-a very heavily populated area.
I know you have met with each state, and thank you profoundly for your candor and work.
But no one is listening where I live, and I doubt I am in the minority.
Posted May 23rd, 2007 at 2:31 pmWe knew that the online pandemic flu community was vibrant. And the volume and depth of conversation here at the Pandemic Flu Leadership Blog in the past 24 hours has certainly demonstrated that. Our aim, as the Secretary stated, is to help more Americans to recognize the importance of individual pandemic flu preparedness and to engage thoughtful people in a discussion that addresses the challenges we face in convincing people to prepare, and similarly grapple with the obstacles that many people face in getting more prepared at home and at work.
We are reading your messages and want to respond to the questions that are being posed and concerns being expressed. But we also want to establish expectations – which we recognize now that we should have done from the start. (This is, indeed, something new for us.)
The Secretary will be posting to the site on a weekly basis to address the issues that have arisen over the course of that week’s discussion. We hope that you will recognize that his schedule does not permit him to respond to each and every question as they are posted, but please be assured that we are listening to and documenting all that is being said and that your ideas are important to us.
Our primary goal with this blog was to start a conversation that would contribute to the discussion and outcomes from the Pandemic Flu Leadership Forum that the Secretary will be hosting in Washington, DC on June 13. While the space in the room is limited, the space here is boundless.
We can and will tell you more about what we are doing here at HHS to prepare, but that is only part of the solution. I want to reiterate something that the Secretary said. “Preparedness is a shared responsibility and must involve every level of government, every business, every church, every civic organization, every family and every individual. And leaders from every sector have a role to play in communicating the critical need for preparedness at home, within the workplace and in our communities.”
You are leaders. We are counting on you to help us to achieve our goals. We can not do this without you. In that same vein, this blog is a shared responsibility. It is a space for dialogue and problem solving. We are counting on those who come here to not only ask questions, but to answer them – as many have done. We are counting on those who come here not only to present problems, but to offer solutions – as many have done. The government – and Secretary Leavitt — can not do it alone.
I look forward to our conversation.
Posted May 23rd, 2007 at 3:15 pmMr. Secretary
I want to take the time to thank you for addressing this concern.
“In response, I traveled to almost every state and territory to hold planning summits. At every level of government, plans were developed and resources were allocated.”
I have talked to friends and family about this threat and they immediately want to change the subject, I can see a lot of fear in them as they stiffen up and go wide eye. Even though my parents have brought extra food into their house, I noticed that happened after my step mom saw the preps in my closet and knew just how serious I was taking this. In my honest opinion a lot of people want to burry their heads into the sand and just forget it exists because a lot of them are not prepared. I think your message has gotten lost somewhere along the way. I feel the government isn’t doing enough to reach out to the population, the people trust they will get their warning and not just whispers from here and there. They need to know what part they will have to take in part of this, and the message needs to be sent out better where everyone takes it more seriously.
“There is the danger that as avian flu slips from the head lines, people will believe the threat is no longer real.”
I agree with this statement, the threat still exists even if it’s not in the headlines anymore.
The general populace has gotten comfortable in today’s society, they feel the government will get it under control before it reaches them, so why worry right? This is the danger in where they feel they have nothing to worry about because its in the other part of the world when in fact all it takes is one person whose infected to get on a plane and infect everyone on the plane, that’s all it will take for something to get out of control. They may have gotten SARS under control but I also feel that they got lucky with that one. Will we be that lucky next time? So far the team that’s working with the H5N1 feel that they will not be as fortunate this time around if it happens.
“Government alone can’t prepare the nation for a pandemic. This challenge requires your leadership. We have an opportunity to become the first generation in history to be prepared for a pandemic. Let’s continue to work toward that goal.”
I completely agree with this message, a government can only do so much. I have been following H5N1 for a year and notice that the majority of the community thinks the government will bail them out right away. I have also seen a couple of messages from the government stating to have two weeks of tuna and milk stored under the bed, and I do not agree with that statement. I feel that the community in general should have more then two weeks stored, maybe around one to two months or more, because no one really knows how bad its going to be, what the CFR will be like, when the vaccine will be out, and how the economy will be affected or how long it will be when they finally get the next shipment in.
The only thing the community can do is prepare for the worst case scenario, you just never know what’s on the horizon, whether it be a hurricane, getting buried in snow, floods, tornados, terrorist attacks, pandemics, the list of possibilities is endless. Leaning on the government completely is not really something people should get attached too, its more of a look out for your family, have a plan in place, be ready to move in a second if need be. Most people feel that they will know what to do when the time comes but to me without actually having a plan in place, will only lead to panic and chaos if they leave it to the last minute. Why fight over stuff at the store when you can be one of the first people out of the city.
Having the government reach out to the populace like this is a great idea, and I’m hoping more people will take it seriously and begin to prep. I’m hoping a lot of good will comes out of this over the next couple of months. Good luck with the seminars, I wish you success.
Posted May 23rd, 2007 at 3:32 pmMadam Assistant Secretary,
First thank you for clarifying the department’s expectations and goals.
I applaud the Secretary for taking this bold (for government) leap into 21st century citizen participation.
Please let it be known that while we understand we are ultimately responsible for raising awareness and taking care of our own, we are also counting on the Secretary (and staff of course) to help US to help you.
The Secretary can do that by raising awareness to a level not possible by the average citizen, and by applying (with either a carrot or a stick) a sense of urgency through public policy.
I cannot reiterate enough that the message must be consistent throughout all media, that the message must be tempered with reality, and that the message be delivered by a neutral and credible third party.
The current message is NOT filtering down to the local level.
Unfortunately after Katrina, trust must be re-earned with the American people.
It is said that “Hope is not a plan and a plan is not execution towards the goal.”
Only execution matters.
We feel at times that we are salmon swimming up stream on the preparation message.
Please help us to help you (and ultimately all of us) by placing some fish ladders along the way.
I look forward to week two, where we discuss those aids.
Posted May 23rd, 2007 at 4:04 pmSir 5-23-07
I became involved in this while attending college. In a General Biology Course Project we tracked for 6 months the spread of H5N1 and made predictions based upon three different types of results:
1. 1918 Spanish Flu, where 30% of the world population was infected with a CFR of 40%.
2. 1959 Asian Flu again 30% infected with a CFR of 10%.
3. A New Worst Case 40% infected and 50% CFR.
We looked at what would happen to our local rural county. The results went from bad to a 9 month disaster that no one should suffer.
Why did I become involved: to reduce those numbers to a level that I can live with. For 30+ years I gave to my country everything it asked of me and now I’m ready once again to do the same.
If these numbers in black in white cannot not convince people I do not have another answer. But those numbers must be presented to the people so they understand what we are up against.
T I M E !!!
Posted May 23rd, 2007 at 4:46 pmMrs DeFrancis.
With child hood obesity, new birth control, food testing, neonatal care, geriatric medicine and many other issues HHS faces, many realize the pandemic is but one issue amongst many. There are enough blogs to keep one busy 24×7x365x??, but not enough to solve the problem.
Hopefully here we can see what has been done, what we think we know, what issues are out there and what solutions there are.
Please help us turn Pandemic from the 30 ton elephant in the room no one wants to talk about, to a house hold word in our country and others. For my health depends on other countries. Not just tainted cat food from China, nor genetically modified corn from Mexico, but possibly from sick refugees from other countries sneeking into America. We can not stop illegal aliens now. What will happen when they need to escape their country or die there?
My health also depends on oil from other countries. If too many jobs lay people off there will be starving families with lots of idle time to raid others for food and shelter with little fear of arrest. Why? Our prisons are kinda full now. What will we do during a pandemic?
Hopefully you find this as educational as the rest of us. There is soo, soo very much more to cover.
Yes, we can do it. It is only temporary and not the end of the world. We have the chance to document this well enough to truly help those in the next pandemic. To make this the kind of thing found only in a kid’s nursery rhyme. Much like the black plague - “Ring around the rosie. Pocket full of posie. Ashes, ashes, we all fall down.” Just a song, not a threat. That will be a good thing.
Please, let us know what you think. I too look forawrd to the conversation.
Kind regards,
Posted May 23rd, 2007 at 4:51 pmKobie
Numerous comments have focussed on the duration for which people ought to be preparing to protect themselves from a pandemic - and the lack of a consistent and realistic message from the government on that point.
The Dept of Homeland Security recently issued guidance for government continuity plans that assumes
Discussed here:
DHS: Pandemic Influenza: Guidelines for Public Service And Emergency Mgmt
Has the government considered sharing that assumption with the population.
My suggestion would be better sooner than later.
Posted May 23rd, 2007 at 5:17 pmDear Ms. DeFrancis,
Thank you for your clarification and I will gladly do my best to assist in furthering the discourse here as I feel I can contribute.
As a member of an online panflu discussion forum, the one thing all members seem to share is the frustration we feel when discussing panflu preparedness with people we know. The repeated glazed over glances and “oh that” replies is frustrating and defeating to our inner desires to further the cause. We find solace within our online community and see this blog as a glimmer of hope in breaking out of this rut we find ourselves in.
Part of the complacency I see out here is people are so reliant on the Government and their HMO medical plans that they expect all will be taken care of in any disaster event. After all that is what we pay taxes for isn’t it? The pain and agony of a 9/11 or a Katrina are quickly forgotten once the news cameras have packed up and left the scene. First responders and the victims involved in these tragic events know firsthand the true value of being prepared for these types of disasters and we also learn how to do it better for the next time it happens. The rest go on with their lives certain that something like that would never happen to them.
Well the next time is upon us. All of us here have somehow gotten that message concerning a pandemic threat and that is also why we are here at this blog. The question remains how do we get rest involved?
The answer I see lies in grassroots efforts at the local level. Only so much though can be done with just good intentions. My counties MRC program appears to run on a shoe string budget as do similar emergency programs in our county. We certainly can’t expect the Red Cross to do it all alone either their plate is already pretty full. Our communities minimally need additional funding to put for a strong believable message as to the inherent need to prepare now and not later when it will be too late. There are many ready to help get the word out including myself, we just need more backup support from our Government in that what we are doing is essential to our survival. Thank you for your time.
Posted May 23rd, 2007 at 5:21 pmOK, here’s a question I’ve been pondering.
I thought about this a lot in February when I spent a week in Brazil, as a tourist, with both my minor-age children back at home. Perhaps this question is not primarily an HHS matter, but could you forward it to State or Homeland Security, or wherever it belongs?
Do you suppose it would be the right thing to do to widely make it widely known that U.S. citizens who are overseas at the time that pandemic flu arises will have NO support (no medicines, no food, no anything) nor any guaranteed transport out of country to return to the U.S. from the U.S. Dept. of State?
Would citizens (business people, tourists, students and professors studying or teaching at foreign universities, etc.) like to know that they could well be on their own for the duration of a global pandemic, or at least during the first “wave”? Do we think they might pack their bags or arrange their affairs and living situations a little differently if they knew this?
All of what I’m questioning here can easily be gleaned from the U.S. State Department web site; it quite clearly states that there will be no rescue. But, of course, nobody knows this, certainly not tourists and students. Perhaps some corporations with employees traveling overseas frequently are aware and have arranged for quick charter flights out. Or maybe not.
Also, can you explain why U.S. citizens living overseas have been notified through State Department advisories to prepare to shelter-in-place for up to 12 weeks? At the same time that pandemicflu.gov web site advises us here to prepare for TWO weeks?
As someone wrote earlier, inquiring minds want to know.
Thank you.
Posted May 23rd, 2007 at 6:23 pmThanks you Mr. Secretary for allowing this conversation. Your efforts are deeply appreciated and respected.
Others have spoken to this but it is important enough to say again. Roche is cutting back on production of Tamiflu for lack of demand. Many of us would buy Tamiflu out of our own packet if doctors were given a signal that it is OK to do so. My personal physician said avian flu was just something over in Asia and that the govt. would tell him if there was anything for us to worry about. If I have a supply for my family on hand, then we are one less household that will be looking to draw off of the government stockpile.
My employer is seeking to buy Tamiflu for employees & their families but it is not easy for a small employer at least to put such a plan in effect. We’re trying to work through the Occupational Health Dept. at the local hospital but they’re not so sure what all this pandemic flu fuss is about. There are surely other employers who would do the same if they knew a pandemic was a real possibility and they knew that it was possible to make a corporate purchase. Again, any such corporate purchases reduce the demand on the govt. stockpile.
My understanding is that the Federal Govt. has not placed orders yet to achieve the 25% coverage level. While I do not understand why such a purchase is apparently not a priority, the American public could make up the difference through personal purchases if we were only allowed to. Tamiflu is currently the only treatment that offers hope. I know that the govt. will do what it can to fast-track development of a vaccine but even when it is ready it will take years for enough to be made for the US population given so little production capacity in this country. Even if that development & production problem were overcome, we need the Tamiflu at the beginning of the pandemic in hopes of tiding us over until a vaccine is available.
There are perhaps many things that are beyond the ability of the government but allowing us to spend out own money to buy potentially life saving Tamiflu when we know that Roche has available capacity is something that you can do.
Thanks you for listening.
Posted May 23rd, 2007 at 7:19 pmMs. DeFrancis,
Thank you for responding to us. It is good to know that our comments are being read. As much as I would like to be supportive and positive, please indulge me in a critical remark or two.
You have quoted the Secretary with the following comment in post #55: “Preparedness is a shared responsibility and must involve every level of government, every business, every church, every civic organization, every family and every individual. And leaders from every sector have a role to play in communicating the critical need for preparedness at home, within the workplace and in our communities.”
We agree wholeheartedly. In fact, this is a foregone conclusion in Flublogia. Everyone at every level must share the responsibility for prepping. We have known this from the beginning. Unfortunately the Secretary’s message of responsibility has not yet been shared with “every level of government, every business, every church, every civic organization, every family and every individual”. When, precisely, does he intend to do so? Realistically, on-line posting at pandemicflu.gov does not address the general public.
Until Secretary Leavitt undertakes a national media campaign to alert the public of the impending pandemic, and the steps that can be taken to mitigate it, he will have done little to prepare the citzens he serves and we will not only have a national disaster, we will have national security risks. I believe the term is “redrawing the maps.”
At present, Secretary Leavitt is in one of the most unique and enviable positions ever to occur in the life of a public servant. He has the power to alert the general public to the impending pandemic and, by so doing, save tens of millions of lives, thereby assuring his place in history as a true American hero of 21st century. If it is not already too late, his leadership could have a global impact that might save hundreds of millions of lives.
In our minds, Secretary Leavitt has all the power. We wait, somewhat impatiently, to see what he will do with it.
Thank you for your indulgence.
By the way, if you have not yet prepared for an extended “shelter in place” exercise for your own family, you might find this document useful. Feel free to share it with your family and friends:
www.singtomeohmuse
Posted May 23rd, 2007 at 8:10 pmMr. Secretary,
Thank you for what you have done but unfortunately it isn’t enough. We look to our leaders for guidance and help. The guidance you are providing is not getting to the citizens of the US.
I asked my town to be on our pandemic committee. We have none. But they do have a plan, but it is secret for security purposes.
There is zero information available in my community about preparing for any disaster. We are not a very small community, about 15,000.
I am prepping because I know of the danger, but I will be mad as heck if my community dies because of some secret bird flu plan.
I will hold people accountable. I will be heartbroken if people die needlessly because no one told them.
You need to get the word out that communities are on their own and communities need to prepare their citizens.
Someone needs to tell the average Joe that this is real and not a joke.
It will all fall on the government if millions die because of not telling people the truth.
Sorry I seem bitter but I have tried and tried to help my community and it has fallen on deaf and ignorant ears.
Posted May 23rd, 2007 at 9:47 pmIn response to Dr DeFrancis’s call for contributions, I’ve revived a discussion that attempts to summarize some of the ‘Why’s to preparedness, from our old forum that is no longer accessible, and put it in a new diary, Why You Should Take This Seriously.
Hope this is useful.
Posted May 23rd, 2007 at 10:14 pmWithout leadership from the federal government we are no more than voices crying in the wilderness.
We need someone in Washinton to step up to the plate. Otherwise we look like no more than a few nut cases. We are ready willing and able to do our part, we have been for quite awhile. but without the validation of Washinton were limited in what we can do on the local level. Local officials are not taking this seriously in some/most cases, because they see no direction or urgency from Washington. CDC where are you?????? Give us a little help here. We are banging our collective heads against brick walls locally. The focus from Washington has been toward getting businesses to prepare. What about the citizens??
Posted May 24th, 2007 at 12:05 amMr. Secretary,
Daily messages on all media until it is understood. It really is that simple. Once everyone is brought to speed they will figure out what to do for themselves.
Posted May 24th, 2007 at 5:04 amHow can you be a solution when no one recognises that there is a problem?
When any attempts to mention a problem are discounted and scoffed at?
When the person who brings up the idea is derided as a fool or a spreader of panic?
No one can prepare for something that they do not know exists or if it has been mentioned it is glossed over with false messages of reassurance.
Reassurance that is not based on real information and facts is not reassurance- it is propaganda!
Posted May 24th, 2007 at 6:56 amAs a member of the faith community-Christian, this is why I prepare…
There are some members of my faith community who believe that preparing demonstrates a lack of faith in Gods provision. As for me, I believe just the opposite.
Matthew 6:25-34
“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Who of you by worrying can add a single hour to his life? “And why do you worry about clothes? See how the lilies of the field grow. They do not labour or spin. Yet I tell you that not even Solomon in all his splendour was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you, O you of little faith? So do not worry, saying, `What shall we eat?’ or `What shall we drink?’ or `What shall we wear?’ For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”
———-
At the time that this was spoken Jesus Christ was speaking to his disciples about going out in the world, while he was still in it, and spreading the Gospel. There is a caveat here – But seek first his kingdom and his righteousness and all these things will be given you as well.
Jesus Christ clarified this further when he was speaking of a time when he would no longer be actively in the world but when his Holy Spirit would be guiding believers. That time is now, we have been in this time for over 2000 years.
Again, speaking to his disciples he said - (Luke 22:35-36) “When I sent you without purse, and scrip, and shoes lacked ye anything? And they said Nothing. Then He said unto them, “But now, he that hath a purse, let him take it, and likewise his scrip: and he that hath no sword, let him sell his garment and buy one.”
This tells me that we are to be prepared and we are to prepare ourselves for what this world brings to us.
Lot knew that a disaster was imminent. He warned his family and only his wife perished because she looked back at the perishing city. Joseph interpreted the dreams that God impressed upon Pharoah. Joseph knew that a famine was coming and he laid up a huge stockpile that fed Egypt and the surrounding countries. If Joseph had not done that starvation would have resulted. Moses knew disaster was coming and he told people to prepare by placing blood of the Passover sacrifice above the doors so the angel of death would pass over.
The warnings to those who do not prepare also abound. See Genesis 3:19 and II Thessalonians 3:10. We are told that we have to work for what we have. God provides with abundance but he does not prepare the food at our tables. The responsibility is on us to gather and prepare.
We are told to prepare because if we ourselves are not prepared that we cannot love our neighbors as ourselves. (Matthew 22:39) That is a commandment! The Samaritan of Luke 10:30-37 helped the man who was beaten and robbed. We are commanded to “Go, and do likewise”.
How can we help others if we ourselves are not prepared? How best to prepare after we have prepared for our families, is to awaken and warn others.
Posted May 24th, 2007 at 8:41 amTo whom is listening.
This is day four of why we should prepare and the letter keep coming.
I believe it is public health issue because I do not expect the illegal drug trade to suffer much - most cops will be busy. People will have more free time for indoor recreational activities. I do expect maintenance meds for heart conditions, diabetics, birth control, ADHD and mental meds to suffer. That worries me. There was an increase in births from the 1969 blackout. A pandemic lasts longer which makes pre-natal care harder.
Watching a movie like “Mad Max” or “Apocalypse now” is much easier than the mental health suffered from evacuees from Katrina. The thought of our military patrolling the streets is not good. They are busy folks with a full time job and families of their own. I would like to see them only if it helps their moral. I feel they will be just as worried about us as we are. That should not be the case. They should be focused on their job, an important job. To make sure we *only* have a pandemic to worry about.
Finally - “All regularly scheduled disasters will happen on time during a pandemic.” Hurricanes, floods, tornados, earthquakes, snowstorms, wild fires, droughts, etc., etc. will happen like they always do. They will not take the pandemic off. One must be prepared not only for the pandemic but a natural disaster with little chance of rescue.
How would evacuees be handled during a quarantine?
Will organ donors and recipients still be viable?
Blood drives? I have asked the Red Cross but they do not want to talk to me about it. The nations blood supply could dwindle. Guess I worry too much huh?
Kobie
Posted May 24th, 2007 at 9:35 amThere is very little understanding of the danger of a pandemic at the local government level (city, county). Efforts to educate local elected officials by public health have been waived aside. Not one elected official in my county went to your planning summit in my state. To them a pandemic is a non-event. They need to understand how this impacts on their community. Our congressional reps need to light a fire under local elected officials. Public health is operating without the support of local government and is becoming discouraged by the lack of responsibility from them. Without the support of local government there is not going to be any citizen preparedness. The public rarely pays attention to warnings from state and federal officials, but their ears perk up when it comes from a mayor, commissioner, or county executive. It’s like watching the weather. When one of the major networks carries a warning about an approaching storm, the public listens. When a local weather forecaster issues a warning, they take action.
Posted May 24th, 2007 at 11:31 amBig business is supposed to be preparing for a pandemic. I work for a company that has over 150,000 employees and works closely with the government. I have heard from reliable sources that they have a pandemic plan. Not one word has been spoken about this topic at crew meetings or through their web site. It is there if you go looking for it. But you have to know to look for it first. If these big businesses are working with HHS why aren’t they instructed to get the word out to their employees? The employees would listen. This would get a lot of people preparing fairly fast. Then this could be expanded on.
The easiest way’s to get the word out the quickest should be utilized first and this hopefully will have a trickle down effect. Pandemic flu is just one of many things that could effect the world. I believe the clock is ticking and getting louder.
Posted May 24th, 2007 at 12:37 pmMr. Secretary:
I, too, would like to express my appreciation for all of your efforts!
I know that this summit will provide you with valuable input from many concerned and knowledgeable citizens.
I share many of the same concerns that have already been expressed. As many have already said, we need to be prepared for many disasters, not just H5N1, and the time to communicate this is NOW. Please don’t wait until it is too late.
I learned something a couple of weeks ago that you probably already know, but in case others are unaware, I’ll post it here.
I live in Southwest Florida, and I have a couple of close friends with dual citizenship (U.S. and France). The French government has already notified their citizens that live in our country that should H5N1 become the next pandemic, there is a supply of Tamiflu already in this country for them. They have been advised to report to Consulate general of France in Miami for their supply of Tamiflu.
Shouldn’t we be just as proactive for the citizens of our country?
I worry daily about my sister, who is indigent, and a diabetic. Where will she get the money to purchase her insulin should she not be able to work during a pandemic? Where will she get her insulin from, even if she had the money? How will she refrigerate her insulin should the grid go down? How will my neighbor get his heart medication and how will my uncle get his pain med’s for his cancer?
These are just a few of my many concerns.
I live in an area that was hit by 6 hurricanes in a 2 year period of time. We know that it is our responsibility to prepare for disasters. My husband and I are fortunate, and we have the financial means to do this, but so many citizens do not have the financial means.
We can’t let this drag on, Mr. Secretary, we need to get the message out to the people NOW.
Thank you again for all of your efforts, as they are much appreciated!
Seazar
Posted May 24th, 2007 at 12:41 pmMr Secretary, Thank you for talking to us. I would like to make some suggestions. 1. Go directly to the people. State and local officials will resist anything which requires them to spend money. They will avoid any message in an effort to maintain their deny-ability. They are gambling with our lives that this will not happen.
Posted May 24th, 2007 at 2:37 pm2. Place PSA’s on television and in newspapers. Educate and give situation updates. Encourage citizens to contact their local officials and ask to read their local pandemic plan.
3. Publicly ask the Red Cross and Salvation Army to enlist churches and clubs to pack rice/bean/oil food boxes. Provide stickers to place on the boxes with the following messages, Contents Packaged PrePandemic and PostPandemic Decontaminate Box Exterior.
4. Instruct State Health Departments to place PSA’s and situation updates in local newspapers.
5. Encourage parents of newborns and infants to breastfeed or stockpile baby formula.
6. When it becomes obvious after all this that people are still not listening, purchase and distribute body bags.
to be continued…
You can see how fast things are begining to spread. This came out today from the UK.
“On Wednesday, May 23, 2007, a reported and confirmed outbreak of Avian Flu of the H7N2 strain was made. This is a low pathogenic variation of the disease which can cause flu like symptoms. The disease can be transmitted from poultry to human through direct contact but it cannot be transmitted from human to human.
This is low pathogenic, could you imagine if it were not???
***ALSO***
Dr Simmons said there is no ongoing risk to the public, and added: “We do not anticipate this virus transmogrifying into the H5 strain, but it’s not impossible
What if this were in the US today or the next day? What if it were H5N1? Would we be prepared? I think not.
Please help us get the word out Mr.Leavitt, people need to know now.
Thank you!
Posted May 24th, 2007 at 3:35 pmThank you for the opportunity to have input into what I hope will be the creation of awareness and preparedness for Pandemic Influenza throughout the country.
“We are counting on those who come here not only to present problems, but to offer solutions – as many have done.”
Potential solutions:
- Tie a public awareness campaign to an opportunity for retail stores to increase sales by having “Preparedness sections” of a store to sell items such as 20 lb bags of rice in a Super Walmart or coleman stoves, basic first aid supplies, asprin in a regular Target store. (having worked for Target stores for almost 20 years I know they would love to have an opportunity to sell some more stuff)
I have a feeling that if you provided a store such as Walmart with some tear off sheets stating basic needs for a family in the event of a pandemic and basic signing they would do the rest for you with very little need for more monetary input from the government.
40 feet of retail shelving is a very powerful tool in promoting any new product (idea). How many people would feel they needed a gazebo if they had not seen it in a ad and displayed in the lawn and garden area of your local store?
Why not use the resources already available to the US? By thinking outside of the box and creating partners with the backbone of our country, the businesses, we can create an awareness campaign like no other.
- We have a “No Child Left Behind” inititive in this country. This forced all schools to report their students scores on tests. the Schools then need to make plans to bring those children up to speed or lose potential funding. Schools are getting parents involved to help the kids reach the standards.
Have a “No Family Left Behind” prepping intitaive with each city, town, township responsible for promoting preparedness and reporting for it’s citizens. Then they need to make plans for each of it’s families/Citizens to reach the preparedness standards. The neighbors who can afford to do more can assist those who can’t. (This will happen because we as Americans will ultimately do the right thing)
I will call for my fellow Flublogians to, instead of attacking or questioning the priorities of the people who are trying to help us, think of what can be done on your street, in your township, in your community and write it here.
let’s make this happen!
Posted May 24th, 2007 at 3:53 pmGod bless America.
Quote from seazar, concerned citizen in SW Florida:
I learned something a couple of weeks ago that you probably already know, but in case others are unaware, I’ll post it here.
I live in Southwest Florida, and I have a couple of close friends with dual citizenship (U.S. and France). The French government has already notified their citizens that live in our country that should H5N1 become the next pandemic, there is a supply of Tamiflu already in this country for them. They have been advised to report to Consulate general of France in Miami for their supply of Tamiflu.
Shouldn’t we be just as proactive for the citizens of our country?
My comment: Well now, isn’t that interesting? At the same time, the current stated policy of the U.S. government is that for U.S. citizens caught abroad when pandemic flu happens, the deal will be this (unless you are a State employee or employee with another agency or business on assignment with State):
“Sorry, nothing for you here. Move along. Good luck! And no, we will not be chartering a plane for you to get back home. Bye now!”
Furthermore, with France, here we have a French consulate office dispensing Tamiflu. Not an M.D. or pharmacist (although such professionals may be consulting with the embassies and consulates?). But here, your doctor isn’t allowed, or is strongly advised against, writing an Rx for you and your family to have any Tamiflu on hand.
Wow!
Remind me again why I’m not supposed to be cynical?
Posted May 24th, 2007 at 4:05 pmNanoFlower,
I like your post. Business understood and responded to Y2K even if people did not. This could be far, far worse. There are not enough body bags.
In 1850 I lost family to the local yellow fever epidemic as well as 1918. 1850 was worse because bridges between towns where burned, there where detailed stories of how horribly people suffocated in their own fluids and the mass grave dug out side the city now sits in a residential area surrounded by apartments.
My solution is to walk people through a pandemic so they can see what will need to be done and that it will fall on them to do it. There will not be enough morticians. Autopsies will be put on hold or skipped altogether. Single people will be asked to work because “others have families to take care of.” People will be buried in mass graves.
If you really want to scare people - only one U.S. state makes coffee - Hawaii.
Please continue your post NanoFlower
Posted May 24th, 2007 at 4:48 pmRegards, Kobie
This is what I want to see on tv/radio and splashed across page one of newspapers and magazines, MTV etc., and local access cable tv channels:
“We now interrupt your regularly scheduled programming to inform you that the Sec.of HHS has issued a
“Pandemic Preparations Alert”. The Secretary will now address the nation.”
The President should do this, but someone has to!
Posted May 24th, 2007 at 5:58 pmWe need grocery stores with PROMINANT displays featuring PanFlu Pantry items that are on sale that week. Keep the sales & the displays fresh … something different each week, so that they keep looking for more. The grocery stores in our Penna. area are starting to change their stocked goods to include largers 20lb bags of flour, rice, sugar, etc. but noone has noticed it. When I tell neighbors & friends to pay attention the next time they are in the store … then they notice. But are they buying those goods? Are they stocking their shelves? NO. Why? Because they are NOT getting any other information to back up why those larger packaged goods are in the stores, except what I’m telling them. We’re still NOT hearing it on the LOCAL level. So my neighbors are NOT going to buy those larger package on the LOWER level of the grocery shelves! Grocers can do so much to help spread the word!
Posted May 24th, 2007 at 8:01 pmSecretary Leavitt, here is a communication suggestion in advance of a high-pathogenic H5N1 avian influenza outbreak in North America: Officials should take responsibility for the temporary public “over-reaction” which will probably occur.
Officials all around the world continue to conflate “pandemic flu” and “bird flu.”
A few hours ago, the U.S. Treasury Department issued a press release stating, “The Treasury Department announced today that it will sponsor an industry-wide exercise this fall for the financial services sector to test its ability to respond [to] a pandemic crisis, such as a bird flu outbreak.”
In that press release, the terms “pandemic” and “bird flu outbreak” are used interchangeably, although they are completely different problems. Unfortunately, this is typical of thousands of official statements around the world, during the past three years.
I did this early on, too, in articles with titles like: “Bird Flu: Communicating the Risk.”
Even you, Secretary Leavitt! In February 2006 you were quoted as saying, “Avian Flu, when it occurs, will severely test the best-laid plans … and many companies are not making any plans at all.”
The half-listening public understandably feels that when bird flu breaks out nearby, the risk of a pandemic has gone up; a pandemic feels closer. Then people become excessively afraid of eating chicken for awhile, and then government and poultry industry officials and media commentators accuse them of hysteria, irrationality, and panic.
That is definitely not a good way to build trust and rapport with the public — and not a good use of a precious teachable moment, when everyone is temporarily extremely interested in flu.
I don’t think we can stop officials from conflating “bird flu” and “pandemic flu” this way, although it would be nice if Cabinet-level departments would get it right.
But at the very least, officials can decide — before a poultry or wild bird outbreak happens here — not to ridicule the public’s reaction, and to acknowledge that they helped cause the confusion in the first place.
Posted May 24th, 2007 at 9:28 pmMr. Secretary,
Thank you for blogging and for the opportunity to comment. I am a member of the online pandemic flu forum community. My ‘home’ forum is at pfiforum.com. I also am a parent of a child whose age is in the highest H5N1 fatality rate cohort: 76% for 10- to 19-year-olds (CIDRAP News, 2/14/07).
The quality of content and the visibility of the government’s preparedness messages will play a role in whether the U.S. can prepare adequately for a possibly severe pandemic. Furthermore, if the public finds that the government messages now are not completely forthright, then the government will have difficulty getting the public to trust its messages during a pandemic.
The government is relying heavily on the official website at pandemicflu.gov to provide information to the public. While there is much at the website to commend it, incongruent information may hurt the government’s credibility, and by extension, those of us trying to get our local communities to prepare.
The following official advice on pandemicflu.gov for American companies with operations abroad is much more realistic and thus more trustworthy than the advice for us at home. It is apparently based on the nationwide length of one of the multiple waves in the 1918 pandemic:
“Remind employees that normal supply lines may be slowed or inoperable for an extended period of time and to make personal preparations for pandemic for up to 12 weeks (e.g., stockpiling food, water, and prescription drugs).”
In contrast, on the same website, from the checklist for U.S. resident individuals:
“Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.”
“Periodically check your regular prescription drugs to ensure a continuous supply in your home.”
The implication of the two-week stockpile message is that the U.S. is somehow special, and all we need to worry about is two weeks during a pandemic. In fact, if a person goes straight to the Individual Section of the website, they can be left with the erroneous impression that a pandemic will only last for two weeks. This is what a person thought after he asked me what the government has to say about a pandemic, and I referred him to the website. He read that section first. This inadequate two-week stockpile message goes straight to the heart of the issue of trusting the government and is a recurring theme on the flu forums. I then gave the person the pandemic articles from the July/August 2005 and March/April 2007 issues of Foreign Affairs. That got him to take preparation seriously.
The advice to American companies doing business in Ireland is to stockpile for up to twelve weeks. It stands to reason that the advice to U.S. residents should be to consider stockpiling for longer. After all, we have a more complicated, interdependent food supply chain for a vastly larger population, urban areas, and land mass. Most of our medicine is manufactured overseas. Our disruptions may extend beyond the length of a nationwide pandemic wave in 1918.
It would be helpful if stockpile messages abroad and at home were coupled with information about what a severe pandemic may be like. For example, tell people that a pandemic could have multiple waves, each lasting months, or even one long one. It would be helpful for people to know that a severe pandemic could last 18 months or two years. We know that 1918 lasted for at least 18 months. It would be helpful for people to know they have to plan for a worst case scenario when they stockpile, and the next pandemic may be worse than 1918. I have found the courage to say this, but it would be helpful if my government would find the courage, too, when a stockpile message is given out. A child cannot eat hope. If we are covered for a severe pandemic, then we are automatically covered for a moderate or mild one.
We can suspect that despite what the government and we as individuals say, not everyone will stockpile. Using the government scenario, if only 60 percent of farm workers and truckers show up to work in the food supply chain, perhaps during harvest time, this will mean a decline in available food. However, if only 60 percent of the population needs food, then there likely will be a better match between supply and demand.
Please help me to help prepare people in my community by making the government website a more accurate source of information. There are other areas that are not forthright besides the two-week stockpile message. If I can confidently refer people to the government website, knowing it gives rational, accurate information, then I can be more effective on the local level.
Posted May 24th, 2007 at 11:55 pmDr.Lanard makes a very good point.
The media and government all use the terms interchangeably.
This causes public confusion.
Low Path Avian flu
High Path Avian flu
Bird Flu
Pandemic Flu
Pandemic Influenza
To simplify the message, it can be broken down into three categories.
Low Path Avian flu- affects birds only, low mortality rate. HOWEVER if left unchecked LPAI can evolve into HPAI.
High Path Avian Flu- primarily affects birds AND some mammals, high mortality rate. DIfficult to transmit human to human.
Pandemic Influenza (PanFlu)- HPAI, Sustained and easy human to human transmission with a high mortality rate.
Media need talking points and basic fact sheets in order to get it right.
However let us not lose sight that HPAI H5N1 “Bird Flu” is the current top pandemic candidate.
Posted May 25th, 2007 at 1:09 amre to Jody Lanard:
Posted May 25th, 2007 at 1:40 ambird flu is shorter than pandemic flu.
Flubies had been using “panflu”.
Also, pandemic flu isn’t exactly what those meant
either, they meant : H5N1 epidemic(pandemic)
in humans. Let’s create a new word for that !
That might also increase awareness - “hey,
evryone talks about xxx , what’s that ? A new disease ? ”
And people will start looking it up ….
If the situation is worth creating a new word (is it ?), then people
might take it more serious.
Mr Secretary,
Thank you for devoting a whole week of discussions on ‘why’. The subject is complex and there are too many ramifications that need exploration, such as this one, a set of circumstances that, if they were to come together, will decimate a whole generation of young people.
I appreciate the Dept of HHS for creating this platform so that we can share this information with as many people as possible. We need every channel of communication we can find, both domestically and internationally.
Posted May 25th, 2007 at 2:35 amMr. Secretary,
For planning purposes a pandemic occurring this fall with a 50% CFR and 40% infection rate as a worst case senario would be a much more realistic benchmark than the current information that has been provided to the American people to motivate them to prepare.
Posted May 25th, 2007 at 6:08 amIf the Federal Government really wants people to prepare, it needs to put the message in TV commercials and news coverage, outlining how to prepare and how much to prepare. Two weeks worth of supplies is a joke. The urgency of why people need to prepare needs to be at the forefront. I understand panic needs to be prevented, but keeping this information on the Internet is a cop out. It needs to be pushed to people in the main stream media to reach the masses. It has been well over a year since the decision was made to release info slowly. I think it has been too slow. The pace needs to be picked up. There needs to be an aggressive media campaign.
Posted May 25th, 2007 at 7:25 amIt is absolutely essential that everyone prepare their minds, their hearts, and their homes for pandemic influenza.
Most people are not aware of what happened in 1918. Pandemic influenza burned, as fast as a wildfire, throughout the world. It was unstoppable. Pandemic influenza is still unstoppable to this very day. Pandemic flu can happen any month of the year. It struck America in August 1918. Hundreds of thousands of people died in a very short time.
Records of the time are not complete, but they show at least 50 MILLION people died worldwide in the 1918 Pandemic.
Although travel was difficult—by train, horse and carriage, ship, or Model T Ford—the pandemic influenza swept completely over the United states in one month.
Go to any graveyard in your town and you will see many, many graves of people who died in 1918. Entire families died within one week. People felt well in the morning and were dead by nightfall. The pandemic of 1918 killed 2 people out of every 100 living on the Earth within one year.
A NEW influenza virus, H5N1, has now infected and killed almost 300 people in the same way as 1918. When H5N1, (or another deadly pandemic virus), learns to pass easily and quickly among people like a normal cold or flu, a Pandemic will occur.
We are on borrowed time. It is a miracle H5N1 has not learned to spread and kill easily yet. We have had the gift of time to prepare. We have had a clear warning. No other people in the history of the world have ever had the gift of a warning. Pandemics have happened every 27 years, on average, since history has been recorded. We have been expecting a Pandemic for many years now. We are overdue to be hit with a Pandemic. The last pandemic was very mild in 1968. But, influenza viruses in general have become much, much worse since 1968. We are now at 39 years since the last Pandemic, the longest time known in history between Pandemics!
A Pandemic is due any day. There is no warning when it suddenly and quickly starts spreading, sickening, and killing. Once it starts it can sweep the world within a WEEK because of the ease of travel. A pandemic cannot be stopped.
A Pandemic is too big a problem for any government to manage. It will be very SUDDEN and QUICK. There will be no time to plan or think.
We must use our own minds now to plan to stay home for 3 months. 3 months is usually the time it takes for a Pandemic virus to go away.
Be SMART.
S: Store extra food and water so you can
stay home for 3 months.
M: Make a Plan for yourself and people who depend on you
A: Ask your local government if they
have prepared
R: Read about 1918, H5N1 influenza, and how to prepare your home.
T: Tell everyone to prepare!
Have a HEART—-Do your PART!
Sadly, this kind of Pandemic influenza most often kills the young.
Young children and adults will be the most at risk. We must do our part to plan for these young people who will not plan for themselves. We must also plan for the elderly, disabled, and anyone without means to prepare.
Planning for yourself may seem selfish, but it allows you to focus and help others once you are done with your own preparations.
Something you choose to store for a Pandemic may save someone’s life.
With Memorial Day coming up on Monday,
I close with the last few lines of Abraham Lincoln’s Gettysburg Address.
President Lincoln delivered this address to a grieving crowd of 15,000 people on November 19, 1863.
It makes me cry and feel ashamed of America.
“It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced.
It is rather for us to be here dedicated to the great task remaining before us — that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion — that we here highly resolve that these dead shall not have died in vain — that this nation, under God, shall have a new birth of freedom — and that government of the people, by the people, for the people, shall not perish from the earth.”
Posted May 25th, 2007 at 7:28 amPeter - great post!
On the Panflu boards there is a group of tireless individuals who need thanks. They are the ones who comb through all of the local language news reports from Indonesia, Egypt and other H5N1 hot spots and then translate them into English. It is from here that we get most of our international news. Not only do they do this night and day, but they also compare their notes and help us all understand the overall pre-pandemic picture better. Anyone interested in keeping up to date on the unfolding situation should read their work. It is accessible at several of the Pandemic Flu websites listed in these blog entries.
We ran a quick poll at www.pfiforum.com about who was actually on the board. Turns out that he large majority of bloggers are women with children. I think this is key for who the target audience for the Pandemic Prep message is. Reach the Mom’s and you reach America’s pantries.
Posted May 25th, 2007 at 8:57 amMr. Leavitt
A week goes by so fast. You asked “Why Prepare”. I hope these help.
We have a spreading virus that kills 60% of those infected even with good medical intervention.
H5N1 can come here, other virus from Yello Fever to 1918 flu have.
We have no defense, nor does it look like we will. We only have some secondary drugs that help.
Because wild and domestic birds interact, containment is not permanant nor do we know how long it will last.
Current bird culling is not sustainable nor a solution. Killing tens of thousand of birds takes their meat and their eggs off a tight food market with few options.
Becuase we can prepare. We can can greatly reduce or magnify the pain, suffering, death and social cahos such pandemics bring.
It is moraly right and economicly sound that we help. Just like global warming or some astroid that might wipe out the planet - it is easier to deal with this.
Few untested things work well the first time. The preparation involves practice.
Citizens are asking for what to do. We could learn alot from them.
Following the Pearl Harbor raid, 9-11 and Katrina people asked “Why where’t we prepared. Didn’t any one think this could happen?” People are talking and offering their help.
Even if a pandemic does not happen or we do avert it, having these plans in place prepares us for other unforseen emergencies.
History is littered with monuments to those who made plans for A only to have them be the bases for the success of “B”. NASA calls it “Spin off technology”
Doing nothing is neither productive nor cost effective. Turning a deaf ear to ones citizens is bad.
We do not what this to be the most well documented failure to date.
We have a clear and present danger - unprepared citizens in a world with seasonal disasters. I would say fix it, but instead please listen to those who want to help not because it is their job, becuase it is their wish, it is their calling.
Please let us know what you think.
Regards,
Posted May 25th, 2007 at 9:10 amKobie
On “PANIC”
If there is ONE THING that I wish the Beltway dwellers and the communications consultants could take away from this blog exercise is the following:
Banish the word PANIC from the lexicon of Washington DC as it relates to Panedmic Influenza.
Study after study of the empirical evidence suggests, such as in:
www.kfs.uni-kiel.de/…
“In contrast, researchers have found—at least in the immediate aftermath of
disasters—that community resilience and unity, strengthening of social ties, self-help, heightened initiative, altruism, and prosocial behavior more often prevail.”
It is my opinion that the beltway is so concerned with the expectation of public “panic” that the messaging to date has been so restrained as to be completely ineffective.
Let’s dispense with the panic, and move on to rationally illustrating the threat, and a reasonable call to action.
Posted May 25th, 2007 at 12:57 pmDear Mr. Secretary,
You have said repeatedly that “the cavalry isn’t coming” and that the federal government will not be able to save each and every individual one of us.
I totally agree, but I’m a little curious as to what the government WILL be doing during a pandemic?
Have ALL the departments told ALL their employees that they need to prep for an event that could last 18-24 months?
Have they each made comprehensive, detailed, and PRACTICED Pandemic Plans with A, B, C, and D backups that account for a worst case scenario based on what H5N1 is actually doing NOW, i.e., a CFR of 70-80 percent, with the survivors having received advanced life support and ICU-level care?
Do they really believe that every little clerk in every important functional area will show up to work? When I was a civilian with the Federal Govt, very very few functions were identified as critical. Those that weren’t included human resources and payroll. If the payroll specs arent at work, no one gets paid, so why would anyone come to work? If the contracts and budget specs dont come to work, contractors dont get paid. And we were so understaffed due to repeated budget cuts, there was literally zero depth to our functional areas. One person was assigned a whole raft of duties that no one else (including the supervisor in many cases!) knew how to do. Even a conservative 40% employee shortfall would mean a shutdown of some agencies and organizations. And if the attack rate is 50 percent, then you can probably figure that 70-80 percent won’t show up. You may as well turn off your lights, go home, and help save the environment.
And telecommuting: the recent mess with stolen laptops at VA and other agencies resulted in Departmental level orders in many agencies to terminate telecommuting. Of course, all that will be moot if there is no electricity and no internet…
Have you done a survey of the HCW and support staff in your VA hospitals recently? Anybody planning to show up?
In the DC area, the vast majority of govt workers commute from MD, VA or WV. DC is notoriously behind the times in terms of efficient, cost-effective public transportation. If there is no gasoline and people are afraid to use transportation systems that cram them into rail cars like sardines, how are they getting to work? My husband currently commutes 3 hours EACH WAY to Arlington. Do you honestly think he’s going to hike that far if he can’t get gasoline? And while you’re at it, what about the discussion of states and possibly even counties closing their borders? How is anyone going to get INTO the District to go to work?
If you have figured out how people are going to get paid, what about all those folks who signed up (mostly mandatorily, BTW) for direct deposit. My guess is that it won’t take long for a lot of local banks to close up. Ours only has a few tellers and I fully expect them and their even fewer mgmt personnel to take your advice to shelter in place. My pension check may or may not get into my account, I may or may not have access to it thru online banking, and I may or may not have some way to pay my mortgage. Since ALL my income arrives via direct deposit, I won’t have money for food, medicines, or any other supplies.
Oh, yeah. I was supposed to buy all that in advance, but only enough for two weeks.
And what about the military? Most of our National Guardsmen are in Iraq. Are you suddenly going to call them all home to help with the pandemic (bearing in mind that they are now in the Middle East which is a bubbling pandemic zone).
And what about their dependents - Thousands of husbands, wives and children who are going to be essentially abandoned while their Guardsmen are sent to do what, exactly?
With what equipment? With what PPE? And how much prophylactic Tamiflu?
And the regular military? Guarding our borders from being overrun by Mexicans and S. Americans fleeing their own plague zones? Or guarding the currently non-existant vaccine shipments? Or the food shipments that the feds have already said they aren’t going to provide? Or the empty stores and over-run hospitals? Nope. That’s a local issue. So what exactly does DOD have in mind?
And what about local-level security? I asked my County Administrator what his plan was to handle any rioting, looting or even gang-related unrest during a pandemic. His response? “We have 22 Sheriff’s deputies (for the entire county!!), the governor can call out the National Guard, and we have the state police station outside of town.”
Woop-dee-do. Are we looking at federally mandated martial law, and if so, what are the constraints on that re the non-violent, law-abiding, “just tryin’ to get thru this mess” citizenry?
I have some real concerns regarding the Electrical grid, water supplies, and fuel/transportation. This are national level issues that affect US security.
What is DOD planning to do to ensure that these vital systems remain operational?
I attended a Pandemic Flu Summit about a year ago. I addressed my concerns re electrical power and fuel availability to representatives of our local suppliers. “We’ve got it under control,” (insert pat-on-the-head) was the answer, but “in the interests of national security,” they weren’t at liberty to discuss specifics. They were working with The Pentagon.
Unh-huh.
Ok, Mr. Secretary - in your opinion, does DOD have this fully under control so that I can concentrate on stockpiling food and meds and not have to really worry about heat/AC, my wellpump operating so I can water my livestock, and having enough fuel for my tractors for the next year’s planting?
And what about Congress? I believe all our Senators and Representatives have homes in the DC area. Are they planning on staying around the Capitol or will they all head back to their home districts? Frankly, I have trouble envisioning them working cheek-by-jowl in their offices and meeting rooms to keep the government going. Or maybe they DO plan to set a good example for the rest of us by coming to work every day and supporting the economy. (Oh wait, they don’t come to work every day now.)
Have they discussed the Pandemic planning and issues with their staffers and college-age interns? Do they intend to send them all home so that they won’t be exposed? After all, our young people are hugely at risk from H5N1.
And what’s going on with the Embassies and the TOURISTS in DC and other high traffic destinations? I understand that there are now signs at airports and other border crossings advising people about avian influenza. If a pandemic breaks out and people are stuck where they stand, does the federal govt have any idea what they’re going to do with them all. Quite a number are going to be foreign nationals.
Or illegal aliens.
Is Congress working on any plan(s) on how to handle medical care, including the magic vaccine, when illegals are involved? Will non-citizens be given equal access or even be placed ahead of citizens in, shall we say, “lower priority groups?”
Has Congress taken up any sort of financial relief planning, such as putting mortgage payments on hiatus until after the pandemic is over so that people won’t lose their homes?
Or how about some legislation re access to Rx drugs in advance so that the prepping public can actually stockpile things that their lives depend on? I find it totally ridiculous that Roche is cutting production because Americans are not permitted to buy Tamiflu for themselves because our Drs won’t write us prescriptions for stockpiling.
Make it an over-the-counter drug or something accessible NOW, and keep that production line rolling. Same goes for antibiotics, heart medications, asthma meds, insulin, etc., that thousands of people take on a regular basis, have taken for years, and are familiar with managing. Why shouldnt we have a year’s worth of meds on hand instead of the maximum 30-60-90 days? Get the HMOs and life insurance companies onboard and save them a lot of money for emergency treatments - and death payments.
Home health care - I noticed a few days ago that the Red Cross says that they have no supplies of food, water, etc. of their own. Whatever FEMA has, they will distribute. Is FEMA pre-positioning anything in areas with highly vulnerable populations (elderly, homeless, drug addicted, etc.)?
I suggested that my county open up its unused civil defense shelter and start stocking supplies, esp. for the hospitals and first responders. Or enter into a contract with the owners of a long-vacant grocery store in the center of town.
The reply from my County Administrator: the air raid shelter hadn’t been used in a long time. (Yeah, so what’s your point?) And the owner of the grocery store wanted a long-term contract. (And emergency preparedness isn’t a long term project?)
I must be missing something because these sorts of answers strike me as being incredibly off the mark.
Can’t FEMA get involved somehow and designate storage facilities in cities and even outlying areas? Don’t we have Homeland Security coordinators to work with local officials on things like this?
I know you’ve talked to State officials until you’re blue in the face, and I fully appreciate the difficulty of what you are trying to do. But the Federal government is a bully pulpit. With thousands of our tax dollars going into the Treasury, US citizens deserve true leadership in areas where the Feds have expert training and experience.
I believe that Executive Orders exist for just this sort of situation. Please tell the White House that it’s time to get cracking.
If President Bush needs another speech for national airtime, I know a lot of folks qualified to write a blockbuster for him.
Yours truly,
Posted May 25th, 2007 at 5:12 pmGalen McBride
Culpeper, VA
This morning I read through the 91 comments on the Secretary’s message
up to that point. Fascinating stuff.
I wanted to provide two clarifications.
1. Infection or Illness?
Some commentaries about influenza pandemics use “infection” and “illness” interchangeably. Medical and public health authorities dealing with the pandemics of 1918, 1958, and 1968 had little in the way of diagnostic methods with which to establish the presence of “infection” other than by clinical observation of “illness” with influenza-like symptoms. Absent (a) the ready availability of influenza diagnostics with high sensitivity and high specificity and (b) reason to use them routinely on people who are not exhibiting influenza-like symptoms, “infected” but asymptomatic people generally go unnoticed and therefore are not counted as exhibiting “illness”. This is why “illness rate” is better than “infection rate” when characterizing the severity of pandemics.
2. Data on Influenza Pandemics
Different commentators employ different concepts and cite different numbers when discussing the severity of influenza pandemics. Illness Rate and Case Fatality Ratio generally are the most informative metrics.
For the three pandemics of the 20th century, the pertinent data, expressed as approximations for simplicity, are as follows:
In 1918, the Illness Rate (IR) was 29 percent, while the Case Fatality Ratio (CFR) was 2.1 percent.
In 1957, the IR was 25 percent, while the CFR was 0.3 percent.
In 1968, the IR was 39 percent, while the CFR was 0.2 percent.
Reference: Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States, February 2007, page 33, Table 3a. www.pandemicflu.gov/…
Posted May 25th, 2007 at 5:36 pmI want to raise an important issue that I have not seen directly addressed.
It is widely acknowledged that supply chain interruptions will occur during a pandemic. People are advised to store food and water for themselves and their dependents. However, it is also widely acknowledged that people are not preparing and stockpiling, or potentially are not stockpiling enough to ensure an adequate food supply during the shortages that will occur during a pandemic period.
The American Veterinary Medical Association estimated recently that there are over 60 million dogs owned in this country, and up to 70 million cats, fewer numbers of other companion animals are owned. Livestock outnumber people in many areas of the country, and certain groups such as dairy cattle, confined hogs and chickens are dependent upon regular deliveries of feed year round. Any message that we craft for pandemic preparedness should include clear, strongly-worded information to pet and livestock owners about stockpiling feed for animals.
Although the loss of livestock will be tragic and will exacerbate supply chain and animal food shortages, my primary concern as a public health veterinarian is that people will turn their companion animals loose in the face of not being able to care for them. While some small animals such as roaming cats will primarily pose a threat to wildlife and to people as vectors of disease such as rabies or plague, roaming dogs pose a much larger and more widespread threat to society. Loose, hungry dogs will form packs and will hunt. The risk of injury and/or death to people and to other animals may be great.
I raise this issue so that we as a society can prepare for this potential event.
1) Have clear education and guidance to pet and livestock owners to prepare food stocks for their dependent animals. Communities, agricultural coops, local state and federal agencies and organizations such as the USDA, AVMA, Humane Societies, etc. are all potential participants in this planning.
2) Have contingency plans to control loose and feral companion animals. We may not be able to depend upon animal shelters during this type of crisis due to the sheer numbers of animals and the allocation of local resources to other areas during a pandemic. I suggest involving law enforcement officials, rural landowners, hunters, and livestock owners in this planning.
Thank you for this opportunity to share my concern.
Posted May 25th, 2007 at 5:50 pmMr. Secretary,
Thank you for the opportunity to address to you, my thoughts and concerns. I have been following pandemic flu for over a year now. I want to make it clear to you, that your message is NOT getting out, even to the Federal Sector. I am an Air Traffic Control Specialist, for the Federal Aviation Administration, D.O.T, with over 22 years of tower and RADAR experience.
We have no plan. Period.
There is a plan to make a plan, or so I’ve been told, but if pandemic flu hits anytime soon, I firmly believe the nations Air Traffic System will collapse. We are already suffering from a staffing shortage, and with estimates of up to 40% absenteeism, we just won’t be able to keep up with the traffic. I understand that in a full-blown 1918-style pandemic(and for the record, I see the potential for a much more severe pandemic), there probably won’t be much flying, but there will be the need to relief flights, lifeguard flights/air ambulances, and National Security flights. Most facilities have anywhere from 5 or 6 to ten times that working at any one time…in close proximity to each other…sharing common equipment. There will be no way to use the “3-foot” rule. The FAA has no PPE for us to use; no gloves for us, no masks (how does one wear a headset with mask?) I am lucky in that my Air Traffic Manager shares my concerns, and if the time comes, we might be able to work out something locally, but it could involve breaking Federal Rules or Federal Laws. Payroll rules for example, or time-on-position rules. We have no flexibility to tailor a local plan, and no flexiblity to deviate from rules and Laws in an emergency. We need this flexibility. What might work for Chicago O’Hare won’t work for Grand Forks Tower. But, most importantly, we need something! Anything would be a start.
I sincerely hope that you read and listen to this, and once again, try to get the word out.
Thank You for listening.
Signed,
A Very Concerned Controller
p.s. In the comment above from William F. Raub, Ph.D., he states CARs and CFRs from 1918, 1958, and 1968. The current CFR appears to be well above 60%. Moreover, as far as I can tell (and I am NOT a scientist), there is no scientific reason for the CFR to reduce significantly. Are there plans in the works for a 10% CFR? 25% CFR? 50% CFR?
Posted May 25th, 2007 at 6:14 pmWilliam F. Raub, Ph.D., Science
You bring up an good point we have battered around - how to make this the best, most accurately documented pandemic to date. To save the next generation from having to start from scratch, how do we save the lessons learned while preserving HIPPA privacy.
This means having consistent terms, both in the US and outside, saving samples and tracking patient’s progress.
I am on board with a lot of things short of issuing me and everyone else a bar coded bracelet, RF ID tag or micro chip implant. It is more than Biblical, it relies on technology that may fail. Having a manual system as a backup is more than just the ghost of Hyman Rickover. It helps.
If there is going to be a disaster - can the people involved meet first? There is nothing worse than showing up at an emergency and seeing people exchange business cards asking “So what do you do?”
Team building helps. Both in my city and with volunteer groups, we have a rapport. I can call on or be called on by others that I only see at funerals, disasters and camping events. Simply because we have worked together there is trust, plans come together quickly with few questions of “does he/she know what they are talking about?”
I look forward to next week’s blog.
Regards,
Posted May 25th, 2007 at 6:35 pmKobie.
BUDGET BILL?
Mr. Secretary:
I have read that the Pandemic Preparedness funding was cut from $650 Million in the emergency funding bill vetoed by the President to $174.2 Million in what is now expected to be signed (of which $161 Million is for foreign pandemic preparations - State Department funding.)
What in the world are they thinking? What role did the administration have in this aspect of the compromise?
As much as I appreciate this blog as an attempt at improving the lines of communications, if this is seen as window dressing to divert attention from a flagging federal committment to pandemic preparedenss, well, good luck with that.
appropriations.house… (pp 12 and 17)
Posted May 25th, 2007 at 7:25 pmDear Dr Raub,
Thank you for your clarification. I would however like to point out to that overall or averaged-out IR and/or CFR figures can hide the vulnerability of specific age groups. In the 1957 pandemic, even though the overall IR was 25%, the IR was 52% for children aged 10-14, and 54% for age 15-19.
Similarly, the current average CFR for H5N1 infections is 60%, but it varies from 40% for those aged 50 or over, to 76% for those aged 10-19.
A convergence of high IR and high CFR, even if significantly attenuated, would cause a very catastrophic number of deaths in the vulnerable age group.
A discussion on this topic and the implications for countries with different demographic challenges are ongoing at Flu Wiki here. I hope you can find the time to visit the link and give us your opinion and advice.
Thank you!
Reference: Glezen WP, Emerging infections: pandemic influenza. Epidemiol Rev. 1996;18(1):64-76.
Posted May 25th, 2007 at 7:59 pmWhile seconding the comments of all who have said the message is not reaching the local level, I do not wish to be repetitive…but some bears repeating. The failure at the local level, from my observations, is a combination of the monumental nature of the problem and leadership ego. A crash course in ICS and NIMS would be extremely helpful to all in positions of leadership (including first responders and all critical response personnel). Health care leaders, for some reason, do not think they need to have a basic understanding of the “assets” of their community. Without a resource inventory — of people and supplies/equipment — as a baseline, that is shared across ALL disciplines in emergency response, communities cannot effectively execute plans. The second point is that there is NO plan if people (the citizens) are not informed of the basic elements of the plan. Above and beyond all else, however, is the need to take a “tough love” approach to preparedness. By linking social service agencies and charitable organizations (food banks, etc.) to those with financial needs (vis a vis stocking supplies) and facilitating preparedness (again, at the local level), we can give the vast majority of people the ABILITY to prepare. If they choose not to do so, and there are no mental disabilities behind their choice, the consequences of their choice are theirs and theirs alone. It’s simply past time to play hard-ball.
And to appeal to the citizenry (in multiple languages), one should remind them that they have children or grandchildren who are probably in the high mortality group. Failing to prepare is equivalent to intentionally sacrificing our children.
Posted May 25th, 2007 at 9:59 pmMr. Secretary,
I’m concerned about the level of preparedness in our schools. According to San Diego State University, “Twenty percent of the U.S. population attends or works in schools.”
www.sdsuniverse.info…
In their video broadcast (available at the above link), the California Department of Health Services together with the Department of Education, target every state educational institution- from preschools to universities- in order to increase awareness and promote pandemic planning. While this broadcast is very well done and contains valuable information to educators, it provides only guidelines and recommendations. What concerns me is that our children’s safety is ultimately left up to the effectiveness of our individual county, district or the institution itself, and while some are very pro-active, others seemingly have only accomplished a bare minimum.
The CDC’s “Community Strategy for Pandemic Influenza Mitigation” as it pertains to schools, again, is full of recommendations, with closures based upon the “Pandemic Severity Index”. However, final decisions are expected to be made regionally and they are admittedly subjective.
I feel that something this important should be addressed in simple, straightforward terms that cannot be misinterpreted by county officials, administrators or by parents. The message should be consistent from state to state, county to county. Parents need to know precisely what to expect. The “trigger” criteria used to close my neighborhood school in California should be the same for my niece’s school in Texas. Understandably, due to the unpredictable spread of infection, both schools would not likely close at the same time, but they would share the same carefully determined criteria for closure. Otherwise, I fear that many communities, whether from lack of funds and/or lack of planning, will be facing an unnecessary crisis when schools fail to close in a timely manner.
At the college level, canceling classes and closing dorms early on in a pandemic will be critical for college students needing to travel any distance to get home. For me, any preparation I do will mean nothing if my children are unnecessarily exposed to a deadly virus or trapped in a city hundreds of miles away from home.
Thank you for this opportunity to be heard.
Posted May 26th, 2007 at 1:03 amAs a blogger and a lover of democracy I am very pleased to see this initiative. Congratulations on opening the door to comments directly from the people. I’ve posted about it here: govblogging.com/2007…
Posted May 26th, 2007 at 2:14 amThe supplemental funding appropriations link provided above says this on page 17:
Avian Influenza – The supplemental legislation provides $161 million, the amount requested.
appropriations.house…
Please explain why Pandemic Planning is not viewed as a priority worthy of major funding.
Posted May 26th, 2007 at 6:51 amDear Mr. Secretary,
As our newly appointed Surgeon General, Dr. James W. Holsinger, Jr., is probably wondering what he should do first. May I suggest stumping for pandemic preparedness?
Lots of Letters to the Editor of our major newspapers, speechifying before Congress, beaucoup press conferences with lots of cool quotes and plenty of photo ops?
Maybe even a little “oout and aboout” to address professional organizations, both medical and non? Visiting hospitals, schools, you name it. Anywhere that someone will report about it.
The last SG whose name I can recall is Dr. Koop, because he actually championed something valuable to the ordinary citizen.
He had plenty to say and wasn’t afraid to say it. And look - smoking (one of his “pet projects”) isn’t nearly as commonplace nor as accepted as it was even a few years ago. Second-hand smoke in public and workplaces no longer threatens thousands.
Dr. Holsinger - are you listening? To put it bluntly, the last few SGs have been a waste of air in terms of leadership. Wouldn’t you rather be remembered for the good you did, the strong leadership you provided that saved thousands of lives - instead of not being remembered at all?
Posted May 26th, 2007 at 9:08 amIn 1918, the Illness Rate (IR) was 29 percent, while the Case Fatality Ratio (CFR) was 2.1 percent. - Dr Raub
The figures that you cite for the 1918 pandemic are in line with those that I’ve encountered elsewhere; they are accurate, but they are also somewhat misleading. The 2.1 percent CFR would apply only to the US population; the CFR for the global population as a whole was very close to 10 percent (assuming a population of 1.8 billion, and 50 million deaths; and if you substitute 100 million for the number of dead, then the CFR approaches 20 percent).
If an H5N1 generated pandemic is “only” as ferocious as the 1918 pandemic, then the outcome, here, will very likely exceed the roughly 2 million direct deaths that current “predictions” generally specify. There is no reason, at all, to expect that the US will “only” experience one-fifth the number of deaths that the rest of the globe will have to endure, if we get a repeat of 1918.
We got lucky on that one; perhaps a “silent” wave preceded the first acknowledged wave, and provided some herd immunity at that time. What insulated our population at that time isn’t known, but we cannot — with any degree of certainty — count on a similar outcome, this time.
Posted May 26th, 2007 at 10:38 amKansasAnnie (post #101),
First of all, a small apology.
Far be it for me as a foreign national to tell you how your government works, but my understanding is that your Constitution makes very clear demarcations between the powers of the Federal vs State and local branches of government.
Since public health and school closure policies as pertaining to community mitigation in a pandemic are the domain of State and local authorities, and since the Feds have already issued very clear recommendations for good practice, it may be helpful for the public to engage with your state and local public health and education authorities to work out how these recommendations can be implemented in your area to save lives.
The process of public engagement for these policies is ongoing right now, and is vital to the success of implementation in each local area. I would recommend that you, and other readers in general, download and keep a copy of the CDC Interim Guidance on Community Mitigation in a Pandemic, and ask your local officials what steps they are taking to implement these recommendations. As always, it is easier to influence and assist decision making before rather than after the event.
For those for whom the prospect of ploughing through 108 pages of official text is slightly daunting, there is a bullet-point version of the major components of the guidance here
.
A lot of work is needed to bring about the proper use of these powerful interventions, not least the necessity to find solutions to some of the secondary consequences of school closure, eg providing food for kids on free school meals. As Secretary Leavitt said, government can’t do everything. Communities will only benefit from these measures if they are willing to participate and make things happen.
For those who will question how much these measures are going to cost, I will with respect direct them to the following quote from one participant in the consultation process that put together the guidance document:
Posted May 26th, 2007 at 2:19 pmSend out a news release weekly during these 5 weeks with the forum topic. Should be easy and take less then 30 minutes. Bring more people to the forum-expand awareness.
Week one is almost over, so this weekend write one up a new press release/new topic and get it out early next week.
Post and or send out a memo to every state health agency to immediately begin ACTIVE communications with doctors offices, hospitals, red cross so everyone is on the same page. Do this weekly/bi-weekly with a different focus on the same subject–keep it in front of them.
Have the information on the Internet and your Intranet if its necessary to keep some details confidential. And for goodness sake, convince the AMA to participate in a proactive way. If we are all giving out the same data we won’t seem so off the wall, we need a united front.
Give out guidelines to inform doctors to prescribe Tamiflu with instructions on when and how to use it. Stockpiles could then be used for those less likely to be able to afford it.
Roche I think would like more people to buy it, more profit for them and of course discounted would be even better for the people and still Roche would make more money since at this time as I write this, purchasing it legally is being actively discouraged and prevented.
Prescribe antibiotics ahead of time and have pharmacies have larger inventory of the most needed ones. Same thing with regular prescription drugs that people need to live. Do it now beforehand otherwise they won’t be available. A large percentage of our lifesaving drugs are produced overseas, and should the pandemic start there, no one will be shipping to the United States. The more lives they save now the more money they make up-front & afterwards since hopefully there will be more survivors to continue buying their drugs.
Which also means, a memo needs to go out strongly worded that Health Insurance Commissioner need to also give permission/guidelines to cover up to three months worth of prescriptions.
Let them know the real current status of bird flu in other countries, that there has been CONFIRMED limited H2H HPAI /H5N1. Give all the descriptive details and make it real and not an episode of House.
Give the current CFR and let them know that it does not need to drop efficiency in transmission.
Let them know that even with vents, tamiflu and other heroic efforts of the medical profession that more then half have died.
Now this same information can be sent to all the organizations, medical professions…so one really good document; well written can get the information out effectively via email, faxes, snail mail, and on the Internet and Intranet. Interns could handle the delivery of this information rather quickly.
Meanwhile another team can be working on the PSA’s The general public does not need all the same gory details as the medical profession does, (even though it propelled me into action) but they need to be told the REAL risks associated with the looming threat of a pandemic.
These PSA’s and similar data(list of food & supplies to have on hand) need to be given to other outlets as well, businesses, chambers of commerce, grocery outlets, libraries, SCHOOLS, Universities, religious and faith based organizations, mortuary and funeral homes, financial institutions, utilities….and have these same organizations put into their normal mailings, bills, check statements, hand outs at the grocery stores … information about preparing for emergencies.
Chamber of Commerce has contact information for their businesses in their states and smaller communities; they would be a perfect tool to use to help get this information out and to then have companies share the information not only with their employees but to ramp up production on needed items, smaller businesses could stock more items and if choreographed correctly there will be no need for high risk/loss production or excess overhead at this time.
That’s my .02 for now.
Posted May 26th, 2007 at 4:04 pmDr. Raub,
Thank-you for your clarification of illness rate. However, my understanding that it is expected that at least 30% of the population of the US will be infected during a pandemic. Would you agree with that number? If not, what number do you think is good to use for planning purposes? As regards H5N1, over 50% of infected people have died. If H5N1 goes pandemic with its current CFR, we can therefore expect over 50 million dead in the US alone, primarily young people and children. Please see my post at #10 for documentation that H5N1 may go pandemic at its current CFR.
So, let me ask again - Are there any plans to deal with a pandemic virus with a kill rate of over 50%? If so, what are they?
Thanks for reading these posts.
Posted May 26th, 2007 at 4:30 pmWhy is it critical for each of us to prepare for the threat of pandemic influenza?
I think a better question would be: What would happen to our family and our community if we choose to NOT prepare and a pandemic occurs?
The consequences are unpredictable because we do not yet have a pandemic with an established Case Attack Rate (CAR) or Case Fatality Rate (CFR). That being said…. If we all only prepared for a Cat 1 Hurricane…..(or pandemic) We would be totally unprepared for the Cat 3 hurricane that devastated New Orleans…. (or Cat 5 or greater pandemic as in the 1918 pandemic) Right now we are looking at a virus that has a CFR of greater that 60% with the availability of tamiflu and vents and antibiotics. That knowledge certainly does not leave me with a warm fuzzy feeling.
In December 2005, Michael Osterholm, Director of the Center for Infectious Disease, Research and Policy (CIDRAP) spoke to the Council for International Relations about the threat of a Pandemic and about our “just in time” delivery system. He focused on medications, which I had never considered to be an issue. Read the transcript yourself here:
www.fluwikie.com/upl…
The focus I finally came to terms with after listening to Julie Gerberding with the CDC at the Florida Pandemic Summit in February 2006, gave me chills.
Her comment that the sero-prevalence studies showed that mild cases were very few to none. Of course, at the time, this was good news and bad news. Good, because it indicated that the H5N1 virus was not readily transmitted human to human. Bad, because this meant that the lethality was high even with treatment.
Over the last year, H5N1 has easily crossed the species barrier, infecting mammals with the same high CFR. Felines, which never before had documented influenza, apparently can now easily infect each other through droplet transmission.
This year, I watch the H5N1 virus becoming more transmissible from human to human, with increasing ease. Many inconsistencies are reported in whether the patients had contact with poultry. Yet, we have not heard any reports of what findings they have arrived at, nor do we, in the public arena heard the results of any further sero-prevalence studies.
That is why I think it is critical to prepare.
I understand you also would like to hear our thoughts on possible solutions to perceived barriers. I will think about this and discuss in a second post.
Posted May 26th, 2007 at 8:12 pmSuggestions for preparing the public:
Many have already voiced numerous suggestions on telling the public the truth… and I agree. Many have suggested making it easy by enlisting some of the major distributors help in promoting readily assessable items in bulk for long term storage. (Lets just not get them from China, right now..
) I agree and would advise enlisting the assistance from the major food chains. also. I believe they may have ideas.
So how do you start? How about a weekly update on emerging infectious disease? Play it on all National Networks on the Friday night news and the Sunday night news. Reports can originate from the HHS, the CDC, and the WHO, even specific issues of the problems that would be faced by millions, the moral decisions, the ethical decisions, and the scarcity of everyday items, which would occur in a pandemic. One minute, twice a week.
Public Service announcements that apply to national audiences, and local audiences. Save money by having a contest for college kids to produce them.
Posters: Be creative. Again… Let the public design them. Display them in all Public Buildings.
Then How about a TV series……. The history of emerging infectious diseases. You can use Laurie Garrett’s book “The Coming Plague”. Be factual, and truthful. Let the public know what problems Public Health, and the CDC, the WHO, and scientists have faced while educating themselves and trying to get the public to hear their message on what is happening (at that time) and how to protect themselves and to prevent the spread. DO NOT BE AFRAID OF SAYING “WE DO NOT KNOW”.
Make it a continuing historical series… But, not a documentary. Let the public know what parts are true and what parts might be suspected. Use famous directors, and famous actors. Once you have them on board, for the long term, it will be in the media.
Of course, the problem with a series, is there would not be any specific main characters over the span of a series. I sure someone could figure that out, though. (Could do something like West Wing, but non partisan) But, a movie would not work. They are entertaining, but edited to be a couple of hours. You want the general public to know how emerging infections evolve, and how to prevent it.
This way, maybe people who have money will want to focus on the poor, those who have special needs, or 3rd world populations. But, the general population, will get an idea
BTW… I do not know Laurie Garrett.
OK… Those are my thoughts………
Posted May 26th, 2007 at 8:52 pmCorrected Mr the Secretary
Thank you for assisting us in obtaining ‘statements from authority figures’ thus helping us to get the job done in prompting preparedness.
Why is it critical for each of us to prepare for the threat of pandemic influenza?
Simply because it works, it does indeed reduce morbidity and mortality.
At flutrackers.com we had the priviledge of having numerous public health officials from many countries, we are visited monthly by more than 125 countries and we are editing in 11 languages.
In the equatorial pandemic of Chikungunya that started in the Isle of La Réunion in the Indian Ocean in the fall of 2005, we have witnessed the consequences of this infection and had the opportunity to make a difference among the Health Ministries who had jurisdiction over 1.5 billions of people.
Altough the information is present on the Internet it does not mean it is easily accessible nor in the proper languages.
Our first work consisted of gathering and organizing the latest information available. We translated it and forwarded it via the FluTrackers website to many influential public health officials and practitioners.
At first the proliferation and serious of this series of chikungunya epidemics was denied by the various governments that experienced the outbreaks.
The economic consequences are large for the economy of any region that experiences an outbreak.
The effect is greatest for the tourism industry.
This denial had its repercussion in time for preparedness and in the numbers of cases among the population.
What was perceived has the most annoying and upsetting behaviour was the ‘pretentious condescendence of some medical professionals, understating the gravity of the situation and even becoming counter productive for the proactive health care workers.
It became obvious that credibility and straightforward statements became a must for the general population who lost confidence in their doctors, pharmacists and health care workers.
Once the governmental & medical entities recognized the gravity of the situation then more cooperation and collaboration began to occur between all concerned parties: governments, health care practioners, industries, and citizens.
We then translated and shared the information available on the diseases, symptoms, treatments and, most importantly, mosquito control measures and techniques.
We are now doing the same for dengue and other emerging diseases.
Just as stated in your opening statement, an efficient preparedness cannot rely on the government alone. Indeed a pandemic is too serious to be dealt by only the governments, the experts of all fields or journalists alone.
It would be extremely helpful if the medical and pharmaceutical industries would inherit some of your humility and relay the truth about a pandemic and state that there is no “magic pill” to avoid the serious medical and social consequences of a pandemic.
By nature a pandemic needs the effort of all the community and we must now coordinate the contributions of all proactive people.
Despite the fact that rich countries have spent billions on pandemic planning, we, on the blogosphere still are not funded by governments, institutions or big corporations.
We have demonstrated our efficiency, our social responsibility, and our effectiveness, it is now time for the governments to forward a portion of their budget to non-profit organizations of volunteers that are bearing the cost of this social work.
Thank you for acknowledging the importance of the blogosphere and medical internet forums by creating this governmental blog.
I would like to thanks all people, journalists, experts, institutions and governmental agencies for allowing the informations accessible.
Truly
Posted May 27th, 2007 at 11:00 amSnowy Owl
Mr. Secretary,
By now, if you have read all the blogs and comments, you must realize that a grassroots movement has begun.
Extensive volunteering at a community level to raise Pandemic Awareness has been going on for 2 years or so.
We ‘flu warriors’ have been creative in our ways to get information out to the public.
We need help in ‘legitimizing’ our efforts so we can continue them without the skeptical responses we get from local leaders and community members.
We need your help in lighting an ‘awareness fire’ beneath the place where community leaders sit.
We need your help in getting folks to prepare (and for more then 2 weeks).
Why not a Citizen Pandemic Preparation Corp?
We have taken the time to learn and respond. We have hands on experience and we are knowledgeable.
Posted May 27th, 2007 at 4:21 pmWhat a GREAT idea, Science Teacher!
Posted May 27th, 2007 at 5:25 pmPerhaps HHS is strictly concerned with the disease itself; perhaps non-medical concerns fall to DHS. In western culture, with our heavy dependency upon everything technical, people need to prep for both the medical impact and the societal impact of a pandemic. Perhaps it is not within HHS’s area of responsibility to address the societal aspects of a pandemic; if that is the case, please ask that those who are responsible begin to engage the public. There is no way the govt can succeed without public engagement - the govt doesn’t have the resources. And the public has grown very accustomed to JIT living; the public needs time to get ready. I wish we still had civil defense; it was a solution to a different problem, from another era - and it would serve remarkably well toward addressing the local level issues we face today.
Posted May 28th, 2007 at 12:18 pmWhat are my constituents’ concerns?
There are a lot of very knowledgeable people who either write or lurk on the flu forums. A lot of them want to go out and change and alert and help the world. Many have either been ridiculed or are hesitant because they think they will be ridiculed, branded as ‘scaremongerers’. Or they are afraid that come a pandemic, someone will remember them and ‘visit’ them for their preps.
It just seems to me such a waste, for all these wonderful, talented, committed, and creative folks to be cast aside, their talents unused, when the world desperately needs them.
The question, therefore, is this: what needs to happen for this to change?
Everything that I’ve read tells me that the online community has the pulse of the problem about right. That a pandemic is very likely. That it can happen at any time. That it is likely to be catastrophic.
We believe the public ought to be told. We differ among ourselves as to how to tell, what to tell, or how best to get people aware and prepared. We are also aware of some government’s or the stockmarkets’ concerns about starting panics, although these don’t worry us as much because it is our almost universal experience, in trying to communicate this risk, that complacency or denial is the rule and urgency the rare exception.
The problem is, too many of us have had bruising encounters when trying to communicate this risk, so that we are afraid to talk to our neighbors, afraid to share what we know.
One of the things I’ve been doing is to put out user-friendly information for community leaders on our forum. I know some of them read us. Not many, probably nowhere near enough.
But that was one of my incentives for putting up diaries such as this bullet-point summary of the 108 page CDC Community Mitigation Guidance, or this synopsis of the most recent science on tamiflu efficacy and resistance. It is also why, for a long time, I’ve been saying governments need to tell every citizen to put aside enough provisions for at least 2 weeks in anticipation of a pandemic.
I got flamed for that. Which is ok, it comes with the territory. But the reason why I did that was to try and put out the message that “hey, we’re not weirdo’s and doomsday survivalists. We understand the realities of working with the public. Or rather between the public and the bosses.” We, or I, just want to say, “Look, there is a whole bunch of people right here who know a lot more than some ‘experts’ who give people advice. What’s more, we give it for free. We are willing to get out there and help, in whatever way we can.”
All that we need is for leaders to come out and publicly acknowledge that we have a problem. No, not in the way that’s been done up to now, although we appreciate that as well. But to step up, get the whole world’s attention, get your countrymen’s attention, and have a heart-to-heart talk. To say, we’ve got a problem. The whole world, the whole of humanity, has a problem. Which if we, as the generation running the show, do not put our hearts and minds and guts and sweat and everything we’ve got into it, we will live to see the day when what is left of our children and grandchildren will say “You knew. Why didn’t you do something?”
Can you look them in the eye then?
Can you, when 5%, 10%, or 30% of the next generation is wiped out?
Can you tell your grandchildren, if you still have them, why they no longer have friends their age?
When the leaders have made that decision, to go public, really public, with at the very least the message that
then we, the whole bunch of us here who agonize about this day and night, can also go public. We can go and talk to our neighbours, our community leaders. We can help organize local support networks. We can educate parents, teachers, volunteers, on everything from infection control to how much water a person needs per day. We can set up, recruit, and help train home healthcare volunteers, or man hotlines for basic flu questions. We can organize childcare for essential workers, or make sure kids on free school meals get fed when schools are closed, or produce homeschool materials for parents to use.
There’s a whole lot of us here who know a lot, as some of you have already found. At the moment, many are silent because we know that we will not be taken seriously. Some of us worry that we will be the target of theft or worse. We lay awake at night agonizing about this.
But if government has taken the lead, has come out and said, yes, these things are necessary, then we can get started.
So, how about it, Mr President? You are where the buck stops, in this country. Why don’t you take the lead? Look, I will even strike a bargain with you. If you are worried about being branded a scaremongerer, which I can perfectly understand having been there myself, don’t tell them about the worst-case scenarios, at least not just yet. Just tell enough to justify high-profile community action. We will teach them the rest along the way.
We need to get started.
It won’t hurt, I promise. You have some excellent professionals on staff who can help you get the message right. It may even surprise you how many of us will stand with you if what you say is sincere, urgent, and supported by science.
Better yet, why not make this non-partisan? Enlist the Bush Sr-Clinton team that worked so well in the Indian Ocean tsunami efforts. Or whoever else you think will be most successful in carrying the message across.
I assure you, if you do this, if and when a pandemic happens, you will know that that one act alone will have saved tens or hundreds of thousands, maybe even millions of lives.
There will be generations because of you, Mr President.
Would you say that it’s a worthwhile legacy to leave behind?
Posted May 28th, 2007 at 6:53 pmFor a year now, as a volunteer board member, I have been involved in the Safe America Foundation’s (www.safeamerica.org/) Prepared Not Scared! initiatives to help stimulate pandemic flu preparedness. With increasing levels of corporate support and the involvement of federal as well as state and local governments, the Foundation has played a role in connecting the business community with government.
Recently, this organization joined with the government of France in a joint exploration of preparedness and some of the international implications. Some of the discussions may be of interest. Summaries are on my blog (johnmallencommunicat…);see posts for May 14 and May 7.
In the United States forums have been conducted in Chicago, New York, Philadelphia and Los Angeles with others being planned.
Clearly, it is but one voice. If it has not yet done so, I hope Secretary Leavitt and HHS will consider inviting Safe America to participate in the June 13 leadership forum.
Posted May 28th, 2007 at 11:02 pmI have a question for Post 94, Dr. Raub, PHD and Advisor to the Secretary:
For the 1968 Pandemic you state that the illness rate was 39%. Wow! With approximately 200 million population in 1968, that means some 78 million were ill, and then with a .2% case fatality rate, then some 155 thoustand died. Are we certain about those figures????
My understanding was only about 35 thousand died in the US in 1968. If the stats are not for the US, but for the world, then it appears that the 1918 and 1957 information is incorrect.
Would you be so kind as to clarify this as some of us planners use these scenarios in our preparation.
Thanks a bunch.
Posted May 29th, 2007 at 11:29 amThe following comment raises an issue that has troubled many of us for some time now. The issue is whether the assumption that the lower CFR estimated for the US in 1918 (vs the global CFR) is appropriate to include in assumptions for ’severe’ pandemic planning scenarios.
If so, what is the basis for relying on this significantly lower assumption? What conclusion has been made as to the reason for this lower death rate for the US in 1918? Has it been concluded that the reason is still valid today and that no other reasonably forseeable factors would lead to a different result now?
Clarifying this issue is important because the referenced illness rates and case fatality rates used by the US can be found in a host of other pandemic preparedness plans of US localities and other countries where they may or may not be appropriate.
US Planning Assuptions:
www.pandemicflu.gov/…
For further reference:
1917: US Population 103 Million
World Population: 1.8 Billion
1957: US Population: 172 Million
World Populaiton: 2.88 Billion
1968: US Population: 200 Million
World Population: 3.56 Billion
2006: US Population: 300 Million
World Population: 6.5 Billion
For those that would like some context to these figures for the US population, one source is here:
www.cidrap.umn.edu/c…
To paraphrase Secretary Leavitt:
Any country that thinks the only pertinent statistics are those within its own borders, with the idea that somehow, in the end, what happens elsewhere will not happen “here” or will not significantly affect what happens “here”, will be tragically wrong.
I look forward to responses to both Dylan (105) and Monotreme (108) to help clarify the basis and limits of use for these statistics.
Posted May 29th, 2007 at 3:11 pmTo: William F. Raub, Ph.D., Science Advisor to the Secretary, Department of Health and Human Services
On a related note:
For purposes of applying the US Pandemic Severity Index, what will be the official universe for which the Case Fatality Rate is projected in determining Pandemic Severity?
Will the statistics gleaned from the first areas of outbreak (assuming they are consistent) be utilized with or without adjustment by a ‘US CFR Reduction Factor’? If so will the factor be that currently estimated for 1918?
So long as the assumption continues that the US will experience a significantly lower CFR, lack of clarity on this aspect of the PSI will create great potential for confusion, conflict and potentially catastrophic delay in NPI implementation.
Posted May 29th, 2007 at 3:21 pmSec. Leavitt,
Thank you for this opportunity to communicate with you, the DHHS team, and participants at the June 13 leadership forum for pandemic preparedness.
A question has appeared on several of the flu discussion boards; I present it here.
Referring to this document:
www.usfa.dhs.gov/dow…
Best Practices and Model Protocols - Dept. of Homeland Security
April 2007
We note on page 7 (of 37), this one of five “Planning Assumptions”:
“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.”
Questions: How does this assumption square with advice at pandemicflu.gov to households and communities to acquire food and supplies for two weeks? Is this yet another example of mixed messaging?
What do the terms “directed” and “self-quarantine” mean in this context? Who will be “directing”? Does “self-quarantine” mean voluntary, or not?
Reading through the Dept. of Homeland Security document, it leaves the impression that DHS is preparing to be active and visible during an influenza pandemic. DHS clearly urges local communities to become educated and prepared NOW, and promotes sharing this information with all citizens NOW not after pandemic begins. (Yes, say we “flubies.” That’s what we’ve been saying for quite a long time.)
DHS is worried about a lot of issues in that paper. I urge everyone to read it. I have today sent it to local Emergency Services director and asked her to read it and forward it to the city manager, city council, sherrif and other law enforcement agencies.
Posted May 29th, 2007 at 8:35 pmQuestion: Will the 2007 report from the Centers for Disease Control concerning Non-Pharmaceutical Interventions (NPIs) in a flu pandemic be fully shared ahead of time with participants at the Leadership Forum for Pandemic Preparedness?
In my view, everyone there should be up-to-date on that report and the suggestions that flow from it. Buy-in amongst leaders for things like widespread and long school closures (the singel most effective measure to mitigate spread) will have to come first before anyone can be expected to “persuade” the rest of society.
Also, what about the April 2007 Homeland Security document I cited above? Are conference participants going to be pointed to that document and asked to become familiar with its contents ahead of time?
Posted May 29th, 2007 at 9:56 pmcontinues from #75
7. Encourage the public to contact their local water boards and inquire about their plans to keep the water flowing during a pandemic.
8. Have the FDA make Tamiflu an over the counter drug and arrange for citizens to be able to purchase it at the same price offered to the states.
9. Encourage the public to call their dentists and pediatricians and inquire about their plans to continue their practice during a pandemic.
10. Encourage citizens to get pneumonia and tetanus vaccinations.
Kobie, We probably do not have enough food in the country for everyone to stockpile even for 3 months, that’s why we need to start now. If only 20% prep now that will be a start and those people will be out of everyones way when the volume is turned up.
Posted May 29th, 2007 at 11:31 pmMr. Secretary,
I attended our State Summit as a concerned citizen and parent, and I heard your forthright message. The grueling travel schedule you undertook to the states and territories to personally deliver that preparedness message underscored its urgency and importance. I appreciated your courage and effort. I wish I could say the same about my elected leaders.
I am disheartened to know that President Bush and members of Congress have access to antivirals and a pre-pandemic vaccine now and first-tier access to a pandemic vaccine, yet have ‘compromised’ by removing the domestic pandemic funding from the supplemental bill last week - funding that would go toward the public having the same level of coverage as our leaders.
The funding was, in part, for vaccine capacity building and stockpiling. In fact, some of the funding was for retrofitting existing facilities - contracts that should have been awarded last October with an anticipated period of performance of seven to eight years.
In Switzerland, every citizen counts at the same time as their leaders for antivirals and a pre-pandemic vaccine, and for a vaccine during a pandemic; it is a reflection of their leadership. They begin receiving shipment for pre-pandemic vaccine for the entire population this summer. Instead, U.S. citizens are being asked to choose who should receive scarce resources while our leaders do not provide the funding nor the will to cover everyone as fast as possible with the same coverage they have. It is unconscionable.
I’ve read that a universal influenza vaccine is at least ten years away. We need a Manhattan-style project for pandemic vaccine research and capacity building now - for the sake of the nation, for the sake of ALL citizens.
Posted May 30th, 2007 at 1:37 amSec.Leavitt,
I applaud your efforts to educate Americans about the need to prepare for the next pandemic. However, today most Americans are completely clueless on the subject, even though they can speak at length about Anna Nicole Smith, Paris Hilton, Angelina Jolie. For the most part, we Americans work hard, enjoy life and don’t want the party to stop. People don’t want to think about a pandemic because it is depressing.
But there are ways to make Americans pay attention to subjects that are life threatening like smoking, cancer, drug addiction.
I believe that you need a multipronged approach to public awareness, one that is not sporadic, but continuous and hard hitting. Much can be learned from successful advertising campaigns.
Think for a moment about the job of educating people about disability insurance (yawn) or car insurance, but almost everyone understands the AFLAC and GEICO message.
Here are some suggestions: Enlist some celebrities and put them in public service ads. Have George Bush Sr. and Bill Clinton do some public service ads like they did after the tsunami hit Asia. Educate the Black Caucus on what will happen to the economically disadvantaged when the pandemic strikes. Enlist Hollywood to make a movie about pandemic influenza like “28 Days.”
In summary, what you have done to educate Americans is laudable, but much, much more needs to be done by other highly visible and media-oriented sectors of our society.
Thank you for this opportunity to voice my opinion.
Posted May 30th, 2007 at 6:44 amJohn Mallen - Safe America
I attended your Conference at NBCTV studios. It was clearly obvious that most participants in the room did not have a clue as to the severity of the H5N1 virus - lots of 1918 numbers (of 2.5% death rates) were thrown around.
from your website
www.safeamerica.org
“A minimum amount, and a good starting point, would be enough to sustain
your family for two weeks. Start slowly - work on gathering supplies over
summer. Continue to monitor government announcements and
recommendations. ”
2 weeks was the recommended stockpile of food and water which virtually none of your staff had done yet. It is clear by the writings on this blog that 2 weeks is not nearly enough and will send people out into the peak of the viral storm to try and resupply.
I strongly recommend that you up the time for prep to 12 weeks.
Posted May 30th, 2007 at 9:05 amMr. Secretary,
Why haven’t there been any PSA’s on TV this week and last calling attention to this blog and the reason(s) that you set it up?
Why haven’t you issued a press release that made it to all the major newspapers and TV/radio stations?
Why haven’t you called a press conference to discuss what you are trying to do here?
None of these are hard and I’m sure you have at least one Public Affairs type on your staff who knows how to make it all happen almost instantly.
How long did it take President Roosevelt to tell the Nation that we were at war with Japan after Pearl Harbor in l941? Less than a day, as I recall.
What are YOU waiting for?
Posted May 30th, 2007 at 10:45 amCommunications and outreach are essential to pandemic preparedness. To help people learn more about the threat of pandemic influenza and the steps they can take now to prepare the Department of Health and Human Services has undertaken a number of efforts, including this blog and the engagement of community leaders.
Earlier this year, we developed a series of radio and television public service announcements (PSAs) that were sent to more than 1,000 stations across the country. The PSAs, which are in both English and Spanish, have aired in such communities as Dallas, St. Louis, and Philadelphia. Additionally, basic facts sheets and planning tips and checklists are available on the government supported website, PandemicFlu.gov on the page titled “Pandemic Flu and You Planning Tips”.
We know, however, that people want to hear from members of their community about the need to prepare. That is why we are undertaking this campaign to provide local communities with pandemic planning information that they can share with their community. This blog and the Washington, DC Forum serve to kick-off this effort. We issued a press release last week about the campaign and will discuss the results of both the blog and the Forum at a press conference following the Forum.
Posted May 30th, 2007 at 2:53 pmSuzanne C. DeFrancis,
“We know, however, that people want to hear from members of their community about the need to prepare.”
Excuse me, but nobody wants to hear from me about this in my community especially the Public Health Officer. I need support from your department in a major way.
Posted May 30th, 2007 at 3:23 pmSorry for any duplication. This was posted yesterday on the Secretary’s post but seems to have gotten lost.
——————–
At every level of government, plans were developed and resources were allocated. Today, we are better prepared, but there is still much to do.
I am just a peep in the wilderness (US designated biomedical “frontier”). However, my region (Kuskokwim Yukon Nushagak) is supposed to be in the front lines of pandemic flu. Therefore, we ought to be the model for the best in preparedness.
=============================
March 1, 2006
I started a local source of preparedness information, via Internet, My 3 things everyone should know to prevent pandemic flu because there was no information, only a warning, for us about “bird flu”
Last April 2006 I heard the Secretary was visiting each state about pandemic flu preparedness. I tried to contact him. Nowhere at the federal sites, HHS or pandemicflu.gov was there contact information for the Secretary. I finally had to use the form at Firstgov.gov–
I contacted my Senator Murkowski, in part to ask why the legislative branch was supposed to handle the correspondence with the executive branch. In due course, a generic letter was sent from HHS to Senator Murkowski who forwarded it to me.
=================================
The Dept of Homeland Security isn’t that much closer to the “grassroots”– I am still the only person in a region the size of Oregon to try to participate in their Lessons Learned. I tried to start a discussion on public involvement and pandemic influenza—
March 10, 2006–
For example, I noticed that there are no categories within this site’s functional areas which include that fourth form of US government, tribal governments.
We have a situation currently where a lot of attention (nationally, internationally, state) has recently been placed on detecting the “next assault on American security”, i.e., bird flu. But it is already too late to avoid initial distress. People are responding ineffectively. There has been no public discussion of human infectious disease transmission; disease ecology, etc. If the regional hub has an emergency response plan, it is news to the general public.
Imagine this, if you were in a community which has suddenly been designated in the news media as THE entry point for the next human tragedy. There are certainly unique local issues (the only evacuation or entry route is 3 jets a day, *if* the weather is clear. And if one has already made the 100 mile trip to the regional hub.) But the larger issue of an inadequate view of security and health (as particularistic or solely disciplinary issues, perhaps), rather than a comprehensive view, still applies.
=================================
October 15, 2006 (FluWikie)
Public Health Grand Rounds PanFlu
I’m disappointed in what CDC (and UNC) has done with the PanFlu webcast and interactive forum. Webcasts are always a problem for those of us on dial-ups (although this was not too bad).
The presentation was a good concise summary. However, none of the questions submitted for the hour’s webcast were transferred over to the forum. The forum was not really prominent; few used it (maybe few knew of the webcast) and interest quickly died. It seemed to be (was presented in a manner of) a one-off.
The other problem, which goes to the larger issue of who prepares and who uses the “social” Internet for preparedness, is that none of the discussion is about communities driving the inquiries; what happens if one doesn’t have advanced governmental capacity in health (e.g., most tribal governments and frontier and remote communities. NC and California and Wash state are not frontier governments); if schools have not trained a critical thinking population? We seem to have a huge number of MySpace users (300+?) given our regional population (20,000) but no one uses it to ask why the Fire Chief doesn’t think preparation is useful or to ensure the designated City Council member shows up for PanFlu briefings or to call the “Bird Flu Hotline” to find out if the federal agents there know how to answer the phone (they didn’t).
There is a scale factor also– a thousand people urging city hall to do something in Boise or NY state or Des Moines can be heard; but the comparable number for us is something like 1 or 2.
One or two people without complementary resources are not effective.
Web 2 is only a component of communication. Ironically, many traditional communities have a long history of complex non face to face communication; very few institutions have been willing to look at how that works in order to make the Internet more effective.
CDC may have a blog now, but public health agencies and academic departments and NGOs still operate from the top down and require supplication from communities. There are 2 main problems with this approach–the science and health is incomplete, by definition, without the other experts fully involved and 2) it’s us who are frontier not only in sparse population density (400 miles from Wal-Mart; 3000 miles from the nearest active nuclear test-site) but we also are the first to spot many environmental and infectious illnesses, before it hits suburbia.
The US Fish & Wildlife site does not identify how to sign up for news releases; there are no feeds for them, either, as far as I could figure out. After all the hullabaloo about the bird testing, the only way I could find and post results (days or weeks before the state and local news media) was via Google news searches, which I then had to track down to verify.]
==================================
November 7, 2006
It is important to get accurate test results back to the communities involved in the sampling. I have seen some news media results but I prefer the actual test results to understand something of the meaning. (”no bird flu” or do you mean no HPAI H5N1? Which birds and how many had what kind of specific results?)
Keep in mind the hunters who collected samples (and ate the birds) and sent their children out to gather eggs, did so with some apprehension. A generic response of “no bird flu in North America” when the newsmedia reports various strains in wild birds harvested afterwards (or in previous years) in other states– doesn’t instill confidence.
So far, the actual test results are not available to the general public. And the HEDDS table of testing results, “LOW PATHOGENIC “NORTH AMERICAN” H5N1 AVIAN INFLUENZA STRAIN IN WILD BIRDS PRESUMPTIVE AND CONFIRMED TEST RESULTS” doesn’t include the 16,150 or so Alaska samples. Does this mean Alaska isn’t part of the US or North America or that none of our birds has any form of H5N1? If the data are confirmed, is there any way to get a hold of them? bird species, #, locale, year, what found?
Regarding academics vs. governmental openness to technology (ideas)– I have experience on all sides. The intellectual diffusion is mostly in one-direction (top-down circular and digging ever deeper). Some disciplines are worse than others. I am comfortable stating that the absolutely worse situation was as a tribal scientist in remote communities dealing with CDC, ATSDR, EPA, IHS, UC-LANL, UAF, states of Alaska and NM, et al. The CDC refused to fund their first tribal health assessment program because we didn’t include epidemiological data, which was the purpose of the proposal in the first place. Tribal scientists were not invited to the “mystery disease” (hantavirus) seminar in Albuquerque. Recently, local information was prohibited from the mass vacc clinic unless the organizers provided it and no one was allowed to participate unless they were employed by the sponsoring institutions.
As institutions learn to respond to the Internet, they will learn to respond only to those who know how to supplicate the system. They don’t have collaboration with communities as colleagues. They “venture out” not live amongst.
====================================
May 29, 2007
So, after a year of official planning–
This year’s “bird flu alert” (April 17) consisted of one radio talk, warning again to “cook your bird” and don’t pay attention to any but the government websites. We had a citywide blackout for about an hour until the electric utility could fix the problem. I tuned my emergency radio to the only two stations. They were knocked out. Only the recorded weather broadcast from the airport was active. Later, someone reported driving around town and the firehouse was dark, city hall was dark, police was dark.
Gasoline and oil for electricity is sitting in the Bering Sea because the river is too low to float it to town this year. The prices for groceries and household supplies have gone up again because everything comes flown into the two local stores by US Mail (the nearest road is 400 miles east). However, food stamps won’t cover stocking even bulk food items, much less toilet paper and Purell. Maybe 10% of our adult, able-bodied men in many communities are in Kuwait. This month half the resident providers at our local and only hospital, federally funded, have moved away (our other group of providers resides elsewhere and rotates in by plane). Only one provider at the public clinic remains. And speaking of Katrina, you’ll never guess which agency is responsible for erosion and relocation in our delta, sans human ecology and biocultural expertise. (www.nytimes.com/2007…). Unless there is a Web 2 rent party even the little bit of independent information and coordination I can provide must stop June 1.
But, TA-DAA!!! “every level of government” declared “disaster readiness” last November (2006) because 700 to 750 people (published numbers vary) went through a mass vaccination (POD) clinic. We each got a multi-colored sticker at government expense and a printed wallet pass which allows access “In the event of an infectious disease outbreak” to the non-existent emergency shelter.
Posted May 30th, 2007 at 3:27 pmwww.flickr.com/photo…
Goju at #128
Actually, I want to add that we are hearing this same theme repeated over and over. Citizens, however informed or even credentialed, have limited credibility if official information about the pandemic threat is not reaching the public.
Earlier today, I went through the first 125 posts on this blog, and counted 72 expressing the need in varying degrees of urgency for HHS to convey the message all the way to the grassroots level. For a single issue on a blog that is about preparedness not communication, this need for massively improving indeed revamping of pandemic communication from the government should come as a wake up call.
Mr Secretary, there is no other message more uniformly conveyed on this blog that this single one:
I hope this forms a solid part of the next round of HHS activities.
Posted May 30th, 2007 at 4:24 pmQuote from post #127, Suzanne DeFrancis, HHS:
“Earlier this year, we developed a series of radio and television public service announcements (PSAs) that were sent to more than 1,000 stations across the country. The PSAs, which are in both English and Spanish, have aired in such communities as Dallas, St. Louis, and Philadelphia. Additionally, basic facts sheets and planning tips and checklists are available on the government supported website, PandemicFlu.gov on the page titled “Pandemic Flu and You Planning Tips”.
Thank you for those actions.
Those actions combined represent about 1 percent (maybe) of what informed and motivated citizens think needs to come forth from DHHS. How many times and how many ways do we have to say this:
People “out here” are UNINFORMED and don’t care to become informed nor take action on behalf of their own households and their local communities unless they hear consistent, repeated, not-fuzzy, clear, truthful messages from all quarters. We activists and even local governments who MIGHT be concerned about how to motivate local citizens to get busy preparing need some fertile ground in which to plant the ideas out here. THAT is where your department can be helpful, if you would.
Posted May 30th, 2007 at 4:25 pmSuzanne DeFrancis, HHS says:
“Earlier this year, we developed a series of radio and television public service announcements (PSAs) that were sent to more than 1,000 stations across the country. The PSAs, which are in both English and Spanish, have aired in such communities as Dallas, St. Louis, and Philadelphia.”
I live in a major metro television market and have not seen a SINGLE pandemic PSA in any form, on any media
in the last year.
Perhaps they were sent and aired at 2 a.m along with the used car commercials ?
The message is NOT getting out to those that need it most.
Posted May 30th, 2007 at 6:00 pmThere are things that governments need to do, and there are things we need to do for ourselves. This should be seen, in an ideal world, as a shared responsibility. That, in no way, detracts from points made in comments above (after all, this is rarely an ideal world!).
We are asking (Leadership And Listening), for validation of our efforts, but those are efforts we have been doing and will continue to do. We should not leave the impression that the work is all for the government. In fact, the simple, positive and respectful message for the Secretary is: we support you doing your part because it will help us do ours (and there is a lot we can do - see Michael Coston’s The Stuff That Solutions Are Made Of and Nedra Weinreich’s Preparing for Persuasion) for examples.
Posted May 30th, 2007 at 6:18 pmThank you, again, for that thoughtful post. Stand on Guard for Thee (and its predecessor Ethics and SARS: Learning Lessons from the Toronto Experience), the CDC ethics framework, and similar frameworks from the UK and New Zealand can be found here.
Posted May 30th, 2007 at 6:23 pmAsst. Secy. DeFrancis, I appreciate the effort DHHS and Secy. Leavitt have made to host this discussion on how we all can best share the responsibility for preparing the American public for a flu pandemic.
In this discussion at Secy. Leavitt’s blog, I have noticed that one theme has emerged more than any other. People who have already accepted your challenge to engage and educate their communities have made a consistent request. SusanC at #130 summarized it very succinctly:
Your countrymen are telling you they need your voice to support theirs. They are telling you they need YOU to go out there and tell the people.
Coincidentally, upon reading your response, Asst. Secy. DeFrancis, both SusanC and I (unbeknownst to each other) were moved to pick up our pencils and tally the number of posts here that have overtly made a request for direct support from your agency for their own, already begun, community efforts. They are not asking for support in terms of funding or programs - simply your voice to support theirs.
SusanC’s tally reflected my own - more than 50% of the posts on this blog request not, as you stated, “that people want to hear from members of their community.” No. That is not what those who have tried to communicate with you by means of this blog have found.
The folks who have distilled this message for you are the very members of their community you are seeking, and they are already making valiant efforts to do as you ask - they are actively involved in attempting to engage, educate, and prepare their neighbors to be resilient in the event of a pandemic influenza. They are meeting resistance because while they have the heart and energy and initiative to do as you ask, they do not have your authority.
This authority has been vested in you by the American people. It is a powerful force. No one will bring a church leader or an inner city activist in front of a congressional panel, post-pandemic, and hold them responsible for failings in our nation’s ability to survive a pandemic storm. Those who will appear there, if things do not go well, will be our federal and state agencies. They are vested not simply with the choice to act to protect the American people, but with the responsibility to do so. They have the authority that others do not have, and those with the authority will be held accountable.
I am not surprised that SusanC and I undertook a similar tally. We are both moderators at pandemic influenza discussion forums, she at Fluwiki www.fluwikie.com , and I at Pandemic Information Forum www.pfi.com . In our roles, we have become accustomed to doing a great deal of listening. Forums and blogs are designed for listening, learning, discussion, and feedback. At these forums, as in the great Forums of Athens or Rome, much can be learned. I hope you will truly listen to the voices of those who post here. They are your community leaders, they are engaging the public, and this is what they need from you:
#27: For, without an effort by the Federal Government to more aggressively, beyond the level of the internet, reach out educate our citizens and thereby validate and support these highly influential leaders from the business, faith, civic and healthcare sectors whom you have called to this leadership forum, I do not believe that they, alone, can bring this critical message to action.
#30: The few things I’ve done quietly to encourage preparation for a pandemic have had little effect, because the government hasn’t said it’s important.
#31: We need someone in authority to address us, and prepare us for this coming crisis. We need leadership.
#35: Don’t forsake your duty. Send the message now, send it often, send it forcefully.
#40: There are many things the government can’t and shouldn’t do for our citizens – making sure we all understand this threat isn’t one of them
#41: …you can lead in the area of self-sufficiency all over the world…Create the vision and take practical steps to make it workable.
#46: …we are counting on you to provide us with the leadership.
#47: Until the federal government treats this as a priority, no one else will treat it as a priority.
#49: Clear messages about the potential risk of a pandemic need to be quickly provided to the public.
#57: We are also counting on the Secretary (and staff of course) to help US to help you…by raising awareness to a level not possible by the average citizen
#61: There are many ready to help get the word out including myself, we just need more backup support from our Government in that what we are doing is essential to our survival.
#64: Unfortunately the Secretary’s message of responsibility has not yet been shared with “every level of government, every business, every church, every civic organization, every family and every individual”. When, precisely, does he intend to do so?
#65: You need to get the word out that communities are on their own and communities need to prepare their citizens. Someone needs to tell the average Joe that this is real and not a joke. It will all fall on the government if millions die because of not telling people the truth.
#67: We are ready willing and able to do our part….but without the validation of Washington were limited in what we can do on the local level. Local officials are not taking this seriously in some/most cases, because they see no direction or urgency from Washington
#112: We need help in ‘legitimizing’ our efforts so we can continue them without the skeptical responses we get from local leaders and community members.
#115: At the moment, many are silent because we know that we will not be taken seriously…But if government has taken the lead, has come out and said, yes, these things are necessary, then we can get started.
Posted May 30th, 2007 at 7:32 pmMs. DeFrancis,
I apologize in advance for my frustrated tone, but you asked, and we have told you, and it doesn’t seem as if you’re hearing what we’re saying.
How many non-Flubies have found, or even know about this blog?
Community leaders have not gotten engaged; they’re not even dating seriously.
I haven’t seen a PSA, either, and I live in a state capitol.
Many posts have told you that in our experience, people don’t want to hear from members of their community, and won’t until the leaders of our nation have said that a pandemic will be more than a minor inconvenience.
I don’t think anyone here is interested in assigning blame. We have a lot of solutions, but until an authoritative source tells people that there’s a problem, they won’t hear what we’re saying, either.
Posted May 30th, 2007 at 8:01 pmI have never seen a PSA the closest thing was the dancing penquin commercial for a pharmaceutical company.
Sigh.
My local officials, health department-well they don’t want me to worry my pretty little head about it. I went to a meeting they held in a school-they were truley clueless on several points
I asked intelligent respectfull questions, I already new the answers but I was trying to lead them so more in the audience would understand-they pooh poohed me, down played my concerns and told people this was nothing to be concerned about. They would take care of everything and everything will be fine.
I want the PEOPLE to make informed decisions based on truth-facts. We; the government and the PEOPLE are supposed to be a team working together for the greater good. Please help us help you and ourselves at the same time!
Posted May 30th, 2007 at 8:57 pmSecretary and Ms.Defrancis,
I heartily agree with the post from dgb re: no one at the local level (exception perhaps in Minnasota and Seattle/King County) is taking this threat seriously, if they even have heard of it. I also have not seen any PSA’s on TV. Attempts for 2 years to get pandemic planning initiated locally have failed-my township doesn’t see fit to see themselves as a business entity that could be in serious financial straits.
Governors, mayors, county commisioners need to be told directly to discuss this in public-TV, radio, on Ipods. And not only to discuss it but initiate immediate planning for how it will impact the function of government,vital services and the common citizens.
Only then will individuals, NGO’s, and community have a change to work together for the common good.
Better a year too early than a day too late.
Posted May 30th, 2007 at 9:50 pmThank you for putting this website up! I think it helps ease everyone’s fears about the possibility of a pandemic. Thanks again!
Posted May 31st, 2007 at 10:46 amI congratulate the Department of Health and Human Services for this new blog, which will enhance the nation’s ability to prepare for an influenza pandemic. This unprecedented use of “new media” to solicit public input is another example of HHS’ leadership support of pandemic preparedness efforts. While avian flu is fading from the headlines, planning and preparation for an inevitable pandemic continues with great vigor and focus.
State pandemic planners recognize that minimizing the impact of a pandemic through community planning and response requires active engagement and full involvement of all levels of government and sectors of society. A coordinated response requires collaboration and cooperation with stakeholders and networks of multi-disciplinary systems in all planning and response activities.
The complex issues that state and local public health are tackling include infection control measures, targeted social distancing and quarantine/isolation measures, prioritizing pharmaceutical countermeasures, school dismissal, and liberal leave policies. They are also developing plans and strategies to address second and third-order effects, like duration of implementation, intervention fatigue, socioeconomic disparities, sustained, predictable absenteeism, and economic impact. These activities require coordination among all sectors at the community, state, federal, and international levels.
A pandemic is a public health and societal event that requires governmental public health and the private healthcare sector to play pivotal roles in planning and response. Many of the activities in the National Implementation Plan and the HHS Plan involve state governments either directly or indirectly, but one sector cannot do it alone. When the time comes, expertise beyond public health and healthcare, including creative leveraging of resources and committed partners, will be critical to planning and ensuring a seamless response.
State and local jurisdictions need a solid understanding of the extent and nature of community resources so that they can tailor their pandemic planning assumptions. In addition to leading high-level discussions with governors and regional stakeholders, state health agencies are engaging businesses, academia, other governmental agencies, faith-based organizations, and tribes to craft comprehensive operational strategies. They are reaching out to communities through state-wide pandemic flu summits and public engagement events to tap into available expertise and experience that has supported the growth of planning networks. This Pandemic Flu Leadership Blog is a real opportunity to capture innovative solutions and meaningful exchange from thought-leaders, planners, and practitioners.
Thank you for this opportunity to participate and contribute.
Paul E. Jarris, MD, MBA
Posted May 31st, 2007 at 10:54 amExecutive Director
Association of State and Territorial Health Officials
Thank you for the phenomenal information infrastructure and funding the federal government is providing. The detailed planning documents are great, if anyone reads them. Your personal leadership has also been fantastic.
However, it is still not penetrating the way it should at the local level. Unfortunately our local folks don’t watch Charlie Rose or listen to NPR. They wait for the regional person from the state to show up and tell them the same thing that was published a year earlier on pandemicflu.gov and then they make a minimally satisfactory response. They look at something like “Community Strategy” and say that’s nice but my state guy didn’t give it to me and then they toss it on the huge stack of unread federal documents.
Local governments rank preparedness of all types at the bottom of the stack if at all, if they have time. They spend not a cent of local government money and then gripe at “federal” requirements. In fairness, they are also overloaded with federal programs. Here our local folks are dealing with NIMS compliance, federal wildfire programs, interoperable communications requirements and a host of other federal programs. Staff is also still reeling from BT preparedness process where they literally had to stand public ridicule at the hands of their elected bosses; “that’s rdiculous, we don’t have to ever worry about that here, why are you wasting your time on that stupid program.” In our case one of our senior elected officials refuses to get vaccinated for even seasonal flu because he believes vaccinations are some type of plot or against nature.
However, despite this, change is slowly happening here, we are fortunate that we have in the past six months built up momentum and now have a very effective pandemic task force. We have been working on this for two years although it wasn’t until Phase II funding arrived that concrete steps started to happen.
Here are some tips for others on how to get things moving and really engage stakeholder partners and gov. staffs:
- call HHS press office, get the DVD of the pandemic public service announcements, find someone with video skills, pull the PSA’s into a form that can be used on a computer then build them into powerpoint presentations, put them on your ipod and show at meetings, etc. these things are great and I could physically see a change on people’s faces and body posture when we showed them at our task force meetings.
- go to the Charlie Rose website, order several copies of the DVD of the show with Secretary Levitt’s interview and statement “failure of local government to prepare is an abdication of responsibility at the most fundamental level.” That one minute of video with that quote did more than two years of berating locals to pay attention. Pass the DVD’s around to elected officials and staff. The whole interview ought to be on pandemicflu.gov
- go to your library or wherever you need to and dig up copies of 1918 newspaper reports of the pandemic in your area. Don’t print them from the web, copy the original articles.
- dig up copies of your local board of health or equivalent’s resolution regarding “spanish flu” from 1918
- prepare a historic overview of what concretely life is like during a pandemic. Remind people that, at least initially, our tools will be same as they had in 1918 and not much better.
- take detailed minutes of preparedness task force meetings, email them to every local mayor, town/city manager, and a wide stakeholders list
- stay concious of local budget cycles, get well ahead of them when preparing surge supply and other funding requests. Frame request subtly as “if you don’t fund this people will die.”
- don’t do a single other activity until you have a concrete, NIMS compliant, incident command structure at least for the first few levels and have determined who would serve where. Without this there is no accountability or commitment. Once people see themselves in a box they become engaged. Also, when you begin risk communications the very first question asked will be “who’s going to be in charge if this thing hits?” Unless you have that org chart ready you can’t answer that question.
Also, take the HHS PSA’s and create a second audio only version. They work equally well as radio spots. Distribute to all your local media outlets in both video and audio form. Put them on your information web site in a form people can easy download/play or put links to video.pandemicflu.go….
This stuff works, here in our rural county we have seen a sea change in attitudes amongst senior preparedness folks using these concrete tools.
However, it is also a long slow slog. In the Colorado mountains we pound into people who backcountry ski and run the risk of dying in an avalanche “don’t let your schedule override nature’s.” That means get out very early, before the sun hits the snow and you risk goes way up, don’t let your personal schedule determine your safety, respect nature’s schedule. Unfortunately the same principles aren’t applied to pandemic preparedness. We let our budget cycles, other workload, more sexy stuff, and personal schedules determine our preparedness. We think it’s ok for the process to take five years. Meanwhile, out there every moment of every day H5N1 or something else is constantly evolving, spreading and not concious of any of our human schedules.
Some concrete issues that could render preparedness moot:
a) surge supplies; we got a funding request together last year for $50k in surge supplies and a shared funding formula to spread the costs amongst local governments, it worked, we are now ordering the supplies, however that’s only enough stuff for about one week. It seems impossible that we will ever obtain funding for the DHS recommended 90 day supply. We also cannot get any data on what would come from SNS. We need specific quantities so we can make sure we aren’t wasting time and money on duplicative purchases but are told “you won’t know until it arrives in the truck.” Even data on anti-virals was seen to be super-secret until I walked into a meeting with a printout of the purchasing schedule for SNS anti-virals from pandemicflu.gov.
b) Oxygen, oxygen, oxygen. Here at a very high altitude we are very concerned about the need for oxygen in our alternative care settings. We’ve found great detailed guidance in documents resulting from CO’s BT exercises. However any solution runs anywhere from $90,000 to $200,000 and is going to be a very hard sell.
c) at each government meeting I ask “how many of you have two weeks of food and supplies at home for your family?” About 10% of the room raises its hands. If we can get the preparedness folks to prepare how can we get the public to do so?
d) this effort is landing in the lap of people with little political weight. Local county nurses just aren’t going to ever have the weight of say the Sheriff in the fight for priorities. Ancient powers of public health are being rescucitated however the historical role of public health as a key emergency response function is not understood by many people.
e) other issues on the federal front have severely impacted people’s receptiveness to any message from the feds. A local newspaper editor told me “this is just a plot by the Bush folks to distract attention from Iraq.” It’s hard to tell an elected official that the same people who botched WMD intelligence are now telling us to worry about nature’s WMD, federal credibilty has been severely weakened.
As a citizen, watching the inner workings, or more often non-workings of government preparedness is the most frustrating experience of my life. I personally have built and sold two startup companies in less time than pandemic preparedness has taken and we’re really still just getting out the gate. I want to grab people by the collar (and often do verbally) and say “if my fellow citizens really understood what was needed and why and how slow you people are to get it together they be outraged and demand change.”
I don’t know what the answer is to this problem and everyone in the system tells me “you just have to get used to it.” Mr Secretary, why don’t you make an unannounced trip to a rural county somewhere, followed by TV cameras, walk in and tell them you want to see their pandemic planning results. Don’t tell anyone, don’t have the state people scurrying around saying “you have to hurry and get this posted to the website, the feds are coming to inspect.” Better yet, call an unscheduled, unannounced exercise in some region of the country. It would also help if those pandemic psa’s were appearing in prime time, frequently, on radio and tv.
Don’t accept or believe what you have coming up the long pipeline from the local level to you. Everyone is “teaching to the test.” Self-certifying compliance at the state and local level is useless. Who in their right mind is going to fill out a federal or state sefl-evaluation preparedness report and say “we’re not doing this?” They are going to blow smoke up the pipe at you and you’ll think all is well. Meanwhile the plans say nothing concrete and use the word “coordinate” to mean “we can’t really be bothered to think this problem through right now.” Most are copies of the neighboring county’s weak plan. Perhaps the word “coordinate” should be banned from all planning documents.
Finally, stop everyone from sugar-coating the news. Look right in the camera and tell the truth to your country’s citizens and their elected officials and say “while we can’t tell if or when, this will happen someday and if you don’t get it together a lot of people will die unecessarily and it will be on your watch.” If one reads deeply into the federal documents, particularly those from DHS, one sees much grimmer scenarios than those in pandemicflu.gov. What is the real story? Everyone wants to reassure the public, don’t, some level of fear is rational and motivating. Everytime an article appears saying something like “a universal vaccine might be coming some day” our locals say “hey, look we don’t have to worry as much about this.” Exactly that happend with the recent news on the 3M respirator approval. Someone walked into a task force meeting and said “this solves all our problems.”
Again, thank you for your efforts and please, please figure out a way to pound the message home to every local government in the country, bypassing the states if necessary.
Respectfully,
Burnt_Out_CO_Citizens_Rep
Posted May 31st, 2007 at 12:50 pm“Burnt Out CO”. Excellent blog! I’ve posted this elsewhere, but I’ll piggyback on what you’ve pointed out. Local government does not get it. I’m the preparedness manager at a county public health dept. and am meeting the same frustrations as CO. I get a pat on the head “doing a good job, keep it up,” but no financial, political, or even mild interest in a pandemic. A pandemic is a community problem, with health implications. My elected officials need a governor, or state representative/senator, or congressional rep to beat the drum (this assumes they understand the implications of a pandemic). We need help at the local level getting the message out to the public. PSA’s in prime time. Governors, or the state health secretary, visiting communities and asking to review their pandemic preparations. National spokesperson who can keep preparedness in the news at least once a week. Too many people believe that we will come up with a silver bullet when a pandemic strikes. They need to understand how fragile the health care, business, and energy system is when you have a 40% absentee rate. Help us get the word out.
Posted May 31st, 2007 at 2:37 pmConnectRN & Others:
Don’t wait for PSA’s run by the Feds. You particularly can take action since you are a government employee with the right title. The HHS Press office (address can be found at video.pandemicflu.go…) is very accomodating and will send you the DVD. Copy it and give copies to your media outlets. Get a high school kid who can in about 10 minutes produce a sound only version. Give it to your local radio stations, put it on your website (make it the sound embedded in your main info page). Use it in presentations. I can’t emphasize enough the impact seeing three of those PSA had at our task force meetings. I converted them to Ipod format and carry them around and plug the Ipod into a TV whenever I’m around decision makers and ask them to watch them. Somehow, the fact that they see it on a TV and it says HHS on it makes a huge difference. Also the PSAs are very well done.
Posted May 31st, 2007 at 7:22 pmDr. Jarris,
Thank you for joining us in this conversation. The work of ASTHO became known to many on the flu forums through the The Public Engagement Project on Community Control Measures for Pandemic Influenza jointly sponsored with the Keystone Center. Indeed, I must say it was IMO one of the most successful community engagement and public consultation processes which provided key input that informed the drafting of the CDC Interim Guidance on Community Mitigation. The proceedings were reported and enthusiastically discussed and debated by the online community, eg. see here and here. Indeed, many of us cut our teeth on NPI with the ASTHO process, so a big Thank You is in order here!
It is perhaps a sign of the success of the process that a google search of ASTHO public engagement returned the Flu Wiki forum link as the top result.
That is not to say that grassroots efforts can replace official endeavors. (Indeed, the ability to differentiate popularity from excellence is perhaps one of the most basic requirements of public service! 
)
While the more user-friendly medium of the informal sector can greatly facilitate public engagement by providing access to information that would otherwise be unavailable (for example, by ‘translating’ the more technical aspects of policy or science into plain language for the general public), this obviously cannot replace the policy deliberations or the scientific research that can only be undertaken by official and professional bodies.
This interactive HHS blog is another example of how a dynamic two-way communication mechanism can be established for the purpose of harnessing the informal and uncredentialed talents which are normally too widely dispersed in time or space to be utilized effectively.
As you pointed out so eloquently in your post, there is much work to be done, and many parties that have roles to play. The best returns are IMHO only gained by continual participation and mutual respect. I applaud the ASTHO and your leadership in these efforts, and I look forward to future collaborations on pandemic preparedness and related matters.
Best wishes,
Posted May 31st, 2007 at 10:04 pmSusan Chu MD
Editor
Flu Wiki
Ladies and Gentlemen of the Department of Health and Human Services,
When I first heard of this blog, my reaction was a cynical who cares? It will just be another conversation between ordinary folk who have been tracking the evolution of H5N1 from it’s breakout in Hongkong to today’s complete and utter disaster in Indonesia.
The cynics among the flu bloggers have a short hand term for the 50 state message that Secretary Leavitt gave to the governors:
WTSHTF YOYO
- which is blog speak for:
When The S— Hits The Fan, You’re On Your Own.
The actions by the Federal Government to date has not changed my opinion one iota. The government’s actions, as far as we can see, have been skewed towards continuity of government, but not protection of the population. How sad.
The message of YOYO - You’re on your own, is, in my opinion, is only one half of the message that needs to be delivered.
The other half, the more important half, the half that must not only be communicated, but made into an imperative action cycle is:
YOYO DOES NOT WORK!
Many of the posters to this blog, as well as to the other flu sites, have decided that YOYO means that they have to become self sufficient with 90 days of supplies or more. Intuitively, they know that this will not work without their neighbors also becoming self sufficient because in the event of a severe pandemic, a higher risk than becoming infected is the risk of your neighbors running out of food, water, and supplies and having to scrounge for supplies anyway they can.
This is why so many preppers are agitated. They selfishly want others prepped as well because they know their well being depends on it.
While a pandemic will quickly become a national and global crisis, the real action of survival will be on the subdivision level, the community level if you will.
YOYO means that the feds won’t be coming to the rescue. YOYO means that the state gov will not be coming to the rescue. YOYO means that the city will not be coming to the rescue.
The US, contrary to popular legend, was not built by the lone settler. It was built by small groups of like minded people trying to make life for themselves and their children better, safer, and more prosperous. If a person expects to survive a pandemic event by practicing YOYO, they will most likely fail.
We must band together at the street level and help our neighbors. We must encourage community activism. We must encourage community preparedness. We must rekindle the social aspect of the American spirit.
The message must not be YOYO, but PNTHYN.
Prepare Now To Help Your Neighbor
Because if 80% of Americans can be motivated to prepare to help themselves and their neighbors, that leaves a much more manageable 20% that will depend on the ability of larger governmental organizations to provide assistance.
Posted May 31st, 2007 at 10:46 pm“Because [IF] 80% of Americans can be motivated to prepare…”
“If”…that word is a non-starter.
There has been a failure of DHHS for this “overdue” pandemic to present any research that proves the pandemic will occur shortly.
Yet the DHHS, last pandemic, spent funds, developed an analytical construct by which to develop predictions, and issued probabilities backed by analyses.
Few people make life decisions on mere speculation. There has been no attempt to publish scientifically quantified risk analyses of pandemic.
We all recognize that severe pandemia is just that, “severe”. We also all recognize that we have no reasoned positions published that prove this pandemic is shortly to occur or that it will be severe.
As a consequence, the public has filtered out the DHHS message.
Of course, the DHHS message is rational, “if” the basis on which the message is based is provenly probable. But to date, none of the prior research methodologies have been re-published and no studies have been undertaken to rationally deduce, based on current facts, any dependable information, either way, regarding severity of and probability that the event will occur in any pressing near term time frame.
I and other bloggers have long ago prepared for this event. Yet, that is based upon conjecture. We remain without scientific or academically vetted analysis as to probability of time or severity.
We all know we will die. We do not allocate effort towards that event. Yet, in this case, we are being asked, without factual justification, to do just that.
Maybe the old “plans” will be dusted off?
I for one wish to know where we humans stand vis a vis pandemicflu. Americans are trained to think for themselves. So, as an older TV commercial used to say, “Where’s the beef?”
Posted June 1st, 2007 at 9:19 amSecretary Leavitt,
Today the sequence of the first confirmed H5N1 case in mainland China was released. Although the 24 year old male died in Beijing over four years ago, the release of the full sequence from A/Bejing/1/2003(H5N1) was welcome. The sequence shows that the H5N1 has origins in northern China and has sequences that have since flown into Europe, the Middle East, and Africa via migratory birds. As you know, this dramatic spread in H5N1 to almost 50 countries west of China has origins that trace to wild birds at Qinghai Lake in central China in May, 2005.
The sequences from these isolates were unique and were easily traced. All isolates west of China were the Qinghai stain and the H5N1 continues to evolve. This evolution can be most effectively studied through the sequences of the isolates. Although you and WHO have called for transparency and sharing of data, the hoarding of sequences by government affiliated labs continues.
Mainland China just released sequence data for the first time in a year, and calls for more transparency and sharing are loud and clear. However, the effectiveness of these requests are blunted by the continued hoarding of sequences. WHO still maintains a private database of sequences generated by their H5 reference labs, and other government agencies in the United States and Canada continue to hold low path H5 seqeunces, including H5N1 isolated in 2005 and 2006.
These sequences can be used to monitor and understand the evolution of H5N1, yet they remained locked up in secret databases. The CDC in the US gets samples from H5N1 infected patients in the Middle East and Africa, but has never released a single sequence from those regions. The CDC has released sequences from Indonesia and southeast Asia, but has not released any Qinghai sequences, including many from this season’s outbreak in Egypt.
Similarly, agencies in the US have been involved in H5N1 surveillance, and although low path H5N1 has been isolated, none of those sequences have been released. The surveillance program in Canada began with collections in August, 2005, yet those sequences have also been withheld.
Similarly, when H5N1 moved into Europe in 2005, countries sent bird samples to the WHO reference lab in England for confirmation. These effects increased markedly in early 2006 when human H5N1 cases were confirmed in Turkey. Over 700 H5N1 positives were found in Europe alone in early 2006, yet the vast majority of those sequences are still being hoarded, 1 -1 ½ years after isolation.
Release of this data is long overdue, and efforts by the United States on making the sequences public would significantly reinforce calls for transparency and sharing of critical sequence data, which not only provides evidence for the understanding of H5N1 evolution, but also provides valuable information which can be used to predict the evolution of H5N1.
Posted June 1st, 2007 at 12:18 pmMedia coverage of avian influenza outbreaks has also led to a waning of interest in preparedness, but the media interest level is somewhat linked to reported cases, which may be significantly below actual infection rates. Today, northern Vietnam reported the confirmation of a second H5N1 case. Along with two suspect cases, one of whom has died. All cases were in northern Vietnam, which had reported a number of large clusters in 2005. Those cluster were associated with a lower case fatality rate, but as the size of the clusters grew, reporting stopped.
There were no human cases reported in 2006, and the first human case in 2007 was reported last week. Now there are four confirmed or suspect cases, but these are not yet covered in WHO situation updates.
The FDA approved pandemic vaccine is directed against a Clade 1 2004 isolate from Vietnam. The vaccine titer in the clinical trial was low, but to date it is the only approved vaccine. All human cases outside of southeast Asia have been Clade 2, but sub-Clade 2.3 has been reported in southeast Asia and may be responsible for the upturn in reported cases. These new cases come amid media reports on the decline of H5N1.
However, many countries that have reported no H5N1 are completely surrounded by countries that have active H5N1 outbreaks. The Middle East is a prime example. H5N1 this year has been reported in Egypt, Kuwait, Turkey, Krasnodar, Afghanistan, and Pakistan, yet countries such as Iraq, Iran, and Israel report not activity. These failures to detect / report H5N1 have led to predictions of H5N1 decline. However, major areas of concern exist in Bangladesh and Ghana, which have both recently reported H5N1 outbreaks for the first time ever.
Similarly, there are H5N1 reports in Siberia, South Korea, and Japan, strongly indicating that H5N1 is alive and well and will migrate into Europe, the Middle East, and Africa again in the fall.
The declines are also due to poor surveillance programs which have focused on live wild birds. Although H5N1 Clade 2.2 (Qinghai) has been found in many dead or dying wild birds, only Russia and Egypt have found H5N1 in live healthy wild birds. Thus, most of the surveillance is detected to produce false negatives because the assays are not sensitive enough to detect the virus. Virus can be indirectly detected in sequences of low path H5. Many of the changes in high path H5N1 can be found in low path. However, the sequences of low path H5 have been withheld, especially in North America (Canada and the US).
However, although the virus is rarely found in live wild birds, sequences can be used to map the distribution routes of H5N1 genetic material. This was dramatically demonstrated this year when the same H5N1 genetic change appeared in Russia, Egypt, and Ghana at the same time. These changes also demonstrate how H5N1 evolves, which can be used inn creating vaccine targets.
Posted June 1st, 2007 at 2:43 pmDear Mr. Secretary,
Why do we, the people need to prepare for the coming pandemic?
Simply because a truly moderate or severe pandemic (Transmission rate 3, CAR 40%, CFR 6-12%) will have a profoundly negative effect on the lives of all Americans that can not be prevented by any mitigation save one, becoming self sufficient.
The American people are currently unaware of the devastating effect a severe pandemic occurring today will have on our modern complex society and the globalized economy. Most are tragically confused about our present vulnerability to pandemic. The common assumption is that our vast technological prowess, healthcare infrastructure, natural resources, military might, wealth, and highly specialized workforce is well equipped to manage the threat of pandemic. Of course, the precise opposite is true. As systems become more complex, they are also more easily disrupted by the failure of one or more critical systems that other aspects of the economy and society depend upon for support. Like a house of cards, the entire structure is subject to collapse under these conditions.
In 1918, Americans were much more self-sufficient than they are today. Men and women were more accustomed to hard physical work in the home, field, and factory. They had significantly more basic survival knowledge and skills than the average American today. Most had gardens, the men knew how to hunt and fish, the women knew how to can and preserve the food the family produced. Sewing, carpentry, and forestry skills were commonplace within the population as a whole. These people could feed themselves, repair their leaky roof, make or repair their own clothes. They were also adroit at entertaining themselves with song, reading, and story telling. While most had access of some sort to medical care, its primitive nature at the time was really not a factor in 1918 except to increase the incidence of post-influenza bacterial pneumonia among those confined to crowed treatment facilities.
Almost everyone working in this economy today is a specialist. For them to perform their work function required considerable training and study. It will not be possible to replace the absentee railroad engineer, RN, coal miner, firefighter, farmer, long haul teamster, or waterworks supervisor when they are unable to work do to illness. The point being our vastly increased economic interdependence today compared to 1918 is both the reason for our economic success as a nation while at the same time represents our greatest vulnerability to an event like pandemic. This simple fact is not widely recognized or understood.
The reason we, the people need to prepare for the coming pandemic is because we will not be able to depend upon our usual sources of supplies and services we all take for granted today during the long emergency.
The reason we, the people, need to prepare for the coming pandemic is because government at all levels is incapable of preparing adequately to provide for us during the pandemic long emergency. Anyone who plans to depend on their Federal, state, or local government for reliable assistance of any type during the pandemic run the risk of suffering the most horrific consequences.
The reason we, the people need to prepare for the coming pandemic is because if we don’t there is a high probability that our families will suffer terrible abuse including death or disability from illness, starvation, and civil disorder.
The reason we, the people need to prepare for the coming pandemic is because no one else can do it for us. Everyone rich and poor alike will be subject to the same ill winds that will test each of us like never before in our lives. It will not be possible to depend on outside help from any source during the long emergency.
The reason we, the people need to prepare for the coming pandemic is because self sufficiency in the provision of our basic needs is the only rational response to the catastrophic circumstances everyone will find themselves in during the pandemic.
Thank you very much for sponsoring this forum and for the work you have done to increase awareness of this key issue,
Sincerely,
Grattan Woodson, MD
Posted June 8th, 2007 at 2:57 amDecatur, GA
thank you for this blog.
Posted June 9th, 2007 at 11:38 amThe Monster Under The Bed
Those of us in the flu forum world (Flublogia) wonder why the general population is not preparing for the next pandemic. Some speculate that we are too busy with our lives of collecting more stuff and entertaining ourselves with trivial pursuits of all varieties to pay much attention to a threat that admittedly may not materialize in the near future. Others believe that ‘the sheeple’ haven’t been told the truth by the awful ‘Powers That Be’. Still others blame the mass media for failing to cover the emergence of the H5N1 virus for fear of burning out their audiences and subscribers, and thus, loosing advertising dollars. So, more Paris Hilton and Anna Nicole.
I wonder if there isn’t a more subtle reason people are not preparing. I am speculating that an avian flu pandemic is the ‘monster under the bed’, the ‘Boogeyman’ – the same one that was under our beds when we were children.
I have two remembrances from my childhood that cause me to think so. The first is the remembrance of laying in the dark in a state of terror for fear that the Boogeyman was hiding under my bed in the dark. I thought that he only came out from under the bed in the dark, so I struggled with my fear, trying to gather the courage to jump off the bed and tear madly across the room to turn on the light before he got me. I never did turn on that light; I just fell asleep after awhile.
The second remembrance is that of asking where my father’s mother was – my paternal grandmother. I lived my early childhood with my maternal grandmother, so this was a natural question. My father told me that she died when he was very young and he had no remembrance of her. He never mentioned her, and never talked about his early childhood. My father was born in Philadelphia in 1916.
I only recently made a connection between the 1918 Flu Pandemic and my grandmother’s death because, throughout my years of formal education, there was absolutely no mention of it. It wasn’t until I read John Barry’s book “The Great Influenza: The Epic Story of the Deadliest Plague In History”, that I even knew there was a pandemic much less having knowledge of the severity of it.
Is it possible that the event was so horrifying that the entire human family repressed the event and buried it deeply into their subconscious? Most combat veterans I have known haven’t liked to talk about their experience. Could the pandemic of 1918 been so psychologically and emotionally horrific that it became a civilian equivalent of battlefield experience? For the civilian population, could it have become the monster under the bed?
In a similar way, is it possible today that more people are aware of the threat of an influenza pandemic than we are aware of? Mentioning avian flu at a social gathering certainly seems to be a social faux paux. It’s on the list of topics you don’t discuss - like politics and religion.
Perhaps having the courage to seriously examine the possibilities is the equivalent of having the courage to dash for the light switch. But, if you can just get to the light switch, the Boogeyman can’t get you, and your fears become manageable with taking action and with education.
If what I’m speculating has some merit then it’s clear that overwhelming people with frightening information will only drive the Boogeyman deeper into our collective subconscious. On the other hand, soft peddling the message will allow us to just fall asleep after awhile.
It seems to me the message should be twofold. The threat is real, but we are not powerless. We can turn on the light.
Mr. Secretary,
It does not matter whether anyone recommends a two week stockpile, or twelve weeks if the reason for having to choose is not clear. Until someone pulls the Monster from under the bed, and turns on the light, we will simply fall asleep in our beds and awaken someday, shocked into wakefulness when we realize it wasn’t a bad dream afterall.
As this forum draws to a close I detect a sense of sadness and resignation in the flu community. Some have suggested that you legitimize the flu community and send us forth to be your messengers. Well, I say the inclusion Mike Coston and Greg Dworkin, two respected members of the flu community, as guest bloggers has already granted legitimacy to the flu community and its efforts to educate and assist as many as possible. You asked for leaders, and leaders stepped forward. You asked how to relay the message, and you received answers. What more could you ask for?
But, what will be your response to our offer? Many are sad because you apparently have not agreed with our assessment. But, what is disappointing is not that you may have disagreed, but that you didn’t disagree enough to respond, as your guest bloggers have. Yet, the concern of the flu community is not with itself, it is with others. And, regardless of the success or failure of this effort from our point of view, the flu community will continue to try and reach everyone it can right up until that point when collective memory is cleaved into what came before, and what came after ‘the day…’.
But, I am not without hope, and neither is the flu community. So, I will leave this current effort with the words of someone who has already said it better than I.
Tho’ much is taken, much abides;
and tho’ We are not now that strength
which in old days Moved earth and heaven, that which we are, we are;
One equal temper of heroic hearts,
Made weak by time and fate, but strong in will
To strive, to seek, to find, and not to yield.
Alfred, Lord Tennyson
Posted June 11th, 2007 at 3:21 pmC Mundy a.k.a. - Snicklefritz
“I feel your pain” My niece cam back on college break saying she can do more to solve, i.e. fix, global warming than she can to protect herself from the pandemic.
It took me a couple of days to make a dent in her thinking.
BTW, “The general issue with people is they are not general issue - they are all different” - a shepard in the field of knowledge. Some see the pandemic is a bad transitory disaster far better than WW-III or worse. Others hear the word pandem…(doubt they hear the end of it) and just shut down. To them a pandemic is a horrible non sensical un-stoppable killer of the good, the bad, the rich, the poor and the young over the old. They are right. But do not stop there - ask the next question.
“Ask not what your country can do for you - but what you can do for your country” (I’m a JFK fan as you can tell)
Ask how do you help your country and how do you help yourself. Take it from there.
Yes I am feeling the sting and pain of having to break the ice and inform people when our government has not. Dr Dworkin has even more stories.
Ok our government has done good things. Where are the press releases we can use? Where is the validation? Where is the current plan so we are all moving together not working against each other or working out of sync?
For week 3 of this blog you know what I want. I want the co-ordination mechanism. Yea. One big lesson from Katrina was the organization and co-ordination of efforts. It also brought tears to my eyes when I tried to sign up and found out there was a three day waiting list. Yes that many other good souls where already wanting to help. Without being asked they answered the call.
Regards,
Posted June 11th, 2007 at 4:54 pmKobie
This one makes sence “One’s first step in wisdom is to kuesstion everything - and one’s last is to come to terms with everything.”
Posted June 14th, 2007 at 5:13 amI wrote this yesterday for the Leadership Forum, but the event bloggers have done such a marvelous job and there is so much to read that it has become quite hard to find some specific posts. For the purpose of continuity of discussion, I thought it best to re-post it here. Apologies to the moderators for having to post this yet again!
It is also posted, as always on the Flu wiki forum, where the discussion is ongoing.
Leadership and Moral Courage
by: SusanC
Wed Jun 13, 2007 at 09:03:24 AM EDT
posted on the hhs blog 8:47am today.
Mr Secretary,
Last time I posted, I had some harsh words for you, as did many others. When you started this blog, I’m sure you had no idea that you would meet with such passion. It is not something that you are used to; it would probably have made you feel unsettled, bewildered, perhaps angry, most likely there would have been an element of unwillingness to take more risks.
Today you are opening a meeting, an important one. You are taking a major step in bringing the American people with you in preparing for a pandemic. And today, something else is also going to happen. The meeting will be brought to many people in their homes or places of work by live blogging. With the experience of the past weeks behind you, you know that, along with the other speakers and panelists, every word that you say that is brought to our attention will be mercilessly scrutinized. Many who have not forgotten their disappointments from the past weeks will be looking for the first mistake that you make. The first utterance that smacks of condescension, cluelessness, or attempts to water down the risks, will be pounced upon at speeds only limited by the ability of the moderators to handle the traffic.
That is a hard place to be in. I sympathize with you enormously. I doubt that many will want to be in your shoes.
There is a very simple solution.
Yesterday, I started a diary on our forum on ‘Leadership and Moral Courage’. I started it because I was uncertain of the way forward. I needed help. I had one advantage that you do not have, not yet, anyway, I think. I understand the online flu community, or flublogia. I know the ropes. I know how it all works.
What it all boils down to is two words: accountability, and sincerity.
See, in a world where thousands can read your words and respond in realtime, it is very easy for the whole thing to descend into a state of anarchy. Like the playgrounds where we spent the long summers of our childhood, we needed some rules, to make the playground habitable. Like all playground rules, nobody remembers how these came about. They appeared at some point and evolved and matured over time. They are also unspoken. Which makes it all very daunting for the new kid on the block, cos there is no one to explain them to him. Most get by by watching and following what others do. Some make mistakes and get into trouble. If you are lucky, you get no more than a brief period of rejection, after which you are accepted into the fold again. But, by and large, unless they are arrogant and obnoxious, most new kids eventually become an accepted and comfortable member of the gang.
On flublogia, the most important playground rule is this: you have to support what you say by reason or by source. And the second rule is: You don’t have to be right, but you have to be sincere. You cannot say something just cos you say so, and expect other people to accept it unquestioningly. Like I wrote in my last post, we have no hierarchy. We respect neither rank nor name nor credentials, only open and sincere discourse backed by credible and verifiable sources of information.
The online community is passionate. They are also knowledgeable, but not in the traditional sense. Like all information on the internet, the knowledge is non-local. None of us know the answer to everything about pandemic influenza. But for each question, there is always someone somewhere who knows part of the answer to part of the question, even if it is just where you might find the answer. We use this ‘distributed’ knowledge to generate the more formal knowledge that you see on the wiki. We call this the ‘hive mind’. Anyone with a question or problem can tap into this enormous pool of knowledge and wisdom; all you need to do is ask, sincerely, and listen with respect.
Which is what I did, for help in writing this today. I posted a diary. I told my online friends I was uncertain what was the best way to approach the problem. I needed advice. I got them - input, opinions, advice, wisdom, all at the same time.
At the same time, I am also a free agent. I get to choose what to do with the advice given by others. They do not take me to task when I do not do what they suggest, as long as they can see that I have been sincere, and I can show them the reasons why I decide to act in a certain way. We respect individual freedom; we agree to disagree, on a daily basis.
Mr Secretary, you have at your disposal, should you choose to use it, an enormous, bottomless pool of resource and talent. More importantly, this is also an enormous pool of goodwill and support.
If you are deemed to be sincere, if you don’t talk down to people, if you don’t insult their intelligence, if you don’t make unsubstantiated or unreasonable statements and try to assert them by authority alone, the same passion that you have seen in the protests will be there to support the work that you do.
In the coming days and weeks, you will be putting out policies or advice that will ’sound alarmist’ to others. You have the necessary and unenviable task of waking up a sleeping, complacent, pampered nation to the harsh realities that a pandemic might bring. Many will not want to hear your message. Many will want to take their wrath on you, to shoot the messenger. Being a leader, by definition, you will be so far ahead of the people you are trying to lead that they will fail to understand you. The vast majority will not support you initially and for a very long period of time into the future. I guarantee that speaking the truth about pandemic risks will make you unpopular in many places. It will take a lot of courage to do what is right as well as what is necessary.
Mr Secretary, we on flublogia believe you have inside of you the kind of moral courage that is needed to get the job done. We know this, by the mere fact that you started this blog. We recognize the sincerity inherent in inviting one of the most active and seasoned members of the opposing party onto your podium today. These are not the acts of someone who is only interested in passing the buck. These, with respect, are the acts of a tempered radical. We in flublogia are mostly tempered radicals too, and we recognize one of our own when we see one.
Yesterday, in a meeting organized by Trust for America’s Health, they conducted an interesting experiment. They simulated the beginning of a pandemic outbreak, but, unlike most other exercises, they included a blogger as one of the players. What they found was instructive. While the mainstream media representatives were deciding what to go with as a story, the story was already on the blogs, and neither the President the governor nor the media could control the message. They discovered that, in the world of realtime blogging, nobody can control the message.
In preparing the nation for a pandemic, one of the big unknowns will be whether society will remain stable. Whether people will be supportive or suspicious of each other and of government. Whether they will comply with instructions for social distancing as well as going to work to support the infrastructure. Or whether they will choose to hide and greet strangers with arms of the cold and dangerous kind.
A few weeks ago, the whole world watched the tragedy of the abduction of four-year old Madeleine McCann from a resort in the Algarve. We learnt that precious hours were wasted that could have brought a happy ending instead of the present torment that her parents are going through. We learnt that the initial hours of any police investigation often decide the success or failure of the eventual outcome.
In a pandemic, what happens in the first five minutes will be crucial. And those five minutes will not happen at a quarantine center, at the CDC, at a hospital, or at the White House. It will happen online, within flublogia. The speed with which information, rumors, opinions, trust, will spread will only be limited by the capacity of the internet, which will still be robust enough, in the first five minutes. No one can control how those five minutes will play out; but goodwill, humility, willingness to engage, willingness to learn, will not go unremembered, in those first five minutes, and all the rest of the minutes and hours and days and months that will follow.
Mr Secretary, let me take this opportunity to wish you a very successful meeting that will not only prepare the American people for a pandemic, but will also generate the kind of goodwill that will see this nation through the most difficult times that a pandemic will bring.
Yours sincerely,
Posted June 14th, 2007 at 8:45 amSusan Chu MD
Editor, Flu Wiki
For those who are interested in how the ‘hive mind’ works, read part 1 of the Leadership and Moral Courage discussion, while I was collecting everyone’s input, here. There are some great and thought provoking comments, and the discussions are still going on!
Posted June 14th, 2007 at 10:09 amMr. Secretary,
People need more information. Cause no one is believing what is going on.
Posted June 20th, 2007 at 7:54 pmYou got to have media coverage. Show more movies and pictures of the pandemic. Get a grass roots movement going to educate the public. Get the public involved now. I am very serious.
I have been researching for 3 years about the h5n1 virus and what it can do to us.
Key word EDUCATE the public more.
GET it out in the news. NOW
Mr. Secretary,
This is what I as a indivual thinks needs to be done.
1. Plan to provide food for those who can not get enough food to survive daily let alone for a pandemic prepareness stockpile.
2. Lets get the plan going to make sure that all receive the medications they are willing to pay for to have ready incase they are not able to leave home during a pandemic.
3. Pamplets in everyones mail boxes alerting them of the pandemic. Educate them. Give them ideas of how to survive the pandemic. They will read it.
4. More info on how workplaces will function during a pandemic. I happen to work in a bank. And you know that they won’t close the banks. So I need some reasurance how I am going to be made safe during the pandemic. As well as others who must go to work doing essential jobs needed to keep running during a pandemic.
5. Educate the students in school about pandemic flu. Cause kids bring home all sorts of germs.
6. Plans to utilize civilians who wish to help during the pandemic. Give them ideas and guidelines.
7. We the people are ready to hear the facts that will help us survive.
My grandmother died of the 1918 in Massachusetts. I was drilled in my head the terrible thing that it is.
I hate to see others go uneducated.
She was very young and left my father a small boy alone. He took water to all the tents outside the hospital to the sick and dying people. It is a reality in my family what a Pandemic can do.
And will do. I have photos he kept of the flu tents. Miles of tents in fields cause there was so many sick the hospitals couldn’t hold all the sick.
I hope all that read here don’t take it lightly. And wake up to what is facing our nation.
Lets all unite and join together as one nation by the people for the people.
And make a difference to help man kind.
Don’t let this pandemic keep you from learning about it. Be strong and read all you can about it.
Education is the key to survival in this situation.
For now practice good hygiene. Be aware.
Be alert. For the signs.
Thankyou Mr. Secretary,
I have faith in you. You do a great job. A hard job a big task. But at least your getting the word out.
Mary
Posted June 20th, 2007 at 9:01 pmDear Mr. Secretary,
As a husband of a handicap woman and a father of two children. I find this pandemic to be very real and very frighting. Do to unforseen circumstances in my family. I work and don’t even make ends meet. I live in public housing. And not eligible for food stamps or health care. How are we suppose to put food away for this pandemic. And the food pantry we go to don’t give us enough food to be able to put any away let alone have enough for a family of 4 eat for 2 weeks.
My suggestion is maybe the food pantrys could give a little more food to families like mine to have to put away for a disaster or pandemic.
More needs to be done to help the less fortunate survive this pandemic.
Please help us. We need your attention and support on this.
The government may not be able to help during the pandemic. But they sure can help us now by bringing back the government butter, cheese, can meats, that so many of us need to make ends meet. It use to be called the commoditys program. That little extra food of dry eggs, powdered milk makes a difference in the mouths of hungry children.
Please don’t get me wrong. I work hard and just can’t make it. And have no idea how I make it through a pandemic without a little extra help getting a food stockpile together.
Thank you Very much for listening.
Posted June 20th, 2007 at 9:23 pmMr. Secretary.
Sincerely and Concerned parent.
Manuel
Dear Mr. Secretary,
I am sorry it is only in these final days before June 27th the real information blockage comes to light - local governments.
You have been to every state and outside the country. You have taken a risk with this blog. Short of mailing or calling each of us you have reached out.
It is the local public health and state governments that have not done more. They have been given the message, the manual for “State officials.” I have heard very little.
The government promotes the general good, it does not provide general good.
HHS monitors and sets guidelines so people know where problems are, what works and what does not. HHS does not hire local people to carry out those actions.
Stopping short of saying “Fire them”; I do hope your office is open to credible and documented reports of resistance to getting the message out.
It would be a shame if TPTB and the citizens got the message but middle management responsible for delivering the word did not.
Yes this puts more work on us in the field. However it seems logical. We know what is best for our area and can see if the work is being done. If people are responding or tuning out the message.
Importantly - during a pandemic the local folks will be making most of the decisions. We the people will do most of the suffering, crying, dying, burring the dead and dealing with the horror. Not HHS, nor TPTB but the local folks. Hence each city, town, tribe should be ready to act and protect its people with at hand people and resources not a call to Washington DC.
My concerns are: Our messages will not mesh.
Food banks will be seen as a solution even though they often get food near or at its expiration date - not their peak of freshness.
Food banks do not get the wide variety of goods - like powdered milk.
Food banks are not large enough to serve all.
The mentally challenged and others will not take advantage of food banks.
Some do not have storage room - they are living in hotels or temporary housing for battered wives/husbands.
The list goes on.
Do not get me wrong - TPTB are not off the hook.
I still expect our government to:
Developed vaccines, do and or promote research, apply pressure to distribute virus samples amongst countries & companies.
To leverage the incredible buying power of the feds so we the people can purchase a variety of PPE and supplies while companies re-coup delivery and manufacturing costs or even make a small profit.
To have non-biased testing of what works and what does not - then make that information available.
To help stamp out price gouging just because an emergency has been declared.
To investigate and prosecute counterfeit drug makers
I hope to have government support the clear message- Learn to be ready, prepare now. Have as much food and water on hand as you can - up to three months or more. Even if we only have small shortage - prices will skyrocket by the law of “Supply and demand.” Not everyone can shop at the commissary. Also in the message keep the food that is viable in case of power outage. If you want to know if your plan works - practice it for a week.
I am sad and bothered that we can not force people to prepare. Free will is free will. However we can make it so they can never say “Why didn’t you tell me?” if the local governments deliver your message.
SusanC posts “You have an almost bottomless well of talent, drive and people to draw from.” May we also see how much we can do.
Some sort of “In 2005 H5N1 was a small problem. It is growing. Do not loose sight of it. Celebrities like to make the news so please as good citizens balance the tabloid trash with something helpful like H5N1-Preparation is power. Be someone to look up to not only for your glamor but your actions.”
Regards,
Posted June 21st, 2007 at 8:41 amKobie
Dear Mr. Secretary,
I want to say thank you for your efforts. I paid attention and became informed, like many others, through the online forums. I mostly just read and learn all can while visiting.
I don’t think that the message has made it into the minds of your average citizen yet though. Since you mention more of a grassroots effort in preparedness and communities will be more or less on their own I have a question.
Why is it that you are not using organizations already established within communities to spread the word?
In my experience, so far, the government and schools in my area have done little to nothing to inform parents about the threat of a pandemic. My child’s school had said nothing. If you look around though you notice that the involved parents are the ones doing most of the work to improve the children’s lives and education.
Why not team up with the Girl Scouts, Cub Scouts, Boy Scouts?
The Boy Scout motto is “Be Prepared” and they have emergency preparedness built into their program. They teamed up with Homeland Security to have families be more prepared for emergencies by having an Emergency Preparedness Award.
You can read about it here www.scouting.org/pub…
In my area the same parents involved in scouting are the same ones running the PTO, coaching sports teams, teaching religious classes, and volunteering in the community.
In my humble opinion these are the people that everyone will turn to in a crisis and the ones with the skills to get a community through a crisis. They also are the ones with the connections to get a community prepared for a pandemic. These are the people that get things done.
Just my thoughts. I hadn’t heard this avenue mentioned before, so I thought I would.
Thanks for listening,
Posted June 21st, 2007 at 11:39 amA concerned parent
Why is surplus food not being made available to the people who can not afford to stock up for this Pandemic.
I can afford to prepare. But see so many who can not get enough supplies to be ready for this pandemic.
Who is going to help them now. Before the Pandemic arrives.
Are there plans to help hungry people who really try but just can not make ends meet.
This is America we should be able to address this issue now.
If we make a plan to distribute food to the needy to be prepared for the pandemic or during the pandemic. Won’t this cut down on civil unrest. Senseless fighting for the struggle to survive?
Posted June 21st, 2007 at 3:24 pmDear Secretary Leavitt,
Tomorrow June 27th the blog ends - but I hope not HHS conversation. Blogs will continue to refine and grow, leaving the average unformed person further behind.
The first post by GsCs was when - we all have our own opinions.
The second post of this blog was by Richard Mitchell, RRT-NPS who was trained Mass Casualty Care/Mechanical Ventilation asking how HHS will use him.
After that the messages had a common theme - The government can not do it all, local people must be prepared, the message is not getting to local governments or local folks.
Amongst all the statistics on the number of posts, web site visits, etc is the true result - cross checking of ideas and helping people moving on to make things better.
Now that we have been introduced help us help ourselves and others. On July 31st know that the “plans” are not getting down to those who must carry them out - the citizens.
Use Admiral Agwunobi’s line “How can you lead people who are not prepared to follow?”
Use E. Deming’s quote of “The only thing worse than training all your employees and having some of them leave, is not training any of them and having them all stay.”
Lastly it is hard to lead people when they won’t say where they want to go or when they want to get there. On this blog we want to go get ready and we want it as soon as practical. I am guessing the U.S. citizen wants HHS to help with their health during an emergency. While you have done your part - the message does not seem to get down to us. Please help us lead by publicly getting the message out to prepare.
Thank you - yes you. The bloggers (SusanC, Lugon, Gujo, ITW (Mr. Jensen),CottonTop,Atropine, Flutracker, StandigFirm, Dr.Dave, Bannor, ACM (actually above average) Grace RN, et. al. ). Thank you for the moderators and for working over the weakened, to those who worked behind the scenes.
Thank you to those who posted Dr Dworkin, Mr Coston, Admiral Agwunobi, Sister Talone, Mrs Patton, Mr Redlener, Mr. Ruesga, Mrs Weinreich, Mr. Pierre Omidyar, Dr. Benjamin, Mr. Leavitt as well as those at the HHS summit.
Dr. Dworkin says our posts make a difference. I trust him that they do. We have not only shown passion and commitment but insight and deep understanding of both the simple and complex parts of pandemic.
We the people where the first Army, the first Navy, the first citizens. Take us away and all you are left with are some buildings and papers. Having elected the president and all of congress as well as filling the ranks of the DoD with friends and family I believe we can be trusted to help with this too.
Best wishes.
Regards,
Posted June 26th, 2007 at 4:30 pmKobie
“If you are not defending the country - make it a country worth defending” - Kobie
Secretary Leavitt, you are either going to tell your fellow Americans to prepare for a very serious pandemic or you are not.
You are either going to tell them this before a pandemic is underway, or you are going to wait until it is here.
While so many committed citizens have lobbied long and hard here at the DHHS blog for you to make the most prudent decisions in this regard, I venture to guess that you have already made up your mind on this subject, or nearly so. You may fairly say in response to the repeated appeals here that “we don’t know if” and “we don’t know when” and “we don’t know which virus, or combination thereof.” Granted. We can conjecture, and we have here, but nothing is certain. As Dr. Dworkin has recommended, the Precautionary Principle should ideally figure as the conservative standard of guidance. You have a lot of leeway in answering these repeated requests to inform our fellow citizens in advance of a pandemic, Mr. Secretary, and I suppose in doing so you’ll make others happy, and some less so. Again, I won’t repeat their requests as I believe the near-term track has already been decided upon, and you will take whatever path you believe is most prudent in an effort to fairly handle these substantial unknowns.
Therefore, I’ll ask only this. Please, when you do know the truth, please tell it.
We can abide uncertainty, but not untruths.
Somewhere in the hierarchy below you, a mixed message is being dealt. Where it was birthed, I do not know, but it has led to double dealing with our public. Just today in the Palm Beach Post (FL) a news story ran this bit of information about what will happen “if the area becomes the target of biological warfare or a flu pandemic”:
“The county would receive immunizations from the strategic national stockpile within 12 hours. Those immunizations, in turn, would be sent to 45 distribution points where patients would be evaluated and volunteers would administer immunizations…”
www.palmbeachpost.co…
You and I both know this is untrue. But, now 200,000 Palm Beach residents believe it. My own area’s district health official believes it too – someone has told her the same thing. And we have heard of many, many others. We pick up these news stories all the time at the pandemic flu sites.
We know that no immunizations will be forthcoming from the SNS within 12 to 48 hours. You cannot stop a pandemic, Secretary Leavitt, but you can use your position to stop this pandemic of untruths that are being peddled to an unaware and trusting American public.
I hope you begin this effort tomorrow.
Further, many of us have heard tales of an/some extremely virulent “Atypical Flu A” that has circulated in the United States during the past several months. Requests for further information on the subtypes of these atypical flus made by family members have gone unanswered. If your agency, the CDC, is aware that a recombination or reassortment of seasonal flu with an avian flu has already happened and that it has been found in human cases in North America, the CDC has an obligation to tell both you and the American people this.
In early April, a perfectly healthy 15 year-old girl named Jessy who lived near me here in CT died as a result of a super-virulent “Flu A.” The story was run in our local press:
www.rep-am.com/story…
Jessy’s father, Joe, seeking further information about what might have happened to his daughter, also reported her story at PFI:
( www.singtomeohmuse.c…)
As reported by Joe, Jessy (a fine and healthy athlete) played lacrosse one Thursday afternoon on the local playing fields. The next morning, a Friday, she felt unwell, and visited the doctor. She tested positive for Flu A, but her lung X-rays were clear and she started on Tamiflu by noon. By mid-afternoon she began to cough up a little blood, and by 5:00 this had increased substantially. Jessy was taken to the ER. An X-ray at 9:00 p.m. showed that now her right lung was full. By midnight, a full team of specialists arrived from Hartford and Jessy was intubated, put on a respirator, and flown to Hartford. She was later flown to Boston, where some of the regions top infectious disease specialists tried to help her. They could not. The physicians in Boston asked Jessy’s family if she had had any recent contact with chickens or ducks. She had not, but she had played lacrosse on local fields here in the countryside of CT during geese migration season.
Secretary Leavitt, if “flu A” cases like Jessy’s are demonstrating signs of avian recombination or reassortment, the pubic deserves to know. You deserve to know, and CDC should be forthcoming to both our leadership and our public if this is already happening. Jessy is one case, a frightening virulent and fatal case of “flu A” that is nearly identical in presentation and outcome to the H5N1 cases I read about in the Indonesian press every day. If a virulent new H5N1-related flu arrive in a pandemic guise, Jessy will be only one tragic case among many, many, more young people. We need to keep our children out of such a storm. We need to be prepared. And we need the truth. (And, Secretary Leavitt, if you know more about what CDC’s investigations into Jessy’s flu’s subtype and sequences might have told, please let us know. Dr. Dworkin knows where to find those of us who are trying to help Jessy’s parents find these answers).
So please, Secretary Leavitt, it is true that there is so very much that is not known about a potential pandemic, about H5N1, about how human and avian virus combine to cause disaster. But much is known too. All we can ask is that you tell us the truth about that. Tell us the truth about what you do know. We count on you to act and to inform your fellow Americans in only the most ethical way.
Posted June 26th, 2007 at 5:50 pmDear Mr. Secretary Leavitt,
From May 24th to June 25th the WHO has confirmed 8 more H5N1 cases and 5 deaths.
Sources:
May:
www.who.int/csr/dise…
June:
www.who.int/csr/dise…
HIV /AIDS started out slow. We thought we could control it. It was a private matter.
Worse, disaster after disaster shows that most people are not prepared for short term simple events.
I believe we are not prepared for a long term disaster.
Disasters are going to happen. Any one who thinks a hurricane will never hit the US again is wrong. Any one who never thinks we will have a snow storm is wrong. Anyone who thinks we will never have a tornado or flood is wrong.
Anyone who thinks we will never have a pandemic is wrong. Pandemic happen. I hope everyone believes the scientists and the historians, not just the few hundred folks following H5N1 closely.
Lets not squander the opportunity to strengthen our selves, survive the pandemic and learn lessons to save our grand children from the next disaster.
The virus is not going away. The virus is not dying out.
History and science has shown that you can win the lottery. History and science has shown that pandemic happen and people die. H5N1 does not require you to buy a ticket nor go looking for it. Fact H5N1 will spread on its own. It will come to us.
Regards,
Kobie
P.S. This blog is ready by many. Americans and allies and those who are not allies. Using strategies from the middle ages there are several High concept, low tech attacks that can be carried out against either us or our friends. Hence, these letters are cut short.
I trust those in power are taking care of this as are our allies and friends. I can save my family but not my country. I do not want to emerge from the pandemic only to find the legs have been cut out from under the government and military. How is the military to continue if there is no one making their fuel, the food, the ammo, the parts. How is the military personnel to continue at their job if all they hear is pain and fear at home. Pain not from an enemy but something we let happen.
Kobie
Posted June 27th, 2007 at 8:34 am