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October 23, 2005


Every community in America would go on red alert. At that point, the federal government "can't come in and take over," Libbey said. "The math alone just doesn't work."

Even more so, because human spread of the virus is likely to originate outside the U.S. Our federal government can't go in and vaccinate all the birds of Indonesian duck farmers (and use the good stuff). We can't impose "clean days" once each month in Chinese markets.

Will we limit entry to the U.S. from people who live in or have visited southeast Asia? Even U.S. citizens returning from there? Should we?

It's a short fix, if a fix at all. If the rest of the world comes down with a deadly flu, the U.S. will be affected.

Thinking locally is important. But I guess the big question for the CDC & other federal health agencies, is how well can the U.S. government control a duck farm half a world away?

it can't. that's why preparation has to be done at this end of the world.

PS. see this.

(I guess not all those airports have international terminals though.)

I'm having a hard time picturing what happens in a few years if avian flu spreads rapidly in those other countries, even if we are well-prepared at home. How long we can stay healthy under any circumstances, as the world becomes the equivalent of a crowded airplane cabin full of sick people coughing. And even if we stay healthy, how we'd do without all those people in the world. Spiritually, in one sense, since it's still Sunday morning, but economically too. I guess I'm saying that the attitude, "we can't do much there, let's stay focused on here" seems like a hard line.

(I guess not all those airports have international terminals though.)

25% or so of international travelers go through 5 airports: LA,SF, Chicagom detroit and NY - with connecting flights. Once they land, they disperse very quickly to the little ones.

Imagine a busy day at O'Hare, and then the next day everyone on flight 801 gets ill. where are they now?

"we can't do much there, let's stay focused on here"

The most important thing we can do is there, but you have to understand that you can't stop a pandemic. If everyone was open and transparent in Indonesia and China (not!), you still coudn't do it and that hardly the case today.

Therefore, you have no choice but to prepare here, whoile you try to help everyone else. This is not US-centric, it's part of what's needed. see this.

Great reference there -- for anyone else reading who likes to skim, jump to this part to read about action abroad.

The key questions: Will the government of Vietnam, Thailand, Cambodia, or Indonesia know promptly if it encounters a cluster of bird flu victims, suggesting that the virus may be acquiring the knack for h2h transmission? Will it tell us what it knows? Will it tell us when it’s not sure yet, just suspicious? Above all, will it let us take our own blood samples?... And ask yourself how cooperative you think the United States government would be if the positions were reversed — if some other country wanted access to a U.S. patient’s blood in order to develop a vaccine that U.S. citizens were unlikely ever to be able to afford ... or even offered a chance to buy.

Where there has been almost no action so far, as far as I know, is international pandemic preparedness. Suppose prevention fails and we end up facing a severe pandemic, a rerun of 1918? What can we do together now to make that eventuality less horrific for us all? What are our chances, for example, of working out a way to keep travel and transport operating? (Our experts will tell us that quarantines are hopeless and pointless beyond the very earliest phases of pandemic spread; our intuitions and politics will tell us to try anyhow.) What are our chances of coming up with humane ways to address the inevitable border tensions when people start trying to flee from places where the virus is hot to places where, at the moment, it is not?

Exactly. Not trying to minimize local preparedness. Just wondering, what are we forgetting?

Hong Kong has done a good job addressing it. I wonder if, politically, there are ways of exploiting the latent competitiveness (is that right?) between Hong Kong and China to encourage better Chinese health policy. Use China'a nationalism in their own interest (and ours).

as to Hong Kong, we're trying to learn from them. See here.

You're bringing up the right questions, 'pockets. I wish we had more answers.

PS if you ask me a Q where I don't have a reference, I'll be forced to find one and add it to flu wiki.

I blogged a list of points a plan should include, based on my reading of The Great Influenza, about the 1918-19 pandemic. Points such as these:

* All city and town administrators (city managers, mayors, councilmen, etc.) notified of steps to be taken in event of pandemic (school closings, closing movie houses, cancellation of events with large public attendance, temporary hospital openings, etc.)

* For each city, town, and state clear (and lengthy) lines of succession for all critical positions of authority--i.e., who succeeds to a position in the event the current holder is incapacitated, dies, or cannot be located. Positions for which such succession must be defined include civil authorities, police chief, health authorities, coroners, fire chief, and the like.

* How to keep essential functions operational even when many personnel fall ill--e.g., combining fire stations if there are too few ambulatory firefighters at a station to effectively fight a fire.

excellent, LG. necessary and helpful.

My experience in Indonesia during the SARS epidemic indicates to me that you can forget stopping bird flu arrivals from that part of the world unless you block EVERY incoming flight from east of Hawai'i.

On my trip from Singapore to Denpasar, Bali, in March 2003, we all received poorly translated, badly printed (as in some words illegible) little what-to-do-if squares of paper. These listed some symptoms and advised anybody with them to head for a doctor. I would guess 90% of those wound up in a trash basket before recipients left the airport. On a more recent trip, they were still passing these out, though SARS is not much threat these days.

Denpasar isn't a huge airport, but it's international and hundreds of thousands of tourists fly into and out of there everyday. If a human-to-human flu virus shows up in large enough numbers in Jakarta, it will be in Denpasar soon enough. From there, the largest share of tourists fly to five destinations in Australia every day, Taipei, Singapore, Kuala Lumpur and, through connecting points, to San Francisco and Los Angeles.

If I get human-passed bird flu on Wednesday, fly out of Bali on Friday, what I've been reading indicates that a bunch of you could have the disease by Monday.

Ooops! Hundreds of thousands of tourists every day? Try thousands.

South American parrot died of bird flu while held in quarantine in Britain.

The virus is not necessarily in South America -- the parrot may have contracted it from Tawainese birds it was housed with in the quarantine facility.

Besides the content, placement of this story is noteworthy. It was placed in the topmost featured headlines on NYTimes online. Twice recently friends have asked me what I thought of the bird flu news. People are listening -- they don't know what to do, but they're listening.

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