Inside the White House Plan for the Pandemic

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A poultry worker disposes of dead chickens on a farm infected with a milder type of avian flu virus on the outskirts of North Tuddenham, Norfolk, England, on April 30, 2006.

Don’t count on just vaccines, or only the feds. A White House report establishing a national response to a global disease outbreak, including bird flu, warns that state and local law enforcement may have to enforce isolation or even quarantine procedures in certain cases to try to contain the pandemic. Such measures, which would be undertaken with the help of the National Guard, illustrates the profound potential consequences of a severe flu pandemic, which could require medical care for a substantial percentage of the world’s population, close schools and businesses and disrupt government services when they are needed most.

"Our efforts require the participation of, and coordination by, all levels of government and segments of society," President George W. Bush writes in a letter at the start of the report, adding that the nation has already "taken a series of historic steps to address the pandemic threat."

The red, white and blue, 227-page report is partly a plan for other plans, encouraging businesses and state and local governments to prepare for a flu pandemic just as they would for a terrorist attack or natural disaster, and not rely on the federal government to do everything. Amid increasing reports of bird flu in Asia, President George W. Bush released last November the "National Strategy for Pandemic Influenza," which set out a broad vision for preparedness and response, and today’s more detailed document is a blueprint for implementing that plan.

David Heyman, homeland security program director of the Center for Strategic and International Studies, praised the White House plan for placing "a greater emphasis on non-pharmacological interventions" than in previous reports, including Bush’s plan last November. But he said "much more needed to be done," including providing more specific guidance to cities and states about what they should do.

The report, aiming for a tone that is realistic but not alarmist, said a pandemic would have "significant ramifications for the economy, national security, and the basic functioning of society." The report cites a Congressional Budget Office estimate from December that a modern pandemic could lead to the deaths of 200,000 to 2 million citizens. And it points out that even people who are not infected could miss work for weeks because of the illness of family members or public-health guidance to limit contact with others, threatening "the functioning of critical infrastructure providers, the movement of goods and services, and operation of anchor institutions such as schools and universities."

Guidelines for business range from the obvious to the disconcerting:

— Clean sinks, handles, railings and counters more often, since the virus can live for up to two days on such surfaces.

— Disinfect phones and keyboards.

— Reduce face-to-face meetings that are unnecessary, such as among colleagues working on a joint project.

— Keep three feet of distance ("spatial separation," in government-speak) among individuals. Other "social distancing measures" include staggering breaks, establishing flexible work hours and locations, and encouraging telecommuting.

Administration officials, backed by experts, have decided against sealing borders with Canada and Mexico in the event of an outbreak. The report says that "would likely delay but not stop the spread of influenza to the United States, and would have significant negative social, economic and foreign policy consequences." Alternatives include screening of people entering the United States, possibly with checks pre-departure, en route and upon arrival, because of the flu’s typical two-day incubation period. Still, for all its detail, the report is a reminder that the nation, as Bush is fond of saying in the context of terrorism, "safer, but not yet safe."