“Thank you, Matt, please call me Tom. I appreciate this opportunity to talk about the recent developments in China.”
“First, could you describe the Department of Health and Human Services’ role in preparing and responding to a pandemic.”
“Gladly, Matt. This department has many roles, all critical to our nation’s robust capability to deal with a pandemic. First, our encompassing goal is to implement the national strategy to prevent or slow a pandemic flu’s entry into the United States, to limit the domestic spread of the disease, and to mitigate disease suffering and death. All while sustaining the nation’s economic and essential services infrastructure. The bottom line is that DHHS is responsible for building an infrastructure to detect and respond to an outbreak.”
“Tom, that sounds like a momentous task. How is it possible for a department of the government to implement and monitor such a broad-reaching goal? Frankly, some experts just don’t think it’s possible for one department to accomplish these goals, or they question whether your department has the reach and authority to enforce the national plan.”
“Well, you’re right when you state that we can’t possibly do this alone. It would not be possible for us to oversee implementation of every aspect of the national plan, or enforce it, as you say.
“DHHS directs each state, county, city and organization to create their own strategies and procedures, aligned with the goals of the national pandemic response strategy.”
“You’re talking about the 381 page national plan?” Matt asked.
“Yes, the very one. Our department empowers local governments to build partnerships with health care facilities and community leaders, and to develop an effective communications infrastructure for the timely dissemination of information. This will also be a critical aspect of a pandemic response, and DHHS has recently completed a major upgrade to the communications components. One that will facilitate communication on a local level. First, a national emergency satellite broadcast system just came online a few weeks ago, which will give anyone with access to a GPS receiver, GPS-enabled cell phone, satellite radio or home satellite service full access to national emergency information. Best of all, each state will have the capability to stream information to the satellite system for rebroadcast to local responders and civilians. This system was spearheaded by DHHS and will play a major role in the event of any emergency. Matt, almost every cell phone built today is GPS-enabled. This puts the information right at everyone’s fingertips.”
“This certainly sounds like a major improvement over radio and television broadcasts, which could be subject to power failure. Given the current situation, when will information regarding this system be given to the public and local government?”
“Already in progress for local and state governments. The full send and receive capability should be rolled out to them within the next few weeks. As for the public, they can find all of the information they need on the DHHS website at dhhs.gov under accessing emergency satellite broadcast.”
“Tom, back to the idea of delegating implementation to local governments. We’ve heard from several experts who all agree that the national plan is solid, but argue that very few of the recommendations have been implemented because federal funding is simply unavailable. We’ve heard some sobering statistics. Some citing a compliance rate of less than 10% with national plan recommendations. Most states, cities and towns don’t seem to be able to find the money within their own budgets to implement your recommendations, and little money is flowing down from Washington. Critics also suggest that most of the money that the Congress and Senate is willing to allocate to pandemic response is heading overseas to fund the WHO.”
“Certainly these critics like to point fingers at Washington whenever they can, but several reviews and accounting estimates conducted by our department indicate that implementation of these strategies would costs very little in terms of money. Are they time intensive, requiring the cooperation and effort of numerous local organizations and governments? Absolutely. A pandemic is a complex emergency, requiring an effective and coordinated response on many levels. Preparation for a pandemic is similar in scope. The bulk of the costs occur once the pandemic strikes, and when this occurs, each state and local area will receive disaster area level funding to ensure continuity of pandemic response operations.”
“I don’t know if I agree. Let me read directly from the DHHS manual. ‘Ideally, states develop a multilayered strategy that delineates responsibilities at all levels of society to ensure the viability of government functions and services, such as energy, financial, transportation, telecommunications, firefighting and public safety. This strategy will assist businesses and utilities with continuity of operations, collaborating with the healthcare sector on issues like stockpiles, available beds, isolation and quarantine plans, surge capacity, personnel protection, communications links and pharmaceutical supply and distribution. It will coordinate offsite treatment and triage locations, medical stations, and implement a mass fatality plan.
“Tom, this sounds like an expensive proposition. My parents’ hometown can barely scrape together enough money to repair minor damage to its roads. If not from the federal government, where will we get this money?”
“Well, first, I don’t agree with the statistics that claim only 6% of national plan is implemented. We’ve seen amazing progress throughout the nation, without reliance on more federal money. An appropriate level of funding is available at all levels, for implementation of the plan. However, this is not the first time we’ve heard this criticism, and as a department, we are working hard to increase funding of these grants. Our goal is to develop and implement a comprehensive national pandemic response strategy, and if more money is required, then we will take the case to Capitol Hill.”
“I hope that the system, as it stands today, will be effective enough to deal with a crisis, if one arises.”
“Matt, since 2008, our nation’s pandemic response capability has been vastly improved. From vaccination production and research capability to antiviral stockpiling. We learned a lot from the avian flu and applied those lessons to the national plan in place today.”
“Speaking of today. What is DHHS’s primary goal or concern today regarding the crisis in Asia, and what part of the national plan is being implemented?”
“We are working in close coordination with the CDC and WHO to receive real-time information regarding any and all aspects of the crisis. Our number one priority will be to prevent this disease from entering and spreading in the United States. Currently there is no indication that the disease has spread outside of China, though we have activated passive foreign traveler detection protocols. In essence, customs officials have been alerted to identify and track any travelers arriving on foreign flights that appear ill.”
“Will these travelers be detained?”
“Not under passive protocols. Active protocols require a massive personnel increase, as you can imagine, and are implemented when it is certain that a pandemic-grade illness is headed to our borders. Passive protocols will flag these travelers and their destinations, so that they can be contacted if they are later suspected to be infected by a pandemic disease.”
“Has DHHS considered the possibility that the mystery disease has already entered the U.S. in considerable numbers? For nearly three days, travelers have left China for the U.S. and hundreds of other locations abroad. If the disease originated in China, this seems reasonable. If the disease originated somewhere else, like China claims, then the same theory applies.”
“We’ve definitely considered this, however, the number of passengers traveling to the U.S from China in a two-day period is small. We are tracking all of these passengers and taking steps to ensure that if any of them are sick with this disease, they will be treated immediately. The travel ban on China is still in effect, given the circumstances, which ensures that we are dealing with a finite number of passengers that we can track. DHHS, along with the WHO, feels confident
that disease is limited to China. China’s own detection and response capability is first rate. We have been assured by the Chinese that only essential travelers departed China during the time in question, and that these passengers were screened prior to leaving the country. Even if their screening didn’t catch all of them, our screening will, as will the efforts of our neighboring countries. Right now, we are taking the appropriate steps given the information available. And the information is flowing much more effectively than in 2008. The Chinese, in particular, have stepped up and taken responsible steps to ensure unfettered access for international response teams and to open critical lines of communication between our nations.”
Morning View interview with ISPAC Co-Founder
Early November 2013
“Welcome back to the show. Unfortunately, Dr. Gustafson had to cut the interview short to handle an emergent development. However, in the brief segment before commercial, it became clear to our viewers that two clearly opposing viewpoints exist regarding the current pandemic threat. Where does your organization plan to go from here?”
“Matt, I hope I didn’t run Dr. Gustafson out of town, so to say. He is a very brilliant doctor and scientist, but I gather the sense that his common sense and true opinions are being held hostage by the overwhelming and overreaching bureaucracy of the WHO and its parent organization, the United Nations. Where do we go from here? Well, our organization is minute compared to the WHO and is mostly an investigative and research body.
“Our main objective is to learn as much as possible about this new virus. We know it’s highly contagious, or transmittable. We know it’s highly pathogenic, meaning that if you are exposed to it, you are very likely to get sick from it. What I’d like to know is H16’s behavioral timeline once a patient is infected. A behavioral map. This is important. How long does a patient remain asymptomatic, no detectable symptoms? How long after infection does it take for the patient to start shedding the virus, or spreading it? How many days does a patient shed the virus, while showing no symptoms? This is especially critical, since this is when a patient is likely to spread the flu most. When they have no idea they’re carrying the flu, and neither does anyone else. Business as usual. Other things I want to know is the average ratio of new cases caused by a single case. This is hard to determine, but very useful when projecting disease transmission.
“Then, we want to know about the symptoms, especially the progression of symptoms. Is there an immediate risk of death like that seen in the 1918 Spanish flu and seen in very limited numbers in 2008? How long typically until pulmonary complications arise? Everything, Matt. The more we know, the more we can predict and help direct national and international strategy. Once this data is available, we can establish clinical attack rates and case fatality rates, god forbid.”
“How far away are you from establishing this behavioral timeline?” Matt asked.
“I am pretty sure we have a rough timeline now, but it is very rough. We’ve only been in the field observing and testing infected patients for a few days. Ideally, you would want to observe a patient that was presumably healthy, came in contact with an infected individual, then contracted the virus. The earlier we start observation and treatment, the better. We have plenty of those now, but the majority of our cases have been sick for close to a week, especially those from Indonesia. At first we rely exclusively upon anecdotal information to establish a patient’s timeline, then as more patient data is available, we can more accurately establish the timeline. Sorry if I sound like I am dodging the question, Matt, I believe a rough timeline will be available shortly, possibly in the upcoming press release.”
“Thank you, Dr. Ocampo, for our viewers, we’ve just been informed that this information update will occur at 9 a.m. Eastern Standard Time, and we will certainly cover this release, live on this channel. Dr. Ocampo, before you get back to work in Atlanta, do you have any recommendations for our viewers? Something they can do right now to help prepare and protect their families from the possibility of a deadly pandemic.”
“Sure, Matt, but let me make one thing as clear as possible. This new virus is not a possibility, it is a reality. H16 will spread around the globe like any other pandemic. I truly believe that containment is no longer a viable option, unless an immediate, massive effort is undertaken by the WHO, with the cooperation of every nation on the planet. Unfortunately, I can’t imagine a scenario in which the WHO can get its resources out of China quick enough to lead this effort. With this being said, individual families can log on to our website and obtain pandemic preparedness checklists, or call our toll-free number and this list will be read by an automated system. The best way to safeguard your family is to execute as many items on those checklists as possible, starting from the top of the checklists. The more important items and tasks are listed first.”
“Can you give our viewers more specific advice?”
“Sure, just remember that the lists are detailed, but if you start at the top, you’ll hit the most important items. As for specific advice, in a nutshell I would recommend that you buy as much nonperishable food and water as possible, avoid contact with others, practice the personal protective measures, PPMs, identified on the lists, and make sure you have a way to stay warm, especially with winter descending. There is just no predicting the extent that the pandemic may affect essential services, so you should try to arrange for temporary, or if possible, permanent sources of heat and electricity. Also, buy a hand-cranked radio, so you can receive local broadcasts that may contain important information. I can’t stress enough how important it is to maintain social distancing. This will cause an uncomfortable feeling of isolation, but it is the single most effective way to avoid the pandemic flu. That’s the quick version, Matt, once again, I urge everyone to visit our website or call our toll-free number, which I am being told right now is displayed at the bottom of your screen.”
“One last thing before you leave. Have you heard any talk about research into a vaccine for H16?”
“Matt, everyone is talking about it. I can guarantee everyone that the issue of a vaccine is a top priority. I’d be surprised if work on the vaccine has not already begun.”
“Will your organization be involved with the vaccine research?” Matt asked.
“Not directly. This will be a coordinated effort between the bio-pharmaceutical industry, DHHS and the CDC. Most of the top research and development will occur in the private sector.”
“Thank you very much, Dr. Ocampo. Best of luck to you and your teams, and we extend our prayers and hopes for the team in Indonesia.”
Joint CDC and ISPAC Press Conference
Early November 2013
Alex was sitting by himself on the brown leather love seat in their family room, waiting for the live broadcast of the ISPAC information update. The Morning View had cut away to a live picture in a large conference room with stadium seating. The camera was focused on a podium to the left of a large, wall-mounted screen. The picture on the screen featured both ISPAC and CDC logos, side by side. Another podium flanked the screen on the right side. The setup reminded Alex of the Iraq War briefings he’d watched when he returned from the war. Rumsfeld and all of his pentagon lackeys just bullshitting their way across every living room in America. The information at the bottom of the screen told Alex that the broadcast was “Live from CDC Headquarters in Atlanta, Georgia.”
A man and woman, both dressed in business attire, walked to the middle of the stage, shook hands and then separated, taking positions behind opposing podiums. To Alex, it almost looked like the start of a debate. Alex recognized Dr. Allison Devreaux, of the ISPAC, as she settled in behind the left podium.
“Ladies and gentlemen, thank you for your attendance. We have a lot to cover, but before we start, I would like to introduce Dr. Joshua Relstein from the CDC, who has an exciting announcement. Joshua.”
“Thank you, Allison. I am proud to announce that the CDC and ISPAC are formally joining forces to coordinate pandemic effo
rts abroad and, most importantly, here at home in the U.S. This strategic partnership, formed in time of crisis, will focus the world’s best scientific resources against the growing pandemic threat. We have received a similar pledge from the European Union’s European Centre for Disease Prevention and Control (ECDC), which occupies a similar role for the EU, as the CDC does for the United States. We welcome their cooperation with open arms. Thank you, Allison.”
The screen changed to a world map, showing red triangles all over East Asia and the western Pacific Rim. Dr. Devreaux adjusted her microphone.
“This unified front is critical in the fight against a very rapidly spreading pandemic virus. As you can see on the screen, as of this morning, CDC, ISPAC and ECDC field teams have confirmed H16 cases in over 85 locations mainly spread throughout the Western Pacific and Southeast Asia. Cases have been confirmed as far away as Cairo, Pakistan, and India. U.K. health officials confirmed that the suspect passengers caught yesterday were indeed sick with H16. Cases of interest, CIs, are being reported from several major European, Middle Eastern, and African cities. Currently no CIs have developed in the Americas. We have prioritized and are responding to each of the reported CIs. Additionally, the CDC, in conjunction with Roche pharmaceuticals, has developed simple H16 detection kits for local hospitals around the world. Soon, our teams will not have to evaluate every CI in order to confirm H16.
“Every hospital and clinic worldwide will have the capability to isolate and identify the H16 virus, just like they can identify any of the previously known disease and virus types. Until just yesterday, the world had never seen H16, so not even the most sophisticated medical centers could have confirmed the cases without these kits. H16 is now in the world library of identifiable microorganisms. These kits are being sent everywhere, via the fastest delivery available, just as soon as they roll off the production line.”
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