Effect Measure

Border state flu planning

The headline — U.S. border states preparing for pandemic flu threat — sounded weird, but this is about some good ideas. The weird part was expecting this was about hardening the borders to keep bird flu out. In fact, however, it is about something much more sensible: the clear understanding that this virus doesn’t care about political borders:

California and Arizona, two states bordering Mexico, are working together to address the emerging threat of an influenza pandemic.

California Governor Arnold Schwarzenegger and Arizona Governor Janet Napolitano have co-sponsored a joint declaration at the on- going 24th annual Border Governors Conference to establish a border state council to coordinate regional response and preparedness. The council will focus on both preparedness and response.

The Governors also invited other border governors to send their experts on public health, wildlife and agriculture to a meeting in California in November to assess the council’s progress and plan next steps.

[snip]

Napolitano said the border states “have accomplished a great deal by working collaboratively on a number of issues and pandemic flu is no exception” and “this will enable us to work more closely on our protocols already in place.”

The constant, international movement of people, goods and services has increased the nation’s vulnerability to a global pandemic. (Xinhua)

The states intend to work with Mexican counterparts to coordinate pandemic flu plans. Mexico has excellent public health scientists, so this is a logical and useful step. In addition, there are a number of specific points to the coordinated response:

  • Surveillance and detection: Develop a comprehensive surveillance and detection program, with special emphasis on monitoring death and disease among birds in critical wetland locations, and develop procedures to watch, detect and respond to avian flu in domestic bird populations;
  • Biosecurity: Strengthen border biosecurity to minimize the illegal transport of wild and domestic birds and products contaminated with avian flu.
  • Public health: Enact methods to monitor, detect and respond should people become ill with avian flu. This effort will include assessing education and training needs region-wide, producing influenza planning materials for use by national, state and local governments on both sides of the U.S.-Mexican border, creating joint contingency plans and testing emergency responses;
  • Information sharing: Share information on surveillance and detection;
  • Planning: Include border states in binational preparedness planning and require that states produce and enact work plans annually that outline cross-border preparation and response;
  • Funding: Provide dedicated funding to the border region for public health emergencies and fund coordinated wild and domestic bird surveillance, response and information sharing through the U. S. Department of Agriculture and Department of Homeland Security;
  • Flexibility: Give border states the flexibility to use federal funding most appropriately.

Rational, forward looking, commendable. Now they need some help from the federal governments in the US and Mexico. A day’s worth of Iraq War expenditure ought to do the trick.

Comments

  1. #1 william
    August 26, 2006

    Border state flu planning for H5N1 is good. But what is not good is the possible inability of the Mexican government to implement the plan after September 1.
    What is being ignored is Mexico may be near a violent revolution. For those who read Spanish, please go to
    http://www.jornada.unam.mx/2006/08/26/index.php
    In La Jornada, you can read about what is happening. On July 2, Mexican citizens went to the polls to elect a new president for 6 years. There was massive voter fraud. On September 1, President Fox will name Felipe Calderon of the Pan party as the president of Mexico. This will happen in the congresional building in Mexico City. That building will be surrounded by a 2 meter metal fence. There will be army tanks, Mexican Army troops, and federal police surrounding the building.
    In the state of Oaxaca in Mexico, the teachers are on strike. Governor Ruiz has lost control of the situation. The teachers are demonstrating in the streets, and blocking the traffic. The police at times shoot the demonstrators.
    The teachers are trying to take over and destroy the local TV stations. An engineer for one of the local TV stations was shot and killed in the rioting. The governor has asked president Fox for federal assistance.
    The problem is that presidential candidate Andres Manuel Lopez Obrador claims he won the election. But President Fox insists Felipe Calderon won. Those voters who voted for Andres Obrador are convinced Obrador won the election.
    In the Mexican Revolution of 1910 an estimated 2 million Mexicans died. If Mexico blows up on September 1, or at some later date, there will be a massive attempt by Mexican citizens to enter the US to escape the violence. And if a bird flu pandemic hits, many of these Mexican may be infected with H5N1. This will require a draconian response by US government officials to control the situation on the border with Mexico.
    Please remember the US imports vast quantities of oil from Mexico. That may soon stop. If you thought the situation is Iraq is bad, just wait until Mexico becomes a failed state on the southern border of the US. “You ain’t seen nothin yet folks.”

  2. #2 Man of Misery
    August 26, 2006

    Interesting commentary. It doesn’t quite square with other accounts. Yes, Obrador and his supporters claim he won. Calderon and his followers beg to differ. A partial recount gave the victory to Calderon. Various news sources, including those who support the leftist agenda (www.politicalaffairs.net “marxist thought online” and Worker’s World at http://www.workers.org “workers of the world unite”) state that JMLO is alienating his supporters by his stridency. Having said that, there are legitimate questions about the election and the transparency of the recount. (see http://www.democracynow.org/article.pl?sid=06/08/24/1425237)

    In the teacher’s strike, they first took over a public radio station. When the governor sent in troops, who shot at the teachers and then trashed the station, the teachers fled and took over several privately owned stations.

  3. #3 M. Randolph Kruger
    August 26, 2006

    William and MoM. The suggestion of a draconian response to a massive attempt to breach our borders has been discussed and planned for years. This response was originally planned when Daniel Ortega then President of Nicaragua attempted to invade Honduras and then Mexico in the 80’s. His plan: Start a refugee surge to the north into the underbelly of the US of Mexcians, Salvadorans, Guatamalans, intentionally bypassing Belize which would have brought the Brits into it.

    Our plan? Stop it at its source and that was to first massively bomb the invaders of those countries (Nicaraguan troops) and then regime change. We did that. Ortega started with 600,000 and he left with 100,000 thanks to R. Reagan. Its a war that never occurred and you never heard about. IF the situation crumbles to our south, the immediate response will be to invade Mexico. Its easier to do that and implement new elections that would be internationally overseen than to let it go to hell in a bucket. It would finally change all of the problems that the 30 families in control of the country are causing. I can only imagine what would happen to those people if they started flooding into NM, AZ,CA and Texas. Use of refugees as a weapon is grounds for invasion under the UN Charter. Its deliberately left ambiguous but its there and believe me, we will do it if it becomes necessary.

    A little political freedom is a dangerous thing.

  4. #4 Name
    August 26, 2006

    Cross border planning is also happening in the Pacific NW, with lots of talk about coordination between Oregon, Washington & BC on the Canadian side.

  5. #5 K
    August 26, 2006

    M. Randolph Kruger – please cite documents or links to articles to support your contention about Nicaragua. The folks I know who were working in Nicaragua with Habitat for Humanity never heard of this. The Nicaraguans were dirt poor, but beginning to do better under Ortega. After Ollie North and his boys funded the contras by selling weapons to Iran (oh my selling weapons to evil Iran) Nicaraguans became even poorer.

    Hmm Michael Leeden was involved in all that. Perhaps he created that story about the Ortega Plan to justify the Contra affair. Same Micheal Leeden who was involved in the forged document that helped get us into Iraq.

    http://en.wikipedia.org/wiki/Iran-Contra_Affair

  6. #6 Charles Roten
    August 27, 2006

    OMG.

    Now people are freaking out about the Mexican border.

    In the Mexican Revolution of 1910 an estimated 2 million Mexicans died. If Mexico blows up on September 1, or at some later date, there will be a massive attempt by Mexican citizens to enter the US to escape the violence. And if a bird flu pandemic hits, many of these Mexican may be infected with H5N1. This will require a draconian response by US government officials to control the situation on the border with Mexico.

    William, in all likelhood, the variant of H5N1 which hits us will, among other things, be using birds as vectors.

    What this means is that border control is a lost cause. If we sealed the land border tighter than a drum, which we have never managed to come even close to doing, the pandemic would still fly right over the heads of the watchers.

    In fact, even the birds will get there late, if the SARS experience is any guide. H5N1 will walk right off of a 747 at LAX or Seatac or JFK in the body of someone who isn’t symptomatic yet and has no idea they are even ill.

    Within one or two weeks after that, four on the absolute outside, it will be coast to coast.

    The hypothetical Mexican refugees will have to worry as much or more, themselves, about migrating right smack into a plague, as we will about whatever they’re carrying.

    M. Randolph Kruger: I would be pleased if you tendered us some actual hard evidence that Nicaragua was planning an invasion of Mexico. But I would also be quite surprised. You have never before handed us any substantiation of your wilder claims besides hot air.

    And …

    A little political freedom is a dangerous thing.

    Never thought I’d see you in full agreement with V. I. Lenin about anything.

  7. #7 Ron
    August 27, 2006

    So far the history of avian flu has been the flow from the US to Mexico. Mexico’s principal anti-flu activity involves monitoring areas of US for flu outbreaks and banning trade from those areas before the virus can be introduced. An example is the ban last month on poultry products from Michigan after the detection of H5 there.The last serious AI outbreak (that I am aware of) was introduced from poultry products from Pennsylvania in the 1990s.

    The flow of poultry products from the US to Mexico is still the major threat for Mexico, even more than migratory birds (though the trade now goes both ways, thanks to Tyson chicken and Pilgrims) so the image of gringos worried about them rebellious Mexicans infected with H5N1 violating their border is actually kind of laughable.

  8. #8 Trina
    August 27, 2006

    I think h5n2 is endemic in Mexico. Did they ever have an outbreak of h5n1?

  9. #9 Ron
    August 27, 2006

    So far no H5N1 has been detected in Mexico

  10. #10 mary in hawaii
    August 27, 2006

    Charles r: Regarding what you said about the most likely way of H5N1 spreading: ” H5N1 will walk right off of a 747 at LAX or Seatac or JFK in the body of someone who isn’t symptomatic yet and has no idea they are even ill.” This is of course absolutely true, and is the biggest concern that I have with the widespread prophylactic use of Tamiflu in flu outbreak regions, without the concurrent quarantine. (I thought quarantine or isolation of public in areas where Tamiflu was used in this manner was in the WHO protocols…but I may be remembering wrong. I’ll have to go look it up). Point is: if tamiflu truly masks the symptoms, then it increases the risk that someone who is asymptomatic could hop a plane to anywhere in the world. I know that risk already exists, but it seems like we increase it many-fold by this blanketing treatment.

  11. #11 mary in hawaii
    August 27, 2006

    Okay, I took the time to go to the WHO website and look up their draft protocols for containment of an avian influenza pandemic. Although strictly speaking (as far as what has been made public) the criteria for a phase 2 containment has not been met (see page 10 of the Draft): ie, there has not been “two generations of transmission in a health care facility” involving at least “one health care worker”, WHO none-the-less has responded to the Cikelet outbreak with what is inarguably a Phase 2 containment response, by employing “Mass antiviral prophylaxis”…which it does NOT do in phase 1 situations. (see pages 10-14 of the WHO draft.)

    But they are doing only a partial Phase 2 containment strategy, omitting the other important social distancing or quarantine protocols. They may believe this compromise was the best solution, since there is still uncertainty regarding whether the outbreak meets all criteria for what they term “exceptional measures”, and social distancing and quarantine are, in their own words, “socially disruptive.”

    However it is possible that they erred here, being human, in that the widespread use of tamiflu as a preventative without the concurrent quarantine/isolation could do more harm than good in allowing asymptomatic carriers to spread H5N1 (just as it seemingly does in poultry populations.)

    Also, someone in an earlier post to this blog stated that a cluster of >25 cases was the WHO benchmark for upgrading the situation to a stage 4, where these kinds of containment strategies would be put into effect. I am a little confused about the terms Phase (which seems to be concerned with containment measures, and is only either Phase 1 or Phase 2 in this WHO draft) and the pandemic alert stages, (in which we are currently stage 3 possibly 4). The criteria in the WHO draft for a pandemic Phase 2 response states there only needs to be “Moderate to severe respiratory illness (or deaths) in 5 to 10 persons with evidence of human to human transmission in at least some…..At least 2 of these persons should have laboratory confirmed H5N1 infection.” If they say 5 to 10, where does the idea that WHO has a ‘cluster >25 benchmark’ come from?

  12. #12 mary in hawaii
    August 27, 2006

    Here again! I went back to the WHO website to find the answer to my own question. On the November 2005 WHO GLOBAL INFLUENZA PREPAREDNESS PLAN, page 8, it says under Phase 4 “Small clusters with limited human to human trqansmission, but spread is highly localized.” and then goes on to say under “Examples: One or more clusters involving a small number of cases, e.g. a cluster of < 25 cases lasting < 2 weeks.” Ah, the difference the little arrow makes! LESS than, not MORE than 25 cases. Phase 5 is “25-50 cases lasting from 2 to 4 weeks”.

  13. #13 mary in hawaii
    August 27, 2006

    lost the last part of that transmission. you’d think I was on a cell phone! Anyway, Phase 4 is a cluster of LESS THAN 25 cases lasting less than 2 weeks and Phase 5 is 25-50 cases lasting 2 to 4 weeks.

  14. #14 Jon Singleton
    August 27, 2006

    Mary in hawaii: “However it is possible that [WHO staff] erred here, being human, in that the widespread use of tamilflu [in response to the Cikelet outbreak] as a preventative without the concurrent quarantine/isolation could do more harm than good in allowing asymptomatic carriers to spread H5N1 (just as it seemingly does in poultry populations.)”

    Mary, thank you for your research and postings — your statements are exposing the nub of this apparently evolving H2H-H5 pandemic.

    Using your language, I too wonder ’bout this prophylactic use of Tamiflu in flu outbreak regions, without concurrent quarantine, vis a vis the increased risk of an asymptomatic (H2H?) H5 carrier moving round metropolitan areas and/or traveling overseas, unwittingly exposing the virus to many others.

    Strangely, the n-inhibitors might become the medium through which this virus eventually spreads and H2H evolves in human populations — WHO should become more watchful and guarded with both the tamiflu and quarantine protocols due to this new and bizarre fact.

    Cheers:*) and Aloha pumehana — Jon

  15. #15 Kevin
    August 28, 2006

    Let’s not forget there are lives at immediate risk from B2H / A2H infection. H2H at the moment seems rare even with symptomatic humans. There is not much evidence for asymptomatic infection of humans period, let alone H2H spread via asymptomatic carriers. If viral loads are in fact reduced to undetectable levels with Tamiflu treatment, H2H is improbable. Quarantine individuals taking Tamiflu prophylatically? Impractical for several thousand people anywhere, never mind rural Indonesia. I concede issues with with incomplete treatment regimes and possible development of resistance ( in the event an individual is both on Tamiflu and infected ). Speculation is fine, but in the affected areas, lives are at immediate and measurable risk from B2H/A2H.

  16. #16 Tim B
    August 29, 2006

    Jon Singleton, You have a misunderstanding of what scientist believe is causing chickens to be asymptomatic carriers of H5N1. Its the widespread use of vaccines not antivirals that’s making experts on H5N1 concerned that poultry populations are continuing to spread the desease unnoticed. This gives the virus a place to become entrenched and the time it needs to quietly mutate into a deadly pandemic.

    What concerns me with using Tamiflu blankets is the risk that the virus might mutate into a Tamiflu resistant strain. Tamiflu and social distancing are the only defenses we have against this very frightening virus. These blankets are risking losing the only defense you’ll have if you do become infected. H5N1 has given us many suprises. If the WHO doesn’t become more guarded in using the only antiviral we have against this tricking virus the next surprise might be a Tamiflu resistant strain.

    If that were to happen and you’re a health care worker would you go to work or stay home to protect your family. A Tamiflu resident avian flu pandemic would create a very scary situation. Borders wouldn’t matter much if this were to happen and the death rate remains close to what it is now.

    OK, I just scared myself. It’s off to Costco tomorrow to restock all the supplies I’ve eaten lately.

  17. #17 Marissa
    August 29, 2006

    Mary, thanks for finding the numbers on the phases. I was scratching my head trying to find their origin!

    I’ve said many times I’m against tamiflu prophylaxis except for healthcare workers. Reason? Zero monitoring. H5N1 has already demonstrated an annoying tendency to mutate in the presence of this drug. If you blanket an area with tamiflu that has individuals infected with H5N1 and you don’t have 100% compliance, you just increase the chances for resistance developing. Dozens of papers on the subject with various antibiotics. Anyone know what dosages they’re using in Indo? 75 mg daily is too low, in my opinion.

  18. #18 Jon Singleton
    September 1, 2006

    Re: Human infections/deaths with/of H5N1 in Cikelet, West Java Province, Indonesia:

    Heya Kevin and Tim B,

    In an earlier response to Mary, I was voicing a shared opinion on probable (((FUTURE DIRECTIONS))) of H5N1 on the basis of Cikelet, West Java Province, Indonesia:

    The proverbial legal jury is still out on H2H H5 and has had to timetravel draft-in computer techies from a probable future (a small joke re: Terminator 3 movie on television this weekend in Oz) to analyze the computer hardrives of WHO, Recombinomics et.al. to find out what is going on re: confirmed H2H H5 cases — eg. WHO post mortem data on familial clusters!?!

    Anyway… Yes, a B2H/A2H infection paradigm has been the mechanism from 1997 to present. I agree with your comments Kevin and also those of Professor Guan Yi (see Reuters article below) re: A2H, “Indonesia should do more animal surveillance and understand how the virus behaves…”

    But! But it’s n-inhibitor misuse/overuse which might become the medium through which this virus eventually spreads and H2H evolves in human populations — as I said, “WHO should become more watchful and guarded with both the tamiflu and quarantine protocols…”

    Cheers:*) and Aloha pumehana — Jon

    PS: The late reply is due to my current legal victimization by a homophobic Federal Australian government body called Centrelink — a social security agency which refuses to pay me money causing my downward spiral into the debt trap.

    WHO.com — Avian influenza situation in Indonesia update 28 (21 August 2006)

    http://www.who.int/csr/don/2006_08_21/en/

    Excerpt: [Human deaths within the remote Indonesian subdistrict of Cikelet, West Java] from respiratory illness are known to have occurred in late July and early August, but no samples were taken and medical records are generally poor. Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans…

    Recombinomics.com — Evidence of Human H5N1 Transmission in Garut Cluster (August 22, 2006)

    Excerpt: [The gap in familial cluster] disease onset dates indicates the patients who died earlier infected the patients who tested positive later. Although the disease onset dates may not be available, the early dates for the deaths would also indicate there was human-to-human transmission…
    http://www.recombinomics.com/News/08220603/H5N1_Cikelet_Evidence.html

    AlertNet.org (Reuters Foundation) — Expert calls for animal surveillance in Indonesia

    By Tan Ee Lyn

    HONG KONG, Aug 31, 2006

    http://www.alertnet.org/thenews/newsdesk/L31473621.htm

    Excerpt: More troubling, there have been clusters of human infections and in at least one case, health experts have been able to confirm direct human-to-human transmission of H5N1.

    Although the virus remains largely a disease in birds, there are fears it might mutate and become easily transmissible among humans, setting off a pandemic that could kill millions…

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