Effect Measure

The overlooked flu planners

An excellent article on the CIDRAP site by Maryn McKenna (late of the Atlanta Journal Constitution where she had the CDC beat) won’t be news to readers here, but it is news that it is news. The subject is efforts by non public health types in preparing for pandemic influenza. McKenna notes that recent reports by two different but highly regarded groups has noted that governmental planners are not making full use of grass roots groups outside of professional boundaries. In fact they aren’t making use of them at all. Communication with the public is one way.

The first report, “Community Engagement: Leadership Tool for Catastrophic Health Events,” was published Apr 4 by the Center for Biosecurity at the University of Pittsburgh Medical Center (UPMC). The report, which sums up the findings of a 27-member panel convened by the center during 2006, asserts that official planning incorrectly assumes the public will panic and create a “secondary disaster.”

“The civic infrastructure” comprised of the public’s collective wisdom and capability to solve problems; voluntary associations (both virtual and face-to-face) that arise from shared interests or a public good; and social service organizations that look out for the well-being of various groups?is essential to managing a mass health emergency,” the report says.

“US homeland security and health emergency policies, however, do not adequately reflect the civic infrastructure’s proven contributions in catastrophes. Nor have most top officials yet realized the potential value for local and national communities–and for themselves–of preparing knowledgeable, trained networks of constituents who can mobilize in a crisis.” (Maryn McKenna, CIDRAP)

The second report comes from the Institute of Medicine (IOM), the medical component of the National Academies of Science:

The report quotes Jason Corburn, assistant professor in the urban planning program at Columbia University, New York City: “Engaging community members and their knowledge about how they move through the world, and what they know about their disease management and exposure risks in their community, can contribute to better science and policy.”


“The rational planning unit is the neighborhood,” [risk communication expert Peter Sandman of Princeton, N.J.] said in an interview. The ideal planning unit “wants to be geographically compact, it wants to be something with more storage capacity than individual homes, and it wants to be something that, when government has its hands full, can be autonomous.”

This is the moving idea behind The Flu Wiki (our sister site) and McKenna appropriately quotes my Wiki partner DemFromCT:

The central cyber-site for pandemic planning is the FluWiki, a sprawling collection of thousands of collectively assembled posts that has garnered 1.5 million visits in its 22 months. In FluWiki’s earliest days, participants anonymously shared advice about preparing their own households, said Dr. Greg Dworkin, a pediatric pulmonologist in Danbury, Conn., who is one of the site’s volunteer editors under the name “DemfromCt.”

But in recent months, he said in a phone interview, participants have begun reaching out to each other through pages dedicated to US states and foreign countries and have begun sharing strategies for area preparation and for communicating with public health agencies and local governments. At the same time, a few planning agencies have begun using the site as a resource; the New York State Department of Health, he said, posted its draft guidance for using scarce ventilators during a pandemic to the FluWiki before the document’s public release.

Michael Coston (A Flu Diary), Crawford Kilian (H5N1) and Debi Brandon (A Bird Flu Journey) are also given thmbnail sketches and quoted. It’s nice to see flublogia given its due. Through McKenna’s story CIDRAP now becomes the third important source to point to the vast well of knowledge, wisdom and expertise being overlooked by “official” planners. She points to a few exceptions (Berkeley, California and Seattle-King County health department), notable for being so different. As for the rest, it is a case of blindness and misconceptions about “the public.” This is a prejudice that is difficult to overcome. Too bad for everyone concerned.

I have only given a few excerpts from this substantial piece. Give it a read (here).


  1. #1 Tom DVM
    April 19, 2007

    All efforts by this volunteer community are repeatedly destroyed by authorities false assurances.

  2. #2 M. Randolph Kruger
    April 19, 2007

    Tom-It is said that it will go something like this and you already know most of it. First we will get the warning signs which most will discount. Second will be the actual large size clusters and the media will hype it to no end. At that point in time it will already be too late for many, many people that will be just going about doing their jobs like nothing is going on and mostly because thats what the government tells them to do. Then it arrives in your (our) little hamlet. The number of cases will overwhelm all medical care facilities of all kinds. Medical supplies that ranged in the two week supply will be almost instantaneously used up.

    Bigger cities will actually cope less capably than little ones. The ones that are high density will suffer all sorts of problems and more so where its cold. If the power grids snap, they wont be back for months. Lack of food, water, medicines, you name it it wont be there for you to trot down to the corner store to obtain. Nor in many cases will it be there for an extremely long time. Fire is a distinct possibility. Cold will become a factor too. MegaCity arrangements such as LA, NYC, Atlanta, Dallas, Boston where there are miles upon miles of nothing but rooftops will break down completely. Chaos at the least, anarchy at the worst.

    Its all on the assumption of a 5% CFR too. What if its worse? Piling on is the term. It would just be in orders of magnitude after even 3-5%. I think we could weather a 5% and maybe up to a 8% but after that its every man for himself with a slow recovery to sanity as the wave dissapears.

    After say three months and all that were going to go went, we would be like a post Katrina society as all would be in the world. Some worse, some better, some a lot better. For those Congress and Administration haters, I dont think that the bunker is going to save them. Someone will walk in with it. A rat, dog, cat some vector of some kind will be through the door and infect someone. In those enclosed spaces of the protected bunker, they will have all the supplies they need and an enclosed area to infect too. Chances are that they wont fair any better than us.

    Fact is that the noise I have seen from just about every government on this planet has been that there is no need to panic, go about your business. All the while they are laying out cash like Kevin Federline spending Britney Spears money to “process” the problem. Thats pretty much how I know its coming, cash. No government spends cash they dont have unless its totally necessary. Indonesia was to cull birds and get money for compensation. All it did was boost the bird production when they should have been killing and sitting it out for a couple of innings. They did and didnt and we have them interecepting bird shipments out in the Java Sea to buy cheap birds now. Malaysia and Mayamar interestingly dont show the first case of human infection, but how could that be. So plenty of governmental butt covering going on.

    Will we see a pandemic of bird flu? That is the 3.4 trillion dollar question for the US and lesser degrees of money for other countries. The toll wont be just money, it will be people too. Worst case 3-4 billion people. Everyone can start a pool and all you have to do is survive and put in a number and pay a buck to enter. What a pot that would be if put up worldwide as to what the winning (losing) number would be for CFR.

    Could we stem CFR’s. Some I think. Thats just BF CFR’s though. I look at what my state is doing and its just now weighing in on them that just having Tamiflu around just aint going to get it. Everything from emergency legislation to preparing for a food event of some sort has to be done and even then it still wont change too many outcomes at least for now if they get it. Vaccine we need, vaccine we dont have, vaccine we likely wont have if the processes are understood to make it in quantity and time arent there. We simply dont have the resources and wont.

    Doom and gloom? Hell yeah. But I quote V, from yestedays Vaccine Dreams. Its exactly what a Colonel told me once and it was in a combat situation. Being what it is, I didnt know it was a current version of an old quote. The Colonel said, “Always assume the worst, then plan for it, mitigate and then look for a sign of weakness, and exploit it. ”

    V’s quote, “”Some people believe that everything will turn out for the best, they are therefore destined to be disappointed. I on the other hand prepare myself for the worst, should it not occur, I am delightfully surprised.” and she attributed it to Benjamin Franklin.

    Logistically the ability to prepare doesnt exist either to take care of our 300 million. They are working on that but the tactics that will be used will be brutal to some and the ACLU will have a field day afterwards if they are around. Take a look at the faces the day after Katrina that were on the tube. Its like I said long ago that the first effect will be – astonishment.

  3. #3 SusanC
    April 19, 2007


    One of the best piece of mention that Flu Wiki has gotten recently, is from the Indonesian press. http://www.newfluwiki2.com/showComment.do?commentId=42638 Hat tip to Katy at PF!

  4. #4 SusanH
    April 19, 2007

    In my local county public health office, we have been doing exactly what was suggested. For over two years, our major focus is to educate our communities about what a possible pandemic could do and work with them in ways to prepare. We had a Pandemic Tabletop and out of that came our “Community Pandemic Planning Committee” made up totally of various interests ie. hospital, media, business, Homeland Security, fire, law, elected officials, and anyone else that wants to participate. We meet monthly and will meet whenever we think something is happening.

    We have had our local grocery store have a reduced price caselot sale with information on how to stock up for at least 6 months. We are working on a project to have some kind of ribbon system to use on homes that indicate if everything is okay, or someone is ill, or there is a dead body in the house etc.

    Since we are very small communities, everyone works somewhere for a living and then wears 2 or 3 different volunteer hats, so our group is extremely well rounded. Our attitude is no one is coming to save us….we must save our selves and our communities.

  5. #5 DemFromCT
    April 19, 2007

    SusanH highlights that many local PH departments from Larimar County, CO to Seattle-King County are trying hard to do the right thing. They generally get little credit amongst the carping about places that aren’t yet up to speed.

    Don’t paint everyone with the same brush. The fact is that the CDC NPI mitigation plan has pushed the issue down to the states where it belongs. The problem isn’t just (lack of) funding, it’s infrastructure at the state level. if there’s time, this will be a huge help. As Randy says, ‘when’ is the big unanswered question. Given enough time, we will get there. If it happens now, we are screwed.

    Both reports that CIDRAP mentioned need to be read. Monica Schoch-Spana at UPMC notes that the grass roots should not miss what PH is doing, just as PH should not ignore the grass roots.

  6. #6 DemFromCT
    April 19, 2007

    PS Efforts by the American Red Cross are appreciated as well. There’s more to PH than the government.


  7. #7 M. Randolph Kruger
    April 19, 2007

    Imagine my concern level when at an local EMA meeting I found that the Director had never read the NPI, and didnt even know the symptoms of BF. The EMT’s did, but said they didnt have equipment to even hang over the face of the sick. Oh, they had masks okay but only filters for a week before they would plug in high volume environments. I now know the full symptoms of BS.

    I guess my big question is going to be that all things being equal which they aint, at what point in time will they toss the towel in each state? Here is my thought on that. Once BF arrives in most places so far it becomes endemic in everything from the local dirt, to birds to whatever. Its there. If we hunker down for for months while someone else gets it other than us, whats to say that it doesnt just keep hammering us after the first wave? Is it thinkable that it might?

    Adaptive mutation would mean that the vectors stay there for way too long a time. I got six months of food right now, fuel that I figure will allow me to get the news, power the freezer and fridge for three hours a day and solar powered LED’s for lights. You all know my position on ammo and weapons and we wont go there. BUT, what if it does become near permanently endemic. We would become scarecrows and at about the 8-12 month mark and its adaptive and endemic this nation along with all the others would cease to exist. Could it take the population down to zip? Could it be an extinction level event?

    I guess what I am saying is “what if” and I have run this out to the logical conclusion for what we have seen so far. It would take some sort of intervention such as a vaccine to make it go away and we are YEARS away from that even with the Sanofi Kool-Aid that was made.

    52 is looking pretty good right now in the CFR’s, but I am betting that the number on the older ones is going to change dramatically to the higher side as it finally wedges itself into us. I may be off base on this of course but what happens if it goes endemic, stays around and reassorts, recombines every year or so? H1N1 is out there just waiting to do one or the other and could go pandemic itself again. A lot of what ifs and the preparations are all good to date, but really what if.

    Revere, does the current pattern of BF mate up with 1918 pretty well IYO?

  8. #8 Lea
    April 19, 2007

    MRK: you’re not off base on your thinking, it’s interesting to see where the mind leads individuals. lots of unknowns in this world and it’s the not knowing that gnaws at people, or makes them nervous.
    don’t really follow the notion that mankind would be extinct because of an endemic although the thought that it could keep “hammering” us is not out of the question.
    we’ll see won’t we? it’ll be interesting to witness the changes on the globe and perhaps even changes in the way mankind treats one another.

  9. #9 Earl E.
    April 20, 2007

    Lea–I heartily agree with your statement above:

    “It’ll be interesting to witness the changes on the globe and perhaps even changes in the way mankind treats one another.”

    I don’t think anyone can argue that mankind treats each

    other well at present. If there is one good thing that

    can come from a severe event, it is that people find they

    need one another, and need to help and respect one another.

    In one community—–many, many different talents in many

    people are right there—–ready to benefit the whole community.

    These talents will come to light once the initial shock and terror subside.

    When all people are humbled—when all are at risk—when anyone—no matter how much money they have—has the same experience—–things may change for the better.

    I HOPE!

  10. #10 Lea
    April 20, 2007

    Thanks Earl E.
    And yes, humility, it’s almost as if it’ll be forced on people. Imagine that!

  11. #11 M. Randolph Kruger
    April 21, 2007

    The Prez is requesting an additional 7 billion for this stuff now. The Dems in Congress are going to have to have humility and definitely come off of their horses in a hot and fast hurry. This could become the political debate of the next 10 years. With a request for 10 billion to fight it in, the Dems arent going to be able to “Blame Bush” for bird flu. Its time to fire up those emails, faxes and letters again – I get the distinct impression from Osterholm, Gellin, Webster that time is very likely running out.