Effect Measure

The military and pandemic flu

The US military didn’t plan for the aftermath of Iraq. You know, controlling the civilian population? So they’ve learned their lesson. You gotta plan for it:

The US military has begun to plan for a possible avian flu pandemic that could kill as many as three million people in the United States in as little as six weeks, a Pentagon planning document said.

The Defense Department’s “Implementation Plan for Pandemic Influenza,” which was posted Wednesday on a Pentagon website, lays out guidelines and planning assumptions for US military services and combatant commands.

Possible scenarios include US troops being called in to put down riots, guard pharmaceutical plants and shipments, and help restrict the movement of people inside the country and across its borders.

The plan envisions fast moving, catastrophic waves of disease that would overwhelm health facilities and cripple the ability of state and local authorities to provide even basic commodities or services. (Agence France Presse)

Their planning assumes a “fatality rate” of 1% (p. 8), while the AFP article says the planning is based on 3 million deaths (1% of the population) so presumably the 1% number is not case fatality ratio but population mortality, but I couldn’t find either CFR or total mortality in the DoD document. Either way, this is far below the current case fatality ratio for H5N1, although a 1% population mortality is arguably about a 1918 level (3 – 5% CFR based on 20 – 35% infection). The document acknowledges that quarantine is a non-starter. In general the planning seems to envisage support of civilian activities, including support activities, quelling civil unrest and protection of critical infrastructure.

I’m glad they are thinking about what to do if there is a major pandemic. In actual fact, however, they will be struggling to keep their own operations going while caring for their own dependents and personnel. Like other communities, they’ll also be on their own.

I don’t think we’ll get much support from our troops.

Comments

  1. #1 Pixie
    May 11, 2007

    It’s unlikely we’ll see any official planning documents that project the CFR will come in at any level higher than that experienced in 1918. The decision to utilize that estimate is a political one, and I doubt it will be changed until experience here on the ground forces a change.

    Revere, have you seen this new DoD document as well?

    Pandemic Influenza: Clinical and Public Health Guidelines for the Military Health System (23 April 2007) http://fhp.osd.mil/aiWatchboard/pdf/piclinicalphguidelinesmhs.pdf

    It presents a great deal of sound guidance for clinicians and others dealing with the just prior to Phase 6 portion of the pandemic. Much of what we’ve all learned from places like Indonesia seems to have been incorporated there.

    However, the majority of the paper does concern the time period before the virus moves into Phase 6. There is not too much delineated for Phase 6 itself. It seems that at that point, many of the outlined strategies would have failed, and the silence on strategies for that portion of the pandemic seems to imply that the only remaining one would be to just get through it, somehow or other.

  2. #2 revere
    May 11, 2007

    Pixie: Thanks for the link. Hadn’t yet seen it (like a lot of other stuff, alas).

  3. #3 Nick
    May 11, 2007

    There is a lot more about the DOD’s planning here: http://fhp.osd.mil/aiWatchboard/index.jsp

  4. #4 crfullmoon
    May 11, 2007

    Would have less riots to plan on
    if they’d tell people Pandemic Year Preparedness is Patriotic
    (and, unavoidably necessary).
    Oh well…

  5. #5 Tom DVM
    May 11, 2007

    …and the estimate of collateral damage?

  6. Here is a link to how Monty Python saw the aftermath of a pandemic, in their video:
    Monty Python: Not Dead Yet -Bring out your dead!

    I apologize in advance, if any of the “boffin” sensibilities in this blog are offended by the Python humor:)

    http://www.youtube.com/watch?v=kuvB7j9n-II&eurl=

  7. #7 revere
    May 11, 2007

    ” apologize in advance, if any of the “boffin” sensibilities in this blog are offended by the Python humor:)”

    You’re joking, of course. Aren’t you?

  8. #8 DavidK
    May 11, 2007

    Meanwhile,
    in a small country far away:
    ===============
    Exercise Cruickshank, the first pandemic exercise involving all government and health sector agencies, was aimed at strengthening the country’s Influenza Pandemic Action Plan.
    Yesterday, table-top exercises and a simulated response to a pandemic were held at most international air and sea ports.

    It was the first day of a four- day exercise, costing about $750,000, aimed at testing border control, quarantine and hospital plans, disease containment, deployment of antiviral drugs and establishment of community centres to assess and treat people with influenza.
    Ref:
    http://www.stuff.co.nz/4056120a10.html

  9. #9 Anne Laurie
    May 12, 2007

    I kind of assumed that the intense network-news coverage of the “official” reponse to the latest Midwestern tornado disasters — specifically, the governor of Kansas ranking on Teh Decider because the Kansas National Guard has most of its heavy equipment and too many of its troops occupying Iraq — was the Nonofficial-Official MSM-Government shorthand for “Hey, Americans? Whatever bad stuff happens in the next 18 months, don’t look to either your federal or state governments to rescue you, ‘kay? Because all the ugly footage after Katrina — well, it’s not just poor non-white Americans your government doesn’t give a flying frig about anymore. The Privateers, er Privatizers, have won the argument, and everybody not in a Blackwater-protected gated community is officially expendable.”

    Because these days, Americans have come to treat the MSM the way people in the former USSR used to treat Pravda… which is almost as discouraging as the world of pain that the thugs now in possession of the Oval Office have put us all into.

  10. #10 M. Randolph Kruger
    May 12, 2007

    Uh guys….I believe that there was these little wars called WWII, Korea, Vietnam and that those thugs that were in office then treated us no better. Its Congress and not the Administration that is responsible. Even the fixes for Walter Reed are in the appropriations bill for Iraq. Want to talk about crimes…. pick a war, get a dart board of Presidents and put them all up there and throw a dart and hit one. It still wont hit the people that are most responsible.

    The Governor of Kansas by the way has made no requests for any equipment other than federal disaster assistance. No one is going hungry, no one is on a roof top and the most that they need right now is roof tops… The rest are gone in a town of 10,000. Fact is they were damned lucky to lose as few as they did. But… Hmmm GWB has to be at fault because he is in charge of global warming which MUST have caused a tornado. Anyone seen Dorothy and Toto, we need them for yet another fantasy. Bush Bashing has become an art.

    As for this 1918 1-5% event stuff for the flu, someone and somewhere better get their asses wired back to their heads because I havent seen anything approaching 1% for the people who get it since it was officially called novel. Without a vaccine it wouldnt matter if the equipment was across the street or in Iraq, the outcomes would be except in the most miniscule of order …the same.

    It simply will not make a difference where the troops are when it happens other than physical location.

  11. #11 revere
    May 12, 2007

    Uh Randy: You may have been in the military, but I’ve worked for the VA. Everyone bears some responsibility, here, including the Republican Congress, but the DVA is in the Executive Branch and they also make the budget requests and tell their cronies who were in charge in congress for the last 6 years what the priorities are. You are just wrong on this one.

  12. #12 Melanie
    May 12, 2007

    Randy,

    You are wrong on the facts. Gov. Sibelius made repeated requests for equipment.

    Bush’s budget request for next year includes a 2% cut for the VA, while we are in the middle of two wars.

  13. #13 M.Randolph Kruger
    May 12, 2007

    Just as the Dems were in charge of DVA when my Dad reported to them and given a number to investigate a service related injury to the throat. He was given a number and a year later he was dead. Nice if they had just put him in front of a doctor…. Our GP finally got him but it was too late. That injury point was from being on the deck of the Ranger when it was under attack. A bullet went down the bore of a 4 inch gun and exploded the warhead just as the breech was closed. Threw shrapnel into his neck. Not much… it was just contaminated with fulminate of mercury. The resultant tumor finally closed the carotid off and he stroked.

    To the end you know he never blamed anyone for the way things are Revere. You would never, ever, hear him denigrating anyone or especially the country. He didnt blame the government for having a tumor either. Both he and I have seen a lot worse and we didnt have to do anything but walk out the door and drive ten minutes south. All of these programs to enrich our society have made us so dependent on government. No personal responsibility. Its management by committee in this country which allows for no one to be responsible directly. Those programs and thats what they are will be gone permanently if BF breaks out. Anyone who thinks that we as a country will survive intact in anything larger than 5% or so is nuts. Leave the equipment in Iraq…. We will just have another program to buy more equipment to prop up the economy.

    As a side note, those trailer homes in Arkansas are heading to Kansas at direct order of the President.

  14. #14 M. Randolph Kruger
    May 13, 2007

    Melanie… as with Blanco…. No formal request was made for federal disaster assistance until about a day or so afterwards. Nor did the good governor specify as required by the law (you folks have heard of that now havent you) what was needed. As with Blanco this ambiguous problem solving is first blame Bush for tornado’s, second blame Iraq if you have 10,000 people with problems because their houses are on the ground. Give me a break!

    Folks you have to understand. There is federal disaster assistance, and there is federalization. I havent seen anything other than a request for comm support. The town is gone…. cant fix that overnight. But hmmm… the Governor is running for reelection and its hard to blame oneself when you havent followed the law. As with Blanco mobilization requires a federalization request. If GWB mobbed up say the 3rd Herd and sent them in, they would impeach him. Goofball Governor knows that and probably never thought it would happen on her shift. So she didnt make her request, when she did it was improper in format and she got shit.

    The USGOVT pays 80% of the budgets for the states to maintain a National Guard. The troops were activated under a federal order. Michael Dukakis tried the same thing with Bush1 and he lost big time. He tried to withold those troops on the premise that something MIGHT happen. Every loser Dem wanted a reduction in the general force levels as a part of the Peace Dividend….. Uh-huh. We had so few tactical aircraft that they had to move the ACC to Milano for Kosovo…How come Clinton gets a pass when he starts a war that we are still in? 50,000 troops are over there. Tell you what. Get the Governor to call for that equipment from Hillary. I am sure it will carry a lot of weight with her. By the way, everyone including the governors and legislatures agree to provide those troops in a national emergency or war by law. Dont call the president. Call your state legislature and governor.

    Its nothing more than another Bush Bash opportunity. It gives them more points to throw at Iraq. I want you all to take the opportunity to start down the alphabet and pick something and go ahead and bash Bush up and dont forget to add the war in there too. Its over now in just under 17 months. What are you going to do then? We will still be in Iraq and if we pull out then Saladins resurrection will start. It ends with a nuke on one end or the other.

    As for the 2%. Yup you are right. Its mostly because the surge in Iraq is going to cause a surge in the VA. But once they are gone they wont need the budget. Most of the WWII’s are going in the next ten years, Korea is fast on the heels, and Vietnam hits the lower tier about now. The complaints are there, just as they were during Vietnam, Korea, and WWII.

    As for the VA problem, take a number. The line is going to get shorter very soon.

  15. #15 g510
    May 14, 2007

    Re. responsibility: How many times I’ve heard, “it’s safe, we’ve got insurance.”

    Think about that for a moment: how does having insurance make something safe? This is pure magical thinking, that a talismanic piece of paper changes the conditions of physical objects and live bodies. Instead of taking responsibility for actual safety (or whatever) in its physical sense, that responsibility is shuffled off to the insurance agency.

    All insurance can do, at most, is pay money that will allow certain types of damage to be repaired and certain types of objects to be replaced. Insurance doesn’t prevent hazards or accidents any more than praying to the asteroid god prevents asteroids from hitting the earth. Yet it is used as an excuse for failing to take responsibility for physical conditions and events.

    And it hapens all the time. And it goes to show that Big Government isn’t the only cause of people acting irresponsibly.

    “Smart Eight-year-olds Want to Know” Dep’t:

    “Daddy, why are you building another wood house right where the tornado wiped out our last wood house?”

    So a tornado wipes a town off the map and then they talk about rebuilding. Are they going to rebuild all the houses in reinforced concrete? Or are they just going to rebuild a bunch of stick-frame houses with minimal added protection? And why the hell would anyone want to rebuild more of what just got blown to smithereens? And why would we even tolerate taxpayer money being spent for doing so…?

    Hint: In the globally-warmed future of increasingly violent storms and extreme weather, the rule ought to be: If your town is wiped out, the only way you get money to rebuild is if you do it in a manner that can’t be wiped out by a repeat performance. Yes that means that towns wiped out by floods could only be rebuilt after dams or levees were put up, or would have to be rebuild on higher ground. Yes that means that towns wiped out by tornados would have to rebuild with ferrocement or reinforced concrete, or all the buildings would have to be underground (there are ways of doing this that still give you windows with outdoor views).

    But if we’re talking about taking responsibility for anything, we ought to start by challenging the proposition that people can keep rebuilding the same old stuff and we’ll pay for rebuilding more of the same old stuff each time it gets wiped out, over and over again. Once is enough.

  16. #16 ExtremeIII
    May 14, 2007

    You may be interested in what the GAO had to say about the DoD Pandemic Influenza Implementation Plan: http://www.gao.gov/cgi-bin/getrpt?GAO-06-1042 . Not a scather, but reveals more fundamental problems with the DoD’s ability to pull off such a complex undertaking (like no real accountability and no real resources behind the plan).

    The other thing you all might find interesting is to look through pages 21-31 of DoD’s plan. It gives quite a bit of insight into the current state of affairs in military public health which, if you read between the lines of this document, it seems is just as atrophied as public health is in the rest of the country.

    At least this plan seems to put emphasis on public health (they seem to be building public health capacity throughout the document) as the main means of addressing pandemic influenza.

    EIII

  17. #17 crfullmoon
    May 14, 2007

    (I wish g510 was the decider-guy) …”the rule ought to be: If your town is wiped out, the only way you get money to rebuild is if you do it in a manner that can’t be wiped out by a repeat performance”…

    Should also be the rule for any new construction or renovation in areas that have floods, tornadoes, earthquakes, hurricanes, wildfires…

  18. While the medical response to pandemic flu will be important to controlling its spread and limiting its toll, there are considerable non-medical issues related to flu preparedness that are essential for ensuring the continued well-being of the nation’s economy. Planning for Continuity of Operations (COOP) and Continuity of Government (COG) is critical to maintaining the overall viability of society. Thus, while we rightly prepare for the flu, we must be equally prepared to function during the flu.

    The Center for Technology and National Security Policy of the DOD’s National Defense University has prepared a number of freely-available items which can help civilians be prepared both before and during the flu. “Bird Flu and You” is a poster available in 9 languages with basic information about influenza preparedness. “Weathering the Storm” is a report with information about planning for COOP, including instructions for carrying out “tabletop excercises” with a COOP plan.

    Electronic copies of the poster are available at http://www.ndu.edu/ctnsp/Bird_flu.htm. Electronic copies of the report are
    available at http://www.ndu.edu/ctnsp/Def_Tech/DTP%2038%20Weathering%20The%20Storm.pdf, and to request hard copies of the report, contact the Life Sciences group at lifesciences@ndu.edu.

    Robert E. Armstrong, Ph.D.
    &
    Mark D. Drapeau, Ph.D.

    Center for Technology and National Security Policy
    National Defense University
    Washington, DC

  19. #19 revere
    May 31, 2007

    Dr. Drapeau: Thank you for the link. As you will see via the left sidebar under “Bird Flu” category we cover both the medical and non-medical aspects here continuously, as does Flu Wiki, Flu Trackers, CurEvents, etc. We hope you will come here and those sites, too, to see what people are saying. We are glad to have your link.

  20. #20 DavidK
    December 21, 2007

    Meanwhile,
    in a small country far away:
    ===============
    Exercise Cruickshank, the first pandemic exercise involving all government and health sector agencies, was aimed at strengthening the country’s Influenza Pandemic Action Plan.
    Yesterday, table-top exercises and a simulated response to a pandemic were held at most international air and sea ports.

    It was the first day of a four- day exercise, costing about $750,000, aimed at testing border control, quarantine and hospital plans, disease containment, deployment of antiviral drugs and establishment of community centres to assess and treat people with influenza.

  21. #21 crfullmoon
    December 21, 2007

    I wish g510 was the decider-guy) …”the rule ought to be: If your town is wiped out, the only way you get money to rebuild is if you do it in a manner that can’t be wiped out by a repeat performance”…

    Should also be the rule for any new construction or renovation in areas that have floods, tornadoes, earthquakes, hurricanes, wildfires