Jakarta Pandemic, The (70 page)

“Right now, do the locations you are investigating fit any broad pattern or trend of disease transmission?”

“That’s quite a question, Kerrie. Perhaps FBC is better informed than I anticipated. Without jumping to conclusions, I would have to answer yes. At this early point, it vaguely resembles the model of transmission seen in 2008. This is extremely, and I repeat, extremely early to conclude anything. But let’s just jump ahead, way ahead of ourselves and theorize that the cases under investigation are linked to an identical strain. I warn again, this is a theoretical exercise. No information exists, to my knowledge, about any of these specific cases. Just geographic trends.

“Given these trends, 75% of the suspect sites geographically correspond with the earliest reported cases outside of China during the 2008 avian flu pandemic. That is, the cases under investigation are on the path of direct flights from Hong Kong International airport, which most certainly was one of the primary jumping points for the 2008 pandemic. Interestingly, the current leads only correspond in the 20-40% match range for direct flights from Beijing or Shanghai, but all of them match with direct flights from Hong Kong.

“This indicates a specific pathway trend from Hong Kong. Kerrie, if I had to guess a worst-case scenario, I would guess that China experienced an unknown health epidemic in the areas surrounding Hong Kong, heavily industrialized and populated areas, and that the Chinese suspect that the infection came from abroad. Probably somewhere close by in the Southeast Asia region. If so, the disease hit China mainly through Hong Kong International Airport and could very likely be on its way around the world. Hong Kong International Airport handles over 180,000 passengers a day, traveling to over 168 destinations worldwide. Many of them direct. If a virus launches through Hong Kong International Airport, it could end up anywhere in the world. Of course, we have no idea if a disease is even the problem in China. Sorry to cast such dim light on the situation.”

“No need to apologize, Dr. Ocampo. It would be fair to say that opinions like the one you just expressed frequently place you in WHO crosshairs. You have certainly been an outspoken critic of the WHO in the past.”

“And present,” Dr. Ocampo said.

“Your primary disagreement relates to the state of pandemic preparedness in the U.S. and abroad. Specifically, you are extremely critical of the WHO’s influence on the process.”

“Absolutely. They feel the need to own it and treat it like a commodity. The more control they have over it worldwide, the more money they receive in UN support and direct national financing. Their monopoly and influence over pandemic planning policy abroad, and here in the U.S., puts the world at grave risk.”

“Can you explain how it puts the world at risk? In the simplest terms possible.”

“Are you implying that I might delve too deeply into the topic?”

Kerrie suppressed another laugh. “Well, let’s just say that you have a trend toward detail, and we have a fair amount to cover for our viewers.”

“Touché. Let me see. The WHO’s infrastructure and efforts are focused on regional containment. They acknowledge the inherent difficulty of containing a pandemic flu strain too close to its source and instead focus on regional efforts. In the case of an outbreak in China, they would expend considerable resources in China, but the bulk of the resources would be allocated to detection and containment throughout Southeast Asia. Additional emphasis would be placed upon worldwide detection and hotspot containment worldwide.

“In essence, the WHO strategy focuses on building a shield, or wall, to keep the flu contained. This is the strategy that the WHO has sold to the world since 2008, and the world pays for it with billions upon billions of dollars. Unfortunately, these billions go to the WHO and not to state and federal agencies responsible for funding domestic pandemic preparedness plans. In early 2009, the Bush administration, in conjunction with the CDC and Department of Health and Human Services, published a 381 page document outlining local, state and federal responsibilities for pandemic preparedness. A little late on the draw, but it brought many subject matter experts together and produced a worthy document. It was a great starting point. Unfortunately, without funding, it just sits on shelves at every government level, collecting dust. We estimate a 6% compliance rate with the action items outlined in this publication, at all levels. The worst rate is at the local city or town level, about 3%, and this is quite arguably where it will count the most in the event of serious pandemic. The money is simply not available in local budgets, and federal grants are nearly non-existent for any city smaller than Los Angeles.”

“You said that the local city and town level is the most important in your view. Why?”

“Simply stated, in the face of a serious pandemic threat, that is, a novel flu strain that is highly transmissible and contagious, we can’t possibly hope to keep the disease out of our borders. Even the national flu pandemic document acknowledges that any measures taken to contain or shield the U.S. from a pandemic will only delay the flu’s entry into the U.S. by a few months or even weeks. This is exact verbiage. Think of our country’s borders. Thousands of illegal and legal aliens enter the U.S. every day, and thousands of planes land from hundreds of different countries. These are just two of the most obvious holes. The U.S. borders are like a sieve. There is absolutely no way to effectively close off our borders, airports and seaports, or to screen the large volume of travelers that pass through our country. Once the pandemic flu enters the country, it will spread everywhere. Then where do we stand? We will certainly be well behind in the planning process. 6% compliance, on average, with all the national flu pandemic plan recommendations? That’s way behind, and I suspect the action items encompassing that 6% are the easiest and least expensive to implement…and probably the least effective against a pandemic.

“I didn’t really answer your question properly. I am saying that the arrival of the flu will be inevitable in your community and that the outwardly focused, WHO-supported efforts will not be useful to your community. Without a properly-funded and coherent local government plan, chaos will quickly descend. That chaos will enhance the flu’s deadliness two or threefold.”

“Dr. Ocampo, WHO representatives have repeatedly criticized this premise, labeling your organization’s research in this area of study as flawed. They say that your casualty projections are extremely excessive and that your assessment of the impact on essential services is exaggerated. Dr. Pierre Neville, head of the WHO’s pandemic impact study group, is quoted saying that the ‘ISPAC’s predictions are alarmist science fiction.’ How do you respond to the WHO’s stance toward the ISPAC’s projections?”

“Ah, Dr. Neville, he is quite the character. Certainly one of the WHO’s more colorful attack dogs. The problem with their criticism of our projections is that the WHO leans way too heavily on the experiences of the 2008 pandemic. They insist that 2008 is the perfect model for all future pandemics. On the contrary, we believe that the 2008 pandemic flu strain was a relatively weak pandemic strain, especially compared to the 1918 Spanish flu, and that the world’s healthcare system and essential services infrastructure was barely challenged. Bear with me as I explain this in some detail.

“In 2008, for both modernized and developing nations, hospital-based care remained available to a vast majority of infected individuals, drastically improving outcomes and contributing heavily to the low overall case fatality rate. Although the situation in many developing nations approached, and in some cases crossed the tipping point for the availability of hospital or clinic-based care, most modernized nations’ system were never truly challenged by the 2008 pandemic. This outcome would be different in the face of a deadlier and more infectious virus. The breakpoints for inpatient healthcare availability, in both modernized and developing nations, would be reached quickly, and the result would be catastrophic.

“We calculate that, in any given area, all available inpatient services such as hospital beds, ventilators, observation rooms, and medical staff would be occupied within 2-3 weeks of a pandemic reaching that area. Just based on 1918 pandemic flu patterns, within weeks, in the U.S. alone, the health care system would need 200% of all existing hospital beds, 500% of existing intensive care unit beds, and over 200% of available ventilators to meet the flu demand. Once inpatient capacity was filled, patients would be given a set of home-based care instructions and turned away.”

“Turned away? Where would they be sent?”

“Home.”

“Really? That doesn’t sound like a great option.”

“It isn’t. The predicted survival rates for hospital-based care versus home-based care differ greatly, based on the severity of the patient’s flu symptoms and easily recognizable patient risk factors such as age, chronic disease, and general health. The best example is demonstrated by patients in a medium-high risk category, who are typically either very young or very old, or have an underlying chronic disease that can lead to further complications, like diabetes, heart disease, or a pulmonary disorder. For this group, patients treated within a stable and fully-resourced inpatient setting would survive at a rate of 80-85%, while patients treated in a stable home setting, with access to basic medical supplies, would be expected to survive at a rate of 40-50%. It is important to note that these figures applied to best-case scenarios in each setting, where access to power, water, medical supplies, competent medical personnel and equipment remains constant. The predicted difference between the two, in even the best of circumstances, is remarkable. Once all inpatient services are occupied within the first few weeks of a more virulent pandemic flu and basic medical stockpiles started to disappear, the expected rates of survival would plummet in both settings by 20-40%.”

Kerrie commented,
“80-85% sounds bad enough, but 40-50% is a depressing statistic. This is the best-case scenario?”

Dr. Ocampo said,
“For this group. The outcomes prognosis for low-risk patients is much better, and for high-risk patients, much worse.”

Kate said,
“That puts survival rates in the home at 10% or less once inpatient services vanish. For the medium-risk group. If you’re a high-risk patient, you’re as good as dead.”

Alex said, “That’s ugly.”

“Kerrie, this isn’t science fiction, it’s a commonsense-based statistical prediction. A complicated one that accounts for hundreds of factors and balances trends from several pandemic models. Not just one, like the WHO model. The bad news doesn’t end here.

“Our public planning experts agree that during a more severe pandemic, the combination of both a rapidly-growing infection rate and an overwhelming fear of infection will lead to massive absenteeism rates in all sectors of public and private service. Inevitably, high absenteeism rates and rampant sickness will seriously deteriorate the reliability of fuel delivery and degrade both municipal and regional public service departments’ ability to repair, maintain and operate their systems. In a short period of time, once local fuel reserves are exhausted, or system maintenance exceeds the capability of the remaining personnel, a general collapse of essential services like electricity, public water, food distribution, communications and public safety will follow. Eventually, even the hospitals and temporary pandemic treatment centers may face severe personnel shortages, exhaustion of essential supply stockpiles, and the loss of a stable power source. Our experts find it nearly impossible to predict the duration of time that these essential services would be affected. Only that the likelihood of losing many of these services was extremely high. Without basic survival needs, like running water, food, heat and medical supplies, they theorize that adequate home treatment of the flu would be nearly impossible, further exacerbating the flu’s case fatality rate.

“Given the inherent difficulty of predicting the duration of an essential services blackout, our experts even voice concern for the survival prospects of non-infected individuals and flu survivors. Statisticians and epidemiologists worldwide acknowledge that even in the most modernized parts of the world, like the Pacific Rim, Europe and North America, very few families have an adequate supply of food or water to last for even one week, and national food reserves might remain inaccessible to most population groups. Even if accessible, no coherent rationing plan exists, and in any event, on-hand reserve supplies would not last for more than a few weeks. Once the food and water distribution capacities are interrupted, even families that live within a few miles of several major food stores would find it nearly impossible to procure safe food or water.”

“Doesn’t the national pandemic flu plan provide guidance for food distribution plans?”

“Not really. It recommends that a detailed national plan be devised, and it tasks the state and local governments to develop their own plans, but our latest investigation found that very few documented plans exist. Los Angeles has a plan, but they lack the ability to tie into an effective state and federal plan. So what is the point of having a plan? It’s not their fault, those plans just don’t exist. So if one of the nation’s largest cities’ plan is rendered useless by lack of support from higher echelon government levels, why would any other cities or states bother to spend the money to develop their own plans. It’s hard to fault them. Support for these measures needs to filter down from above, in the form of mandate, inspection, funding and most importantly, leadership. This climate does not currently exist here in the U.S. Amazingly, the national document does not delineate a chain of command in the event of a pandemic, or even suggest who is in charge. A heavy emphasis is placed on the Department of Health and Human Services’ role in a pandemic, but they are given no clear leadership authority. The role of the military is not even mentioned. All of this will have to be established after the pandemic hits, adding to the confusion.”