Possibilities
Retired
I want to alert journalists of this video.
The official link has now been removed, however you can view the google cached version. It contains chilling information.
http://74.125.95.132/search?q=cache...nd+security+pandemic&cd=1&hl=en&ct=clnk&gl=us
It's taken me a few hours of my personal time to try to write down some of the questions and answers from the panelists on 06/03/09. I will update this later as it is very time consuming but I believe important as there are some very honest replies in it.
Summary of comments made by the panelists. I may have made some mistakes making the transcript as I did it hurriedly, but here goes. ..
Dr. Paul Jarris: “We will have an initial vaccine bolus available in October, but we don’t know how fast, it’s going to grow. That vaccine will come out with an initial bolus, and we don’t know what that amount is going to be. It will then come out in weekly numbers, with a certain amount per week. We don’t know how much that will be. Then we have to distribute then on a per capita basis around the country. Then we have to go down a priority list for vaccinations, which incidentally is setup for H5N1 (bird flu) not H1N1. We don’t know how many unknowns there are here. What will the adjuvants do? We haven’t done any safety studies yet. We don’t know if it’s one dose or two doses. There are so many complexities here. We will not know ahead of time in order to make the decisions. We have to come up with operational assumptions, then act around those operational assumptions with different scenarios[earlier he spoke of preparing based upon a mild case, worst case, and a probable case scenario].
The cost of providing a vaccine to every American…
Dr. Paul Jarris: We don’t know what the vaccine is going to cost. We don’t know the cost of the adjunctvants yet. So probably between $5-10 per dose. Ten dollars is about what a dose costs for the seasonal flu. ..and we assume 600 million doses. Then we have to give the vaccine. There’s a number of ways, we have a number of states that have health departments, and we had them give a cost/benefit analysis. Medicare pays $18. We checked with the Visiting Nurse association. We checked with the private sector. So there’s a range of $12-30. We picked $15 as a reasonable dose. So that alone is another 9 Billion dollars.
On deciding when to commit to making a particular vaccine based upon the current virus type based upon strain changes in the southern hemisphere.
Dr. Paul Jarris: There is seed stock developed now, that’s my understanding. I’m not Dr. Fauchi (sp??). But that’s my understanding. If the variation has not been tremendous around the world, so we think we’ll have a vaccine that will cover all the options unless there is a major mutation. [What about the recent mutation that makes it airbourne?]
So that seed stock would have to be put into production. At the same time we need 2-3 months to do scientific tests to ensure safety, response, and dosage…things like that. So we will have to make the decision soon and early. We’ve already put in a purchase order in the this country. Not only because we need the lead time for production, but because other countries are in line. ..Britain and France, so we need to put our place in line. So we need to get that done very soon.
It’s another decision to give it. We’re going to have to look at that in the Fall based upon the safety, given what we know, we have this vaccine, “Should we actually give it to people?”. We have to carefully consider that[ i.e.1976 swine flu vaccine debacle]. Every vaccine has side effects. We have to weigh the severity of the flu in the fall versus the side effects of the vaccine. That’s a later decision that will have to be made with a August or September timeframe.
How should the vaccine be distributed, by the states or with federal guidelines…
Mr. John Tomasian: states have developed vaccine distribution plans and they have priority lists. That matters according to a sense of the federal consensus in regards to priority. I don’t think there’s a huge variation, so I would say, that the states administrate it, with a joint discussion between the federal and the state about priority. I’m saying that, because, I think it’s safe to say that we would not have vaccines for everybody. So we have to be focused on the essential service individuals and the most vulnerable populations. Otherwise, I think we can go to the open market distribution of the vaccines.
Dr. Stephen Ostroff: Specific to the vaccine, there’s obviously a lot of unknowns. There’s a couple of other points to consider. We shouldn’t consider the current situation as being in the past tense. We in Pennsylvania, our numbers have gone up by a third since I put my testimony together this weekend. So it’s quite active right now [June 3, 2009] in PA; it shows no sign of abating. We all assumed it would dampen down over the summer months. The virus may not have read the textbook, and may not decide to do that. The other thing that we have to remember is that in 1918, which is the model that we’re all looking at, the virus came back very early. It cam back in September. ..and it came back with a vengeance in September. If we wait until the usual influenza season in the winter, in terms of our thinking of what might happen, and in terms of vaccines, then we need to put our thinking on the fast track, in terms of what we think the vaccines going to do in the next couple of months, it[the virus] may have jumped ahead of us, and could come out in a form that is more severe then it currently is. The other issue is that we’re relying quite heavily on anti-viral drugs. The antiviral drug of choice, if you look at the seasonal strain that was floating around, that was resistant to that drug. If this particular virus decides to become resistant and gets together with that strain, and transfers its resistance…then you get out of the assumptions in planning. So I don’t think we have a lot of time to make these decisions. I think that the virus is telling US. Virtually all influenza in the US now is this virus[swine flu]. We need to make our decisions relatively quickly.
Where should the billion dollars that was recently approved be appropriated ?
Dr. Stephen Ostroff: There are a lot of needs(laughs), and I think many of them have been pointed out. We have not been nor are we doing the sort of things that we would need to do for a full fledged pandemic. I think we do need to come up with our plans on how to distribute the vaccine. I think that when the vaccine becomes available, there’s not going to be enough for everybody, and that we need to make decisions based upon who gets it, and who doesn’t. We need to do that based upon what we see with the patterns of disease. I think we need to work out, better than we did, on how to distribute antiviral medication. And very quickly we need to determine what we’re going to do concerning the medical surge issues. Most of us have not had to exercise that portion of our pandemic plan. Lastly if there’s a lot of disease, we need to monitor what is going on as well as do the diagnostic work. PA is the sixth largest state and we have 300 cases, and it’s all we can do now to count what we’re seeing, and do the diagnosis in our laboratories[ they won’t be able to track it]. We’re relying upon two people in our laboratories to do this work, and if we’re behind 50%, we need to figure out how to increase our bench strength in the Fall because these will be serious problems for us.
He talked about his 20 years working with the CDC, and stated, “We don’t like it to be so prescription without a lot of wiggle room. As far as school closures, we set up our policy right from the very beginning. We held to that policy all along. Initial recommendations from the CDC weren’t quite correct, and we think that CDC recs later weren’t quite correct. So we don’t want them to be so prescriptive that it looks like we don’t know what we’re doing. Every state must take that guidance and interpret it and translate it to their local circumstances. That’s what they’re doing in Arkansas and that’s what we’re doing in Pennsylvania.
Regarding the medical surge and given the economic downturn, and layoffs of first responders and state budgets…
Dr. Paul Jarris: We’ve lost 11 thousand physicians in the states and local areas, and that pace is continuing. Since the Outbreak, we’ve taken a drastically reduced workforce and put them in effect on two shifts from one shift. There is only so much that people can do. Some states have actually run out of places to bill, so they’re ramping down their response during an escalating outbreak. So again we need a federal response to this mounting epidemic and to protect the American people.
Mr. john Thomasian: At NGA, we project that the states will be facing 170 and t50 billion in deficits, so it’s a tough time, it’s difficult to build a response around a peak event that may not occur. If there were more funds, there could be some critical areas that could be helped: surge capacity, lab capacity is sorely needed in the states. Clearly states will ne to build as much surge capacity as they can afford to do, but honestly this is an area that we will be tested in, and found sorely behind if a large event does come.
Ms. Bernice Steinhardt: Looking at vaccines, at best if we began today[06/03], then we’re looking at November for initial production lines for this virus. We still have this long period between now and then, and communities have to respond to the continuing epidemic and to a surge later in a more virulent form, so the kinds of planning needs to be address such as what kinds of capacities need to be built in as regards funding and allocation. We need to keep that very much in mind.
Significance of WHO moving to Phase 6, how does that change things in the US?
Dr. Stephen Ostroff: Not much practically. All planning and thinking are predicated upon what to do based upon the US situation. The difficult of WHO moving to phase six is that it trips off a whole cascading amount of activities some appropriate some inappropriate based upon their particular circumstances. We’ve seen some countries do things regarding entry and exit screening that may not be the best application for us and in regards to resources. The way that[WHO] define it, doesn’t make that much difference to us.
Dr. Paul Jarris: I agree with my colleague in terms of our response within our borders, because we have the epidemic. But as a global leader, it may very well change what we do. As this spreads around the world, and frankly, it’s academic whether we are at level six or not, because we met the criteria over a month ago, but those are political discussions, the issue is what role will the US place as a health diplomacy role. If we have health outbreaks hitting undeveloped countries, who do not have an infrastructure for public health, and we see many more deaths, because many of these countries have high rates of HIV, then what will the USA do? What’s our responsibility to do to assist these nations? What’s our responsibility to the rest of the world regarding vaccines and anti-virals. If we were producing antivirals and vaccines domestically? Vaccines require adjuncvants, and if the whole world requires them, we probably do have to change our adjuncvants to stretch them further. I would suggest our scientific and political heads meet with global leaders since we have some global issues to discuss regarding US leadership.
About geographic spread of the virus…does it increase the chance of mutation?
Dr. Paul Jarris: Every infection increases the chance of mutation. Viruses do mutate rapidly. As they travel around the world and are exposed to different populations of humans and animals, there’s an increased chance of resortment. Since this is a novel virus, there’s a heavy evolutionary pressure to evolve, we cant’ tell if it will resort or not. The great fear s that it will resort with H5N1 or seasonal influenza that is Tamiflu resistant and then we’re in trouble. It’s another one of the unknowables.
Can states activate the medical reserve corp?
Mr. John Thomasian: I’m not completely familiar with the activation process. I believe they can but I will have to get back to you on that.
Dr. Paul Jarris: There is a medical reserve corp. It’s been very helpful in very limited disasters around the country. What we’ve found in areas severely hit like Texas and Louisiana during their hurricanes though was that medical reserve corps are people who have other jobs. When you are mounting a sustained response, they can’t be counted on to be there day in and day out. The doctors, nurse, and health departments have to return to their hospitals to do their assigned shifts, so what Texas has found is that though they welcome them, they’ve had to go out and contract for paid professionals work for them so that you have performance standards. That will be important in the Fall with vaccinations. If we have to do mass dispensing of Tamiflu, we’re going to have to hire hospital nurses, or contract nurses through the VNA, which means that with them returning ton work at the hospitals we will have to offer time and a half, weekend pay, things like that.
How did the media, public health officials, and elected officials do getting the word out to the public in the early days of the pandemic?
Mr. John Thomasian: The public officials and media did a good job in communicating to the public. On the nature of the disease, and where it was[pure BS]. The breakdown in some areas was in”what is the appropriate government response?” There was some initial hesitancy in discussing quarantines, why you should, why you shouldn’t, and issues like travel bans. Should we block the border with Mexico? Initially the communication was very good. The public had an idea that the disease was existing out there. This wasn’t a disaster, and that they were communicating.
Dr. Paul Jarris: There was a study done by Harvard University, 88% of Americans survey expressed satisfaction in the information they were getting. You did a good job, it was clear, and Dr. Bassert(sp) should be commended. He did a wonderful job as acting director of the CDC. The one place we’ve not done well is that we are shutting it down. Can’t find anything in the media anymore. We should be using this time now to let people know that “Now is the time to prepare”. They shouldn’t have to figure out in the Fall, if school is canceled, “How are they going to take care of their kids? How are they going to telecommute? What if their elderly parent gets sick? We are missing an opportunity now ahead of time to let people know about the Fall.
Ms. Bernice Steinhardt : I think I would agree that the community response were first-rate, but I think looking back to when we first began seeing cases of Bird Flu in humans, there was initially an enormous amount of attention, and then it fell off. For most people this issue went away. And unfortunately what the public loses interest in, government loses interest in. Members of the public health community never lost sight of this problem, but let other issues take priority. We need to keep sight of the importance of this whether it is covered in the media or not.
Dr. Stephen Ostroff: There’s been a public tendency that when something happened with the flu, it would be like the Big Bang, and when that didn’t happen, then everyone shrugged their shoulders and said “What’s the big deal here?”. You heard a lot of descriptions of this as mild. Flu is never mild. We tried vigorously to say that this is not mild now. ..and it could be even more severe in the coming months. There is a segment of the population who felt this was oversold to them, when in point of fact, many of us are very concerned with what we are seeing right now, and we think it is going to happen in the Fall, and I think I would echo the comment that we have to reinforce the message that what you’ve seen so far is not necessarily what you will see later on,
What do you recommend the private sector do during this lull?
Ms. Bernice Steinhardt: I have suggestions for the government in working with the private sector. We have a series of councils for working with critical infrastructure. They could be used much more than they are. How are governments going to handle state border closings.[!!!] Vital issues for commerce. Discussions should be on-going between government and the private sector. We’re not having those discussions.
What is the single most step we can take to improve our preparedness in the next three months? How should we do your suggestions?
Dr. Stephen Ostroff : I wish I could tell you there is a single step. There isn’t, there’s a series of steps. Get our house in order I regards to vaccinations since that is the single best measure for influenza. I do have one concern, I see more morbidity and mortality as we go along, so I think we have to think about how we deal with medical surge issues. I think regarding vaccinations is that we need to place our bets on what we currently know, and not doing so would be a significant mistake. (He was questioned about the possibility of delaying due to resortment).
Dr. paul Jarris: There’s so much to be done. The single most important subject is appropriate sufficient resources in the next few weeks with supplemental. There is so much to be done, we won’t be able to catch up later. You asked how to prioritize the Billion, we’ll the vaccines alone would cost 15 Billion, so I??? If we appropriate less then what is needed, as in the 15 Billion needed for vaccines versus only a billion appropriated, then which 1/15 of the US population do you vaccinate, and which 14/15 are you not going to vaccinate?
Mr. John Thomasian: I’ll take my comments beyond the public health area. This was not a test, this was not even a pop quiz, when we had workshops, we ased the officials, when 90 million Americans get the disease, and we had 105 million needing hospital care, and an estimated 1.9 million deaths, I would have the states consider how they would handle planning and continuity of society[!!!!], how would public safety react? How would we handle a high rate of absenteeism in state government and critical infrastructure…food services, electricity, etc? I would use these next few months to consider what if this became the true pandemic, and consider what we would be looking at under the 1918 scenario?
The official link has now been removed, however you can view the google cached version. It contains chilling information.
http://74.125.95.132/search?q=cache...nd+security+pandemic&cd=1&hl=en&ct=clnk&gl=us
It's taken me a few hours of my personal time to try to write down some of the questions and answers from the panelists on 06/03/09. I will update this later as it is very time consuming but I believe important as there are some very honest replies in it.
Summary of comments made by the panelists. I may have made some mistakes making the transcript as I did it hurriedly, but here goes. ..
Dr. Paul Jarris: “We will have an initial vaccine bolus available in October, but we don’t know how fast, it’s going to grow. That vaccine will come out with an initial bolus, and we don’t know what that amount is going to be. It will then come out in weekly numbers, with a certain amount per week. We don’t know how much that will be. Then we have to distribute then on a per capita basis around the country. Then we have to go down a priority list for vaccinations, which incidentally is setup for H5N1 (bird flu) not H1N1. We don’t know how many unknowns there are here. What will the adjuvants do? We haven’t done any safety studies yet. We don’t know if it’s one dose or two doses. There are so many complexities here. We will not know ahead of time in order to make the decisions. We have to come up with operational assumptions, then act around those operational assumptions with different scenarios[earlier he spoke of preparing based upon a mild case, worst case, and a probable case scenario].
The cost of providing a vaccine to every American…
Dr. Paul Jarris: We don’t know what the vaccine is going to cost. We don’t know the cost of the adjunctvants yet. So probably between $5-10 per dose. Ten dollars is about what a dose costs for the seasonal flu. ..and we assume 600 million doses. Then we have to give the vaccine. There’s a number of ways, we have a number of states that have health departments, and we had them give a cost/benefit analysis. Medicare pays $18. We checked with the Visiting Nurse association. We checked with the private sector. So there’s a range of $12-30. We picked $15 as a reasonable dose. So that alone is another 9 Billion dollars.
On deciding when to commit to making a particular vaccine based upon the current virus type based upon strain changes in the southern hemisphere.
Dr. Paul Jarris: There is seed stock developed now, that’s my understanding. I’m not Dr. Fauchi (sp??). But that’s my understanding. If the variation has not been tremendous around the world, so we think we’ll have a vaccine that will cover all the options unless there is a major mutation. [What about the recent mutation that makes it airbourne?]
So that seed stock would have to be put into production. At the same time we need 2-3 months to do scientific tests to ensure safety, response, and dosage…things like that. So we will have to make the decision soon and early. We’ve already put in a purchase order in the this country. Not only because we need the lead time for production, but because other countries are in line. ..Britain and France, so we need to put our place in line. So we need to get that done very soon.
It’s another decision to give it. We’re going to have to look at that in the Fall based upon the safety, given what we know, we have this vaccine, “Should we actually give it to people?”. We have to carefully consider that[ i.e.1976 swine flu vaccine debacle]. Every vaccine has side effects. We have to weigh the severity of the flu in the fall versus the side effects of the vaccine. That’s a later decision that will have to be made with a August or September timeframe.
How should the vaccine be distributed, by the states or with federal guidelines…
Mr. John Tomasian: states have developed vaccine distribution plans and they have priority lists. That matters according to a sense of the federal consensus in regards to priority. I don’t think there’s a huge variation, so I would say, that the states administrate it, with a joint discussion between the federal and the state about priority. I’m saying that, because, I think it’s safe to say that we would not have vaccines for everybody. So we have to be focused on the essential service individuals and the most vulnerable populations. Otherwise, I think we can go to the open market distribution of the vaccines.
Dr. Stephen Ostroff: Specific to the vaccine, there’s obviously a lot of unknowns. There’s a couple of other points to consider. We shouldn’t consider the current situation as being in the past tense. We in Pennsylvania, our numbers have gone up by a third since I put my testimony together this weekend. So it’s quite active right now [June 3, 2009] in PA; it shows no sign of abating. We all assumed it would dampen down over the summer months. The virus may not have read the textbook, and may not decide to do that. The other thing that we have to remember is that in 1918, which is the model that we’re all looking at, the virus came back very early. It cam back in September. ..and it came back with a vengeance in September. If we wait until the usual influenza season in the winter, in terms of our thinking of what might happen, and in terms of vaccines, then we need to put our thinking on the fast track, in terms of what we think the vaccines going to do in the next couple of months, it[the virus] may have jumped ahead of us, and could come out in a form that is more severe then it currently is. The other issue is that we’re relying quite heavily on anti-viral drugs. The antiviral drug of choice, if you look at the seasonal strain that was floating around, that was resistant to that drug. If this particular virus decides to become resistant and gets together with that strain, and transfers its resistance…then you get out of the assumptions in planning. So I don’t think we have a lot of time to make these decisions. I think that the virus is telling US. Virtually all influenza in the US now is this virus[swine flu]. We need to make our decisions relatively quickly.
Where should the billion dollars that was recently approved be appropriated ?
Dr. Stephen Ostroff: There are a lot of needs(laughs), and I think many of them have been pointed out. We have not been nor are we doing the sort of things that we would need to do for a full fledged pandemic. I think we do need to come up with our plans on how to distribute the vaccine. I think that when the vaccine becomes available, there’s not going to be enough for everybody, and that we need to make decisions based upon who gets it, and who doesn’t. We need to do that based upon what we see with the patterns of disease. I think we need to work out, better than we did, on how to distribute antiviral medication. And very quickly we need to determine what we’re going to do concerning the medical surge issues. Most of us have not had to exercise that portion of our pandemic plan. Lastly if there’s a lot of disease, we need to monitor what is going on as well as do the diagnostic work. PA is the sixth largest state and we have 300 cases, and it’s all we can do now to count what we’re seeing, and do the diagnosis in our laboratories[ they won’t be able to track it]. We’re relying upon two people in our laboratories to do this work, and if we’re behind 50%, we need to figure out how to increase our bench strength in the Fall because these will be serious problems for us.
He talked about his 20 years working with the CDC, and stated, “We don’t like it to be so prescription without a lot of wiggle room. As far as school closures, we set up our policy right from the very beginning. We held to that policy all along. Initial recommendations from the CDC weren’t quite correct, and we think that CDC recs later weren’t quite correct. So we don’t want them to be so prescriptive that it looks like we don’t know what we’re doing. Every state must take that guidance and interpret it and translate it to their local circumstances. That’s what they’re doing in Arkansas and that’s what we’re doing in Pennsylvania.
Regarding the medical surge and given the economic downturn, and layoffs of first responders and state budgets…
Dr. Paul Jarris: We’ve lost 11 thousand physicians in the states and local areas, and that pace is continuing. Since the Outbreak, we’ve taken a drastically reduced workforce and put them in effect on two shifts from one shift. There is only so much that people can do. Some states have actually run out of places to bill, so they’re ramping down their response during an escalating outbreak. So again we need a federal response to this mounting epidemic and to protect the American people.
Mr. john Thomasian: At NGA, we project that the states will be facing 170 and t50 billion in deficits, so it’s a tough time, it’s difficult to build a response around a peak event that may not occur. If there were more funds, there could be some critical areas that could be helped: surge capacity, lab capacity is sorely needed in the states. Clearly states will ne to build as much surge capacity as they can afford to do, but honestly this is an area that we will be tested in, and found sorely behind if a large event does come.
Ms. Bernice Steinhardt: Looking at vaccines, at best if we began today[06/03], then we’re looking at November for initial production lines for this virus. We still have this long period between now and then, and communities have to respond to the continuing epidemic and to a surge later in a more virulent form, so the kinds of planning needs to be address such as what kinds of capacities need to be built in as regards funding and allocation. We need to keep that very much in mind.
Significance of WHO moving to Phase 6, how does that change things in the US?
Dr. Stephen Ostroff: Not much practically. All planning and thinking are predicated upon what to do based upon the US situation. The difficult of WHO moving to phase six is that it trips off a whole cascading amount of activities some appropriate some inappropriate based upon their particular circumstances. We’ve seen some countries do things regarding entry and exit screening that may not be the best application for us and in regards to resources. The way that[WHO] define it, doesn’t make that much difference to us.
Dr. Paul Jarris: I agree with my colleague in terms of our response within our borders, because we have the epidemic. But as a global leader, it may very well change what we do. As this spreads around the world, and frankly, it’s academic whether we are at level six or not, because we met the criteria over a month ago, but those are political discussions, the issue is what role will the US place as a health diplomacy role. If we have health outbreaks hitting undeveloped countries, who do not have an infrastructure for public health, and we see many more deaths, because many of these countries have high rates of HIV, then what will the USA do? What’s our responsibility to do to assist these nations? What’s our responsibility to the rest of the world regarding vaccines and anti-virals. If we were producing antivirals and vaccines domestically? Vaccines require adjuncvants, and if the whole world requires them, we probably do have to change our adjuncvants to stretch them further. I would suggest our scientific and political heads meet with global leaders since we have some global issues to discuss regarding US leadership.
About geographic spread of the virus…does it increase the chance of mutation?
Dr. Paul Jarris: Every infection increases the chance of mutation. Viruses do mutate rapidly. As they travel around the world and are exposed to different populations of humans and animals, there’s an increased chance of resortment. Since this is a novel virus, there’s a heavy evolutionary pressure to evolve, we cant’ tell if it will resort or not. The great fear s that it will resort with H5N1 or seasonal influenza that is Tamiflu resistant and then we’re in trouble. It’s another one of the unknowables.
Can states activate the medical reserve corp?
Mr. John Thomasian: I’m not completely familiar with the activation process. I believe they can but I will have to get back to you on that.
Dr. Paul Jarris: There is a medical reserve corp. It’s been very helpful in very limited disasters around the country. What we’ve found in areas severely hit like Texas and Louisiana during their hurricanes though was that medical reserve corps are people who have other jobs. When you are mounting a sustained response, they can’t be counted on to be there day in and day out. The doctors, nurse, and health departments have to return to their hospitals to do their assigned shifts, so what Texas has found is that though they welcome them, they’ve had to go out and contract for paid professionals work for them so that you have performance standards. That will be important in the Fall with vaccinations. If we have to do mass dispensing of Tamiflu, we’re going to have to hire hospital nurses, or contract nurses through the VNA, which means that with them returning ton work at the hospitals we will have to offer time and a half, weekend pay, things like that.
How did the media, public health officials, and elected officials do getting the word out to the public in the early days of the pandemic?
Mr. John Thomasian: The public officials and media did a good job in communicating to the public. On the nature of the disease, and where it was[pure BS]. The breakdown in some areas was in”what is the appropriate government response?” There was some initial hesitancy in discussing quarantines, why you should, why you shouldn’t, and issues like travel bans. Should we block the border with Mexico? Initially the communication was very good. The public had an idea that the disease was existing out there. This wasn’t a disaster, and that they were communicating.
Dr. Paul Jarris: There was a study done by Harvard University, 88% of Americans survey expressed satisfaction in the information they were getting. You did a good job, it was clear, and Dr. Bassert(sp) should be commended. He did a wonderful job as acting director of the CDC. The one place we’ve not done well is that we are shutting it down. Can’t find anything in the media anymore. We should be using this time now to let people know that “Now is the time to prepare”. They shouldn’t have to figure out in the Fall, if school is canceled, “How are they going to take care of their kids? How are they going to telecommute? What if their elderly parent gets sick? We are missing an opportunity now ahead of time to let people know about the Fall.
Ms. Bernice Steinhardt : I think I would agree that the community response were first-rate, but I think looking back to when we first began seeing cases of Bird Flu in humans, there was initially an enormous amount of attention, and then it fell off. For most people this issue went away. And unfortunately what the public loses interest in, government loses interest in. Members of the public health community never lost sight of this problem, but let other issues take priority. We need to keep sight of the importance of this whether it is covered in the media or not.
Dr. Stephen Ostroff: There’s been a public tendency that when something happened with the flu, it would be like the Big Bang, and when that didn’t happen, then everyone shrugged their shoulders and said “What’s the big deal here?”. You heard a lot of descriptions of this as mild. Flu is never mild. We tried vigorously to say that this is not mild now. ..and it could be even more severe in the coming months. There is a segment of the population who felt this was oversold to them, when in point of fact, many of us are very concerned with what we are seeing right now, and we think it is going to happen in the Fall, and I think I would echo the comment that we have to reinforce the message that what you’ve seen so far is not necessarily what you will see later on,
What do you recommend the private sector do during this lull?
Ms. Bernice Steinhardt: I have suggestions for the government in working with the private sector. We have a series of councils for working with critical infrastructure. They could be used much more than they are. How are governments going to handle state border closings.[!!!] Vital issues for commerce. Discussions should be on-going between government and the private sector. We’re not having those discussions.
What is the single most step we can take to improve our preparedness in the next three months? How should we do your suggestions?
Dr. Stephen Ostroff : I wish I could tell you there is a single step. There isn’t, there’s a series of steps. Get our house in order I regards to vaccinations since that is the single best measure for influenza. I do have one concern, I see more morbidity and mortality as we go along, so I think we have to think about how we deal with medical surge issues. I think regarding vaccinations is that we need to place our bets on what we currently know, and not doing so would be a significant mistake. (He was questioned about the possibility of delaying due to resortment).
Dr. paul Jarris: There’s so much to be done. The single most important subject is appropriate sufficient resources in the next few weeks with supplemental. There is so much to be done, we won’t be able to catch up later. You asked how to prioritize the Billion, we’ll the vaccines alone would cost 15 Billion, so I??? If we appropriate less then what is needed, as in the 15 Billion needed for vaccines versus only a billion appropriated, then which 1/15 of the US population do you vaccinate, and which 14/15 are you not going to vaccinate?
Mr. John Thomasian: I’ll take my comments beyond the public health area. This was not a test, this was not even a pop quiz, when we had workshops, we ased the officials, when 90 million Americans get the disease, and we had 105 million needing hospital care, and an estimated 1.9 million deaths, I would have the states consider how they would handle planning and continuity of society[!!!!], how would public safety react? How would we handle a high rate of absenteeism in state government and critical infrastructure…food services, electricity, etc? I would use these next few months to consider what if this became the true pandemic, and consider what we would be looking at under the 1918 scenario?
