CDC flu drill observed

In case you hadn't noticed, under the Bush administration all government agencies have been classifying more and more information. All under the aegis of denying terrorists access to vulnerable information.

Instead it's had the complete opposite effect, making us less secure. Got to love bad government.

Well you get to see it in action. Really inaction. I in my position for the exercise and there was a LOT of information as you and TonyP flowing note as being absent. It wasnt that they didnt want you to know. It was classified from a need to know position. Tony P. You didnt need to know. Some of it I knew and didnt want to. The exercise was called off and the reaction from the responders was the same as Revere's was. Many expressed their anger about not continuing it.

Reason: So nice that you can coordinate your disasters on a certain day and time like Katrina, the North Ridge Quake, and bird bug. One email that was sent to thousands said that one of the best times for this to happen and ensure a total disaster is at Thanksgiving/Xmas time. Everyone would be at home happily spreading it and enjoying the ablutions of the holidays.

Just the old Monty Python trick; can't figure out how to conclude the sketch;
Ice storm -go home!

We are not amused.

We need to know or the communities won't prepare on their own initiatives for this.
And we'll need a new govt afterwards, too, if there's enough people left to shake a Constitution and a stick at...

:-/

Unbelieveable! MRK: "I in my position for the exercise and there was a LOT of information as you and TonyP flowing note as being absent. It wasnt that they didnt want you to know. It was classified from a need to know position. Tony P. You didnt need to know."
*****
How do you classify any information as some other person "do not need to know"?! How can you know what another one needs to know? Are the people in CDC and the Bush gang in some position to know better than the people themselves? Arrogant! Obscene!

Due to the alacrity with which some view the withholding of information, I would strongly defend any clinical personel who refuse to participate in any pandemic response.

I will prepare arguments to persuade my community's health-care providers to refuse to waste their lives serving authorities who consider them unimportant and (probably) expendable.

There is no "need to know" when only the frontline workers know anything which needs to be known.

The most important lesson from this drill is that responders at all levels must set up robust densely connected unauthorized communication networks with their peers.

We can expect authorities to be more zealous to prevent information than to provide it.

The drill was designed and run by MPRI, an Atlanta consulting company led by retired military officers. The CDC is paying the company $7 million for its work on the drill, future exercises and some planning work.

MPRI being notable, among other things, for its extensive work in "private security contracting" in Iraq.

Which has worked out *ever* so well. A brilliant success story from the very start. It really does leave one with a feeling of confidence to know that CDC is entrusting such critical matters to a firm with such solid bona fides.

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1) you must empower every worker and every potential volunteer from every community.

2) If you want volunteers; it might be a good idea to set aside billions of dollars to pay them!!

Greg: Health care workers and ordinary people do amazing things in emergencies and I expect the same if a pandemic occurs. I think anyone who argues against the impulse to help others is, well, misguided. What is your point and how does it help anyone?

marquer: Is there something wrong the exercise they devised? Because it sounded pretty realistic to me. What exactly is your point? That CDC contracts with some disreputable companies? Yawn.

Tom: If you demand to be paid, you're not exactly a volunteer. Fortunately, there will be many true volunteers, if history is any gauge. And I'd put money on that you'll be one of them, your cynicism aside.

I actually really thought I'm going to work during the becoming pandemic, but now knowing that We in the front line won't be told everything about the virus because "we don't need to know" I'm starting to think just SIPing.

I think Greg's point was not that he'd encourage others not to help, but but that he'd defend those who chose not to because they were denied the information necessary to make an informed decision about their own or their patients' safety.

And that is a fair point. Emergencies will create heroes, but there is a difference between being brave and being suicidal. And how can people even know what brave things would be helpful if they have no roadmap to what is going on? Information would be confused, incomplete, and contradictory in the early stages anyway; active cover-ups of what is known won't lead to the slightest trust of whatever is announced.

And then there's this:

More disturbing to CDC employees was how much information Gerberding and some other key officials held back, because not everyone in the room had the necessary security clearance. At one briefing, it became clear that some of the agency's top viral experts were in the dark about some potentially important details.

What the hell? These are CDC scientists, not techs in foreign labs or far-flung small town doctors. You know who they are, and you know you need them. Friggin' run (some more) background checks, and get them the security clearance. That's one thing that can and should be done now.

caia, Greg: You are reading quite a lot into this. I am all too familiar with the problem of holding back information on security grounds in ways that hurt us. But I don't see how that translates into health care workers helping or not helping. I don't think this will be a consideration for many. Nor would I condemn any who didn't work. That's a choice and people make it for lots of reasons, some of them extremely good and praiseworthy. But many will work and do it selflessly. That is important to keep in mind. There will be heroes and we should celebrate that and even enourage it. I, personally, don't want to say anything that interferes with it. So that was an expression of my strong feelings on the subject. Things will be tough enough and none of us know if we will make the grade. The last thing I need is an excuse. I'd be only too eager to use it.

Revere, can you give an example of the kind of information that would be with-held in such a circumstance?

Is it things like, say, the route by which vaccine or anti-viral carrying trucks will be entering or leaving an area? That is something which I think could conceivably be legitimately 'need to know' information in the setting of clinical emergency--while the docs might not make nefarious use of such information, if they know, they can be coerced to reveal it. I can imagine gangsters targeting such a delivery the way they would target an armored car.

Or is it things like, 'the CFR is still 70% but we'll call it 5%'? If so, then that's a different kettle of fish.

I don't care if Gerbingder wears a pink tutu doing a table top-until someone from a very high level of federal government gets on primetime TV and states clearly that all local governments big and small need to quit thinking their county, state and federal people will 'save' them, to prepare as if were Katrina+++ and they will be SOLO for months, nothing, and I mean nothing, will be done to get even marginal grass-roots preparations started.

Revere. First of all the comments weren't cynical.

First, if you want volunteers to follow, they must be empowered. The days of taking orders from Doctors or any other authority for that matter are over...

...In a pandemic of the potential severity of H5N1, money will not be enough of an incentive to keep people on the job. I happen to know well the smell of an animal after four or five days and having bodies piled in the streets tends to induce panic...

...that is where the empowering comes...and empowering requires really only one question...what do I have to do for you and what do you need to stay on the job...

...and this is not any job...this will be equivalent to telling the nurses to look left and right and two of three of you will not be here after the pandemic.

You may think that I am grossly exagerating the potentials but you read tea leaves just like I do and the cynics and the skeptics about an imminent pandemic seem to be gone...don't they.

The argument of a mild pandemic only stould a couple of years ago when they could get away with it. The fact is that this virus is breaking all the rules and has continued to for nine years.

If I indeed end up being 'the leader' in this mess...I cannot in good faith ask persons to follow me over the cliff without recompense...That's where the wages come in because you may be sending two of three persons to their death.

You seem to underestimate (in my opinion) the effect of the SARS outbreak in Toronto and elsewhere in 2003. Nurses are smart...they talk and they will not again, anywhere in North America, put up with bullshit from any authority.

I don't think that makes me a cynic.

Tom: I don't think we disagree but we express it very differently. I don't plan to give anyone orders. If anything, I'll be taking them. I hope I have the courage to just help. None of us knows how we'll react and I don't want to game it out ahead of time. If and when, I hope we can be prepared as much as possible and we all want to help make that happen. After that, who knows? But if I don't show up or I go down, I still have great confidence there will be brave souls to take my place and I don't want to say or do anything to make that less likely to happen.

Ice storms in Atlanta--it doesn't take much; however, a real emergency could occur under these circumstances and most CDCers are from places that have real winter. The security clearance business also is troubling--either make sure people in relevant position shave it or don't bother. Gerberding has been good at PR, I wouldn't give her too much credit here, esp. given the ice storm & security clearance blunders.

I agree that people will pitch-in, but not everyone will do so unquestioningly and they shouldn't. One of the big handicaps of infectious disease practice and epidemiology is the abstracted form of technocratic solutions that are enthusiastically embraced but often impractical in practice. These are the kind of people who think adult circumcision will put a big dent in the HIV problem w/o considering the barriers (culture, cost, infection control in rural clinics, medication, time lost to work) that don't go into a simplistic regression equation. A flue epidemic of even small size will be rife with rumor and docs who can't communicate with the public. I used work with these people....

Well folks ah guesses I be one of those people they will be paying. All cynicism aside. Anyone who goes out to do a pandemic in any capacity is nuts and a hero at the same time. There isnt enough PPE to go around on a good day and if it hits that 8% mark the shit is going to hit the fan. Starvation could become a real problem in the USA. Just in time anything is going to be Just Hope It Arrives.

I say again-300 million people in this country now. 8% CFR would translate to nearly 1/3rd of the people getting it. That would likely boost the CFR's and post flu CFR's. The military would be in charge within days of this upon a declaration of a state of emergency or request for federal disaster assistance. NOT SO FAST GOVERNOR. ... By law they cannot even cross the borders of a state with federal troops without the governors permission. That would be granted but I could forsee a governor hoarding the resources of his state in lieu of another and thats when the Federal Disaster Declaration clause comes in. Timeline-47 Day supply of food in the US under normal consumption and unevenly distributed. At approximately three weeks the food supply will be exhausted to a large degree and certainly within 60 days for all considerations. Even the hoarders are going to be running low. They are going to forage if able. The CFR's actually might help the living because they wont be around to take up the existing supplies. Timing is the most important thing for me in my mind. What if-At 25 days (existing coal supply) runs out? What if-Say farmers cant put a crop into the ground or get it out? What if-They cant make electricity to make fuel or run gas pipe pumps to the NE. A lot of what ifs and what could happen.

Thin-There were a lot of things implied the other day from that exercise that I figured out but didnt get the full drift on. This kind of stuff falls under the National Security Act and the government operates as it has for almost a century on a "need to know" basis and it matters not what you think you need to know. They will tell you what THEY think you need to know. Its not obscene... its the law. Further, I have posted before on the process of obtaining a civilian clearance for the "need to know" stuff. You will have to pay for it of course, but they would grant you the clearance after some time. But guess what? Once you know, you will of course not be able to tell anyone because they dont have a need to know. You cant declassify stuff just because you want to. Why do you think that none of these watchdog groups ever go for the clearance process? Its because if they do, they are done as a watchdog group. Cant say shit about it at all any longer. Catch-22.

Revere I was thinking along the lines of Lisa the GP's comment, key things like CFR or where it's spread. Not getting out that information in a timely manner in the name of not causing "panic" would very probably backfire. I wasn't being cynical, really, other than about the institutional missteps we get inklings of.

I also agree that many people will go beyond what anyone could demand of them; I think being honest about the situation shows respect and gives people the credit that they can make the brave choices. And being less than forthcoming could backfire. (I'm having Sandman and Lanard moments.)

The last thing I need is an excuse. I'd be only too eager to use it.

It sounds terrible to say, but it's times like this I'm glad I have no (pandemically relevant) useful skills.

But I have people I love who do. A selfish part of me wishes they would demur... but as I love and know them, I doubt they will.

Uh-Give 'em Hell Gracie! Thats my entire view on this stuff. By the time someone gets on the TV and does something more than giving it a ho-hum "It might mutate into a highly infectious version that is lethal to humans...." blah-blah, no one is going to keep supplies on hand. The only real vaccine we have thats tried and true'd is what the Africans have done since Olduvai Gorge... Isolation/quarantine of the sick. Never get too far from your food source. They are for instance the dirt, the plant or the slaughter, the harvest or hauling into camp, the preparation and then the mouth. We are all four of those except between the harvest and the mouth we have, the processing plant, the transportation to the distribution center, the distribution center to the store, your arrival at the store, the transportation back from the store, then cooking it or preparation and then...to the mouth. Make sure you go Africa on this one.

My neighborhood is now ready for something short of a nuclear blast.. might even survive that one some of them. They are starting to spread the word and these people dying in Indonesia are serving to ensure that more and more prepare. Graphics speak louder than words. They can all read a trendline.
End result is that the outcome may not be clear, but its clearer than most peoples vision can see.

Revere, I have personal experience of helpers doing amazing things. I want them to continue doing amazing things. I do not want them callously murdered before we need them most, by some inflated ego withholding critical information for fear that one of the people who need it might not have been certified sin-free by his demon-ridden fantasies.

Kruger did not say he worried that information would fall into enemy ears. He specifically denied intent to withhold information from any particular individuals who need it. He said that all information is withheld,,, even from the cronies when there is no convenient clandestine opportunity.

"need to know", is not about the requirements of your job. "need to know" is not about your ability to use information. "need to know" is certainly not about protecting yourself from unnecessary risks. "need to know" is about somebody else's ignorant paranoia.

You are a scientist, Revere. You told us you were in Chicago 1968. You know that a good way to do a lot of damage, to yourself and to those you propose to help, is to blindly follow orders delivered by oblivious messengers.

You have read the SARS report. I bet you have talked with people who were there. You have read about this CDC drill. I bet you have talked to people who were there too.

You, and I too, know that that the vast majority of health workers and volunteers will help, at the cost of their own lives. They deserve a lot of awe and respect. They deserve all the material assistance, and especially all the information, we can give them. Authorized or not.

They deserve all the support we can give them too, physical, moral, emotional, intellectual, when the least little willowisp of doubt whispers, this is wrong, get out, live to help another day. It is foolish, frankly disrespectful, to praise their courage whilst dismissing their training and experience.

My helpers are going to know that, if they are scared, or tired, if they think some martinet in Atlanta or Washington is wasting them, they don't need to stand tippytoe in the trench watching the mud rise to their nostrils. They are going to know that nobody has a right to browbeat them against their better instincts.

They are going to know also to the best of my ability, when some paranoid gives them bad information because they don't have the authorized magic decoder ring, good arguments to test that disinformation. Good arguments to accurately test their own ethics. Good arguments that preserving themselves is ethical, too.

They cannot help us properly, nor preserve themselves, unless they can say, no. No, you can't waste me. No, I will not accept bad information. No, I decide what it is I am seeing.

Revere, I have been reading Effect Measure for long enough. You will help. Like everyone else here. More importantly, Revere, when you start hearing nonsense orders, you will not meekly obey. You will put down your bedpan and object loudly and lucidly.

You are not the only one who can evaluate and choose. My old GP doesn't have your training and experience. She probably doesn't have your social conscience either. She will have my support, my demand, that she evaluate our situation and make the best choices we can. We both will be safer because she can choose, because she can refuse.

One final point : I won't have the best information. You won't have the best information. Authority won't give whatever information they obtain. (As Grace RN says, they won't even be able to give it.) The best information is going to evolve from a million cot-side observations. It is going to become the best information, if it does, by being shared and evaluated by a million cot-side observers. Information can be shared only if it is spoken and heard, cot-side to cot-side, ward to ward, clinic to clinic, county to county, random stranger to random stranger.

CDC is not going to help us. The military will be guarding symbols from chimerae. Governments will be projecting facades of control. Media will be sabotaging any information they get with balancing opinions and patriotic lies.

Listen to Grace RN.. we have to do it all ourselves... with a little help from our friends, if we start setting up those unauthorized networks, now, today, this minute.

Greg, caia, etc.: Everyone is extrapolating from the security "need to know" comment, since that was the only one that had a relevance to this discussion. That is an entirely different issue. The risk communication issue is something else. Authorities sometimes do this well, sometimes badly and that will vary with locality and agency and individual official. We should be pushing for honesty, since that will be the best policy overall, but don't confuse it with the comment in the post about security.

Will there be confusion? Yes. The most important thing is that we have some trust that we are being given the best information available, not that it is always correct.

I'm in Atlanta, close to the CDC, and the "ice storm" was non-existant. North of the city, some schools were closed Thursday. But Atlanta was pretty much ice-free. Even for Atlanta, where any accumulation leads to general panic, the "ice storm" was nothing. Stopping the drill just doesn't make sense to me. At. All.

Greg. Your post at 4:14 is a beautiful piece of writing: to the point, clear and concise: not a word wasted.

Thanks...it was a joy to read!!

marquer: Is there something wrong the exercise they devised? Because it sounded pretty realistic to me. What exactly is your point? That CDC contracts with some disreputable companies? Yawn.

It's a question of reputability, but it's also a question of professional competence. If someone came to you for a job and their CV showed that their most recent position was as a trainer of the (disastrously inept) new Iraqi Army, would that not give you pause? That's MPRI. Literally. That's what they have been doing since 2003.

More to the point, the US government has developed a genuinely bad habit of conducting analyses and performing simulations, and then ignoring or burying unfavorable outcomes.

Look at NASA's purportedly independent safety analysis boards set up after the Challenger loss. They turned out to be a bunch of Agency employees who acted as passive rubber stamps for management. Which led fairly directly to the incineration of Columbia and her crew.

Or consider the expensive (circa $300M) and elaborate war game which the Rumsfeld Pentagon ran back in 2002, "Millennium Challenge". The intent was to reconfirm the ability of American forces to control the Persian Gulf in a crisis.

Instead, what happened was that the leader of the Threat team, Marine LtGen Paul van Riper, fought a classic improvisational insurgency model. He used motorcycle couriers instead of interceptable radio communications. He hit the Navy with a swarm of simulated suicide speedboats for which they were not prepared, and sank a couple of very expensive naval platforms.

"No fair!" said the Pentagon brass, as van Riper was well on the way to winning (or at least to denying the US team victory). They stopped the sim and restarted it with new ground rules which were more favorable, essentially making the whole costly endeavor into just a giant glossy PR wank.

"A culture not willing to think hard and test itself does not augur well for the future," is what van Riper said in retrospect, and I think he is spot on the mark.

So when a firm like MPRI, which has made its bones by vigorously agreeing with and lackadaisiacally implementing dumb-ass US government policies abroad, is put in charge of something as important as a supposedly realistic pandemic sim, my bullshit detector sounds at top volume.

Always remember the continued prosperity of MPRI and company is a function of not giving offense to their government patrons. Not a recipe for objectivity.

--

marquer: OK. Reasonable point. Thanks.

I wouldnt bet on anything but obfuscation the first couple of real days of the flu. Then some of the truth, then most of it, then all of it. My BS timeline as I have come to call it should really be something less than a month. At the three week mark, the realities of the street will be kicking the ass of MSNBC. They wont be lefty at this time no matter who is reporting it.

The other part to this relates to when they declare a state of emergency by states. The president likely will never call for martial law unless lawlessness kicks in. The state of emergency is just under that, gives the president extraordinary powers to screw things up and allows for the subjugaton of the masses using troops. The key to this will be the total number of states calling their individual problems "state of emergency" . The second they ask for Federal assistance, they toss the towel. The Federal Government will not be able to cope or react to what is for all intents and purposes a biological attack. No way to cover all the bases unless total control is asserted.

That would be bad.

Revere, your proposition that "the most important thing is that we have some trust that we are being given the best information available" ...excepting the trivial case that it may be the best available, and simultaneously worst, because it is the only information we have... is precisely what I and others dispute.

Every precedent we have ridicules the notion. If you believed it, Effect Measure would not exist.

Even if authority takes its collective tongue out of its colon and decides to tell the truth, communication will be chaotic to nonexistent. Wires will be down. Gatekeepers will be up. Messengers will be ambushed for their water bottles.

That is not reason to do nothing. It is reason to do smart.

It is reason to distrust all information, distrust especially those with a history of betraying us. And to provide ourselves with alternate communication networks, alternate sources of information and of wisdom.

Tom DVM, thank you. I can take liberties with language which Revere and others cannot.

Greg: That kind of radical skepticism isn't very useful or sustainable. Your post is full of information, some of which will undoubtedly be proved false. Why should I believe you?

MRK: Martial law is a giggle. No troops, dude.

Revere, you should not believe me.

You should not believe me, for the same reason you should not believe H2N1 will mutate into a human pandemic : it is hypothetical. You should not believe me, for the same reason you should not believe CDC : we lack credibility regarding such phenomena (I have no history, CDC has too much history). You should not believe me because you have the wit and the freedom to evaluate and to choose for yourself.

However, you should consider my proposals for the same reason you should consider an H2N1 mutation : the potential outcomes might be very bad; while most of the preparation is cheap and in any case useful for any health disaster or none. You should consider my proposals for the same reason you consider CDC's advice : we might be right. You should consider my proposals because you, everyone each in your own context, can evaluate whether they make sense in your context.

To follow CDC's advice because you think it is the best of all you have does not guarrantee survival but it improves your chances. To follow CDC's advice because you have refused to consider any other is probably a good way to remove your genes from the common pool... good bye, thanks for saving us the trouble.

You started Effect Measure because you were (and continue to be) skeptical. People read Effect Measure because they are skeptical. I am not adding much to those original skepticisms.

I am merely saying, make your skepticism conscious and conscientious, feed it information, turn your ignorant fear into informed confidence.

Never believe. Not CDC. Not Revere. Not even me.
.

GZH-I think you had better pull the Homeland Security Act out and then read the departmentals on and what kind of power they have to act before you say, "No troops." Truth be known, thats all they are going to really have that they can depend on .

So, MRK, are you saying (by you last comment) that they will enlist new troops from the able-bodied they find on the street? That's how I read your comment. The Homeland Security Act is too confusing to read.
Thanks, Steph

MRK: Not if the flu preferentially attacks younger and previously healthy adults. Troops will be overrepresented in mortality/morbidity. Hardly available for many additional duties.

Steph. No thats not what I am saying. I am saying that they will die with their boots on while protecting the interests of the United States. There will be minor mutinies which will be dealt with if necessary. But most understand from their bio-warfare training that as long as they are in their gear and using it properly they will be okay.

Epitope-In the 70's when I was in, bio was not trained for extensively. Only chemical attack as a rule. Now and when I left in the 90's bio and chem take the front seat over radiological (nukes). They are all required to show proficiency to the level of the kill and they use simulated bugs that they can detect on your skin and under your mask if you simulatedly got it. Penalty for dying is stripping a floor and rewaxing it. About a day for some hallways. Not a lot of failures except in the newbies that are just learning. They learn buffer operations and how to stay alive.

You make the assumption that they wont work in it. They will. I will be too. As long as someone doesnt violate a protocol, there is no reason for them or us to get sick. First protocol prepare, second train, third weather, fourth recover.

MRK: i hope to meet you during the last 2 protocols:....weather and recover.am enjoying the battle of wits in this forum. very informative and useful.as a former EMS i know the duties to your community and as a family man, i know the duties to them. choices to be made by the individual based on the first 2 protocols: prepare and train, will, in fact, be the most useful information of all.

In the defense of the CDC:

Calling off the drill due to an ice storm seems to me to be an understandable, if not ideal, decision. If the point of the drill was to test the responce and abilities of the CDC, for the first public, with-the-press drill, you don't want foul weather. You want to know that the truck didn't show up because it got misrouted, not because of road conditions. You want to know that your supply chain is broken, not that your supplier is plowed in.

You don't test highly complex systems in adverse conditions first. You get them working, and then throw problems at them.

As for MPRI: They do a hell of alot besides Iraq. And to be fair, if we exclude everyone whose done contract work in Iraq from being "reputable" and competent, the entire defense industry is gone. A great many of these people gave perfectly reasonable advice, or are quite competent. They also train police, and corporations, and other government agencies. And you have no idea what kind of hand they have actively had in Iraq, unless you have a far, far better security clearance than probably anyone who reads Effect Measure. Judge the drill on its actual merits, and from what I have read, MPRI set down a reasonable, well-conceived scenario that was well within what the CDC could expect.

Eric: Regarding calling off the drill, I think my post is in agreement with your comment. I also agree regarding MPRI. As far as I could see, their drill was realistic. Regarding their roll in Iraq, however, I think marquer is right. It doesn't take a security clearance to see this.

Revere,

I think your post was indeed in agreement, mine was more a statement to several other responces on the thread.

As for Iraq...what marquer is arguing is entirely possible. However, I have known too many intelligent, competent people in that rather impressive morass our country has created that have been either ignored or outright ordered to ignore their own conclusions and judgement, to be quite so ready to set it at their doorstep without knowing more. To paraphrase an account of a training excercise:

"The missles were far too accurate, turn down their range and crew accuracy."