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Mixed messages, cafeteria-style preparedness won't cut it in swine flu flight

Those of us who have been preaching pandemic preparedness for years are extremely and understandably interested to see how this entire swine flu situation unfolds. For us, the societal impact and response is almost as important (and perhaps more important) than the actual spread of the disease.

One element of pandemic preparedness and (now) mitigation is risk communication, or what you tell the public. And I am not at all sure that the government's risk communication aspect has been handled as smoothly or as honestly as it could.

Not at fault (yet) is the media. I have been very impressed with the coverage and the quality of reporting from NBC, CNN and FoxNews. Fox and NBC have relied upon Osterholm; CNN has Gupta On the Ground in Mexico City, and Fox has Geraldo warmed up in the bullpen to close. NBC's Bazell has been spot-on. These three networks have been quite good at educating the public and relating history.

These networks, however, will not "go it alone" and recommend certain actions unless and until the government does.  They are in the business of reporting news, not making policy.

What people want to know is exactly what to do right now. People are concerned-to-scared. Few people now are openly scoffing at the headlines since the WHO raised the pandemic threat level. That act by Geneva was, in and of itself, an act of risk communication.  It was an excruciatingly calibrated decision for the WHO to make. But they made it.

Why the decision-making angst in Geneva? The WHO has resisted the urge to raise the pandemic threat level for years. This blogger, along with hosts of others, have actively called for a Phase Four designation based solely on H5N1 human cases. Now, with the expansion of swine H1N1, that designation has been attained. And that is serendipitous good news for all who wanted stronger surveillance for all potential strains. Therefore, one "peace dividend" of the raising of the pandemic threat level may be to catch more human H5, H7 and H9cases.

The other dividend was clearly meant to get more Earthlings to take this threat more seriously. And that is the opening, the entree, that we cannot squander. To not use this opening that the WHO has given governments would be criminal.

So what should we be telling people? We should be telling them to prepare and to learn more about influenza. I am not talking about the Romero-esque TV commercials that the Ford Administration ordered up during the 1976 swine flu scare. I am talking about telling people to get their "hurricane kits" or "earthquake kits" restocked and brought up to speed. It is time to re-educate the American people on previous pandemics and previous near-misses, such as 1946 and 1951, with viruses that were also H1N1 but were much more virulent and, some thing, either swine-like or were actual swine influenzas that jumped the species barrier back in the day.

Telling people to buy one to two weeks' worth of food, water and medicines to prepare for hurricane season -- an annual hit-or-miss proposition with a clear historical precedent of occurrences -- is not considered folly; it is considered prudent.

Likewise, to tell people not to prepare similarly, in the face of the greatest threat to public health since SARS, also with a clear historical precedent, is equally prudent.

So why is everyone afraid to do so?

That brings up another issue: I wonder if anyone is testing this new swine flu against the antibodies of people who went through 1946 and 1951? Those people and their entire age group may be partially immune to this new strain and we may not even be aware of it. That may help explain the reason why older Mexicans and others are not falling in quantity.

By now, you should have a clear plan of action for Phase Four, Phase Five and the dreaded Phase Six. Phase Four should include beginning your "hurricane kit," or your all-hazards kit. It should include two weeks' worth of food, water and influenza and intestinal medicines and Gatorade to restore electrolytes. The Bush Administration was preaching this for three years, with not panflu threat! Emergency managers, including my very good friend and soon-to-be FEMA head Craig Fugate, have been preaching this Gospel of Personal Responsibility action item for years and years.

Why we are not telling people to do this nowis bizarre.

At some point, we need to tell people to update those kits and to prepare. To have told the American people to stock supplies from 2005 to 2008 and then NOT tell people to do so in the face of a potential pandemic sends a mixed message which is bad, bad, bad.

What I will call "cafeteria-style" preparedness also won't cut it. If you had a plan for Phase Four, stick to the plan. If that plan meant stocking, then stock. If it meant fleeing to the equator, bad timing, unless that's where you were headed anyway.

I can tell you that in my own plan, as one detail, I order a stop to all vacuuming in Phase Five. That is because vacuuming will stir up particles that had drifted to relative harmlessness on the rug, to dry out and become inert. Vacuuming reactivates those particles, kicks them up back into the air where they can be re-inhaled. Business and political leaders would do well to order the same action -- but in Phase Five.

As I mentioned in my Computerworld blog of 2008: For hurricanes and pandemics, plan one category higher.you need to assume ahead of the experts, the government spinmeisters and the virus/hurricane/calamity itself. You will never go wrong if you plan one category ahead of the approaching event.

If nothing else, you'll have a great ravioli supply for those midnight snacks if we all stand down.

Reader Comments (2)

Great advice, Scott. I appreciate your calm demeanor and style of writing. Just got back from Costco (in a so far non-swine flu US state), where you could tell the bottled water supply had been picked at, but otherwise, no visible signs from people's baskets or the shelves that folks are stocking up.

April 28, 2009 | Unregistered CommenterAmy

Hi, Scott- you have some great advice here, which echoes my own thoughts about preparedness. I talk a lot about this on my own blogs, and like Amy, appreciate your level-headed style.

Makes me wonder how our other NALIT colleagues are handling this. Disaster prep has been one of my 'hobbies' for a long time, but I am serious enough with it that I got CERT training, among other things. I'm definitely linking to your blog- there is some valuable info here.

April 30, 2009 | Unregistered CommenterLorie Johnson

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