Embassy Buenos Aires Avian Influenza Tripwires and

UNCLAS SECTION 01 OF 04 BUENOS AIRES 003110 SIPDIS SENSITIVE, SIPDIS STATE FOR S/ES - O/CMS - Office of Crisis Management Support E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMR AR SUBJECT: Embassy Buenos Aires Avian Influenza Tripwires and Contingency Planning Reference: (A) State 219189 (B) State 220047 (C) Buenos Aires 2914 ¶1. Sensitive But Unclassified - Not For Internet Distribution. ¶2. (SBU) Summary: Embassy Buenos Aires has created an Avian Influenza (AI) Mission Task Force (MTF),chaired by the DCM and composed of a program coordinator and representatives from MED, CON, RSO, MGMT, FAS and ESTH. The MTF recently met to explore Post's current posture, the Argentine health care environment and the advance planning necessary to confront a possible AI epidemic. The GOA has created an extensive AI Contingency plan based on Pan American Health Organization (PAHO) and U.S. practices and may be capable of implementing it, depending on the severity of an AI outbreak. However, a lack of resources makes it probable that a sustained AI epidemic would overwhelm the Argentine healthcare system within a short period. ¶3. (SBU) The MTF identified steps that should be taken immediately, created an implementation action plan and developed a series of tripwires and corresponding responses. Of particular concern to the MTF is the lack of a stockpile of antivirals at Post and the unavailability of the drugs on the local market. ¶4. (SBU) In determining appropriate tripwires, the MTF factored a fast transmission rate, especially if the virus develops the ability to spread directly from human-to-human, into all assumptions concerning AI due to the historically rapid geographical dispersion of pandemics, the pace of modern air travel and Argentina's location as a major migratory bird flyway. The tripwires also consider likely civil unrest and the probability that basic services and business organizations would either cease functioning or dramatically cut back services in the event of a pandemic. End Summary. ¶5. (U) Embassy Buenos Aires has created an ongoing Avian Influenza (AI) Mission Task Force (MTF),chaired by the DCM and composed of a program coordinator and representatives from MED, CON, RSO, MGMT and ESTH. The purpose of the MTF is to explore Post's current posture, the Argentine health care environment in the event of a pandemic and coordinate the advance planning necessary to confront a possible AI epidemic, and develop emergency response procedures. ¶6. (SBU) The MTF observed that Post currently does not have a supply of antiviral drugs and recommends obtaining enough of the drugs to ensure 100% coverage of all Embassy staff (including contract personnel) and EFMs in order to ensure continued Embassy operations. ¶7. (SBU) There are a number of high-quality hospitals and clinics in the greater Buenos Aires area. The quality and number of facilities outside of the capital varies greatly depending on the region, with healthcare in the northern provinces of a particularly low quality. ¶8. (SBU) The GOA has created an extensive plan based on Pan American Health Organization (PAHO) and U.S. practices to deal with a possible outbreak of AI and coordinated the plan with the Ministries of Health in Chile, Uruguay and Brazil. The Ministry of Health (MOH) is active and involved and the GOA may be capable of implementing the plan depending on the severity of the outbreak and the availability of antivirals and vaccines from outside sources. ¶9. (SBU) A lack of resources makes it probable that a sustained AI epidemic would overwhelm the Argentine healthcare system within a short period. The GOA would need assistance with personnel, detection laboratories and medical equipment such as respirators and isolation wards if a pandemic outbreak occurred in Argentina. The GOA does not currently have a supply of antiviral drugs, such as Tamiflu, although the GOA claims it is currently negotiating for a stockpile of the drugs. ¶10. (SBU) Post has sufficient resources to shelter essential personnel in place at the Embassy for two weeks. ¶11. (SBU) Post management has tasked two U.S. citizen employees, ESTH Officer Tim Hall and Post Medical Officer Dr. Michael Heald, with responsibility for inputting the tripwire data. Both possess secret clearance or higher. ¶12. (U) All DoD personnel are under COM authority. BUENOS AIR 00003110 002 OF 004 ¶13. (SBU) In determining appropriate tripwires, the MTF factored a fast transmission rate, especially if the virus develops the ability to spread directly from human to human, into all assumptions concerning AI due to the historically rapid geographical dispersion of pandemics, the pace of modern air travel and Argentina's location as a major migratory bird flyway. Post's plan also addresses the civil unrest and breakdown of basic services that could result from a pandemic outbreak in Latin America. It is highly possible that basic services and business organizations would either cease functioning or dramatically cut back services. ¶14. (SBU) All tripwire responses have been made under the assumption that an effective human vaccine will not be available. Any of the tripwires discussed below could occur independently of each other. It is also possible that two or more tripwires could occur sequentially or simultaneously. ¶15. (U) In the course of discussions, it was apparent that certain actions need to take place now, before any tripwires are met, in order to be fully prepared in advance. This report lists A) actions that require immediate attention, and B) tripwires and responses. ¶16. (SBU) A) Actions to be taken immediately: - As deemed necessary by Post management, provide Mission briefings for both American and LES employees and dependents. Topics will include General AI info, MED guidance, Post's contingency plans and the address of the Embassy website containing information about avian influenza. (Action: MGMT and MED) - After briefing Mission (see above),provide American Citizen Community with information presented during briefing via email. (Action: MGMT and MED) - Identify Staff with medical background and skills. (Action: MED) - Train non-medical personnel in caring for those suffering from AI and to supplement the health unit staff in the event of a pandemic. (Action: MED) - Request sufficient Tamiflu to cover all staff (including contract employees) and EFMs. Conduct inventory of personal protective equipment (gowns, gloves, protective eyewear, alcohol-based cleaners and N95 respirators). In coordination with Consular Section, determine quantities needed in the section. Procure needed supplies. (Action: MGMT and MED) - Provide proper security measures for Tamiflu supply in mission. (Action: RSO) - Stockpile emergency supplies for a period of at least several weeks. This should include a practice of maintaining full tanks of fuel in all vehicles. (Action: MGMT and GSO) - Plan for continuation of operations with reduced staff and prepare for conducting work from home or other locations under conditions of a pandemic limiting access to mission offices. This includes the ability to disseminate warden messages from an alternate location. (Action: DCM and CONS) - Identify essential staff to remain through possible authorized or ordered departure. This list will likely mirror that in the Emergency Action Plan (EAP). (Action: DCM) - Identify staff with medical issues or risk for severe disease to depart when authorized. (Action: MGMT and MED) - Prepare pre-planned packets - including travel orders - for potential Mission evacuees under an authorized departure. (Action: MGMT and GSO) - Engage host country officials, including NGOs, to keep abreast of host country's AI response strategy and health care capabilities. (Action: ESTH) - Update list of alternative local physicians in case the Post doctor is unavailable. Alternative doctors should be briefed by Post medical staff on AI procedures. (Action: MED) - Inspect MRE and bottled water supplies. Determine if BUENOS AIR 00003110 003 OF 004 additional MREs and other supplies should be ordered to sustain Mission operations and for unforeseen contingencies. (Action: MGMT and GSO) - Conduct periodic meetings of the MTF to review Post's AI preparedness posture. (Action: DCM and all sections) ¶17. (SBU) B) Tripwires and Responses: Tripwire One: A substantial and sustained spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission anywhere in the world. - EAC meets to confirm tripwire has been crossed. - Provide Mission briefings for American and LES employees and dependents. - Restrict official and unofficial travel. - Ensure that any public announcements or travel warnings issued are disseminated to American citizens in host country. - Recall all employees who are currently in remote areas. - If the disease has already reached the U.S., consider sheltering in place of all non-essential personnel in lieu of authorized departure. - Begin preparations for actions in Tripwire Two. Tripwire Two: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission in Latin America or South Africa. - EAC meets to confirm tripwire has been crossed. - Provide Mission briefings for American and LES employees and dependents. - Restrict official and unofficial travel to suspected areas. - Request authorized departure of non-essential staff and family members. If this is not possible due to shutdown of airports or if the disease has already reached the U.S., non- essential staff and families should shelter in place. (It is probable that staff and family members will onQ have a limited time to depart Argentina. This will depend on the rate of dispersion of the disease and the pandemic associated shutdown of national and regional airports.) - Non-essential personnel will be placed on administrative leave. - Cancel incoming official travel to host country except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. - Ensure that staff purchases sufficient supplies of Qod and water for a shelter in place scenario. - Social restrictions (restrict movements of all personnel in the city; restrict dinner parties, participation in sporting events, etc.) - Begin preparations for actions in Tripwire Three. Tripwire Three: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission in Argentina. - EAC meets to confirm tripwire has been crossed. - Provide mission briefings (perhaps by phone or email) for American and LES employees and dependents. - Cancel incoming official travel to host country except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. - Coordinate with CA/OCS on issuance of guidance (public announcement ortravel warning, as appropriate) urging American citizens to defer all non-emergency travel to host country and particularly the affected regions. - In coordination with the Department, prepare press guidance. - Implement home quarantine of any staff or dependents who have been in contact with a person confirmed to have an AI infection and implement at home monitoring procedure. - IF AD/OD is not permissible, instruct all non-emergency American and LES staff to remain home on administrative leave. Children should remain home from school. - Implement social distancing (limit movement of all personnel and dependents in the city). - Plan for home visits to sick individuals who receive care under the Embassy health unit. - Consider delivery service of groceries and other essential items to residences. - Depending on level of public inquiries, Embassy staffs and equips a situation room. Consular officers should establish a database tracking American citizens who have been quarantined, hospitalized or ill at home. Also, prepare guidance for American citizen community on treatment BUENOS AIR 00003110 004 OF 004 options. - Reduce consular operations to emergency consular services only. - Consider dividing the Marine Security Guard detachment into two separate and independent entities to decrease the risk of the spread of the disease and ensure proper coverage of classified materials. - Severely restrict visitor access to Mission. - Consider prophylactic Tamiflu treatment only for staff that is required to be in direct contact with potentially infected persons and those at high risk if they develop the disease. - In the event of civil unrest, consider increasing the size of the local guard force and the frequency of patrols to personal residences. If necessary, consider relocating personnel sheltering in place to a safer location. Alternate Tripwire: Mission employee or eligible family member develops AI infection. Alternate Tripwire Response: - Employee or eligible family member begins Tamiflu treatment. - Medevac if possible; otherwise home quarantine patient and anyone who has had direct contact with patient. GUTIERREZ