SRI LANKA: AVIAN FLU TRIPWIRES AND SHELTER-IN-

UNCLAS SECTION 01 OF 06 COLOMBO 002121 SIPDIS STATE FOR OIE DANIEL SINGER AND REBECCA S DALEY STATE FOR SA/INS S/ES-O/CMS - OFFICE OF CRISIS MANAGEMENT SUPPORT E.O 12958: N/A TAGS: AMED AEMR AMGT ASEC CASC EAGR KFLO TBIO ECON CE SUBJECT: SRI LANKA: AVIAN FLU TRIPWIRES AND SHELTER-IN- PLACE PLANS REF: A) COLOMBO 1592, B) COLOMBO 1992, C) COLOMBO 1993, D) STATE 219189 ¶1. SUMMARY: THIS CABLE REPORTS OUR REVISED AVIAN INFLUENZA (AI OR H5N1) TRIPWIRES AND SHELTER-IN-PLACE PLANS REQUESTED IN REF D. THIS CABLE SUPERSEDES REF C. ¶2. SRI LANKA LACKS SEVERAL CRITICAL RESOURCES - TAMIFLU, LABORATORY EQUIPMENT TO IDENTIFY AI, AND MODERN, FULLY EQUIPPED HOSPITALS. IF AI COULD BE DIAGNOSED RAPIDLY AND IN A DEFINED AREA OF SRI LANKA, THE SRI LANKAN GOVERNMENT (GSL) COULD OSTENSIBLY CONTAIN AI. WORKING-LEVEL OFFICIALS ARE ACTIVELY DEVELOPING PLANS AND SEEKING RESOURCES. YET AI IS NOT A HIGH PRIORITY WITHIN THE GSL. DEVELOPMENT OF POLICIES AND STAFFING OF MINISTRIES FOLLOWING A PRESIDENTIAL ELECTION AS WELL AS A TENUOUS CEASEFIRE, TAKE HIGHER GSL PRIORITY THAN AI PREPAREDNESS. POST ANTICIPATES IT IS ABLE TO PROVIDE SHELTER IN PLACE FOR SEGREGATING PERSONNEL BY UTILIZING THE CHANCERY AND HOMES AS DETAILED IN THE TRIPWIRES. DRAWDOWN MAY BEGIN IN TRIPWIRE 3 - WITH SUSTAINED HUMAN-TO-HUMAN TRANSMISSION OCCURRING IN COUNTRIES WITH REGULARLY SCHEDULED FLIGHTS TO SRI LANKA. END SUMMARY. ¶3. US EMBASSY COLOMBO'S REVISED TRIPWIRES WERE PREPARED BY POST'S AVIAN INFLUENZA WORKING GROUP (AIWG) AND HAVE BEEN APPROVED BY THE CHIEF OF MISSION. WE INVITE AND WELCOME FEEDBACK FROM RELEVANT OFFICES AND AGENCIES WITH EXPERTISE IN EMERGENCY PLANNING AND/OR INFLUENZA. ¶4. POST'S ADMINISTRATIVE COUNSELOR, FOREIGN SERVICE MEDICAL OFFICER, ECONOMIC OFFICER, CHIEF OF CONSULAR SECTION AND AID HEALTH AND HUMANITARIAN ASSISTANCE PROGRAM OFFICER ARE MEMBERS OF THE AIWG. IN ADDITION TO CONSULTING WITH GOVERNMENT OFFICIALS AND MULTILATERAL REPRESENTATIVES (REFS A AND B) AND PREPARING THESE TRIPWIRES, POST HAS DISTRIBUTED AN ADMINISTRATIVE NOTICE TO ALL PERSONNEL REGARDING AI SYMPTOMS AND PREVENTIVE MEASURES. THE CONSULAR SECTION HAS ALSO INCLUDED A LINK TO THE STATE DEPARTMENT AVIAN FLU FACT SHEET WITHIN ITS MEDICAL INFORMATION PAGE FOUND AT: HTTP://SRILANKA.USEMBASSY.GOV/MEDICAL_INFORMA TION.HTML. THE AIWG WILL CONTINUE PLANNING FOR A POSSIBLE PANDEMIC, INCLUDING REFINEMENT OF PROGRAMS AVAILABLE TO EMBASSY PERSONNEL IN THE EVENT OF A PANDEMIC. ¶5. THE FOLLOWING AMERICAN CITIZEN EMPLOYEES WILL BE RESPONSIBLE FOR INPUTTING THE TRIPWIRE DATA: ALEXIS SMITH, ELSA BRITT, AND CAROLINA RUDISEL. KEY ASSUMPTIONS -------------- ¶6. THE AIWG HAS MADE THE FOLLOWING ASSUMPTIONS FOR PLANNING PURPOSES: - THE CURRENT THREAT TO PERSONS IN SRI LANKA, AND USG PERSONNEL IN PARTICULAR, IS LOW. NO BIRD HAS YET BEEN DIAGNOSED WITH AI IN SRI LANKA. THE CONTINGENT RISK IS THAT H5N1 BEGINS TO TRANSMIT ACTIVELY BETWEEN HUMANS. RISK WOULD BE MANAGEABLE IF HUMAN-TO-HUMAN TRANSMISSION OCCURRED ONLY IN CASES OF EXTENSIVE INTIMATE CONTACT. TRANSMISSION BY CASUAL HUMAN-TO-HUMAN CONTACT WOULD REQUIRE RAPID ACTION TO PROTECT OUR PERSONNEL. - THERE IS A LOW PROBABILITY THAT SRI LANKA WOULD BE AT THE CENTER OF ANY OUTBREAK OF HUMAN-TO-HUMAN AI INFECTION. BUT IF CASUAL CONTACT WOULD RESULT IN AI INFECTION, SRI LANKA IS ONLY A SHORT AIRLINE FLIGHT AWAY FROM PROBABLE OUTBREAK CENTERS. DUE TO THESE FACTORS, WE CHOSE TO DEFINE THREE SEPARATE TRIPWIRE LEVELS FOR CIRCUMSTANCES WHICH ALL FALL WITHIN IN THE EXAMPLE TRIPWIRE 1 FOUND IN REF D. - SRI LANKA'S CAPITAL CITY, COLOMBO, IS ALSO ITS INTERNATIONAL TRANSPORTATION HUB. VIRTUALLY ALL INTERNATIONAL TRAVEL BEGINS OR ENDS WITHIN 20 MILES OF COLOMBO'S CITY CENTER. ANTICIPATING THAT HUMAN-TO-HUMAN AI WOULD MUTATE IN THE HIGH-RISK PARTS OF THE WORLD FOR AI AND ARRIVE THROUGH THESE TRANSIT CHANNELS, WE CONSIDER SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN ANY PART OF SRI LANKA AS EQUALLY THREATENING TO OUR PERSONNEL. THEREFORE, WE DO NOT DISTINGUISH BETWEEN INFECTION WITHIN RURAL AREAS AND THE CAPITAL CITY AS FOUND IN SAMPLE TRIPWIRES 2 AND 3 OF REF D. - SRI LANKAN MEDICAL FACILITIES ARE ALREADY NEAR CAPACITY EVEN WITHOUT AN EPIDEMIC OF ANY SORT. MEDICAL FACILITIES WILL BE UNABLE TO HANDLE A LIMITED NUMBER OF CASES. THERE ARE NO ENTIRELY SUITABLE ISOLATION WARDS SHOULD H5N1 HUMAN-TO-HUMAN TRANSMISSION BECOME HIGHLY EFFICIENT. - DEPENDING ON THE SPEED OF A HUMAN-TO-HUMAN OUTBREAK, U.S. CITIZENS COULD BE QUICKLY CUT OFF FROM EVACUATION ROUTES. - POST WOULD BE UNABLE TO OBTAIN ESSENTIAL MEDICAL AND BASIC SUPPLIES IN THE EVENT OF A CRISIS AND SHOULD STOCKPILE ADEQUATE PROVISIONS. CURRENT PREPARATORY ACTIONS -------------- ¶7. IN ADDITION TO REGULAR MEETINGS OF THE AIWG AND SEVERAL DISCUSSIONS BY THE EAC, POST IS TAKING OR CONSIDERING THE FOLLOWING ACTIONS IN PREPARATION FOR A POSSIBLE AI PANDEMIC: - BEGIN REGULAR COMMUNICATION WITH OVERSEAS SCHOOL OF COLOMBO AND OTHER INTERNATIONAL SCHOOLS USED BY US FAMILIES AT THE EMBASSY ON THEIR AI PREPARATIONS AND PLANS. - PREPARE FOR POTENTIAL NEED FOR PERSONNEL TO WORK AT HOME AND COMMUNICATE WITH THEIR CONTACTS FROM SHELTER-IN- PLACE LOCATIONS. - THE COMMUNITY LIAISON OFFICER AND MEDICAL OFFICER WILL PREPARE A LIST OF BEST PRACTICES FOR EVACUATION - WHETHER FOR AN AI-RELATED EMERGENCY OR OTHER FOR PURPOSES. - DEVELOP AND MAINTAIN A LIST OF PERSONAL EMAIL ADDRESSES OF USG PERSONNEL IN CASE OF EMBASSY SHUTDOWN AND/OR NEED TO COMMUNICATE WITH PERSONNEL AT SHELTER-IN- PLACE LOCATIONS. - PREPARE LIST OF AI-SPECIFIC ESSENTIAL PERSONNEL AND PREPARE FOR POTENTIAL NEED TO LODGE SUCH PERSONNEL AT CHANCERY. (NOTE: DUE TO THE NATURE OF A HEALTH-RELATED EMERGENCY AND POSSIBLE SHELTERING OF ESSENTIAL PERSONNEL AT THE CHANCERY, THIS LIST WILL DIFFER FROM THE REGULAR LIST OF ESSENTIAL PERSONNEL. END NOTE.) - DEVELOP SMS CAPABILITY FOR EMBASSY TO EFFICIENTLY COMMUNICATE WITH EMBASSY COMMUNITY AND AMERICAN CITIZENS. - TRAVEL ORDER PACKETS ARE ALREADY PREPARED SHOULD EVACUATION BE REQUIRED. TRIPWIRES AND RECOMMENDED ACTIONS -------------- THE CHIEF OF MISSION HAS APPROVED THE FOLLOWING TRIPWIRES AND POSSIBLE ASSOCIATED ACTIONS: ¶8. TRIPWIRE ONE: SIGNIFICANT OCCURRENCES OF AI TRANSMITTED FROM BIRDS OR OTHER ANIMALS TO OTHER BIRDS OR ANIMALS EMERGE IN SRI LANKA; NO EVIDENCE OF SUSTAINED TRANSMISSION TO HUMANS. (Note: "Significant occurrences" include transmission to a population of non- migratory birds or animals within a geographically limited area or transmission in more than one area of the country. "Sustained transmission to humans" is the transmission of disease beyond the situation where a single infected person transmits to another single person with whom he/she is in extremely close physical contact, e.g., sick child to mother. End Note.) POSSIBLE ACTIONS: - EAC meets to confirm tripwire has been crossed. - Restrict official and unofficial travel to affected areas, bird markets and similar facilities. - Reiterate current Center for Disease Control (CDC) recommendations to staff and post's food service regarding AI prevention: reinforce caution against consuming improperly cooked eggs or poultry meat as well as advise on proper handling of raw poultry products; advise people to avoid butcher or wet markets where poultry is prepared; consider issuing further recommendations regarding preparation or consumption of poultry. - In coordination with the Department, release a warning announcement to Mission personnel and a warden message to private US citizens and post the announcement on the website. - Hold a town hall meeting with the American community to discuss AI and other topics of interest. - Continue regular communication with Overseas School of Colombo and other international schools used by US families at the embassy on their AI preparations and plans. ¶9. TRIPWIRE TWO: ANY CASE OF BIRD-TO-HUMAN OR ANIMAL- TO-HUMAN TRANSMISSION OF AI IN SRI LANKA POSSIBLE ACTIONS: - EAC meets to confirm tripwire has been crossed. - Restrict travel to affected areas. - Release a warning announcement to Mission personnel, and in coordination with the Department, release a warden message to private US citizens; post the announcement on the website. Information will include details of the episode, instructions on watching for signs and symptoms of avian influenza, triage criteria and the use of personal protective equipment. - Ensure that any public announcements or warnings issued relating to neighboring countries regarding AI are disseminated with American citizens in host country. ("Neighboring countries" include both countries geographically near as well as those with direct flights to or from Sri Lanka.) - Begin stockpiling water and canned goods to prepare for possible need to quarantine individuals returning from areas where human-to-human transmission may occur (i.e., prepare for Tripwire 3). - Instruct Embassy community regarding the medical response and Emergency Action Committee (EAC) Plan. - Continue regular communication with Overseas School of Colombo and other international schools used by US families at the embassy on their AI preparations and plans. ¶10. TRIPWIRE THREE: SUSTAINED HUMAN-TO-HUMAN TRANSMISSION OCCURS AS EVIDENCED BY A CLUSTER OF CASES IN COUNTRIES WITH REGULARLY SCHEDULED DIRECT FLIGHTS TO SRI LANKA (E.G., CHINA, INDIA, MALDIVES, THAILAND) POSSIBLE ACTIONS: - EAC meets to confirm tripwire has been crossed. - EAC considers requesting authorized departure of U.S. family members and non-essential personnel, potentially recommending authorized departure of only individuals at high risk for AI. - Consider recalling all employees who are currently in remote areas - Personnel who have frequent contact with the public will use protective gear including masks, according to MED guidance. - Restrict travel to affected countries. - Do not grant country clearances to non-emergency TDY personnel from or transiting affected countries. - Conduct home visits to sick individuals who receive care under the Embassy health unit. - Quarantine USG and Foreign Service National (FSN) personnel who are returning to Sri Lanka from affected countries for two weeks or for the predetermined time of virus incubation. - Order mandatory sick leave with enforced quarantine at home for any employee who shows any flu-like symptoms or has a family member with flu-like symptoms. - In coordination with the Department, issue a public announcement to private American citizens. - In coordination with the Department, prepare press guidance. - Continue communication with Overseas School of Colombo and other international schools used by US families at the embassy on their AI policies. - Establish daily briefings on AI status/cases with Ministry of Health or WHO. - Close American Center Library to public access. ¶11. TRIPWIRE FOUR: SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN SRI LANKA POSSIBLE ACTIONS: - EAC meets to confirm tripwire has been crossed (perhaps by phone or email). - In consultation with CA, provide emergency consular services only. - Cancel incoming official travel, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. - EAC considers requesting authorized departure. EAC discusses ordered departure (on the assumption that the airlines will take passengers from countries where human- to-human transmission has occurred). - Consider options for minimizing workplace exposure (e.g., teleconferencing). - Instruct all non-emergency American and LES staff at post to remain home on administrative leave. Children shall remain home from school. - Order mandatory sick leave with enforced quarantine at home of any employee who shows any flu-like symptom or has a family member with flu-like symptoms. - Implement home quarantine of any staff or dependent who has been in contact with a person confirmed to have an AI infection and implement at home monitoring procedure. - Conduct home visits to sick individuals who receive care under the Embassy health unit. - Permit visitors embassy access for emergency purposes only. - Consider using designated space to isolate emergency personnel (those not on leave) to prevent risk of transmitting to families or to others who are on leave. - Divide 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. - Consider delivery services of groceries and other essential items to residences. - Personnel who have frequent contact with the public will use protective gear including masks as directed by MED. - Cancel local community gatherings until confirming there are no immediate further occurrences of cases in Sri Lanka. - Advise closure of Overseas School of Colombo and other international schools used by US families at the embassy. - Those personnel who are required to be in direct contact with potentially infected persons will be considered as candidates for antiviral prophylaxis. - Release a warning announcement to Mission personnel, and in coordination with the Department, provide a warden message to private US citizens; post the information on the website. Information will include details of the episode(s) and advice on means of prevention, as well as treatment options. Urge American citizens to defer all non-emergency travel to Sri Lanka. - Depending on level of public inquiries, Embassy may staff and equip a situation room. - Consular officers establish a database tracking American citizens who have been quarantined, hospitalized, or ill at home. - In coordination with Department, prepare press guidance. ¶12. TRIPWIRE FIVE: ONE OR MORE EMBASSY OR IN-COUNTRY PERSONNEL SUSTAIN HUMAN-TO-HUMAN TRANSMISSION POSSIBLE ACTIONS: - EAC meets to confirm tripwire has been crossed (perhaps by phone or email). - Order mandatory sick leave with enforced quarantine at home for affected personnel. - Initiate treatment of affected individuals with antivirals; medevac if possible. - Those personnel who are required to be in direct contact with potentially infected persons will be considered as candidates for antiviral prophylaxis. - Release a warning announcement to Mission personnel, and in coordination with the Department, provide a warden message to private US citizens; post the information on the website. Information will include details of the episode(s) and advice on means of prevention. - In coordination with Department, prepare press guidance. - Continue all actions listed in Tripwire 4. ¶13. POST-TRIPWIRE DETERMINATIONS The AIWG will continue monitoring the situation and recommend to the EAC when particular threats are no longer substantial. Advice from in-country contacts as well as medical and agricultural contacts worldwide will be used in forming such recommendations. ENTWISTLE