AVIAN INFLUENZA: MANAGUA CONTINGENCY PLANNING AND TRIPWIRES

UNCLAS SECTION 01 OF 04 MANAGUA 003257 SIPDIS SIPDIS OES FOR DSINGER AND RDALEY; S/ES-O/CMS E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMRS NU SUBJECT: AVIAN INFLUENZA: MANAGUA CONTINGENCY PLANNING AND TRIPWIRES REF: A. STATE 183776 ¶B. STATE 202102 ¶C. BANGKOK 7157 ¶D. STATE 220047 ¶E. MANAGUA 03077 ¶F. STATE 219189 1) SUMMARY: This telegram responds to Reftel F request for post Avian Influenza pandemic contingency planning information. Tripwire input officers are Regional Security Officer Michael W. Poehlitz, Assistant Regional Security Officer Keenan J. Smith, and Foreign Service Health Practitioner Paula J. Wilson. Tripwire reporters have received access instructions for the online tripwire application and ClassNet log-on access information in order to input, modify, and delete post's tripwires. The Embassy Managua Emergency Action Committee (EAC) met and discussed tripwires and post-specific responses. The Health Unit staff has inventoried personal protective equipment (PPE) and ordered additional supplies. A shipment of Tamiflu is expected to arrive in Managua at the beginning of next year, in accordance with Office of Medical Services instructions in Reftel A. The task force reviewed and considered preparedness steps outlined in Reftel F and has posted tripwires to trigger Embassy Managua's actions to mitigate/counter a future Avian Influenza pandemic condition or threat. END SUMMARY. 2) Nicaragua-relevant resource limitations were previously outlined in Reftel E. Following the lead of Reftels C and D, we agree that the key tripwire event in a potential avian influenza outbreak is "efficient and sustained human-to-human transmission" and have listed responses under the assumption that an effective human vaccine will not be available and that tripwires may not be sequential. 3) Updated host country data: Available medical treatment capability in the event of an outbreak includes 32 respirators in Managua (26 for adults, 6 for children) and 74 intensive care beds, distributed among 11 public and private hospitals in Managua. When queried, some hospitals preferred not to divulge the numbers of ICU beds and respirators they possess. 4) The ability of Nicaragua's public health system to respond to and manage an AI outbreak or epidemic is balanced between good communication potential and limited treatment capability. The AI threat ranks high among GON priorities and is an agenda item at the Ministry of Health's regular meetings. Host country officials are engaged, cooperative and knowledgable. They have responded immediately to Embassy/USAID requests for information with thoughtful, competent reports. A lack of Tamiflu and other medication is problematic, however, and public health physicians have been conducting a strike for weeks. Media reports suggest the strike will continue into the beginning of 2006. 5) Post's ability to shelter within Nicaragua will be determined by the severity of an outbreak and the specific tripwires crossed. In this earthquake-, volcano- and hurricane-prone country, Embassy personnel are already advised to maintain a two-week supply of basic foodstuffs and water. The Health Unit inventoried personal protective equipment (PPE) and has ordered additional supplies. 6) Tripwires, which will not necessarily be crossed in this order, are as follows as of late December 2005: --TRIPWIRE ONE: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission in a neighboring country in Central America. Embassy Actions in response to Tripwire One --EAC meets to confirm tripwire has been crossed. --Restrict travel to the affected country or affected areas within the country, except for personnel involved in possible investigation/containment efforts. --Coordinate with U.S. Mission in the affected county regarding that Mission's plans for possible public announcements, warden messages, or plans for evacuating personnel. --Provide Mission briefings for staff (American and LES) and dependents. Actions to be taken immediately: --Provide Mission briefings for American and LES employees and dependents. --Refer to previously prepared draw-down list of minimum essential personnel. --Procure additional needed supplies, if needed, to supplement in-stock Tamiflu, masks, gowns, gloves, protective eyewear, alcohol-based cleansers, and N95 respirators. --Remind family members, who have previously been advised about contingency food and water supplies, to maintainkeep at least a two-week supply. --Consult established mechanism for conducting work from home if a pandemic limits access to Mission offices. --Form a working group to develop a plan of action to support potential embassy evacuees. --Prepare travel orders to avoid a last-minute backlog. --TRIPWIRE TWO: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission through close, prolonged contact in an isolated section of Nicaragua. Embassy Actions in response to Tripwire Two: --EAC/AI Subcommittee meets to confirm that tripwire has been met. --Restrict travel to the affected region(s) of the country. --Encourage departure of non-essential personnel and dependents, with authorized departure of designated essential personnel on a case-by-case basis. --Suspension of some Embassy services and operations. --In coordination with the Dept., revise travel warning to add message advising Americans to leave country. --Update website and issue public announcements as necessary. --Per State 183776 (10/05/2005),prophylactic treatment with Tamiflu will be considered only for staff who are required to be in direct contact with potentially infected persons. --Assist in evacuation of private American nationals. (Note: Managua is a medium-sized embassy, not far from the U.S.) --TRIPWIRE THREE: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission through close, prolonged contact near the Mission offices. Embassy Actions in response to Tripwire Three --EAC Subcommittee meets to confirm that tripwire has been met. --Cancel incoming official travel, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. --In coordination with the Dept., issue updated warden message, travel warning and website, press guidance and releases. Urge all American citizens to defer all non-emergency travel to Nicaragua. --Implement home quarantine of any staff or dependents who have been in contact with a person confirmed to have an AI infection. --Reduce Consular Section visa appointments to a minimum to reduce risk of spreading disease within the Embassy and to make more staff available to provide emergency assistance to American citizens. --Emergency Action Committee meets regularly to determine next steps as tripwire circumstances develop. Next steps could include: -- Close and/or reduce Embassy to minimal staff, reduce services and operations to emergency consular services and other designated services and operations. -- Continue voluntary departure of dependents and non-essential staff. --TRIPWIRE FOUR: Efficient and sustained human-to-human transmission in a neighboring country in Central America. Embassy Actions in response to Tripwire Four --EAC/AI Subcommittee meets to confirm that tripwire has been met. --Restrict travel to the affected country, except for CDC, FAS, AFRIMS or other personnel involved in possible investigation/containment efforts. (Note: Determine what type of quarantine/restriction by Nicaraguan authorities may be placed on these personnel returning to Nicaragua.) --Coordinate with U.S. Mission in the affected country regarding that Mission's plans for possible evacuation of personnel. --Provide Mission briefings for staff and dependents. --MED and designated EAC members meet with school administrators to assess school vulnerability. --Embassy staffs and equips a situation room. Uses cleared press guidance to respond to press inquiries. --Maintain normal Consulate and Embassy operations, with close monitoring of the situation. --Embassy Emergency Action Committee meets regularly and coordinates closely to determine next steps as tripwire circumstances develop. Next steps could include: -- Reduction of consular services and suspension of other designated services and operation. -- Close offices and/or reduce Embassy to minimal staff. -- Authorize voluntary departure for dependents and non-essential personnel. (Note: Authorized departure will be dependent on possible Government of Nicaragua restrictions on outgoing travel and on possible U.S. restrictions on incoming travel.) -- Except for designated essential American and LES staff, all others remain home (administrative leave) or on authorized departure; children remain home from school or on authorized departure. -- Continue to purchase additional supplies of food and water. -- Social restrictions: restrict movements of all personnel in the city, restrict dinner parties, sporting events, etc.). --TRIPWIRE FIVE: Efficient and sustained human-to-human transmission within Nicaragua. Embassy Actions in response to Tripwire Five: --EAC/AI Subcommittee meets to confirm that tripwire has been met. --Issue revised travel warning and update website advising American citizens to defer all non-emergency travel to Nicaragua. --Authorized voluntary departure of dependents and non-essential personnel. (Note: Authorized departure will be dependent on possible Government of Nicaragua restrictions on outgoing travel and on possible U.S. restriction on incoming travel.) --Cancel all incoming official travel, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. --Provide Mission briefings for staff (American and LES) and dependents and to school administrators at schools used by American staff; recommend schools) close. --Embassy at minimal staff, reduction to emergency consular services, suspension of designated services and operations. --Except for designated essential American and LES staff, all other remain home (administrative leave) or on authorized departure; children remain home from school or on authorized departure. --Ensure that staff purchase additional supplies of food and water. --Social restrictions: restrict movements of all personnel. --Split the Marine Security Guard detachment into two separate and independent units. (In the event individuals in one unit acquire the disease, the other unit can still ensure proper coverage of classified materials.) --Restrict visitor access to Mission buildings. If entry into Mission buildings is necessary to conduct business, visitors must undergo screening procedures to include temperature monitoring and/or questionnaire related to symptoms/exposure. (Note: There are no studies that provide verification regarding effectiveness of these procedures. They also will not identify people who are contagious or asymptomatic or have minimal symptoms. The level of restrictions on access to Mission facilities should depend on the particular circumstances at that moment.) --Embassy staffs and equips a situation room and a call center for inquiries from American public and the press. --Establish a database listing details of any American citizen, hospitalized, quarantined, or ill at home. --MED closely monitors availability of outgoing commercial flights. --Embassy Emergency Action Committee meets regularly and coordinates closely to determine next steps as tripwire circumstances develop. Next steps could include: -- Restrict/prohibit visitor access to internal Mission facility offices. -- Ordered departure of non-essential personnel and dependents with authorized departure of designated essential personnel on a case-by-case basis. (Note: Ordered or authorized departure will be dependent on possible Government of Nicaragua restrictions on outgoing travel and on possible U.S. restrictions on incoming travel.) -- Suspension of additional Embassy services and operations. -- In coordination with the Dept., revise travel warning to advise Americans to leave Nicaragua. -- Update website and issue public announcements as necessary. -- Consider prophylactic treatment with Tamiflu for staff required to be in direct contact with potentially infected persons. -- Assist in evacuation of private American nationals. (Note: Significant evacuation from Nicaragua may not be feasible for a variety of reasons, including the potential and added risk of acquiring influenza at crowded airports or on international flights during a true pandemic, travel restrictions and possible quarantine measures. A complete evacuation of all Mission personnel and closure of Embassy Managua would be determined at a later stage in an AI pandemic.) 7) These preparedness measures include early contingency planning as of December 2005. The characteristics of a human-to-human outbreak will of necessity change some of the details for both "shelter in place" and a possible drawdown of personnel. The Emergency Action Committee will include an avian influenza item on its agendas as needed to evaluate the threat and report the disease's progress on other continents. TRIVELLI