ITALY: AVIAN INFLUENZA POST CONTINGENCY PLANNING

UNCLAS SECTION 01 OF 05 ROME 004188 SIPDIS SENSITIVE DEPT FOR S/ES-O/CMS, OES/IHA, EUR/WE, EUR/EX, CA/OCS/ACS/EUR E.O. 12958: N/A TAGS: AMGT ASEC AMED CASC AEMR KFLO TBIO SENV EAGR ECON PREL IT AVIAN INFLUENZA SUBJECT: ITALY: AVIAN INFLUENZA POST CONTINGENCY PLANNING AND TRIPWIRES REF: A. 05 STATE 219189 ¶B. 05 ROME 004113 (U) SENSITIVE BUT UNCLASSIFIED - NOT FOR INTERNET DISTRIBUTION. ¶1. (U) In response to ref A, Embassy Rome DCM met on December 14 with representatives from the following sections/agencies: Management, Consular, Science, Health Unit, Foreign Agriculture Service, Foreign Commercial Service, and Office of Defense Cooperation (ODC/DOD). The Regional Security Office and the Public Affairs Office were not present, but are also participating in Tri-Mission planning. The group reviewed GOI preparations against AI and human pandemic influenza and discussed the minimum preparedness steps in ref A. Participants concluded that no AI tripwires have been crossed in Italy. ¶2. (U) ESTH Counselor Jill Byrnes, Agriculture Attachee Robin Gray, and/or ECON-SCI OMS Diane O'Guerin will input tripwire data into the Tripwire Reporting and Integrated Planning System (TRIPS). ¶3. (SBU) PREPAREDNESS MEASURES TAKEN/TO BE TAKEN -------------- -------------- (A) BRIEFINGS: In October, the Embassy issued Management Notices in English and Italian containing information on Avian and pandemic influenza furnished by the Regional Medical Officer. They are posted on the Embassy's web site. The Health Unit (HU) has information on AI available for visitors to the HU. In prominent public areas around the Embassy, Management has posted flyers with guidance on avoiding the spread of viruses and germs during the flu season. Information from the Department on AI has been posted on the Rome Embassy Consular web site. (B) MEDICAL EXPERTISE: The HU has identified staff and eligible family members with medical background and skills, and will continue to update this information. At a date TBD, the HU will train non-medical personnel in caring for those suffering from influenza. In October and November, the HU offered influenza vaccinations to staff. (C) TAMIFLU/PPE: The HU has inventoried personal protective equipment (PPE) and has determined that sufficient quantities are on hand. The Tamiflu shipped by the Department has not/not arrived as of December 30. TO BE DONE: The HU will determine additional amounts needed if tripwire three is �0A;reached, and will plan for procuring additional supplies. The HU will also decide how to allocate Tamiflu and PPE among the three Rome diplomatic missions, the three consulates, and the three consular agents. (D) SECURITY: When the Tamiflu arrives, it will be locked securely in the HU pharmacy, which is located within the well-protected chancery. (E) EMERGENCY STOCKPILES: In January, Management will issue guidelines for employees to stockpile emergency supplies (food, water, blankets, medicine). Management is compiling an inventory of emergency supplies already stocked in safehavens as part of the Tri-Missions' emergency preparedness review in advance of the Turin Olympic Games to be held in February, 2006. (F) CONTINUITY OF OPERATIONS: Management already has a plan for continuation of operations with reduced staff (including at an alternate location). All sections/agencies are updating/compiling lists of employees' home e-mail addresses to prepare for the contingency of conducting work from home. Most DOS staff and key other agency staff have been issued UHF radios. The Consular Section has the capability of disseminating warden messages electronically (IBRS, ACS ) or by telephone (to key wardens, club and program directors) from an alternate location. (G) DRAWDOWN PLANNING: Tri-Missions, Consulates, and Embassy sections/agencies have reported to Management their minimum staffing patterns to ensure continuity of operations during a possible authorized or ordered departure. The actual decision on which personnel will remain on duty will be determined at the time, based on local circumstances and taking into consideration the health condition of individual staff. (H) MEDICAL ISSUES: The HU has identified staff with medical issues or risk for severe disease who would depart when authorized. This information will be factored into the drawdown plans. (I) The Human Resource Office has prepared pre-planned packets, including travel orders for potential Tri-Mission evacuees under an ordered or authorized departure. Back-up orders are updated quarterly at the Alternate Command Post. (J) STRATEGIES FOR BORDER CLOSINGS: By January, Embassy will have devised strategies for responding to border and airport closures. This scenarios may very well unfold, as the November 30 draft GOI AI/pandemic influenza preparedness plan (ref B) calls for introducing "cordons sanitaires" at Italy's borders, as well as travel controls at airports in case of widespread human-to-human transmission of the AI virus. Management will coordinate closely on this issue with the Embassy's DOD offices. Consular staff would seek to assist Americans with emergencies caused by the inability to depart (fund transfer, local medical information, etc.). (K) TOWN HALL BRIEFINGS: Starting o/a January, Embassy will provide assembly-style briefings with remote participation by DVC for the staffs (American and LES) of the three diplomatic missions in Rome (bilateral Embassy, Embassy to the Holy See and U.S. Mission to the UN Agencies in Rome),the three consulates (Florence, Milan, Naples),the three consular agents (Genoa, Trieste, Palermo),and the Turin Olympics Liaison Office. The Consular Section will provide a summary to consular agents by telephone or e-mail. Briefers will include: the Tri-Mission Ambassadors and/or DCMs, Health Unit, Regional Security Office, Foreign Agriculture Service, Consular Section, representatives from the US Mission to the UN Agencies in Rome (who have close contact with animal health experts from the UN Food and Agriculture Organization - FAO),and others TBD. (L) GOI OUTREACH: Embassy's Agricultural Affairs, Science, and Consular Sections, as well as the Health Unit and the Office of Defense Cooperation, have had extensive contact with host country officials on Italy's AI response strategy and health care capabilities. In addition, the U.S. Mission to the UN Agencies in Rome works closely with the Food and Agriculture Organization (FAO) and the Animal Health Organization (OIE),agencies at the forefront of AI monitoring and containment. (M) NEIGHBORING POSTS: Management will monitor the AI situation in neighboring countries and will consider creating a separate working group to coordinate with neighboring posts to develop a plan of action for supporting potential Embassy evacuees from neighboring posts in the Balkans with limited medical resources. BEGIN TRI-MISSION ITALY/CONSULATES AI TRIPWIRES: -------------- --- ¶4. (SBU) INTRODUCTION -------------- -- RESOURCE LIMITATIONS: Italy Tri-Missions and Consulates are relatively well prepared to face an AI human pandemic. An advanced economy, Italy has efficient transportation and distribution networks, sophisticated socialized and private medical care, and an extensive service sector. The climate in most of the country is very mild (Mediterranean). Tri-Mission and Consulate buildings are large, secure and well furnished. LES are experienced, able and loyal. We foresee two factors that could severely limit our ability to cope with a full-fledged human AI pandemic. One, the large size of the tourist and expatriate Amcit community could severely strain consular resources if travel were restricted and/or the national health system were overwhelmed. Two, the Italian national health system could become overwhelmed by demand, particularly in southern regions where it is not as efficiently supplied or managed. -- PUBLIC HEALTH SYSTEM: Italy's public health system is developed, but suffers from inefficiencies and spot shortages, particularly in southern regions. According to the latest data (2002),there are a total of 245,880 hospital beds, averaging nationally 4.3 per 1,000 inhabitants. Almost 217,000 of these are for acute care. Medical personnel are trained to world standards. -- The GOI's draft AI/Pandemic influenza preparedness plan (ref B) addresses critical issues such as laboratory capacity, maintaining and augmenting rosters of available health care workers, and AI-specific education and outreach to medical professionals and the public. It is clear from the plan that the GOI, which is a member of the International Partnership on Avian and Pandemic Influenza, is addressing the human health aspects of AI seriously and methodically. -- SHELTERING IN PLACE: Tri-Missions and Consulates have the ability to shelter in place for weeks or longer. Posts already have supplies in safehavens, and Embassy Rome has a well stocked commissary. Non-perishable food, including the world-famous dried pasta and olive oil, is readily available. Mineral water is a staple, and Rome, in particular, boasts many fountains supplying potable water. Italy's Mediterranean climate (with the possible exception of Milan's consular district) is comfortable almost year-round in the event that heating systems are not maintained. Tri-Mission and Consulate properties are large and well appointed. In Rome, the Ambassador's residence is situated on extensive, secure grounds that could offer shelter relatively close to the Tri-Missions. -- COORDINATION WITH DOD: DOD has a large presence throughout Italy, and the Embassy's Office of Defense Cooperation is a key member of the AI preparedness team. The Embassy closely monitors DOD's AI planning. An Embassy representative will participate in the European Command's (EUCOM) AI planning conference in Germany from January 9-12, ¶2006. The GOI plans to send representatives from the Ministries of the Interior, Health and Defense. ¶5. (SBU) 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. ¶6. (SBU) RESPONSES TO TRIPWIRE ONE -------------- -- EAC meets to confirm that tripwire has been crossed. Consulates participate by DVC or telephone. -- Restrict travel to the affected country, except for US Mission to the UN Agencies in Rome, FAS or other personnel involved in investigation/containment efforts. Monitor GOI entry restrictions. -- Coordinate with U.S. Mission in the affected country regarding plans for public announcements, warden messages or draw-down/evacuation plans, and on possible assistance to Mission evacuees on authorized departure. -- Provide Mission briefings for American and LES staff and dependents. Consulates to participate by DVC. Consular Section to provide summary to consular agents by telephone or e-mail. -- Monitor any AI-related public announcements or travel warnings issued by the EU or neighboring posts, link them to the Consular Section's web site, and transmit them to American citizens (AmCits) in Italy. ¶7. (SBU) TRIPWIRE TWO -------------- A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission in one or more Italian rural or less-traveled areas. ¶8. (SBU) RESPONSES TO TRIPWIRE TWO -------------- -- EAC meets to confirm that tripwire has been crossed. Consulates participate by DVC or telephone. -- Monitor GOI travel restrictions or quarantines, and consider authorized departure for U.S. family members, staff with identified medical risk, and non-emergency staff. -- Depending on region(s) affected, consider reducing staff to minimum levels or reducing services at affected Consulates to emergency Consular services and other designated operations. Other missions/Consulates maintain full services/operations. Depending on the level of inquiries, the Rome Consular Section could activate additional telephone extensions and/or a toll-free number to respond to questions from the public using a prepared script. -- Restrict travel to the affected area, except for US Mission to the UN Agencies in Rome, FAS or other personnel involved in investigation/containment efforts. Monitor GOI internal/international travel restrictions. -- In coordination with the Department, issue public announcement, warden message, or travel warning and update web site cautioning American citizens against non-essential travel to the affected area(s). Provide press guidance for the potential use of the Missions, consulates, neighboring posts, the Department, and concerned government agencies. Coordinate public affairs and media activities with the consulates/consular agents. If appropriate, Consular officers would meet with members of the American community for in-person briefings. -- Provide Mission briefings for American and LES staff and dependents. Consulates to participate by DVC. Consular Section to provide summary to consular agents by telephone or e-mail. -- Institute screening practices for all visitors to USG facilities (RSO, Health Unit). -- Mandatory sick leave (home quarantine) for any employee who shows any flu symptoms or has a family member with flu symptoms (Health Unit). Treat with Tamiflu according to Department guidelines. ¶9. (SBU) TRIPWIRE THREE -------------- A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission near or within Rome or other large Italian city. ¶10. (SBU) RESPONSES TO TRIPWIRE THREE -------------- -- EAC meets to confirm that tripwire has been crossed. Consulates (if still open) participate by DVC or telephone. -- Authorize voluntary departure of dependents and non-essential staff. Except for designated essential American and FSN staff, all others remain home on administrative leave or on authorized departure status. Decisions on which personnel will remain on duty will be determined by individuals' states of health. -- Tri-Missions maintain full service operations, monitoring situation closely. Consular Sections would provide ACS emergency services only. Depending on level of inquiries, Embassy Consular Section activates additional telephone extensions and/or establishes a toll-free number for American citizens and the press. -- Coordinate with the Department and neighboring missions and issue guidance (warden message, travel warning, web site) urging American citizens to defer all non-emergency travel to Italy and/or to depart Italy if travel conditions permit. Update web site. Coordinate with the Department to prepare press guidance. Consular Sections assist with evacuation of American citizens if travel conditions permit. -- Cancel incoming official travel to Italy, except for personnel involved in investigative/containment efforts, or as decided by the COM. -- Continue screening of all visitors to USG facilities using protective gear. -- Provide Mission briefings (by e-mail or phone) for American and LES staff and dependents, including consular agents. -- Implement home quarantine (mandatory sick leave) for any staff or dependents who have been in contact with a person confirmed to suffer from AI (monitored by Health Unit). Plan for home visits to sick individuals eligible for care from the HU. Treat with Tamiflu according to Department guidelines. -- If authorized or ordered departure is not possible because of GOI travel restrictions, instruct all non-emergency American and LES staff to remain home on administrative leave. Children remain home from school. Consider social distancing measures (limiting venues of human-to-human contact). Ensure staff purchase additional supplies of food and water. SPOGLI