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
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