CHILE: POST TRIPWIRES FOR AVIAN FLU

UNCLAS SANTIAGO 002590

SIPDIS

SIPDIS

E.O. 12958: N/A
TAGS: AMGT ASEC CASC AMED KFLO AEMR CI
SUBJECT: CHILE: POST TRIPWIRES FOR AVIAN FLU

REF: A. SECSTATE 219189

B. SANTIAGO 2423

C. SANTIAGO 2431


1. (SBU) Summary: Embassy Santiago continues to develop
preparedness measures against avian influenza (AI) through
the Emergency Action Committee, chaired by the DCM and
composed of the AMB, RAO, EPOL, RSO, DAO, MILGRP, DEA,
LEGATT, APHIS, PAO, FCS, CONS, MGT and MSG. This plan
includes a description of tripwires and associated action
plans. Chile's Ministry of Health established a National
Committee for Influenza to coordinate tracking and treatment
of AI. The GOC has an extensive, internet-published
preparedness plan for preventing an AI pandemic in Chile, and
has coordinated with international and regional partners.
While Chile's medical facilities are generally adequate and
in some cases excellent, the GOC lacks resources to properly
track, detect or prevent widespread distribution of AI. Post
does not currently have the ability to shelter in place, but
personnel could likely be maintained at home for a reasonable
amount of time. End Summary.


2. Should an AI outbreak occur, the EAC has created an
action plan, including first responses, and developed a
series of tripwires (with the approval of RMO Lima). When
identifying appropriate tripwires, the EAC assumed a fast
transmission rate, the inability to access air travel, the
need to avoid any "double standard," communication with local
international schools; and coordination with Clinica Las
Condes and Clinica Alemana, the top two hospitals in
Santiago. Action items resulting from a crossed tripwire may
include authorized or mandatory departure of personnel. The
EAC also noted that Post does not have an adequate stockpile
of antiviral drugs, and is actively exploring how to obtain
supplies for all Embassy staff and EFMs.


3. Aside from two private high-quality hospitals in
Santiago, the quality and number of facilities in Chile
varies greatly. Private hospitals and clinics tend to offer
better service than public medical facilities, and healthcare
outside of the metropolitan area generally tends to be of
lesser quality.


4. The GOC has created an extensive plan to address AI,
available on the internet at:
http://www.minsal.gov.cl/ici/pandemiainfluenz a. In 2004, the
Chilean Congress passed a resolution to create the National
Response Commission for Outbreaks and Sanitary Emergencies
under the jurisdiction of the Ministry of Health (MOH). The
mandate of this committee is to (a) propose contingency plans
to confront the outbreaks of infectious diseases, with a
particular emphasis on AI; (b) monitor the implementation of
these contingency plans; and (c) provide technical advice to
the country's decision-makers. Committee members are largely
MOH staff as well as representatives from the Agricultural
and Livestock Service (SAG) and the Chilean Society for
Infectology. Under-Secretary of Public Health, Dr. Patricio
Bustos, has been identified as the key contact for
international coordination on this issue.


5. The GOC has also worked with international partners on
the AI issue. The ministers of health from the Andean region
met in Peru in October 2005, which resulted in a signed
declaration of commitment to coordinate on AI. The GOC's
domestic plan repeatedly cites coordination with the World
Health Organization.


6. While Chile has experience with avian influenza issues
due to a 2002 outbreak of the disease in poultry, the public
health sector does not enjoy the same levels of resources or
manpower as the agricultural export sector when it comes
fulfilling its emergency plans. Current deficiencies include
a lack of human and financial resources to properly survey
and detect AI. The GOC also lacks resources and equipment to
widely distribute protective gear. Several vaccines are
available in Chile, including Vaxigrip (Aventis Pasteur),
Fluarix (Glaxo Smith Kline),Influvac (Solvay),Agrippal S1
(Chiron) and Inflexal V (Berna). The MOH plans to purchase
the H5N1 vaccine when it becomes available. In addition, the
MOH continued its annual flu vaccine program in 2005, and
hopes to significantly expand the number of recipients beyond
the current 1.75 million.


7. Post does not currently have the ability to shelter
employees in place for any length of time. However, Embassy
employees could likely be maintained at home for a reasonable
amount of time. For long-term healthcare and nutritional
needs, Chile's distance and long, narrow geographic
configuration could become problematic in obtaining
assistance.


8. Post management has tasked two U.S. citizen employees
with responsibility for inputting tripwire data: Jacqueline
Ward, EST Officer, and Deborah Fairman, Consul. Both
employees possess a secret clearance or higher.


9. All DoD personnel are under COM authority.


10. The following baseline tripwires were approved by the
Santiago EAC and in substance by RMO Brooks Taylor. The
following proposed tripwires address the possibility of human
cases of avian influenza in Chile and/or evidence of the
virus demonstrating more efficient human-to-human
transmission elsewhere in the world. To avoid repetition,
only new measures taken under each Tripwire are listed - all
previous measures under previous Tripwires will be
maintained. These tripwires are based on the following
assumptions, should sustained human-to-human transmission
become a reality.

Assumptions:

The disease would spread rapidly, both within a particular
country and internationally.
Once the World Health Organization has declared a human
pandemic - but probably even before then - airlines will
cancel flights as countries try to control the spread of the
disease. Some countries may bar individuals coming from
infected countries.
The Embassy must keep in mind "double standard" concerns, and
will coordinate consular, medical, evacuation, etc. with
appropriate Department offices.
The Embassy must keep in mind that many of its children
attend international schools, which must be kept in the
information loop as well.
The Embassy should carefully consider all the ramifications
of authorized departure and/or ordered departure, as in fact
it may be safer to remain in Chile.
The Embassy should remain in constant contact with Clinica
Las Condes and Clinica Alemana, as well as with the Ministry
of Health.
The Embassy will procure sufficient supplies of Tamiflu, N100
Nano-masks, N95 masks, and additional hand cleansers, as well
as the items recommended in the RMO's list.11.


11. Tripwire 1: Any case of avian influenza among humans in
Chile.

Action:

11a. Management Section/Health Unit will send an information
notice to all Mission personnel.
11b. The Consular Section will send a warden message to all
American citizens detailing the episode and suggest
preventive measures. The notice will also be posted on the
Embassy website.
11c. Embassy will notify RMO Lima and State Med.


12. Tripwire 2: Confirmed human-to-human transmission
occurs in one or more neighboring countries - singly or in
clusters - but not in Chile.

Action:

12a. Consider immediate authorized departure of U.S. family
members and non-emergency personnel in consultation with the
Department, if the U.S. itself is relatively avian flu-free
and if the airlines are flying. Have evacuation plans for
both the healthy and sick. Explore evacuation by military
airlift.
12b. Institute screening practices for all visitors to U.S.
Government facilities, limit their numbers, and refuse entry
to those visibly ill or who are coughing.
12c. Order mandatory sick leave for any employee who shows
any flu-like symptoms or has a family member with flu-like
symptoms. The Health Unit will issue detailed flu symptom
descriptions and monitor Embassy employees.
12d. Issue a warden announcement to American citizens.
12e. Require use of masks and hand cleansers, AND consider
use of the prophylactic Tamiflu (oseltamivir) by U.S. and
Chilean staff in positions that require contact with the
public.


13. Tripwire 3: Significant numbers of human cases of avian
flu (H5N1, H7N7 or others),presumably transmitted from birds
or other animals, appear in Chile, but without evidence of
sustained human-to-human transmission.

Action:

13a. All official and unofficial travel to affected areas,
bird markets and similar facilities will be prohibited.
Outside visitors to the Embassy will continue to be limited.
Tamiflu will be given as a prophylactic to those U.S. and
Chilean staff who have regular contact with the general
public as part of their work.
13b. Management Section will send a warning announcement to
Mission personnel. The Consular Section will send a warden
message to private American citizens and to tourist hotels
and cruise ships that are frequented by traveling Americans.
Embassy will post the warning announcement on the Embassy
website.
13c. Health Unit will provide detailed briefing to Embassy
community, and if appropriate, to the international schools.
Check with Clinica Las Condes and Clinica Alemana to ensure
that they are still able to handle large numbers of avian flu
patients.
13d. Consider authorized departure measures or even ordered
departure measures - in conjunction with the State Department
- if the airlines are still flying and if there are any
recognized safehaven countries who are accepting outsiders.
Communicate pertinent information and options to the Embassy
community at town hall meetings or via e-mail, as the
timeline will be short.
13e. Issue Travel Warning to Americans considering travel to
Chile, in conjunction with the Bureau of Consular Affairs.
13f. Encourage all employees to stock up on food and other
necessities in the event there is an announcement of an
imminent pandemic.


14. Tripwire 4: Sustained human-to-human transmission in
Chile, but not in Santiago.

Action:

14a. Restrict consular services to emergency basis for
American citizens only. No visa services (except on a
severely restricted case-by-case basis),as it would be
expected that commercial airlines have canceled flights.
14b. Implement authorized departure. Consider ordered
departure in conjunction with State Med, at the discretion of
the Chief of Mission. If commercial airlines are not flying,
consider use of military airlift. It would be ideal to have
enough people leave post so that those left behind would
equal the amount of Tamiflu on hand.
14c. Consider implementing selective administrative leave
for those Americans who remain at post and FSN employees.
Consider other options for minimizing workplace exposure,
like tele-commuting.
14d. Continue mandatory sick leave for any employee who
shows any flu-like symptoms or has a family member with
flu-like symptoms.
14e. Consider home quarantine and limiting venues of
human-to-human contact.
14f. Mandatory screening of visitors, who shall be limited
to those whose business absolutely must be conducted in
person; mandatory use of protective gear, especially N95
masks for Embassy screeners.
14g. Health Unit to initiate appropriate use of prophylactic
Tamiflu (oseltamivir) for minimal U.S. and Chilean staff
remaining on the job.
14h. Update warden message, Travel Warning, and Consular
Information Sheet.


15. Tripwire 5: Sustained human-to-human transmission, as
evidenced by clusters of cases in Santiago.

Action:

15a. Implement ordered departure, if airlines are still
servicing Santiago, and if there are any avian flu-free
countries to fly to. Consider use of military airlift, if
the U.S. or any avian flu-free countries are allowing
incoming flights from affected areas.
15b. Implement administrative leave for all FSNs. Consider
other options for minimizing workplace exposure, like
tele-commuting.
15c. Initiate appropriate prophylactic use of Tamiflu for
any American employees and family members remaining at post.
15d. Issue warden update and inform American community that
the Embassy will only offer emergency AmCit services by phone.
KELLY