CORRECTED COPY: AI REPORT #7: POST'S AI-SPECIFIC

UNCLAS SECTION 01 OF 04 BRIDGETOWN 000338 SIPDIS SIPDIS DEPT PASS TO USAID/GH/RCS/KELLY WOLFE AND LAC/PEG MARSHALL E.O. 12958: N/A TAGS: AEMR AMED AMGT ASEC CASC EAGR EAID ETRD KFLO KSCA, SENV, SOCI, TBIO, BB, GJ, XL SUBJECT: CORRECTED COPY: AI REPORT #7: POST'S AI-SPECIFIC CONTINGENCY PLANNING AND TRIPWIRES REF: STATE 219189 ¶1. This is a corrected cable in response to reftel. See additional information in para 2 about Embassy's activities and constituent Post in Grenada, changes in para 3 on Post's geographic areas of responsibility and concern, and tripwire-related changes in para 5. ¶2. Summary: Post's Avian Influenza Working Group (AIWG) met on November 23 and January 27 to develop preparedness measures to meet the threat of a avian influenza (AI) human pandemic. Consequent to these meetings, AIWG members inventoried medical supplies and identified medically trained and medically at-risk staff in a pandemic scenario. AIWG members also began making plans for mission briefings, social distancing, warden messaging, and continued operations in a drawdown situation. AIWG members formulated and refined AI-specific tripwires and tripwire responses. Post's AI preparations and plans also apply to constituent-post Embassy Grenada. Because Post's geographic area of concern is diverse, extensive, and consists of many small-island states, Post prefers to maintain its AI-specific tripwires and tripwire responses as general guidelines rather than trying to outline a particular Post response for every possible scenario. End Summary. ¶3. Post's AIWG met on November 23 and January 27 to develop preparedness measures against the threat of a AI human pandemic. The AIWG formulated AI-specific preparations, contingencies, and tripwires, and followed up with AI-specific preparatory activities. (Note: Because of the high level of human interaction in the Caribbean, the AIWG is taking the whole region as its area of concern. Post covers the seven Eastern Caribbean islands of Antigua and Barbuda, Barbados, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, and St. Vincent and the Grenadines. Post's consular district, however, extends beyond these seven countries to the islands of Martinique, (French) St. Martin, St. Barthelemy, Montserrat, Guadeloupe, the British Virgin Islands, and Anguilla. There are also several Dutch island countries in the Lesser Antilles. Because the small U.S. State Department mission in Grenada is a constituent Post, all tripwires and tripwire responses enumerated in this cable apply to that mission as well. End Note. -------------- Early AI-Specific Preparations -------------- ¶4. Concerning AI-specific preparations, AIWG members have inventoried and ordered medical supplies, including medications and protective gear; identified staff who would be medically at-risk during a pandemic; and identified staff with medical skills who can assist Post's nurse in a pandemic. AIWG members also continue to plan for smooth AI-related information flow to American staff, LES, and Americans in the consular district through mission briefings and warden messaging respectively. Post has begun to inventory and stockpile fuel, food, water, and other emergency supplies. The AIWG members are also weighing options for Mission drawdown and social distancing. -------------- AI-Specific Tripwires and Tripwire Responses -------------- ¶5. AIWG discussions have generated the following list of AI-specific tripwires and post responses: Tripwire One: Pathogenic virus strain H5N1 infects an animal in a Caribbean country; or there is human infection with pathogenic H5N1 in the non-Caribbean Western Hemisphere, but without sustained human-to-human (H-2-H) transmission anywhere in the world. Tripwire Responses: a. Convene Emergency Action Committee (EAC) to confirm tripwire has been crossed. AIWG makes report to EAC concerning contingency plans and AI-related activities in host countries. EAC issues recommendations. b. Provide town hall and other briefings to American and LES employees and dependents. c. If applicable, bar travel into areas suspected to have H-2-H transmission. d. If applicable, disseminate public announcements and travel BRIDGETOWN 00000338 002 OF 004 warnings about H-2-H regions among American citizens in Post's Consular District. e. Continue convening AIWG to review contingency plans, survey medical supplies, and monitor AI-related activities in host countries. Tripwire Two: Pathogenic H5N1 infects a human in a Caribbean country, but without H-2-H transmission; or there is sustained H-2-H transmission anywhere in the world. Tripwire Responses: a. Convene EAC to confirm tripwire has been crossed. The AIWG makes its report to EAC concerning AI-contingency preparations and AI-related activities in host countries. The EAC issues recommendations. b. Provide town hall and other briefings to American and LES employees and dependents. c. Disseminate public announcements and travel warnings about H-2-H regions among American citizens in Post's Consular District. d. Bar USG travel into H-2-H suspected areas. e. Consider recalling all employees from remote areas. f. In the case of human AI illness in a Caribbean country, consider requesting authorized departure of non-essential staff and family members, and begin implementation planning. g. Continue convening AIWG to refine contingency plans and to monitor AI-related activities in host countries. Tripwire Three: There is sustained H-2-H pathogenic H5N1 transmission in a Caribbean country, but not yet in the Lesser Antilles; or someone in the Lessor Antilles becomes infected with pathogenic AI, but without H-2-H transmission. Tripwire Responses: a. Convene EAC to confirm that tripwire has been crossed. The AIWG makes its report to the EAC concerning AI-contingency plans and AI-related activities in host countries. The EAC issues recommendations. b. Provide town hall and other briefings to American and LES employees and dependents. c. Bar USG travel into H-2-H suspected areas. d. If medically advisable, request authorized departure of all non-essential staff and family members. Begin planning to implement medically advisable authorized departures. e. Consider canceling incoming official travel to host country, except for personnel involved in investigative or containment efforts, or as otherwise deemed necessary by the Chief of Mission (COM). f. In coordination with the Department, issue public announcements, warden messages, and travel warnings cautioning American citizens against nonessential travel to suspected areas. g. In coordination with the Department, prepare press guidance. h. Institute mandatory sick leave for employees who exhibit flu-like symptoms, or who have a family member exhibiting flu-like symptoms. i. In consultation with CA, limit consular services as necessary. j. Implement use of personal protective equipment (PPE - gloves, masks, etc.) according to MED guidance. k. Plan for home visits to sick individuals who would receive care and medications under Post,s health unit. l. Plan for the delivery of food, water, medical supplies, and other essential items to residences. m. Plan for the implementation of social distancing measures n. Provide, in consultation with medical staff, prophylactic Tamiflu or other antiviral treatment for staff who are BRIDGETOWN 00000338 003 OF 004 required to be in direct contact with potentially infected persons. o. Convene AIWG to refine contingency plans, including plans for social distancing, quarantines, emergency delivery of food and supplies. AIWG continues to monitor AI-related activities in host countries. Tripwire Four: Sustained pathogenic H5N1 H-2-H cases occur on any Lesser Antilles island or a USG employee becomes ill with pathogenic AI. (Note: Besides U.S. Embassy personnel in Barbados and its constituent post in Grenada, there are 115 Peace Corps volunteers and administrative staff distributed among the islands of Antigua, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, and St. Vincent. There is also a seven-person U.S. Air Force tracking station and a Consular Agent in Antigua, as well as a Consular agent in Martinique. End Note.) Tripwire Responses: a. Convene EAC to confirm that tripwire has been crossed. The AIWG makes its report to the EAC concerning AI-contingency plans and AI-related activities in host countries. The EAC issues recommendations. b. Provide Mission briefings, some perhaps by phone or e-mail, for American and LES staff and dependents. c. Cancel incoming official travel to host country, except for personnel involved in investigative or containment efforts, or as otherwise deemed necessary by the Chief of Mission (COM). d. Coordinate with CA/OCS on issuance of guidance (public announcement or travel warning) urging Americans to defer all non-emergency travel to host countries and particularly the affected regions. e. In coordination with the Department, prepare press guidance. f. Implement home quarantine of any staff or dependents who have been in contact with a person confirmed to have an AI infection and implement at-home monitoring procedures as needed. g. Instruct all non-emergency American and LES staff to remain home on administrative leave. h. Implement social distancing measures: Children should remain home from school, and all personnel should avoid crowds and social gatherings. Consider moving well people out of AI-endemic areas to safehavens. i. Implement home visits to sick individuals receiving medications or care under Post,s health unit. j. Relocate Embassy personnel to designated residences. k. Deliver food, water, medical supplies, and other essential items to residences as needed. l. Depending on level of public enquiries, Embassy staffs and equips a situation room. Consular officers establish a database tracking quarantined, hospitalized, or ill-at-home American citizens. Post issues guidance for American community on treatment options. m. Reduce consular operations to emergency consular services only. n. Divide Marine Security Guard detachment and local guard squad into two separate and independent entities respectively to decrease the risk of spread of the disease and ensure proper coverage to Mission. o. Restrict visitor access into Embassy buildings. p. Provide, in consultation with medical staff, prophylactic Tamiflu or other antiviral treatment for staff who are required to be in direct contact with potentially infected persons. q. Continue convening the AIWG on an ad hoc basis to monitor AI-related activities in host countries. The AIWG, in coordination with Post's EAC, continues to monitor and guide Post,s AI-related activities. BRIDGETOWN 00000338 004 OF 004 ¶6. Comment: Post's area of concern (the Caribbean) is diverse and geographically extensive. Although the countries of Lesser Antilles are coordinating their AI preparations with the Pan American Health Association (PAHO) and the Trinidad-based Caribbean Epidemiology Center (CAREC),Post anticipates that, beyond protocols for tissue sampling, the countries in the region may respond to an AI pandemic in various and unpredictable ways. To assure maximum flexibility of action, Post therefore believes it is best to use the above tripwires and tripwire responses as general guidelines, instead of trying to outline a list of particular Post responses for every possible scenario. End Comment KRAMER