AVIAN INFLUENZA TRIPWIRES - EMBASSY GEORGETOWN

UNCLAS SECTION 01 OF 05 GEORGETOWN 000039 SIPDIS Bogota for RMO Mexico City for RMO FRC for RMM USAID FOR GH/RCS - KELLY WOLFE USAID FOR LAC - PEG MARSHALL E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMR GY SUBJECT: AVIAN INFLUENZA TRIPWIRES - EMBASSY GEORGETOWN REF: A) STATE 219189 B) STATE 183776 C) STATE 202102 D) GEORGETOWN 1279 ¶1. SUMMARY: Embassy Georgetown's Avian Influenza Response Committee has prepared the following tripwires in the event of an avian influenza outbreak in the region, the United States or Guyana itself. The committee reviewed tripwire reports by other posts especially the excellent tripwires prepared by Embassy Bangkok. Participants included representatives from MED, CDC, CON, RSO, ADM and Peace Corps. The committee agreed on four tripwires: an Avian Influenza outbreak in the region, an Avian Influenza outbreak in the United States, an outbreak in Guyana and efficient human-to-human transmission of the virus in Guyana. Each of the first three tripwires was divided into two scenarios (A and B). Situation A imagines transmission of Avian Influenza is limited to bird-to-human or very inefficient human-to-human contact. Situation B imagines human-to-human transmission is more efficient. END SUMMARY -------------- Immediate Actions -------------- ¶2. The Government of Guyana (GoG) is preparing for Avian Influenza, GoG's actions are covered in detail by reftel D. CDC, USAID and Embassy officials are actively participating in the GoG's national influenza committee and assisting in preparations. GoG has prepared a national influenza plan and is procuring materials to produce oseltamivir (the generic form of Tamiflu). Post finds the GoG is doing its best to prepare for the possibility of an influenza pandemic but notes Guyana is a developing country whose inadequate public health sector is already overburdened by a high incidence of HIV/AIDS. ¶3. Certain actions should be undertaken before any tripwires are met. - Continue to work with the GoG and monitor their preparedness. - Provide briefings for Mission staff and dependents. - Prepare a draw-down list and a list of minimum essential personnel in the context of an avian flu outbreak. This list will likely be different from existing lists compiled by the EAC for other emergencies. Post expects more CDC and USAID staff to remain and some persons deemed essential on the current EAC list may not be essential for an influenza outbreak. - Inventory supplies of Tamiflu and protective equipment, including gowns, gloves, protective eyewear, alcohol-based cleansers, and N95 respirators (in progress). Determine what more is needed in the context of Tripwires below, and procure the additional needed supplies. - RSO to ensure the local guard contractor procures protective equipment for the guard force. - Advise mission personnel and family members to keep at least a 7-day supply of food and water at home. - Sections should evaluate mechanisms for conducting work from home or other locations under conditions of a pandemic requiring limiting access to Mission offices. - Prepare pre-planned packets - including travel orders to the extent possible - for potential Mission evacuees under an authorized departure, to avoid a last minute backlog. - Consular section should plan town hall meeting with U.S. citizens about general safety concerns and the threat of an influenza pandemic. - Front Office should raise with the GoG the issue of their plans for quarantines and travel restrictions to the U.S. in the event of an influenza outbreak there. COMMENT: Guyana has strong economic and social ties to the United States. Guyana's elite regularly travel to the U.S. for medical care, vacations and business. Post does not expect travel to and from the United States would be restricted even in the case of an outbreak in the U.S. END COMMENT -------------- Tripwire One -------------- ¶4. Tripwire 1A is: "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 Suriname, Brazil, Venezuela, or the Caribbean Region." COMMENT: Guyana is relatively isolated with few land or air connections to other countries in the region. Brazil is linked by a single road, Suriname by a single ferry and Venezuela by informal boat crossings. Normally there are only direct air links to Trinidad, Barbados, Brazil the United States and Canada. END COMMENT Embassy Actions in response to Tripwire One: - AI Subcommittee meets to confirm that tripwire has been met. - Restrict travel to and from the affected country or effected areas within the region (excluding airport layovers). This will depend on any restrictions on re-entry implemented by the Government of Guyana. - Coordinate with U.S. Mission in the affected country regarding that Mission's plans for possible public announcements, warden messages, or plans for evacuating personnel. - Provide Mission briefings for staff (American and FSN) and dependents in Guyana. - Ensure that any public announcements or travel warnings issued by neighboring posts are transmitted to American citizens in Guyana and publish the updates on the Consular Section's web site. - Maintain normal Embassy operations, but maintain close monitoring of the situation. ¶5. Tripwire 1B is "Efficient and sustained human-to-human transmission in Suriname, Brazil, Venezuela, or the Caribbean Region." Embassy Actions in response to Tripwire 1B: - AI Subcommittee meets to confirm that tripwire has been met. - Steps taken as in A above. In addition: - Travel restrictions include airport layovers in affected countries. - Embassy Emergency Action Committee meets regularly to determine next steps which could include: - Reduction to emergency Consular services and suspension of designated services and operations. - Authorize voluntary departure for dependents and non- essential personnel. Authorized departure will be dependent on possible Government of Guyana restrictions on outgoing travel and on possible U.S. restrictions on incoming travel; post does not anticipate such restrictions. - Ensure that staff purchases additional supplies of food and water. - Restrictions on movements of personnel in the city, dinner parties, sporting events and other social events. -------------- Tripwire Two -------------- ¶6. Tripwire 2A is: "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 the United States or Canada." COMMENT: Guyana and the region have few direct transportation links to Asia, Africa or Europe. Nearly all air travel and a great deal of the cargo from those regions comes through the United States. It is very likely that avian influenza will be detected in the U.S. before it is found in Guyana. END COMMENT Embassy Actions in response to Tripwire Two 2A: - AI Subcommittee meets to confirm that tripwire has been met. - Consider restrictions on travel to Canada - Consider restrictions on travel to US. - Provide briefings for Mission staff and dependents. - Use cleared press guidance to respond to press inquiries. - Maintain normal Consulate and Embassy operations, but closely monitor the situation. ¶7. Tripwire 2B is: "Efficient and sustained human-to-human transmission in United States or Canada." Embassy Actions in response to Tripwire Two B: - Steps taken as in A above. In addition: - Embassy Emergency Action Committee meets regularly to determine next steps which could include: - Reduction to emergency Embassy services and suspension of designated services and operations. - Authorize voluntary departure for dependents and non- essential personnel. Authorized departure will be dependent on possible Government of Guyana restrictions on outgoing travel and on possible U.S. restrictions on incoming travel; post does not anticipate such restrictions. - Ensure that staff purchases additional supplies of food and water. - Restrictions on movements of personnel in the city, dinner parties, sporting events and other social events. -------------- Tripwire Three -------------- ¶8. Tripwire 3A is: "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 anywhere in Guyana." COMMENT: Georgetown has Guyana's only international airport, the largest hospital, most of the port facilities and most government functions. Because so many things in Guyana are centered on the capital, post concluded that Avian Influenza anywhere in Guyana will quickly reach Georgetown. END COMMENT. Embassy Actions in response to Tripwire Three: - AI Subcommittee meets to confirm that tripwire has been met. - Restrict travel to the affected region(s) of the country except for CDC or other personnel involved in possible investigation/containment efforts. - In coordination with the department, issue a public announcement, warden message, or travel warning and update the website cautioning American citizens against nonessential travel to Guyana. -Provide press guidance for the potential use of the Mission, neighboring posts, the Department and concerned government agencies. - Provide briefings for Mission staff and dependents. - Implement home quarantine of any staff or dependents who have been in contact with a person confirmed to have an AI infection. - Instruct all staff (American, FSN and domestic staff) with influenza symptoms or close contact with a person confirmed to have an AI infection to remain at home and call health unit for telephone triage. - Emergency Action Committee meets regularly to determine next steps as tripwire circumstances develop. Next steps could include the following: - Division of each section of the Embassy into two teams, working alternate days. If a member of one team becomes sick and the team is quarantined the other team would still be able to function. - Restrict visitor access to Mission buildings. If entry is necessary, visitors will go through screening procedures including temperature monitoring and/or a questionnaire related to symptoms/exposure. COMMENT: There are no studies that provide verification regarding effectiveness of these procedures. They also will not identify people who are contagious but asymptomatic or have minimal symptoms. The level of restrictions on access to Mission facilities should depend on the particular circumstances at that moment. END COMMENT. - Reduction to emergency Embassy services and suspension of designated services and operations. - Authorized voluntary departure of dependents and non- emergency staff. In deciding whether to authorize voluntary departure, the EAC should take into account not only the medical risk, which may be minimal, but the availability of treatment in Guyana and the perceived risk by employees and family members. - Except for designated emergency American and FSN staff, all others remain home on administrative leave or on authorized departure. - Cancel incoming official travel, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by Chief of Mission. - MED and designated EAC members meet with school administrators to review advisability of closing the schools. - Establish a database listing details of any American citizen, hospitalized, quarantined, or ill at home. - Ensure that staff have 30 day supply of food and water at home. - Restrictions on movements of personnel in the city, dinner parties, sporting events and other social events. - Embassy staff instruct their household staff not to report to work. Live-in staff will be under the same restrictions as mission personnel and dependants. -------------- Tripwire Four -------------- ¶9. Tripwire 4 is: "Efficient and sustained human-to-human transmission in Guyana" COMMENT: Post assumes that available medical facilities in Guyana would be saturated immediately. END COMMENT Embassy Actions in response to Tripwire Four: - AI Subcommittee meets to confirm that tripwire has been met. - Depending on conditions elsewhere issue revised travel warning and update website advising American citizens to depart Guyana or remain in their homes and limit human contact for next 30 days. Recommended time period for isolation will be revised based on experiences of other affected posts. - Authorized voluntary departure of dependents and non- emergency personnel. - Cancel all incoming official travel, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by the Chief of Mission. - Embassy at minimal staff, reduction of consular services to emergency American Citizen Services (passports and CRBAs) and suspension of designated services and operations. - Embassy staff to instruct their household staff not to report to work. Live-in staff will be under the same restrictions as mission personnel and dependants. - Except for designated emergency American and FSN staff, all others remain home on administrative leave or on authorized or ordered departure. Children remain home from school or on authorized departure. - MED and designated EAC members meet with school administrators to review advisability of closing the schools. - Division of each section of the Embassy into two teams, working alternate days. If a member of one team got sick and the team were quarantined either section or embassy wide, the other team would still be able to function. - Ensure staff have a 30 day supply of food, water and fuel at home. 30 days was chosen because it is the limit of our fuel supply. This point will have to be reconsidered if experiences at other posts dictate that the outbreak takes longer to run its course. - Restrict visitor access to Mission buildings. If entry is necessary, visitors will go through screening procedures including temperature monitoring and/or a questionnaire related to symptoms/exposure. COMMENT: There are no studies that provide verification regarding effectiveness of these procedures. They also will not identify people who are contagious but asymptomatic or have minimal symptoms. The level of restrictions on access to Mission facilities should depend on the particular circumstances at that moment. END COMMENT. - Embassy considers creating a situation room. - Establish a database listing details of any American citizen, hospitalized, quarantined, or ill at home. - ADMIN closely monitors availability of outgoing commercial flights. - Embassy Emergency Action Committee meets regularly to determine next steps as tripwire circumstances develop. Next steps might include: - Ordered departure of non-emergency personnel and dependents with authorized departure of designated emergency personnel on a case-by-case basis. Ordered or authorized departure will be dependent on possible Government of Guyana restrictions on outgoing travel and on possible U.S. restrictions on incoming travel. - Per reftel B 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. Significant evacuation from Georgetown may not be feasible for a variety of reasons including the added risk of acquiring influenza at crowded airports or on international flights during a true pandemic, travel restrictions and possible quarantine measures. BULLEN