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

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Immediate Actions
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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

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Tripwire One
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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.

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Tripwire Two
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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.

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Tripwire Three
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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.

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Tripwire Four
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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