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06MADRID1 2006-01-01 01:06:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Madrid
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					  UNCLAS SECTION 01 OF 03 MADRID 000001 




E.O. 12958: N/A



1. (SBU) Mission Spain has begun the contingency planning
process to prepare for the unique challenges posed by a
potential Avian Influenza (AI) outbreak in Spain. The key
action officer for Mission preparations is Embassy Madrid
Post Medical Officer Doctor Jose Peralba. He and his office
are the primary liaison point with M/Med, the RMO, and local
medical resources. In addition, he is the primary liaison
with his counterpart at the U.S. military base at Rota,
Spain, and has already contacted his counterparts there
regarding Avian Influenza. Dr. Peralba is also the Post
Medical Officer for Consulate General Barcelona and includes
the Consulate in all Avian Influenza preparations.

2. (SBU) Internally, we have stocked a large supply of
Personal Protective Equipment (e.g., masks and gloves) (300
N-95 masks and 6400 disposable gloves) and we are waiting for
M/Med shipments of the anti-viral "Tamiflu." In addition,
the Medical Unit has updated its contacts with local medical
services (e.g., hospitals, emergency rooms, doctors, and
ambulance services).

3. (SBU) Embassy Madrid's Consular Section and Consulate
General Barcelona monitor Spanish press reports on Avian
Influenza and consult regularly on this issue with Post
Medical Officer Peralba and Mission ESTHOFF. The Madrid
Consular Section and Consulate General Barcelona have
circulated a warden message to the resident U.S. citizen
community and study abroad programs. This warden message,
which can be accessed through the "Bird Flu" link on, includes basic information on the illness and
links to CDC and State websites and information sheets.
Mission plans to add a link the Spanish Health Ministry's
Avian Influenza Plan (in English).




4. (SBU) Mission Spain will endeavor to accomplish
outstanding "Preparedness Steps" outlined in paragraph 8 of
Reftel. Measures that the Mission will undertake, under the
leadership of the Post Medical Officer, will include, but not
be limited to:

-- increasing education for hand hygiene and cough
etiquette, self shielding, isolation and quarantine;

-- preparation of signs at all entrances referring to flu
symptoms that request that employees contact the Medical Unit
if they have symptoms;

-- insuring that the stock of Personal Protective Equipment
is adequate;

-- insuring that the stock of "Tamiflu" and "AB" are

-- distributing information about symptoms and temperature
checking with a simple flow chart and algorithms for Mission
employees and family members;

-- updating contacts with schools attended by official
family members;

-- establishing guidelines for stocking of water, food and

-- establishing guidelines for communications in the event
of an AI pandemic;

-- updating Mission staff on new AI-related events and the
health response;

-- evaluating who should be considered a "higher risk"
individual in the event of an AI pandemic (e.g., under two
and over 60), and thus subject to earlier evacuation back to

-- starting an Mission education program related to AI

-- establishing optimal methods for delivering assessment
and care to individuals with AI, including the designation of
discreet areas for screening, triage, and care of affected

-- establishing procedures for the medical evaluation and
isolation of quarantined persons who exhibit signs of AI-like

-- developing tools and mechanisms to limit the
stigmatization of affected persons and family members;

-- establishing procedures for delivering medical care, food
and services to persons in isolation or quarantine, taking
into consideration the special needs of children and persons
with disabilities;

-- developing protocols for monitoring and enforcing
quarantine measures;

-- ensuring the legal authority and procedures exist for
various levels of movement restrictions; and,
-- establishing procedures for issues related to employment
compensation, job security and administrative leave.




5. (SBU) Spain has a capable national health care system
similar to that found in other developed European economies.
Host country medical treatment facilities would be able to
address limited AI outbreaks but, like any other developed
country, could be overwhelmed if a large pandemic develops.
Post would be able to shelter in place for an extended
period, and would probably need to if air travel were
curtailed to and from the United States depending on the
extent of an outbreak.

6. (SBU) Tripwire One: Sustained human-to-human
transmission of a virulent mutation of AI anywhere else in
the world. If this happens, Mission anticipates that
human-to-human transmission will reach Spain within a matter
of weeks.

-- begin immediate preparations for arrival of second
tripwire, including:

-- distribution of stocks of masks and gloves;

-- identification of high risk members of the mission
community (e.g., under 20, over 60, pregnant, etc.) for
possible evacuation back to CONUS (in keeping with HHS and
M/med guidelines);

-- announcements to the mission community coordinated with
announcements to AmCits resident/visiting Spain;

-- encouraging of social distancing;

-- streamlining of AI and essential issues reporting back to

-- preparations for "snow day" (M/med term) operations at
Mission Spain facilities;

-- reduction of permitted visitors into Embassy and
Consulate compounds;

-- mandating that all ill Mission employees should not/not
come to work and should plan to work from home as much as

-- contact schools attended by official family members;

-- stocking of seven-day supply of food/water at personal

-- stocking of NEX;

-- topping up fuel tanks and GOV/POV fuel tanks; and,

-- distribution of equipment to maintain communications with
Mission community and enable officers to work from home
(radios, blackberries, FOBs if available, lists of home phone
numbers and home e-mail addressees).

7. (SBU) Tripwire Two: Sustained human-to-human
transmission in Spain, which can be expected to occur
simultaneously in several Western European locations.

-- trigger "snow day" operations (initially for a 10-day
period); including, but not limited to:

-- Embassy, Consulate General Barcelona, and Consular
Agencies would essentially be closed for all but essential
staff (RSO/MSG, IPC skeleton crew, Maintenance skeleton crew,
Medical Unit, CONS/ACS, and Motorpool), with all other
personnel remaining at home;

-- Children will be kept home from school;

-- Mission staff will be instructed to avoid social
gatherings/public places;

-- Mission staff will be instructed to monitor their
temperatures, record their symptoms and call designated
Health Unit staff for verbal screening;

-- Medical Unit will respond to cases of infection within
the official community and determine need for house
quarantine or hospitalization (care may be given in either
Mission facilities or at residences);

-- Medical Unit will document all screening conversations
and any follow-up;

-- EAC will consider authorized departure for high risk
personnel and family members if human-to-human transmission
has not reached the U.S.;

-- Mission will coordinate with USNATO and Rota regarding
mutual support and any evacuation planning that might involve
U.S. military or USG contract aircraft;

-- CON/ACS will address needs of resident/visiting AmCit

-- Medical Unit will initiate contact with host nation
medical services;

8. (SBU) General evacuation from Spain to CONUS is not
likely to be an effective option. Human- to-human
transmission, if it develops, will likely hit the U.S. about
the same time it hits Europe. Spain's medical infrastructure
and its ability to contain outbreaks are on par with the U.S.
Evacuation to CONUS may make sense in individual cases but
probably not for the general Mission community. Extrapolated
to the larger resident and visiting AmCit community, however,
may mean coordination of commercial and charter flights to
return a significant number of individuals to the U.S. Post
is also aware that the arrival of AI in the U.S. may lead us
to restrict access to the U.S. and thus inhibit any effort to
return AmCits to the U.S.




9. Per reftel request, Embassy Madrid nominates Management
Section OMS Lesley Acs and GSO, Margaret Kurtz-Randall, as
the two mission employees who will be responsible for
inputting Avian Influenza tripwire data into the Tripwire
Reporting and Integrated Planning System (TRIPS) data base.
Both hold
Top Secret clearances.