BAHRAIN: AVIAN INFLUENZA CONTINGENCY PLANNING AND

UNCLAS SECTION 01 OF 04 MANAMA 000039 SIPDIS SENSITIVE S/ES-O/CMS - OFFICE OF CRISIS MANAGEMENT SUPPORT, NEA/ARPI E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMR TBIO BA ECTRD SUBJECT: BAHRAIN: AVIAN INFLUENZA CONTINGENCY PLANNING AND TRIPWIRES REF: A. MANAMA 1874 ¶B. STATE 219189 Sensitive but unclassified; please protect accordingly. Not for Internet distribution. ¶1. (U) Post has taken a number of measures in anticipation of the potential threat posed by Avian Influenza (AI). Post MED has held Mission briefings to help Embassy staff better understand AI and AI personal risk mitigation strategies. Post has contracted an LES to continually disinfect commonly handled items, such as doorknobs and elevator buttons. Post Management has completed an inventory of critical medical items, including N-95 respiration masks and placed orders to fill any deficiencies. Post has established and convened an Avian Influenza Working Group (AIWG) to compile the following tripwires for recommendation to the EAC. The AIWG, chaired by EconOff, includes representation from Management (including MED),Public Affairs, Consular, Pol/Mil, and the Defense Attache. Post is served by a Regional Medical Officer based in Riyadh and employs two LES nurses who alternate duty to fill one FTE. Bahrain hosts the U.S. Navy Fifth Fleet and the Defense Attache has reviewed the NAVCENT Pandemic Influenza Plan in order to assist the AIWG in coordinating Post's tripwires with the NAVCENT plan, particularly with regard to medical and departure transportation assistance. ¶2. (SBU) The AIWG assesses that Bahrain is well situated to implement many precautionary aspects of its AI national strategy at a pre-pandemic stage (Ref. A). Although Bahrain's draft strategy has yet to be approved, several key elements have already been implemented. The Ministry of Health has adopted an Integrated Capacity Development Program for laboratory specialists with direction from the WHO. It has also recently acquired laboratory equipment allowing local subtyping. However, MED Emboff, who has worked in Manama for many years as a health practitioner, evaluates that the GOB real world ability to detect new influenza strains is limited. Emboff cautions that in the past, limitations of personnel, expertise and technology have limited the Ministry of Health's ability to implement plans as laid out on paper. Emboff observes that one important medical facility, the Salmaniya Hospital complex, is already straining to meet current demand, with insufficient beds or staff to meet daily needs. However, local private hospitals currently have excess capacity and could absorb some increased activity. Post will enter draft tripwires into the Tripwire Reporting and Integrated Planning System (TRIPS) as directed per Ref. B, subject to EAC approval. Designated tripwire reporters are Management OMS Tracy Chandonnet (e-mail: ChandonnetTL@state.gov, phone: 971-1724-2968) and EconOff Stephen Simpson (e-mail: SimpsonSC@state.gov, phone: 971-1724-2986). ¶3. (SBU) -------------- TRIPWIRES -------------- TRIPWIRE 1: SIGNIFICANT NUMBERS OF AVIAN INFLUENZA (AI) TRANSMITTED TO BIRDS OR OTHER ANIMALS IN BAHRAIN OR GULF REGION - MGT will provide the mission community with facts on local outbreak, provide guidelines on proper handling of foodstuffs and advise staff of food and medical items to stock in home in case of outbreak (Same message to Amcit community). - MGT will ensure that all staff are educated on the proper disposal procedures of dead animals. - MGT will also collect home email addresses for all employees and send a Management Notice to all staff to sign-up for warden messages via email. - PAO, in coordination with Ministry of Information officials, will consider any press procedures deemed necessary at that time to inform the public. - CON will provide community with facts on local outbreak, guidelines on proper handling of foodstuffs, advise of food and medical items to stock at home in case of an outbreak. - MED will encourage flu shots for all mission personnel and American direct hire family members, and will train Embassy canteen staff on proper food handling. TRIPWIRE 2: ANY CASE OF AI AMONG HUMANS IN BAHRAIN OR GULF REGION (ANIMAL TO HUMAN TRANSMISSION) - MGT will ensure that Post,s Alternate Command Center is fully prepared and stocked. - MGT will repeat Management update and warnings outlined in Tripwire 1. - MGT will consider requesting additional TDY MED personnel. - MGT will check all emergency supplies and have enough water and MREs on hand for a fixed period (TBD) for essential operations. - MGT will put up signs in the Embassy about proper hand washing techniques and coughing etiquette, and will teach cleaning staff how to disinfect offices and employees how to keep their workspaces clean. - MGT will consider cleaning/removing outdoor furnishings in public areas of the Embassy compound. - MGT will collect and tally skill bank results to identify those with medical backgrounds. - PAO/CON will update internet or other public information. - CON will repeat and update information about the outbreak and provide guidelines to the community and establish coordinating groups with other missions - MED will train guards, first responders, Marines, LES, and US community in first aid, home health care, and temperature-taking. - EAC will consider limiting staff movements to home, work and essential shopping only. - EAC will consider limiting public access to Embassy. - EAC will consider advising Embassy parents to suspend sending children to school. TRIPWIRE 3: SPIKE IN THE NUMBER OF ANIMAL-TO-HUMAN TRANSMISSION CASES IN BAHRAIN OR GULF REGION INDICATING AN INCREASE IN THE TRANSMISSIBILITY OF THE VIRUS AND/OR CAUSING A SERIOUS STRAIN ON LOCAL MEDICAL FACILITIES - MGT will issue regular updates on AI for the mission community. Travel to affected areas will be restricted as appropriate. - MGT will consider requesting authorized departure of family members and non-emergency personnel, and administrative leave for non-essential personnel, and will also consider preparing travel authorizations for expedited return to home leave addresses of remaining staff. DAO will evaluate NAVCENT,s ability to support this effort and coordinate as appropriate. - CON/PAO will continue to issue Warden Notices (if appropriate),update the public internet website, and issue public announcements. Amcits may be advised to adjust travel plans to minimize exposure. - CON will inform the Amcit community regarding the best available local medical resources. - DAO will liaise with NAVCENT efforts. - MED will communicate with local hospitals and clinics on their findings in possible AI cases. - MED will also make available hand-washing supplies and tissues to Embassy staff, and review drugs stocks and other medical supplies. TRIPWIRE 4: SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN GULF REGION OR MORE THAN ONE COUNTRY, BUT NOT IN BAHRAIN - MGT will repeat all notifications to mission community, and consider requesting authorized departure of family members and non-emergency personnel. - MGT will consider administrative leave for non-essential personnel. - MGT will consider mandatory administrative leave for any employee who exhibits any flu symptoms or has a family member with flu symptoms (monitored by the Med Unit); employees with flu-like signs will be sent home. At this point, Post will consider setting up screening measures at points of entry, and will consider restricting TDY personnel coming to Bahrain. - MGT will consider distributing Personal Protective Equipment (PPE) to appropriate staff in the Health Unit and other staff who interact with the public. - CON will continue to provide all services to Americans and update public announcements if needed, and will provide non-immigrant visa services only for persons traveling with Americans returning to the US and for official GOB travel. - CON will continue to process all pending immigrant visa cases with existing appointments but will make no new appointments. - CON will continue to coordinate with other diplomatic missions, Med/Washington, and desk officers, and will consider requesting that the Department issue a travel warning. - CON will consider shelter-in-place and quarantine planning, if appropriate. - CON will consider limiting visa services and will consider requesting authorization to suspend visa services. PAO will support any subsequent decision to do so with appropriate public service announcements. - MED will concurrently prepare guidance for family members on how to treat AI patients at home. - MED will train guards, first responders, Marines, LES and US community on the use of PPE and masks. Med will also send weekly status reports to Department. - MED will bifurcate in an effort to minimize MED personnel exposure to AI. One nurse/team will be dedicated to making house calls on potentially infected Embassy staff (A motorpool driver will be assigned to the Health Unit). The other nurse/team will be dedicated exclusively to treating staff at the Embassy. TRIPWIRE 5: SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN BAHRAIN - MGT will continue to implement screening at Embassy entry points, consider restricting TDY personnel, and continue to inform the mission community of new developments. - MGT will consider providing delivery service for groceries and other essentials to residences. - CON will continue issuing information notices to the American community, but will restrict operations to providing emergency American citizen services. - CON will also consider requesting a travel warning for Bahrain. - MED will maintain a working relationship with local medical facilities, GOB and U.S. Naval support activity. - MED will implement mandatory temperature checks and screening for Embassy staff. - MED will instruct employees to stay home if they are ill. - MED will issue advice on home quarantine practices and send Health Unit personnel to make house calls as needed. TRIPWIRE 6: MISSION EMPLOYEE DEVELOPS AI - MGT, in addition to considering all actions outlined above, will disinfect offices, begin daily contact with staff for any update on illnesses in staff households, implement mandatory temperature checks for all personnel, and will consider a drawdown of staff. - CON will consider all actions outlined above. - MED will provide psychological support to employees, and if possible, continue home visits to sick individual(s) and evaluate further treatment options including admission to an ICU medical facility, or medevac. - MED will continue appropriate actions outlined above. ZIADEH