EPIDEMIC PREPAREDNESS: COOPERATION BETWEEN CHIHUAHUA, NEW

UNCLAS CIUDAD JUAREZ 000980


E.O. 12958: N/A
TAGS: KFLU PGOV MX
SUBJECT: EPIDEMIC PREPAREDNESS: COOPERATION BETWEEN CHIHUAHUA, NEW
MEXICO, AND TEXAS


1. Summary: The state of Chihuahua has been working closely
with Texas and New Mexico health departments for three years to
coordinate preparations for a potential outbreak of a highly
contagious influenza or similar illness. However, New Mexico
and Texas state officials report that their work has been
impeded by a lack of funding. The states have held joint
conferences to inform local stakeholders of the status of
emergency preparedness. At a meeting on July 30-31, 2008,
officials urged participants to develop emergency plans for
their own organizations. Based on past experience, medical
experts from all three states and the CDC agreed that closing
the border in the event of a flu outbreak would slow the spread
of disease for no more than one month. After that, a closing of
the border would serve no medical purpose. End Summary.


2. This year, more than 300 government officials from Texas,
Chihuahua and New Mexico, along with representatives from NGOs
and local businesses, have attended two conferences sponsored by
New Mexico state authorities to discuss plans for responding to
the potential outbreak of an epidemic respiratory disease. The
most recent meeting was in late July, and speakers admitted that
they could not say what a highly contagious strain of avian flu
might look like, how it would spread, and how to develop a
vaccine for it. A Pan American Health Organization Medical
Officer from El Paso later described any such predictions as
futile "soap opera."


3. To the extent that medical experts were willing to make
predictions, they were based on observations about how influenza
behaves in an unvaccinated population. Based on this model,
epidemiologists expected rapid transmission of the disease among
integrated border populations. Pointing to the limited medical
services available in many locations along the border under
normal circumstances, medical experts said that communities
could not count on hospitals to mount an effective response
against the first wave of disease, and businesses and
individuals should prepare their own action plans.


4. Cooperation between Chihuahua, Texas, and New Mexican health
authorities has so far focused on developing common protocols
for the identification of cases, and procedures for reporting
them to the Centers for Disease Control and Prevention. Only
Chihuahua has moved beyond these initial stages to run practice
drills within its state health care system, leading U.S.
officials to admit that, despite a late start in this tri-state
effort, Chihuahua is now further ahead in its preparations. New
Mexico and Texas officials bemoan the fact that they have not
received enough funding to conduct even limited field tests.
The three states are just beginning to address more advanced
planning needs, such as identifying stockpiling sites and how to
handle a surge in hospital caseloads. A table top exercise is
in the planning stages, to fill the gap created by the lack of
field testing.

Utility of Closing Ports of Entry


5. Based on modeling of the spread of influenza in a population
without effective vaccination, medical experts predict that if a
new disease were to first appear in the border region, it would
be identified almost simultaneously on both sides. Since
symptoms would take up to seven days to manifest themselves,
contagion would by then be well underway and closing the border
would do little to delay the spread of disease. By contrast, if
the first cases were identified elsewhere, closing ports of
entry quickly would be more effective since border residents
would not yet have been exposed to the same degree. Still, the
most that could be achieved would be to slow the rate of
infection for a month. After that, contagion would be
widespread throughout the region, and keeping the border closed
would serve no medical purpose.


6. Most governmental representatives at the July meeting
believed the border would not be closed in the event of an
epidemic because of provisions of the 2007 North American Plan
for Avian and Pandemic Influenza. However, a senior New Mexican
official thought the border would be closed early because
closure is a critical element in slowing the spread of disease.
He added that no matter what the North American Plan might say,
"nationalism will win out. A country will always protect its
own citizens first."


7. An official from U.S. Customs and Border Protection told a
Consulate officer that together the Departments of Homeland
Security, Transportation and Defense have reviewed emergency
border crossing procedures in the event of a flu epidemic. He
said that the smaller ports of entry in this district would
close first in the event of a serious threat to U.S. public
health. This action would channel traffic into the CDC's El
Paso Quarantine Station. In view of anticipated staffing
shortfalls due to illness, El Paso and Juarez officials would
give priority to clearing shipments of critical supplies
northward and southward.

Local and Regional Contacts



8. Key officials involved in these coordinated emergency
preparations include:

Chihuahua:
- Dr. Luis Carlos Esquivel Ruiz, Medical Coordinator,
Secretariat of Social Development
- Dr. Gumaro Barrios, State Epidemiologist, Chihuahua State
Health Services;
- Dr. Jose Luis Mendoza, Deputy Director of Preventive Medicine,
Chihuahua State Health Services

Mexican Federal Government:
- Dr. Gustavo Ramirez Rosales, Area Chief for Epidemiological
Surveillance, Mexican Institute for Social Security (IMSS, which
runs four major hospitals in Juarez)

Local U.S. Government Representative:
- Dr. Miguel Escobedo, Medical Officer, Centers for Disease
Control and Prevention, El Paso Quarantine Station

New Mexico:
- Albert Sanchez, Border Health Emergency Health Preparedness
Coordinator, Bureau of Emergency Management, New Mexico
Department of Health
- Anne Pascarelli Barraza, Pandemic Planning and Performance
Outcomes Manager, Bureau of Health Emergency Planning,
Department of Health
- Paul Dulin, Director, Office of Border Health, Department of
Health

Texas:
- Cynthia Morgan, Pandemic Influenza Program, Texas Department
of State Health Services
- Flor Puentes, MPH, Early Warning Infectious Disease
Surveillance Coordinator, Department of State Health Services,
Region 9-10, El Paso

Others (not at the conferences):
U.S.-Mexico Border Health Commission:
- Dr. Elisa Aguilar, Regional Coordinator for Health Programs in
Juarez
- Amb. Eleazar Ruiz y Avila, Executive Secretary for the Mexican
Section, Mexico City


9. Comment: Emergency services experts from Chihuahua, New
Mexico, and Texas have worked closely together for three years
to coordinate their response to the onset of an epidemic in the
border region. Due at least in part to a lack of funding,
however, the three states are far from even addressing
stockpiling of critical supplies, patient surges at hospitals,
isolation and security requirements. State and local medical
officials believe they are now well-equipped at major medical
facilities to make a fast identification of a dangerous new
disease, but they are no further along in actually mitigating
the potential impact.


MCGRATH