Indonesia - Post Contingency Planning and Updated

UNCLAS SECTION 01 OF 02 JAKARTA 000578 SIPDIS SENSITIVE SIPDIS DEPT FOR EAP/MTS, OES, DS/IP/EAP, A/MED AND S/ES-O DEPT PASS TO USDA/FAS/OSTA/ROSENBLUM, USDA/APHIS/ANNELLI, USDA/DU/S LAMBERT DEPT ALSO PASS TO HHS/STEIGER/MSTLOUIS AND HHS/NIH DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL BANGKOK FOR RMO, CDC, USAID/RDM/A, APHIS E.O. 12958: N/A TAGS: TBIO KFLU AMED CASC AMGT PGOV SOCI ID ASEC SUBJECT: Indonesia - Post Contingency Planning and Updated Tripwires REF: A) 2005 Jakarta 9024 B) 2005 State 202824 JAKARTA 00000578 001.2 OF 002 ¶1. (SBU) Summary: Our Emergency Action Committee reviewed and reaffirmed our Avian Influenza (AI) tripwires on March 13. This cable provides minor updates to the original tripwires. End Summary. ¶2. (SBU) Following a review of Ref A, the Mission's Avian Influenza Working Group (AIWG) updated Embassy Jakarta's tripwires to reflect better the actual trajectory of the disease and ensure an accurate and speedy response to the threat posed to humans. The revision reflects the unexpected distribution of H5N1 AI human cases in urban rather than rural areas as envisioned in the original tripwire scenario. The Ambassador has approved the following updated tripwires and possible associated actions. The AIWG has determined that post has reached Tripwire 1 and taken the actions listed in para 6. ¶3. (SBU) Indonesia has 105 confirmed human fatalities from avian influenza (AI),a number of them in family clusters in the greater Jakarta metropolitan area. The Ministry of Health has instructed all health care providers in the city to refer suspected cases of AI to three AI referral hospitals for Jakarta: Sulianti Saroso Infectious Diseases Hospital, Persahbatan, and Gatot Subroto Army Hospital. Although each hospital is equipped with limited number of respirators and isolation rooms, they would quickly become overwhelmed in the event of a pandemic. ¶4. (SBU) One U.S. commercial carrier, Continental Micronesia, flies twice weekly from Denpasar, Bali to Honolulu via Guam. All other commercial flights via Singapore or Bangkok require an overnight stop. There is a Cathay Pacific flight from Jakarta to Hong Kong that does not require a stopover in Asia. Individuals flying on Cathay Pacific can connect on US Airlines directly to U.S. cities. If traveling from Jakarta directly to Tokyo on Garuda or Japan Airlines, they can connect with any U.S. carrier directly to the U.S. the same day of arrival. During the SARS epidemic in 2003, �A;Singapore refused entry to any traveler with a fever. Countries that serve as transportation hubs in Asia would impose border control measures and restrict entry to travelers originating in Indonesia. To the extent possible, U.S. staff and dependents should depart Indonesia at the beginning of a pandemic. ¶5. (SBU) The Regional Security Office (RSO) will input tripwire data into the TRIPS system. ¶6. (SBU) Begin Mission Jakarta AI tripwires: Tripwire 1: Spike in number and broadening geographic spread of animal-to-human transmission cases in Indonesia. Actions: a) Restrict official and unofficial travel to wet markets. b) Release warning announcement to Mission personnel and warden message to American citizens. Prepare talking points for domestic and international press. c) Provide detailed briefing to Embassy/Consulate staff. d) Communicate pertinent information to the embassy community by way of venues such as town hall meetings, the embassy web site and newsletter articles. e) Review and update Mission contingency plans. Tripwire 2: Confirmed, sustained human-to-human transmission in one or more of the other at-risk countries in the region (but not in Indonesia),indicating an increase in transmissibility of the virus. This is particularly significant if there are multiple, geographically diverse clusters. JAKARTA 00000578 002.2 OF 002 Actions: a) Consider authorized departure for U.S. family members and non-emergency personnel. b) Institute screening practices for all visitors to USG facilities. c) Mandatory sick leave for any employee who shows any flu symptoms or has a family member with flu symptoms. Monitoring by MED Unit. d) Public announcement to the American community. Prepare press guidance/talking points for domestic and international press. e) Department of State makes public announcement regarding travel to the region. f) Assess availability of commercial flights. g) Recommend stockpiling of food and water supplies for 90 days, in the event post personnel would not be able to depart in a pandemic (Tripwire 3). Tripwire 3: Sustained human-to-human transmission in Indonesia. Actions: a) Reduction to emergency consular services only. b) The Chief of Mission recommends implementation of authorized or ordered departure, at his discretion, if departure is still possible. c) Implement administrative leave for non-emergency FSNs. d) Mandatory sick leave for any employee who shows any flu symptoms or has a family member with flu symptoms. Monitoring by MED Unit. e) Consider social distancing measures, such as home quarantine and limiting venues of human to human contact, such as community gatherings. Consider restricting children from school. f) Screening of all visitors and use of protective gear (masks, gloves, clothing). g) Public announcement to the American community. Prepare press guidance/talking points for domestic and international press. h) Department of State makes public announcement regarding travel to the region. i) Advise and request assistance from DoD as needed. Alternative Tripwire: A Mission employee develops Avian Influenza, in the absence of a broader outbreak per tripwires 1, 2, or 3 above. Actions: a) Treat the victim. Medevac if possible. b) Disinfect office. c) Administer Tamiflu to close contacts. d) Prepare press guidance/talking points. HUME