HONG KONG'S UPDATED AVIAN INFLUENZA/PANDEMIC

UNCLAS SECTION 01 OF 05 HONG KONG 000461

SENSITIVE
SIPDIS

STATE FOR CA/OCS/EAP,
STATE FOR M/PRI FOR ROBIN MORRITZ
STATE FOR SES-O FOR ELIAS PARRA
STATE FOR AAIT
STATE FOR OES/IHA
STATE FOR MED
HHS FOR OGHA - STEIGER, HICKEY
CDC ATLANTA FOR CCID AND COGH

E.O. 12958: N/A
TAGS: AMED AMGT ASEC CASC KFLU KSEO KPAO TBIO HK CH
SUBJECT: HONG KONG'S UPDATED AVIAN INFLUENZA/PANDEMIC
TRIPWIRES

REF: A. STATE 6306

B. STATE 13929


1. (SBU) SUMMARY: Post submits the following updated Pandemic
Influenza (PI) tripwires for consideration and coordination
in response to Department-provided guidance and action
request (Reftel A). These tripwires were developed as part
of Post's ongoing efforts to ensure we are as prepared as
possible for a pandemic event and have taken into account the
latest available information and HKG's capabilities and
likely responses. Per department instruction, Post is now
working to update these tripwires in the Crisis and Emergency
Planning Application (CEPA)(Reftel B). END SUMMARY.


2. (SBU) Post continues to view tripwires as prompts to
consider options and not absolute triggers. The Department PI
tripwires have been carefully reviewed and are incorporated
into Post's pandemic response planning. Post assumes that if
Avian Influenza (AI) becomes efficiently able to transmit
human-to-human, infections would spread quickly throughout
the region and that Hong Kong, because of its location along
China's south coast, dense population, and role as a regional
transportation hub, could expect infections and exposures
within a short period. Post's variations from Department
tripwires reflect HKG capabilities and expected actions as
well as provide fidelity on a range of anticipated local
indicators and possible options.

Hong Kong is Well Prepared
--------------


3. (SBU) Hong Kong is perhaps the best prepared city in Asia
and among the best prepared in the world to respond to a PI
outbreak. Building on lessons learned from previous
outbreaks of AI and as the epicenter of the SARS outbreak in
2002, Hong Kong has committed tremendous resources to
building this PI response capability. Hong Kong's first line
of defense is a capable AI surveillance program headed by the
Agriculture, Fisheries and Conservation Department. Poultry
farms and food markets are heavily monitored and both wild
and domestic birds are tested regularly for AI. If the AI
virus is found, strict quarantines and protocols are
initiated with the full cooperation of Hong Kong's citizenry.



4. (SBU) Hong Kong's second line of defense, the Center for
Health Protection (CHP) and Hospital Authority, are likewise
highly professional and has adequate resources to deal with a
PI outbreak. The health care system has in place detailed
contingency plans, large stocks of anti-viral medications and
experienced staff who are well trained and equipped. Hong
Kong authorities fully cooperate with the World Health
Organization (WHO) and are well networked with U.S. medical
authorities. Hong Kong authorities and medical staff are
also well linked regionally and cooperate with and support
both Macau and mainland China authorities in routine AI
surveillance and planning for a PI emergency. Private
Americans can receive prescription medications via mail and
local hospitals will provide emergency services to all
foreigners and then seek reimbursement.

Tripwire One
--------------


5. (SBU) Multiple AI human infection in more than one country
in the region; Or, Hong Kong's 3-tier response system goes
from lowest response of &Alert8 to Level 2, "Serious"; Or,
a significant AI outbreak in Hong Kong poultry populations or
a confirmed AI human case in Hong Kong with potential
widespread human health impact (no human-to-human

HONG KONG 00000461 002 OF 005


transmission).

a. (U) Conduct outreach efforts with local health authorities
and reconfirm all established lines of communications.

b. (U) Review medical supply levels and Personal Protective
Equipment (PPE) inventories; top off as needed.

c. (U) Review/update warden system and F-77 report.

d. (U) Closely monitor WHO, CDC, and other AI reporting and
HKG announcements for updates and recommendations;
disseminate relevant information and instructions to
Consulate staff through internal e-mails and published
announcements and to private AMCITs through newsletters and
web-based announcements; advise AMCITs where to obtain
up-to-date information about the situation and about
Consulate operations.

e. (U) Remind and encourage Consulate staff and AMCIT
community to maintain first aid kits that include hygiene
items, basic medical supplies and medications; reference USG
recommendations to maintain sufficient emergency supplies,
including food and some water, to last up to twelve weeks.

Tripwire Two
--------------


6. (SBU) Dramatic increases in the number of human AI cases
in the region; Or, reports of multiple AI infections in Hong
Kong; Or, authoritative reports or indications of
AI-triggered human quarantines, restrictions on travel,
reports of imminent closures of regional borders or
curtailment of civil aviation; Or, regional AI-triggered
unrest/panic; Or, WHO raises Pandemic Alert Phase to level 4
(small clusters with limited human-to-human spread) and U.S.
Federal Government Response is raised to Response Stage 2.

a. (U) Emergency Action Committee (EAC) meets to review
situation. EAC, in consultation with the Operations Center's
Crisis Management Staff (S/ES-O/CMS) and, if applicable, the
State Department Task Force, confirm that Tripwire 2 has been
crossed.

b. (U) Review with Consulate staff Post's protective,
treatment and preventative protocols, to include social
isolation procedures.

c. (U) Review with staff designated to assist the Medical
Unit the bio-protection protocols, duties and procedures
necessary to assist in the triage and care for Consulate
staff or others showing AI-like symptoms.

d. (U) Re-train employees in the use of PPE and N95 masks;
consider issuing PPE, masks, sanitizers and other supplies to
employees for both office and at-home use.

e. (U) Verify all emergency phone trees and personnel rosters
(to include the WebPASS Post Personnel System) are updated
and test emergency communications and notification equipment
and procedures.

f. (U) Consider convening a Town Hall and OSAC (perhaps
virtually by internet video conference) to disseminate
information and respond to concerns regarding pandemic
response preparations; if conducted, ensure any information
provided is also sent to the AMCIT community. Information
should emphasize that if a pandemic is declared, private
Americans should consider departing at the earliest stage,
while commercial options remain.

HONG KONG 00000461 003 OF 005



g. (U) Consider the initiation of protective/preventative
protocols, including an intensified disinfection regime.

h. (U) Consider restricting regional TDY or authorized
regional leave travel to affected areas.

i. (U) Consider additional liberal leave, flex-time and
telecommuting policies to reduce consulate staffing; consider
actions, such as reduced appointment times and walk-in
services, to reduce crowding and congestion in public access
areas of the Mission.

Tripwire Three
--------------


7. (SBU) Confirmed multiple large clusters of efficient AI
human-to-human transmission in the region or a confirmed
cluster of AI human-to-human transmissions in Hong Kong; Or,
WHO declares Pandemic Alert Period 5 (larger clusters but
human-to-human spread still localized).

a. (U) EAC subsumes AIWG. EAC, in consultation with the
Operations Center's Crisis Management Staff (S/ES-O/CMS) and,
if applicable, the State Department's Task Force, confirm
that Tripwire 3 has been crossed.

b. (U) Issue or re-supply staff with PPE, sanitizers and
other supplies for both workspace and home use; initiate
protective/preventative protocols and intensified
disinfection regime.

c. (U) Consider canceling non-essential regional TDY or leave
travel and official visitor/delegation travel.

d. (U) Issue an OCS-cleared warden message with the latest
available AI guidance from HKG health authorities, U.S.
Department of State, CDC and WHO.

e. (U) Consider requesting authorized departures to the U.S.
of EFM and non-essential personnel. If granted, Department
will issue Travel Warning, and Post will disseminate it to
the AMCIT community. Inform host government and other
foreign missions of drawn status.

f. (U) If authorized departure is requested but not granted,
provide mission briefing for employees and dependents
emphasizing procedures in the event the Under Secretary for
Management encourages employees to exercise liberal departure
options (SMA, R&R, etc.)

g. (U) Consider advising employees to withdraw children from
local schools and inform the AMCIT community of any decision
to do so.

h. (U) Consider reducing Consulate operating hours and
services and in consultation with CA, consider reducing visa
services and reducing ACS services to emergency services only.

Tripwire Four
--------------


8. (SBU) Sustained/documented AI human-to-human transmission,
evidenced by a cluster of cases in Hong Kong or clusters of
infection in more than two countries in the region; Or, clear
evidence of AI human-to-human transmission spread in Hong
Kong's general population, evidenced by secondary cases
resulting from contact with an index case. Or, Hong Kong's
3-tier response system goes from Level 2, &Serious8, to
Level 3, &Emergency8; Or, WHO declares a Pandemic Period

HONG KONG 00000461 004 OF 005


Phase 6 (increased and sustained transmission in the general
population),U.S. Federal Government declares Response Stage
3 (widespread human outbreaks in multiple locations
overseas); pandemic situation is such that it is difficult to
get seats on the commercial flights still operating.

a. (U) EAC, in consultation with the Operations Center's
Crisis Management Staff and the State Department Task Force,
confirm that Tripwire 4 has been crossed.

b. (U) Office and LES Consular staffing augmented to respond
to needs of AMCIT community, but otherwise reduce staffing to
essential operations and personnel only. Non-essential staff
placed on administrative leave.

c. (U) Consider establishing a 24-hour working group to
assist staff and respond to inquiries regarding treatment
centers and welfare and whereabouts concerns.

d. (U) Ensure that controlled/classified documents have been
reduced to a less than one-hour destruct time.

e. (U) Send reminders to employees about health precautions,
as well as procedures to report an emergency; ensure the same
information is provided to AMCIT community. Americans should
also be provided with information about HKG-established
alternate care sites and given advice on how to obtain food
and medications.

f. (U) Review host government's emergency mortuary set-up and
ensure that Post will be able to assist Americans coordinate
with medical authorities when a body must be placed in a
mortuary facility.

g. (U) Request an update to the Travel Alert or Travel
Warning to reflect current circumstances and Post actions; if
the Department issues a revised Travel Alert or Travel
Warning, Post should promptly disseminate it to the local
AMCIT community.

Tripwire Five
--------------


9. (SBU) The pandemic situation is such that random acts of
violence or an increase in threats are occurring; Or, the
pandemic situation is such that the HKG cannot contain civil
unrest.

a. (U) At the Front Office level, call the State Department
Operations Center to report on the developing situation.
EAC, in consultation with the Operations Center Crisis
management staff and the State Department Task Force, confirm
that Department Tripwire 5 has been crossed.

b. (U) If not already done, set up and staff a 24-hour
control room with stable electrical supply as well as
telephone and internet access.

c. (U) Consider requesting Ordered Departure; if requested,
provide information about potential numbers of private
Americans departing and transportation availability.

d. (U) Consider actions that must be accomplished in the
event all employees depart Post and operations are suspended;
be ready to initiate document destruction.

e. (U) Update AMCIT community with the latest guidance
concerning safety, travel and housing; if ordered departure
is granted, disseminate the Department Travel Warning and
strongly urge private Americans to consider relocating to the

HONG KONG 00000461 005 OF 005


U.S. Warden message should note that Consulate services may
soon become unavailable to those who stay.

f. (U) Arrange administrative control of residences and
personal property of departing U.S. Government personnel. At
the discretion of the Chief of Mission, in coordination with
the Department, assistance may be extended to foreign
nationals when humanitarian or U.S. national security
interests dictate. Post must obtain prior approval from the
Department before offering departure assistance.
DONOVAN