From Operation Topoff to Operation Dumbkopf
In my previous blog, I mentioned the results from Operation Topoff, conducted back in 2000. In a simulated plague outbreak due to bioterrorism, local, state and federal officials tested their health care system to see how it would deal with large numbers of ill people as a result of an infectious disease. In the exercise, hospitals were quickly overwhelmed. The decision was then made to quarantine everyone in the city of Denver in their homes. What we would call "protective sequestration" or "shelter-in-place" (SIP) today. However, there were some problems with this approach (Lessons Learned from a Full-Scale Bioterrorism Exercise, Emerging Infectious Diseases):
... quarantining two million persons is not simple. Essential workers must be
identified, be given prophylaxis and protective barriers, and be permitted to do their jobs.
Other members of the community can stay in their homes only a few days before they
need fresh supplies of food. Therefore, a one-time, blanket quarantine order is unlikely to
be successful and cannot be enforced unless these and many other issues are
addressed. The hospitals were quite demanding in their requests for reinforcements, and
we made great efforts to assist them. However, by day three of the exercise it became
clear that unless controlling the spread of the disease and triage and treatment of ill
persons in hospitals receive equal effort, the demand for health-care services will not
diminish. This was the single most important lesson we learned by participating in the
exercise.
The results of this exercise are not surprising to us. Flublogians quickly realised that the best way to slow the spread of a pandemic influenza would be for everyone who could to stay in their homes until the outbreak in their communities was extinguished, at least 6-12 weeks. It would seem obvious that if you want people to stay in their homes this long, they need to be able to eat something during this time. It would also seem obvious that the best way to accomplish this would be to tell people they need to stockpile food for at least 6-12 weeks.
Essential workers will still need to do their jobs to keep the water and electricity flowing. The only way to protect them from infection while they are on the job will be to provide them with high-quality personal protective equipment and train them in how to use it properly.
Although Operation Topoff used a bioterrorist agent in their exercise, it was also intended as guidance for planning for an influenza pandemic. The problems raised in this exercise, and the obvious solutions, should have been considered by the CDC and other federal agencies once H5N1 was identified as a serious threat. Have they? Unfortunately, no.
Currently, the official US government position is that the public only needs to stockpile for 2 weeks, 4 weeks short of the likely minimum outbreak length. And most people have no idea that they should stockpile for even 2 weeks. The high production value but low content Public Service Announcement put out by the federal government has been seen by few and offers no specific recommendations other than going to the pandemicflu.gov site (transcript). The number one government risk communications consultant told the public that putting the pandemic on the back burner was a good idea.
As far as I know, no power or water essential workers have been fit tested for respirators or trained in how to use personal protective equipment (PPE). Even many hospitals have not purchased sufficient PPE for their critical employees.
We are occasionally told that the government and business have everything under control. The lessons from Operation Topoff and commonsense tell us that that cannot possibly be true. Unless the majority of the public are prepared to shelter in place for 6-12 weeks and essential workers are provided with PPE and the training that they need to use it properly, chaos and destruction will occur in the event of a severe pandemic, unnecessarily.
The conclusions from Operation Topoff were quite reasonable. Unfortunately, governments around the world have decided to implement Operation Dumbkopf in response.
Friday, May 18, 2007