The US Navy canceled the deployment of the USS Dubuque after a sailor was diagnosed with the swine flu. How will the military respond if the new A/H1N1 flu reaches pandemic proportions? Flu season is ending in the northern hemisphere. The new flu will remain a public health hazard for a few more weeks, but then it should abate naturally.
In the southern hemisphere, flu season is just beginning, so we can expect to see outbreaks in such countries as Brazil, South Africa and Australia. This will be a preview of coming attractions of what America has to look forward to this fall. Internationally, significant short-term unemployment in countries with economies that were already in marginal condition could contribute to political instability.
In the northern hemisphere, where most of the world's population lives, we can expect to see cases beginning again, possibly as early as August, but surely before the end of the year -- October through November. There is every reason to expect widespread and prolonged closing of schools, and it is not unrealistic to expect workplace absenteeism rates of 20% to 40%. Citizens and employers need to plan for scenarios in which tele-commuting may be mandatory for weeks or months, as workers stay home either to care for sick family members or children or simply to cut down on social interaction at the workplace.
Public health authorities need to keep explaining to the population some basic facts about swine flu: you don't get it from eating pork; the mask that you're wearing is to keep your cough in, not other people's germs out; you need to wash your hands frequently. And they need to demonstrate that the government does have plans for school and workplace closings and for shutting down public gatherings in order to mitigate the hazards, should that become necessary.
This is not quarantine. Quarantine aims to keep a disease in, and this flu will be difficult to contain because its victims are infectious for up to 48 hours before they have any symptoms at all. We need to communicate to the public that the way to mitigate the spread of swine flu is to have people stay at home, avoid large public gatherings and avoid touching surfaces where the virus can survive outside the human body for several days.
Considering the possibility of significant school and workplace closings in the fall, the U.S. government needs to begin explaining plans now. It should have in place a national emergency unemployment program so that hourly workers don't face economic catastrophe if they have to stay home for some period of time. And business owners need help to ensure that workers have jobs to return to when the pandemic ends.
The Defense Department released its plan for pandemic influenza in September 2006, but it is little more than a plan for planning, and the critical Continuity of Operations (COOP) and Continuity of Government (COG) documents in Annex G have not been publicly released. THe Secretary of Defense approved US Northern Command [USNORTHCOM] CONPLAN 3551 "Concept Plan to Synchronize DOD Pandemic Influenza Planning" on October 15, 2007. Each of the other Combatant Commands have developed implementing plans, such as U.S. Pacific Command (USPACOM) CONPLAN 5003 "Concept Plan For Bio-hazard Preparedness And Response To Pandemic Influenza". The Concept Plans have not been publicly released.
One major uncertainty surrounding the military's preparedness in the face of pandemic influenza is the availability of flu vaccine.
The US Department of Health and Human Services and the US Department of Homeland Security promulgated the "Guidance on Allocating and Targeting Pandemic Influenza Vaccine" in July 2008. Vaccine will be allocated and administered according to tiers. The highest priority Tier 1 consists of 24 million Americans, including 700,000 deployed military forces. Another 1.5 million national security personnel are among the 15 million Americans in Tier 2.
Given the roughly six months needed to begin production of a new vaccine, it seems unlikely that appreciable amounts of vaccine would be available much before October 2009.
The Congressional Budget Office noted in September 2008 that "When all .. factors uncertain availability of imports, higher content per dose, and more doses per course are taken into consideration, current U.S. capacity to produce pandemic vaccine is only about 12.5 million courses." That is, only half the vaccine needed for Tier 1, never mind Tier 2. Given time, more vaccine can be produced, and eventually all 300 million Americans in all five tiers would be vaccinated.
If pandemic influenza peaked in February 2010 [February being the usual peak of the flu season], most military personnel would have been vaccinated. But in 1918 the Spanish Flu peaked in September, and a repeat performance would find America's military unprepared.
In all probability, the Department has two pandemic plans. One plan is a continuity of operations plan - how the military plans to maintain combat readiness in when some fraction of troops are sick with flu or have ill family members. The other plan would cover how the military will help keep the country going in the face of the social disruptions that may result from a pandemic.
All large organizations do continuity of operations planning: how to remain organized when faced with external sources of disorganization. Any enterprise that depends on having large numbers of people in the right place at the right time must plan for snow days. Any enterprise that uses computers must have some plan to back up and restore data. From the beginning of the Cold War, the Federal Government undertook Continuity of Government planning, trying to keep the Presidency functioning during World War III. More recently, in response to less cataclysmic threats, this principle has been extended to Critical Infrastructure Protection, to include over a dozen major industrial sectors, such as electricity and banking. All now have continuity of operations plans intended to cover all manner of natural and human induced disasters.
The Defense Department has unusually high continuity of operations requirements for combat capabilities. Combat units consist of hundreds or thousands of highly trained troops, executing intricately planned and rehearsed operations. Absentee rates of a few percent are normal. Absentee rates of 10% significantly impact combat readiness. Studies have suggested that civilian medical facilities might experience absentee rates of about 40% in the face of pandemic flu. Such high absentee rates would render military units combat ineffective, and unready for deployment.
This does not mean the America must ask the Taliban for a time-out in Afghanistan while we cope with a bout of the flu. Nor does it mean that North Korea will have a window of opportunity during which it can act out without fear of a U.S. response. It does mean that the military will be taking extra measures to ensure combat readiness during a pandemic.
Military bases are small and not-so-small towns. Many are more or less self contained in ways that civilian communities cannot be. They are populated by people accustomed to military discipline, who understand that they are defending democracy so that others may practice democracy. Closing schools and other measures to curtail social gatherings that transmit infection will be more readily implemented on base than off. Existing family support groups provide the basis for family care so that uniformed personnel can remain mission-focused.
A pandemic will not strike all America all at once. A nation-wide pandemic of three months' duration would actually consist of a series of local pandemics lasting a month or so, some starting and ending before others. And these local pandemics in turn may be thought of as a series of micro-pandemics of a few weeks' duration, each at a different school or workplace. Just as not every city will be stricken simultaneously, not every military base will suffer the flu at the same time. And just as different schools will get the flu sooner than others, so too individual military units will sicken and recover before others.
Commander and planners will have to monitor the progress of the flu through the US military. Healthy units and bases will remain on call, combat ready. As bases and units are stricken, they will be removed from the on-call list, and returned once they recover. In this way, even mobilization for a major theater war would be delayed by no more than a few weeks.
America's enemies should not hope to count the flu virus as an ally.
But American troops may also be called on to respond at home, to quell domestic disturbances. The US military has long had so-called Garden Plot plans to respond to civil disturbances. Under the Insurrection Act, Federal troops have been deployed ten times from 1957 [in Little Rock] to 1992 [in Los Angeles]. United States Northern Command [USNORTHCOM], responsible for Homeland Security operations, has developed Concept Plan (CONPLAN) 2502 Civil Disturbance Operations.
There is a potential for significant domestic social disruption if consumers discover that vital supplies of everything from hand sanitizer to masks to cough medicine are sold out. There may be significant disruption in the workplace from absenteeism, particularly if school closings become widespread. The SARS epidemic is estimated to have cost the world at least $40 billion, and some are now estimating that a flu pandemic of swine flu could cut as 5% of GDP in lost output - nearly a trillion dollars.
Under the "Guidance on Allocating and Targeting Pandemic Influenza Vaccine", high priority Tier 1 recipients of vaccine will include politicians ["mission-critical personnel"], while Tier 2 recipients include bankers ["Financial clearing & settlement personnel"]. The rest of the public may have difficulty understanding why politicians and bankers are getting protected, but not ordinary Americans.
The Department of Homeland Security has developed 15 planning scenarios for domestic consequence management, ranging from cyber attacks to biological terrorism. Pandemic flu is by far the most difficult and challenging. All the others are either local in extent, temporary in duration, or both. Only pandemic flu assaults the entire country, simultaneously, for an extended period of time. Imagine Hurricane Katrina, not for a week but for three months, not just in New Orleans, but nation-wide.
After September 11th, one of the most frustrating parts of personal preparedness was figuring out what supplies were needed at home. We knew we needed duct tape, but it was not clear how much, or why. Some emergency kits were left over from hurricane evacuation guidance, and were too little, while others were Cold War civil defense preparedness plans that listed everything needed to restart a new civilization on the rubble and ruins of the old. [A medium sized trailer was needed to haul all this stuff.]
With time, it has become clear that home preparedness for pandemic flu requires food. Not just the three days' supply needed to ride out a hurricane, but more like a couple of weeks', if not a couple of months' supply, to ride out a protracted interval of social distancing. The American food supply network does not stock enough food for the entire U.S. population to stockpile over the next few months.
Local shortages of bottled water and other items routinely emerge from panic buying in advance of severe winter weather. Local shortages of Tamiflu and surgical masks developed within a few days of the first news reports of the pandemic. At some point, with growing awareness of the need for home stockpiles of food, more generalized grocery shortages will emerge, along with the risk of extensive civil disturbances.
This dire scenario is no inevitable. Mexico imposed extensive population restrictions without provoking public unrest. If pandemic flu emerges in the Southern hemisphere in the weeks ahead, public responses deserve as much attention as medical developments.