Why you should care about Indonesia

You need to care today about what is going on in Indonesia, and you need to start paying very close attention to events within that archipelago nation. The reason is the sudden convergence of events, scientific papers, and government decisions regarding what we call "bird flu," or avian influenza.

First, if you need background on influenza and want to get caught up on events, use my personal Blogsite, http://www.scottmcpherson.net/ as a guide. Also bookmark the Florida CIO Council's Pandemic Website, where you can download just about everything you ever wanted to know about avian flu and how IT professionals should prepare. And be sure to check all the links at both sites.

We have never seen a pandemic in what we call the Information Age, and we barely dodged a bullet during the SARS epidemic. SARS has not gone away, by the way -- it just went back underground. As recently as last week, the Chinese were fearful that a severe outbreak of an unknown respiratory virus in Hong Kong was possibly SARS, and the Hong Kong government went so far as to close every grade school two weeks in advance of the Easter celebrations because of fear that SARS had returned.

The unknown virus turned out to be a new strain of H3N2 seasonal flu. But lessons learned from SARS caused the Hong Kong government to immediately react and close the schools, displacing some 500,000 students.

Back to Indonesia. Over a year ago, in protest of what it considered imperalistic moves by the Western democracies and Australia to capture Indonesian H5N1 samples in order to turn a profit and develop a vaccine no Indonesian could afford, the Indonesian government stopped sending human samples of H5N1 bird flu to the World Health Organization. That decision was rescinded about a month ago, and Indonesia resumed sending samples to the WHO and CDC. Why?

This week, at an Atlanta conference sponsored by the US Centers for Disease Control, a team of Indonesian researchers revealed that for the first time anywhere, a documented case of human co-infection of H5N1 and H3N2 influenzas took place. A teenage girl developed both an H5N1 bird flu infection and an H3N2 seasonal flu infection.

This is the dreaded "reassortment" scenario, where human and avian influenzas get together in a kind of viral Woodstock, grokking and sharing free love and swapping genetic material until the music's over and it is time to fold the tents and depart a human epithelial cell in the nose or throat.

Those new, hybrid human/avian influenza cells go on to have cellular love-in after love-in, until your body is overtaken by this new, novel influenza that no human has immunity or resistance to.

Regrettably for Humankind, you have been traveling in airplanes, trains, buses and cars for days, gleefully shedding this new and novel virus until you suddenly feel like Death itself. By then, it is too late. Too late for any of us.

Now, the co-infection in Indonesia did not result in that 'reassortant" virus. Thank the God of your faith for that! But it proves that co-infection has happened. And this case happened a year ago, which means that statistically, it could have already happened in Indonesia scores, if not hundreds of times. Look at the human case numbers and case fatality rates for Indonesia. While small compared to malaria or chikungunya virus, the H5N1 figures grow weekly. If co-infection happens too many times, it dramatically increases the possibility that a pandemic could start. But as they say, it only takes one successful viral conversion to launch the Next Pandemic.

Why did this conference receive this paper at this time?

Now consider the recent statement by the world's veterinarian, FAO Chief Veterinary Officer Joseph Domenech. The FAO is the United Nations' Food and Agriculture Organization. The FAO is to chickens and ducks what the WHO is to people. In Rome this week, Dr. Domenech all but stated that Indonesia had lost the handle on containment of H5N1 in domestic poultry, and that a human reassortant virus was a major concern. Here is how the Russian news service RIA Novosti carried the story:

ROME, March 18 (RIA Novosti) - A United Nations agency said on Tuesday the bird flu virus, common in Indonesia, could mutate into a form that could easily be transmitted from person to person causing a global pandemic.

Indonesia has the world's highest human death rate from bird flu with 104 fatalities, or one third of the global death toll. About 80% of cases in the southeast Asian nation have been traced to the Jakarta region.

The Rome-based Food and Agriculture Organization (FAO) warned in a statement that there could be more human cases if the government and the international community fail to act more effectively to contain the spread of the virus at source, among birds.

"I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic," FAO Chief Veterinary Officer Joseph Domenech said.

All but two of Indonesia's 33 provinces have been hit by bird flu outbreaks, according to the FAO report. Insufficient financial aid and human resources, as well as poor public relations are hampering efforts to contain the disease, Domenech said.

The FAO official also warned that new types of the deadly H5N1 strain have recently emerged, which may make vaccines currently in use redundant.

The American press started carrying the story only after they ran out of governors and troubled popstars to fry.

Why did the FAO come out with this story this week?

Finally, the British government just this week published its updated National Security Strategy. Here is a nation that, like the US, has experienced its share of terrorism. It routinely is breaking up terror cells and foiling sinister plots.

In light of this series of threats, what does the combined might of all British security, defense and intelligence forces consider the biggest threat to the UK? A flu pandemic.

OK, this is an IT blog, so let's make all this germane to you. What this means to you, IT professional, is that while only a madman would dare try to predict when a pandemic might strike, the odds of such a pandemic occurring within the next few years are increasing with each new disclosure. And I have learned that in public health, there are few coincidences.

Since we have not had a pandemic in the Information Age, it means no one knows exactly what the effects of a serious flu pandemic would be on your operations. But try on 30% daily staff absenteeism for starters. While only ten to fifteen percent of the population might actually be sick, factor in all the people who will stay at home to supervise small chiildren when all the schools and day care centers close, plus those caring for sick family members. Imagine that 30% absenteeism lasting for weeks. Now imagine if anywhere from two to five percent of those thirty percent never came back.

Now plug in severe supply chain failures and the rippling effects of an oversaturated Internet and communications networks. Think how slow the Internet was the morning of 9/11 and imagine those sluggish networks persisting for weeks.

Now add in cyber hijinks, courtesy of everyone from some bored 15-year old in Cleveland to the Communist Chinese government. Now imagine your typical seasonal disaster scenario -- from hurricanes to tornadoes to floods and fires -- overlayed on top of a pandemic. Not a pretty recipe at all.

We have already seen that many of the decisions about pandemic awareness are political decisions. That involves chain-of-command permissions and delays in making public statements, all in an effort to avoid a Rush to Judgment. We have seen nations making policy decisions with obvious global impact while their own people are infected with a virus whose ability to both mutate and kill has never -- I mean never -- been seen before in influenza circles.

One would ask, How in Sam Hill do you prepare for such a scenario? Well, here are my tips for readiness:

First, gain an understanding of influenza. Read John Barry's seminal work on the 1918-1919 Spanish Flu pandemic, The Great Influenza. After reading his book, you will understand why your grandparents and great-grandparents never spoke of that event. It is the story of an entire nation that experienced something akin to post-traumatic stress syndrome.

Then, get busy. If you are a Gartner customer, download its white papers on pandemic preparedness for IT. Subscribe to Google alerts using "bird flu" as the keywords. Read the flu blogsites such as Avian Flu Diary and H5N1, and sites such as CIDRAP, Flutrackers.com and newfluwiki2.com. Read Computerworld correspondent Patrick Thibodeau's series of blogs and articles on pandemic preparedness. And of course, subscribe to my Blogsite's RSS feeds.

Bottom line: Learn to perform your own surveillance and prepare to make good decisions about what is going on. No one is going to snap his/her fingers and begin the pandemic. There will be an interlude before all Hell breaks loose. Learn how to recognize when that interlude starts and the orchestra is warming up, about to play the overture to the first act.

Look at where your organization's planning effort fails: usually, in terms of the event's duration. Most disaster recovery and continuity of ops plans have an event window of 72 hours to one week. Pandemics come in waves, and each wave can last up to three months. If your BCP/DR plans do not have at least a one-month event horizon, they will fail.

Pull your old Y2K supply-chain failure tab out and update it. Then put it into your pandemic plan binder. Y2K was a superb exercise for events such as a pandemic. Just think of a pandemic as Y2K where the people fail, not the computers.

Forget vaccines and antivirals during a pandemic. Focus on the Things Momma Taught Us instead. They are:

  1. Wash your hands! Especially when you go to the potty.
  2. Cough or sneeze into your sleeve, not your hands or into the air.
  3. Keep a respectable distance from strangers.

These three basic steps, coupled with prodigious use of hand sanitizer and vinyl gloves, will save more lives in a pandemic than vaccine and antivirals combined. And these rules hold true for regular flu season, too. Enforce them.

Now train for this. Hold tabletops regularly. Task your staff to think of stuff you haven't thought of yet. Engage and involve your organization's full leadership. And then take the lessons learned from the tabletops, change your plans, and train some more.

There are diseases that are more lethal than influenza. Take Ebola, for example. Ebola kills about 80% of those it infects. But Ebola has a quick incubation period, and death occurs so quickly, the virus usually cannot escape the confines of the village that spawned it. Likewise, SARS, with its 10% death rate for those who caught it, moved quickly and people got sick quickly. This actually allowed public health professionals to get in front of the virus before it became a pandemic. By the way, one lone person was the international vector of SARS. One person enabled SARS to spread to three continents. He was a hotel guest and airline passenger.

In contrast, influenza takes its time, and you can be infectious and shed virus to your friends and family for days without feeling ill. This is precisely what makes influenza so contagious. This is why influenza is the best disease to prepare for. Once you have factored in a flu pandemic, every single other bio/chem disaster becomes quite easy to manage.

Finally, pray for the people of Indonesia. And pray that we can hold off a pandemic just a little while longer.

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