Once the RRSTs entered, if the H5N1 virus was detected, rapid mobilization of the host nation’s resources was implemented in accordance with WHO pandemic containment and treatment plans. These guidelines accounted for the various stages of economic and industrial development found throughout the world, and served as a baseline for immediate action. Quickly following the activation of the host nation’s resources, Rapid Response Assistance Packages (RRAPs) were deployed, sometimes in several stages, containing vaccine, medical augmentation material, and additional WHO personnel. The RRAP personnel provided education and pandemic plan implementation expertise to the host nation’s government and health services infrastructure, and in extreme cases, simply assumed control of all efforts to fight the pandemic.
The WHO’s enhanced response capability in 2008 proved effective against the emerging H5N1 pandemic.
Media Excerpts cut from the first draft of The Jakarta Pandemic
Among the first reports - The Morning View
Late October 2013
“In day two of a tense political standoff between China and the United Nations, China has further tightened travel restrictions into their country, essentially cutting off all foreign commercial air travel into the country. Hong Kong International airport continues operations, but no flights are permitted to continue into the Chinese mainland. Observers described the scene at Hong Kong International as organized chaos, as airport officials and Chinese government workers struggle to maintain order in one of the busiest in the world. Now, let’s talk to Jeff Talon, who is currently in Singapore, only recently released from Hong Kong International airport. Jeff?”
“Yes, Matt.”
“Jeff, could you describe your stay at the airport and the circumstances that led to your stay? I believe you were headed to Hong Kong International from Singapore, when the travel restriction was announced?”
“That’s exactly right, Matt, we were close to two hours out of Hong Kong when the captain announced that the flight would continue to the airport, but that all passengers with continuing flights to destinations within China would not be allowed to proceed. If Hong Kong International was a connection to another country, you had very little hassle upon arrival, but for those of us with continuing flights into China, it was truly unbelievable.”
“How so, Jeff.”
“First, very little information was passed to us. We were simply told to stand in line. We were put onto a bus that crossed the airport and deposited us inside a closed hangar. It was nearly 8 hours before anyone in a position of perceived authority came to gather our information, presumably to arrange transportation out of the country. Even then, they provided no further information regarding our status. From there, it took at least another day, with little to no information, before we were suddenly herded back on a bus and put on a Singapore Airlines flight back to Singapore.”
“Sounds frightening, did they ever give you any information regarding the travel ban?”
“No, Matt. This is what scared everyone the most. None of our cell phones worked at first, presumably because the cell towers and nodes had been shut down by the government. This set off a panicky mood among passengers, especially since we had been whisked away from the terminal with no explanation. We weren’t the only passengers taken out of the terminal. We joined nearly 600 other passengers already in the large hangar, and hundreds more arrived shortly after us. We think they filled several of these large hangars, maybe more. There was some speculation about a war, but these rumors were put to rest by passengers arriving later in the morning. Rumors of a possible flu outbreak began circulating by midday, compounded by the fact that all of the Chinese government and military officials were wearing masks.”
“Jeff, what were the conditions like in the hangar?”
“Pretty awful, Matt, but we were not mistreated, we were just ignored for a long time. I think they had their hands full at that airport. Like I said earlier, it took nearly 8 hours before they started to process our information, and unfortunately, it took nearly this long to get any food or water. The hangar itself was temperate, thankfully, but as you can imagine, it was quite claustrophobic, and the Chinese officials would not let anyone out of the hangar for any reason. I was glad to get out of there the following day, very glad to say the least.”
“That doesn’t sound like fun, I hope you didn’t have to go to the bathroom too often,” Matt joked.
Alex piped in, “Jesus, that would have been my first concern. Getting to that toilet first, before the other 800 other people decide they have to squat over the hole.”
“They don’t squat over holes in China,” Kate protested.
“They certainly do. Maybe not in the main airport terminals, but any bathroom built for the hangars would be constructed according to local standards, which in my experience throughout Japan and Korea, is very likely to be a porcelain hole in the ground. These things flush, and are nice, but to an untrained westerner, they present a challenge. There are bound to be some missed bombing runs, and…”
“Okay, I get the picture,” Kate said, shaking her head with a look of disgust.
“Yeah, Matt, I’m trying to forget the bathroom situation. Simply unforgettable, especially after about 12 hours in that hangar.”
Alex stated, “I’m sure they ran out of shit-paper after the first 50 guests, probably not high on their priority list. What a nightmare.”
“Thank you, Jeff. Now, let’s head over to our World Health Organization correspondent, Carolyn Davill.”
“Good morning, Matt, I’m reporting from outside WHO headquarters in Geneva, Switzerland, where a considerable buzz has developed since yesterday’s surprise Chinese clampdown on travel into China. There are many theories and speculations, but it remains clear today that China has not released any verifiable information regarding their decision. Sources close to the WHO stated that the primary speculation, and the greatest concern, is a pandemic threat developing in China. However, officials admit they are puzzled by the one-way travel restriction declaration. Flights are still departing China for all regions of the world, exports are continuing, and the importation of raw goods has not been restricted, although it is unclear how much longer this may be the case. Our WHO source claims that there is serious discussion within the UN regarding the institution of immediate travel restrictions with China, similar to those seen in 2008. We have also heard that several nations are possibly hours away from announcing independent travel restrictions with China.”
“Interesting, Carolyn, early reports from our Washington, D.C., correspondents and UN desk indicate that lawmakers on Capitol Hill will be meeting for an emergency session to discuss the events, and we are in the process of confirming that the UN has also declared an emergency session to respond to the Chinese travel ban. Carolyn, the prospect of possibly another pandemic-grade illness in China is a terrifying prospect for everyone. What have you heard from your sources at the WHO, specifically regarding this theory? Have they seen any indication that it may be true?”
“First, let me say, Matt, that the WHO is not releasing much information. We do know that they are in active negotiation and contact with Chinese health and government officials. They have assured us of this. As far as specific pandemic information, our sources told us that they were very unnerved by the fact that all Chinese government and military personnel at the airport were wearing face masks, and that all of the airport personnel were also soon given the same equipment. One rumor persists that several passengers were screened through a medical triage center, where apparently Chinese health officials were very concerned with identifying flu symptoms.”
“Certainly an ominous possibility, let’s hope this doesn’t pan out. Have you heard any speculation about why the travel ban is one way, and that travelers are allowed to leave China?”
“Well, Matt, once again, no definitive information exists regarding the logic behind the ban, however, there are several theories. The predominant theory is an economic one, specul
ating that if there is an outbreak, China does not want to disable its economy by limiting exports or imports, or even the export of its talented human force around the world. China is a dominant world power, having catapulted back onto the world economic scene after the 2008 pandemic, in a more powerful position than before. It is possible they hope to contain any problem arising. I can tell you this, despite an enhanced capability to handle pandemic threats, officials at the WHO are concerned about China’s lack of timely communication. They do not want a repeat of 2008.”
“Interesting, Carolyn, what are some of the other theories?”
“Matt, another theory on the table is that China is concerned about an external disease threat. This would make more sense given the one-way travel ban, clearly aimed at keeping travelers out of China, however, more credence is being given to the first theory, especially in light of China’s track record in 2005 and 2008.”
“Carolyn, have health officials at the WHO detected any suspicious virus activity throughout Southeast Asia that might support the second theory about an outside threat?”
“Our sources have not confirmed any unusual patterns, and WHO, CDC and GeoSentinel outbreak alert web pages have not highlighted any trends. However, the International Scientific Pandemic Awareness Collaboration is focused on the second theory. Our contact at the ISPAC states that they are actively investigating several dozen unidentified flu-like cases spread throughout Asia, specifically focused on the areas south of China.”
“What has been going on in this area?”
“Unfortunately, there is not much information on the ISPAC website, and our contact said that they just dispatched additional resources to the area. But our source did say that several International Society of Travel Medicine (ISTM) sponsored clinic sites linked into the GeoSentinel system have reported uncorrelated illnesses, mostly from foreign travelers.”
“Thank you, Carolyn, I am sure we will be hearing from you again shortly.”
“Thanks, Matt.”
“It’s thirteen after the hour and time for a quick break. When we return, we’ll hear from Dr. Donald Fendelman of the CDC, who will provide some background information about the world’s pandemic outbreak detection capability.”
Morning View Interview with CDC Virologist
Late October 2013
“Good morning, everyone, welcome back. We now shift back to the U.S. to speak with Dr. Donald Fendelman of the CDC, who is one of the world’s leading virologists. Dr. Fendelman, good morning.”
“Good morning, Matt.”
“Doctor, thank you for taking time out of what must be a hectic schedule, given the circumstances.”
“Always a pleasure, Matt.”
“So, what can you tell us about the current situation in China.”
“Well, first, thank you for inviting me to speak to such a wide audience. I hope I can shed some light on current events, but I am afraid that the CDC may not have much more to offer than the WHO. I can say that we are working with the WHO to formulate a plan to address the situation in China, with the Chinese Health Ministry. Our hopes and intentions are to resolve this within the realm of International Health Organizations and avoid further political, military or economic posturing. We are also operating in a liaison mode with the ISPAC and providing them with assistance to further investigate some of their concerns regarding recent developments. As you are aware, the relationship between the ISPAC and WHO is strained, to put it mildly. However, it is the CDC’s position that the ISPAC provides a unique perspective to the pandemic preparedness equation and should be afforded every opportunity to participate on a wide-scale level. Because of this stance, some of us at the CDC probably won’t be receiving Christmas cards from the WHO any time soon.”
“Yes, I imagine you won’t. You just mentioned recent developments. Are you referring to the uncorrelated illness cases surfacing in Asia, outside of China?”
“Yes, Matt, most of our efforts are focused in line with the WHO’s to address China’s travel restrictions. As such, we will allocate resources to help the ISPAC investigate any angles that we cannot simultaneously prosecute. At least a few dozen cases have attracted the attention of international health agencies, spanning several locations within Southeast Asia, but absolutely no conclusions can be drawn from these cases. They appear flu-like, and in most cases were reported second hand to local ISTM sites and picked up by the GeoSentinel system. Some of these cases have been reported first hand to ISTM sites, and these are the easiest to investigate. I presume ISPAC officials will start with these cases. Keep in mind, Matt, that tensions are high in this region, and rumors of some sort of outbreak in China are running rampant. So it is likely that we will see a massive increase in reported illnesses, of many varieties, including sicknesses not typically reported to GeoSentinel linked sites.”
“Doctor, you mentioned the GeoSentinel system, could you give us a brief rundown of this systems current capabilities?”
“Sure, Matt, in 1995, scientists at Emory University, backed by both the International Society of Travel Medicine (ISTM) and the Centers for Disease Control and Prevention (CDC), established a system called GeoSentinel, which served to monitor emerging infections of potential global impact. Currently utilizing 52 GeoSentinel sites and 253 ISTM clinics on six continents, CDC and WHO officials can track the introduction and progression of diseases with pandemic potential. Since 2005, the main focus of the GeoSentinel system has been the detection and tracking of flu virus strains.”
“This system has been significantly enhanced since 2008. Right?” Matt said.
“Yes, Matt, in 2008, only about 41 GeoSentinel sites existed and about 145 ISTM clinics. The newly-expanded system is truly the backbone and primary detection capability of the WHO’s Global Outbreak and Response Network (GOARN). The WHO also utilizes Forward Liaison Teams (FLT), first introduced at the outset of the 2008 pandemic.”
“Doctor, refresh my memory if you could, the FLTs are deployed once a pandemic outbreak is identified and sent to locations likely to receive infected travelers?”
“Yes, Matt, good memory, the FLTs are deployed in the likely path of the pandemic outbreak, with the mission of augmenting GeoSentinel detection capabilities. The FLTs interface with host-country health officials and assist with the immediate development and implementation of a grass-roots-level virus detection and reporting network. The network utilizes national and local level representatives, comprised of health service providers and government service officials, to extend the capability to detect the early onset of flu cases within their area of responsibility. Ideally, within a week of FLT arrival, a system would be developed that could detect the presence or intrusion of suspected flu virus activity, and immediately report it to the WHO for further investigation. Once an effective system was developed, the FLTs would either remain in place to further develop host capabilities, or be re-deployed to another area of interest. This system worked very well during 2008.”
“Doctor, can you confirm whether any of these teams have been deployed to Southeast Asia?”
“Matt, I really can’t say for sure, the WHO retains complete authority over the use of these assets, although in many cases CDC personnel fill slots on those teams. To my knowledge, none of our personnel have been notified. That is a great question for the WHO.”
“Finally, Dr. Fendelman, what are some of the other capabilities that the CDC can deploy?”
“Well, the CDC does not actually deploy its own teams overseas, it agrees to fill slots, at nearly all levels, within the WHO’s Global Outbreak and Response Network. Currently, this network includes the previously mentioned Forward Liaison Teams, Rapid Response and Surveillance Teams (RRST) and the Rapid Response Assistance Packages (RRAP). In a declared pandemic environment, the RRSTs tirelessly scour the planet, investigating potential virus outbreaks and reporting the findings to the WHO for immediate asset allocation. Ideally, an RRST is deployed within a few hours of a credible virus report. RRSTs operate un
der the full support of the United Nations’ military enforcement arm. Likewise, admittance and full cooperation with the RRST by the host governments is mandatory, and noncompliance is decreed by the UN security council to be an immediate, hostile action against world safety and security. With the full weight of the UN, RRSTs typically operated unhindered, as was seen during 2008.
“Once the RRSTs detect a pandemic virus, rapid mobilization of the host nation’s resources is implemented in accordance with WHO pandemic containment and treatment plans. These plans can be tailored for the full spectrum of economic and industrial development found throughout the world and serve as a baseline for immediate action. Quickly following the activation of the host nation’s resources, Rapid Response Assistance Packages (RRAPs) are deployed, sometimes in several stages, containing vaccine, medical augmentation material, and additional WHO personnel. RRAP personnel also provide education and pandemic plan implementation expertise to the host nation’s government and health services infrastructure. In extreme cases, they will simply assume control of all efforts to fight the pandemic.”
“Incredible, I truly hope this is not where we are headed. Dr. Fendelman, thank you again for talking with us, good luck today.”
“Thank you, Matt.”
“It’s reassuring to know that a lot of agencies are working on this as we speak. Hopefully, we’ll all get some solid information soon.”
The Jakarta Pandemic Page 53
