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30. mai 2006

Austraalia vaatenurk

Austraaliast siis järgnev jutt
Indonesia's approach to bird flu concerns Abbott
The Federal Health Minister Tony Abbott says he is concerned about Indonesia's efforts to manage and control the spread of bird flu.

There have been several recent bird flu deaths in Indonesia.
After releasing a revised plan to handle an influenza pandemic, Mr Abbott revealed his concern about Indonesia's approach to bird flu. "There is still not effective surveillance of poultry stocks, there could be improvements in reporting," Mr Abbott said.

But Australia's chief health officer John Horvath is playing down the concern. He says if there was a pandemic outbreak, the nation's proximity to Indonesia would not make much difference. "Where it breaks out it would be a worldwide event within 24 hours," he said.

Outbreak simulation

A major exercise involving the simulation of an influenza pandemic will be held later this year. Federal and state governments will take part in the four-day trial in Brisbane in October. It will simulate the arrival of an international passenger infected with pandemic influenza.

Mr Abbott says the plan also considers how to handle overseas travellers. "We would be requiring the captains of all incoming planes to make positive declarations as to the status of their passengers," he said. "Any plane that arrived with infected passengers would be placed in quarantine, what we wouldn't be doing though is ordering the shutdown of all international transport."

The Federal Government has changed its plans for allocating anti-viral drugs in the event of an influenza pandemic.
The Government had previously planned to give stockpiled medicines to a wide range of essential service workers if there was an outbreak of influenza, such as a bird flu pandemic. But a revised strategy released today proposes only giving the drugs to those infected, and health workers treating them.

Mr Abbott says the previous aim is not feasible. "We came to the conclusion in consultation with the states that the attempt to keep prophylaxis going for the up to 1 million people who would normally be deemed essential was simply not going to work, there would never be enough anti-virals to do so," he said.

29. mai 2006

kellel on suurem õigus elule?

Who lives? Flu crisis may make us pick
Experts are divided on who gets the limited vaccine in case of a pandemic.
By LISA GREENE, Times Staff Writer
Published May 29, 2006

Imagine the worst: A deadly new strain of flu speeds across the globe, and as it approaches the United States, the reality is grim.

There isn't enough vaccine to prevent people from getting the virus. Not enough medicine, hospital beds or even ventilators to treat the sick.

Whom do you save?

What was once an abstract philosophical dilemma has become an urgent health policy question. The most immediate danger, Asia's killer bird flu, hasn't turned into a worldwide epidemic because it hasn't yet developed the ability to spread easily from person to person.

But public health officials must prepare for the threat of a disease that could spread with explosive speed. A global epidemic could kill nearly 2-million people and hospitalize nearly 10-million just in the United States. If a pandemic hits any time soon, scientists estimate that there may be only enough vaccine for about 10 percent of the population during the first year of the illness.

"In a situation like that, we will have to choose,'' said Dr. Greg Poland, director of the Mayo Clinic Vaccine Research Group and a member of the advisory committee on vaccines for the federal Centers for Disease Control and Prevention. "We're not used to that. We want everyone to get on the lifeboat.''

But in this instance, most people won't fit. And already, some of the nation's top ethicists and flu experts disagree about who should go first.

"I'm not a fan of the rules as they've been presented,'' said prominent bioethicist Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "I'm not sure they've explained why they're doing what they're doing.''

The priority vaccinations

The guidelines now listed in the federal pandemic flu plan call for health care workers and vaccine producers to be vaccinated first. Few argue with that; without them, there will be nobody to care for the sick.

"If you have doctors and nurses that don't come to work, you have nobody taking care of flu patients,'' said Dr. Bruce Gellin, director of the National Vaccine Program Office for the federal Department of Health and Human Services.

After that, the guidelines call for certain vulnerable groups to be vaccinated, such as pregnant women, and then people older than 65. Healthy children would come last, along with other healthy people ages 2 to 64.

It's more than an abstract policy for LeeAnne Cochran.

The 27-year-old Tampa resident was watching her three kids make their way to a park play gym one afternoon last week. She had a quick reaction to who should get the first vaccine: "The kids, I think.''

But her youngest child, 6-year-old Chelsey, was listening.

"No, you should get it first,'' she told her mother.

"But I don't want my kids to die,'' Cochran said.

"We don't want you to die!'' Chelsey said.

"But you have a whole life ahead of you.''

Is it that easy? Should Chelsey, Marissa and Devin get vaccine before, say, the elderly? Before their grandmother?

"I don't know,'' Cochran said. "It's a hard decision. Yeah. I'd have to say the kids. It's kind of selfish. But I have three kids.''

That question has been a key point of contention for scientists as well.

"There was substantial discussion of priority for children," Gellin said. "It's not as if they were ignored ... healthy children have been at low risk in prior pandemics.''

Does age matter?

It's the age question that has incited the most debate. In setting the guidelines, the federal group assumed that this pandemic would be similar to earlier ones in 1957 and 1968, and that the elderly would be among the most at-risk for severe illness and death.

But others question whether that's true. In the worst flu pandemic, the 1918 Spanish flu that killed more than 40-million people around the globe, the most deaths occurred among healthy young adults.

What would really save the most lives?

"Government policies have been, the people most likely to get sick, the people most likely to be in danger,'' Caplan said. "But you could argue that in real scarcity, it makes sense to take into account the best chance of surviving. Instead of the 85-year-old with pneumonia, you could say you're going to treat the 30-year-old.''

Caplan and colleagues recently put together a group, the Ethics of Vaccines Project, to discuss such questions.

Protecting children makes medical sense, Poland said. Some studies show that vaccinating children for regular flu decreases the spread of flu in the whole community. Children gather together in school, swapping homework, hugs and germs at a rapid rate.

"Children tend to be super-spreaders,'' Poland said. "So in reality, if I give it to a 2-year-old, I'm protecting the 2-year-old, the parents, the sibling, the grandparents. If I give it to an 80-year-old, I'm probably not going to protect the same number.''

That depends on the nature of the pandemic, Gellin said. Who gets vaccinated could change depending on who gets sickest.

"All this is shaped by how a pandemic looks,'' he said. "You need to have a process that would allow that kind of flexibility - to have some understanding of how it's playing out.''

Also, studies that show vaccinating children provides a protective effect on the community reflect situations when enough vaccine was available to cover all the children, Gellin said. In a pandemic, that might not happen.

Underlying the medical questions are more philosophical choices. Whom do you want to save? How do you decide which lives have the most value? Dr. Ezekiel J. Emanuel, chair of the Department of Clinical Bioethics at the National Institutes of Health, recently upped the debate with a provocative essay in Science magazine.

Federal guidelines suggest saving the most lives, rather than giving people a chance to live more years or their natural lifespan, wrote Emanuel and a co-author, expressing their personal opinions, not federal policy.

The two propose giving younger people higher priority based on that idea, then combining it with what they call an "investment refinement." They would give a higher priority to 13-year-olds than 2-year-olds, balancing the teenagers' "more developed interests, hopes and plans" that have not yet come to fruition.

The federal guidelines follow the same philosophical principles as vaccination for a normal flu season, Emanuel said.

"It's a completely different situation,'' he said. "The potential for mortality is high. The potential for social chaos is completely different ... the principles underlying pandemic flu (vaccination) need to be realigned too.''

Some say protect children

Others also argue for protecting children as a philosophical choice.

"The thing that would make the most sense to me, is not to prevent deaths, but to preserve as many quality years of life as possible,'' said Dr. John Sinnott, clinical director of the Signature Program in Allergy, Immunology and Infectious Disease at the University of South Florida College of Medicine.

How choices are made is an essential part of the equation, too, Caplan said. Although there have been some government-sponsored forums on the topic, Caplan said there hasn't been nearly enough public debate.

"The person who's more informed is more likely to comply,'' he said. "Part of the reason to have a discussion of the rules is so people will follow them. It's all the glue you've got.''

Other hard decisions would have to be made as flu spread. Who would get flu medicine, such as Tamiflu? Ventilators? Beds in hospitals' intensive care units?

Some of those decisions would be similar to those made with vaccine, doctors said. Health care workers, once again, would be high priorities for getting Tamiflu, an antiviral medicine that could reduce the severity of the flu. But other decisions might mean uncomfortable choices: giving beds to the extremely sick - but not the frailest of all.

"When you're really overwhelmed, you start to ration by triage,'' Caplan said. "Let go of the people so injured and sick that you don't know if you can help them. Like on a military field ... we do it a lot in war.''

And that, doctors say, is what a true pandemic would be.

26. mai 2006

karmid valikud ja eetika

see oli üks huvitav artikkel :)

Pandemic planning puts ethics in spotlight
Amy L. Becker Staff Writer

May 25, 2006 (CIDRAP News) – When vaccine supplies are limited, should children, young adults, or seniors move to the front of the line for shots? Is it appropriate to remove one person from a ventilator to put somebody else on the machine?

Those are samples of the thorny ethical questions pandemic planning raises. People rely on ethical frameworks to answer them. Some experts are encouraging Americans to think aloud about rationing and other problems expected during a flu pandemic, to enhance public awareness and cooperation.

Having a public discussion about values is a crucial step in preparedness, said Arthur Caplan, PhD, Emmanuel and Robert Hart Professor of Bioethics, chairman of the Department of Medical Ethics, and director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.

"If you want support for decisions, you must get people to understand the underlying rationale, and that's what ethics is," Caplan said in a recent interview. "It's important to have a framework. It's important to have consistency or to explain expectations. It's in the interest of getting compliance."

Exploring vaccine priorities offers an example of how to explain the ethics behind a pandemic planning issue. In its pandemic influenza plan issued in November 2005, the US Department of Health and Human Services (HHS) made recommendations about which age and occupational groups should have priority for vaccination. Vaccine production and distribution workers, as well as frontline healthcare workers, received top priority, as recommended by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP).

Several other groups followed, including people between 6 months and 64 years old with two or more high-risk conditions or prior hospitalization with pneumonia or influenza, pregnant women, household contacts of severely immunocompromised people, household contacts of children 6 months or younger, public health and emergency response workers, and key government leaders. The recommendations are subject to change depending on the epidemiology of a pandemic virus.

In making those recommendations, ACIP members quickly focused on minimizing hospitalizations and deaths, said Jon Abramson, MD, ACIP chairman and Pediatrics Department chairman at Wake Forest University School of Medicine in Winston-Salem, N.C. Four ethicists outside the Centers for Disease Control and Prevention (CDC) participated closely, Abramson said. At least one proposal that seemed logical to Abramson got "shut down" by the bioethicists, and ACIP followed their advice.

"It's incredibly valuable" to have ethicists' participation, Abramson said. "If you can't make your case to the public on ethical principles, you're in trouble."

Another way to allocate vaccine
The ACIP recommendations were challenged on May 12, when bioethicists writing in Science suggested an alternative. Ezekiel J. Emanuel, head of the Department of Clinical Bioethics at the National Institutes of Health, and Alan Wertheimer, a senior research fellow there, called the NVAC-ACIP guide the "save-the-most-lives" principle.

The authors suggested focusing instead on what they called the "life-cycle principle," based on the idea that each person should have an opportunity to live through all the stages of life. They also suggested refining that principle based on gradations within a life span. This would give priority to people between early adolescence and middle age on the basis of the amount people have "invested" in their lives balanced by the likely time left to live, they wrote in Science. Under that principle, "20-year-olds are valued more than 1-year-olds because the older individuals have more developed interests, hopes, and plans but have not had an opportunity to realize them."

The authors also emphasize public order as a principle that should affect the ranking of flu vaccine recipients. That would emphasize the value of ensuring safety and protecting the availability of life's necessities.

Combining the principles would lead to high priority for vaccinating those involved in bringing vaccines to the public, as well as healthcare workers. It would emphasize vaccinating people aged 13 to 40, who are last in line under the NVAC-ACIP recommendations.

Explaining the rationale for federal guidance helps state planners, according to Kathy Harriman, PhD, MPH, RN, supervisor of the Infection Control and Antimicrobial Resistance Unit of the Minnesota Department of Health.

If states don't understand and buy into federal guidelines, Harriman said, myriad localities could have differing standards of care and priorities.

"I find it troublesome that states and local governments will make different decisions," she said. But she added that room for disagreement is the American way, and different localities have different needs and resources.

"The decision logic should be the same in each place," she said. At this point, however, many aspects of pandemic planning principles remain unclear. "How are decisions being made? Who's making them? Who's deciding who's making them?"

A member of the Healthcare Infection Control Practices Advisory Committee (HICPAC), which advises the CDC, said that bioethics is part of the committee's work, but she described a less-explicit process.

"I think the discussions occur, but they're not named," said Carol O'Boyle, PhD, RN, an assistant professor of nursing at the University of Minnesota. For instance, in discussing distribution of seasonal flu vaccine in the face of a projected shortage last year, "We did look at the greatest good. We did look at protection of the vulnerable."

Bringing ethics out in the open
Caplan said that articulating the ethics underlying federal recommendations could enhance US pandemic planning. He described the two most important roles for ethicists as (1) offering suggestions about the fairest approach when rationing is necessary and (2) explaining what the rules are and why they exist.

For example, he said, it's important to explain to hospital staff members that they have an ethical duty to go to work during a pandemic. In an informal poll, he recently asked medical students whether they would report to work during a pandemic. About 40% said they would not.

"I was completely astounded," Caplan said. "I didn't think it was going to be that high." Those informal findings have led him to plan a formal survey for hospital employees to learn more about their feelings on the issue, he added.

To date, Caplan gives the federal government low marks for talking about its decision-making process. The federal pandemic plan shifts a great deal of authority to states, which he called "a risk transfer" from the federal government.

"It's not even clear who is supposed to be in charge and to enforce the rules," Caplan said. He called for town forums, congressional hearings, and high school and college teaching units to discuss rationing and resources. He suggested enlisting the support of popular media representatives such as Oprah Winfrey and CNN TV's Anderson Cooper to host discussions.

"I want it out there," Caplan said. "It's nice that there are experts, but ultimately ethics should facilitate democratic discussions."

Caplan is doing his part by leading the Ethics of Vaccines project, an 18-month effort begun December 7, 2005, to understand the vaccine field and propose an ethical framework to guide people in the safe, effective, and ethical use of vaccines. It includes a Web log intended to generate more discussion about ethics and vaccines.

CDC tries citizen forums on vaccine issues
A separate effort is under way at the CDC, said Roger Bernier, PhD, MPH, senior advisor for scientific strategy and innovation at the agency. A vaccine expert and epidemiologist, Bernier became convinced a few years ago that some segments of the American public had a "trust problem" on vaccine issues. He developed a public engagement model to elicit public opinion and tested the model for the first time on pandemic influenza. The result was a collaboration among 14 public and private organizations that linked about 300 stakeholders and citizens in four regions and involved citizen forums.

The groups reached consensus, Bernier's report said. Assuring the functioning of society (using a minimum number of vaccine doses) was the first immunization goal, and reducing individual deaths and hospitalizations due to influenza was the very close second. "There was little support for other suggested goals to vaccinate young people first, or to use a lottery system or a first come, first served approach," the report noted.

Different groups bring different perspectives to the analysis of policy issues, or, as Bernier said in an interview, different lenses. Public health experts and advisors have not been explicit in the past about their own perspectives. It is important not to substitute citizens for experts, but when decisions are values-driven, citizens can play an important role in articulating the values.

"This project illustrates that the lenses are not always identical, and shows the usefulness of public engagement," Bernier said.

"We need the public for three reasons," he added. "We need their help, we need their advice, and we need their buy-in. . . . Even if we have the world's greatest plan, if there's not compliance, it can't be implemented."

Putting health threats in context
Steven Miles, MD, a professor in the Center for Bioethics at the University of Minnesota, urged people to take an additional step back and make sure that discussions about pandemic planning are occurring in the appropriate context—by assessing the threat in relation to other and potentially more pressing health threats worldwide.

"It's ethics' role to basically insist on a structural firewall between the politics of fear-mongering and homeland security, and the science of public health risk assessment," Miles said. "Within the context of that firewall, we need threat assessments that address bioterrorism threats compared with other health threats, and a way of dealing with both the certainties and the uncertainties."

The threat of pandemic flu, like the threat of an anthrax attack, has been removed from the context of other public health threats, such as multidrug-resistant tuberculosis (MDR-TB) and polio, and ought to be reintegrated into that context, Miles said. Right now, gauging the likelihood of a pandemic or anthrax attack occurring within a given period, as well as assessing their health and economic effects, amounts to plucking probabilities out of the air, in his view. In contrast, the threat of MDR-TB is much better understood.

"We can get a better sense of where our money has to be allocated," he said. Although fighting the Marburg fever outbreak in Angola last year got a lot of public attention, the expense of sending a medical team to contain an outbreak that affected only a few hundred people should be considered in the context of the impact of MDR-TB in Angola.

"We win the skirmish with Marburg as MDR-TB makes a full scale assault on our health systems," Miles said.

Miles went so far as to assert that bioethics has never been optimally used in settling major healthy policy questions. The field has been used "to issue a benediction on courses of action that have already been decided upon," he said. "In the context of a genuine moral controversy, where the political balance of power is not set, where the uncertainty is high, the ability to bring in bioethicists to set up a framework of arguments has never been done."

Caplan sounded a more optimistic note.

"Ethics is very powerful," he said. "It's the glue to prevent anarchy. I'm not saying it'll work, but it's the best glue we've got."

See also:

Citizen voices on pandemic flu choices

Science article "Who should get influenza vaccine when not all can?"

HHS pandemic vaccine priority groups

Ethics of Vaccines project: http://www.vaccineethics.org/

University of Toronto Joint Centre for Bioethics' publication "Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza"

25. mai 2006

finantsturud mäletavad sars-i

Pandemic fears as bird flu kills seven of this man's close family
By Mark Henderson, Lewis Smith and Leo Lewis

enamus juttu siis sumatra klastrist, sh pilt ainsast ellujäänust haiglavoodis, aga üks huvitav lõik finantsturgude kohta

Reports and rumours of the outbreak caused chaos in financial markets and prompted a bout of panic-selling of currencies and stocks.

In a volatile day of trading on the Tokyo exchanges, the currencies of Indonesia, Thailand, the Philippines and Singapore all sustained big losses as traders fled towards the perceived “safe haven” status of the US dollar.

“There is no way to look at this WHO inquiry and not be worried,” one Tokyo-based currency trader said. “These are markets that have lived through Sars and know very well the economic impact of potential pandemics. Even if the disease itself is contained, you get people cancelling important business trips, and tourism drops off a cliff.”

Indoneesia kontekstist

Poverty, forgotten diseases weigh heavily on Indonesia
Thu May 25, 2006 1:35 PM BST

By Tan Ee Lyn

JAKARTA (Reuters) - In a squatter settlement at the heart of central Jakarta, half a dozen Indonesian children play as a few scrawny chickens flit amongst them.

The H5N1 bird flu virus has killed 33 people in Indonesia -- and as many as seven in a single family in north Sumatra this month -- but Suhadi, 71, could not be less concerned.

"I have reared chickens for the last 40 years and never been sick. We have traditional medicine and herbs," said Suhadi, who brought up his 11 children selling drinks from his ramshackle hut. He also supplements his income selling eggs and chickens.

His family kept more than 30 chickens until two months ago, when the government began cleaning up the city's backyard poultry. Although officials promised to pay 5,000 rupiah for every chicken turned in, Suhadi and his wife Hapsah gave most of their birds away to relatives. They are now left with six.

"I was very sad to give them away. It's always sad to see them killed because of bird flu," Hapsah said.

Since the H5N1 made its first known jump to humans in Hong Kong in 1997, experts stress the best solution is to separate poultry from people. But that is far easier said than done.

Nearly 10 years on, 60 percent of China's estimated 14 billion chicken population and 30 percent of Indonesia's one billion are still kept in the backyards of homes, free to roam and play with children -- out of simple economic necessity.

"We are poor. We sell some of our chickens sometimes, and sometimes, we eat them," said Hapsah, who says an egg fetches 1,000 rupiah and a hen as much as 35,000 rupiah.


Experts are now probing if there might have been occurrences of limited human-to-human transmission in the Sumatran family cluster, the largest to date.

This has spooked financial markets even though scientific evidence has shown that the virus has not mutated into one that can spread easily among people -- a necessary precursor to a pandemic possibly happening.

But in Indonesia, a vast archipelago of 17,000 islands where more than half of its 220 million population live on less than $2 a day, there are far weightier problems to worry about -- and poverty is but one.

"What I want to put into perspective is an estimated 300 people die everyday from tuberculosis, 2,000 children die everyday of acute respiratory infections, 30,000 people die annually from malaria, do people even bat an eyelid?," said Firdosi Mehta, acting representative of the World Health Organization in Indonesia.

The country was rocked last year when polio, which had been absent for 10 years, suddenly made a comeback.

"An importation took place from Nigeria due to migrant workers, Haj travelers. It came into Indonesia, very close to Jakarta and spread to several provinces. Up till now we have 304 confirmed polio cases in the country," Mehta said.

"The routine immunization program was very deficient in some areas. There were pockets of unimmunized children which let the virus come in and spread widely in such a large country."

International health agencies and the government have since conducted five nationwide vaccination programs to try to interrupt the transmission of the wild polio virus. But authorities would have to monitor for the next six months to see if the efforts are successful.

24. mai 2006

pandeemiaplaani näidis

väga põhjalik pandeemiaplaani koostamise juhis firmadele, 106 lk, näidised, blanketid

22. mai 2006

äärelinna kogukonna pandeemiaplaanid

jutt siis Ohio ajalehest
If bird flu strikes, neighborhood will be ready
Block party part of Clintonville effort to unite against crisis
Monday, May 22, 2006
Barbara Carmen

Clintonville’s newest neighborhood block watch is planning a big summer street party as a key part of its plan to fight bird flu.

Eight neighbors gathered Thursday at a corner cafe to sip coffee and start planning how they might unite to prepare for a deadly flu outbreak or any other disaster.

"Should it happen, the recommendation will be social distancing, do the elbow bump and stay 3 feet away — and that’s not practical always," said Betsy Hubbard, one of the meeting’s leaders.

The neighbors agreed they have a lot going for them. Their wide Clintonville front porches would allow them to both stay apart and stay connected.

They can buy the recommended three months’ worth of food stocks, which might pinch their wallets but isn’t impossible, as in some poor neighborhoods.

And, as a group, they’re welleducated. Thursday’s gathering included a retired teacher, a Central Ohio Breathing Association research director, and an information-technology manager.

But like most people these days, few know all their neighbors. So the plan is to organize as an official city block watch through the Columbus Division of Police.

Then, they’ll throw a block party to meet the 80 neighbors on E. Longview Avenue between Calumet and High streets. The neighbors likely will chat about the usual stuff such as recent housing sale prices, new paint jobs, new babies, new neighbors — and impending death.

Columbus Health Commissioner Dr. Teresa Long applauded the residents’ plan for a block party.

"It’s important for people to get to know their neighbors and get informed," she said. "It sounds like they’re getting connected, and that’s important for all kinds of emergencies, whether it’s a serious winter storm, a blackout or a pandemic."

A three-month food supply appears to be more than enough, Long said. Many families might not have the income and space for such a big supply.

She also recommended that each household have up to a six-week supply of any medicines prescribed by doctors. Residents also should have emergency kits that include matches, candles, a manual can opener, a flashlight, soap, a thermometer, tissues, anti-fever medicine and water, Long said.

The new Longview Avenue Neighbors Association is passing out "contact information" sheets to compile a street directory and create a database of those who can help during a pandemic flu, blizzard or blackout. They’re looking for military or survival training, and firstaid, carpentry, medical or foreign-language skills.

The neighbors also are asking for emergency-contact information. And they’re spreading the word about a system of colored flags neighbors can use to signal how they’re doing.

"Red would mean ‘We’re in deep trouble,’ while orange would mean ‘Somebody’s sick,’ and green, ‘Everybody’s fine,’ " said Judy Kress, a Longview resident who works for the Breathing Association.

The flag idea is interesting, Long said. But residents must know exactly what each means.

"If you put out a red flag, does it mean go get a doctor or does it mean come inside, they need help? " she asked.

Scientists are closely watching a fatal strain of the flu, one currently transmitted only by direct contact with sick birds. They fear, however, that the virus will mutate or hitchhike on an everyday flu bug and start jumping from person to person.

The world is overdue for a bad bout with the flu, said Kress, whose Breathing Association is working with county and city officials to prepare.

"I got to thinking about how we have young neighbors with families. If parents are sick, how can we as a neighborhood help the children? And what about people who are older, or who live alone? "

Neighbors at the meeting were full of questions: How much food would they need? Why would you need to store water?

In the end, they agreed it would be best to plan for the worst and hope for the best.

WHO raport H5N1 viiruse levikust vee ja kanalisatsiooni kaudu

WHO: Review of latest available evidence on risks to human health through potential transmission of avian influenza
(H5N1) through water and sewage
Last updated 24/03/2006

kommentaar IFlu'st allpool

Open water such as reservoirs, lakes or rivers which have been contaminated by infected migratory birds might be able to spread the H5N1 bird flu virus to humans who drink or swim in the water, but there is insufficient data to be sure concludes a recent World Health Organization report.

The report, entitled ‘Review of latest available evidence on risks to human health through potential transmission of avian influenza (H5N1) through water and sewage’ [PDF], raises serious questions about the safety of the public using water which may have been contaminated by asymptomatic migratory birds, as well as a possible risks to sewage workers from infected human and other excreta.

The possibility that the H5N1 virus may be able to be spread to humans drinking or swimming in contaminated water has long been the stuff of legend among amateur flu trackers. Their argument being that asymptomatic migratory waterfowl excrete the virus; that the virus can live in untreated water for some time; and that therefore humans might be at risk, has now been officially recognised. The threat remains theoretical because there is little proven evidence to support the hypothesis and it should be made clear that that properly treated water poses little or no risk to humans.

The report makes it clear that the fact that waterfowl excrete influenza viruses into water does not necessarily mean that it is a route of transmission between birds, nor proves the extent of the risk posed to humans. Some other viruses are also excreted into water without being transmitted. However, there is some evidence which suggests that this may not be true for H5N1.

The report however calls for more research and suggests that where treatment is impossible, it may become necessary to restrict access to reservoirs of water which might be shared by migratory waterfowl and humans – or to put it another way, stop people drinking or swimming in water where H5N1 has been found.

The report also suggests that there is evidence that excreta from infected humans, just like bird excreta, may theoretically provide an avenue for human to human spread of the H5N1 virus, although again the data is limited. If further research confirms this, it may have major implications for the disposal and treatment of human sewage and require improvements to safety procedures for sewage workers.

Drinking water remains safe – it’s important not to over dramatize the implications of the report – but you may want to think twice about swimming in open water frequented by migratory birds.

hispaania gripi kirjeldus

Memories of 1918 flu pandemic haunt 21st century
Sun May 21, 2006 10:37am ET
By Toni Reinhold

NEW YORK (Reuters) - As health agencies worldwide scramble to stop bird flu from becoming a pandemic that could claim millions of lives, memories of the murderous flu that swept the globe almost 100 years ago haunt the 21st century, passed on from generation to generation, or, in my case, from grandmother to granddaughter.

My grandmother lived through the Great War, the Roaring Twenties, the Great Depression, World War Two, the cultural revolution of the '60s and three decades beyond.

There was little that could threaten her nerve but until the day she died, Marie Starace was afraid of two things. One was lightning. The other was "The Grip" -- the deadly flu that wreaked havoc on the Brooklyn, New York, neighborhood where she was born and raised.

So vivid were her memories of the influenza pandemic of 1918-19 that whenever she saw us with open coats and throats exposed to the cold, she would gravely warn: "Button up or you'll get the grip." When I was a teenager -- about 50 years after the horrible episode -- I had the sense to ask what this dreaded "grip" was.

"It was a terrible thing. So many people died from the grip when I was a little girl that it seemed like every family lost someone," my grandmother told me.

"It was heartbreaking to see mothers crying for their children. Some of them lost two and three children. I'll never forget one woman crying in my mother's arms because she lost her children and her husband."

"People didn't want to say when someone in their house was sick because the place would be quarantined and no one could get out to work," Granna recalled.

"Some people went out in the middle of the night to get the undertaker because they didn't want it to get around that someone in their house had died from the flu. They were afraid of being reported to the Health Department and quarantined."


The flu that killed an estimated 20 million to 100 million people worldwide was known in the United States as the Spanish flu or "La Grippe" because it ravaged Spain early on.

Studies show that it was caused by an avian flu virus -- the H1N1 strain -- that could be passed from human to human. The fear today is that the current H5N1 strain of bird flu could mutate and do the same.

In 1918, word of the illness in Europe was carried to Brooklyn's shores by troops returning from the battlefields of World War One and seamen who helped breathe life into New York City's ports. It was suspected that some of them carried the flu as well.

My grandmother lived on Van Brunt Street in an area of Brooklyn known as Red Hook. Folks on Van Brunt called their patch Erie Basin for the water basin that was a port to ships from around the world. My great-grandfather, Salvator Starace, earned a living there as a longshoreman and ship's pilot.

Erie Basin bustled with hard-living, hard-working families, many of them European immigrants and their children.

Granna had her ninth birthday on November 11, 1918 -- the day peace was declared in "the war to end all wars" -- and she hiked to an armory with throngs of Brooklynites to mark the day. It was a long walk from the docks but for a precocious youngster it was part of the thrilling and gritty life of early 20th century Brooklyn.

"There was a big parade. I marched alongside the soldiers and one of them gave me a nickel. People were crying because the war was over," she recalled.

An ocean of tears would be shed in the months that followed as the country returned to mourning -- this time for victims of The Grip.


"Momma would make soup and bring it to the sick," Granna told me. "A lot of them were very poor and the war didn't help. We didn't have so much but she did the best she could."

As the flu spread, my great-grandmother, Antonia, had to take greater care lest she bring it home to her children. "It got so bad that momma had to leave the soup at people's front doors," she said.

The Grip caused high fevers, headaches, coughing, pain, and a pneumonia so virulent that it left people struggling for breath until they suffocated. Death came quickly by many accounts.

"They had a hacking cough and raging fevers," Granna said. "But they couldn't go to hospitals even if they wanted to because they were filled up. And they died so fast."

By many accounts, hospital staffs were severely depleted as doctors and nurses succumbed to the flu. "Men who had been medics in the Army tried to help the sick. But there was no place to put them," Granna said.

Children skipped rope to the rhyme "I had a little bird, Its name was Enza. I opened the window and in-flu-enza." Meanwhile, evidence of the scourge around them mounted.

The city handed out gauze masks to stem the spread of the flu. In Erie Basin, "People tied handkerchiefs and scarves around their faces to protect themselves when they went outside," Granna recalled.

"It seemed like there was a black wreath on almost every door," my grandmother said of the markers of loss. "So many people died that they ran out of space for the dead. Bodies were put on ice inside horse-drawn trucks that came around to pick up the dead. There were hardly any funerals. I don't know how they could have had that many funerals. And besides, people were afraid to go to church."


By a number of accounts, bodies piled up as morgues ran out of space and the supply of coffins dwindled. At a time when wakes for the dead were often held at home, funerals were restricted to only minutes to limit people's exposure to each other.

Potters Field, a burial ground for the poor and anonymous on Hart Island in New York City, became a resting place for some of Erie Basin's dead because their families couldn't afford cemetery plots, my grandmother said.

"No one really knew what to do. No one knew how to treat it. What could anyone do? You couldn't stop living," Granna said.

In 1918, 4,514 people in Brooklyn died from influenza from a population of 1,798,513, according to almanacs published in 1918 and 1920 by the Brooklyn Daily Eagle newspaper. Thousands more had been infected but survived.

Over the years, I spent many hours with my grandmother talking about the past and her memories of The Grip were consistent. I walked the streets of Erie Basin with her when I was a little girl, visiting her father who lived on Van Brunt street until he died in the 1960s. My great-grandmother died in the 1970s. Granna died in 1996.

But as I read the stories about the spread of bird flu today and six members of a family in north Sumatra dying from the H5N1 virus in eight days, I hear Granna's voice warning: "Button up or you'll get The Grip."

21. mai 2006

WHO: ravisoovitused ja riskigrupid

WHO Rapid Advice Guidelines on pharmacological management of humans infected with avian influenza A (H5N1) virus
May 2006


Human cases of avian influenza A(H5N1) infection have remained rare and sporadic, but the disease is very severe and the case fatality is high. With the H5N1 virus now confirmed in birds in more than 50 countries, additional sporadic human cases should be anticipated. Using innovative guideline development methods based on the best available evidence, the WHO assembled an international panel of experts in March 2006 to develop rapid advice for the pharmacological management of patients with H5N1 infection. The recommendations are classified as strong or weak and cover several specific patient and exposure groups for the treatment and chemoprophylaxis of H5N1 virus infection. All recommendations are specific to the current pre-pandemic situation and are based on careful consideration of the current evidence about benefits, harms, burdens and cost of interventions. As there are currently no clinical trials in patients with avian influenza H5N1 disease, the overall quality of evidence on which to base judgments is very low.

Recommendations for treatment of patients with confirmed or strongly suspected human infection with the H5N1 virus

Where neuraminidase inhibitors are available :

Clinicians should administer oseltamivir treatment (strong recommendation); zanamivir might be used as an alternative (weak recommendation). The quality of evidence if considered on a continuum is lower for the use of zanamivir compared to oseltamivir.
Clinicians should not administer amantadine or rimantadine alone as a first-line treatment (strong recommendation).
Clinicians might administer a combination of a neuraminidase inhibitor and an M2 inhibitor if local surveillance data show that the H5N1 virus is known or likely to be susceptible (weak recommendation), but this should only be done in the context of prospective data collection.

Where neuraminidase inhibitors are not available:

Clinicians might administer amantadine or rimantadine as a first-line treatment if local surveillance data show that the H5N1 virus is known or likely to be susceptible to these drugs (weak recommendation).

Recommendations for chemoprophylaxis
To assist countries in prioritizing the use of antiviral drugs for chemoprophylaxis, particularly where their availability is limited, a three-tier-risk categorization for exposure was developed (see Risk categories).

Where neuraminidase inhibitors are available:

In high risk exposure groups , including pregnant women, oseltamivir should be administered as chemoprophylaxis, continuing for 7–10 days after the last exposure (strong recommendation); zanamivir could be used in the same way (strong recommendation) as an alternative.

In moderate risk exposure groups, including pregnant women, oseltamivir might be administered as chemoprophylaxis, continuing for 7-10 days after the last exposure (weak recommendation); zanamivir might be used in the same way (weak recommendation).

In low risk exposure groups oseltamivir or zanamivir should probably not be administered for chemoprophylaxis (weak recommendation). Pregnant women in the low risk group should not receive oseltamivir or zanamivir for chemoprophylaxis (strong recommendation).
Amantadine or rimantadine should not be administered as chemoprophylaxis (strong recommendation).

Where neuraminidase inhibitors are not available:

In high or moderate risk exposure groups, amantadine or rimantadine might be administered for chemoprophylaxis if local surveillance data show that the virus is known or likely to be susceptible to these drugs (weak recommendation).

In low risk exposure groups, amantadine and rimantadine should not be administered for chemoprophylaxis (weak recommendation) .

In pregnant women, amantadine and rimantadine should not be administered for chemoprophylaxis (strong recommendation).
In the elderly, people with impaired renal function and individuals receiving neuropsychiatric medication or with neuropsychiatric or seizure disorders, amantadine should not be administered for chemoprophylaxis (strong recommendation).

Recommendations for other treatments:
Routine use of corticosteroids, use of immunoglobulin and interferon, and ribavirin. should not be used outside the context of a randomised trial, but ribavirin particularly should not be used in pregnant women (strong recommendation).

Recommendations for use of antibiotics
It is not possible to make specific recommendations about individual antibiotics because resistance patterns vary widely from country to country. However, the general recommendations that were made are:

In patients with severe community-acquired pneumonia regardless of the geographical location, clinicians should follow appropriate clinical practice guidelines (strong recommendation).
In patients with confirmed or strongly suspected H5N1 infection who do not need mechanical ventilation and have no other indication for antibiotics, clinicians should not administer prophylactic antibiotics (strong recommendation).
In patients with confirmed or strongly suspected H5N1 infection who need mechanical ventilation, clinicians should follow clinical practice guidelines for the prevention or treatment of ventilator-associated or hospital-acquired pneumonia (strong recommendation).

The panel encourages feedback on all aspects of these guidelines, including their applicability in individual countries. Emergence of new influenza A viral subtypes or a change in the pathogenicity or transmissibility of the H5N1 virus, the development of new pharmacological agents or the availability of important clinical research data will lead to an update of these guidelines.

Risk categories

High risk exposure groups are currently defined as:

Household or close family contacts of a strongly suspected or confirmed H5N1 patient, because of potential exposure to a common environmental or poultry source as well as exposure to the index case.

Moderate risk exposure groups are currently defined as:

Personnel involved in handling sick animals or decontaminating affected environments (including animal disposal) if personal protective equipment may not have been used properly.
Individuals with unprotected and very close direct exposure to sick or dead animals infected with the H5N1 virus or to particular birds that have been directly implicated in human cases.
Health care personnel in close contact with strongly suspected or confirmed H5N1 patients, for example during intubation or performing tracheal suctioning, or delivering nebulised drugs, or handling inadequately screened/sealed body fluids without any or with insufficient personal protective equipment. This group also includes laboratory personnel who might have an unprotected exposure to virus-containing samples.

Low risk exposure groups are currently defined as:

Health care workers not in close contact (distance greater than 1 meter) with a strongly suspected or confirmed H5N1 patient and having no direct contact with infectious material from that patient.
Health care workers who used appropriate personal protective equipment during exposure to H5N1 patients.
Personnel involved in culling non-infected or likely non-infected animal populations as a control measure.
Personnel involved in handling sick animals or decontaminating affected environments (including animal disposal), who used proper personal protective equipment

19. mai 2006

soovitused religioossetele ühendustele


Prepare the Host in advance with priests blessing both water/wine. Hand out wafers prior to local cases.

Hold all services outdoors, in sunlight, with several feet between church members. This will necessitate a mic set up in advance. It will also mean church-goers will have to bring their own chairs from home.

Pass on the coffee hour, and hand-shaking.

Set up a phone tree based on how close families are to one another. If one family does not answer the phone a close neighbor can check up on them. This should be done from a safe distance in case someone is sick.

A pantry needs to be set up immediately. Ask only for items that can be stored. Urge all members to have at least a three month food supply on hand. Give guidance as to what should be stored. Remember that many will have to use only the cheapest of foods in order to comply.

Have the womans auxiliary start a program teaching basic cooking skills, and using stored foods. Contact your local Mormon church for help with the fundamentals.

All members should have a basic course in first aid and a minimum knowledge in how to care for the sick.

If your denomination requires last rights, then either the priest needs to have several sets of personal protective clothing. Also lots of masks and gloves. Or, a formal service which does not require the priest to be physically present.

The most important ways a church or faith-based group can be of immense value is to help members know they will not be going alone through this valley of death. Teamwork, vigilance, compassion, and guidance prior to the outbreak, will go a long way in alleviating suffering and death.

18. mai 2006

linnugripifilm torrentis

et siis seesamune ABC telefilm nüüd torrentboxis üleval
mitte et ma piraatlust propageeriks :D
aga selle vaatamiseks paraku muid variante ei ole

sikutasin alla, vaatasin läbi - suht kõhe oli jah, eriti arvestades ametlikke kommentaare et "eks see umbes nii võib välja näha jah" (vt allpool kuskil on kommentaarid toodud)
reaalsed õudukad on alati kõhedamad kui täielikult ebareaalsed

11. mai 2006

USA valitsuse ametlik juhend kodanikele

Pandemic Influenza Planning: A Guide for Individuals and Families
Get Informed. Be Prepared.

U.S. Department of Health and Human Services May 2006

U.S. Department of Health and Human Services
May 2006

"While the Federal Government will use all resources at its disposal to prepare for and respond to an influenza pandemic, it cannot do the job alone. This effort requires the full participation of and coordination by all levels of government and all segments of society... perhaps most important, addressing the challenge will require active participation by individual citizens in each community across our Nation."

George W. Bush, President
United States of America

"Pandemics are global in nature, but their impact is local. When the next pandemic strikes, as it surely will, it is likely to touch the lives of every individual, family, and community. Our task is to make sure that when this happens, we will be a Nation prepared."

Michael O. Leavitt, Secretary
U.S. Department of Health and Human Services

Pandemic Influenza - Get Informed. Be Prepared.
This guide is designed to help you understand the threat of a pandemic influenza outbreak in our country and your community. It describes commonsense actions you can take now in preparing for a pandemic. We cannot predict how severe the next pandemic will be or when it will occur, but being prepared may help lower the impact of an influenza pandemic on you and your family. Additional information including a planning checklist for individuals and families can be found at www.pandemicflu.gov.

Importance and Benefits of Being Prepared The effects of a pandemic can be lessened if you prepare ahead of time. Preparing for a disaster will help bring peace of mind and confidence to deal with a pandemic.

When a pandemic starts, everyone around the world could be at risk. The United States has been working closely with other countries and the World Health Organization (WHO) to strengthen systems to detect outbreaks of influenza that might cause a pandemic.

A pandemic would touch every aspect of society, so every part of society must begin to prepare. All have roles in the event of a pandemic. Federal, state, tribal, and local governments are developing, improving, and testing their plans for an influenza pandemic. Businesses, schools, universities, and other faith-based and community organizations are also preparing plans.

As you begin your individual or family planning, you may want to review your state's planning efforts and those of your local public health and emergency preparedness officials. State plans and other planning information can be found at www.pandemicflu.gov/plan/checklists.html.

The Department of Health and Human Services (HHS) and other federal agencies are providing funding, advice, and other support to your state. The federal government will provide up-to-date information and guidance to the public if an influenza pandemic unfolds. For reliable, accurate, and timely information, visit the federal government's official Web site at www.pandemicflu.gov.

Pandemic Influenza - Challenges and Preparation
As you and your family plan for an influenza pandemic, think about the challenges you might face, particularly if a pandemic is severe.

You can start to prepare now to be able to respond to these challenges. The following are some challenges you or your family may face and recommendations to help you cope. In addition, checklists and other tools have been prepared to guide your planning efforts. A series of planning checklists can be found at www.pandemicflu.gov/plan/checklists.html.

Essential Services You Depend on May Be Disrupted

* Plan for the possibility that usual services may be disrupted. These could include services provided by hospitals and other healthcare facilities, banks, restaurants, government offices, telephone and cellular phone companies, and post offices.

* Stores may close or have limited supplies. The planning checklists can help you determine what items you should stockpile to help you manage without these services

* Transportation services may be disrupted and you may not be able to rely on public transportation. Plan to take fewer trips and store essential supplies.

* Public gatherings, such as volunteer meetings and worship services, may be canceled. Prepare contact lists including conference calls, telephone chains, and email distribution lists, to access or distribute necessary information.

* Consider that the ability to travel, even by car if there are fuel shortages, may be limited.

* You should also talk to your family about where family members and loved ones will go in an emergency and how they will receive care, in case you cannot communicate with them.

* In a pandemic, there may be widespread illness that could result in the shut down of local ATMs and banks. Keep a small amount of cash or traveler's checks in small denominations for easy use.

Food and Water Supplies May Be Interrupted and Limited

Food and water supplies may be interrupted so temporary shortages could occur. You may also be unable to get to a store. To prepare for this possibility you should store at least one to two weeks supply of non-perishable food and fresh water for emergencies.

* Store two weeks of nonperishable food.
* Select foods that do not require refrigeration, preparation (including the use of water), or cooking.
* Insure that formulas for infants and any child's or older person's special nutritional needs are a part of your planning.


* Store two weeks of water, 1 gallon of water per person per day. (2 quarts for drinking, 2 quarts for food preparation/sanitation), in clean plastic containers. Avoid using containers that will decompose or break, such as milk cartons or glass bottles.

Being Able to Work May Be Difficult or Impossible

* Ask your employer how business will continue during a pandemic.
* Discuss staggered shifts or working at home with your employer. Discuss telecommuting possibilities and needs, accessing remote networks, and using portable computers.
* Discuss possible flexibility in leave policies. Discuss with your employer how much leave you can take to care for yourself or a family member
* Plan for possible loss of income if you are unable to work or the company you work for temporarily closes.

For the Business Checklist visit: http://www.pandemicflu.gov/plan/businesschecklist.html

Schools and Daycare Centers May Be Closed for an Extended Period of Time

Schools, and potentially public and private preschool, childcare, trade schools, and colleges and universities may be closed to limit the spread of flu in the community and to help prevent children from becoming sick. Other school-related activities and services could also be disrupted or cancelled including: clubs, sports/sporting events, music activities, and school meals. School closings would likely happen very early in a pandemic and could occur on short notice.

* Talk to your teachers, administrators, and parent-teacher organizations about your school's pandemic plan, and offer your help.
* Plan now for children staying at home for extended periods of time, as school closings may occur along with restrictions on public gatherings, such as at malls, movie theaters.
* Plan home learning activities and exercises that your children can do at home. Have learning materials, such as books, school supplies, and educational computer activities and movies on hand.
* Talk to teachers, administrators, and parent-teacher organizations about possible activities, lesson plans, and exercises that children can do at home if schools are closed. This could include continuing courses by TV or the internet.
* Plan entertainment and recreational activities that your children can do at home. Have materials, such as reading books, coloring books, and games, on hand for your children to use.

For the "Childcare, School, and University Checklist," visit: http://www.pandemicflu.gov/plan/tab5.html

Medical Care for People with Chronic Illness Could be Disrupted

In a severe pandemic, hospitals and doctors' offices may be overwhelmed.

* If you have a chronic disease, such as heart disease, high blood pressure, diabetes, asthma, or depression, you should continue taking medication as prescribed by your doctor.
* Make sure you have necessary medical supplies such as glucose and blood-pressure monitoring equipment.
* Talk to your healthcare provider to ensure adequate access to your medications.
* If you receive ongoing medical care such as dialysis, chemotherapy, or other therapies, talk with your health care provider about plans to continue care during a pandemic.

A "Family Emergency Health Information Sheet" is provided in this guide and at: http://www.pandemicflu.gov/planguide/familyhealthinfo.html

Pandemic Influenza - Prevention and Treatment
Stay Healthy

These steps may help prevent the spread of respiratory illnesses such as the flu:

Cover your nose and mouth with a tissue when you cough or sneeze-throw the tissue away immediately after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based (60-95%) hand cleaner.
Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
If you get the flu, stay home from work, school, and social gatherings. In this way you will help prevent others from catching your illness.
Try not to touch your eyes, nose, or mouth. Germs often spread this way.


Vaccines are used to protect people from contracting a virus once a particular threat is identified. After an individual has been infected by a virus, a vaccine generally cannot help to combat it. Because viruses change over time, a specific pandemic influenza vaccine cannot be produced until a pandemic influenza virus emerges and is identified. Once a pandemic influenza virus has been identified, it will likely take 4-6 months to develop, test, and begin producing a vaccine.

While there is currently no human pandemic influenza in the world, the federal government is facilitating production of vaccines for several existing avian influenza viruses. These vaccines may provide some protection should one of these viruses change and cause an influenza pandemic. The supply of pandemic vaccine will be limited, particularly in the early stages of a pandemic. Efforts are being made to increase vaccine-manufacturing capacity in the United States so that supplies of vaccines would be more readily available. In addition, research is underway to develop new ways to produce vaccines more quickly.


A number of antiviral drugs are approved by the U.S. Food and Drug Administration to treat and prevent seasonal influenza. Some of these antiviral medications may be effective in treating pandemic influenza. These drugs may help prevent infection in people at risk and shorten the duration of symptoms in those infected with pandemic influenza. However, it is unlikely that antiviral medications alone would effectively contain the spread of pandemic influenza. The federal government is stockpiling antiviral medications that would most likely be used in the early stages of an influenza pandemic and working to develop new antiviral medications. These drugs are available by prescription only.

Stay Informed

Knowing the facts is the best preparation. Identify sources you can count on for reliable information. If a pandemic occurs, having accurate and reliable information will be critical.
Reliable, accurate, and timely information is available at www.pandemicflu.gov.
Another source for information on pandemic influenza is the Centers for Disease Control and Prevention (CDC) Hotline at: 1-800-CDC-INFO (1-800-232-4636). This line is available in English and Spanish, 24 hours a day, 7 days a week.
Look for information on your local and state government Web sites. Links are available to each state department of public health at www.pandemicflu.gov.
Listen to local and national radio, watch news reports on television, and read your newspaper and other sources of printed and web-based information.
Talk to your local health care providers and public health officials.

USA pandeemiategevuskava

National Strategy for pandemic influenza implementation plan
233 lk pdf

8. mai 2006

NYSE pandeemiamemo börsiliikmetele

(sügab kukalt)
uudistes on täielik vaikus, nagu oleks igal pool nii kaunis kevad nagu Eestis :)
ja siis avaldab New Yorgi börs pandeemiajuhendi oma liikmetele .. müstika :O

NYSE Information Memo Number 06-30




The ongoing spread of avian flu has raised concerns among governmental and public health officials of a near term pandemic flu. A pandemic flu would involve the person-to-person transmission of a “virulent human flu that causes a global outbreak, or pandemic, of serious illness.”1 Although there is no pandemic flu at this time, were one to occur, it may cause a significant and extended business interruption differing materially from the emergencies recently confronted by member organizations of the New York Stock Exchange LLC (the “Exchange”). For example, a pandemic flu is expected to occur in multiple “waves,” each potentially spanning weeks or longer, and thus might have a substantially greater duration than the blackout of August 14 and 15, 2003, or the terrorist attacks of September 11, 2001. In addition, a pandemic flu is expected to involve outbreaks in numerous domestic and international locations. Therefore, unlike the regional emergencies created by Hurricanes Katrina and Rita, a pandemic flu might impact a member organization’s main office, branch offices, back-up locations, suppliers, and customers, regardless of their geographic diversity.

Due to the concern over a potential pandemic flu, NYSE Regulation, Inc. is issuing this Information Memo to provide guidance to member organizations as to how to assess whether their Business Continuity and Contingency Plans (“BCPs”) would be suitable for a prolonged, widespread public health emergency.2 This memorandum reflects the current state of publicly available information concerning a potential pandemic and commonly accepted strategies for pandemic preparedness. Ultimately, the key to any BCP is flexibility: member organizations should tailor their planning efforts to their particular business models and customer needs, and should become and remain informed about developing pandemic flu projections.

Exchange Rule 446, “Business Continuity and Contingency Plan”

BCPs are mandated by Exchange Rule 446. Briefly, by way of background, Exchange Rule 446(a) requires member organizations to “develop and maintain a written business continuity and contingency plan establishing procedures relating to an emergency or significant business disruption” that is reasonably designed to enable the member organization to meet its existing obligations to customers and addresses the member organization’s existing relationships with broker-dealers and counterparties.3

Exchange Rule 446(c) sets forth ten minimum elements that a BCP must address. They are the following:

1) books and records back-up and recovery (hard copy and electronic); 2) identification of all mission critical systems and back-up for such systems; 3) financial and operational risk assessments; 4) alternate communications between customers and the firm; 5) alternate communications between the firm and its employees; 6) alternate physical location of employees; 7) critical business constituent, bank and counter-party impact; 8) regulatory reporting; 9) communications with regulators; and 10) how the . . . member organization will assure customers prompt access to their funds and securities in the event the . . . member organization determines it is unable to continue its business.

A “mission critical system,” as defined in Exchange Rule 446(e), is any necessary system “to ensure prompt and accurate processing of securities transactions, including order taking, entry, execution, comparison, allocation, clearance and settlement of securities transactions, the maintenance of customer accounts, access to customer accounts and the delivery of funds and securities.” The Exchange has previously stated that in preparing BCPs, member organizations should emphasize having multiple levels of back-ups, a geographic diversity of back-up facilities and outsourced services, up-to-date technology for back-up facilities, a variety of telecommunications options, robust testing of BCPs and back-up facilities, and time recovery standards and business prospects for various situations.4

The Exchange also has stated that a member organization’s BCP must recognize the interdependence of securities industry participants. Specifically, a member organization’s BCP must include “procedures that assess the impact that a significant business disruption would have” on: businesses with which the member organization has an ongoing relationship concerning the support of its operating activities; lending banks; and counterparties such as institutional customers or other broker-dealers.5 Such procedures ought to address “whether alternative actions or arrangements with respect to their contractual relationships with critical business constituents, banks, and counter-parties would be appropriate upon the occurrence of a material business disruption to either party.”6 Furthermore, the Exchange has provided that BCP testing should be coordinated with other institutions, “taking into consideration the broad interdependence among industry participants . . . member organizations should coordinate with key external entities that could cause a BCP to fail such as telecommunications and service providers, subsidiaries and suppliers, and outsourced functions.”7

BCPs should be flexible documents that adjust to emerging threats to business continuity. According to Exchange Rule 446(b), “member organizations must conduct, at a minimum, a yearly review of their business continuity and contingency plan to determine whether any modifications are necessary in light of changes to . . . operations, structure, business or location.” The Exchange has advised that “[r]isk assessment is an essential component of business continuity planning. When preparing, updating, and maintaining a BCP, . . . member organizations must dedicate resources to periodically assess risk factors so that plans remain viable and effective in light of evolving circumstances.”8

At present, member organizations should assess the unique risks posed by a pandemic flu to determine whether their BCPs would be viable in the event that the avian flu were to give rise to a pandemic. In conducting that assessment, member organizations should consider utilizing the Federal government’s Business Pandemic Influenza Planning Checklist, available at http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf. In addition, member organizations should consider the following guidance.

Guidance Concerning Potential Business Disruptions of a Pandemic Flu

Historically, pandemics have occurred three to four times per century. Thus, regardless of whether the current avian flu causes a pandemic, there remains a substantial risk of a pandemic, involving some disease, in the not too distant future.

In light of the threat of a pandemic, or any biologically based threat, member organizations should review their BCPs and make any necessary modifications. The threat of a pandemic poses unique challenges and therefore requires special planning. Because of the potential business disruption that a pandemic would cause, the securities industry should plan specifically for such an event keeping in mind the following five specific risks:

(1) Pandemics can have multiple strains that arrive in separate waves. The cycles might span many months. Firms therefore should evaluate the viability of their BCPs in the event that they would have to be operative for periods of weeks or months.

(2) The United States government has indicated that it may resort to quarantines in the event of a domestic outbreak, and foreign governments’ reactions may be similar or more drastic. Firms should evaluate the viability of their BCPs in light of potential restrictions on travel, as well as on gatherings of large numbers of people in one location.
(3) Pandemics can have a multinational or global scale.

(4) Pandemics can impact large percentages of the population and of a company’s work force (as many as 30% to 40%). In addition, fear may deter healthy people from attending work.

(5) A pandemic could result in the loss of multiple personnel within the same business unit (including business continuity managers). As a result, firms should consider whether their succession plan is adequately extensive.

Some questions that firms should consider in light of the risks a pandemic poses to their operations include:

- Many health officials believe that a best practice would be to have a multi-tiered response determined by various pandemic-related trigger points. So, for example, if human to human transmission occurred abroad, that would trigger the firm to implement certain contingencies, whereas if an occurrence of the outbreak occurred in the U.S., that would trigger implementations of additional contingencies. Has the firm established escalating contingencies for various trigger points?

- Do the firm and/or firm service providers have the technological infrastructure and capacity in place to support widespread telecommuting and/or operations from back-up sites?

- BCPs may call for the activation of one or more back-up sites in response to certain events. The conventional use of a back-up site is as a response to a geographically localized event. Firms should consider whether a back-up site would be a viable option in the event of a pandemic. If the firm uses a vendor to provide back-up space, has the firm evaluated whether the vendor is capable of providing space in the event that multiple customers require usage simultaneously?

- Has the firm considered the impact of requiring employees to work at a remote location over a long timeframe?

- Has the firm conducted tests, including telecommuting and teleconferencing capabilities, to evaluate its ability to execute both the technological and the logistical aspects of its BCP?
- Does the firm have supervisory, surveillance, and record-keeping systems in place to permit employees to work from home for prolonged periods? Has the firm tested the functionality of such systems? Does the firm have procedures for supervising employees who work from home for prolonged periods?

- Business continuity planning for the financial industry has historically focused particular attention on firms’ clearing and settlement functions as well as on trading operations, both of which are viewed as critical. Does the firm have contingencies in place that ensure functioning of these critical operations in the event of conditions including, but not limited to, limitations on travel and on public gatherings?

- Do any components of the firm’s BCP involve activities or the suspension or modification of business practices that will require regulatory approval? If so, firms should start a dialogue with regulators.
- Has the firm considered the Human Resources implications of a pandemic? Such considerations include, but are not limited to, the operational and financial impact of a significant percentage of the staff being absent or taking short-term disability leave.

- The Federal government has recommended that firms establish partnerships with other members of their sector to provide mutual support and maintenance of essential services during a pandemic. Has the firm identified critical business partners, and has each party determined what it expects of the other during the various conditions that may arise in the event of a pandemic, to ensure that clearing, trading, and other critical functions remain operational? If a firm were to determine, for example, that a critical supplier does not have an adequate BCP or the capability for ensuring supply in the event of a certain trigger, the firm should investigate whether it would require alternative business partners or whether it would be able to consolidate its transactions with fewer business partners.

- How will the firm respond to a shutdown of national mass transit? Has the firm evaluated how to prevent employees from becoming stranded, or how to respond if they are stranded, in the event of a mass transit shutdown while employees are traveling on business?

- Educational programs are an important tool that can help businesses remain functional in the event of a pandemic. Has the firm initiated a program to educate its employees about the potential pandemic and firm contingency plans?

When considering responses to various pandemic scenarios, firms may want to read “High Level Principles for Business Continuity,” which was prepared by the Joint Forum of the BASEL Committee on Banking Supervision, The International Organization of Securities Commissions, and the International Association of Securities Supervisors. Annexes II and III are Case Studies on the impact of the 2003 SARS outbreak on the Hong Kong and Canadian securities markets, respectively. Additional information is available on various government and health organization websites.

Potential Regulatory Relief

NYSE Regulation, Inc. has provided short-term relief from certain regulatory requirements during prior business interruptions. NYSE Regulation, Inc. anticipates that, in the event of a pandemic or other public health emergency, a flexible approach to regulatory requirements will be appropriate. Some of the areas of potential regulatory relief currently under consideration by NYSE Regulation, Inc. include the following:

- extensions of time for standard filing requirements;

- flexibility with respect to office space arrangements;

- delays in real-time supervision where technology monitoring is feasible;

- additional time for reconciliations;

- extensions of time relating to licensing requirements; and

- flexibility with respect to compliance with certain provisions of clearing agreements.

Further guidance as to regulatory relief will be issued as circumstances warrant.

Questions concerning pandemic planning may be addressed to Anne DeSimone at (212) 656-2373 or Thomas Leahy at (212) 656-2340 in the Risk Assessment Unit. Questions concerning Exchange Rule 446 may be addressed to Stephen Kasprzak at (212) 656-5226 in Member Firm Regulation.

Allison A. Bishop

Vice President

Risk Assessment

2 Member organizations are not required to continue doing business in the event of a business disruption. However, a member organization’s BCP must address how it “will assure customers prompt access to their funds and securities” in the event that it discontinues business operations. Exch. R. 446(c)(10). Nothing in this Information Memo is intended to suggest that in the event of a pandemic, a member organization must stay in business. A member organization should consider, nonetheless, whether its existing plan for permitting customers prompt access to their funds and securities in the event of a business shutdown will be viable under expected pandemic conditions.
3 The Exchange previously provided general guidance as to the requirements of Exchange Rule 446 in Information Memo No. 0424 (May 3, 2004), and Information Memo No. 0580 (Oct. 13, 2005).
4 Information Memo No. 0580 at 12 (Oct. 13, 2005).
5 Information Memo No. 0424 at 3 (May 3, 2004).
6 Information Memo No. 0424 at 3 (May 3, 2004).
7 Information Memo No. 0580 at 3 (Oct. 13, 2005).
8 Information Memo No. 0580 at 2 (Oct. 13, 2005).