Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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—Tony Abbott, Australian Minister for Health2847

What should we do when the whole world gets sick? “From my perspective,” Osterholm has said, “we pray, plan, and practice.” “We have to plan as if this will happen tonight.”2848 Pandemic planning needs to be on the agenda of every institution, including every school board, every food distributor, every mortuary, every town hall, and every legislature.2849
The corporate world seems to be the first to have awakened to the threat. Corporations from Boeing to Microsoft to Starbucks have started mobilizing continuity plans,2850 though details have been considered “privileged company information.”2851 Microsoft did reportedly distribute bottles of hand sanitizers to all of its 63,000 employees worldwide.2852 The national U.S. preparedness plan still remains to be employed across the country. Both Osterholm and Frist2853 use the example of the Manhattan Project—the U.S. government’s all-out drive to develop the atomic bomb during World War II—to describe the intensity of initiative required to ready the nation in time.2854

The paradox of a pandemic is that it is worldwide, but intensely local. Nobody is “outside” the pandemic to send help.2855 “Communities, in large part, will be on their own,” predicts the executive director of the National Association of County and City Health Officials.2856 The same may be said of individuals. The president of the College of General Practitioners laid out the bottom line: “Self-management and self-reliance will be the cornerstone.”2857

Every family must draft and implement its own plan and discuss that plan with friends.2858 Every organization one is affiliated with—schools, clubs, work, places of worship—must be pushed to initiate its own plans.2859 “We must hang together,” Ben Franklin is attributed as saying, “or assuredly we shall all hang separately.” Health and Human Services Secretary Leavitt has criticized Americans for not preparing sufficiently. “People have not exercised adequate personal preparedness,” he said, “to last more than three or four days in their normal environment without going to the store.”2860

According to WHO risk communication experts, these grave public warnings are useful on four different levels. First, people will hopefully take responsibility for preparing themselves logistically. Second, they may help spur their communities into greater preparedness. Third, people may be more supportive of their governments’ planning efforts, and, fourth, when the pandemic begins, the advance notice will have given people time to get used to the idea emotionally, feel less panicky, and take a more active role in protecting themselves, their families, and their communities.2861

Why haven’t we heard more from public officials urging individuals to prepare for what experts declare is a coming pandemic? One reason is that officials do not want to panic the populace. “What I’ve found is that, behind the scenes, many public health officials are distancing themselves from this global-health-crisis rhetoric,” says a former chief medical officer of Ontario. “It’s not like terrifying someone about smoking or HIV, where you’re actually asking them to do something about it.”2862 “Scaring people about avian influenza accomplishes nothing,” he says, because we’re not asking people to do anything about it.” The mistake doesn’t lie in scaring people, though; it is in failing to realize and communicate just how much the public can do right now to prepare.2863

“How Scared Should We Be?” asked the title of a Time magazine story on bird flu. The subtitle answered: “Scared Enough to Take Action.”2864 We can immediately start getting into the habit of practicing proper hand hygiene and respiratory etiquette. We can, as some risk management specialists have recommended, call our doctors to ask for prescriptions of Tamiflu or Relenza and fill the prescriptions before drugstores run out.2865 We can prepare our family’s pandemic preparedness kit.

The kit would contain everything one might need to stay at home for a period that could last from days to months with or without running water and electricity.2866 Everyone’s checklist will differ based on individualized family needs, but one can start the list by writing down what necessities are used as they come up on a day-to-day basis.2867 The New Zealand government has taken the additional step of including in the back of all the nation’s phone books a list of instructions as to what to do when the pandemic strikes and items to stock in one’s “B-ready kit.”2868

In a remarkable speech at a conference in Wyoming, Health and Human Services Secretary Leavitt said,
When you go to the store and buy three cans of tuna fish, buy a fourth and put it under the bed. When you go to the store to buy some milk, pick up a box of powdered milk. Put it under the bed. When you do that for a period of four to six months, you are going to have a couple of weeks of food, and that’s what we’re talking about.2869
Though critics dismissed his comments as a bit fishy—comparing it to “duck and cover” during a nuclear attack2870 —he was at least on the right track. Shortly afterwards, the Department of Health and Human Services released guidelines for a more varied menu. After all, “Powdered milk and tuna?” Jay Leno quipped. “How many would rather have the bird flu?”2871

Launched late in 2005, the official U.S. government website pandemicflu.gov has morphed into quite a useful resource for those who have access to the internet, listing downloadable pandemic planning checklists and guides for schools, businesses, and community groups. The preparedness guidelines for individuals and families focuses on the stockpiling of food, water and essential supplies.

The family food checklist focuses on nutritious staples that can be stored without refrigeration and eaten without cooking, such as ready-to-eat canned goods.2872 Other possibilities include instant packaged mixes like instant oatmeal, mashed potatoes, and cup soups (though these require water that may be in limited supply), as well as shelf-stable aseptic packaged soups and juices. There’s even a cookbook out—Apocalypse Chow—a humorous yet serious attempt at palatable “pantry cuisine,” using jarred, canned, and freeze-dried foods.2873

How much food is enough? Anthony Fauci, the National Institutes of Health’s infectious disease chief, recommends stockpiling “a few weeks’ worth of water, a few weeks’ worth of non-spoilable foods.”2874 Osterholm told Oprah, “Everyone should have enough food today so that they could basically be in their homes for four or five weeks….”2875 Expert Webster has a three-month store of food and water in his home.2876

Some have recommended locating a rural refuge, if possible, to ride out the storm away from population centers and any ensuing civil unrest. If people have a “house in the hills,” Webster urges, “then go for it--and stay there for three months. And have enough food there already so you can stay as far away from your neighbors as possible.”3173 Rural states like Vermont expect their populations to as much as double to accommodate urban refugees. Vermont officials have reserved freezer space from Ben and Jerry’s to store overflow corpses.2877

Food and water might also be more easily obtained in the countryside.2878 FEMA recommends a gallon of water per person per day,2879 with additional allowances for any household pets. According to FEMA, one can disinfect water (sourced from a freshwater stream or lake) by keeping it at a rolling boil for a full minute or, if unable to boil it, by using water-purifying tablets found in camping stores or using bleach:
Recipe for Water Purification
1 quart (liter) of clear water
10 drops of unscented liquid household chlorine bleach

Mix well and let stand for 30 minutes before drinking. Double the amount of bleach for cloudy or colored water, or water that is extremely cold. The water should have a slight chlorine odor after purification. If not, repeat dosage of bleach and let stand an additional 15 minutes. If the chlorine taste is too strong, try pouring the treated water back and forth from one clean container to another several times.2880
The Boy Scout motto, “Be prepared,” begged the question, “Be prepared for what?” The founder of the Scouts replied, “Why, any old thing.”2881 With another pandemic inevitable, the best we can do is mediate the consequences. This means doing our best to avoid falling ill, developing contingency plans to survive the infection, and making all necessary preparations to endure social chaos. “The objective of pandemic preparedness can only be damage control,” said top WHO flu expert Klaus Stöhr. “There will be death and destruction.”2882