Thursday, May 8, 2008

Peakniks and Pandemic: Implications for the Foreign Service

Just this week, AP reports that an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated in a flu pandemic or other disaster. The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies and included the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

According to AP: "the task force suggests that hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care. Those out of luck are the people at high risk of death and a slim chance of long-term survival.” The recommendations are specific, and include the following:

  • People older than 85
  • Those with severe trauma, which could include critical injuries from car crashes and shootings.
  • Severely burned patients older than 60
  • Those with severe mental impairment, which could include advanced Alzheimer's disease.
  • Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

The AP report cited Public health law expert Lawrence Gostin of Georgetown University who called the report an important initiative but also "a political minefield and a legal minefield." And that these recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force. If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

That may be, but so is the policy of “remain in country” for overseas Americans and “shelter in place” for official government employees. What are the real ethical concerns of leaving our nationals to fend for themselves overseas (is there one, they went by choice)? What about leaving the people who work for our Government overseas (is there one, they signed up for worldwide availability)? Perhaps it is useful to note here that the pandemic of 1918-1919 which was the most severe in history caused at least 675,000 in the United States but up to 50 million deaths worldwide. I've asked the Official Historian what happened to our diplomats overseas in 1918 but have not heard anything.

The Remain in Country During Pandemic flyer reminds overseas Americans:

“Remember that U.S. embassies, consulates and military facilities lack the legal authority, capability, and resources to dispense medications, vaccines or medical care to private American citizens overseas. If you are a private American citizen (e.g. living, working, touring, studying overseas) you will need to rely on local health care providers and locally-available medications since U.S. government facilities will not be able to provide medications or treat you.”

In short – you’re on your own. The website has this checklist for US businesses with overseas operation.

But apparently official Americans, our Foreign Service folks will also be asked to “shelter in place,” wherever that might be; which means - no evacuations from anywhere, no C-130 Hercules military transport plane will come get us. Since majority of the FS are deployed overseas, we too, will be on our own in a foreign country. Have we, at least, done a table-top exercise on this? Is there any post out there who has conducted a pandemic scenario in a table-top exercise? I really would like to know.

The flyer further states:

“Based on varying conditions abroad, Americans should prepare contingency plans and emergency supplies (non-perishable food, potable water or water-purification supplies, medication, etc.) for the possibility of remaining in country for at least two and up to twelve weeks.”

Let’s say we have a medium size post with 500 official Americans and family members. The pandemic preparation website indicates that we need at least 1 gallon of water a day per person. Right there, for a 500-person post, we would need 500 gallons a day. That’s a 7,000 gallon requirement in two weeks and a 42,000 gallon requirement in 12 weeks. We would have quite a conundrum, won’t we? - and that’s just with water.

So the question asks by BBC Magazine, “Do you need to stock up the bunker?” somehow got stuck in my head and would not let me be. Brendan O'Neill writes that “there are scientists who believe that bird flu could shift so it could pass from human to human, resulting in a global pandemic that could kill 50 million people. But that there are threats that seem more immediate. The price of food is rising dramatically and oil is at record prices. Even brief periods of crisis can have severe consequences.”

Apparently in some green discussion circles, those concerned about "peak" problems – that is, the potential for the production of things such as oil and food to peak and then to start declining – are now referred to as "Peakniks" according to the same article.

Also cited in the article was Barton Biggs, a former chief global strategist for Morgan Stanley and author of Wealth, War and Wisdom, who now runs the hedge fund Traxis Partners in New York, who suggests that all right-minded people should "assume the possibility of a breakdown of the civilized infrastructure." He further elaborates: In a world in which people and systems are increasingly "interconnected", the potential for infrastructure to collapse is great, he says. Political disturbances in Kenya, drought in Australia or crop disease in South America can quickly affect food prices in the UK. And globally, everything from modern mass agriculture to transport and industry is dependent on the availability of oil. "I'm just suggesting," says Mr. Biggs, "that if you can afford it you should invest in a bolthole. A farm, perhaps, where you could live for a month and survive." "I am talking Swiss Family Robinson," he says, referring to the famous 1812 novel about a Swiss family that survives after being shipwrecked in the East Indies. "You should have food, water, medicine, clothes. And possibly AK47s to fire over the heads of any guys, depending on how bad things become."

Since we are going to be ordered to “shelter in place,” Mr. Biggs’ survival kit advice of food, water, medicine, clothes, and AK47s, sounds good to me. I don’t know about a bolthole or a farm, I’m sure we have no appropriated money for that; would a vault do?

1 comment:

Consul-At-Arms said...

I've quoted you and linked to you here: