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H5N1: What’s The Plan for the Worst Case Scenario

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Here’s an excerpt of my interview yesterday with Majority Leader Frist. It deals with fundamental questions of who’s in charge in the event of the appearance of H5N1 in the U.S., both as to the increasingly likely appearance of the virus among birds, and the not yet likely but still potentially ominous appearance of the disease in humans. I did not get from the interview that there is any clear delineation of authority. I did get the sense that if H5N1 shows up here, we are ripe for a replay of Katrina-like chain of command controversies:

HH: Now Senator Frist, give me your understanding. It’s spreading like wildfire right now, and in Indonesia and China, today, this very day, there are massive kills underway of poultry, wild and domestic. Who has the authority, should the bird flu in birds get to the United States, to order these kind of poultry kills, which will obviously impact our economy a great deal. Whose got that right?

BF: Well, your point is very well taken. Ultimately, the Secretary of Health and Human Services is going to make the call. But it very quickly falls over into the agriculture, farming community, because that is where one of the first steps will be taken, the actual quarantining, telling people to stay at home, advising people from a public health standpoint will go through the Secretary of Health and Human Services, Secretary Leavett.

HH: But is there a federal law that authorizes federal authorities…I’m thinking after Katrina, we did this dance with the locals where they didn’t want us in, and as a result, the feds got blamed. Is there a federal statute on the books that says the Director of HHS operaing pursuant to Presidential authority, can take control of neighborhoods and of poultry farms, and things like that, and order sequestration and anything else that needs to happen?

BF: There’s specific provisions for things like what we just talked about, in terms of manufacturing, vaccine manufacturing, protection from the use of anti-viral agents, and dictating the use of anti-viral agents. State law, in most states, are either addressing or have addressed, although about half of them have not yet addressed the actual quaratining commands. And that will come from the state level, and it will be upon advice from the federal level, but ultimately from the state level.

HH: Senator Frist, what happens if we have a replay of New Orleans, where the advice being given from the federal level is disregarded or simply not acted on by local officials. That was a matter of life and death. This could be a matter of pandemic.

BF: Yeah, this is much bigger.

HH: Should there be stand-by authority for the…

BF: The risk now, because this is an infectious agent, to which you don’t, nor do any of your listeners today, have any natural immunity to this. That’s what’s so unique about this virus, and unlike the common flu virus, or any other virus that you know, practically. You have no immunity, and that’s why there’s been about 170 people, 169 infected. About 60% of those people have died, because there’s no natural immunity. And second, in all likelihood, it’ll spead, even if you’re not infectious, even if you’re not coughing and sneezing. You couple those things together, there’ll be rapid spread through not just a geographis location, but across this country, with there to be massive devastation. A Congressional Budget Office, or General Accounting Office prediction of what would happen if there was similar penetration to what happened in 1918, 1919, would affect our economy by a decrease in our economy size, or our GDP, by about 5%, or about $600 billion dollars.

HH: We’ve got a minute left, Senator Frist. So should the Congress of the United States equip the President with the authority he will need in the even that states are simply ineffective or recalcitrant?

BF: Well, I think so. I think so, but I’m addressing this from the straight-out public health standpoint, and my knowledge from the science of how ill-prepared we are as a nation today. Now also, let me just say, Hugh. I don’t want my comments to be used to cause panic and paralysis. I do want the American people to know that I, knowing what I know as a scientist, as a doctor, believe that we’re unprepared, and we’re doing everything we possibly can in terms of monetary investment, but also organization, delivery of the appropriate medicines that are possible. And I think it’s incumbent on us to have clear lines of authority from the President through the Secretary of Health and Human Services, through the states, down to the local communities.


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