A leading U.S. health agency staged a war game this week to test its response to one of the worst health emergencies it could imagine — an outbreak of avian flu on American soil.
The exercise, which ended on Friday, was designed to simulate how the Centers for Disease Control and Prevention would marshal its resources, coordinate with other branches of government and, crucially, reassure the public while preparing it for a possible pandemic.
“If we were at the beginning of a pandemic this is exactly what it would look like,” said CDC Director Julie Gerberding at a news conference early in the 48-hour drill, which involved hundreds of officials.
If things turn out wrong it could lead to a “catastrophe beyond our planning,” she said.
In the script, a student infected with a new strain of H5N1 virus returns from Indonesia where a bird flu outbreak is under way. He dies but not before infecting others, including members of a swimming team.
On Day One, 12 people contract the disease in four states and 25 percent die, a rate that shows the virus to be particularly lethal.
By Day Two, there are 25 cases and CDC is forced to consider whether to recommend ordering schools to close, banning flights from Indonesia or even shutting U.S. borders.
They decide against these measures but send experts to Indonesia, release a quarter of the U.S. stockpile of flu vaccines and force all international flights to land at just 10 airports to screen passengers and limit the disease’s spread.
Like ‘24,’ without the violence
Health experts say that in real life it’s just a matter of time before a global flu pandemic strikes. The 1918 pandemic killed up to 100 million people — 650,000 in the United States — and there have been two subsequent less-severe pandemics.
In some ways the war game resembled the hit U.S. TV show “24,” with health officials battling in real time to save the United States from imminent disaster, though of course minus the violence.
Like the Counter Terrorism Unit at the heart of “24,” the CDC used its Director’s Emergency Operations Center, a high-tech command post at which scores of doctors and public health experts assist decision makers who in turn brief government leaders.
Behind the scenes, planners draw on a wealth of research.
In calculating whether to close the border, for example, there are hundreds of studies on the movement of pathogens, the impact of public health decisions on the economy and the potential social and political repercussions.
“What we do (in the exercise) is tailor our thoughts over the last few years to the specific scenario that is playing out. These are the facts on the ground: do our theoretical constructs hold,” said Martin Cetron, CDC director of the division of global migration and quarantine.
Another consideration was whether to adopt a “containment” model, by trying to stop the virus’ spread, or a “mitigation” model, by taking steps such as closing schools to lessen its impact once it can pass freely from person to person, he said.
If they overreact, it could stifle the economy and cause a host of unintended consequences. If they do too little they could fail to impede the spread of the disease.
Learning from mistakes
So will the United States be safer? The exercise is part of a long-term plan involving multiple layers of government to prepare for public emergencies. The game, set up by a team of former military planners, is followed by an extensive effort to analyze mistakes.
“Doctrine number one is that we are learning, so we expect to make mistakes ... We expect to own the mistakes that we make .... We are a great agency but we are not perfect,” Gerberding told a staff briefing at the outset of the drill.
But in an ominous note, the next stage of the exercise to be held over the summer will start with the assumption that the bird flu outbreak has become a full blown pandemic.