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In responding to catastrophe -- an 8.0 and above earthquake, a thousand year flood, a cascading  biological contagion, etc.  --  right after providing potable water is the problem of food distribution.  In some of Lee Clarke's worst case scenarios there is a more basic problem of maintaining food production. This week both of Australia's leading political parties added food security to their list of policy priorities for the current national election. One member of the Australian Senate writes, "The world has embarked on a dangerous era of food insecurity and imperialism which will fuel conflict and famine if it is ignored. Australia is not immune. Land and water should be treated as strategic resources by us as they are by many in the world." The Department of Homeland Security explains that  Homeland Security Presidential Directive 9, "establishes a national policy to defend the agriculture and food system against terrorist attacks, major disasters, and other emergencies. America's agriculture and food system is an extensive, open, interconnected, diverse, and complex structure providing potential targets for terrorist attacks. U.S. agriculture and food systems are vulnerable to disease, pest, or poisonous agents that occur naturally, are unintentionally introduced, or are intentionally delivered by acts of terrorism." Given the obvious importance of food, are there vulnerabilities in the current food system worth particular attention?  Well, as a possibility, help me refine this hypothesis: Economies of scale suppress risk resilience.   The food system is one context where this hypothesis might be tested. Over the last half century increasing scale and specialization of production and processing have significantly reduced the consumers cost of food as a proportion of overall income.  The source of this savings has, however, also substantially reduced the number, diversity, and  distribution of producers and processors. This narrows the ability of the food system to bounce back from a catastrophic event.  If this is true for the food system might it also be the case for other supply chains? I am the son and grandson of grocers.  I grew up working on the farms of downstate Illinois.  In my lifetime I have seen the food system move from what now seems simple, to complicated, to a sort of complexity and -- if a catastrophe would occur -- to potentially teetering on the edge of chaos. Some of my earliest memories are of farmers backing their trucks up to grandpa's slaughterhouse.   The hogs and cattle -- rarely some sheep -- were off-loaded into the two dozen wooden stalls attached to the white cinder-block slaughterhouse. Monday through Saturday nearly everyone listened to the Dick Herm Report on WBYS radio (We Bore You Stiff, the older kids called it).   With the bark of an auctioneer Herm would give the regional and Chicago prices for agricultural commodities. Grandpa paid a few cents less per pound than the Peoria market. For some bigger producers it made financial sense to get more per pound by trucking their livestock to Peoria or beyond. But for others, given the cost of time and gasoline, one of several nearby receiving yards or processing plants did fine.  For most farmers livestock was only one of several products.  When I chored with my friend Jeff we would slop the hogs, feed the chickens, hay the beef cattle, weed the beans, and give the dairy cows grain to eat while we milked them. My dad's grocery stores bought dressed hogs from my grandpa's (and other's) slaughterhouse.  At each grocery store a butcher would saw the carcass into various cuts of pork and grind the sausage.  Cause and effect was knowable even by a six year-old.  The livestock were born, raised, slaughtered, packaged, sold, and eaten all within several miles of each other. I knew the farmer, processor, butcher, and buyer. The production, processing, and distribution nodes of the food system -- at least in downstate Illinois -- were thick and overlapping.  The supply chain was densely redundant, complicated and in some ways complex. Above, the Cynefin Framework Today pork production -- and most agricultural production -- is much more highly concentrated.  In 1969, according to the US Department of Agriculture, 644,882 farms raised 89,296,278 swine.  By 1992 186,627 production operations sold 109,775,439 pigs and hogs.  That's a shift of 138 head per farm to 588 per farm.  In 2002 the number of production sites had fallen by more than half to 78,895.  In 2002 over half of all swine were raised on "farms" with over 5000 head each. The geographic range of pork production has also narrowed.  Take out Northern Iowa and Eastern North Carolina and very few of us will have ham for Christmas or even a ham sandwich for lunch.  Pork processing is even more concentrated than production.   Many food products have experienced similar consolidation and concentration. Today, compared to my early days, the supply chain for food is much more streamlined, specialized, and price efficient.  In 2004 a hog producer with 1000 head spent about $40 per hundredweight.  The same year raising a hog farrow-to-finish cost the producer with fewer than 100 head almost $80 per hundredweight. (See Hogs Lead Way in Transformation)  In 1969 the retail cost of pork chops was about $1.39 per pound.  This week many stores are selling assorted pork chops at $2.49 per pound. At least one regional chain is advertising a "Big Sale" with pork chops at $1.99 per pound. Given forty-one years of inflation that is an extraordinary bargain. Economies of scale in production, processing, and distribution have contributed to price containment of pork and other foodstuffs.  This is a real benefit.  Is there a cost? I just came back from several days visiting my parents. Most of the 400 acre  family farms that I knew as a kid have been consolidated.  Except for acreage owned by the Amish and a few small organic operations, corn, soybeans and cattle are what you see again and again stretching over the horizon (and there are long horizons in central Illinois). Dad has sold his grocery stores and grandpa's slaughterhouse closed twenty years ago. When I asked the local market's meat manager (no longer a butcher) about where his meat comes from he laughed and said, "Off the truck, before that who knows."  Because the supply chain originates far away and draws on unknown sources there is an impression of complexity.   And across these attenuated supply chains there are complex characteristics: lots of filters, need for pattern recognition, and some aspects of adaptive response. But is the food system "complex" as defined by the Cynefin framework?  The crowd sourcing of many more independent producers and processors has been reduced and standardized.  Open markets have been replaced with much more predictable production contracts.  The entire system has been reengineered and squeezed to maximize every penny-per-pound.  In some ways, with fewer participants and fewer relationships the food system is actually much simpler than four or five decades ago. Toward the end of his brief video overview of the Cynefin framework David Snowden warns, "The boundary between simple and chaotic is different from the other boundaries...  If you start to believe that things are  simple -- you start to believe that they're ordered, you start to believe in your own myths, you start to believe that past success means you are invulnerable to future failure -- you effectively move to the complacent zone which is the boundary between simple and chaotic and you fall over the edge in a crisis... and recovery is very, very expensive." Have economies of scale so simplified the food system that we can now sense it on the very edge of chaos? (Editorial Note:  Last week John Comiskey encouraged me to apply Cynefin and/or Tara to a prospective problem.  He suggested a cyber threat.  I decided to focus on a network -- the food system -- that I understand better than I understand most cyber networks.  But it seems to me these issues of consolidation, centralization, simplification, and such might have analogies to the cyber domain.  For now, though, that is only a hypothesis.)

Order diazepam no prescription, In 2005, Stewart Baker joined the Department of Homeland Security as Assistant Secretary of Policy for the entire Department of Homeland Security under Secretary Michael Chertoff. The position, Kjøpe diazepam online, which evolved from the Assistant Secretary for Border and Transportation Security Policy and Planning position, has the following responsibilities, according to the DHS website:

• Leads coordination of Department-wide policies, order diazepam without prescription, programs, Cheap generic diazepam, and planning, which will ensure consistency and integration of missions throughout the entire Department.

• Provides a central office to develop and communicate policies across multiple components of the homeland security network and strengthens the Department’s ability to maintain policy and operational readiness needed to protect the homeland.

• Provides the foundation and direction for Department-wide strategic planning and budget priorities.

• Bridges multiple headquarters’ components and operating agencies to improve communication among departmental entities, eliminate duplication of effort, osta alennus diazepam, and translate policies into timely action.

• Creates a single point of contact for internal and external stakeholders that will allow for streamlined policy management across the Department.

Baker would hold the position for the next four years, Kjøpe billig diazepam, tackling a variety of issues from border and travel to cybersecurity and the Committee on Foreign Investment in the United States (CFIUS) to bioterrorism.  In his upcoming book, Skating on Stilts: Why We Aren’t Stopping Tomorrow’s Terrorism, Baker offers an intriguing view of our homeland security posture that ties back to the central theme that technology is both our savior and our enemy as it empowers not only us but our foes.  Coming from Baker, Indiana IN Ind. , who has been described by the Washington Post as “one of the most techno-literate lawyers around, Buy diazepam online without prescription, ” the analysis of homeland security technology from a policy/legal prism is refreshing.  This is not a Luddite's view of why technology harms, but an expert's finely woven story of "how the technologies we love eventually find new ways to kill us, and how to stop them from doing that."

A subtheme throughout the book is that information sharing, Georgia GA Ga. , or lack thereof, Købe diazepam, has hindered our nation’s efforts to fight terrorism, especially when “privacy” has played a role.  In setting up a discussion of what led to his time at DHS, Baker recounts some of the failures leading up to 9/11, diazepam online, including the information sharing wall put up at the Department of Justice between intelligence and law enforcement elements of the agency, Diazepam kopen, as well as challenges at the Foreign Intelligence Surveillance Court. His view is of someone who has spent time in the intelligence world as the General Counsel of the National Security Agency and as General Counsel of the Robb-Silberman Commission investigating intelligence failures before the Iraq War. The account dives into the intricacies of Justice and its overseers, West Virginia WV W.Va. , as well as how bureaucracy and personalities can so easily define our government’s most sensitive policies. Kaufen diazepam, The book then looks at his days at DHS and attempts to strengthen border and travel programs and policies for acronym-named programs, including Passenger Name Records (PNR), the Visa Waiver Program (VWP), buy cheap diazepam online, Electronic System of Travel Authorization (ESTA), North Dakota ND , Western Hemisphere Travel Initiative (WHTI), and Computer Assisted Passenger Pre-Screening System II (CAPPS II),  among others.  If you have ever doubted Washington's love of acronyms and initialisms, order diazepam online, this read will certainly change your mind.

In evaluating efforts in the aviation space, Baker is critical of a number of groups that he deems to have stood in the way of the Department’s mission during his tenure, including the private sector, European governing bodies, bureaucrats, Congress, and privacy/civil liberties groups, all of whom he argues are all about the status quo and not open to change.  Some of his criticisms are valid while others seem to simplify the views of the various actors.  For example, in dismissing some of the tourism industry’s concerns related to travel policies, he argues that the industry did not want innovation in government security on the border, order diazepam no prescription. Diazepam online cheap, Having been in the trenches at the U.S. House Homeland Security Committee during many of these debates, I would argue that the balancing of the numerous parties’ interests and concerns was not always that simple or easy to discern, acquistare a buon mercato diazepam, especially when assessing the right security path forward.  Some programs mentioned in the book, Illinois IL Ill. , such as WHTI, succeeded, in part, online diazepam, because they were implemented once necessary infrastructure had been deployed. Order diazepam no prescription, His strongest concerns are reserved for privacy and civil rights advocates and the government policies they either tout or hate.  There is a great deal of skepticism for “hypothetical civil liberties” and “hypothetical privacy concerns,” without evidence of demonstrated abuses by the government. He cites numerous incidents, ordering diazepam no rx, some of which certainly demonstrate the tension between privacy and security co-existing.  A few of the examples he uses have even been explored here at HLSWatch, Köpa billiga diazepam, including complaints about whole body imaging machines in airports.  See, e.g. Order diazepam no prescription, The Right to Be Left Alone (October 27, 2009) and “Where are all the white guys?” (November 10, 2009). Reading the book, privacy and civil liberties supporters may find it hard to balance Baker's call for imagination when tackling homeland security policy and decisionmaking without calling for a similar level of creative thinking when addressing how those policies and decisions will affect privacy and civil liberties.

The book goes on to describe how the Department and Administration tackled (or failed to tackle) cybersecurity and biosecurity and the differences between the approaches, Montana MT Mont. . In both sections, Diazepam discount, privacy and information sharing are undercurrents, though we also see some interesting discussions of such topics as patent protections, self-regulation, and the evolution of security in each of these areas.  The discussions are intriguing and provide both a history and analysis of why we are where we are on those issues.   The cybersecurity and related CFIUS discussion brought back some memories to this self-proclaimed cybergeek, including some of my first interactions with Baker when he was in private practice and I was at the Justice Department.

One last observation: while the focus on the book is obviously on the time that Baker served at the Department under Secretary Chertoff, it leaves much to the imagination of what work Secretary Ridge and his team- from their early days in the White House after 9/11 until the changing of the guard to Secretary Chertoff - undertook and how that may have contributed to some of Secretary Chertoff's and Baker's successes, challenges, and mindset.  In addition, despite the focus on privacy and civil liberties, there is little mention of the other DHS offices, including the Privacy, Civil Liberties, and General Counsel’s offices, who may have been engaged in many of the battles noted by Baker. The book is not lacking in detail or intrigue because of these exclusions, though I wonder how they affected the decisions of Baker and his policy team. Perhaps these items are the subject of another book for another time, order diazepam no prescription.

Stewart Baker provides insight into a D.C. perspective of homeland security and the struggle of a Department to tackle technology, privacy, and information sharing. The book provides some valuable lessons for those who are on the frontlines of homeland security policy as they attempt to tackle future threats. For an observer of homeland security development, Skating on Stilts: Why We Aren’t Stopping Tomorrow’s Terrorism is a must-read. The book will be released on June 15th and is available for pre-order on Amazon.com.  In the meanwhile, excerpts from the book and other missives from Baker can be found at a blog with the same name, http://www.skatingonstilts.com/.

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A zombie is a "re-animated human corpse that feeds on living human flesh." Order cialis no prescription, Mostly they serve as fodder for popular entertainment.  But an attack by real zombies would be anything but entertaining.

Four Canadian mathematicians who wrote  "When Zombies Attack!: Mathematical Modeling of an Outbreak of Zombie Infection" warn,

".., Colorado CO Colo. . if zombies arise, Acquistare online cialis, we must act quickly and decisively to eradicate them before they eradicate us."

The scholars -- Philip Munz, Ioan Hudea, Joe Imad, ordering cialis from canada, and Robert J. Utah UT , Smith -- are from  Carlton University and the University of Ottawa.  They developed what is surprisingly "the first mathematical analysis of an outbreak of zombie infection." The article will be published as Chapter 4 in the soon to be released book  "Infectious Disease Modeling Research Progress."

While obviously not realistic, their analysis "demonstrates... how modeling can respond to a wide variety of challenges in biology."

The link between their work and biological attacks, ordering cialis, pandemics, Farmacia cialis baratos, and related public health threats to the United States is an obvious one.

Why zombies matter to homeland security

The authors describe their basic model for zombie infection, discuss equilibria and stability issues, and then suggest conditions under which eradication of the zombie infection can occur, order cialis no prescription. Based on their analysis, they conclude "only quick, pharmacy cialis, aggressive attacks can stave off the doomsday scenario: the collapse of society as zombies overtake us all."

The chapter starts by discussing the origins of zombies in the Afro-Caribbean spiritual belief system of "Vodou."  But the idea of the zombie dates back at least to the Middle Ages, Buy cialis online without prescription, and has appeared in the cultures of China, Japan, the Pacific, Montana MT Mont. , India, Comprare cialis sconto, Persia, Arabia, and the Americas, buy cialis online.

As the reader familiar with the concept may recall, Acquistare a buon mercato cialis, zombies have no will of their own. Their heart and lungs and all their body functions operate at minimal levels, at least according to the traditional view, Connecticut CT Conn. .

Modern zombies are very different from voodoo and folklore zombies. Contemporary zombies are mindless monsters who do not feel pain and who have an immense appetite for flesh.  They have a particular hunger for human brains (as the disturbing video at this link illustrates Order cialis no prescription, ). For cialis online, A zombie's objective is to kill, eat or infect people. When a susceptible person is bitten by a zombie, lowest price cialis, it leaves an open wound contaminated by saliva, Osta cialis, thus infecting the susceptible individual.

Informed speculation suggests the saliva disrupts oxygen flow to the brain.  The lack of oxygen seems to be the specific mechanism that turns otherwise normal people into zombies.

Consequently in the few cases of zombie-ism that have been adjudicated by courts, kopen goedkope cialis, authorities have concluded that because the zombies suffer from brain damage, New Hampshire NH N.H. , they cannot be held accountable for the havoc they cause.

This clearly has hampered -- but not eliminated -- the search for effective prevention and mitigation strategies.  Here is where the Canadian team makes its, probably inadvertent, but still foundational contribution to Homeland Security

Summary of the argument

In Section 2 of their paper, the authors outline the basic model describing how -- like a deadly virus -- zombies grow and increase (please see Figure 1, where S are those who are susceptible to attack, Z are the zombies, and R are those who have been "removed" but who can return to the arena after an encounter with Z), order cialis no prescription. The authors correctly note their model is "slightly more complicated than the basic SIR [susceptible, infected, Virginia VA Va. , and removed] models that usually characterize infectious diseases."

The authors discouragingly find that from the perspective of their basic model, Comprar en línea cialis, "In a short outbreak, zombies will likely infect everyone."

The remainder of the article discusses strategies available for dealing with a zombie attack:

• Section 3 (The basic model, with time latency), Vermont VT Vt. ,


• Section 4 (The model, Texas TX Tex. , plus quarantine),


• Section 5 (The model incorporating a cure for zombie-ism), and


• Section 6 (Rapid and aggressively escalated destruction of zombies)

The interested reader can view the full analysis of each variation by downloading the original paper here.  I found the math to be slightly impenetrable (see the figure below for an example), buy cialis pills. But the authors' conclusions are starkly clear:

"An outbreak of zombies infecting humans is likely to be disastrous, Cheap cialis tablets, unless extremely aggressive tactics are employed against the undead. While aggressive quarantine may eradicate the infection, this is unlikely to happen in practice, cialis online stores. A cure would only result in some humans surviving the outbreak, although they will still coexist with zombies. Order cialis no prescription, Only sufficiently frequent attacks, with increasing force, will result in eradication, assuming the available resources can be mustered in time."

The authors acknowledge the key difference between their model and traditional views of infectious disease is in their model "the dead can come back to life."

They admit their scenario is unrealistic if taken literally, "but possible real-life applications [of their model] may include allegiance to political parties,... diseases with a dormant infection," and -- one might add -- a zombie-like commitment to certain beliefs, attitudes, policies, and organizational arrangements.

The article ends by summarizing the strategic implications of the analysis:

"A zombie outbreak is likely to lead to the collapse of civilization, unless it is dealt with quickly. While aggressive quarantine may contain the epidemic, or a cure may lead to coexistence of humans and zombies, the most affective way to contain the rise of the undead is to hit hard and hit often. As seen in the movies, it is imperative that zombies are dealt with quickly, or else we are all in a great deal of trouble."

.

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Ordering viagra online, On Friday, the Department of Justice ended its  investigation of the 2001 Anthrax attack, which killed five, sickened 17, disrupted postal service, and caused the evacuation of a Senate building.  In order to bring closure to what has been a much-questioned and controversial investigation, the Department issued an investigative summary, along with tons of additional documents, some requested by FOIA requests.  The nearly 3000 pages of documents can be found at: http://www.justice.gov/opa/pr/2010/February/10-nsd-166.html. Arkansas AR Ark. , According to a press release issued by the Department:

The Amerithrax Task Force, which was comprised of roughly 25 to 30 full-time investigators from the FBI, buy viagra online, Ordering viagra no rx, U.S. Postal Inspection Service and other law enforcement agencies, Vermont VT Vt. , Cheap viagra online, as well as federal prosecutors from the District of Columbia and the Justice Department’s Counterterrorism Section, expended hundreds of thousands of investigator work hours on this case, købe viagra online. Cheap viagra without prescription, Their investigative efforts involved more than 10,000 witness interviews on six different continents, buy cheap viagra online, For viagra online, the execution of 80 searches and the recovery of more than 6,000 items of potential evidence during the course of the investigation, comprare viagra. Viagra en ligne afin, The case involved the issuance of more than 5,750 grand jury subpoenas and the collection of 5, viagra online, Ordering viagra no prescription, 730 environmental samples from 60 site locations.

The conclusion of the report:  Dr. Bruce E, ordering viagra online. Ivins at the United States Army Medical Research Institute of Infectious Diseases ("USAMRIID") was the lone individual responsible for creating and mailing the "RMR-1029" anthrax-infected letters.  Ivins committed suicide in July 2008, order viagra online. Viagra for sale, The report includes two sections describing an early suspect, Dr, viagra farmacia a buon mercato. Idaho ID , Steven Hatfill, who "became widely known in August 2002 as a person of investigative interest."  The report spends a page and a half explaining why Hatfill was an early suspect and how he was eliminated through scientific breakthroughs.  The report contains no mention of the  apology and $5.8 million settlement Hatfill received from the government for being wrongly exposed as a suspect, Alaska AK . Goedkope viagra apotheek, The report lays out what would have been the government's case against Ivins if he had lived.  First, it discusses "opportunity, buy viagra online without prescription, Kjøpe viagra online, access, and ability, order viagra online cheap, Order viagra online, " noting that:

• RMR-1029 was the source of the weapon and originated from Ivin's flask


• Ivins had suspicious lab hours just before the Anthrax was mailed


• Other suspects who could have accessed RMR-1029 have been ruled out

In terms of Motive, the report notes:

• Ivins life's work appeared destined for failure, online viagra, Ostaa halvalla viagra, absent an unexpected event


• He was increasingly being criticized for his efforts


• He felt abandoned in his personal life

The report then assesses his mental health before proceeding to evidence that revealed that the envelopes used were sold at a post office in Maryland/Virginia and included language that was similar to the writings of Ivins.  The report then said that Ivins acted suspiciously and took many actions that suggested he had a guilty conscious.  It also noted that he had a habit of using false identities and ended with evidence showing the letters had been mailed from Princeton, NJ, across from a sorority for which Ivins had a "long-standing obsession...dating back 40 years."

Not everyone appears satisified with the report.  Congressman Rush Holt, who has introduced the Anthrax Attacks Investigation Act of 2009, stated that "Arbitrarily closing the case on a Friday afternoon should not mean the end of this investigation," adding that the "evidence the FBI produced would not, I think, stand up in court."

Holt has long been a critic of the investigation and his legislation, which had been introduced in previous years, would establish a Congressional commission to investigate the 2001 anthrax attacks and the federal government's response to and investigation of the attacks.

While it is not clear that the legislation is needed to review a single investigation, especially nine years after the fact, it is clear that the government should have a systematic approach for dealing with a biological attack, whether committed by a sole actor or a terrorist organization.  The report issued by Justice does not explain what has been done on the preparedness and response side to assure that U.S. officials are prepared.  Its release, however, does give the Departments of Homeland Security and Health and Human Services opportunities to highlight their efforts on the biosecurity front.  If those efforts are not enough and more needs to be done, then now is a good as time as ever to start pushing biopreparedness and response.

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Yesterday Senators Lieberman and Collins, chairman and ranking member of the Senate Homeland Security and Governmental Affairs Committee, introduced  the Weapons of Mass Destruction Prevention and Preparedness Act of 2009. Senator Lieberman explained, "Our bill would strengthen security at labs using the most dangerous pathogens, improve our capabilities to assess the threat of terrorists acquiring WMD, ensure that citizens get critical safety information, and develop a means for quickly delivering life-saving drugs to areas that have been attacked." According to a joint statement available on the Senate Committee's website, the legislation would also,

• Require HHS to designate the most dangerous pathogens which have significant potential to be used effectively in a biological attack.
• Require DHS to set new security standards for labs using the most dangerous pathogens, including risk assessments, personnel reliability programs, and staff training.
• Require a national strategy for dispensing antibiotics and other medicines to the public and expand a pilot program for using the Postal Service to dispense them. 
• Require communications plans to convey instructions to the public – including whether to evacuate or shelter-in-place – in the critical moments after an attack.
• Support a National Bioforensics Analysis Center to identify the perpetrator of a WMD attack rapidly. 
• Provide personal medical kits to emergency responders in order to enable them to respond quickly to a WMD attack without jeopardizing their own safety. 
• Require DHS and the Federal Bureau of Investigation to provide better terrorism threat and risk assessments to the public.
• Promote citizen and community preparedness for WMD attacks, including by authorizing grants to States.

The  bill is not yet available via the Thomas website. The Senate Committee's website  provides a pdf of  the proposed legislation.

In the Washington Post's Saturday Style section Brigid Schulte brings us a great feature story on the down-and-dirty of catching H1N1.  She packs alot of facts into a  personal context.  Read her story at How, Gulp! You Get Sick. This week the CDC released child care guidelines. Friday the Pan American Health Organization released a new regional update on H1N1 infection. Friday's Wall Street Journal had a good update on vaccine development: Swine flu remains mild as vaccine advances.

On September 1 there was a White House afternoon meeting focused on H1N1.   It was a gorgeous day in DC.  After the meeting the President offered some comments to the media in the Rose Garden.  In my judgment his most helpful comments were,

And most importantly we need everyone to get informed about individual risk factors, and we need everyone to take the common-sense steps that we know can make a difference. Stay home if you're sick. Wash your hands frequently. Cover your sneezes with your sleeve, not your hands. And take all the necessary precautions to stay healthy. I know it sounds simple, but it's important and it works. Finally, for people who want to learn more about this virus, please go to www.flu.gov, or talk to your doctor.

It is a good example of management discipline that the President brought together his generals:  Napolitano, Brennan, the secretaries of Education, Commerce, Health and Human Services and the CDC Director as the influenza "battle season" begins.  If any other more specific purpose was being advanced, no one is  telling me. (Politico has a video of the Rose Garden remarks (after an annoying ad).) (YouTube: Lynne Anderson singing, I Never Promised You a Rose Garden)

"This report is being read very carefully."  That's what John Brennan said about the PCAST's H1N1 study released yesterday morning.  I assume you have already heard or seen the headlines full of worst-case numbers. You, too, can give the 64-page document a close read. Here it is: Report to the President on US Preparations for 2009-H1N1 Influenza (a bit more than 2 megs). After reading  I hope you can correct a couple of my key take-aways.  It was late (or actually, early) and I was grumpy while reading, so I probably missed something important.  First, it is unlikely that a vaccine will be available early enough to be of much help.  And other means of medical mitigation are more case-based than population-based. Here's a quote from the report,

The fall resurgence may well occur as early as September, with the beginning of the school term, and the peak infection may occur in mid-October. But significant availability of the 2009-H1N1 vaccine is currently projected to begin only in mid-October, with several additional weeks required until vaccinated individuals develop protective immunity. This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious disease.

Second, the report's authors seem conflicted regarding the principal means of non-medical mitigation. Another quick quote:

A key element in mitigating the spread of an epidemic is compliance with social distancing measures—for example, staying home from work or school or avoiding public gatherings such as concerts or sporting events when ill. However, compliance is unlikely when economic or other disincentives punish individuals for these behaviors. It is critical that appropriate Federal officials take the lead in identifying these disincentives and removing or minimizing them. Since immunizing large segments of the popula­tion likely cannot be completed before late November or early December, the use of social mitigation measures may represent the most effective means for reducing transmission of virus in the fall when it is spreading most efficiently.

Actually, that paragraph -- by itself -- seems stronger because it is taken out of context.  The tone of the whole report left me with a sense that support for aggressive social distancing is squishy.  The reluctance I read between-the-lines may emerge from the PCAST’s entirely reasonable preference to impose a social distancing strategy only when and where there is clear empirical evidence for doing so. But as the report also notes, a key shortcoming in national preparedness for pandemic,

... is the lack of a rapid system for assembling detailed clinical data on severe cases that can provide a statistically adequate and continuously updated picture of risk groups and clinical course. Current systems rely on non-standardized reports from local health departments and on peer-reviewed case series, which are slow to become public.

Even if the existing disincentives to social distancing can be minimized in the next few weeks -- which strikes me as less than likely -- we don't have a surveillance and reporting system sufficient to make fine-tuned strategic interventions. So... where does that leave us? Interested in your take-aways.  More background: Press Secretary's positioning of the PCAST report President's Council of Advisors on Science and Technology Surveillance and studies during a pandemic (European Centre for Disease Prevention and Control) Epidemiology of fatal cases associated with H1N1 (Eurosurveillance) City has closed mind on closing schools (Juan Gonzalez, Daily News) While written before the PCAST report was publicly available, this Washington Post indepth piece is relevant: Flu strategists see schools on the front line.

An H1N1 vaccine is unlikely to be ready on time -- or in sufficient quantity -- to have much impact on its spread this fall.  Tom Randall with Bloomberg reports, "Just 45 million of 195 million doses ordered for the U.S. will be delivered by mid-October, said health officials who lowered their estimates yesterday. The vaccine will probably require two shots given three weeks apart, and the body won’t produce antibodies for two additional weeks, according to an Aug. 7 report by the Department of Health and Human Services." “'This has been a virus that’s been smoldering, particularly among children at the many summer camp outbreaks,' said William Schaffner, of the Vanderbilt University School of Medicine. 'There’s no doubt it’s coming, and we could see it as early as September. Every pediatrician, internist and public health official is cross-eyed' with worry, he said." Shortfall expected in US swine flu vaccines (AFP) US tries to counter some delay in swine flu shots (AP) US government to advise businesses on swine flu (Reuters)

The Erasmus University Medical Center in the Netherlands, in cooperation with Ranj Serious Games, has produced an online game focused on preventing, mitigating, and responding to pandemic. It's a great idea reasonably well executed.  If you are on broadband you can access the game at http://www.thegreatflu.com/.  Don't try unless your connection is solid and speedy. According to the game-makers website, the goal of the game is "to increase the awareness and the level of knowledge about viruses and the complex way viruses spread and evolve."  The Great Flu is fundamentally a strategy game where you deploy assets in anticipation of or in response to emerging events. You decide what and where you should invest and you only have so much budget, so every choice begins to limit future choices. If you make bad choices the number of infected and dead increase more rapidly.  If you make good choices body-count slows and the spread across the planet can even be stopped. Here are some of your action options and their cost.  You have a budget of 2 billion Euros at the start of the game.

• Distribute face masks: 7 million Euros
• Improve health care: 20 million Euros
• Close schools: 10 million Euros
• Close markets: 5 million Euros
• Close airports: 250 million Euros
• Isoloate symptomatic individuals: 80 million Euros
• Establish early warning system: 100 million Euros
• Inform civilian:s 5 million Euros
• Improve research facilities: 200 million Euros
• Stockpile vaccine type A: 120 million Euros
• Stockpile vaccine type B: 120 million Euros
• Stockpile antiviral medicine: 100 million Euros

The game is slow to load and is mostly a visually enhanced interactive spreadsheet.  By adjusting variables in one cell you impact other cells.  Anyone who has played around with "dynamic" budgeting knows the basic drill. The key to winning, if it can be called that,  is timing.  Early investments in research, surveillance, and basic health care will pay big benefits.  The timing of where and when to stockpile vaccines and antivirals can get complicated and expensive.  In this game, you are more likely to lose than win.  And most "wins" still involve lots of disease and death.  So does Grand Theft Auto.  In managing a pandemic, so does the real world. On Thursday Treale Fristoe, a thoughtful critic of gaming, complained that, "It takes quite a while before the virus even appears, during which time the player can do nothing but wait (or quit, which I expect many players would do)."  This is not precisely true.  Because I know something about pandemic mitigation, I started deploying assets before there were any disease reports.  But there is no way most players will realize this.  Otherwise I agree with Fristoe's balanced critique of what is good and bad in the game. Fristoe  hightlights the need for a tutorial.  Even more helpful would be a user-friendly backgrounder.  Most gamers don't mind losing.  In fact many find losing motivational.  But then they want some clues to doing better.  That would be a great moment to have easily available a user-friendly primer on pandemic preparedness... including washing your hands. I bet the budget for The Great Flu was under $200,000 and I wouldn't be surprised if it was designed and delivered in less than nine months (six months?).   The return on investment will be high.  It would have been even higher with a bit more investment.  Just as in fighting a pandemic.

-+-

For the last ten years, until my semi-retirement last June, I was CEO of a small company that developed, among other things,  "serious games" for corporate, defense, and homeland security clients.  So I am biased, but this approach to public information and public education has enormous potential when it is done right.

In a recent discussion with the USA Today editorial board, Secretary Napolitano said:

You can speculate about a 1918-type situation, (but) the data suggest that we will have an outbreak more similar to what happened in the '50s, or perhaps what happened in 1968. I prefer that we educate people about what we are more likely to experience: a heavy outbreak in the fall that has a focus on young people, including college-age and pregnant women. Then, we will focus on what we need to do to work our way through that, such as keeping schools open as much as possible.

That's entirely reasonable, given what we know about the virus today -- especially given how H1N1 is presenting in the Southern Hempishere during the winter flu season there.  With rather rare exceptions, the new virus has been no more virulent than the seasonal flu of recent years. But is the Secretary's tone potentially too reasonable?  Focusing on those germ-factories -- otherwise known as schools -- makes a lot of sense.  Great gobs of written guidance has been made available to school administrators.   This is even more important than usual given the youth-oriented targeting of this virus. Most confirmed cases have involved  individuals 19 years of age and younger. (See the European Centre for Disease Prevention and Control H1N1 Risk Assessment) But none of the teachers or school administrators I know had seen or heard of the pandemic plans until I sent them along.  In a joint op-ed published yesterday, Secretaries Duncan, Napolitano, and Sibelius (the three bears?) encourage,

Parents should talk to their employers and make child care arrangements in case their kids get sick. And if a school closes, learning shouldn’t stop. Schools need to create opportunities to learn online and work with parents to find ways for students to bring textbooks and other resources home.  If you’re an employer, you should plan to get by with a reduced staff. You don’t want an employee who’s ill to spread flu in the workplace. If you’re a medical provider, you should plan to handle more calls and patient visits."

All good advice.  Is anyone listening? At the NAFTA summit John Brennan, Deputy National Security and Assistant to the President for Homeland Security and Counterterrorism, was considerably more severe in his tone:

“I think everybody recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die... The strategy and the effort on the part of the governments is to make sure we do everything possible and we collaborate to minimize the impact, and make sure that the severity of the illness is kept at a minimum.”  (More by Sam Youngman at The Hill)

What's included in "everything possible"?  Some are expressing concern. In late July CNN reported on some DOD contingency planning for something more than a plus-up of the seasonal flu.  Earlier this week Fox  News reported that the prospect of military involvement in an H1N1 response is prompting angst from both left and right.  Well, someone is listening. But they are talking about the constitution, not the contagion.  This suggests a fully functioning civil immune system.  Glad to see it and we are probably in for a veritable explosion of libertarian white blood cells. According to Josh Gerstein at Politico, "The Obama administration is quietly dusting off an effort to impose new federal quarantine regulations, which were vigorously resisted by civil liberties organizations and the airline industry when the rules were first proposed by the Bush administration nearly four years ago." (See the current Executive Order 13295) Depending on our personal angles, any of us can quibble with what is being said or proposed or planned.   My quibble is for a bit more of John Brennan's growl and a bit less of Janet Napolitano's reassurance.  But my "just right," is probably too hard or too soft for you. The biggest challenge today is less a matter of what is being said than what is being heard.  I don't perceive many are listening.

• Access the school recommendations.  Please pass them along.
• Access the workplace recommendations. Please pass them along.
• Access the family preparedness recommendations.  Print them out.  Read them.  Give them to your loved ones.  Talk about the recommendations.  Take action.

Do what you can today to be better prepared whatever unfolds over the next few weeks.  Otherwise, an unexpected mutation in the virus could have us all sounding like the end of the story: "Goldilocks woke up and saw the three bears.  She screamed, "Help!"  And she jumped up and... ran away into the forest."

Yesterday the New York Times editorial board highlighted an urgent homeland security threat.  I am not pointing to their second piece, Chemical Plants Could be More Safe.  While undoubtedly a real risk, as far as we know there is no actionable intelligence on plans to attack US chemical facilities. Tuesday's lead editorial in the Times is entitled, "States in Distress."  It outlines consequences of $143 billion in state budget cuts.  In twenty-one States public health funding has been among the biggest losers. There is actionable intelligence, known vulnerabilities, a specific threat sequence, and potentially ominous consequences for an Autumn pandemic.  Despite this we are accelerating a process of public health disarmament. The Illinois public health budget has been cut 25 percent and further cuts are threatened.   At one point in late July the Illinois budget  had zeroed out funding for infectious disease surveillance.   Heroic last minute efforts restored the money, but there is still a huge budget deficit to close and the public health budget is still at risk. In Sacramento County, California the public health department's budget has been reduced from $9.8 million in 2007-2008 to $5.1 million this year.  The number of county  public health positions has been reduced by one-fourth.  More cuts are possible as the County attempts to adjust to  reduced State funding. On July 27 the Chief Justice of the West Virginia Supreme Court noted in a judgment against the State's Department of Health and Human Resources, "I conclude that DHHR's ability to adequately comply herein with its legal obligation was caused not by any desire of a DHHR employee or administrator to do so, nor by the best efforts of DHHR employees and administrators, but rather by the continuing lack of requisite resources which DHHR receives to meet its mission. There is only so much that dedicated DHHR personnel can accomplish without adequate resources. I am deeply troubled and concerned about this continuing resource problem _ a problem which I sense may be worsening and may be becoming systemic." The same could be said for a whole host of public health departments and functions across the United States.  Committed professionals are doing their best with less and less.  But  budget reductions, staff cuts, and distraction undermine the fundamental capacity of even the most dedicated professional organization. Yesterday Secretary Napolitano highlighted the lag-time and increased vulnerability between the beginning of school -- late this month -- and the hoped-for availability of an H1N1 vaccine in mid-October. Yesterday news reports suggested a possible pattern of H1N1 resistance to Tamiflu in Southern Texas. (See possible correction from CIDRAP).  Yesterday other news reports seemed to confirm that H1N1 had evolved a resistance to Relenza.  Perhaps H1N1 will ultimately prove to be no more than a tweak of the seasonal flu. It could also be considerably worse.  We don't know.  There is no way to be certain.  But H1N1 is not the only threat  requiring ongoing care by public health professionals. Precisely because of the uncertainty, this is the time  to reinforce our front lines of surveillance and defense.  Instead we are reducing our troop levels, withdrawing our artillery, grounding our planes, and moving our ships into drydock. In considering the current situation of our State and local public health capacity the analogy of a bio-medical Munich  -- or at the very least, a kind of summer Sitzkrieg -- is hard to avoid. UPDATES: Inside the fight against a flu pandemic (TIME) California nurses say swine flu training, protections inadequate (Mercury News) Some measures won't help prevent flu pandemic: report  (Reuters) Public Health and Medical Responses to the 1957-58 Influenza Pandemic (UPMC-Center for Biosecurity) WHO sees swine flu vaccination from next month  (Reuters)

Yesterday the House Armed Services Committee, Subcommittee on Terrorism, Unconventional Threats and Capabilities heard testimony on chemical, biological, radiological, nuclear, and high-yield explosives(CBRNE)  consequence management.  (See and hear the video.)  David Heyman, DHS Assistant Secretary for Policy, set out the CBRNE threat.  Reviewing a list of recent events, Heyman concluded, "We can no longer discuss risk abatement of chemical, biological, and nuclear/radiological attacks as if these types of attack are unthinkable or undoable. U.S. intelligence, and the most recent intelligence around the world, continue to report that terrorists are intent on acquiring CBRNE weapons for use against the United States." There is a brigade-size federal active duty element allocated to NORTHCOM as a "CBRNE Consequence Management Response Force"  a/k/a CCMRF. A second brigade is scheduled to be in place by October.  A third by October 2010.  While specializing in CBRNE threats, the same forces could be deployed in response to a variety of events. In his prepared testimony, General Victor Renuart, the USAF four-star who heads NORTHCOM, explained, "CCMRF is a task force (approximately 4,700 people) that operates under the authority of Title 10. CCMRFs are self-sustaining and may be tailored to any CBRNE event. A CCMRF is composed of Army, Marine, Navy and Air Force units with unique CBRNE training and equipment and general purpose units trained to operate in proximity to a hazardous or contaminated environment. CCMRF capabilities include event assessment, robust command and control, comprehensive decontamination of personnel and equipment, HAZMAT handling, air and land transportation, aerial evacuation, mortuary affairs, and general logistical support to sustain extended operations.” In October 2008 the American Civil Liberties Union initiated a FOIA request that raised several concerns regarding the CCMRF, including, "The deployment of CCMRF marks the first time an active military unit has been given a dedicated assignment to Northern Command, which was established in 2002 to assist federal homeland defense efforts and coordinate support of civil authorities. It raises important questions about longstanding separation between civilian and military government within the United States -- a separation that dates to the Nation's founding and that has been reiterated in landmark statutes, most importantly, the Posse Comitatus Act 18 U.S.C. Para. 1385."  The Posse Comitatus Act forbids federal troops to be deployed with police powers. Following Hurricane Katrina an effort to significantly weaken the Posse Comitatus Act  was initially successful, but the legal changes were subsequently overturned in 2008. The current language is the same originally adopted by Congress in 1878.  The potential life-saving and order-restoring capacity represented by the CCMRF is widely recognized.  The use of active duty federal troops for this purpose is seen by some as a creeping militarization of the home front. At yesterday's hearing the Congressmen -- of both political parties -- kept coming back to "who's in charge?"  About nineteen minutes into the hearing, Mr. Smith, the subcommittee chairman, interrupted an explanation of HSPD-5's intricacies, asking, "Does anyone of those groups have the lead?"  If there's a real catastrophe, what's the real chain-of-command? It is a good question.  The answers, of course, are variations on "Well, it depends."  As the hearing proceeded -- maybe because of the provisional answers offered -- the questions were increasingly directed to General Renuart.  The implicit assumption seemed to be: the man in uniform will be in charge.  Encouraging this impression is a principal reason why uniforms are worn.   If the General is in charge, then who's in charge of the General? The prepared testimony of each witness was constitutionally restrained: federal forces will be deployed at the request of Governors to support civil authorities. The  protocols of HSPD-5 and the National Response Framework will ensure effective collaboration across roles and responsibilities.  But what about when local civil authority has been overwhelmed by the catastrophe? About half way through the hearing Congressman Kline began his inquiry by stating, "I am still, sort of grappling -- and I think all of us are at one level or another -- with the fundamental question of who's in charge."  The Congressman then reviewed a variety of National Guard and DOD assets and asked, "When are these forces federal, when do they work for the state, when do they work for the Governor, when do they work for the General?" The General responded, appropriately and accurately, well... it depends. A bit later Congressman Miller, asked what happens, "if the Governor and the local officials don't get it; they absolutely have  become overwhelmed -- as they did with Katrina -- and don't make the call (to the President) quick  enough?" There was a pregnant pause before the General responded.  "Well, Mr. Miller, I think  the President ultimately has a responsiblity for the nation to make a determination of the speed at which some event is unfolding.  That is not a NORTHCOM decision.  My role is to ensure that, if I'm asked, to be sure that I have all the pieces in place to be supportive.  So I would defer to the national leadership to make a policy decision as to the ability of an individual state. That's really not mine to call." I expect the General's answer is accurate... even in its  opacity.  Is it an appropriate answer? In terms of civil-military authority, certainly yes.  In terms of constitutional balance of powers? Probably not. Funny how the Tenth Amendment can suddenly rise up as if from the dead:  "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." General Renuart is a practical man.  He wants to do his duty.  In a time of crisis he will be prepared to render protection and care.  How can we allow him to do so with confidence while preserving the practical benefits of local capacity and the constitutional protections of state sovereignty? The hearing was rather chaste in exposing the Tenth Amendment issue, but the bare skin was there for all to see.  Whether titilating or horrifying probably depends on your taste. Buried in the prepared testimony -- never referenced in open session -- was an interesting suggestion for how we might restore some constitutional  modesty and, even perhaps, some honest dignity.  More on this in a Friday post. UPDATE: A July 30 New York Times editorial entitled: The military is not the police.

The H1N1 virus is sweeping the Southern Hemisphere.  According to the July 9 edition of  New Scientist, "H1N1 virus seems to be replacing the seasonal flu viruses that circulated till now - classic pandemic behaviour. This raises concerns that seasonal flu vaccine, which some companies are still making, may be useless when the northern hemisphere's flu season arrives later this year." Australian public health authorities are reporting 60 to 90 percent of flu cases are due to the H1N1 virus, depending on the region. This morning's Daily Telegraph of Sydney headlines, "Swine flu threatens to wipe out workforce."  The report continues, "Health authorities have lost the battle against swine flu, conceding it now makes up about 60 per cent of all influenza cases. And it is only going to get worse as businesses already feeling the impact brace for bigger numbers in staff absenteeism... It is expected to be the worst flu season on record with numbers expected to skyrocket in coming weeks. Health experts yesterday warned workplaces will be hard hit with every worker off at least twice this winter with flu symptoms. Currently 100 out of every 1000 workers are off sick - an increase of 20 per cent from last year..."  Argentina is facing a similar situation, where the Buenos Aires Herald's headline reads, "Argentina almost paralyzed by H1N1."  While mortalities remain at or below averages for seasonal flu, the New Scientist report, above, suggests we should not depend on this continuing. (See WHO map of H1N1's current scope and impact.  See July 6 WHO case count by nation.) White House Flu Summit Yesterday, calling in from the G8 summit in Italy to the Flu summit in Maryland, the President warned, "It's clear that although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak, that the potential for a significant outbreak in the fall is looming.... We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation. And the most important thing for us to do in this process is to make sure that state and local officials prepare now to implement a vaccination program in the fall, but also that they are working on an overall public communications campaign with the White House and the possibilities that we may need to be dealing with schools that are seeing significant outbreaks of H1N1." "And we've looked at past cases of this being properly handled and situations like this being improperly handled, and one of the most important differences is where it's well handled, state and local officials have complete ownership over this issue, they are providing good ideas to the federal government, they are critical links to inform us what's working and what's not..." (Underline by Philip Palin.) "We may end up averting a crisis. That's our hope. But I think that if we are all working together in a thoughtful, systematic way based on the best science possible, that even if this turns out to be a serious situation, we can mitigate the damage and protect our neighbors and our friends and coworkers." (The President's complete remarks and a video of the flu summit are available from the White House blog. More information on the Flu Summit and related is available from www.flu.gov) Nurturing Resilient Readiness and Response In late August last year, HSPD-21was released as policy guidance.   It states, "The four most critical components of public health and medical preparedness are biosurveillance, countermeasure distribution, mass casualty care, and community resilience." Biosurveillance systems are tracking H1N1.  Countermeasures, such as Tamiflu, have been distributed. Mitigation measures, such as social distancing, were seriously exercised in several jurisdictions during the initial outbreak.  A new vaccine is under development, but may not be ready in time.  Mass casualty care and community resilience are not sufficiently ready.  In fact, the media frenzy combined with the  mild outcomes of the initial H1N1 outbreak may have undermined resilience efforts. Yesterday's Flu Summit was an effort to kick-start serious and sustained attention to resilience for the second wave of the contagion coming this fall/winter. HSPD-21 describes community resilience as the "demand side" of a health emergency, "Where local civic leaders, citizens, and families are educated regarding threats and are empowered to mitigate their own risk, where they are practiced in responding to events, where they have social networks to fall back upon, and where they have familiarity with local public health and medical systems, there will be community resilience that will significantly attenuate the requirement for additional assistance." (The complete text of HSPD-21 is available from the Department of Homeland Security.) Unfortunately, the work to nurture community resilience had barely begun, was delayed by the change in administrations, and has been further complicated by the economic recession. Assuming we have about 100 days before H1N1 returns with some vengeance,  to what would you give priority in building community resilience? Additional coverage of yesterday's Flu Summit and related reports: H1N1 threat has not passed (FoxNews) Mass campaign against pandemic may begin in fall (Washington Post) Obama warns of return of swine flu in the fall (New York Times) Swine flu summit focuses on preparedness (Atlanta Journal Constitution) Swine flu vaccination program may target schools (WebMD) Swine flu's life cycle defies traditional pattern (Miami Herald) Businesses hit as swine flu takes over (Australian Broadcasting Corporation) More swine flu coming our way (The Times, South Africa) Special powers in Chile to drive down H1N1 cases (MercoPress) Remarks by Secretary Napolitano on HSPD-5 and H1N1 (DHS release)

Despite the end of flu season in the Northern Hemisphere, the incidence of H1N1 continues to increase.  Over 1 million Americans are now estimated to have the virus. Several jurisdictions, including Washington D.C. and Wisconsin, are seeing an unusual number of cases of summer flu linked to H1N1. In the Southern Hemisphere, the H1N1 virus is displacing the former seasonal strain.  Late yesterday the Buenos Aires region joined four other Argentine provinces in declaring a health emergency.  Schools  have been closed and other social distancing tactics are being implemented. Argentina's response to the virus has been delayed and complicated by a national political campaign that concluded with an election on Sunday.  (More from the Buenos Aires Herald) The Center for Infectious Disease Research and Policy has released a helpful round-up of good practice guidance for pandemic preparedness.  The Pennsylvania Department of Health is offering workshops to help businesses prepare for pandemic. Every Friday the Centers for Disease Control and Prevention update US laboratory confirmed cases of H1N1 at its FluView website. UPDATE: Good late Wednesday overview of the situation in the Southern Cone from the Associated Press.

A sharper version of this H1N1 distribution map is available at the WHO website. The World Health Organization -- as long expected -- has declared a Phase 6 pandemic. It is a breaking story with plenty of coverage, including from the BBC, New York Times, and the WHO itself (a bit delayed). UPDATE:  At about 1:00 eastern Dr. Margaret Chan, Director-General of WHO, offered a public explanation of  the Phase 6 Declaration. "This particular H1N1 strain has not circulated previously in humans. The virus is entirely new. The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries. This is only part of the picture. With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place. Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable." Within 60 minutes of Dr. Chan's news conference, DHS and HHS released a joint statement from Secretaries Napolitano and Sebelius.  “Today’s decision by the WHO was expected and doesn’t change what we have been doing here in the United States to prepare for and respond to this public health challenge. Once we saw how fast this virus was spreading, we activated our pandemic plans and started doing all the things we needed to do to keep the public as safe and secure as possible,” said Secretary Sebelius. “What this declaration does do is remind the world that flu viruses like H1N1 need to be taken seriously. Although we have not seen large numbers of severe cases in this country so far, things could possibly be very different in the fall, especially if things change in the Southern Hemisphere, and we need to start preparing now in order to be ready for a possible H1N1 immunization campaign starting in late September.” The Wall Street Journal is reporting that, "full pandemic flu vaccine production will start in two weeks." Several media organizations clearly had stories pre-loaded for the long-delayed and long-expected announcement.  As a result, most of the  early reports are measured in tone.  The most serious concern is focused on how the H1N1 virus might mutate during the Southern Hemisphere's flu season that is just beginning.  Early reports from Chile indicate that H1N1 is crowding out older versions of the seasonal flu.