The Survivalist Returns
What's wrong with the CDC's new pandemic planning guide.
Read David Shenk's series on how to survive every kind of catastrophe here.
"Cascading consequences" is one of those elegant phrases that disaster planners use to refer to very bad stuff happening later on—hypothetical events that only occur as a result of other events and are therefore very difficult to predict and even more difficult to plan for. It's not the initial head-on collision, but the divorce resulting from the affair precipitated by the sense of worthlessness fueled by the lost job clinched by the rude insubordination fed by the frustration from the lateness from the traffic jam caused by the head-on collision.
If you're Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, and you're trying to figure out precisely how to react to a hypothetical human-transmissible form of the H5N1 "bird flu" virus, cascading consequences are what you live and breathe. Should you quarantine cities? Close schools? Restrict public transportation? What happens to a complex urban civilization when people, supplies, and services get arbitrarily derailed?
Last week, the CDC issued a comprehensive new "pre-pandemic planning" guide (PDF here) for communities that includes contingencies for five category levels of pandemic. In the mildest scenario, Category 1, communities would not be urged to do much beyond voluntary isolation of ill patients in their homes. In Category 5, the most severe, schools might be cancelled for months at a time, work schedules could be staggered, and public events banned.
The CDC guide is well-intentioned and clear, but it suffers from three profound problems. The first is a hindsight/foresight problem. Pandemics can't be tracked in advance with satellites and don't give off measurable wind speeds. In practical terms, as Gerberding has already acknowledged, we're going to have to assume the worst right away and make category distinctions months later. Sending the message now that we can nuance a pandemic—that we're going to be able to respond with anything less than a massive and coordinated effort—could end up spawning dangerous confusion.
The second, and larger, problem is that we simply do not know at this point which social measures will make things better and which will make them worse. School closures sound like a good idea, but they didn't protect any community during the last pandemic in 1918, and they don't work for seasonal flu. Furthermore, there are cascading consequences: What about the millions of kids who depend on schools for meals? What about the economic and infrastructure disruption from adults having to stay home from work? And if the virus seems to be hitting cities in waves and rolling around the country several times, when—exactly—do you re-open the schools?
The third and most important problem is what's missing from this CDC document: a vaccine endgame. The report is candid about vaccine being the best "countermeasure" and explicitly states that its strategy is to delay the epidemic "in order to 'buy time' for production and distribution of a well-matched pandemic strain vaccine." What it doesn't explain is why the federal government can't accelerate a vaccine program given the very real prospect that this could become the worst public-health crisis in nearly a century. "The government is moving way too slowly on the vaccine," says one pandemic expert involved in U.S. policy discussions. "We're on a five-year timeline and we need to be much more ambitious and aggressive. That's the one thing that could change this whole equation."
Where does this leave citizens? The Survivalist sees three separate courses of action.
1. Be a constituent.
We all need to pressure policy-makers to start a crash vaccine program.
2. Be a community citizen.
The CDC plan is a decent start and a vast improvement on past government efforts. But effective pandemic response will require extensive what-if conversations at every level of society—in the workplace, at the PTA, at the water-filtration plant. Do your part by imagining what your practical role would be and discussing it with colleagues and neighbors.
3. Be a survivalist.
If you're as worried about a pandemic as I am (and as Julie Gerberding is), take nothing for granted. Carefully game out your own family response: Could you manage to telecommute for several months? To the extent possible, every family should be prepared for some level of isolation, with necessary food, health, and entertainment supplies. In a pandemic scenario, social distance can slow down the spread of the disease and buy valuable time for a vaccine.