We’re bombarded with warnings about the next wave of the swine flu epidemic. I don’t know what this all means. Any thoughts are welcome! Other chapters in this series:
(2) Update: about the swine flu epidemic, 9 October 2009
(3) Is the Swine Flu pandemic being used to an excuse to expand government powers (UK edition)?, 14 October 2009
(4) Who to blame for the delay in producing the swine flu vaccine?, 4 November 2009
(5) More about the swine flu pandemic: about Cassandras, 26 November 2009
From Center for Disease Control CDC H1N1 forced quarantine docs leak, Zero Hedge, 2 September 2009 — Excerpt:
… it was only last week that the Massachusetts State Senate passed a law making it a relatively serious crime to refuse a mandatory vaccination or to break a quarantine order. This law also includes rather astounding violations of the 4th Amendment, including warrantless searches and seizures of property if deemed necessary in an ‘emergency’. This new Massachusetts law also included authorizations for illegal arrest without a warrant and of forced vaccination of the public. But the political activity is not limited to the states.
Yesterday Obama held meetings with senior cabinet officials regarding H1N1 ‘pandemic preparedness’ including HHS Secretary Sebelius. So this is not idle speculation. There is something going on here. Either the government knows something we do not, or this is the biggest hype since the dot com bubble.
- Valuable background reading
- Some handy forms for your pandemic police state
- The Daily Kos provides another perspective on this
- A detailed analysis by the ACLU
- Update: similar measures taken in the UK
- Articles about the 1918 pandemic
(1) Valuable background reading about the swine flu hysteria
- Pandemic preparedness (influenza), World Health Organization
- Wikipedia entry for the Model State Emergency Health Powers Act
- “Cops jump on swine-flu power: Shots heard ’round the world“, WorldNet Daily, 1 September 2009 — “Pandemic bill allows health authorities to enter homes, detain without warrant.”
(2) Some handy forms for your pandemic police state
None of these are from primary sources, so they might be fake.
- Florida Quarantine of Facility Order
- Florida Quarantine to Residence Order
- Florida Quarantine to Detention Facility Order
- Iowa Home Quarantine Order
(3) The Daily Kos provides another perspective on this
A series at the Daily Kos by DemFromCT about The National Response Framework And You, Fall 2007
- About the National Response Framework
- The 15 Emergency Support Functions
- Pandemic Flu Preparation and the Role of Internet Communities
- The National Response Framework And You
- The ACLU, Pandemic Preparedness, and You, 20 January 2008
(4) A detailed analysis by the ACLU
Executive Summary from “Pandemic preparedness“, American Civil Liberties Union, 14 January 2008 — “The need for a public health approach – not a law enforcement/national security approach.”
The spread of a new, deadly strain of avian influenza has raised fears of a potential human pandemic. While the virus is not easily transmissible to humans, were it to mutate to be more highly contagious to or between humans—a possibility whose probability is unknown—an influenza pandemic could occur.
Government agencies have an essential role to play in helping to prevent and mitigate epidemics. Unfortunately, in recent years, our government’s approach to preparing the nation for a possible influenza pandemic has been highly misguided. Too often, policymakers are resorting to law enforcement and national security-oriented measures that not only suppress individual rights unnecessarily, but have proven to be ineffective in stopping the spread of disease and saving lives.
The following report examines the relationship between civil liberties and public health in contemporary U.S. pandemic planning and makes a series of recommendations for developing a more effective, civil liberties-friendly approach.
Conflating Public Health with National Security and Law Enforcement
Rather than focusing on well-established measures for protecting the lives and health of Americans, policymakers have recently embraced an approach that views public health policy through the prism of national security and law enforcement. This model assumes that we must “trade liberty for security.” As a result, instead of helping individuals and communities through education and provision of health care, today’s pandemic prevention focuses on taking aggressive, coercive actions against those who are sick. People, rather than the disease, become the enemy.
Lessons from History
American history contains vivid reminders that grafting the values of law enforcement and national security onto public health is both ineffective and dangerous. Too often, fears aroused by disease and epidemics have justified abuses of state power. Highly discriminatory and forcible vaccination and quarantine measures adopted in response to outbreaks of the plague and smallpox over the past century have consistently accelerated rather than slowed the spread of disease, while fomenting public distrust and, in some cases, riots.
The lessons from history should be kept in mind whenever we are told by government officials that “tough,” liberty-limiting actions are needed to protect us from dangerous diseases. Specifically:
- Coercion and brute force are rarely necessary. In fact they are generally counterproductive—they gratuitously breed public distrust and encourage the people who are most in need of care to evade public health authorities.
- On the other hand, effective, preventive strategies that rely on voluntary participation do work. Simply put, people do not want to contract smallpox, influenza or other dangerous diseases. They want positive government help in avoiding and treating disease. As long as public officials are working to help people rather than to punish them, people are likely to engage willingly in any and all efforts to keep their families and communities healthy.
- Minorities and other socially disadvantaged populations tend to bear the brunt of tough public health measures.
The Problem with Post-9/11 Pandemic Plans
Current pandemic planning policies fail to heed history’s lessons. Since 9/11, the Bush Administration has adopted an all-hazards, one-size-fits-all approach to disaster planning. By assuming that the same preparedness model can be applied to any kind of disaster —whether biological, chemical, explosive, natural or nuclear — the all-hazards approach fails to take into account essential specifics of the nature of the virus or bacteria, how it is transmitted, and whether infection can be prevented or treated. Following this flawed logic, several state-based proposals have sought to address any “public health emergency,” ignored effective steps that states could take to mitigate an epidemic, such as reinvigorating their public health infrastructure, and instead resorted to punitive, police-state tactics, such as forced examinations, vaccination and treatment, and criminal sanctions for those individuals who did not follow the rules.
Specific pandemic flu plans have also been adopted by the federal government and nearly every state and locality. The plans are poorly coordinated and dangerously counterproductive. By assuming the “worst case” scenario, all of the plans rely heavily on a punitive approach and emphasize extreme measures such as quarantine and forced treatment. For example, the U.S. Department of Health and Human Service’s Pandemic Influenza Plan posits a “containment strategy” that calls for massive uses of government force, for example to ban public gatherings, isolate symptomatic individuals, restrict the movement of individuals, or compel vaccination or treatment.
Toward a New Paradigm for Pandemic Preparedness
This report calls for a new paradigm for pandemic preparedness based on the following general principles:
Health — The goal of preparing for a pandemic is to protect the lives and health of all people in America, not law enforcement or national security.
Justice — Preparation for a potential pandemic (or any disaster) should ensure a fair distribution of the benefits and burdens of precautions and responses and equal respect for the dignity and autonomy of each individual.
Transparency — Pandemic preparedness requires transparent communication of accurate information among all levels of government and the public in order to warrant public trust.
Accountability — Everyone, including private individuals and organizations and government agencies and officials, should be accountable for their actions before, during and after an emergency.
… The threat of a new pandemic will never subside. But the notion that we need to “trade liberty for security” is misguided and dangerous. Public health concerns cannot be addressed with law enforcement or national security tools. If we allow the fear associated with a potential outbreak to justify the suspension of liberties in the name of public health, we risk not only undermining our fundamental rights, but alienating the very communities and individuals that are in need of help and thereby fomenting the spread of disease.
Maintaining fundamental freedoms is essential for encouraging public trust and cooperation. If our public agencies work hand in hand with communities to provide them with a healthy environment, access to care, and a means for protecting their families, rather than treating them as the enemy, we will be far better prepared for a potential outbreak.
(5) Update: similar measures taken in the UK
Response by The National Council for Civil Liberties to the UK Department of Health’s proposed changes to the Mental Health Act of 1983 with regard to Pandemic Influenza, October 2009 — Excerpt:
(I.) The purpose of the consultation is to ensure the MHA can still operate effectively if the number of medical professional staff is reduced through illness during the swine flu pandemic. It states that the current planning assumptions are for a 10-12% rate of absence from work in the general population in the peak period of the pandemic and states that health and social care organisations as a whole have a high number of staff with childcare and caring responsibilities so the percentage of staff off work could be up to 25%. No references are given as to where these figures come from. Reference is made to the fact that front line health and social care workers will be offered the swine flu vaccine, yet any reduction in the number of those affected as a result of vaccination is not estimated in the consultation document.
(II.) In particular, the consultation proposes reducing from two to one the number of doctors required to approve the involuntary detention and forced treatment of a person. It also proposes removing the need for a second opinion doctor before a person is compulsorily medicated. In respect of people detained under Part 3 powers, who are in involved in criminal proceedings, it proposes suspending the time limits by which a person is admitted to hospital after a court order or conveyed to hospital etc (proposals are to amend over nine sections). It also proposes allowing people who do not have formal evidence of competency or the completion of training to be approved as those who can make certain orders under the MHA.
(III.) While we understand the Department of Health’s very real concerns about the impact a pandemic could have on our hospitals and the potential gravity of future swine flu outbreaks, we do not believe these proposals have been properly considered. A comprehensive public consultation response is also now unlikely given that the total consultation period is less than four weeks. While we understand the urgency of the perceived threat of swine flu, it is reasonable to imagine that the Government would have been planning contingency measures for a number of years for a pandemic of this sort given there have been other scares in the past (i.e. Bird flu, SARS etc) and that consultation on any such measures would have been published back in June when the pandemic was announced. It is also questionable whether the area of mental health is the only area in which changes like these would be necessary in the event of staff shortages due to the pandemic. Arguably prison services, police services, immigration facilities, remand centres etc would all be affected, yet as far as we know no proposals for change have been made in respect of these services. We are therefore unclear as to why the operation of the MHA has been singled out and we do not believe that the case has properly been made out to show that temporary measures of the kind proposed here are necessary. No evidence is given as to where the estimate of staff absenteeism comes from and it is not broken down into the relevant staff categories (i.e. doctors, psychologists etc).
(IV.) It is important to recognise the intrusiveness of the powers contained within the MHA. Depriving a person of their liberty and requiring them to undergo medical treatment significantly engages a person’s human rights. …
(V.) We are concerned that this rushed and seemingly ill-thought through proposed measure will have longer term implications that will outlive any swine flu pandemic. The use of such ‘emergency’ measures sets a worrying precedent when linked with NHS staff shortages. …
(6) Articles about the 1918 pandemic
(a) “Bacteria main cause of 1918 deaths“, Reuters, 6 February 2009 — A good non-technical explanation.
(b) “Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic“, John F. Brundage and G. Dennis Shanks, Emerging Infectious Diseases, August 2008 — Excerpt:
Deaths during the 1918–19 infl uenza pandemic have been attributed to a hypervirulent infl uenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. This sequential infection hypothesis is consistent with characteristics of the 1918–19 pandemic, contemporaneous expert opinion, and current knowledge regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria.
This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain–specifi c vaccine is unavailable or inaccessible to isolated, crowded, or medically underserved populations.
(c) “Transmissibility of 1918 pandemic influenza“, Keith P. Klugman, Christina Mills Astley, and Marc Lipsitch, Emerging Infectious Diseases, February 2009 — Excerpt:
Brundage and Shanks have studied time to death from the onset of influenza symptoms during the 1918 pandemic in military and civilian populations and found a median time to death of 7–11 days. They argue that these data support the idea that the deaths may be predominantly due to bacterial superinfection after the acute phase of influenza. We observed a similar 10-day median time to death among soldiers dying of influenza in 1918, a finding consistent with the time to death for a bacterial superinfection, specifically pneumococcal bacteremic pneumonia.
The major bacterial pathogen associated with infl uenza-related pneumonia in 1918 was Streptococcus pneumoniae. Neither antimicrobial drugs nor serum therapy was available for treatment in 1918.
(d) “Pandemic Payoff from 1918: A Weaker H1N1 Flu Today“, Christine Soares, Scientific American, November 2009 — Excerpt:
Although the swine flu outbreak of 2009 is still in full swing, this global influenza epidemic, the fourth in 100 years, is already teaching scientists valuable lessons about pandemics past, those that might have been and those that still might be. Evidence accumulated this summer indicates that the novel H1N1 swine flu virus was not entirely new to all human immune systems. Some researchers have even come to see the current outbreak as a flare-up in an ongoing pandemic era that started when the first H1N1 emerged in 1918.
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