Nov 14

Written by: admin
11/14/2008 2:06 PM

The idea of stopping flu "at the border" has received almost uniformly bad reviews from public health experts. Once human to human transmission starts we won't be able to stop it by closing our borders, although we likely will cause the usual unintended consequences, like preventing vital personnel and supplies from getting to where we need them. At least if we do it in the usual ham handed way this administration is famous for. We learn via CIDRAP News that federal officials are still willing to give a "risk-based border strategy" (RBBS) a go, at least in the form of an exercise. Now, at least, the objective is vastly scaled down. It is just to slow spread enough to give a little extra time to prepare and "educate" the public:

Officials from several agencies recently converged on Miami's international airport to take part in a full-scale exercise of the federal government's risk-based strategy to slow the spread of a future pandemic influenza virus across US borders.
Christine Pearson, a spokeswoman for the US Department of Health and Human Services (HHS), attended the first day of the 2-day drill on Nov 5 and told CIDRAP News that, unlike previous tabletop discussions to test the risk-based border strategy (RBBS), the exercise at Miami included a real plane and actors who played the role of passengers in an airport setting.

"It provided a level of realism that we hadn't had in past exercises, which had mostly been facilitated discussions," she said.

The RBBS is a short-term strategy that the federal government will use in the initial states of a pandemic to delay the spread of the virus enough to afford officials a little extra time to educate the public on how to protect themselves from the disease, produce and distribute vaccine, and position medication and supplies, Pearson said. The strategy involves screening international air passengers to gauge if they are sick or have potentially been exposed to others who are sick with the pandemic virus.

The system would begin when it's clear that a pandemic influenza virus is spreading globally and would end as soon as the virus begins causing illnesses in the United States. (Lisa Schnirring, CIDRAP News)


Ideas like this often sound good at first but often don't survive closer scrutiny. The idea is to turn on the RBBS fast enough and uniformly enough (essentially at all the important international airports) that it can delay the pandemic seed from sprouting within US borders but not any longer so that it doesn't begin to become a hindrance rather than a help. What is likely is that the system will be too slow to start, not cover everything it needs to and too slow to stop. Once you put in place a mechanism for limiting travel and movement, local jurisdictions will be very reluctant to abandon it.

That's if it works. In fact we have no idea whether a system like that would have any meaningful slowing effect, or if it did, for how long. We know we can slow travel and the movement of goods and services. That part is certain. So there is a significant downside without a good fix on the upside.

Everyone will have their own ideas about this, of course. My view is that this is somewhere we shouldn't go. That's my version of travel restrictions for flu.

Cross-posted by revere at www.scienceblogs.com/effectmeasure

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