US embassy cable - 05COLOMBO1993

UNCLAS SECTION 01 OF 04 COLOMBO 001993 
 
SIPDIS 
 
STATE FOR OIE DANIEL SINGER AND REBECCA S DALEY 
STATE FOR SA/INS 
 
E.O 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, ECON, CE, Avian Flu, MIssion Security 
SUBJECT:  SRI LANKA:  AVIAN FLU TRIPWIRES 
 
REF: A) COLOMBO 1592, B) COLOMBO 1992 
 
1.  US EMBASSY COLOMBO'S TRIPWIRES AND POSSIBLE ACTIONS 
FOR VARIOUS AVIAN INFLUENZA (AI) SCENARIOS WERE PREPARED 
BY POST'S AVIAN INFLUENZA WORKING GROUP (AIWG) AND HAVE 
BEEN APPROVED BY THE EMERGENCY ACTION COMMITTEE (EAC). 
WE INVITE AND WELCOME FEEDBACK FROM RELEVANT OFFICES AND 
AGENCIES WITH EXPERTISE IN EMERGENCY PLANNING AND/OR 
INFLUENZA. 
 
2.  POST'S FOREIGN SERVICE MEDICAL OFFICER, ECONOMIC 
OFFICER, CHIEF OF CONSULAR SECTION AND AID HEALTH AND 
HUMANITARIAN ASSISTANCE PROGRAM OFFICER ARE MEMBERS OF 
THE AIWG.   IN ADDITION TO CONSULTING WITH GOVERNMENT 
OFFICIALS AND MULTILATERAL REPRESENTATIVES (REFS A AND 
B) AND PREPARING THESE TRIPWIRES, POST HAS DISTRIBUTED 
AN ADMINISTRATIVE NOTICE TO ALL PERSONNEL REGARDING AI 
SYMPTOMS AND PREVENTIVE MEASURES.  THE CONSULAR SECTION 
HAS ALSO INCLUDED A LINK TO THE STATE DEPARTMENT AVIAN 
FLU FACT SHEET WITHIN ITS MEDICAL INFORMATION PAGE FOUND 
AT 
HTTP://SRILANKA.USEMBASSY.GOV/MEDICAL_INFORMA TION.HTML. 
THE AIWG WILL CONTINUE PLANNING FOR A POSSIBLE PANDEMIC, 
INCLUDING REFINEMENT OF PROGRAMS AVAILABLE TO EMBASSY 
PERSONNEL IN THE EVENT OF A PANDEMIC. 
 
KEY ASSUMPTIONS 
--------------- 
 
3.  THE AIWG HAS MADE THE FOLLOWING ASSUMPTIONS FOR 
PLANNING PURPOSES: 
 
THE CURRENT THREAT TO PERSONS IN SRI LANKA, AND USG 
PERSONNEL IN PARTICULAR, IS LOW.  NO BIRD HAS YET BEEN 
DIAGNOSED WITH AI IN SRI LANKA.  THE CONTINGENT RISK IS 
THAT H5N1 BEGINS TO TRANSMIT ACTIVELY BETWEEN HUMANS. 
RISK WOULD BE MANAGEABLE IF HUMAN-TO-HUMAN TRANSMISSION 
OCCURRED ONLY IN CASES OF EXTENSIVE INTIMATE CONTACT. 
TRANSMISSION BY CASUAL HUMAN-TO-HUMAN CONTACT WOULD 
REQUIRE RAPID ACTION TO PROTECT OUR PERSONNEL. 
 
THERE IS A LOW PROBABILITY THAT SRI LANKA WOULD BE AT 
THE CENTER OF ANY OUTBREAK OF HUMAN-TO-HUMAN AI 
INFECTION.  BUT IF CASUAL CONTACT WOULD RESULT IN AI 
INFECTION, SRI LANKA IS ONLY A SHORT AIRLINE FLIGHT AWAY 
FROM PROBABLE OUTBREAK CENTERS. 
 
SRI LANKAN MEDICAL FACILITIES ARE ALREADY NEAR CAPACITY 
EVEN WITHOUT AN EPIDEMIC OF ANY SORT.  MEDICAL FACILITIES 
WILL BE UNABLE TO HANDLE MORE THAN A FEW CASES.  THERE 
ARE NO ENTIRELY SUITABLE ISOLATION WARDS SHOULD H5N1 
HUMAN-TO-HUMAN TRANSMISSION BECOME HIGHLY EFFICIENT. 
 
DEPENDING ON THE SPEED OF A HUMAN-TO-HUMAN OUTBREAK, U.S. 
CITIZENS COULD BE QUICKLY CUT OFF FROM EVACUATION ROUTES. 
 
POST WOULD BE UNABLE TO OBTAIN ESSENTIAL MEDICAL AND 
BASIC SUPPLIES IN THE EVENT OF A CRISIS AND SHOULD 
STOCKPILE ADEQUATE PROVISIONS. 
 
TRIPWIRES AND RECOMMENDED ACTIONS 
--------------------------------- 
 
THE AMBASSADOR HAS APPROVED THE FOLLOWING TRIPWIRES AND 
POSSIBLE ASSOCIATED ACTIONS: 
 
4.  TRIPWIRE ONE:  Significant occurrences of AI 
transmitted from birds or other animals to other birds 
or animals emerge in Sri Lanka; no evidence of sustained 
transmission to humans.  (Note:  "Significant 
occurrences" include transmission to a population of non- 
migratory birds or animals within a geographically 
limited area or transmission in more than one area of 
the country.  "Sustained transmission to humans" is the 
transmission of disease beyond the situation where a 
single infected person transmits to another single 
person with whom he/she is in extremely close physical 
contact, e.g., sick child to mother. End Note.) 
 
POSSIBLE ACTIONS: 
 
- Restrict official and unofficial travel to affected 
areas, bird markets and similar facilities. 
 
- Reiterate current Center for Disease Control (CDC) 
recommendations regarding AI prevention: reinforce 
caution against consuming improperly cooked eggs or 
poultry meat as well as advise on proper handling of raw 
poultry products; advise people to avoid butcher or wet 
markets where poultry is prepared; consider issuing 
further recommendations regarding preparation or 
consumption of poultry. 
 
- Release a warning announcement to Mission personnel 
and a warden message to private US citizens and post the 
announcement on the website. 
 
- Hold a town hall meeting with the American community 
to discuss AI and other topics of interest. 
 
5.  TRIPWIRE TWO:  Any case of bird-to-human or animal- 
to-human transmission of AI in Sri Lanka 
 
POSSIBLE ACTIONS: 
 
- Restrict travel to affected areas. 
 
- Release a warning announcement to Mission personnel, 
a warden message to private US citizens and post the 
announcement on the website.  Information will include 
details of the episode, instructions on watching for 
signs and symptoms of avian influenza, triage criteria 
and the use of personal protective equipment. 
 
- Begin stockpiling water and canned goods to prepare 
for possible need to quarantine individuals returning 
from areas where human-to-human transmission may occur 
(i.e., prepare for Tripwire 3). 
 
- Instruct Embassy community regarding the medical 
response and Emergency Action Committee (EAC) Plan. 
 
- Begin regular communication with Overseas School of 
Colombo and/or other international schools used by US 
families at the embassy on their AI preparations and 
plans. 
 
6.  TRIPWIRE THREE:  Sustained human-to-human 
transmission occurs as evidenced by a cluster of cases 
in countries with regularly scheduled direct flights to 
Sri Lanka (e.g., China, India, Maldives, Thailand) 
 
POSSIBLE ACTIONS: 
 
- EAC discuss the possibility of requesting authorized 
departure of U.S. family members and non-emergency 
personnel. 
 
- Personnel who have frequent contact with the public will 
use protective gear including masks.  Visitors will be 
screened by appropriate Mission personnel by taking their 
temperatures as well as question them regarding recent 
travel history and history of respiratory and flu-like 
symptoms. 
 
- Restrict travel to affected countries. 
 
- Do not grant country clearances to non-emergency TDY 
personnel from or transiting affected countries. 
 
- Set up open-air facility on compound for medical triage. 
- Quarantine USG and Foreign Service National (FSN) 
personnel who are returning to Sri Lanka from affected 
countries for two weeks or for the predetermined time of 
virus incubation. 
 
- Order mandatory sick leave with enforced quarantine at 
home for any employee who shows any flu-like symptoms or 
has a family member with flu-like symptoms. 
 
- Issue a public announcement to private American citizens. 
 
- Continue communication with Overseas School of Colombo 
and/or other international schools used by US families 
at the embassy on their AI policies. 
 
- Establish daily briefings on AI status/cases with 
Ministry of Health or WHO. 
 
- Close American Center Library to public access until 
further notice. 
 
7.  TRIPWIRE FOUR:  Sustained human-to-human 
transmission in Sri Lanka 
 
POSSIBLE ACTIONS: 
 
- Provide emergency consular services only. 
 
- Possibly implement authorized departure.  EAC discuss 
ordered departure (on the assumption that the airlines 
will take passengers from countries where human-to-human 
transmission has occurred). 
 
- Consider implementing selective administrative leave 
for FSNs and for those Americans who remain at post. 
Those on administrative leave are instructed to self- 
quarantine to the greatest possible degree.  Consider 
other options for minimizing workplace exposure (e.g., 
teleconferencing).  Prepare a plan for minimal staffing 
should Tripwire 5 occur. 
 
- Order mandatory sick leave with enforced quarantine at 
home of any employee who shows any flu-like symptom or 
has a family member with flu-like symptoms. 
 
- Permit visitors embassy access for emergency purposes 
only. 
 
- Consider using designated space to isolate emergency 
personnel (those not on leave) to prevent risk of 
transmitting to families or to others who are on leave. 
 
- Personnel who have frequent contact with the public 
will use protective gear including masks.  Visitors will 
be screened by appropriate Mission personnel by taking 
their temperatures as well as question them regarding 
recent travel history and history of respiratory and flu- 
like symptoms. 
 
- Cancel local community gatherings until confirming 
there are no immediate further occurrences of cases in 
Sri Lanka. 
 
- Advise closure of Overseas School of Colombo and/or 
other international schools used by US families at the 
embassy.  Consider ordering American USG families to 
keep their children home from school. 
 
- Those personnel who are required to be in direct 
contact with potentially infected persons will be 
considered as candidates for antiviral prophylaxis. 
 
- Release a warning announcement to Mission personnel, 
provide a warden message to private US citizens and post 
the information on the website.  Information will 
include details of the episode(s) and advice on means of 
prevention. 
 
8.  TRIPWIRE FIVE: One or more Embassy or in-country 
personnel sustain human-to-human transmission 
 
POSSIBLE ACTIONS: 
- Order mandatory sick leave with enforced quarantine at 
home for affected personnel. 
 
- Initiate treatment of affected individuals with 
antivirals. 
 
- Those personnel who are required to be in direct 
contact with potentially infected persons will be 
considered as candidates for antiviral prophylaxis. 
 
- Release a warning announcement to Mission personnel, 
provide a warden message to private US citizens and post 
the information on the website.  Information will 
include details of the episode(s) and advice on means of 
prevention. 
 
9.  POST-TRIPWIRE DETERMINATIONS 
 
The AIWG will continue monitoring the situation and 
recommend to the EAC when particular threats are no 
longer substantial.  Advice from in-country contacts as 
well as medical and agricultural contacts worldwide will 
be used in forming such recommendations. 
 
LUNSTEAD