Avian flu drill preps for possible scenario

Let’s pretend.

The first cases of a deadly new strain of avian influenza appear in Eastern Europe. In a few days, the wave of a building pandemic sweeps westward to London, skips across the Atlantic to New York — then shows up in Boston. Day by day, as the crisis multiplies, when and how does Harvard react?

The answer to that hypothetical question came on Monday (April 9) in a drill designed to test the Central Administration’s evolving pandemic plan, the blueprint for a unified and coordinated response to an infectious disease emergency. Taking part at the Holyoke Center were 30 high-level Harvard administrators, including Provost Steven E. Hyman and the University’s vice presidents.

Planners at Harvard have worked for two years to develop a systematic reaction to an influenza pandemic that would be swift, comprehensive, science-based, and humane.

All over the world, similar planning for a pandemic is being done by governments, institutions, and even families. Why? Because of H5N1. This very real strain of the avian flu can cross the species barrier between birds and humans, though not easily. So far, it has only caused localized outbreaks (265 cases) among people in Asia and Africa.

But H5N1, with its 60 percent human mortality rate, is an extreme theoretical worry. If it mutates into a form that makes human-to-human infection easy, it could spread rapidly and cause a pandemic. In 1918-1919, a pandemic of avian flu infected 20 percent of all humans, and killed 50 million.

Harvard’s response to a flu pandemic is built on its existing emergency management structure, which is used in low-intensity situations, like snowstorms. It divides up responsibilities for maintaining operations and making big decisions. It also outlines plans for communications, health care, shelter, and a phased reduction of services.

Any response in a flu pandemic affecting Harvard would be based on “triggers,” specific events that require specific emergency steps. Included might be travel restrictions, an emergency Web site, and the shutdown of all but critical University operations.

On Monday morning, three main response teams were briefed on the rules, then went on to react in real time to a cascade of 49 events in the imaginary pandemic scenario. (The whole event took three hours, but spanned a hypothetical three weeks.)

On the 10th floor of the Holyoke Center, Harvard’s Incident Support Team (IST) made judgments about central University services and resources. It passed on recommendations to the University’s senior leadership.

On the second floor of Holyoke’s health wing, the Crisis Management Team (CMT), headed by Hyman, sat in with the Medical Advisory Committee (MAC). The CMT made important policy decisions. The MAC provided expert advice, and made recommendations for responding to the pandemic.

The stream of hypothetical incidents started at 9:30 a.m. April 9, when the World Health Organization announced the Eastern European outbreak. It ended 21 days later, when the imaginary pandemic was still gaining strength. By April 28 in this fictive future Massachusetts, flu deaths had reached 1,065.

The drill’s scenario was based on the worldwide flu pandemic of 1957, which lasted eight weeks, faded for eight weeks, then flared up for another six weeks. In severity, it was midway between the catastrophic pandemic that started in 1918, and the mild one that hit the world in 1968.

To communicate on April 9, participants used speakerphones, cell phones, and a Web-based emergency management communications system called WebEOC that flashed crisis updates onto huge screens. WebEOC, a state-of-the-art response system, is used by governmental authorities to track and manage disasters.

The drill is “a way of talking through the plan” without the stress of a real crisis, said emergency room physician Paul D. Biddinger, scientific core director at the Center for Public Health Preparedness at the Harvard School of Public Health. Before Monday’s hypothetical pandemic hit, he laid out the drill’s ground rules to the assembled participants in the Holyoke Visitors Center. Afterwards, he guided them through a debriefing.

Biddinger — a veteran of pandemic drills in Massachusetts and Maine, and at major universities — said that one lesson always emerges: People are good at finding things out during a crisis, but not so good at passing them on. “Communications is the hardest thing to get right,” he said.

And it’s usually hard to get a university’s executive leadership to participate “in practicing something so important,” said Biddinger — though Harvard’s high-power April 9 turnout was an exception. “It says so much about the University’s preparedness that all of you showed up today,” he said.

If the drill had been graded, the University would have gotten high marks. As the scenario unfolded, Harvard was typically at least days ahead in reacting to unfolding events when compared with world, national, and state health authorities.

By the time the drill ended, the Harvard response teams were satisfied with the basic structure, but are ready to further address logistical questions. Participants said that communications among administrators and medical experts went generally well — but that Monday’s exercise helped identify response issues that need more work.

Housing is one, said IST coordinator Thomas Vautin, associate vice president for facilities and environmental services. “The missing piece was any kind of a check-in process,” he said, “not so much for regular housing, but for any special shelters or overflow health facilities we might need to set up.”

School by School, systems for tracking students and faculty who are abroad can be improved, said Jorge Dominguez, vice provost for international affairs. They might want to come back to Harvard, but are potential vectors for spreading the disease.

Other points of the pandemic flu response need further thought, including better-defined systems for pay, involuntary leave, and staff child care. Plans are also being developed for essential services at the Schools, College houses, and for the staff reductions that a flu pandemic would cause.

Planners will also improve arrangements for sharing space and services with pandemic-strained local governments; for animal care at research laboratories; and for closing gaps in class work that could impact the conferral of degrees.

Finally, there have to be detailed plans in place for when a pandemic ends, including how to structure the coming academic semester. Said Biddinger, “You start planning for recovery as soon as the event happens.”

Depending on the severity of a real pandemic, Harvard’s crisis teams might not spend much time together — instead, playing out their roles at isolated keyboards and phones throughout the University. “We’re not going to be in the same room coughing and wheezing on each other,” said Hyman.

But in the meantime, he said, while the real H5N1 is still geographically isolated, “there’s a whole bunch of things we need to get on top of.”