This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 05 GEORGETOWN 000039 
 
SIPDIS 
 
Bogota for RMO 
Mexico City for RMO 
FRC for RMM 
USAID FOR GH/RCS - KELLY WOLFE 
USAID FOR LAC - PEG MARSHALL 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMR GY
SUBJECT: AVIAN INFLUENZA TRIPWIRES - EMBASSY GEORGETOWN 
 
REF: A) STATE 219189   B) STATE 183776   C) STATE 202102 D) 
GEORGETOWN   1279 
 
¶1. SUMMARY: Embassy Georgetown's Avian Influenza Response 
Committee has prepared the following tripwires in the event 
of an avian influenza outbreak in the region, the United 
States or Guyana itself.  The committee reviewed tripwire 
reports by other posts especially the excellent tripwires 
prepared by Embassy Bangkok.  Participants included 
representatives from MED, CDC, CON, RSO, ADM and Peace 
Corps.  The committee agreed on four tripwires: an Avian 
Influenza outbreak in the region, an Avian Influenza 
outbreak in the United States, an outbreak in Guyana and 
efficient human-to-human transmission of the virus in 
Guyana.  Each of the first three tripwires was divided into 
two scenarios (A and B).  Situation A imagines transmission 
of Avian Influenza is limited to bird-to-human or very 
inefficient human-to-human contact.  Situation B imagines 
human-to-human transmission is more efficient.  END SUMMARY 
 
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Immediate Actions 
----------------- 
 
¶2. The Government of Guyana (GoG) is preparing for Avian 
Influenza, GoG's actions are covered in detail by reftel D. 
CDC, USAID and Embassy officials are actively participating 
in the GoG's national influenza committee and assisting in 
preparations.  GoG has prepared a national influenza plan 
and is procuring materials to produce oseltamivir (the 
generic form of Tamiflu).  Post finds the GoG is doing its 
best to prepare for the possibility of an influenza pandemic 
but notes Guyana is a developing country whose inadequate 
public health sector is already overburdened by a high 
incidence of HIV/AIDS. 
 
¶3. Certain actions should be undertaken before any tripwires 
are met. 
- Continue to work with the GoG and monitor their 
preparedness. 
- Provide briefings for Mission staff and dependents. 
- Prepare a draw-down list and a list of minimum essential 
personnel in the context of an avian flu outbreak.  This 
list will likely be different from existing lists compiled 
by the EAC for other emergencies.  Post expects more CDC and 
USAID staff to remain and some persons deemed essential on 
the current EAC list may not be essential for an influenza 
outbreak. 
- Inventory supplies of Tamiflu and protective equipment, 
including gowns, gloves, protective eyewear, alcohol-based 
cleansers, and N95 respirators (in progress).  Determine 
what more is needed in the context of Tripwires below, and 
procure the additional needed supplies. 
- RSO to ensure the local guard contractor procures 
protective equipment for the guard force. 
- Advise mission personnel and family members to keep at 
least a 7-day supply of food and water at home. 
- Sections should evaluate mechanisms for conducting work 
from home or other locations under conditions of a pandemic 
requiring limiting access to Mission offices. 
- Prepare pre-planned packets - including travel orders to 
the extent possible - for potential Mission evacuees under 
an authorized departure, to avoid a last minute backlog. 
- Consular section should plan town hall meeting with U.S. 
citizens about general safety concerns and the threat of an 
influenza pandemic. 
- Front Office should raise with the GoG the issue of their 
plans for quarantines and travel restrictions to the U.S. in 
the event of an influenza outbreak there. COMMENT: Guyana 
has strong economic and social ties to the United States. 
Guyana's elite regularly travel to the U.S. for medical 
care, vacations and business.  Post does not expect travel 
to and from the United States would be restricted even in 
the case of an outbreak in the U.S.  END COMMENT 
 
------------ 
Tripwire One 
------------ 
 
¶4. Tripwire 1A is: "A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission through close, prolonged contact 
in Suriname, Brazil, Venezuela, or the Caribbean Region." 
COMMENT: Guyana is relatively isolated with few land or air 
connections to other countries in the region. Brazil is 
linked by a single road, Suriname by a single ferry and 
Venezuela by informal boat crossings.  Normally there are 
only direct air links to Trinidad, Barbados, Brazil the 
United States and Canada. END COMMENT 
 
Embassy Actions in response to Tripwire One: 
- AI Subcommittee meets to confirm that tripwire has been 
met. 
- Restrict travel to and from the affected country or 
effected areas within the region (excluding airport 
layovers).  This will depend on any restrictions on re-entry 
implemented by the Government of Guyana. 
- Coordinate with U.S. Mission in the affected country 
regarding that Mission's plans for possible public 
announcements, warden messages, or plans for evacuating 
personnel. 
- Provide Mission briefings for staff (American and FSN) and 
dependents in Guyana. 
- Ensure that any public announcements or travel warnings 
issued by neighboring posts are transmitted to American 
citizens in Guyana and publish the updates on the Consular 
Section's web site. 
- Maintain normal Embassy operations, but maintain close 
monitoring of the situation. 
 
¶5. Tripwire 1B is "Efficient and sustained human-to-human 
transmission in Suriname, Brazil, Venezuela, or the 
Caribbean Region." 
 
Embassy Actions in response to Tripwire 1B: 
- AI Subcommittee meets to confirm that tripwire has been 
met. 
- Steps taken as in A above. In addition: 
- Travel restrictions include airport layovers in affected 
countries. 
- Embassy Emergency Action Committee meets regularly to 
determine next steps which could include: 
- Reduction to emergency Consular services and suspension of 
designated services and operations. 
- Authorize voluntary departure for dependents and non- 
essential personnel.  Authorized departure will be dependent 
on possible Government of Guyana restrictions on outgoing 
travel and on possible U.S. restrictions on incoming travel; 
post does not anticipate such restrictions. 
- Ensure that staff purchases additional supplies of food 
and water. 
- Restrictions on movements of personnel in the city, dinner 
parties, sporting events and other social events. 
 
------------ 
Tripwire Two 
------------ 
 
¶6. Tripwire 2A is: "A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission through close, prolonged contact 
in the United States or Canada."  COMMENT:  Guyana and the 
region have few direct transportation links to Asia, Africa 
or Europe.  Nearly all air travel and a great deal of the 
cargo from those regions comes through the United States. 
It is very likely that avian influenza will be detected in 
the U.S. before it is found in Guyana.  END COMMENT 
 
Embassy Actions in response to Tripwire Two 2A: 
- AI Subcommittee meets to confirm that tripwire has been 
met. 
- Consider restrictions on travel to Canada 
- Consider restrictions on travel to US. 
- Provide briefings for Mission staff and dependents. 
- Use cleared press guidance to respond to press inquiries. 
- Maintain normal Consulate and Embassy operations, but 
closely monitor the situation. 
 
¶7. Tripwire 2B is: "Efficient and sustained human-to-human 
transmission in United States or Canada." 
 
Embassy Actions in response to Tripwire Two B: 
- Steps taken as in A above. In addition: 
- Embassy Emergency Action Committee meets regularly to 
determine next steps which could include: 
- Reduction to emergency Embassy services and suspension of 
designated services and operations. 
- Authorize voluntary departure for dependents and non- 
essential personnel.  Authorized departure will be dependent 
on possible Government of Guyana restrictions on outgoing 
travel and on possible U.S. restrictions on incoming travel; 
post does not anticipate such restrictions. 
- Ensure that staff purchases additional supplies of food 
and water. 
- Restrictions on movements of personnel in the city, dinner 
parties, sporting events and other social events. 
 
-------------- 
Tripwire Three 
-------------- 
 
¶8. Tripwire 3A is: "A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission through close, prolonged contact 
anywhere in Guyana."  COMMENT: Georgetown has Guyana's only 
international airport, the largest hospital, most of the 
port facilities and most government functions.  Because so 
many things in Guyana are centered on the capital, post 
concluded that Avian Influenza anywhere in Guyana will 
quickly reach Georgetown.  END COMMENT. 
 
Embassy Actions in response to Tripwire Three: 
- AI Subcommittee meets to confirm that tripwire has been 
met. 
- Restrict travel to the affected region(s) of the country 
except for CDC or other personnel involved in possible 
investigation/containment efforts. 
- In coordination with the department, issue a public 
announcement, warden message, or travel warning and update 
the website cautioning American citizens against 
nonessential travel to Guyana. 
-Provide press guidance for the potential use of the 
Mission, neighboring posts, the Department and concerned 
government agencies. 
- Provide briefings for Mission staff and dependents. 
- Implement home quarantine of any staff or dependents who 
have been in contact with a person confirmed to have an AI 
infection. 
- Instruct all staff (American, FSN and domestic staff) with 
influenza symptoms or close contact with a person confirmed 
to have an AI infection to remain at home and call health 
unit for telephone triage. 
- Emergency Action Committee meets regularly to determine 
next steps as tripwire circumstances develop.  Next steps 
could include the following: 
- Division of each section of the Embassy into two teams, 
working alternate days.  If a member of one team becomes 
sick and the team is quarantined the other team would still 
be able to function. 
- Restrict visitor access to Mission buildings.  If entry is 
necessary, visitors will go through screening procedures 
including temperature monitoring and/or a questionnaire 
related to symptoms/exposure. COMMENT: There are no studies 
that provide verification regarding effectiveness of these 
procedures.  They also will not identify people who are 
contagious but asymptomatic or have minimal symptoms.  The 
level of restrictions on access to Mission facilities should 
depend on the particular circumstances at that moment.  END 
COMMENT. 
- Reduction to emergency Embassy services and suspension of 
designated services and operations. 
- Authorized voluntary departure of dependents and non- 
emergency staff.  In deciding whether to authorize voluntary 
departure, the EAC should take into account not only the 
medical risk, which may be minimal, but the availability of 
treatment in Guyana and the perceived risk by employees and 
family members. 
- Except for designated emergency American and FSN staff, 
all others remain home on administrative leave or on 
authorized departure. 
- Cancel incoming official travel, except for personnel 
involved in investigative/containment efforts, or as 
otherwise deemed necessary by Chief of Mission. 
- MED and designated EAC members meet with school 
administrators to review advisability of closing the 
schools. 
- Establish a database listing details of any American 
citizen, hospitalized, quarantined, or ill at home. 
- Ensure that staff have 30 day supply of food and water at 
home. 
- Restrictions on movements of personnel in the city, dinner 
parties, sporting events and other social events. 
- Embassy staff instruct their household staff not to report 
to work.  Live-in staff will be under the same restrictions 
as mission personnel and dependants. 
 
------------- 
Tripwire Four 
------------- 
 
¶9. Tripwire 4 is: "Efficient and sustained human-to-human 
transmission in Guyana" 
 
COMMENT: Post assumes that available medical facilities in 
Guyana would be saturated immediately.  END COMMENT 
 
Embassy Actions in response to Tripwire Four: 
 
- AI Subcommittee meets to confirm that tripwire has been 
met. 
- Depending on conditions elsewhere issue revised travel 
warning and update website advising American citizens to 
depart Guyana or remain in their homes and limit human 
contact for next 30 days. Recommended time period for 
isolation will be revised based on experiences of other 
affected posts. 
- Authorized voluntary departure of dependents and non- 
emergency personnel. 
- Cancel all incoming official travel, except for personnel 
involved in investigative/containment efforts, or as 
otherwise deemed necessary by the Chief of Mission. 
- Embassy at minimal staff, reduction of consular services 
to emergency American Citizen Services (passports and CRBAs) 
and suspension of designated services and operations. 
- Embassy staff to instruct their household staff not to 
report to work.  Live-in staff will be under the same 
restrictions as mission personnel and dependants. 
- Except for designated emergency American and FSN staff, 
all others remain home on administrative leave or on 
authorized or ordered departure.  Children remain home from 
school or on authorized departure. 
-    MED and designated EAC members meet with school 
administrators to review advisability of closing the 
schools. 
- Division of each section of the Embassy into two teams, 
working alternate days.  If a member of one team got sick 
and the team were quarantined either section or embassy 
wide, the other team would still be able to function. 
- Ensure staff have a 30 day supply of food, water and fuel 
at home. 30 days was chosen because it is the limit of our 
fuel supply.  This point will have to be reconsidered if 
experiences at other posts dictate that the outbreak takes 
longer to run its course. 
- Restrict visitor access to Mission buildings.  If entry is 
necessary, visitors will go through screening procedures 
including temperature monitoring and/or a questionnaire 
related to symptoms/exposure. COMMENT: There are no studies 
that provide verification regarding effectiveness of these 
procedures.  They also will not identify people who are 
contagious but asymptomatic or have minimal symptoms.  The 
level of restrictions on access to Mission facilities should 
depend on the particular circumstances at that moment.  END 
COMMENT. 
- Embassy considers creating a situation room. 
- Establish a database listing details of any American 
citizen, hospitalized, quarantined, or ill at home. 
- ADMIN closely monitors availability of outgoing commercial 
flights. 
- Embassy Emergency Action Committee meets regularly to 
determine next steps as tripwire circumstances develop. 
Next steps might include: 
- Ordered departure of non-emergency personnel and 
dependents with authorized departure of designated emergency 
personnel on a case-by-case basis. Ordered or authorized 
departure will be dependent on possible Government of Guyana 
restrictions on outgoing travel and 
on possible U.S. restrictions on incoming travel. 
- Per reftel B prophylactic treatment with Tamiflu will be 
considered only for staff who are required to be in direct 
contact with potentially infected persons. 
-  Assist in evacuation of private American nationals. 
Significant evacuation from Georgetown may not be feasible 
for a variety of reasons including the added risk of 
acquiring influenza at crowded airports or on international 
flights during a true pandemic, travel restrictions and 
possible quarantine measures. 
 
BULLEN