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 ROME 004188 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR S/ES-O/CMS, OES/IHA, EUR/WE, EUR/EX, CA/OCS/ACS/EUR 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC AMED CASC AEMR KFLO TBIO SENV EAGR ECON PREL IT AVIAN INFLUENZA
SUBJECT: ITALY:  AVIAN INFLUENZA POST CONTINGENCY PLANNING 
AND TRIPWIRES 
 
REF: A. 05 STATE 219189 
     ¶B. 05 ROME 004113 
 
(U) SENSITIVE BUT UNCLASSIFIED - NOT FOR INTERNET 
DISTRIBUTION. 
 
¶1.  (U)  In response to ref A, Embassy Rome DCM met on 
December 14 with representatives from the following 
sections/agencies:  Management, Consular, Science, Health 
Unit, Foreign Agriculture Service, Foreign Commercial 
Service, and Office of Defense Cooperation (ODC/DOD).  The 
Regional Security Office and the Public Affairs Office were 
not present, but are also participating in Tri-Mission 
planning.  The group reviewed GOI preparations against AI and 
human pandemic influenza and discussed the minimum 
preparedness steps in ref A.  Participants concluded that no 
AI tripwires have been crossed in Italy. 
 
¶2.  (U) ESTH Counselor Jill Byrnes, Agriculture Attachee 
Robin Gray, and/or ECON-SCI OMS Diane O'Guerin will input 
tripwire data into the Tripwire Reporting and Integrated 
Planning System (TRIPS). 
 
¶3.  (SBU) PREPAREDNESS MEASURES TAKEN/TO BE TAKEN 
--------------------------------------------- ---- 
 
(A)  BRIEFINGS:  In October, the Embassy issued Management 
Notices in English and Italian containing information on 
Avian and pandemic influenza furnished by the Regional 
Medical Officer.  They are posted on the Embassy's web site. 
The Health Unit (HU) has information on AI available for 
visitors to the HU.  In prominent public areas around the 
Embassy, Management has posted flyers with guidance on 
avoiding the spread of viruses and germs during the flu 
season.  Information from the Department on AI has been 
posted on the Rome Embassy Consular web site. 
 
(B)  MEDICAL EXPERTISE:  The HU has identified staff and 
eligible family members with medical background and skills, 
and will continue to update this information.  At a date TBD, 
the HU will train non-medical personnel in caring for those 
suffering from influenza.  In October and November, the HU 
offered influenza vaccinations to staff. 
 
(C)  TAMIFLU/PPE:  The HU has inventoried personal protective 
equipment (PPE) and has determined that sufficient quantities 
are on hand.  The Tamiflu shipped by the Department has 
not/not arrived as of December 30.  TO BE DONE:  The HU will 
determine additional amounts needed if tripwire three is 
reached, and will plan for procuring additional supplies. 
The HU will also decide how to allocate Tamiflu and PPE among 
the three Rome diplomatic missions, the three consulates, and 
the three consular agents. 
 
(D)  SECURITY:  When the Tamiflu arrives, it will be locked 
securely in the HU pharmacy, which is located within the 
well-protected chancery. 
 
(E)  EMERGENCY STOCKPILES:  In January, Management will issue 
guidelines for employees to stockpile emergency supplies 
(food, water, blankets, medicine).  Management is compiling 
an inventory of emergency supplies already stocked in 
safehavens as part of the Tri-Missions' emergency 
preparedness review in advance of the Turin Olympic Games to 
be held in February, 2006. 
 
(F)  CONTINUITY OF OPERATIONS:  Management already has a plan 
for continuation of operations with reduced staff (including 
at an alternate location).  All sections/agencies are 
updating/compiling lists of employees' home e-mail addresses 
to prepare for the contingency of conducting work from home. 
Most DOS staff and key other agency staff have been issued 
UHF radios.  The Consular Section has the capability of 
disseminating warden messages electronically (IBRS, ACS ) or 
by telephone (to key wardens, club and program directors) 
from an alternate location. 
 
(G)  DRAWDOWN PLANNING:  Tri-Missions, Consulates, and 
Embassy sections/agencies have reported to Management their 
minimum staffing patterns to ensure continuity of operations 
during a possible authorized or ordered departure.  The 
actual decision on which personnel will remain on duty will 
be determined at the time, based on local circumstances and 
taking into consideration the health condition of individual 
staff. 
(H)  MEDICAL ISSUES:  The HU has identified staff with 
medical issues or risk for severe disease who would depart 
when authorized.  This information will be factored into the 
drawdown plans. 
 
(I)  The Human Resource Office has prepared pre-planned 
packets, including travel orders for potential Tri-Mission 
evacuees under an ordered or authorized departure.  Back-up 
orders are updated quarterly at the Alternate Command Post. 
 
(J)  STRATEGIES FOR BORDER CLOSINGS:  By January, Embassy 
will have devised strategies for responding to border and 
airport closures.  This scenarios may very well unfold, as 
the November 30 draft GOI AI/pandemic influenza preparedness 
plan (ref B) calls for introducing "cordons sanitaires" at 
Italy's borders, as well as travel controls at airports in 
case of widespread human-to-human transmission of the AI 
virus.  Management will coordinate closely on this issue with 
the Embassy's DOD offices.  Consular staff would seek to 
assist Americans with emergencies caused by the inability to 
depart (fund transfer, local medical information, etc.). 
 
(K)  TOWN HALL BRIEFINGS:  Starting o/a January, Embassy will 
provide assembly-style briefings with remote participation by 
DVC for the staffs (American and LES) of the three diplomatic 
missions in Rome (bilateral Embassy, Embassy to the Holy See 
and U.S. Mission to the UN Agencies in Rome), the three 
consulates (Florence, Milan, Naples), the three consular 
agents (Genoa, Trieste, Palermo), and the Turin Olympics 
Liaison Office.  The Consular Section will provide a summary 
to consular agents by telephone or e-mail.  Briefers will 
include:  the Tri-Mission Ambassadors and/or DCMs, Health 
Unit, Regional Security Office, Foreign Agriculture Service, 
Consular Section, representatives from the US Mission to the 
UN Agencies in Rome (who have close contact with animal 
health experts from the UN Food and Agriculture Organization 
- FAO), and others TBD. 
 
(L)  GOI OUTREACH:  Embassy's Agricultural Affairs, Science, 
and Consular Sections, as well as the Health Unit and the 
Office of Defense Cooperation, have had extensive contact 
with host country officials on Italy's AI response strategy 
and health care capabilities.  In addition, the U.S. Mission 
to the UN Agencies in Rome works closely with the Food and 
Agriculture Organization (FAO) and the Animal Health 
Organization (OIE), agencies at the forefront of AI 
monitoring and containment. 
 
(M)  NEIGHBORING POSTS:  Management will monitor the AI 
situation in neighboring countries and will consider creating 
a separate working group to coordinate with neighboring posts 
to develop a plan of action for supporting potential Embassy 
evacuees from neighboring posts in the Balkans with limited 
medical resources. 
 
BEGIN TRI-MISSION ITALY/CONSULATES AI TRIPWIRES: 
--------------------------------------------- --- 
 
¶4.  (SBU)  INTRODUCTION 
----------------------- 
 
--  RESOURCE LIMITATIONS:  Italy Tri-Missions and Consulates 
are relatively well prepared to face an AI human pandemic. 
An advanced economy, Italy has efficient transportation and 
distribution networks, sophisticated socialized and private 
medical care, and an extensive service sector.  The climate 
in most of the country is very mild (Mediterranean). 
Tri-Mission and Consulate buildings are large, secure and 
well furnished.  LES are experienced, able and loyal.  We 
foresee two factors that could severely limit our ability to 
cope with a full-fledged human AI pandemic.  One, the large 
size of the tourist and expatriate Amcit community could 
severely strain consular resources if travel were restricted 
and/or the national health system were overwhelmed.  Two, the 
Italian national health system could become overwhelmed by 
demand, particularly in southern regions where it is not as 
efficiently supplied or managed. 
 
--  PUBLIC HEALTH SYSTEM:  Italy's public health system is 
developed, but suffers from inefficiencies and spot 
shortages, particularly in southern regions.  According to 
the latest data (2002), there are a total of 245,880 hospital 
beds, averaging nationally 4.3 per 1,000 inhabitants.  Almost 
217,000 of these are for acute care.  Medical personnel are 
trained to world standards. 
--  The GOI's draft AI/Pandemic influenza preparedness plan 
(ref B) addresses critical issues such as laboratory 
capacity, maintaining and augmenting rosters of available 
health care workers, and AI-specific education and outreach 
to medical professionals and the public.  It is clear from 
the plan that the GOI, which is a member of the International 
Partnership on Avian and Pandemic Influenza, is addressing 
the human health aspects of AI seriously and methodically. 
 
--  SHELTERING IN PLACE:  Tri-Missions and Consulates have 
the ability to shelter in place for weeks or longer.  Posts 
already have supplies in safehavens, and Embassy Rome has a 
well stocked commissary.  Non-perishable food, including the 
world-famous dried pasta and olive oil, is readily available. 
 Mineral water is a staple, and Rome, in particular, boasts 
many fountains supplying potable water.  Italy's 
Mediterranean climate (with the possible exception of Milan's 
consular district) is comfortable almost year-round in the 
event that heating systems are not maintained.  Tri-Mission 
and Consulate properties are large and well appointed.  In 
Rome, the Ambassador's residence is situated on extensive, 
secure grounds that could offer shelter relatively close to 
the Tri-Missions. 
 
-- COORDINATION WITH DOD:  DOD has a large presence 
throughout Italy, and the Embassy's Office of Defense 
Cooperation is a key member of the AI preparedness team.  The 
Embassy closely monitors DOD's AI planning.  An Embassy 
representative will participate in the European Command's 
(EUCOM) AI planning conference in Germany from January 9-12, 
¶2006.  The GOI plans to send representatives from the 
Ministries of the Interior, Health and Defense. 
 
¶5.  (SBU) TRIPWIRE ONE 
---------------------- 
 
A spike in the number and/or broadening geographic spread of 
animal to human cases or sustained human-to-human 
transmission in a neighboring country. 
 
¶6.  (SBU) RESPONSES TO TRIPWIRE ONE 
----------------------------------- 
 
--  EAC meets to confirm that tripwire has been crossed. 
Consulates participate by DVC or telephone. 
 
--  Restrict travel to the affected country, except for US 
Mission to the UN Agencies in Rome, FAS or other personnel 
involved in investigation/containment efforts.  Monitor GOI 
entry restrictions. 
 
--  Coordinate with U.S. Mission in the affected country 
regarding plans for public announcements, warden messages or 
draw-down/evacuation plans, and on possible assistance to 
Mission evacuees on authorized departure. 
 
--  Provide Mission briefings for American and LES staff and 
dependents.  Consulates to participate by DVC.  Consular 
Section to provide summary to consular agents by telephone or 
e-mail. 
 
--  Monitor any AI-related public announcements or travel 
warnings issued by the EU or neighboring posts, link them to 
the Consular Section's web site, and transmit them to 
American citizens (AmCits) in Italy. 
 
¶7.  (SBU)  TRIPWIRE TWO 
----------------------- 
 
A spike in the number and/or broadening geographic spread of 
animal to human cases or sustained human-to-human 
transmission in one or more Italian rural or less-traveled 
areas. 
 
¶8.  (SBU)  RESPONSES TO TRIPWIRE TWO 
------------------------------------ 
 
--  EAC meets to confirm that tripwire has been crossed. 
Consulates participate by DVC or telephone. 
--  Monitor GOI travel restrictions or quarantines, and 
consider authorized departure for U.S. family members, staff 
with identified medical risk, and non-emergency staff. 
 
--  Depending on region(s) affected, consider reducing staff 
to minimum levels or reducing services at affected Consulates 
to emergency Consular services and other designated 
operations.  Other missions/Consulates maintain full 
services/operations.  Depending on the level of inquiries, 
the Rome Consular Section could activate additional telephone 
extensions and/or a toll-free number to respond to questions 
from the public using a prepared script. 
 
--  Restrict travel to the affected area, except for US 
Mission to the UN Agencies in Rome, FAS or other personnel 
involved in investigation/containment efforts.  Monitor GOI 
internal/international travel restrictions. 
 
--  In coordination with the Department, issue public 
announcement, warden message, or travel warning and update 
web site cautioning American citizens against non-essential 
travel to the affected area(s).  Provide press guidance for 
the potential use of the Missions, consulates, neighboring 
posts, the Department, and concerned government agencies. 
Coordinate public affairs and media activities with the 
consulates/consular agents.  If appropriate, Consular 
officers would meet with members of the American community 
for in-person briefings. 
 
--  Provide Mission briefings for American and LES staff and 
dependents.  Consulates to participate by DVC.  Consular 
Section to provide summary to consular agents by telephone or 
e-mail. 
 
--  Institute screening practices for all visitors to USG 
facilities (RSO, Health Unit). 
 
--  Mandatory sick leave (home quarantine) for any employee 
who shows any flu symptoms or has a family member with flu 
symptoms (Health Unit).  Treat with Tamiflu according to 
Department guidelines. 
 
 
¶9.  (SBU)  TRIPWIRE THREE 
------------------------- 
 
A spike in the number and/or broadening geographic spread of 
animal to human cases or sustained human-to-human 
transmission near or within Rome or other large Italian city. 
 
¶10.  (SBU)  RESPONSES TO TRIPWIRE THREE 
--------------------------------------- 
 
--  EAC meets to confirm that tripwire has been crossed. 
Consulates (if still open) participate by DVC or telephone. 
 
--  Authorize voluntary departure of dependents and 
non-essential staff.  Except for designated essential 
American and FSN staff, all others remain home on 
administrative leave or on authorized departure status. 
Decisions on which personnel will remain on duty will be 
determined by individuals' states of health. 
 
--  Tri-Missions maintain full service operations, monitoring 
situation closely.  Consular Sections would provide ACS 
emergency services only.  Depending on level of inquiries, 
Embassy Consular Section activates additional telephone 
extensions and/or establishes a toll-free number for American 
citizens and the press. 
 
--  Coordinate with the Department and neighboring missions 
and issue guidance (warden message, travel warning, web site) 
urging American citizens to defer all non-emergency travel to 
Italy and/or to depart Italy if travel conditions permit. 
Update web site.  Coordinate with the Department to prepare 
press guidance.  Consular Sections assist with evacuation of 
American citizens if travel conditions permit. 
 
--  Cancel incoming official travel to Italy, except for 
personnel involved in investigative/containment efforts, or 
as decided by the COM. 
 
-- Continue screening of all visitors to USG facilities using 
protective gear. 
 
--  Provide Mission briefings (by e-mail or phone) for 
American and LES staff and dependents, including consular 
agents. 
 
 
-- Implement home quarantine (mandatory sick leave) for any 
staff or dependents who have been in contact with a person 
confirmed to suffer from AI (monitored by Health Unit).  Plan 
for home visits to sick individuals eligible for care from 
the HU.  Treat with Tamiflu according to Department 
guidelines. 
 
--  If authorized or ordered departure is not possible 
because of GOI travel restrictions, instruct all 
non-emergency American and LES staff to remain home on 
administrative leave.  Children remain home from school. 
Consider social distancing measures (limiting venues of 
human-to-human contact).  Ensure staff purchase additional 
supplies of food and water. 
SPOGLI