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DE RUEHSG #2590/01 3631317
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O 291317Z DEC 05
FM AMEMBASSY SANTIAGO
TO RUEHC/SECSTATE WASHDC IMMEDIATE 8132
INFO RUEHAC/AMEMBASSY ASUNCION IMMEDIATE 2445
RUEHBR/AMEMBASSY BRASILIA IMMEDIATE 3000
RUEHBU/AMEMBASSY BUENOS AIRES IMMEDIATE 2819
RUEHLP/AMEMBASSY LA PAZ DEC 4412
RUEHPE/AMEMBASSY LIMA IMMEDIATE 4386
RUEHMN/AMEMBASSY MONTEVIDEO IMMEDIATE 3145
RUEHQT/AMEMBASSY QUITO IMMEDIATE 1509

UNCLAS SANTIAGO 002590 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMR CI
SUBJECT: CHILE: POST TRIPWIRES FOR AVIAN FLU 
 
REF: A. SECSTATE 219189 
     ¶B. SANTIAGO 2423 
     ¶C. SANTIAGO 2431 
 
¶1.  (SBU) Summary:  Embassy Santiago continues to develop 
preparedness measures against avian influenza (AI) through 
the Emergency Action Committee, chaired by the DCM and 
composed of the AMB, RAO, EPOL, RSO, DAO, MILGRP, DEA, 
LEGATT, APHIS, PAO, FCS, CONS, MGT and MSG.  This plan 
includes a description of tripwires and associated action 
plans.  Chile's Ministry of Health established a National 
Committee for Influenza to coordinate tracking and treatment 
of AI.  The GOC has an extensive, internet-published 
preparedness plan for preventing an AI pandemic in Chile, and 
has coordinated with international and regional partners. 
While Chile's medical facilities are generally adequate and 
in some cases excellent, the GOC lacks resources to properly 
track, detect or prevent widespread distribution of AI.  Post 
does not currently have the ability to shelter in place, but 
personnel could likely be maintained at home for a reasonable 
amount of time.  End Summary. 
 
¶2.  Should an AI outbreak occur, the EAC has created an 
action plan, including first responses, and developed a 
series of tripwires (with the approval of RMO Lima).  When 
identifying appropriate tripwires, the EAC assumed a fast 
transmission rate, the inability to access air travel, the 
need to avoid any "double standard," communication with local 
international schools; and coordination with Clinica Las 
Condes and Clinica Alemana, the top two hospitals in 
Santiago.  Action items resulting from a crossed tripwire may 
include authorized or mandatory departure of personnel.  The 
EAC also noted that Post does not have an adequate stockpile 
of antiviral drugs, and is actively exploring how to obtain 
supplies for all Embassy staff and EFMs. 
 
¶3.  Aside from two private high-quality hospitals in 
Santiago, the quality and number of facilities in Chile 
varies greatly.  Private hospitals and clinics tend to offer 
better service than public medical facilities, and healthcare 
outside of the metropolitan area generally tends to be of 
lesser quality. 
 
¶4.  The GOC has created an extensive plan to address AI, 
available on the internet at: 
http://www.minsal.gov.cl/ici/pandemiainfluenz a.  In 2004, the 
Chilean Congress passed a resolution to create the National 
Response Commission for Outbreaks and Sanitary Emergencies 
under the jurisdiction of the Ministry of Health (MOH).  The 
mandate of this committee is to (a) propose contingency plans 
to confront the outbreaks of infectious diseases, with a 
particular emphasis on AI; (b) monitor the implementation of 
these contingency plans; and (c) provide technical advice to 
the country's decision-makers.  Committee members are largely 
MOH staff as well as representatives from the Agricultural 
and Livestock Service (SAG) and the Chilean Society for 
Infectology.  Under-Secretary of Public Health, Dr. Patricio 
Bustos, has been identified as the key contact for 
international coordination on this issue. 
 
¶5.  The GOC has also worked with international partners on 
the AI issue.  The ministers of health from the Andean region 
met in Peru in October 2005, which resulted in a signed 
declaration of commitment to coordinate on AI.  The GOC's 
domestic plan repeatedly cites coordination with the World 
Health Organization. 
 
¶6.  While Chile has experience with avian influenza issues 
due to a 2002 outbreak of the disease in poultry, the public 
health sector does not enjoy the same levels of resources or 
manpower as the agricultural export sector when it comes 
fulfilling its emergency plans.  Current deficiencies include 
a lack of human and financial resources to properly survey 
and detect AI.  The GOC also lacks resources and equipment to 
widely distribute protective gear.  Several vaccines are 
available in Chile, including Vaxigrip (Aventis Pasteur), 
Fluarix (Glaxo Smith Kline), Influvac (Solvay), Agrippal S1 
(Chiron) and Inflexal V (Berna).  The MOH plans to purchase 
the H5N1 vaccine when it becomes available.  In addition, the 
MOH continued its annual flu vaccine program in 2005, and 
hopes to significantly expand the number of recipients beyond 
the current 1.75 million. 
 
¶7.  Post does not currently have the ability to shelter 
employees in place for any length of time.  However, Embassy 
employees could likely be maintained at home for a reasonable 
amount of time.  For long-term healthcare and nutritional 
needs, Chile's distance and long, narrow geographic 
configuration could become problematic in obtaining 
assistance. 
 
¶8.  Post management has tasked two U.S. citizen employees 
with responsibility for inputting tripwire data: Jacqueline 
Ward, EST Officer, and Deborah Fairman, Consul.  Both 
employees possess a secret clearance or higher. 
 
¶9.  All DoD personnel are under COM authority. 
 
¶10.  The following baseline tripwires were approved by the 
Santiago EAC and in substance by RMO Brooks Taylor.  The 
following proposed tripwires address the possibility of human 
cases of avian influenza in Chile and/or evidence of the 
virus demonstrating more efficient human-to-human 
transmission elsewhere in the world.  To avoid repetition, 
only new measures taken under each Tripwire are listed - all 
previous measures under previous Tripwires will be 
maintained.  These tripwires are based on the following 
assumptions, should sustained human-to-human transmission 
become a reality. 
 
Assumptions: 
 
The disease would spread rapidly, both within a particular 
country and internationally. 
Once the World Health Organization has declared a human 
pandemic - but probably even before then - airlines will 
cancel flights as countries try to control the spread of the 
disease.  Some countries may bar individuals coming from 
infected countries. 
The Embassy must keep in mind "double standard" concerns, and 
will coordinate consular, medical, evacuation, etc. with 
appropriate Department offices. 
The Embassy must keep in mind that many of its children 
attend international schools, which must be kept in the 
information loop as well. 
The Embassy should carefully consider all the ramifications 
of authorized departure and/or ordered departure, as in fact 
it may be safer to remain in Chile. 
The Embassy should remain in constant contact with Clinica 
Las Condes and Clinica Alemana, as well as with the Ministry 
of Health. 
The Embassy will procure sufficient supplies of Tamiflu, N100 
Nano-masks, N95 masks, and additional hand cleansers, as well 
as the items recommended in the RMO's list.11. 
 
¶11.  Tripwire 1:  Any case of avian influenza among humans in 
Chile. 
 
Action: 
 
11a.  Management Section/Health Unit will send an information 
notice to all Mission personnel. 
11b.  The Consular Section will send a warden message to all 
American citizens detailing the episode and suggest 
preventive measures. The notice will also be posted on the 
Embassy website. 
11c.  Embassy will notify RMO Lima and State Med. 
 
¶12.  Tripwire 2:  Confirmed human-to-human transmission 
occurs in one or more neighboring countries - singly or in 
clusters - but not in Chile. 
 
Action: 
 
12a.  Consider immediate authorized departure of U.S. family 
members and non-emergency personnel in consultation with the 
Department, if the U.S. itself is relatively avian flu-free 
and if the airlines are flying.  Have evacuation plans for 
both the healthy and sick.  Explore evacuation by military 
airlift. 
12b.  Institute screening practices for all visitors to U.S. 
Government facilities, limit their numbers, and refuse entry 
to those visibly ill or who are coughing. 
12c.  Order mandatory sick leave for any employee who shows 
any flu-like symptoms or has a family member with flu-like 
symptoms.  The Health Unit will issue detailed flu symptom 
descriptions and monitor Embassy employees. 
12d.  Issue a warden announcement to American citizens. 
12e.  Require use of masks and hand cleansers, AND consider 
use of the prophylactic Tamiflu (oseltamivir) by U.S. and 
Chilean staff in positions that require contact with the 
public. 
 
¶13.  Tripwire 3: Significant numbers of human cases of avian 
flu (H5N1, H7N7 or others), presumably transmitted from birds 
or other animals, appear in Chile, but without evidence of 
sustained human-to-human transmission. 
 
Action: 
 
13a.  All official and unofficial travel to affected areas, 
bird markets and similar facilities will be prohibited. 
Outside visitors to the Embassy will continue to be limited. 
Tamiflu will be given as a prophylactic to those U.S. and 
Chilean staff who have regular contact with the general 
public as part of their work. 
13b.  Management Section will send a warning announcement to 
Mission personnel.  The Consular Section will send a warden 
message to private American citizens and to tourist hotels 
and cruise ships that are frequented by traveling Americans. 
Embassy will post the warning announcement on the Embassy 
website. 
13c.  Health Unit will provide detailed briefing to Embassy 
community, and if appropriate, to the international schools. 
Check with Clinica Las Condes and Clinica Alemana to ensure 
that they are still able to handle large numbers of avian flu 
patients. 
13d.  Consider authorized departure measures or even ordered 
departure measures - in conjunction with the State Department 
- if the airlines are still flying and if there are any 
recognized safehaven countries who are accepting outsiders. 
Communicate pertinent information and options to the Embassy 
community at town hall meetings or via e-mail, as the 
timeline will be short. 
13e.  Issue Travel Warning to Americans considering travel to 
Chile, in conjunction with the Bureau of Consular Affairs. 
13f.  Encourage all employees to stock up on food and other 
necessities in the event there is an announcement of an 
imminent pandemic. 
 
¶14.  Tripwire 4: Sustained human-to-human transmission in 
Chile, but not in Santiago. 
 
Action: 
 
14a.  Restrict consular services to emergency basis for 
American citizens only.  No visa services (except on a 
severely restricted case-by-case basis), as it would be 
expected that commercial airlines have canceled flights. 
14b.  Implement authorized departure. Consider ordered 
departure in conjunction with State Med, at the discretion of 
the Chief of Mission.  If commercial airlines are not flying, 
consider use of military airlift.  It would be ideal to have 
enough people leave post so that those left behind would 
equal the amount of Tamiflu on hand. 
14c.  Consider implementing selective administrative leave 
for those Americans who remain at post and FSN employees. 
Consider other options for minimizing workplace exposure, 
like tele-commuting. 
14d.  Continue mandatory sick leave for any employee who 
shows any flu-like symptoms or has a family member with 
flu-like symptoms. 
14e.  Consider home quarantine and limiting venues of 
human-to-human contact. 
14f.  Mandatory screening of visitors, who shall be limited 
to those whose business absolutely must be conducted in 
person; mandatory use of protective gear, especially N95 
masks for Embassy screeners. 
14g.  Health Unit to initiate appropriate use of prophylactic 
Tamiflu (oseltamivir) for minimal U.S. and Chilean staff 
remaining on the job. 
14h.  Update warden message, Travel Warning, and Consular 
Information Sheet. 
 
¶15.  Tripwire 5: Sustained human-to-human transmission, as 
evidenced by clusters of cases in Santiago. 
 
Action: 
 
15a.  Implement ordered departure, if airlines are still 
servicing Santiago, and if there are any avian flu-free 
countries to fly to.  Consider use of military airlift, if 
the U.S. or any avian flu-free countries are allowing 
incoming flights from affected areas. 
15b.  Implement administrative leave for all FSNs.  Consider 
other options for minimizing workplace exposure, like 
tele-commuting. 
15c.  Initiate appropriate prophylactic use of Tamiflu for 
any American employees and family members remaining at post. 
15d.  Issue warden update and inform American community that 
the Embassy will only offer emergency AmCit services by phone. 
KELLY