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

UNCLAS SECTION 01 OF 03 MADRID 000001 
 
SIPDIS 
 
SENSITIVE 
 
STATE FOR S/ES-O/CMS - OFFICE OF CRISIS MANAGEMENT SUPPORT 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED AEMR KFLO SP
SUBJECT: AVIAN INFLUENZA:  SPAIN CONTINGENCY PLANNING AND 
TRIPWIRES 
 
REF: SECSTATE 219189 
 
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MISSION PREPARATIONS TO DATE 
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¶1.  (SBU)  Mission Spain has begun the contingency planning 
process to prepare for the unique challenges posed by a 
potential Avian Influenza (AI) outbreak in Spain.  The key 
action officer for Mission preparations is Embassy Madrid 
Post Medical Officer Doctor Jose Peralba.  He and his office 
are the primary liaison point with M/Med, the RMO, and local 
medical resources.  In addition, he is the primary liaison 
with his counterpart at the U.S. military base at Rota, 
Spain, and has already contacted his counterparts there 
regarding Avian Influenza.  Dr. Peralba is also the Post 
Medical Officer for Consulate General Barcelona and includes 
the Consulate in all Avian Influenza preparations. 
 
¶2.  (SBU)  Internally, we have stocked a large supply of 
Personal Protective Equipment (e.g., masks and gloves) (300 
N-95 masks and 6400 disposable gloves) and we are waiting for 
M/Med shipments of the anti-viral "Tamiflu."  In addition, 
the Medical Unit has updated its contacts with local medical 
services (e.g., hospitals, emergency rooms, doctors, and 
ambulance services). 
 
¶3. (SBU)  Embassy Madrid's Consular Section and Consulate 
General Barcelona monitor Spanish press reports on Avian 
Influenza and consult regularly on this issue with Post 
Medical Officer Peralba and Mission ESTHOFF.  The Madrid 
Consular Section and Consulate General Barcelona have 
circulated a warden message to the resident U.S. citizen 
community and study abroad programs.  This warden message, 
which can be accessed through the "Bird Flu" link on 
embusa.es, includes basic information on the illness and 
links to CDC and State websites and information sheets. 
Mission plans to add a link the Spanish Health Ministry's 
Avian Influenza Plan (in English). 
 
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MISSION PREPARATIONS SOON TO BE LAUNCHED 
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¶4.  (SBU)  Mission Spain will endeavor to accomplish 
outstanding "Preparedness Steps" outlined in paragraph 8 of 
Reftel.  Measures that the Mission will undertake, under the 
leadership of the Post Medical Officer, will include, but not 
be limited to: 
 
--  increasing education for hand hygiene and cough 
etiquette, self shielding, isolation and quarantine; 
 
--  preparation of signs at all entrances referring to flu 
symptoms that request that employees contact the Medical Unit 
if they have symptoms; 
 
--  insuring that the stock of Personal Protective Equipment 
is adequate; 
 
--  insuring that the stock of "Tamiflu" and "AB" are 
adequate; 
 
--  distributing information about symptoms and temperature 
checking with a simple flow chart and algorithms for Mission 
employees and family members; 
 
--  updating contacts with schools attended by official 
family members; 
 
--  establishing guidelines for stocking of water, food and 
fuel; 
 
--  establishing guidelines for communications in the event 
of an AI pandemic; 
 
--  updating Mission staff on new AI-related events and the 
health response; 
 
--  evaluating who should be considered a "higher risk" 
individual in the event of an AI pandemic (e.g., under two 
and over 60), and thus subject to earlier evacuation back to 
CONUS; 
 
--  starting an Mission education program related to AI 
 
--  establishing optimal methods for delivering assessment 
and care to individuals with AI, including the designation of 
discreet areas for screening, triage, and care of affected 
individuals; 
 
--  establishing procedures for the medical evaluation and 
isolation of quarantined persons who exhibit signs of AI-like 
illness; 
 
--  developing tools and mechanisms to limit the 
stigmatization of affected persons and family members; 
 
--  establishing procedures for delivering medical care, food 
and services to persons in isolation or quarantine, taking 
into consideration the special needs of children and persons 
with disabilities; 
 
--  developing protocols for monitoring and enforcing 
quarantine measures; 
 
--  ensuring the legal authority and procedures exist for 
various levels of movement restrictions; and, 
--  establishing procedures for issues related to employment 
compensation, job security and administrative leave. 
 
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TRIPWIRES 
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¶5.  (SBU)  Spain has a capable national health care system 
similar to that found in other developed European economies. 
Host country medical treatment facilities would be able to 
address limited AI outbreaks but, like any other developed 
country, could be overwhelmed if a large pandemic develops. 
Post would be able to shelter in place for an extended 
period, and would probably need to if air travel were 
curtailed to and from the United States depending on the 
extent of an outbreak. 
 
¶6.  (SBU)  Tripwire One:  Sustained human-to-human 
transmission of a virulent mutation of AI anywhere else in 
the world.  If this happens, Mission anticipates that 
human-to-human transmission will reach Spain within a matter 
of weeks. 
 
--  begin immediate preparations for arrival of second 
tripwire, including: 
 
--  distribution of stocks of masks and gloves; 
 
--  identification of high risk members of the mission 
community (e.g., under 20, over 60, pregnant, etc.) for 
possible evacuation back to CONUS (in keeping with HHS and 
M/med guidelines); 
 
--  announcements to the mission community coordinated with 
announcements to AmCits resident/visiting Spain; 
 
--  encouraging of social distancing; 
 
--  streamlining of AI and essential issues reporting back to 
M/Med; 
 
--  preparations for "snow day" (M/med term) operations at 
Mission Spain facilities; 
 
--  reduction of permitted visitors into Embassy and 
Consulate compounds; 
 
--  mandating that all ill Mission employees should not/not 
come to work and should plan to work from home as much as 
possible; 
 
--  contact schools attended by official family members; 
 
--  stocking of seven-day supply of food/water at personal 
residences; 
 
--  stocking of NEX; 
 
--  topping up fuel tanks and GOV/POV fuel tanks; and, 
 
--  distribution of equipment to maintain communications with 
Mission community and enable officers to work from home 
(radios, blackberries, FOBs if available, lists of home phone 
numbers and home e-mail addressees). 
 
¶7.  (SBU)  Tripwire Two:  Sustained human-to-human 
transmission in Spain, which can be expected to occur 
simultaneously in several Western European locations. 
 
--  trigger "snow day" operations (initially for a 10-day 
period); including, but not limited to: 
 
--  Embassy, Consulate General Barcelona, and Consular 
Agencies would essentially be closed for all but essential 
staff (RSO/MSG, IPC skeleton crew, Maintenance skeleton crew, 
Medical Unit, CONS/ACS, and Motorpool), with all other 
personnel remaining at home; 
 
--  Children will be kept home from school; 
 
--  Mission staff will be instructed to avoid social 
gatherings/public places; 
 
--  Mission staff will be instructed to monitor their 
temperatures, record their symptoms and call designated 
Health Unit staff for verbal screening; 
 
--  Medical Unit will respond to cases of infection within 
the official community and determine need for house 
quarantine or hospitalization (care may be given in either 
Mission facilities or at residences); 
 
--  Medical Unit will document all screening conversations 
and any follow-up; 
 
--  EAC will consider authorized departure for high risk 
personnel and family members if human-to-human transmission 
has not reached the U.S.; 
 
--  Mission will coordinate with USNATO and Rota regarding 
mutual support and any evacuation planning that might involve 
U.S. military or USG contract aircraft; 
 
--  CON/ACS will address needs of resident/visiting AmCit 
community; 
 
--  Medical Unit will initiate contact with host nation 
medical services; 
 
¶8.  (SBU)  General evacuation from Spain to CONUS is not 
likely to be an effective option.  Human- to-human 
transmission, if it develops, will likely hit the U.S. about 
the same time it hits Europe.  Spain's medical infrastructure 
and its ability to contain outbreaks are on par with the U.S. 
 Evacuation to CONUS may make sense in individual cases but 
probably not for the general Mission community.  Extrapolated 
to the larger resident and visiting AmCit community, however, 
may mean coordination of commercial and charter flights to 
return a significant number of individuals to the U.S.  Post 
is also aware that the arrival of AI in the U.S. may lead us 
to restrict access to the U.S. and thus inhibit any effort to 
return AmCits to the U.S. 
 
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TRIPS DATA BASE 
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¶9.  Per reftel request, Embassy Madrid nominates Management 
Section OMS Lesley Acs and GSO, Margaret Kurtz-Randall, as 
the two mission employees who will be responsible for 
inputting Avian Influenza tripwire data into the Tripwire 
Reporting and Integrated Planning System (TRIPS) data base. 
Both hold 
Top Secret clearances. 
AGUIRRE