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

UNCLAS SECTION 01 OF 04 MANAMA 000039 
 
SIPDIS 
 
SENSITIVE 
 
S/ES-O/CMS - OFFICE OF CRISIS MANAGEMENT SUPPORT, NEA/ARPI 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMR TBIO BA ECTRD
SUBJECT: BAHRAIN: AVIAN INFLUENZA CONTINGENCY PLANNING AND 
TRIPWIRES 
 
REF: A. MANAMA 1874 
     ¶B. STATE 219189 
 
Sensitive but unclassified; please protect accordingly.  Not 
for Internet distribution. 
 
¶1. (U) Post has taken a number of measures in anticipation of 
the potential threat posed by Avian Influenza (AI).  Post MED 
has held Mission briefings to help Embassy staff better 
understand AI and AI personal risk mitigation strategies. 
Post has contracted an LES to continually disinfect commonly 
handled items, such as doorknobs and elevator buttons.  Post 
Management has completed an inventory of critical medical 
items, including N-95 respiration masks and placed orders to 
fill any deficiencies.  Post has established and convened an 
Avian Influenza Working Group (AIWG) to compile the following 
tripwires for recommendation to the EAC.  The AIWG, chaired 
by EconOff, includes representation from Management 
(including MED), Public Affairs, Consular, Pol/Mil, and the 
Defense Attache.  Post is served by a Regional Medical 
Officer based in Riyadh and employs two LES nurses who 
alternate duty to fill one FTE.  Bahrain hosts the U.S. Navy 
Fifth Fleet and the Defense Attache has reviewed the NAVCENT 
Pandemic Influenza Plan in order to assist the AIWG in 
coordinating Post's tripwires with the NAVCENT plan, 
particularly with regard to medical and departure 
transportation assistance. 
 
¶2. (SBU) The AIWG assesses that Bahrain is well situated to 
implement many precautionary aspects of its AI national 
strategy at a pre-pandemic stage (Ref. A).  Although 
Bahrain's draft strategy has yet to be approved, several key 
elements have already been implemented.  The Ministry of 
Health has adopted an Integrated Capacity Development Program 
for laboratory specialists with direction from the WHO.  It 
has also recently acquired laboratory equipment allowing 
local subtyping.  However, MED Emboff, who has worked in 
Manama for many years as a health practitioner, evaluates 
that the GOB real world ability to detect new influenza 
strains is limited.  Emboff cautions that in the past, 
limitations of personnel, expertise and technology have 
limited the Ministry of Health's ability to implement plans 
as laid out on paper.  Emboff observes that one important 
medical facility, the Salmaniya Hospital complex, is already 
straining to meet current demand, with insufficient beds or 
staff to meet daily needs.  However, local private hospitals 
currently have excess capacity and could absorb some 
increased activity.  Post will enter draft tripwires into the 
Tripwire Reporting and Integrated Planning System (TRIPS) as 
directed per Ref. B, subject to EAC approval.  Designated 
tripwire reporters are Management OMS Tracy Chandonnet 
(e-mail: ChandonnetTL@state.gov, phone: 971-1724-2968) and 
EconOff Stephen Simpson (e-mail: SimpsonSC@state.gov, phone: 
971-1724-2986). 
 
 
¶3. (SBU) 
 
--------- 
TRIPWIRES 
--------- 
 
TRIPWIRE 1:  SIGNIFICANT NUMBERS OF AVIAN INFLUENZA (AI) 
TRANSMITTED TO BIRDS OR OTHER ANIMALS IN BAHRAIN OR GULF 
REGION 
 
- MGT will provide the mission community with facts on local 
outbreak, provide guidelines on proper handling of foodstuffs 
and advise staff of food and medical items to stock in home 
in case of outbreak (Same message to Amcit community). 
 
- MGT will ensure that all staff are educated on the proper 
disposal procedures of dead animals. 
 
- MGT will also collect home email addresses for all 
employees and send a Management Notice to all staff to 
sign-up for warden messages via email. 
 
- PAO, in coordination with Ministry of Information 
officials, will consider any press procedures deemed 
necessary at that time to inform the public. 
 
- CON will provide community with facts on local outbreak, 
guidelines on proper handling of foodstuffs, advise of food 
and medical items to stock at home in case of an outbreak. 
 
- MED will encourage flu shots for all mission personnel and 
American direct hire family members, and will train Embassy 
canteen staff on proper food handling. 
 
 
TRIPWIRE 2:  ANY CASE OF AI AMONG HUMANS IN BAHRAIN 
OR GULF REGION (ANIMAL TO HUMAN TRANSMISSION) 
 
- MGT will ensure that Post,s Alternate Command Center is 
fully prepared and stocked. 
 
- MGT will repeat Management update and warnings outlined in 
Tripwire 1. 
 
- MGT will consider requesting additional TDY MED personnel. 
 
- MGT will check all emergency supplies and have enough water 
and MREs on hand for a fixed period (TBD) for essential 
operations. 
 
- MGT will put up signs in the Embassy about proper hand 
washing techniques and coughing etiquette, and will teach 
cleaning staff how to disinfect offices and employees how to 
keep their workspaces clean. 
 
- MGT will consider cleaning/removing outdoor furnishings in 
public areas of the Embassy compound. 
 
- MGT will collect and tally skill bank results to identify 
those with medical backgrounds. 
 
- PAO/CON will update internet or other public information. 
 
- CON will repeat and update information about the outbreak 
and provide guidelines to the community and establish 
coordinating groups with other missions 
 
- MED will train guards, first responders, Marines, LES, and 
US community in first aid, home health care, and 
temperature-taking. 
 
- EAC will consider limiting staff movements to home, work 
and essential shopping only. 
 
- EAC will consider limiting public access to Embassy. 
 
- EAC will consider advising Embassy parents to suspend 
sending children to school. 
 
 
TRIPWIRE 3:  SPIKE IN THE NUMBER OF ANIMAL-TO-HUMAN 
TRANSMISSION CASES IN BAHRAIN OR GULF REGION INDICATING AN 
INCREASE IN THE TRANSMISSIBILITY OF THE VIRUS AND/OR CAUSING 
A SERIOUS STRAIN ON LOCAL MEDICAL FACILITIES 
 
- MGT will issue regular updates on AI for the mission 
community.  Travel to affected areas will be restricted as 
appropriate. 
 
- MGT will consider requesting authorized departure of family 
members and non-emergency personnel, and administrative leave 
for non-essential personnel, and will also consider preparing 
travel authorizations for expedited return to home leave 
addresses of remaining staff.  DAO will evaluate NAVCENT,s 
ability to support this effort and coordinate as appropriate. 
 
- CON/PAO will continue to issue Warden Notices (if 
appropriate), update the public internet website, and issue 
public announcements.  Amcits may be advised to adjust travel 
plans to minimize exposure. 
 
- CON will inform the Amcit community regarding the best 
available local medical resources. 
 
- DAO will liaise with NAVCENT efforts. 
 
- MED will communicate with local hospitals and clinics on 
their findings in possible AI cases. 
 
- MED will also make available hand-washing supplies and 
tissues to Embassy staff, and review drugs stocks and other 
medical supplies. 
 
 
TRIPWIRE 4:  SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN GULF 
REGION OR MORE THAN ONE COUNTRY, BUT NOT IN BAHRAIN 
 
- MGT will repeat all notifications to mission community, and 
consider requesting authorized departure of family members 
and non-emergency personnel. 
 
- MGT will consider administrative leave for non-essential 
personnel. 
 
- MGT will consider mandatory administrative leave for any 
employee who exhibits any flu symptoms or has a family member 
with flu symptoms (monitored by the Med Unit); employees with 
flu-like signs will be sent home.  At this point, Post will 
consider setting up screening measures at points of entry, 
and will consider restricting TDY personnel coming to Bahrain. 
 
- MGT will consider distributing Personal Protective 
Equipment (PPE) to appropriate staff in the Health Unit and 
other staff  who interact with the public. 
 
- CON will continue to provide all services to Americans and 
update public announcements if needed, and will provide 
non-immigrant visa services only for persons traveling with 
Americans returning to the US and for official GOB travel. 
 
- CON will continue to process all pending immigrant visa 
cases with existing appointments but will make no new 
appointments. 
 
- CON will continue to coordinate with other diplomatic 
missions, Med/Washington, and desk officers, and will 
consider requesting that the Department issue a travel 
warning. 
 
- CON will consider shelter-in-place and quarantine planning, 
if appropriate. 
 
- CON will consider limiting visa services and will consider 
requesting authorization to suspend visa services.  PAO will 
support any subsequent decision to do so with appropriate 
public service announcements. 
 
- MED will concurrently prepare guidance for family members 
on how to treat AI patients at home. 
 
- MED will train guards, first responders, Marines, LES and 
US community on the use of PPE and masks.  Med will also send 
weekly status reports to Department. 
 
- MED will bifurcate in an effort to minimize MED personnel 
exposure to AI.  One nurse/team will be dedicated to making 
house calls on potentially infected Embassy staff (A 
motorpool driver will be assigned to the Health Unit).  The 
other nurse/team will be dedicated exclusively to treating 
staff at the Embassy. 
 
 
TRIPWIRE 5:  SUSTAINED HUMAN-TO-HUMAN TRANSMISSION IN BAHRAIN 
 
- MGT will continue to implement screening at Embassy entry 
points, consider restricting TDY personnel, and continue to 
inform the mission community of new developments. 
 
- MGT will consider providing delivery service for groceries 
and other essentials to residences. 
 
- CON will continue issuing information notices to the 
American community, but will restrict operations to providing 
emergency American citizen services. 
 
- CON will also consider requesting a travel warning for 
Bahrain. 
 
- MED will maintain a working relationship with local medical 
facilities, GOB and U.S. Naval support activity. 
 
- MED will implement mandatory temperature checks and 
screening for Embassy staff. 
 
- MED will instruct employees to stay home if they are ill. 
 
- MED will issue advice on home quarantine practices and send 
Health Unit personnel to make house calls as needed. 
 
 
TRIPWIRE 6:  MISSION EMPLOYEE DEVELOPS AI 
 
- MGT, in addition to considering all actions outlined above, 
will disinfect offices, begin daily contact with staff for 
any update on illnesses in staff households, implement 
mandatory temperature checks for all personnel, and will 
consider a drawdown of staff. 
 
- CON will consider all actions outlined above. 
 
- MED will provide psychological support to employees, and if 
possible, continue home visits to sick individual(s) and 
evaluate further treatment options including admission to an 
ICU medical facility, or medevac. 
 
- MED will continue appropriate actions outlined above. 
ZIADEH