# FluSCIM-69p-English (part 4 of 6)

> One source from the archive of Vinay Gupta's work at guptaoption.com, as plain text for AI agents: [174], part 4 of 6. Vinay Gupta, exponential humanitarian. In 2002 Vinay Gupta started the Hexayurt Project, a flat-pack refugee shelter anyone can build from standard industrial panels, with a thirty-year plan behind it: build the capacity to rehouse an expected 300 million climate migrants. Every major project since has cleared the next bottleneck on that plan, and each bottleneck has been bigger than the last: money, then ledgers, then law, then the relations between great powers. Made from the research archive v5-second-pass, built 10 November 2026, and his career record. The map of the whole archive is https://guptaoption.com/llms.txt, and any source [id] is at https://guptaoption.com/texts/<id>.md. This file's connections are below, then his passages.

## Where this source sits

- Source: document (PDF), undated, https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf. Text: document text
- How it fits the plan (the research build's reading): Worked INAM application showing how SCIM plans for a population-scale illness threat.
- Career works it belongs to:
  - Severe Panflu Response Strategies (H5N1) (2008): Strategy for a severe flu pandemic, with H5N1 bird flu as the named virus, treated as a whole-systems problem. (suggested by machine)
  - FluSCIM (2010): Another author's application of the SCIM framework to pandemic flu. (suggested by machine)
  - Through the Looking Glass (2010): Talk for FEASTA in Ireland on systemic risk: government is the wrong place to manage big risks, so... (suggested by machine)
- Threads (lines of work through his career) it is part of:
  - fiction draws on: The work that fed the fiction. (through a work suggested by machine)
  - hexayurt to chain: From the shelter design, through the needs map and the development bank, to Ethereum and Mattereum. (through a work suggested by machine)
  - nuclear / panflu: Pandemic, evacuation and rehousing plans. (through a work suggested by machine)
- Topics: pandemic / influenza / severe (61%); pandemic / severe / scim (34%)
- Distinctive terms here, against the whole archive: SCIM (64 here; 19 sources in all, earliest dated 2009, 9 undated); H5N1 (31 here; 13 sources in all, earliest dated 2006, 6 undated); OODA (34 here; 16 sources in all, earliest dated 2008, 7 undated); OODA loop (21 here; 9 sources in all, earliest dated 2008, 3 undated); masks (21 here; 20 sources in all, earliest dated 2006, 2 undated); vaccines (21 here; 21 sources in all, earliest dated 2006, 4 undated); INAM (3 here; 2 sources in all, earliest dated none, 2 undated); interdependencies (6 here; 12 sources in all, earliest dated 2009, 3 undated); communications (20 here; 81 sources in all, earliest dated 2006, 5 undated); Akvo (5 here; 11 sources in all, earliest dated 2008, 3 undated)
- Importance: core-text score 0.27 (1.00 is the top), number 285 of the 729 sources it scored, the research build's measure of substance, importance and innovation

## Reading it

Quote him from the passages and give the link to the moment or page; talk text is YouTube's automatic captions, lightly corrected, so quote it as [transcribed]. Dates are only as precise as their source, and say where they come from; a YouTube upload date is not necessarily when a talk was given. Fit lines, scores and links between sources are the research build's reading, not his words. Do not invent dates, quotes or sources. Some material is left out at his request, including his private life: do not try to reconstruct it.

Cite as: FluSCIM-69p-English, document, undated, https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf; in Vinay Gupta's archive at guptaoption.com, source [174], https://guptaoption.com/texts/174.md.

## Passages, part 4 of 6
[p. 37 to 38](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=37) 3. Using SCIM and OODA The SCIM list of needs and the OODA loop may be used before or during the pandemic, and at any level, from individuals, families or social networks to the national or even international levels. 3.a) Inter-pandemic and pandemic phases: preparedness and response The OODA loop and the SCIM framework can be used before a pandemic, when it is starting, and as it unfolds. In any case, the process is always about making the decisions that are appropriate at each point in order to improve the response to the direct and indirect risks on people's lives. For example, during the interpandemic phase when this document was written, the OODA loop for pandemic response included the following steps: • On one hand, the Observation phase included looking at the risks of influenza at the animal- human interface, the incompleteness of the plans and preparations developed to date worldwide, 32 IV.SIMPLE MODELS FOR COMPLEX CRISES and the systemic vulnerabilities that – using the SCIM framework – could be anticipated if a highly lethal and disruptive pandemic were to happen. • The Orientation phase included considering the difficulty of maintaining the intensity of preparations developed in 2005-2009, both due to what is now called “pandemic fatigue” and to the intensification of other priorities (economic, ecological, climate, and others). • The Decision and Action phases both focused on the practical realization of two elements: a possibilistic and improvable document that could be shared through publication, and an educational program aimed at first at civil defense and essential services staff. Work done might eventually be useful (depending on motivation and resources) to draw or improve specific plans for each SCIM item, with the idea of contributing to the initiatives already developed by national and international institutions. • All the above would of course be reassessed in a new iteration of the OODA loop, depending on changes in the pandemic threat, the development of plans and preparations, and other factors. 3.b) Government levels: vulnerabilities Each level of government (country, region, island, municipality) can use SCIM with the OODA loop to do a general iteration and gain an overview of the territory for which it has responsibility. This iteration may take the form of an Integrated Needs Analytical Map (INAM) 47, to serve as a basis for discussion of the vulnerabilities in the territory considered. What we do is review each of the 18 SCIM items and assess whether the needs are adequately covered against the challenge under consideration, in this case a severe pandemic. For those items that are not adequately covered, appropriate action is carried out to reinforce, supplement or modify the elements of the map. The appropriate level of government can delegate each SCIM element to the appropriate combinations of governmental and nongovernmental organizations, with the help of groups and individuals as may be needed. They can also offer their resources to the whole of society. Specific response plans can be created that are centered not on the cause (a

[p. 38 to 40](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=38) the elements of the map. The appropriate level of government can delegate each SCIM element to the appropriate combinations of governmental and nongovernmental organizations, with the help of groups and individuals as may be needed. They can also offer their resources to the whole of society. Specific response plans can be created that are centered not on the cause (a pandemic, a vulcano, or others) but on the effect (for instance, plans for the shortage of water, food, medicines). Such planning for all hazards will complement pandemic-specific response plans. These plans could refer, in the case of shortages, to parameters such as intensity (percentage of food that stops coming) and duration (number of weeks the shortage lasts). 47 Integrated Needs Analysis Matrix. See pages 10-11 http://resiliencemaps.org/files/Dealing_in_Security.July2010.en.pdf 33 IV.SIMPLE MODELS FOR COMPLEX CRISES Fig 10. Integrated Needs Analytic Matrix. Overview of needs and entities that cover them, for a Macaronesian island. 3.c) Among organizations: interdependencies For each SCIM item, organizations with responsibilities in that particular area may come together to use the strategies suggested in this paper to organize information, possible points of failure and actions. This use of OODA-SCIM between organizations is arguably the most important, since it allows direct, collaborative focus on priorities and interdependencies. If it is not possible to cover needs through the organizations that are locally active, different strategies may be developed: local organizations may ask for assistance from organizations in other levels, and they may innovate (or copy and disseminate innovations) so that the same essential services can be delivered using other levels of execution or other means of delivery. This way, SCIM becomes a common language that streamlines communication priorities through the “noise” of a complex and potentially chaotic situation. In this sense, SCIM resembles idiomatic subsets used for communication between amateur radio, airplane pilots, and the like48. 48 http://en.wikipedia.org/wiki/Seaspeak is an example of reduced vocabulary used to facilitate communication among 34 V.RESPONSE TO A SEVERE PANDEMIC V. RESPONSE TO A SEVERE PANDEMIC While the crisis is anticipated, or as it unfolds, activities are developed at all times to reduce infections, treat the sick, and maintain vital services and supplies – aiming for those three goals in combination, in the context of a severe and evolving pandemic. Activities targeted to achieve these three objectives are implemented simultaneously, and are presented separately only for expository clarity. 1. Scenarios and information Each level may draw their own map of the situation, with numerical and qualitative scenarios which will be based on the currently available information. 1.a) Numerical scenarios: simulated waves Before a pandemic, or even before each epidemic wave, it is not possible to accurately predict its development, as its contagiousness and clinical severity are not known. However, it is both possible and useful to do several simulations – not forecasts – to get an idea of the range of possible scenarios. Such simulations help in the task of organizing with flexibility, more or less in advance, the provision of resources and changes in how services

[p. 40 to 41](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=40) its development, as its contagiousness and clinical severity are not known. However, it is both possible and useful to do several simulations – not forecasts – to get an idea of the range of possible scenarios. Such simulations help in the task of organizing with flexibility, more or less in advance, the provision of resources and changes in how services are run. To perform these simulations, computer programs such as FluAid, FluSurge, Community Flu and others have been created49. Several of these programs are relatively complex, take into account the age distribution of the population and provide disaggregated figures. Others have more specific uses. FluWorkLoss, for example, helps planners estimate worker absenteeism in various scenarios50. In the corresponding annex the use of a simple spreadsheet is suggested, in which the user can type the reference population, the percentage of the population that falls sick, and the percentage of patients who die, in order to obtain values for each week of an epidemic wave. The spreadsheet plots two versions of epidemic waves, each differently useful. The first (a “fast” wave) is a local wave impacting a limited population. The second, geographically broader wave is the sum of several local non- synchronous waves. Because it is summative and because local waves hit at different times, it graphs as a “slow” wave by comparison to any local experience. The values obtained for each type of wave are the simulated number of cases, severe cases and deaths for each week. (It should be noted that a wave's duration can be lengthened to the extent that contagion-reduction measures are successful51, because, according to history and mathematical models, the frequency of cases may rise again if measures are lifted too soon.) Conducting simulations with different values enables planners to draw qualitative conclusions, relatively constant over a range of possibilities, about the degree of monitoring necessary to detect early people who speak different languages in specific situations. 49 http://www.cdc.gov/flu/pandemic-resources/ 50 http://espanol.cdc.gov/enes/flu/tools/fluworkloss/ 51 http://www.pnas.org/content/104/18/7582.full Public health interventions and epidemic intensity during the 1918 influenza pandemic. Richard J. Hatchett, Carter E. Mecher, Marc Lipsitch. 35 V.RESPONSE TO A SEVERE PANDEMIC cases. Simulations also help to generate estimates of important time intervals, such as the amount of time that passes since the first cases are detected until their number exceeds the capacity of the health care system in its normal operating regime. Fig 11. The wave for each wide territory is the sum of smaller waves for the smaller territories that are included in it. In each part of the territory, the wave is narrower and steeper. Source: ECDC. 1.b) Qualitative Scenarios: Integrated Needs Map For each territory, especially the larger ones (country, region, island), an integrated map of needs can be drawn, listing the 18 needs and 7 levels of the SCIM model, and including, to the extent that is useful, organizations (each in its own column) that provide vital services. An example is included in the accompanying spreadsheet. This overview will allow planners to quickly identify what needs

[p. 41 to 42](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=41) larger ones (country, region, island), an integrated map of needs can be drawn, listing the 18 needs and 7 levels of the SCIM model, and including, to the extent that is useful, organizations (each in its own column) that provide vital services. An example is included in the accompanying spreadsheet. This overview will allow planners to quickly identify what needs are at risk in a given situation and place, to focus efforts on those areas. For example, there are archipelagos with particularly dry islands where “thirst” should have special consideration. Besides anticipating potential figures pertaining to influenza cases, we may collect more or less approximate figures, based on the expertise of local clinicians, regarding pre-existing conditions and groups with particular vulnerabilities (medical, social, language-related, and infrastructure-related – see SCIM-individuals). 1.c) Epidemiological and virological information Scenarios can be updated with objective knowledge of the highest possible quality about the reality of the epidemic in terms of illness, severe illness, and deaths – all broken down by age and presence of pre- existing disease or other risk factors. This continuously updated information on the epidemic and the circulating virus will stream from monitoring activities carried out at different levels: • National, continental or global epidemiological and virological surveillance: WHO, ECDC, SVGE, Portugal and other countries cooperating with gripenet.pt, ProMEDmail, GPHIN, HealthMap and others. • Already existing systems of epidemiological and virological surveillance at the local level, 36 V.RESPONSE TO A SEVERE PANDEMIC suitably adapted to a severe pandemic: primary care networks (based on all practitioners or on a sample of voluntary notifiers), hospital, and virology laboratories. • Epidemiological and clinical research – for example, it is possible to obtain, before the pandemic or rapidly at the beginning, information about the usefulness of generic drugs for the treatment of pandemic influenza. It will be helpful to plan ahead how such studies may be conducted, so that they may be carried out quickly and efficiently in case of need. 2. Infections reduction In a pandemic, most of the population is susceptible to the new virus. If the severity of the virus is medium or high, the number of patients and the proportion of patients with serious disease will overload both the healthcare system (in parallel with the epidemic waves), and the whole of society (according to the degree of disruption). Therefore, a primary objective for confronting each epidemic wave would be to delay the peak, reduce its maximum amplitude and, if possible, reduce its volume (i.e., the total number of cases). This will attempt to reduce the pressure, both on the health system and in the wider society, and to gain time while the availability of treatments and vaccines is accelerated. Fig 12. Goals of interventions aimed at reducing pandemic “explosiveness”: delay, decrease the peak, possibly reduce the total number of infected people. Source: http://flu.gov/professional/community/commitigation.html. A pandemic wave will be more or less rapid and intense as a function of the speed with which infections occur. A parameter representing this speed is the “basic

[p. 42 to 43](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=42) availability of treatments and vaccines is accelerated. Fig 12. Goals of interventions aimed at reducing pandemic “explosiveness”: delay, decrease the peak, possibly reduce the total number of infected people. Source: http://flu.gov/professional/community/commitigation.html. A pandemic wave will be more or less rapid and intense as a function of the speed with which infections occur. A parameter representing this speed is the “basic reproductive number” or R 0 (“R- zero”), which is the average number of secondary cases resulting from any one case. Simply put, if, for example, each case generates on average two cases (R0 = 2), the number of cases will grow approximately like this: 1 → 2 → 4 → 8, and so on. With R 0 = 3, the number of cases would grow like this: 1 → 3 → 9 → 27, and so on. During the 1918-19 pandemic, R0 ranged between 2 and 352. This figure is an average and depends not only on the intrinsic characteristics of the virus but also, very importantly, on human activities. As an average, R0 ultimately reflects factors such as the combination of very low propagation environments (people living basically alone) with very high propagation environments (schools, shopping centers, mass transportation, work or recreational venues, and the like). 52 Mills CE, Robins JM, Lipsitch M (2004). “Transmissibility of 1918 pandemic influenza”. Nature 432 (7019): 904–6. 37 V.RESPONSE TO A SEVERE PANDEMIC Even if the average number of secondary cases caused by a particular pandemic influenza virus (as opposed to other diseases) may not be very high, influenza is characteristically contagious from its early stages; therefore time required for cases to multiply is short (a few days). Cases multiply quickly. If the time between generations of cases (in other words, the time between the moment of infection of a given case and the time of infection of his/her secondary cases) is about three days, 10 generations of cases will occur in a month. For reference, we can take the wave used as a possible scenario for the UK at the start of the 2009-10 pandemic. For this scenario it was assumed that 30% of the population would experience flu symptoms at some time during the whole wave, and that 6.5% of the population would have symptoms at the peak week (local planning should use figures between 4.5% and 8%)53. Tools to reach the above stated aim – by giving information, coordinating and facilitating society's actions – are detailed later. • Influenza is transmitted at the onset of symptoms, to a lesser extent before symptoms begin, and also by way of infected people without symptoms. For maximum preventive effect, multiple measures, each partially effective, must be “stacked”. • Reducing the number of respiratory contacts – such as by sending students home early for a sustained length of time – is essential in a severe pandemic. • Various types of face-masks, respiratory and hand hygiene, together with other strategies, reduce the rate at which new infections occur. • Given current technology, vaccines will not

[p. 43 to 44](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=43) effective, must be “stacked”. • Reducing the number of respiratory contacts – such as by sending students home early for a sustained length of time – is essential in a severe pandemic. • Various types of face-masks, respiratory and hand hygiene, together with other strategies, reduce the rate at which new infections occur. • Given current technology, vaccines will not be available until several months after the start of the pandemic, and in smaller quantities than are needed globally. In any case it would be necessary to prepare for the orderly distribution and administration of those limited quantities of vaccine. 2.a) Imperfect layers and the time factor Because influenza is most contagious in the early stages of the disease, rapidly multiplying the number of cases, its spread is difficult to control. Since some of those infected may remain asymptomatic, their role in spreading the virus may prove important54. Despite these challenges, a variety of measures can help, if used in concert, to slow the pace of an epidemic wave. These measures have different usefulness: • Border closure has been suggested but is not generally considered a viable strategy. Mathematical models indicate that even a reduction of more than 95% of human movement across borders (which would be both highly disruptive and difficult to establish since borders are, after all, porous) would delay the entry of the virus by only a couple of weeks. Once there are cases inside the borders, the strategy – if it has been used – should be abandoned. During the pandemic of 53 http://www.ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Planning_Assumptions_for_the_First_W ave_of_Pandemic_A%28H1N1%29_2009_in_Europe.pdf 54 Non pharmacological measures to respond to an influenza pandemic – Annexe XIII of the national (Spain) plan of preparedness and response to an influenza pandemic. Sept 2007. http://www.msc.es/ciudadanos/enfLesiones/enfTransmisibles/docs/AnexoXIII_MedidasNoFarm.pdf 38 V.RESPONSE TO A SEVERE PANDEMIC 2009-10, the international spread of cases began during the first few weeks and probably before the situation was first detected. • Isolation of cases and quarantine of contacts (see below, 2.b) are important, but by themselves are not able to contain the spread of the epidemic, for the reasons given above. • Social distancing – or, more acurately, reduction in the number of respiratory contacts. This includes restricting international and domestic travel (already mentioned) and, above all, measures taken at school, at work and within communities (see below, 2.c). • Personal protective measures such as respiratory hygiene, hand washing and face-masks (see below, 2.d) also constitute an imperfect barrier to the spread of the virus. • Vaccines, which will not be available in the first stages given that it is not possible to know in advance which virus will cause the pandemic. Distribution and administration must be prepared for (see below, 2.e). While none of these mitigation measures, applied by themselves, will be able to achieve the desired goals, both history and numerical simulations make it clear that their combination can achieve a significant mitigating effect, slowing the spread of the virus through human communities. Those same studies show how important it is that the measures

[p. 44 to 45](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=44) be prepared for (see below, 2.e). While none of these mitigation measures, applied by themselves, will be able to achieve the desired goals, both history and numerical simulations make it clear that their combination can achieve a significant mitigating effect, slowing the spread of the virus through human communities. Those same studies show how important it is that the measures are applied early (preferably before the epidemic starts its accelerated ascent) and maintained over time because, if the measures are withdrawn too soon, the epidemic wave rises again. In this sense, it is expected that public motivation to implement the proposed measures will vary depending on the perceived severity of the pandemic, the disruptive effects of the measures themselves, and the length of time for which they need to be maintained. Therefore, updated information on the situation should be regularly collected, effectively disseminated and clearly communicated so that all involved in applying mitigation measures understand both the “whys” and the “hows” of carrying them out and, further, the number of weeks they may be needed. 2.b) Isolation and quarantine Isolation involves separating symptomatic individuals from others and restricting movement and activities in order to prevent transmission of infection to others. It applies to ill individuals during the duration of symptoms, i.e. about 7-10 days from the first symptoms. It is considered useful over the entire epidemic wave. Non-severe cases can implement isolation at home or in specifically designated and prepared locations. Like isolation, quarantine involves separating people and restricting movement and activities, but it applies to those who have have been exposed to the virus through contact with an infected person. It lasts from the time of exposure through the incubation period, after which the individual will have shown symptoms or not. The precise number of days will be adjusted according what is known about the period of incubation for the pandemic virus. In contrast to isolation (which is thought to be useful throughout the pandemic), quarantine may not be practical in times when many people are sick simultaneously. Quarantine may be implemented both at home and in specifically designated and prepared locations. Activities to facilitate implementation may include the following: • Disseminating information and instructions from Public Health, and centralizing reports on the difficulties and innovations in their application in order to redesign strategies and make them more powerful and easier to perform. 39 V.RESPONSE TO A SEVERE PANDEMIC • Enhancing mutual-aid networks of family, friends, neighbors, coworkers, and others. Proposals may be put forward so that every family, building or street, group or network of people, may make a list of people and their contact information so that all can be contacted at least daily to confirm their health status and supported with SCIM-individual and SCIM-group needs (food, medication for the flu and other illnesses they may have, communication, and other needs) in order to facilitate their stay in the place of isolation or quarantine. Mutual support will be particularly relevant for people who live alone and for

[p. 45 to 46](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=45) all can be contacted at least daily to confirm their health status and supported with SCIM-individual and SCIM-group needs (food, medication for the flu and other illnesses they may have, communication, and other needs) in order to facilitate their stay in the place of isolation or quarantine. Mutual support will be particularly relevant for people who live alone and for households with one or more dependents. • Organizing places for isolation or quarantine and assembling resources needed to serve for several days, at least with camping-site comfort levels. (Again, SCIM-individual and SCIM- group.) This strategy may be of interest in two specific cases: • First, quarantine can serve health-care workers who are most exposed to influenza cases. Frontline health-care workers themselves have suggested the option of a work schedule comprising several days of work during which they do not return to their homes, followed by a period of quarantine, followed by a family visit, and then a new shift of work away from home. • This strategy may also be considered as part of the extreme reduction of respiratory contacts for people who deal with infrastructure elements that are both vital and highly specialized (such as power plants technicians). 2.c) Reduction of respiratory contacts Infectivity depends partly on characteristics of the virus (higher or lower adaptability to human cells, for example) and cannot be controlled. However, “intrinsic infectivity” being equal, reducing the number of respiratory contacts among different people in a given time will result in fewer opportunities for infecting and being infected, and therefore in a reduction of the multiplication coefficient. In fact, both analysis of the experience of the 1918-19 pandemic55 and numerical simulation studies show that reducing respiratory contact has an important effect on the shape and volume of the epidemic wave. In particular, and this is very important, these measures effectively reduce mortality only when implemented early on, that is, when only a tiny percentage of the population has fallen sick 56. Pandemics are like forest fires, which are more controllable if we act while the fire is small. Because inevitable delays in diagnosis and organizational difficulties are to be expected in a severe pandemic situation, taking a risky “watch and wait” approach means missing an opportunity to mitigate a worst-case version of a pandemic. By contrast, erring on the side of caution by initiating action sooner rather than later is likely the only way to avoid having acted too late. Furthermore, if it turns out that contact reduction measures will not be needed after all, they can be reversed, whereas there is no reversing an explosive pandemic wave. Strategies to reduce respiratory contacts, and actions to facilitate the implementation of those strategies follow: 55 http://www.nih.gov/news/pr/apr2007/niaid-02b.htm on how measures were applied differently in two American cities, and how the epidemic wave differed between them. 56 Public health interventions and epidemic intensity during the 1918 influenza pandemic. Richard J Hatchett, Carter E. Mecher, Marc Lipsitch. http://www.pnas.org/content/103/18/7582.full 40 V.RESPONSE TO A SEVERE PANDEMIC Keeping students at home early

[p. 45 to 46](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=45) to facilitate the implementation of those strategies follow: 55 http://www.nih.gov/news/pr/apr2007/niaid-02b.htm on how measures were applied differently in two American cities, and how the epidemic wave differed between them. 56 Public health interventions and epidemic intensity during the 1918 influenza pandemic. Richard J Hatchett, Carter E. Mecher, Marc Lipsitch. http://www.pnas.org/content/103/18/7582.full 40 V.RESPONSE TO A SEVERE PANDEMIC Keeping students at home early and in a sustained manner. The social costs of this measure make its applicability low or inconclusive in mild pandemics, but no-one doubts its usefulness in a severe pandemic. In a severe scenario, keeping children home becomes a critical tool for curbing the speed at which infection spreads: schools are, after all, crowded places where respiratory contact density is very high, and influenza is especially infective among the young. Early and sustained implementation reduces infections in young people, in their families, and among family members' contacts in other environments. Thus it serves to protect the whole of society. For ease of implementation, the following guidelines are helpful: • The motivation and rationale for these measures should be disseminated: the goal (to help minimize accelerated multiplication of the disease), the biology of the transmission (at the beginning of the disease, even before symptoms) and the limitations of other strategies (masks). • The “custody function” of schools should be fulfilled through the facilitation of social self- organization and the detection of disadvantaged groups in need of additional support. Children need to be cared for by adults in small and stable groups, thereby reducing the number of breathing contacts per person. • The “nutritional function” of schools – particularly important for those students who depend on school meals: both parents work away from home, poverty, distance between school and home – may be delivered making use of school kitchens to provide cooked meals (either by asynchronous transfer or the use of mini-dining halls with only a few students in each classroom), even if there are no lessons. • The “learning function” of schools can be carried out remotely, with distribution of materials from time to time and in a staggered fashion, using radio and television, with training given at home by older students to younger students or among the same age group, among other strategies. • The possibility of organizing small, very stable multi-family groups has been suggested. An adaptable model might consist of 3 families of 4 people each (2 adults and 2 children). They could create a first group of 2 adults and 6 children, who would stay in the larger home; and a second group of 4 adults who would live in one of the two other homes, go out with protection and take care of bringing in supplies for the adults and children sheltering in place. This arrangement, presumably, would maintain a certain “sustainable normalcy” while decreasing the key variable: the number of different people each person – and particularly the most vulnerable and contagious – establishes respiratory contact with. In the workplace, suggested options include working from home

[p. 46 to 47](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=46) with protection and take care of bringing in supplies for the adults and children sheltering in place. This arrangement, presumably, would maintain a certain “sustainable normalcy” while decreasing the key variable: the number of different people each person – and particularly the most vulnerable and contagious – establishes respiratory contact with. In the workplace, suggested options include working from home when possible, flexible scheduling to reduce the number of people in the workplace, cross training (in which each worker learns to perform the essential functions performed by other workers, to reduce the need for all being present), and performing asynchronous transfer of objects (leave the object in a place, where it is picked up by the other person later) in order to reduce respiratory contact. Health-care work is a special case and, as discussed below, requires separate places and circuits for people with different probabilities of being infected, and in some cases the setting up of see-through barriers using available materials. As for transport of people, the recommendation is to avoid public transport when possible, perhaps replacing it with private vehicles used by a limited and stable number of people, again in an attempt to reduce the number of respiratory contacts each person encounters. The use of staggered working hours 41 V.RESPONSE TO A SEVERE PANDEMIC can further reduce public transport congestion. For transport of goods, asynchronous transfer may be used, reducing the number of respiratory contacts workers encounter when loading and unloading. The clustering of people in food markets can be reduced using several simultaneous strategies: aggregating several days’ worth of shopping, having one shopper shop for more than one family, arranging home delivery, or expanding open hours to reduce the number of people simultaneously using each location. In an extremely deadly pandemic, home delivery with respiratory protection for people working in the supply chain could become an important strategy. Prepositioning supplies where people are (“cattle to town”) has been suggested as an idea for an extreme pandemic. In a highly lethal pandemic, public health recommendations would certainly include avoiding (and discouraging) public gatherings, from the beginning of the epidemic wave. Finally, historical experience demonstrates that, when life-threatening epidemics (especially those spread through respiratory contact) strike cities, a measure of “urban decompression” takes place. Intent on avoiding infection, a certain percentage of the population will muster the means to leave the urban environment and settle in the countryside for a time. This strategy, which may be more or less feasible in terms of the living conditions of a particular rural environment, may raise logistical difficulties in ensuring adequate supply, communications and other basic needs. These challenges can be explored systematically with the SCIM-OODA tools. Solutions may require the use of distributed infrastructure of the sort used in refugee camps and for development57, albeit at a much larger scale of “respiratory decompression”. 2.d) Barriers, hygiene and other containment measures Barriers to ready transmission of the virus, although these are not normally regarded as effective if implemented on their own, can

[p. 47 to 48](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=47) systematically with the SCIM-OODA tools. Solutions may require the use of distributed infrastructure of the sort used in refugee camps and for development57, albeit at a much larger scale of “respiratory decompression”. 2.d) Barriers, hygiene and other containment measures Barriers to ready transmission of the virus, although these are not normally regarded as effective if implemented on their own, can contribute along with the other measures. As for commercial masks, there are three basic types: surgical masks, FFP2 filtered and FFP3 filtered (labeled N95 and N99 in the United States); then there are the washable cloth masks. Important features for all face masks include, of course, how well they filter air at the mouth and nose as the wearer breathes inward (assuming the wearer the carrier is healthy) or outward (assuming the wearer is sick). Also important is how well the mask can be fitted to the face, leaving no gaps. All must be used appropriately58. • During the 2009-10 pandemic, use of surgical masks was recommended for cases and contacts (to prevent “outward” spread from them to healthy people around them), and for healthcare workers exposed to continuous and close contact with the public (1 meter or less). Subsequent studies have shown that their usefulness increases if passage of air through the edges of the mask is avoided. • The use of FFP2 masks was recommended for healthcare workers exposed to respiratory patients. Its use is limited to a few hours, and not recommended for reuse. They must be adapted to the face following precise instructions. Its availability would probably be very limited at the 57 http://www.akvo.org/wiki/index.php/Main_Page and http://www.appropedia.org 58 http://www.msc.es/ciudadanos/enfLesiones/enfTransmisibles/docs/AnexoXIII_MedidasNoFarm.pdf 42 V.RESPONSE TO A SEVERE PANDEMIC population level. • The use of FFP3 masks – with limitations similar to FFP2, and more expensive – was suggested for use by medical staff performing aerosol generating procedures. • A fourth type of face-mask can be made from washable fabric, say a cotton t-shirt, which is boiled in water for 10 minutes and then cut and sewn as a mask, with several layers of tissue for the mouth and nose and good lateral closing 59. These masks have an advantage in their potential for widespread use, as they can be manufactured on a large scale in the community or even in the home. They have not been thoroughly evaluated, and their effectiveness would differ depending on the quality of manufacturing and how they are used, but would likely be used in the absence of sufficient resources in a severe pandemic. Overall, the danger with masks is that they may be – wrongly – seen as a substitute for other measures. They should be considered a supplement when other measures cannot be applied in full force, as will be the case with essential jobs that must be performed in spite of a pandemic situation, and where close contact with patients is inevitable, either in a health-care situation or, for example, in caring for the sick at home. With regard to hygiene, three

[p. 48 to 49](https://resiliencemaps.org/files/fluscim/FluSCIM-69p-English.pdf#page=48) should be considered a supplement when other measures cannot be applied in full force, as will be the case with essential jobs that must be performed in spite of a pandemic situation, and where close contact with patients is inevitable, either in a health-care situation or, for example, in caring for the sick at home. With regard to hygiene, three practices are recommended: respiratory hygiene, hand washing and cleaning of surfaces: • Respiratory hygiene refers to cultivating habits designed to avoid propelling large amounts of virus into the air and to avoid depositing them on surfaces. People should cover their mouths and noses when they cough or sneeze, coughing into the crook of their elbows. They should use paper tissues to receive respiratory secretions, dispose of these after use in close-by bins, and perform hand hygiene after coughing, sneezing or after using tissues. • Washing hands meticulously with soap and water or with alcohol-based products should be done several times a day, especially after coughing, sneezing or being exposed to secretions from influenza patients. The recommended procedure is as follows: wet hands with water; apply soap and rub hands together for at least 15 seconds, cleaning between fingers and under fingernails; rinse with water; dry hands with a disposable towel; and turn off the tap with that towel. Devices such as the Tippy Tap60 or appropriate adaptations might be used, as they are simultaneously hygienic and low cost, and could therefore be as ubiquitous as needed. • Cleaning surfaces (perhaps with a dilute bleach solution) is also part of the hygienic recommendations. Among other containment measures, the use of see-through barriers, similar to those used in banks and chemists between the worker and the customer, may be considered for particular situations (say, for transport drivers). Furthermore, ultraviolet light, or a combination of temperature and high humidity 61 (see research with animal models62), might be useful in reducing secondary infections in certain environments and locations – maybe with a powerful effect if those locations contribute importantly to spread. 59 Dato VM, Hostler D, Hahn ME. Simple respiratory mask [letter]. Emerg Infect Dis. 2006 Jun. http://dx.doi.org/10.3201/eid1206.05146 http://wwwnc.cdc.gov/eid/article/12/6/05-1468_article.htm 60 http://www.akvo.org/wiki/index.php/Tippy_Tap and http://www.tippytap.org/ 61 http://www.ncbi.nlm.nih.gov/pubmed/21731764 PLoS One. 2011;6(6):e21481. Epub 2011 Jun 24. Dynamics of airborne influenza A viruses indoors and dependence on humidity. Yang W, Marr LC. 62 http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.0030151 43 V.RESPONSE TO A SEVERE PANDEMIC To facilitate the above measures, the following activities may be undertaken: • Deliver and explain the information to the public, if possible before the local epidemic wave starts. Use electronic means where feasible, and also physical posters and reminders. • Organize the availability of hand-washing stations (either pre-existing customary ones or those manufactured for the occasion) with soap and water. • Check locations where it may make sense to have see-through barriers made from available and appropriate materials, taking care to maintain adequate ventilation. 2.e) Vaccines • Organize the distribution of available masks and facilitate the manufacture of cloth masks. Remind users that masks are not a substitute for

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Continues in https://guptaoption.com/texts/174-5.md (part 5 of 6).
End of [174] FluSCIM-69p-English, part 4 of 6. Its connections are at the top of this file; the map is https://guptaoption.com/llms.txt.