DR. RICHARD MANDSAGER: Thanks. There are things we can do. Parts of them are personal, parts of them are business, parts of them are government, parts of them are how we think together about things. This slide just shows you some habits of healthy people. If we changed, we included how you handled every year, we do reduce the effect of the yearly influenza we have.

We tend to forget that we just accept as a given that 36,000 people on average are going to die every winter from influenza in the United States. We've just accepted that as a cost of living. There are a lot of people who think if we would get better about staying home when we're sick, about covering our mouths when we cough and sneeze, then we could decrease the yearly impact of influenza and that would be a very good habit for us as people to adopt to try to drive down the yearly epidemics, the costs, the morbidly and mortality, in preparation for minimizing and mitigating, to use Jay's word, the effect of a pandemic.

You can get for your businesses this poster. Multiple web sites are on there. You can get it on our web site. And if we could teach all of us to do this, and my kids give me a very hard time at home right now that I don't live what I try and preach about covering my mouth when I cough or sneeze, we really could do a lot about this, and using -- carrying around a little bottle of hand cleanser regularly, we could do a bunch about this. Respiratory etiquette is a phrase that the scientists talk about more.

There are some other things that can be done. Last year the governor signed House Bill 95 and it was passed by the legislature last year. Last year right about this week the Governor introduced this bill to the legislature. And if we had had a pandemic last year, we had very few governmental tools to quarantine or isolate, if we wanted to try and mitigate the slow spread while we wait for vaccines to become available, while we wait for more anti viral drugs to be available. We did not have good governmental tools here in Alaska. Our statute was dated from 1949.

Today -- or yesterday Kevin Meyer introduced into legislature the kind of what I call the counterpart on the animal side, I call in my line a quarantine and isolation bill for animals to update the statutes for the animal side of this. If this becomes what Jay was intimating is this would become a bird to human transmissible disease there then would become other tools that the veterinarian world would have to use. And so there you have -- that statute also dates from 50 years ago and needs to be updated

We've done a lot in the last few years. It's not like we haven't prepared and we haven't started moving in the direction of where we need to go. This brochure that's at your seat, if you look inside there's one column that says what has Alaska done to prepare? We are working with communities, mass immunization clinics have been held in multiple communities. We're using the annual flu shots in the fall as a way for communities to test: could they give shots to a lot of people in a short period of time?

For example, this fall in Valdez they set up and they did their flu shots. They vaccinated 40 percent of the community of Valdez in six hours and had enough capacity, they could have done 100 percent of the population in Valdez and the Maritime Service (indiscernable) that day, in that eight hour time period as a community. That gives them a fair bit of confidence as a community.

Anchorage last August during the Arctic Shield Northern Edge Exercise practiced handing out pills down here at the Egan Center asking people to come and take their Skittles or M&Ms as a test of how fast could they process people. If we were going to give pills, Tamiflu for example, to people, could we get it to people quickly? Could you screen them quickly, make sure they don't have allergies? Those are the kind of exercises and training that communities need to have ready to go.

Human disease surveillance. Last month our virology laboratory up in Fairbanks brought on line screening a limited ability to screen human samples for H5. We can screen now four or five samples a day if we needed to, and it would only be with the authorization of Jay or one of his staff because we have such limited capacity. But if and when H5 were to get to Alaska in birds, there would become a demand on the human side where people get sick to say "could we screen?" Is it a lot? Is it enough for a big break out? No. But at least it is started. Bird disease surveillance we'll talk about in a few minutes because that's where all the energy is right now in Alaska. And I won't talk any more about that.

But there's lots we got to do. And that's why we asked if we could come talk to you as one of many community organizations that we could talk to. On your table in front of you, if some of you want, there's only three or four on each table, is an 8x11 handout the national government has published over the last month, multiple check list for organizations to use to test themselves about how prepared they are. Whether you're a business or a faith community, a non- profit, and the school one isn't out yet from HHS. It's coming imminently, I'm told. But you can go to the web site and you can get these two.

So for business owners, business leaders, to ask yourself how prepared are we to deal with this? For example, Jay said some businesses are going to have more business, some businesses, your ability, your need for your product may just go away if we were to say to the public at large in Alaska, we think you should not have any public gatherings for the next eight weeks. That would really change how people live. There's all kinds of this voluntary/involuntary kind of stuff that would become engaged as a tool, and it's all about what Jay said, is trying to mitigate the slow spread while we wait for vaccines to come on line and for antiviral medication.

Antiviral strategies. Right now we have a tiny pool of Tamiflu in reserve. We have about 1000 treatment courses in reserve. And think about the pressure if we started to get human disease in this state for that tiny reserve. The hospitals have a little bit more for some of their staff, but nowhere near enough. The president's announcement two months ago when he made the proposal to the congress, included buying and building a large national stock pile of antiviral medicines, mostly Tamiflu.

But he surprised us, frankly, in this state because he recommended to congress that the states need to partner with the national government and states should purchase about 25 percent of the stockpile. If you have a limited supply, then the question is who gets it? And who gets to decide who gets it? In the next few weeks there will be out for public comment a prioritization list.

And if you look at the national plan you can get at least national ideas about what the priority list would be. Health treatment of sick people will be first. Health care workers. And then you start getting the EMS workers, you get to other public safety, troopers, police, the EMS people, decision makers and then in businesses.

In our state, for example, it seems to me that we would probably decide that keeping the airline industry going is pretty important for us to keep the rural parts of the state going. In our state a good chunk of the airline industry might be the essential workers, but other industry folk are really essential, I was surprised, for example, that in the Arctic Shield exercise in August, to realize that Anchorage has about four days of fuel. If the railroad can't come with gasoline, we could have a lot of trouble in this town. So keeping the railroad going might be really important for us in Anchorage.

So there are lots of that discussion that I would like to engage with the business community about. And if we assume, as the planning perspective today, that we have limited supplies of medicine, how do we prioritize? Because if we don't keep the public confidence then a whole lot of bad stuff is going to happen. We saw that in Katrina when civil order started falling apart. And then isolation and social distancing. The new politically correct term instead of quarantine and isolation. We in America like politically correct language. How much is going to be voluntary and how much is going to be involuntary?

I believe we've got to plan on and engage the public in voluntary social distancing. We aren't going to have enough troopers, police to enforce. (indiscernable) won't choose to engage with us. As a planning prospective, I've read some articles that say if we have the public with us we can do this together and we can get 80 percent agreement we can probably slow the threat. We aren't going to eliminate it. I think Jay made the science argument a few minutes ago about that.

So the public health role. Surveillance, clearly Jay and his staff have a big part of -- we've got it to do. Planning and training and exercising that's a big part of our world. Right now if you were to ask how I'm spending money professional life right now I would say it's 25 to 50 percent, it's around this subject. And then the next question is what happens if we don't have a pandemic next year? What happens if it isn't H5N1? Have we wasted the energy?

My argument is the more we train and practice it really doesn't matter then whether it's a tsunami or an earthquake or influenza we're all better ready to deal with it. And we aren't going to be another New Orleans. We are together and the better practiced we are, we're all together in this. But this is going to an energy consuming activity. For you as business leaders where is it on your radar screen? Is it worth the investment, time and energy? Anything we do in this area is going to cost money. Whether it's staff time, changing policies and practices, whatever it is.

So what can you do whether in your family, in your business, as a community leader. Obviously my invitation, my hope is that you and others will engage with us in preparedness planning, participating and supporting the public health roles in the community, and whatever organization you're at. If we got into this then the responsiveness to the public health advice is going to be really important. We've got to be really good at that. We hope that all of you will help spread the message because we're going to have to reach a lot of people.

We saw, with Katrina, I think a reality check. There's a lot of special needs populations. For example, what happens if people don't have access to media, don't speak English, are mentally retarded, are old, and have Alzheimer's? You've got to be prepared to take care of them in the context of something like this. The difference from a tsunami is that this is going to go on and on and on and on and people are going to wear out. Whether it's your business, if you're sustaining, keeping your business going with 30 to 40 percent absenteeism due to illness, or whether it's us, whether it's an assisted living home taking care of people and staff are sick, keep it going in the context of how long this goes on. If you read about 1918 that happened in community after community after community here in America.

The business side of this is hard to talk about in a very short time frame. I would like to just highlight a couple of things. Last week in the Wall Street Journal, a week ago there was an article on the front page called Just In Time Inventories Make U.S. Vulnerable in Pandemic. I was the hospital director at ANMC for a long time. All of us, in whatever business we are, have gone to just in time inventories. There is very little warehousing. We depend on a through-put of supplies and goods in all of our business.

The military, and it's training to some of that, does more just in case planning. For this kind of an event we need just in case planning. Do we need government to have stockpiles. How does business cope if your supply chain gets interrupted? For example, some of you in this room are dependent on the barges coming up on a regular basis to Anchorage. What happens if the barge company lose their staff and aren't able to make supplies for a couple weeks? How well is your business positioned to weather that? And have you thought about that, about your supply chain getting messed up? Establishing sick leave policies. I think this is going to require a profound cultural change in most businesses. We in America are big on heros. If I were to ask for a show of hands, how many of you have come to work when you have a cold and a cough, haven't felt very good, probably had a low grade fever, would every hand in this room go up? And that's the culture in America that most of us live by. Me included. To slow a spread here we would have to change the culture to say if you're sick, you stay home.

What happens to your employees that are single parents that depend on their pay check? Do your business HR policies accommodate liberal leave and in fact, demand that people stay home if they're sick? I think I would contend that most business don't have business HR policies in that regard.

For us as state employees were very poorly positioned right now because the state HR rules basically prohibit working from home. If we want a slow spread businesses should be trying to the maximum extent possible, minimizing contact with other people. And is your business well prepared to encourage people to work from home? I'm told that Microsoft across the world now is equipping their employees' homes such that they can work from home. Now some worldwide business are thinking in that kind of language and investing in that kind of incredible infrastructure to allow and demand that they could be prepared if they need to do that. And obviously communication is going to be a big thing. I would like to read one, about four paragraphs that are the last four paragraphs in this book, which is the book that influenced the president. If you haven't read it yet and you want to think about the impact on America in 1918. And I'd like to read just the last four paragraphs of this author's book.

There was terror afoot in 1918. The randomness of death, its speed and its tendency to kill off the healthiest brought that terror home. The media and public officials helped create that terror. Not by exaggerating the disease but by minimizing it in their attempts to reassure the public. Terror rises in the dark of the mind. An unknown beast tracking us in the jungle. All good horror movies build upon the fear of the unknown, the uncertain threat that we cannot see and do not know and for which we can find no safe haven. In every horror movie, once the monster appears, (tape change) dissipates. Those in authority must retain the public's trust.

The way to do that is to distort nothing, to put the best face on nothing to manipulate nothing. Lincoln said that first and best. The tendency is going to be to minimize that it's here because it's going to have such profound business and economic impact. We've seen Turkey in the last week. The poultry industry business is off 70 percent in the last three weeks in Turkey. The poultry industry in the United States is petrified that it gets to the United States because the same thing could happen here.

But yet so we as public officials, you as business leaders, community leaders, we got to be honest with the public but we also got to prepare to prevent inappropriate destruction of industry in the short term. And that's going to be quite the challenge.

DR. DOUGLAS CAUSEY: Thank you, Richard.