Shortly after the outbreak was confirmed, our USDA arranged with MAFF (UK's Ministry of Agriculture, Fisheries and Food) to send US veterinarians over to assist w/the outbreak as Temporary Veterinary Inspectors (TVI). As part of the agreement, we were granted a temporary membership in the Royal College of Veterinary Surgeons (RCVS), allowing us to practice veterinary medicine in the UK. Civilian US veterinarians were sent as GS-9 or GS-11.

Groups of US vets were sent to London every week for 4-week rotations. I left April here April 25, 2001. Here is my story...

....the political influence is becoming a tense situation, apparently it is now becoming an issue to have this disease wiped out by the election. Thus, Page St. is saying to vets to not take samples on farms that have lesions, but to go ahead and call them an SOS, slaughter on suspicion....meaning they don't have to call it a confirmed case...and this keeps the number of IP's down. These are the comments that almost every one has given us when we ask. Hope this sheds some light on a very grey subject.

Lorna Lanman

The problem here is that (I believe) there is no reliable means of confirmation or rule out of true FMD.

MAFF does have TVI's take samples for serum (AB and virus capture Elisa) and virus isolation, supposedly; but I have not yet heard of any cases confirmed by lab findings.

Overall, it seems the TVI's (including me) do not trust the lab reports.

So, there's the rub, eh? Either we're dealing w/ a huge political problem, and FMD is still spreading more than the reports; or, if the lab results are, in fact, accurate--and the trainers are correct--we have been grossly overdiagnosing the disease.

A US TVI from CDC (Nord, w/my group) has been suggesting using PCR to accurately dx the cases. Makes sense to me. Anyway, there seems to be a fair amount of confusion, frustration, and distrust here among the TVI's--something we can ill afford to have happen at home.

I left at 6:30 this AM to meet them for an 8AM cull; I only made 1-2 wrong turns but made it on time. We culled 650 sheep/lambs, but only 30-40 were by injection. (It is forbidden to use the captive bolt on lambs <15kg.) They also sent a Sr. vet student to assist. It's really nice to have a 2nd vet there if the numbers are very large. The TVI is there to oversee the culling operation to insure it is performed in a safe and humane fashion, which has always been my experience thus far--the cull teams and slaughtermen seem very anxious to do a good job and make sure we're happy--and to euthanize the small lambs by intracardiac injection. Then, we are to examine the carcasses for any signs of disease. (We did not see any here.)

Anyway, with 600 animals, or if there are a lot of lambs, you need at least 2 vets.

They have been using vet students as "lamb killers"; and it's good experience for them.

And then, there's the paperwork. Besides the ubiquitous forms, permits, licenses, postings, there is a 12-page FM1 form which asks everything from who's been off/on the premise in the last 21 days to what you had for supper last nite-and this morning's breakfast!!! (Well, almost...)

TVIs (Temp. Vet. Inspector) were sent out on patrols w/little (if any) training, doing the best they could, and pretty much left to fend for themselves. Sometimes 2 or more TVIs would show up at the same place, sometimes at the same time, with each not knowing about the other. You can imagine the frustration (owner and TVI) if you showed up to inspect some stock only to find they were all culled 2 weeks ago!

An interesting note is, that on a SOS, MAFF is only performing the preliminary C&D and no secondary. (Remember, SOS=Slaughter on Susp., and take samples; these are the ones the TVIs feel suspect, but MAFF will not allow to be called COC (Cull on Clinical). Remember an SOS is NOT an IP, however it will become an IP if the samples come back positive. COCs are by definition an IP. Get it?) Anyway, we (AHOs and I) felt that if they were only SOS, they should still get a secondary C&D.

Back to FMD, an interesting note, on the handling of carcasses. The old policy was that on all IPs, the carcasses were burned or buried on the premise. And that's what we were doing in Scotland. Apparently, the policy has changed, and ALL carcasses are being hauled to a common burial site-that includes the IPs which supposedly have the disease.

Another little monster is raising its ugly, little head out of the SOS policy.

Remember, they used to merely confirm Dx on clinical signs (COC), call it FMD and slaughter. Now, COCs are rarely called, and everything is either negative (no FMD) or SOS (slaughter on suspicion)-COC or SOS, the stock are still culled, either way.

The difference is, on SOSs, blood samples are taken, and the case will or will not become an IP pending lab results. Well, now the news is reporting that at least 33% of the culled farms were NOT infected w/FMD (per lab results, per the news).

Of course, they don't have and/or give the entire picture, but that's not the point.

Anyway, so imagine the "ammunition" those farmers now have for suing MAFF for wrongfully killing their stock. And it's starting to happen. And besides the suits, there is more support/reason for a farmer to stop pre-emptive culling because he is convinced his flock is healthy. So the plot thickens...

It went well, and as usual, from all the reports so far, the farmers are just wonderful, friendly, conscientious people!

No political news today (I think we're about done w/all that!), but it was curious on this call that on talking w/this farmer, his land adjoins what looks like 2 IPs, and although they were over 30 days ago, he was never culled! We were there on the "21-day" sampling to lift the Form D on the Surveillance zone. I say "21-day" because it has been over a month and this has been his first visit! And as far as the IPs go, it's hard to figure. I'll ask around, but don't expect any real, reasonable explanation.

We did have an interesting conversation w/Charles Moir (one of three Div. Vet. Mgrs. here) the other day. We brought up some questions about sample handling, now that they're collecting so many blood samples. They say their lab (Pirbright) says the virus is not heat labile, and refrigeration is not that important. We mentioned how a couple from my group (one from CDC and another from FDA) both expressed some concerns.

Here's a thought: if there are say 100 TVIs at each of 10 DECCs, incl. hotel, laundry, car rental, cellular, per diem, comes to over £15 million (or almost $23M) per month!-just for the TVIs! And then add all the directors, support staff, supplies, admin; then the cost of the reimbursement to the farmers, well it does boggle the mind.

From Lorna Lanman:

Date: Tue, 22 May 2001 18:58:30 EDT

Subject: Foot & mouth disease, preparedness -

Hi. We have asked repeatedly about the deer potentially being infected with FMD. The continued answer is that there is not a problem with FMD in the deer. "The deer become sick and go into the woods and hide until they are well" is the answer that I received one time. When I asked the Epidemiologist in Carlisle this past week about deer, he said that it is a very severe disease in deer and many can die from it. I told him that this was just the opposite of what we had been told before, and he said "believe me, it is a very severe disease in deer." The other answer we had been told was that they were not going to shoot the deer as it would scatter the remainder of the herd all over the area, infecting livestock in other areas. They feel that the deer stay in certain areas and do not travel that far.....unless are scattered by man shooting at them. They also say that deer do not shed much virus, similar to sheep, and thus are not as much of a risk of disseminating the virus.

Also, the lesions that "look" like FMD are probably not FMD and the blood tests prove that it is not. However, some people are seeing lesions in cattle that are the same as they have seen many time in other cattle positive for FME, that are coming back negative on the serology. They are not using the RTPCR test that is available in the US. Some believe that the tests may not be accurate or quality control is lacking or sampling techniques are inadequate or caring for the samples is not adequate. At any rate we are getting a 35% false negative rate.

and again, from Lorna Lanman
Tue, 22 May 2001 18:59:08 EDT
Subject: At the finish line.....
Hi, everyone I'm not sure who won yet. I think it might be a photo finish.

Anyway, we are all finished with our tour of duty here in England. It's been an experience of mixed emotions, and mixed results, but everlasting memories. We all went out to eat tonight and discussed a number of things, including experiences with farmers, and what we think will happen if the US gets FMD.

We all are in agreement that there is not a chance that we will be able to contain it quickly without an effort that is more organized and concentrated than we have set in place at the present.

We won't be able to adequately slaughter, we won't be able to adequately stop movements, we won't be able to adequately dispose of all the carcasses and on and on......unless we get our act together and soon.

We may look at England's mistakes and say "how in the world could they have been so unprepared and be so inadequate in their response?"

BUT, they never ever thought that this epidemic would get this big. I have heard it many, many, many times in the last few weeks......THINK BIG.....If you think you will need a hundred computers, ask for 1000, if you think you will need a thousand people, as for 10,000, if you think you will need a burial site for 100,000 carcasses, make one for 2 million carcasses. THINK BIG and don't ever underestimate the impact of this disease.

You can always downsize, but gearing up in a hurry is difficult, if not impossible. (almost a quote)

England is a very structured country which likes to do things "as they have been done in the past" but it is not a third world country. There are some extremely intelligent people here who have very high standards of living and high standards of work ethics. This is quite a wealthy country, but their farming community has some very difficult problems to solve.

I have marveled at the grit that these people have. They will certainly dig their heels in and get down and dirty to accomplish whatever the task is at hand. They are relentless in their quest at conquering this epidemic, no matter if the politics or the virus are the obstacles along the way. They are not planners, though, and they readily admit it.

Thus, the reason there was no disaster plan in effect to combat a FMD....and they just got through conquering "Hog Cholera" or "Swine Flu."

Plus, they had FMD not 35 years ago that had more infected premises than this epidemic. Wouldn't you think they would develop a disaster plan of attack?

The people of North Carolina got with the program, why wouldn't the Brits?

The stresses on the people in the farming community are at the extreme limit. I thought the story I heard today said it best when Virginia ( who is in our group) told a farmer who lit up a cigarette in the barn "this is not a very good habit to have." His reply was "well, this is not a good time to stop!"

This man had lost 2 stones of weight......I think a stone is 14 pounds....since February when this all started. Most of these farmers who have escaped the disease so far are doing great biosecurity. No one on, no one off. No movements of animals. AND they will talk your arm off as they haven't had much contact with others for weeks.

In Cumbria, they are having a great deal of trouble with farmers not allowing people on the farms. They have adopted the system of teams of TVIs who canvas the area, with inspections every other day for 16 days then at the end of 23 days. They are trying to send the same vets to the same farms to develope a repair with the farmers and minimize the problems. This disease is now showing up in the hefted flocks of sheep....sheep on the hills that have no fences. This is very, very worrisome to everyone. The area near Leeds is now being affected. It is worrisome, also, if it moves on south to the pig farms. BIG TROUBLE. They are certainly not out of the woods yet.

Dr. Moir, the head DVM here at Newcastle, said today that they will definitely need vets until July and probably to the first of October. Haven't decided if I will come back or not. I think I need a rest first!

The big news these past few days is that the vets paid directly by MAFF are not getting paid. Apparently, some have been on the job since the beginning and have never been paid anything. This is quite stressful to many of the foreign vets who brought little money along and are now in the deep red at their hotels for meals.

I told them in the meeting yesterday morning that I didn't feel so bad about making half pay as half of something is better than all of nothing!! They laughed. I have made a lot of notes and gathered a great deal of information....

In fact, I went to the Post and was going to send all the papers home and they wanted to charge me about 130 pounds, which would be close to $200, so I gracefully declined.

I don't know what I'm going to do with these two boxes, but I am not going to pay that much to mail a bunch of papers. I'll try some different routes in the next few days. I hope the pictures made it through ok to you, Tom, and that it will help with your presentation. Tomorrow, we will be back in London and will see Terry Paik again. They had to drive back to Scotland to return their cars, phone, GPS units, etc., then will fly to London. We will meet with the USDA folks and be "debriefed" on Thursday. Some will travel on home and some of us are staying to R and R....it will be difficult getting this "Pub" life out of our system! Also, getting the FAM 30 smell out of our shoes, finger nails, etc. will also be a trick. The really nice car that I have had for 4 weeks smells like it has had a vinegar bath!! See you all in the States and hope that you have enjoyed the reflections and experiences that we have sent. Cheerio......

Lorna

PS We all decided that our new favorite words are "This is a big Cock Up" .....this means .... ......well, figure it out! However, Steve Ellis's desert took the cake, so to speak, it was a currant cake with a sauce at a Pub that was called a ......are you ready for this?........... "a speckled dick" No one dared to ask WHY! Just amazing that we speak the same language.
Bye!
Lorna