"I'm Sorry, Sir. There's Still Postage Due on Yours."

When was the last time you gave the US Postal Service responsibility for delivering a package that absolutely had to get to the recipient as fast as possible?

Right. I don't remember either. 

The administration, though, has nothing but faith in the Postal Service.  In fact, it's willing to make a big bet on the Postal Service's nimbleness, sense of urgency, and dedication to duty. 

And when I say big, I mean really big; it's willing to bet your life on it.

Literally.  If we suffer an anthrax attack, everyone who's been exposed will need antibiotics within three days of the attack.  That's within two days of our discovery of the attack, if we're lucky.  Every day of delay after that is a death sentence for roughly five or ten percent of those exposed.

How will we get antibiotics in the hands of what could be hundreds of thousands of really worried people?  The Administration's answer is contained in an executive order released quietly last week:  We'll get the Postal Service to do it.  Of course they're already demanding armed protection, so we'll send local law enforcement officers with them.

Stop for a moment to imagine the scene.  Postal workers  will be asked to drive into contaminated neighborhoods even though they can't be sure their countermeasures will work against whatever strain has been spread there.  The neighborhoods are full of people desperate to get antibiotics, so for protection, the postal workers will first have to meet up with guys with guns whom they've never seen before.  They'll collect antibiotics from pickup points that they may or may not have gone to before.  They'll meet the guys with guns there, or someplace else that may have to be made up at the last minute.  Then they'll start out on routes that almost certainly will be new to them.  As they go, they will seamlessly and fairly make decisions about whether to deliver the antibiotics to homes where no one is present, to rural mailboxes that may or may not be easily rifled, to people on the street who claim to live down the way, to the guys with guns who are riding with them and have friends or family at risk, and to men in big cars who offer cash for anything that falls off the truck. 

And all this will put antibiotics in the hands of every single exposed person within 48 hours, from a no-notice standing start.

Yeah, that should work.

I don't mean to be flip.  I talk about this in the book, and the fact is that no delivery method will work really well, and so, as a fallback, the Postal Service may be our best option.

That said, no one but an idiot would bet their children's lives on that option.

So here's what I did -- and what you should do too.  I asked my doctor for an emergency supply of antibiotics that would get me through the first week or so of a crisis.  I promised not to take the antibiotics irresponsibly for colds or other viral infections.  And I was ready to change doctors over the issue. 

I got the prescription.

Some public health officials may try to make you feel guilty about "hoarding" antibiotics or contributing to antibiotic resistance.  Poppycock.  If you buy while supplies are plentiful, you're actually making a bigger market for these products and contributing to the maintenance of production capability.  And if you don't take them irresponsibly, you won't affect resistance. 

In fact, you're even being socially responsible.  If we do suffer an anthrax attack and the Postal Service is having trouble keeping up, a sure bet if ever there was one, you can defer your delivery in favor of someone who has no stash.  You'll take a bit of strain off a system that is going to need all the relief it can get.

(In addition to the glow of virtue, you can feel a bit of that leftover 60s civil disobedience thrill.  When I tried to put this home stockpile advice in a speech toward the tail end of the last administration, I was informed by the lawyers that advocating an unapproved use of prescription medicine is a criminal offense under FDA law.  And, while taking antibiotics for an anthrax attack is an approved use, getting antibiotics in case of an anthrax attack is not an approved use.  I think that may mean that this post is, um, a felony.  If so, well, power to the people and come and get me, coppers!)

What's unfortunate about the executive order is that there's not a hint that the administration is considering the home stockpile as the first and best way to prepare for a possible attack.  If that's really the government's last word on the subject, it's like telling passengers that the best response to an air hijacking is to sit tight and wait for the authorities to arrive. 

It's insufferably paternalistic and it's bad advice. 

The only good part about it is, no one is going to listen.

Comments

[Dave Hardy]

Don't encourage drug abuse. Ciprofloxacin is a gateway drug; many users go on to full-fledged Amoxillin abuse.

[DensityDuck]

I'd be more likely to agree with you if doctors didn't use antibiotics as placebo drugs. On the other hand, I guess that's a valid way to get a supply; cough cough, I have a cold, give me some Cipro for my viral infection please.

[NonLawyer]

Don't be silly; this post isn't a felony. As a lawyer, you should know the legal distinction between advocating an action, and doing the act itself. Often advocacy of criminal acts is protected (by the First Amendment) even when the act itself is criminal.

[guy]

"I got the prescription."

What's the shelf life on your stockpile?

Just curious...

[Military Postal Supervisor]

Given that most postal workers are innoculated against the anthrax virus, wouldn't it make more sense to use them versus UPS/DHL/FedEx workers who have not been innoculized?

[gopostal]

The entire purpose of this is to give the Postal Service a role in "Homeland Security."

That way, the union is safe.

The Postal Service realizes that its days are numbered. It's losing billions of dollars every year to better service provided by more efficient private companies and to email and other forms of delivery.

The Obama Administration is merely giving the unions cover so they can continue on indefinitely while losing billions each year. Now, because they ostensibly have the legal duty to deliver anthrax medicine ... their budget is safe!

[Stewart Baker]

Three responses to recent comments:

1. Yes, if postal workers have been vaccinated, that's a big plus. But really, more emergency workers need to be vaccinated. Problem is that the vaccine is short-term and a bit unwieldy.

2. I'm not against using postal workers. I just don't think we can expect them to do a new job perfectly the first time in 48 hours, and we shouldn't pretend that it will go smoothly. If that's true, why not use home medkits as a first line of defense for the prepared. The unprepared will still need plenty of help from postal workers or others.

3. I think the formal shelf life on antibiotics is a year, though that's probably conservative.

[Charles Hallman]

What, may I ask, did you get? Just curious as I like the idea of having my own versus relying on the gum'mint. Thanks!

[Bryan C]

There's another large group of health professionals that we should also have on-board in a major public health emergency, especially in rural areas: veterinarians. They have experience handling drugs (many are the exact same drugs used with humans), administering injections, and basic first aide. And I suspect most equine and livestock vets are already pretty familiar with anthrax, too.

[SSG Jeff (USAR)]

Did you pay full retail for your "emergency stash" of antibiotics or should your insurance plan provider be taking a look at you with a fishy eye?

[David]

I sell stuff online for a living, and have shipped thousands of packages all over the world in the past several years. It's easy to take cheap shots at the Post Office; the line employees there will be the first to tell you the thing is terribly mismanaged. Still, Express Mail is what I use when I need to get a valuable package to a customer right away. In most cases, it's there by noon the next day, though it does take two days for many rural areas. Presumably, things could be sped up yet more in an emergency distribution plan, with the PO setting aside all other mail for a day or two.

Aside from USPS employees already being inoculated, they -- unlike the courier services -- know nearly everybody. Unlike FedEx and UPS, they deliver to everybody, virtually every day. I'm not saying it is guaranteed to work perfectly, but IMHO it's the best option for widespread fast delivery we've got.

[Sully]

I'm with the last commenter. The Post Office is by no means perfect; but in my town it delivers reliably and fast. And even a government bureaucrat is not going to be stupid enough to tamper with the regular carrier routes if efficient delivery is desired. Also, the PO already has the mass sorting capability to get a huge number of small packages distributed to the local routes.

In areas of unrest special arrangements will clearly have to be made; but for delivering 90+ million of the 100 million or more packages (to areas where there isn't unrest) the PO is almost certainly the best option.

[Oregon Trail Yarn]

I also earn my living in e-commerce and find this commentary on USPS lacking.

The USPS is the only one with the experience in daily delivery to every household and street address. The route carriers especially are valuable assets because they have daily experiential knowledge of the inhabitants and geography of their routes. Carriers already go daily into dangerous neighborhoods to deliver the mail, yet remain remarkably unmolested. That human capital should not be overlooked or wasted in an emergency.

[Military Postal Supervisor]

Couple of facts you might not be aware of:

The USPS delivers more items in one day than Federal Express does in a year and more items in one week than United Parcel Service does in a year.

The Postal Service delivers to 146 million businesses and households each day, six days per week. UPS delivers to 8 million addresses daily while FedEx serves even fewer.

Percentage of overnight First-Class Mail delivered on time: 96%
Percentage of Two-Day First-Class Mail delivered on time: 94%
Percentage of Three-Day First-Class Mail delivered on time: 93%

Average delivery reliability for over-night packages from UPS, DHL and FedEx are;
UPS - 90.83%
DHL - 90.66%
FedEx - 88.02%

And those averages are for major metropolitan areas!

Okay, enough with defending the USPS. I think you get the idea now.

[MikeC]

***I think the formal shelf life on antibiotics is a year, though that's probably conservative.***

Pharmacist here. In most jurisdictions, the shelf life on any dispensed medication is one year after the dispensing date, or the expiration date on the bulk package, whichever comes first.

That said, the duration for which drugs retain their potency is highly dependent upon storage conditions. The bathroom medicine cabinet is warm and moist - not exactly ideal. So far as I know, tetracycline is the only commonly-dispensed outpatient drug which becomes toxic after going out of date.

It's also perfectly legal for physicians to prescribe a given medication for any indication they see fit (so long as it's not a controlled substance).

[fit2post]

I purchased some gold coins from the U.S. Mint in Oct 2009. The email confirmation gave a tracking number, so I went to the USPS and pasted the number, which could not be found! Turns out the U.S. Mint ships via UPS, tho' that wasn't mentioned in their email.
Whom do you trust, perhaps?