• 2010 Public Health Preparedness Site Home
  The preliminary program for the 2010 Public Health Preparedness Summit in Atlanta has been released. There's some good stuff again this year.
  (tags: publichealth preparedness conference)

Every couple of months, I get a copy of the magazine Emergency Management delivered to my inbox at work. Now, I’m not usually one for paper magazines, and I generally find the content of emergency management-type magazines to generally be lots of rah-rah and advertisement (bleh), but Emergency Management isn’t so bad. On top of that, they’ve got a robust website and have delved into social media pretty heavily (posting new stories to Twitter and curating an entire stable of blogs). And it’s free.

Anyways.

In this month’s edition, and online apparently, Valerie Lucus had a pretty interesting article on how H1N1 influenza forced UC Davis to rethink their pandemic plans. She brings up a point I’ve danced around for the last few months, but feel pretty strongly about:  our pandemic plans were not very well designed. They were written with H5N1 in mind, and tied almost exclusively to the WHO pandemic levels (some places, I’m sure, added the CDC’s Pandemic Severity Index, but probably not all).

Case in point, and one of Ms. Lucus’ examples; many places had plans to institute drastic social distancing measures when WHO raised the pandemic level to 5, like closing schools and canceling sporting events. The reality is that we hit level 5 with only a handful of cases in this country. I’ve talked about this before, back when we were just trying to figure things out, about the ineffectiveness of the pandemic level system.

This article, though, takes that thinking to the next level. It says that we planned for the worst possible situation, with the intention to “roll back” our response to match the pandemic (which in my mind is totally defensible). And planning for the worst case scenario is the easiest, in my mind. Give it everything, shut everything down, 12-hour shifts, activate volunteers, altered standards of care, the whole nine yards. Alternatively, we already knew the plan for a normal flu season–basically, do nothing.

The real tough decisions, though, were in the middle of those two. What do you do for a flu that’s spreading like wildfire…somewhere else? What do you for a flu that’s about the same as seasonal flu, but carries the weight of the pandemic moniker? If Houston and San Diego were closing schools, should we?

No one had talked about that before. Scratch that, no one I talked to talked about that. We all happily talked about how the government would shut everything down and save the world. Then it happened, and we were forced to make those critical decisions in the heat of the moment–which is EXACTLY what we were supposed to have avoided with all of that pre-planning.

Like I said above, though, everything we did was totally defensible. It was right at the time. The problem is that we’d never had to plan for a pandemic before. Thanks to CRI, we’re ready as all get-out for an anthrax attack (which, if you ask me, is why everyone’s first planning response was to set up PODs–when all you’ve got is a hammer, everything looks very much like a nail), but no one talked about how specifically we could roll back those bludgeoning 1918-like response plans. What were the triggers that should have kicked it into a higher level of response?

When everyone rewrites their pandemic plan this spring, remember these lessons. Planning for the worst case is the easiest; planning for the best case is next easiest; figuring out the middle is the really difficult part. With that in mind, write your plans from the bottom up. What constitutes the best case scenario? What triggers would cause you to respond more aggressively? Even more aggressively? Now, what does the worst case scenario look like? Build plans for each level of the response.

Sure it’s more writing and more exercising. But if we planned from the bottom up, instead of the top down, this spring might have been filled with fewer late night meetings and panicked conference calls.

• 360i: The State of Search Whitepaper
  Quick little document about what goes on in search engines.

  The /really/ interesting part to me is a bullet in the Key Findings section that shows 77% of social media listings found in searches of the top 1,000 brands are not controlled by those brands. These are brands that put millions of dollars a year into their PR efforts, and still three out of every four mentions in social media were made by someone else.

  The last time you had to respond to some emergency, what were 75% of the people saying about you? Do you have millions of dollars to pour out to make sure they're saying the right things about you?

  Mmm hmm.

  (tags: crisiscommunication)
• H1N1's true toll not shown by death tally, picture may take months to come clear – Infection – C-Health
  Really a great article by one of the premiere health reporters in the world about the H1N1 deaths and how we might not know the full effect of the pandemic for years. I highly recommend this reading.
  (tags: h1n1 pandemic)

Holy smokes! My very good friends at NACCHO have finally taken the plunge. I’ve known for a while that they were on Twitter (@NACCHOAlerts and @NACCHOMeets), and that they’ve been big supporters of mine (and Gerald Baron’s Crisisblogger, apparently).

But now, they’ve got their own little H1N1 blog. The posts are signed by Caroline Dobuziniskis. The way the blog page is set up, it looks like there should be more blogs in the future.

Congrats to Caroline and NACCHO. Glad to have you in the deep end of the pool. Keep up the great work.

All of NACCHO’s communications activities, including their blogs, social media presence and publications, can be accessed here.

Thanks for the updated link, Caroline.

Lately, my feed reader has been buzzing with the stylings of a new-to-me blogger. Hailing from Oakville, Ontario, Canada, Patrice Cloutier’s blog, Crisis Comms Command Post, has been doing some really interesting work on crisis communications blogging.

His latest, Is it time to review how PIOs work and JIC structure?, looks at an idea about JICs that I’ve been toying with a lot lately. Specifically, what is the main function of JIC? Is it to coordinate media messaging? Or to massage and enhance the “common knowledge” of an event?

Being someone who has never sat in that traditional media coordination seat, I’ve never been a huge champion of the idea that writing press releases and setting up press conferences should be the main outcome of a JIC. I was always much more interested in the ability of a roomful of PIOs and PA folks finding and taking the prevailing interpretation of a situation and melding that to one that benefits the government agency (or private company) that is charged with the response; as opposed to the latter, where a roomful of PIOs and PA folks is responding to the media’s interpretation of a situation in which they happen to be responding.

This is a bit off the beaten public health preparedness track, but I’ve been focusing so much on crisis comms work lately that it seemed a natural time to pass this blog along to you all. If you’re really looking to loop this back to the conversation at hand, in a pandemic situation, say something like an outbreak of novel H1N1 influenza, what is the role of the PIO? Would a JIC be necessary or beneficial ? What would it do?

I’ve argued that a JIC would be a great idea for such a situation, if only to seek out an respond directly to rumors and half-truths that would dissuade people from taking adequate precautions to prevent the spread of the virus. Is that what your PIO is doing? Should they be?

In any case, check out Patrice’s work here.

• Fort Hood Shootings: News Orgs Put Twitter Lists to the Test
  For Twitter fans, this last week has been one of discovery. Twitter rolled out the ability to group other Twitter accounts into lists, and then share those collected lists with the world. Seems pretty cool, but when gunfire rang out at Fort Hood, Twitter lists became an important, real-time news aggregator. This great article from social media blog Mashable, points out some of the best collected lists.
  (tags: twitter socialmedia crisiscommunication)

Better bloggers than me say that you need a catchy title to your posts – something that will stir conversation and get people’s dander up. I can’t imagine that this one won’t.

By now, I’m sure you’ve all heard about the latest. And if not, I’m sure it will hit the national press soon enough. Several large Wall Street firms have begun receiving H1N1 vaccine from NYC Department of Health and Mental Hygiene to distribute through their employee health units to high-risk employees. Apparently, BusinessWeek broke the story here.

Once that happened, hue and cry. A sternly worded letter from the former NYC Health Commissioner and current CDC Director, investigations are being called for, Senators are writing letters, the whole nine yards.

Rightly or wrongly, I think that NYC DOHMH, CDC and Wall Street are going to get raked over the coals for this. CDC and Wall Street can take care of themselves, but NYC DOHMH will probably come out of this the worst of the three, and they’re the ones least at fault, in my opinion.

Besides all that, I think that giving H1N1 vaccine to large employers with on-site healthcare infrastructure is not the part we should be upset about. In fact, I’m surprised that this hasn’t happened other places already, and I’m positive that it will happen again, and more times, across the country. Maybe not bankers next time, but maybe large manufacturers, etc.

Why?

Because public health departments have been charged with distributing hundreds of millions of courses of vaccine, and they can’t. They simply don’t have the infrastructure. Not enough manpower, not enough drivers, not enough cars, not enough refrigerators, not enough forms, not enough databases, not enough data entry folks, not enough vaccinators, not enough anything. And then along comes a company that says, we have 10,000 people working for us. Give us vaccine and we’ll take care of all of them and their families. Free of charge. Set it and forget it. Take your time and concentrate on the poor, the destitute, the infirm, the non-English speakers, the unemployed, the sick. That’s what public health departments do best anyway.

Boy, I’ll tell you how good that must look to an overworked overwhelmed public health department. And if New York City is doing it? If the best funded and best staffed health department in the country is doing this, I can assure you that other cities, counties and states are doing it.

So, let’s examine the real problem here. The real problem is the same problem that Trust for America’s Health yells about every November. It’s the same problem I’ve yelled about before. After thirty years of budget cuts, hiring freezes, matching grants, new spending only, supplement not replace, preparedness only, first on the chopping block, public health is little more than skin and bones. Public health departments can’t do their job on a normal day, let alone when 10 to 15% of the public is showing up at emergency rooms, vaccine is rolling in and out of the building all day every day, the media calls, the conference calls, the reporting requirements. Imagine all that. And then along comes a company that says, we have 10,000 employees people working for us…

What we’re witnessing is no more than the absolute failure of the United States public health system.

After decades of being stretched and chronically underfunded, after warnings that someday something’s gonna happen, after  letting the infrastructure rot, it finally did happen. A real public health emergency. And the CDC and HHS said that it was a local matter, and we’ll give you all the vaccine you need—more even–, but you’ve got to handle all of the boots-on-the-ground stuff yourself. And the states and counties dusted off their panflu plans and diligently crafted public information messages, and scheduled flu shot clinics and told their surveillance guy to ramp it up for a bit until we get a handle on things. And then they found that none of our previously developed messages worked. And then they had to cancel all of their flu shot clinics cause they didn’t have any vacccine. And then the surveillance guy collapsed from working 12-hour days for 2 months straight. And when the vaccine finally showed up, they only got a third of what they were promised. And then the contract nurses they hired to help out didn’t show up to work and somebody had to cover for them. And then along comes a company that says, we have 10,000 employees people working for us…

In a perfect world, would I be appalled by this turn of events? That Wall Street got their flu shots first? Absolutely disgusted.

But this is far from a perfect world. And while the priority groups were set for a good reason, the fact of the matter is that folks in those priority groups have to catch the flu from somewhere, and I’ll bet that some of them catch it from bankers. Vaccinating everyone decreases the incidence of disease; it decreases the chances that that pregnant woman, or that child, or that asthmatic, will catch the flu. And really, isn’t that the ultimate goal? To keep people from getting sick? When you’re fighting with one hand tied behind your back, do you question who it is that just gave you a baseball bat? No, you grab it and swing for the fences and hope for the best.

The valuable lesson we’ve all learned today? Underfunding public health is the same as undermining public safety. And not in some bioterrorism/emergency preparedness way. In a people get sick and die from a natural disease kind of way. In a traditional public health can, has, and will save lives kind of way.

• A Nation Battling Swine Flu, and Short Vaccine Supplies – NYTimes.com
  An interesting article about vaccine delays, and how that affects HHS' credibility during this campaign. I have some thoughts on this, and hopefully will find a chance to write them up.
  (tags: vaccine hhs h1n1)

Last week, a judge in New York state issued a temporary restraining order against a New York State directive ordering all health care workers to receive both H1N1 influenza and seasonal flu vaccines. Even the Reveres posted on the matter (and subsequently posted on something I’ve thought was a great idea for years, except instead of stickers, I say they should be forced to wear masks).

Now, I’m about as far from a lawyer as you can get, so take this with a grain of salt, but I thought that mandatory vaccinations weren’t a new idea:

See Jacobson v. Commonwealth of Massachusetts.

See school required vaccinations. (see Zucht v. King)

To me, the Jacobson case (while obviously ridiculously outdated) is comparable. In the face of a communicable disease outbreak that is actively causing excess disease and death, the state compelled one of its citizens to receive a vaccine that would protect the lives of those around them. Jacobson objected, and was forced to receive the vaccine in the interest of the PUBLIC’S HEALTH. Given that he was not performing head of bed procedures  on immuno-compromised patients or pregnant women, he actually had a better argument than nurses and healthcare workers against receiving the vaccine.

So what to do?

For me, I see no problem with mandating vaccination for influenza. Every year it’s proven to be safe. And for those that have a religious or philosophical objection, they can apply for an exemption. The exemption would require signing a document affirming that vaccines are the best way to prevent influenza transmission and that their refusal to receive a vaccine may permit the transmission of the potentially fatal disease in the healthcare setting. To wit, the healthcare setting, in order to protect itself from the liability that their employee is exposing them to, should require the worker to be masked while on the grounds of the campus (or office, etc.). Am I being unreasonable here?

Again, I’m no lawyer, so for a more reasoned approach on the matter, an anonymous (not me) letter was published earlier this year calling for a twenty-first century Jacobson v. Massachusetts (PDF direct download).

• Flu Data Shows Concerned Health Officials, Skeptical Public
  I try not to put too much political stuff on this site, but this is a really interesting post by a phenomenal flu blogger.
  (tags: pandemic h1n1 vaccine)