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Guest Post: The Problem with Closed PODs

August 19, 2010

Ed. note: I’ve been having a wonderfully stimulating conversation via email with a colleague recently. The topic: closed PODs. Charlie Algernon (obviously a pseudonym) writes in with a great post pointing out some problems with one of the main mass medication distribution strategies advocated for by the CDC, the closed POD. I really hope this generates discussion because Charlie is the first person I’ve talked with that’s mentioned problems with Closed PODs (problems that I agree need to be discussed).

Many States, with CDC’s encouragement, are developing plans for Closed POD sites. Closed POD sites are non-medical sites (like a factory or other large employer) that agree to receive medication and have pre-trained some of their employees to act as POD staff. Only employees, and in some cases their families, of the business hosting the site are eligible to receive prophylaxis. While Closed POD sites may be beneficial in some limited circumstance, I believe they are generally of little to no value on a community basis and should not be a major component of the POD planning effort. The main issues with Closed PODs are:

1. Closed PODs don’t reduce demand for regular POD Sites.
For example, let’s consider a community of 100,000 people with a single large factory with 6,000 employees and family members. To serve that community I need 7 regular POD Sites. But if the factory opens a Closed POD to serve the 6,000 employees and their families, I can get rid of one POD Site, right? Wrong. Those employees and family members live all over town (and some live out of town), so there’s no single site I can close.

My average reduction of demand at each of those 10 sites is going to be 600 persons. Out of a total service population of 15,000 persons per POD Site, that’s not a game changer.

And that’s assuming all the employees go to the factory for treatment. Since many of them don’t live in the same part of town as the factory, some will chose to use a regular POD Site in their neighborhood instead of driving across town to the factory. So, lets cut our estimate of Closed POD participation in half, and now I’ve only reduced demand by 300 persons per POD Site. Over 30 hours of service that’s just 10 fewer people per POD per hour.

Net result; no change in the number of regular POD Sites for that community and no significant change in the number of people each regular POD site has to serve.

2. Closed PODs increase the administrative burden for emergency planners without providing benefit.
As I’ve shown above, Closed PODs won’t decrease the number of regular Sites in a community. But they will increase the administrative burden. If I enter into an Closed POD agreement with the factory I’m now responsible for another agreement, another plan, and training and exercising another POD crew, with no increase in overall capacity.

3. They take human resources away from regular POD Sites.
For our State, human resources are the limiting factor for POD activities. In general, Closed PODs will use some of those critical human resources, including Law Enforcement and delivery staff, and make them unavailable to regular POD sites. Using the above example, I’m now staffing eight POD sites, when I only need seven.

4. Closed PODs increases the burden on the emergency management system during an emergency.
For every Closed POD in a community I’ve got one more entity to coordinate with, an additional point to supply, more comm traffic, etc, etc, and no net benefit.

5. They create issues for the JIS.
What do I do with information on Closed PODs in my press release? If I include them with the list of regular POD Sites but say they are only for a select group of people I’m going to create confusion and resentment. If I don’t include them in the list of Sites, people with find out anyway (think twitter and text messaging) and I’ve still got confusion and resentment, but now I’m going to get accused of covering up these “VIP” Sites.

6. The perception of preferential treatment. When discrete groups of people are given access to a separate prophylaxis process there can be a perception of preferential treatment. This is especially true of companies or entities that are considered “elite” or that have different demographics than the community at large. If there is a perception of preferential treatment the public dialogue will shift away from a productive discussion of how to protect oneself and become a negative critique of the response.

For all these reasons we should not consider Closed Sites in our general planning. Instead we should be working to get those workplaces that might operate a Closed POD to sponsor regular PODs instead. A sponsored, but open POD would allow the workplace to ensure its employees get treated while at the same time increasing the overall capacity in the community.

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