Transcript Clark County Health District Office of Epidemiology

Emergency Preparedness: The
New Public Health Politics
November 1, 2006
Prepared for what
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Bioterrorism
Mass casualty events
Chemical emergencies
Natural Disasters and catastrophes
Radiation emergencies
Outbreaks
Why we have become concerned
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Oklahoma City Bombing
Y2K concerns
9/11 Terrorist attack
2001 Anthrax outbreaks
West Nile Virus spread
Increase in Hurricanes (Katrina, Ivan, Rita)
Salmonella poisoning cases in 2006
Potential for pandemic outbreaks
In Vegas, how well can we respond?
Important Policy Issues
• Distinguishing between international threats
and regional preparedness
• Placing too much confidence in responding
agencies
– Federal, State, Local governments
– Private, non-profit agencies (funding
opportunities)
• Question: Are we better prepared now than
we were during the cold war?
• What does preparedness mean?
Government focused responses
• Prepare for lowprobability, high
consequence events
• Stockpiling supplies
• Created cynical
public
• Public believed that
terrorist threats
likely, just not to
them
All Hazards approach to Preparedness
• To be ready for all
types of disasters
• Acceptance of
approach increased
after Katrina and
Rita
• Pushed by
Department of
Homeland Security
– www.ready.gov
What is All Hazard Expectation to Public?
• Resources at ready for food, water,
medications, radio and staples, etc.
• Family plans prepared for meeting
places, phone numbers, and
reunification
• Knowledge of local and regional plans
such as evacuation routes, shelter
locations other government information
– Note: In some cases, government does not
want to pre-issue this information
Historical perspective of civil defense
preparedness
• During WWII, most Americans did not
know where to go in case of attack
(most gave it no thought)
• Early Cold War (1953) less than 10%
were prepared and figure didn’t
increase much after Cuban missile crisis
• Thawing of Cold War led to even less
preparedness in terms of civil defense
Preparedness Today
• In natural disaster zones, most
Americans report being prepared,
though significant numbers (> 40% still
are not).
• For terror disaster planning, most
Americans are not prepared. Reflection
of 5 years of no attacks?
Preparedness in the Health Care Facility
• During Rita and Katrina,
most health facilities
were prepared.
• Many still did not have
access.
– Louisiana Nursing Home
deaths
– Hospital evacuation
problems hampered
during Katrina
– Rita nursing home
transportation deaths
Health Care and Preparedness
• Hospitals generally more prepared
because of regular exercises
• Latest efforts for disaster preparedness
involves other long term care facilities
as in case of needed additional facilities
• Incorporation of mobile hospitals in
case of mass casualties
• Adoption of distribution centers for Rx
drugs in cases of pandemics
Bioterrorism
Definition from a Health
Perspective:
The deliberate release into the
civilian population of a natural or
altered disease-causing virus,
bacteria or toxin
…for the purpose of causing illness,
death or inculcating fear.
Bioterrorism
• Disease causing
agents used by
terrorists
– Placed in foods
– Released in the
air
– Introduced
directly into the
population
through infected
persons
– Vectors
Threat from Chemical Agents
• March, 1995 Tokyo
Subway
– Sarin nerve gas
attack in 5 subway
stations, hit
simultaneously
during rush hour
– 11 killed
– 5,500 injured
– 60% suffered PTSD
Terrorist threat for bioterrorism
• 1984 – Salmonella
Poisoning, Oregon
– 750+ ill
• Contamination of
salad bars
– Bhagwan Shree
Rajneesh religious
group
– Attempt to affect a
local election
Threats to Food
• 1996 St. Paul Medical
Center, Dallas
• Shigella dysenteriae 2
– Contamination of
muffins and doughnuts
by a 27-year old lab
technician
– 13 of 45 lab workers ill
– 20 year prison
sentence
Bioterrorism Threat
March 1995 Sarin
12 Dead, 5500 Affected
1972
Typhoid
1984
Salmonella
70
75
80
May 1995
Plague
June 1994
Sarin
7 Dead,
200 Injured
750+ ill
85
90
February 1997
Chlorine
14 Injured,
500 Evacuated
95
1992 Cyanide
1984
Botulinum
1985
Cyanide
April
1997
U235
March 1995 Ricin
April 1995
Sarin
April-June 1995
Cyanide,
Phosgene, Pepper
Spray
00
June
1996
Uranium
December 1995
Ricin
November 1995
Radioactive
Cesium
Anthrax Threat: 2001
• October 2001
• FL, NY, Wash. D.C.,
CT
– 5 deaths from
inhalation anthrax, 6
people recovering
– 11 people recovering
from cutaneous
anthrax
– 42 exposures, no
disease
As of December 5, 2001
Photos: FBI
Las Vegas Risk Profile
• International tourist
destination
– 35 million visitors a
year
• One airport
• Tightly-clustered
high occupancy
buildings
• Fast growth
• Nuclear facilities
Bioterrorism Threat
vs. HAZMAT
• The U.S. is better
prepared for a chemical
than biological terrorism
attack.
• A troubling fact given
that biological weapons
are relatively easy to
produce.
Source: Florida Today. Artist: Jeff Parker
Bioterrorism Threat
vs. HAZMAT
• This problem will
not blow up in
one city and stay
there –
• This is a problem
that will move.
Challenges in Recognizing a
Bioterrorism Event
• Delayed onset
• Wide dissemination
of cases
• Rarity of the natural
disease
• Surveillance
• Communication
• Diagnosis
Source: Vanderbilt Medical Center
Bioterrorism Preparedness
• National – State – Local
involvement
• Metropolitan Medical
Response System
– Expanded existing
emergency preparedness
plans
– “All Hazards Planning”
approach in Clark County
Metropolitan Medical Response
System
• Hospital Response
• National
Pharmaceutical
Stockpile
• Casualty Collection
Points
• Strike Teams
• Private/Public
Partnerships
• Forward Movement
of Patients
Source: Las Vegas Sun 10/21/01
Key Players in
Outbreak Management
• Local
– “First Recognizers”
– CCHD and OOE
– Hospital/ Reference
Laboratories
– OOE Health Alert System
– School Officials
– Media
– Elected Officials
• National
– Centers for Disease
Control and
Prevention
• State
– NSHD State Health Officer
– NSHD State Epidemiologist
– Nevada Public Health
Laboratory
– NV Health Alert System
– NSHD Health Protection
Services
– NV DEM
– NV Dept Agriculture
– Governor & Press Office
– Elected Officials
Public Health - Role and Responsibility
• Delegated powers
and duties of local
Health Officer
– Control and prevent
the spread of
communicable
diseases that may
occur within the
jurisdiction
– Community health
perspective
Public Health Role and
Responsibility
• Lead Agency in
Bioterrorist Event
• Bioterrorism
Preparedness at
CCHD
– Health Alert
System
– Surveillance
– Training
Public Health Surveillance
• Ongoing collection of
data
• Estimates magnitude of
problem
• Detects epidemics
• Documents distribution
& spread
• Monitors changes in
infectious agents
• Allows timely response
Local Epidemiology
Surveillance Systems
• Influenza sentinel
site program
• Gastroenteritis
sentinel site
program
• Public complaints
• Lab reports
• Clinician reports
Role of Epidemiology
BT Preparedness & Response
• Determine if what the
clinician is reporting is
unusual
• Investigate to:
– Determine source and
extent of outbreak
– ID the pathogen
– Contact medical community
– Initiate control measures
Bioterrorism Event
Notification Protocol
• Local Health Officer
– Event Unusual?
– Event Bioterrorism
NOTIFY
State Health Dept
CDC
FBI
Epidemiologic Surveillance Clues
• An unusual increase in the number of people
seeking care
– Postal Workers from NY, D.C., CT
– Right disease, wrong month
Bubonic plague from Mt. Charleston  February
• Right disease, wrong host
Arthritis  Children
Pandemic Flu Impact
1918
2001
World population
1.8 billion
5.9 billion
Transportation
ships, railroad
jets
Flu circles planet
4 months
4 days
Prevention
masks,
disinfectants
vaccines?
Treatments
bed rest, aspirin antivirals?
Estimated dead
20+ million
60 million?
Time Magazine
Top Five Reasons to Report
• Prompt containment of potential outbreaks
• Allows timely intervention
• Over reporting is better than under
reporting
• Minimizes your workload for follow-up
• IT’S THE LAW!!!
Official Code
Of Nevada: 441A.225
All Nevada physicians, laboratories and other health care
providers are required to report a case of or a suspected
case of certain communicable diseases. Reporting enables
appropriate public health follow-up for your patients, helps
identify outbreaks, and provides a better understanding of
disease trends in Nevada.
Biologic Agents - Highest Concern
• Bacillus anthracis –
Anthrax
• Francisella tularensis –
Tularemia
• Clostridium botulinum Botulism
• Viral hemorrhagic
fevers (Ebola, Lassa)
• Variola major –
Smallpox
• Yersinia pestis –
Plague