12Sep / 2016

West Nile to Zika: How One Virus Helped New York City Prepare for Another

New York City helicopter used for larviciding.

No one told the Aedes mosquito that New York is the city that never sleeps.

The type of mosquito that can spread Zika virus (Zika) is most active during the day and hides at night when our city’s mosquito control efforts are in full swing, meaning that our scientists had to find a way to reach it during pre-dawn hours. The solution? Wake it up, force it to take flight, and then kill it.

This is just one of many innovations New York is using to bolster the fight against Zika.

A tale of two mosquitoes

By the time the Zika outbreak was making news, causing birth defects and threatening pregnant women, New York City already had over a decade of experience in tackling mosquito problems related to the spread of West Nile virus. In facing Zika, we have been able to apply many of our existing resources and lessons learned from the West Nile virus response.

However, the mosquito that carries Zika is different than the one that carries West Nile virus, and it needs to be handled differently. New York is home to Aedes albopictus, which has been known to carry Zika – although, unlike the Aedes aegypti of the south, it has not yet been determined how likely Aedes albopictus is to spread the virus to humans in the United States. Because this is still unknown, people need to protect themselves.

To find out more about the risks, we need to catch the mosquitoes and test them. But we can’t use the same traps to catch the Aedes albopictus that we use to catch the West Nile virus-carrying Culex. Culex mosquitoes can be trapped with a combination of carbon dioxide and light. Being daytime creatures that prey mostly on people, Aedes albopictus don’t fall for the same tricks. So we developed traps that use human pheromones to lure them in.

Building on what we have

Aedes albopictus mosquito feeding. — Aedes albopictus mosquito

Meanwhile, some of the things we have always done for West Nile virus work well in the current response.

We know from previous mosquito-control efforts that pesticides are a last resort. Although there are lots of ways to kill a mosquito, West Nile virus taught us that an effective response takes cooperation on many fronts. In New York, we have laboratories for testing, disease control experts to track cases in people, and a call center that manages tests and information from clinicians. Our communication department gets the word out because the best thing we can do for viruses like West Nile and Zika is educate people about how to prevent mosquito bites – wearing the right repellent, removing standing water, and staying indoors when you can.

Many of the resources we acquired for fighting West Nile virus are proving indispensable for fighting Zika. Ten years ago, we got a hand-me-down helicopter from the NYPD, and we’ve been able to use this for aerial spraying over marshlands and unpopulated areas. In the city, we use the same late-night spray trucks. A police car moves ahead of the truck, warning anyone who may still be out on the street. The distinctly New York voice bellowing from the loudspeaker (that of retired assistant commissioner Allan Goldberg) is even the same one we’ve always used.

Sharing what we know

Zika presents us with a very steep learning curve, and it reinforces the need for transparent communication. We’ve set up an interactive website where we can share what we’re discovering with the public. We put out data on a weekly basis: people can zoom in and out on their screens to see where we’re finding mosquitoes. We want everyone to understand about the preventive work we’re doing to help keep Zika at bay.

The complex nature of Zika reveals the strongest and weakest points of the public health system. One thing in particular public health has always struggled with is how to change people’s behavior, which is critical and must happen if we want to stop Zika. We really hope that pregnant women or women who plan to become pregnant will not travel to areas with Zika, but it’s hard to stop people from visiting family or simply enjoying the world.

So far, all of the reported Zika cases in New York – including, as of August, 49 among pregnant women – have been the result of global travel. But just because we haven’t seen local transmission doesn’t mean the potential isn’t there.

This is why we’ve expanded our efforts by hiring extra staff and extending the areas where we do mosquito control and education. We need to continue to collaborate across agencies and in the field – and, in fact, all over the world – to manage a complex response that touches on so many areas. Working together and staying vigilant is our only hope for getting – and staying – ahead of this potentially devastating disease.

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06Sep / 2016

When Preparation Meets Opportunity: Cameroon Gets a Jump on Outbreak Response

Buea-Regional-Hospital-at-the-foot-of-Mt-Cameroon

When Dr. Aristide Abah stepped off the plane that brought him from Atlanta back to his home in Cameroon, there was no time to waste. An outbreak of H5N1 flu threatened the country, and it was up to Dr. Abah to lead the response.

Fortunately, he was prepared.

Dr. Abah had just spent four months at CDC headquarters as part of CDC’s Public Health Emergency Management Fellowship, which invites public health experts from all over the world to learn how to organize an emergency response in their country.

A deadly threat

In Cameroon, H5N1 was raging in poultry, putting people at risk. The virus can spread to people who come into contact with infected birds, and the result can be devastating. An estimated 60% of people who get the disease, die.

A swarm of activity took place around Cameroon’s response: culling chickens, contact tracing, delivering Tamiflu to people who needed it, providing personal protective equipment (PPE) to workers, and more. The country faced challenges; with over 500 sets of PPE needed each day, animal health workers ran out and had to repurpose supplies that were never used for the 2014 Ebola outbreak.

If they were to stop the deadly virus from spreading to humans, the country needed to act fast and be efficient. For Dr. Abah – and for Cameroon’s public health emergency operations center – it was time to put some newfound knowledge to the test.

From fellowship to field

Dr. Abah leads Cameroon H5N1 response — Dr. Abah leads Cameroon’s H5N1 response

Dr. Abah returned home from his fellowship on a Sunday night. On Tuesday, he stepped in as Incident Manager for the response. On Wednesday, he walked around the room and put nameplates at every desk.

This simple action served two important purposes.

The first was to make sure everyone knew their designated roles. In an emergency, we use an organizational structure called an Incident Management System to assign specific roles and responsibilities to every person. This ensures that everyone knows exactly what they and others are doing.

Nameplates also meant that everyone had an assigned seat, so that people who worked on the same tasks sat near each other. When information has to travel fast, proximity is priceless.

After he organized the people, Dr. Abah organized their time. He set up a system that gave everyone an allotted number of minutes to speak at meetings. He even appointed a timekeeper to help stay on track. “As you may or may not know,” joked Kerre Avery, a CDC Emergency Management Specialist who works closely with Cameroon, “it’s the French custom to talk a lot.”

Dr. Abah also improved the way information traveled, both within the response and outside it. He adopted the CDC template for daily update slides and situation reports in the EOC, and added a communications team to the incident management structure to help get critical messages out to the public.

For Dr. Abah, these were the opening steps of a wider plan to respond to the crisis. During his fellowship, he had learned the critical importance of planning and organization. “For me, the planning was key,” he said. “I now know that we can’t do anything without a plan.”

Knowledge can’t wait

When Dr. Abah first learned of the H5N1 outbreak, he had not yet completed his fellowship, but he knew that the lessons he was learning would help his colleagues back home. He set up an internet-based platform so they could all see and benefit from the lessons. He also reached out with new ideas: “I wanted to speak to higher management,” he said. “I told them they had to have an Incident Manager [in the EOC].”

Cameroon was already getting better and better at responding to health threats. A year ago, it took the country eight weeks to activate their public health emergency operations center in response to a cholera outbreak. Several months later, when Lassa fever erupted, they had reduced their response time to a week. By the time H5N1 appeared in local poultry, it took the country less than 24 hours to activate the PHEOC.

Cameroon’s recent improvements – including their investment in sending Dr. Abah to the fellowship – are all part of a worldwide effort to better prevent, detect, and respond to public health emergencies. And their efforts in preparedness are paying off: during the latest outbreak, there were zero transmissions of H5N1 to humans.

Inspiring lessons

The lessons the Public Health Emergency Management Fellowship teaches are designed to be applied to virtually any crisis situation. Since the 2013 inaugural class, CDC has hosted 39 fellows from 25 countries, giving them important education they can take back and use in their home countries.

While in the U.S., Dr. Abah was particularly inspired by a visit to meet Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response in Washington, D.C. Her advice to him summarizes perhaps the most important lessons from the fellowship.

“I keep in my memories three words of advice from Dr. Lurie.” Dr. Abah recalls. “Never give up, stay connected, and get better.”

The Public Health Emergency Management Fellowship is implemented by CDC’s Division of Emergency Operations. The program helps countries meet the goals of the Global Health Security Agenda, including having an emergency operations center that can respond within two hours of a public health emergency.

Learn More

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02Sep / 2016

The Power of Preparedness

The Power of Preparedness. National Preparedness Month 2016.

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

If there were one thing I’d wish for, it would be the ability to predict when and where the next infectious disease outbreak would occur and stop it before it starts. I can’t do that. And neither can anyone else.

At this moment, in addition to combating Zika in the United States and polio in Nigeria and Pakistan, we’re putting out the last embers of Ebola in West Africa, stomping out cholera in Tanzania and Kenya, and fighting yellow fever in Angola. We’re keeping vigilant for the re-emergence of H5N1 influenza and Middle East respiratory syndrome, and monitoring chikungunya, dengue, monkeypox, Lassa fever, measles…the list goes on.

It’s a lot to do. And these are just the diseases we know about. The brutal fact is that there are diseases we haven’t discovered yet. They’re out there, waiting to expose the cracks in our systems – to find the places where we aren’t watching, the areas where we aren’t prepared. And we can’t know the potential danger.

Finding – and filling – the gaps

The fact is, if you leave an opening – any opening – disease will find it. This is why it’s critical to have strong public health systems in place before emergencies happen. We can do more to recognize what causes outbreaks, respond to them faster, and bring them under control more effectively.

Around the world and at home, we need to know the level and types of disease that are normally present, so we can detect when there’s a change that requires our attention. We need safe laboratories that can rapidly diagnose the cause of illness close to the source. We need emergency operations centers that can bring experts together quickly to make decisions. Until we have these things, there will be gaps.

And where there are gaps, there is the potential for disaster. The unexpected eruption of Ebola in West Africa showed us this clearly. Before that there were others: HIV raged undetected for a decade; SARS spread to 37 countries across three continents in four months; Anthrax drew the world’s attention to the threat of intentional releases of lethal pathogens.

The human and economic costs are dear. SARS killed nearly 800 people and cost an estimated $40 billion. Ebola has killed over 11,000 people and cost billions. The potential costs of Zika to the lives of our children are unfathomable.

The value of being prepared

Each day, we continue to learn by doing. Every disaster teaches us how to do better the next time. We are seeing results, both here at home and in countries around the world.

We know that preparedness can stop unexpected health threats, even when the disease is fast moving and deadly. Take Nigeria as an example: with a highly trained team of disease detectives and an emergency operations center at the ready, Nigeria was able to thwart Ebola’s spread in Lagos and elsewhere in Nigeria, stopping the outbreak at 20 cases and averting a potential public health catastrophe.

Cameroon’s emergency operations center was recently able to head off an outbreak of H5N1 influenza by activating within 24 hours of notification. Through investments in training and preparedness, they have dramatically improved their response times – just one year ago, it took that same center eight weeks to respond to an outbreak of cholera.

At home, our flu program serves as a gold standard for how to be flexible and responsive in an emergency. When H1N1 influenza hit, we were able to act faster and more effectively through systems we already had in place for vaccine shipping, coverage, and monitoring. The outbreak response also demonstrated how we can work effectively across sectors – across CDC, between levels of government, and with global partners like the World Health Organization and ministries of health.

Despite these successes, nearly 70 percent of countries remain unprepared to handle a public health emergency. That’s a scary number – and a lot of vulnerable people.

Building well for the future

We cannot accept the status quo; we must put our investments into work that will make the world a safer place for us all. In doing this, we must first believe – as I do – that it is possible to create positive change and get results.

In a time when what pops up in one corner of the world can find its way across the globe in a matter of hours, we all have a responsibility to each other to be prepared.

We cannot take this responsibility seriously enough.

More resources to learn about global preparedness:

National Preparedness Month
Global Health Security Agenda (GHSA)
CDC Global Health
GHSA In Action
World Health Organization
Public Health Matters: Small Changes, Big Dividends: A Global Look at Preparedness
Our Global Voices: On Global Health and Being “Prepared”

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29Aug / 2016

Small Changes, Big Dividends: A Global Look at Preparedness

Soumbedioune fish market in Dakar, Senegal

There’s a big difference between seeing something in a picture and experiencing it in 360-degree reality, saturated with sounds and smells. In the summer of 1987, I traveled to Senegal for three weeks. This was the first time I had really traveled and seen firsthand what the rest of the world was like.

In Dakar, fishermen brought their catches to beach on the edge of town. An open sewer drained directly into the ocean almost in the middle of where the fishermen landed their boats. In addition to the smells, that sewer pipe seemed guaranteed to make people sick. It also seemed that something simple, like moving the drain, could prevent illness. It might have been a naïve idea, but it struck me that there were many opportunities to make small changes that would improve people’s health.

Many of us came to public health because, at some point in our life, we had a similar realization. As a clinician, treating one patient at a time undoubtedly helps people and is rewarding, but working to protect and benefit the community as a whole can provide larger-scale benefits.

Preparedness at the forefront

This is why I’m passionate about being prepared. When an emergency hits, having trained people who know what to do, and having the resources in place to allow them to do their jobs, saves lives. And – as we have seen all too clearly – a lack of preparedness can turn an outbreak into an epidemic, or a natural disaster into a crucible for infectious disease.

Planning ahead and being ready are the most critical things we can do to keep people safe. The world recognizes this, which is why countries have signed international agreements like the International Health Regulations and the Global Health Security Agenda that commit them to being prepared for a public health emergency. We have a long way to go, but we have a clear roadmap for what needs to be done.

And, here in the U.S., we are doing our part to fulfill our obligation to the global community. Recently, we invited a team of international experts to evaluate the ability of the U.S. to prevent, detect, and respond to public health threats. Looking at 19 different areas, they gave us feedback on where we are succeeding, and where we can do better. We will use the results of their report as we continue to build on our expertise.

Knowledge benefits everyone

The benefits of improving our expertise are twofold: not only do we protect ourselves, but we gain knowledge that we can share across the globe as other countries build their capabilities to respond to health threats. We are doing this every day.

CDC’s efforts in developing our Emergency Operations Center provide a great example. What we’ve learned is that the most important investment a country can make is having highly trained people at the ready. When people know what to do, a conference room and a few computers is all it takes to coordinate a response that can mitigate disaster and save lives.

CDC is able to share this kind of information with partners in countries around the world who may not have the resources to do everything at once. From working with Kenya on how to regulate the labs that handle the world’s deadliest germs and poisons, to working with Cameroon and Ethiopia on how to manage an emergency stockpile of medicines, we are helping others learn from our experience, and also learning from them as we go.

We are all connected

Our connection to other countries is more important than ever. As we help build capacity across the globe, we also protect our health here at home. We have to think globally as we build the knowledge we need to prepare for, and respond to, emergencies.

We must keep in mind that, somewhere in the world, there is a draining sewer that might be ground zero for an outbreak. And, somewhere, there is a conference room we could fill with trained responders to help stop it.

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28Sep / 2015

Connecting Neighbors through Social Media

By: Sarah Leary

Online communication and social networks are changing the way that people communicate. Today, people are able to relay messages to those around them and those across the world nearly instantly. This instant communication is playing a critical role in emergency communication.

When the largest earthquake since 1989 hit Napa, California, and the greater San Francisco Bay Area in August 2014, neighbors and local agencies were quick to turn to social media to communicate updates and information about the damage and safety precautions. One of the social networks utilized was the private social network for neighborhoods, Nextdoor, which creates social networks and communication channels specific to individuals’ neighborhoods.

Within minutes of the earthquake, residents used Nextdoor to send urgent alerts out to their communities, warning their neighbors to take cover in doorways, watch out for crumbling chimneys, and keep an eye out for scared and flighty pets. In the days following the quake, neighbors continued to use this new social network to share neighborhood-specific tips on clean-up efforts, offer shelter to neighbors in need, and report sightings of lost pets in the area.

Several Nextdoor agency partners, including both the City of Napa and the City of American Canyon, used social media to inform residents of damages, advice for contacting emergency personnel, school closures, and more. In many areas, social media was used to advise residents to keep an eye out for the sound or smell of leaking gas lines and provided road closure updates.

An incredible number of social media conversations in the greater San Francisco Bay Area that day were related to the earthquake– demonstrating that a connected community is indeed a stronger community. Neighbors connected with neighbors, passing along the latest information on power outages, road closures, and damage reports.

Similarly, during the flash flooding and historic rainfall in Houston , Texas this May, the Houston Office of Emergency Management also turned to social media to send out important safety updates and urgent safety alerts to residents across the city.

“During times of emergency and natural disasters, it is often neighbors who are able to best help each other,” said Rick Flanagan, Emergency Management Coordinator at the Houston Office of Emergency Management. Social media “has played a vital role in, not only helping our residents connected, but giving us an effective way to work directly with residents to make Houston a more resilient, prepared city.”

The ability to connect with the community online rapidly closed the communication gap that previously existed between residents and emergency services.

For towns that have experienced more than their fair share of natural disasters, like the City of Moore, Oklahoma, which has been plagued by tornadoes, social media platforms offer a way to connect communities and increase resiliency.

“The more connected you are to your neighbors, friends, and family, the more invested you are in your community. We have people that have gone through disaster and destruction and they have chosen to stay,” said Jayme Shelton, marketing specialist for the City of Moore. “I think Moore citizens choose to stay because of the people.”

Shelton noted, “We come together as a community during times of disaster, and it would be great if we kept that going throughout the year. We don’t have to have a disaster hit us to know your neighbors.” Social media platforms play a big part in connecting neighbors, community leaders, and emergency management resources.

In 2010, the Pew Research Center released a report stating that 28 percent of Americans do not know a single neighbor by name, and only 29 percent know one neighbor by name.

Social media has enhanced how public agencies and residents work together to build more resilient communities. Public safety agencies across the country are increasingly combining the power of social networks with the power of connected neighbors to help create safer more resilient communities – whether the emergency is a flooding in Texas, an earthquake in California, or a tornado in Oklahoma.

If neighbors are able to be better connected, they will be much more resilient and prepared for anything that comes their way.

Sarah Leary is the Co-Founder and Vice President of Marketing and Operations at Nextdoor, a free and private social network for neighborhoods.

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22Sep / 2015

The Healthy Traveler’s Mindset — Mitigating Risk and Embracing Adventure

By: Cullen Welch

“All courses of action are risky, so prudence is not in avoiding danger, but calculating risk and acting decisively. Make mistakes of ambition and not mistakes of sloth. Develop the strength to do bold things, not the strength to suffer.” —Niccolò Machiavelli

Every Course in Life is Risky

The author takes a plunge. Cullen cliff jumping in Croatia

As a backpacker abroad, I have been exposed to many experiences and foreign diseases that have challenged my health and immune system in ways I never expected. Thanks to my travels, I am now aware that diseases such as tuberculosis, malaria, and influenza are a serious concern to consider in international adventures, but I do not let these health risks slow me down. Instead, I choose to be prepared by understanding how good hygiene, healthy habits, and vaccines can help me reduce these risks. With an arsenal of disease-prevention ammunition at our fingertips, we can find a reassurance and enabling power that allow us adventures to pursue our global explorations.

Every course of action in life is risky – but when it comes to taking adventures abroad one must not only accept and understand the risks, but also know how to manage these risks responsibly. You better believe that I conducted extensive research into the water quality before launching myself from that Croatian cliff!

Embrace the Experience

In my own life, personal risk management has taken on new dimensions through multi-month backpacking and hitchhiking excursions in Asia, India, and Africa. I’ve run into body-engulfing skin rashes in India, Belize, and Malawi; bronchial infections in Zambia and Namibia; and urchin puncture wounds in Mozambique—all of which reminded me of the importance extensive and comprehensive pre-travel preparation.

Though some of my experiences remind me that staying put at home, in my trusted comfort zone with the family physician a phone call away, is safe and secure, I always come back to this favorite lyric from the appropriately named song, Ends of the Earth: “What good is livin’ the life you’ve been given, if all you do is stay in one place?” So despite the risk and health mishaps that I have experienced, I am always drawn back to the adventure and thrill of exploring this great big world.

Don’t Let Fear Stop Your Adventure

Responsible planning motivates many of our professional, relational, and recreational pursuits in life. When it comes to travel and adventure, we often become wary and scared by unpredictability and lack of complete control. These feelings, along with the perception that the daily reality of far-off places’ looks dangerous and unwelcoming, can make many people hesitant to explore the world. My advice, don’t let the fear of the unknown stop your adventure! Be prepared to embrace it.

The best that we can do as conscientious travelers is embrace the reality of risk, equip ourselves with the means to tackle potential problems along the way, and accept that sometimes, rough patches are simply unavoidable as a byproduct of the adventure!

A Few Tips I’ve Learned Along the Way

Whether you are planning a family vacation, studying abroad, or setting out on your own world adventure, here are a few tips for your travels:

Cullen_sm — “Life begins at the end of your comfort zone.” – Neale Donald Walsch [Cullen on Cricket Grounds in Mumbai, India]

1. I once carried an extensive (and heavy) kit of first aid supplies that was less than ideal for a backpacker attempting to travel light. I’ve personally found over time that I can make do very well with just a few basic essentials. Here are a few of my essentials, but also have a look through the CDC’s recommendations for a full traveler’s health kit and make a kit that fits your needs.

Disinfectant, antibacterial ointment, and small bandaging supplies.
Pain/fever relievers such as Ibuprofen/Advil/acetaminophen
Cough drops/throat lozenges
Digestive aids such as activated charcoal or Pepto-Bismol
Skin protection with UVA/UVB protection
Geographically relevant prophylactics such as malaria pills if traveling to certain parts of Central and South America, Africa, and Southeast Asia.
Water purification supplies such as iodine tablets

2. The CDC Health Information for International Travel (“Yellow Book”) is the gold standard for globally recognized health records on travelers. I have found it to be a useful aid in many cases and a necessity for travel through yellow fever countries. It includes an exact history of your lifetime vaccinations, blood type, medications, allergies, and ophthalmic prescription, meaning that in the case of an emergency abroad, international doctors have access to your basic medical records straight away.

3. Be proactive in confirming what vaccinations you may or may not need before leaving home. Some of these you will already have; others require booster shots or additional strain vaccinations. The best way to find out which vaccines you will need for your trip is to talk to your doctor at least 4-6 weeks before your trip. Before my first big outings to India, Southeast Asia, and Africa, I had to get several vaccinations, including: Hepatitis A3, Tetanus, Typhoid, Influenza, and Yellow Fever

4. Duct tape — don’t leave home without it! Seriously, duct tape will fix just about anything in a bind. A length of decent line (rope) isn’t a bad idea either – at minimum, you’ll have a useful clothesline.

5. Also consider how to handle some of these essential travel documents:

Scan or photocopy your passport, credit cards, identification, certification cards, insurance, flight tickets/etc. and leave copies with your family and friends at home. You may also want to electronically distribute these, for easy access later on. If you run into any problems with loss or theft of these documents, having electronic access to them from a remote corner of the globe may prove invaluable.
Purchase additional passport photos beforehand, ready for use during border crossings, visa extension applications, and other potential customs requirements.

6. Establish a communication plan with your family! The frequency and nature of interaction with friends and family will vary widely between travelers, but the important thing is to have at minimum a mutual understanding of a timeline for when you will check in. For me, this is often weekly or biweekly updates, depending upon my location and access to the internet. Share your travel plans and an idea of whereabouts you might be headed.

The world is a big place. The opportunities are endless if we’ll remain ambitious, act decisively, and dare greatly. Don’t be afraid to seek adventure, just remember to be prudent and prepare!

Morning greetings from the sun as it crest Everest

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18Sep / 2015

A Healthy Community is a Prepared Community

Happy Teenage College Students Jumping at Park

What does a prepared community look like?

As communities look at how to prepare for the next emergency, they usually focus on stockpiling emergency supplies, having clear alert networks and ways to communicate with the public, and designating evacuation routes and shelter locations. While all of these are key aspects of emergency planning, one area of preparedness that is often overlooked is community health. Community Health is a term used to describe the state of health and how easy or difficult it is to be healthy where people live, learn, work and play. The health of a community, including ease of access to medical care and community resources available for exercise and encouraging healthy habits, is an important part of emergency planning that can have a positive impact on a community before, during, and after a public health emergency.

What is a Healthy Community?

Woman Selling Fresh Cheese At Farmers Food Market A healthy community is one in which local groups from all parts of the community work together to prevent disease and make healthy living options accessible. Working at the community level to promote healthy living brings the greatest health benefits to the greatest number of people. It also helps to reduce health gaps caused by differences in income, education, race and ethnicity, location and other factors that can affect health. Healthy communities commonly have high vaccination rates to protect citizens from diseases and easy access to medical care and healthy food; are designed for healthy living at home, work, and school; and provide good mental health resources. Often, this also means it is safe and easy to walk, bike, and play in parks and community spaces.

How is a Healthy Community Better Prepared?

Communities that have good health resources in place and healthy community members can often recover after a disaster more quickly and with less negative health issues. Individuals who are in good physical shape, have proper vaccinations, have access to clinical services and medications, and know where to get critical health and emergency alert information, can better recover from a disaster and are more likely to be able to contribute to a community’s recovery efforts. After a natural disaster people may be displaced or may be gathered or taking shelter in crowded group settings. When there is a large number of people gathering or living in these crowded areas, it is imperative that people are up-to-date on their vaccinations in order to reduce the spread of disease. Nurse talking to mother and daughter

Unhealthy communities often have a large number of individuals that are more vulnerable before, during, and after a disaster. Factors that lead to poor health in communities such as high rates of chronic diseases like diabetes and heart disease, limited access to general medical care, and low levels of health education, can cause substantial difficulties for a community recovering from an emergency event. Gaps in medical care can increase significantly after a disaster due to physical damage to health care facilities or from a large increase in the number of people who need medical attention. People who already have poor health are usually more susceptible to disease during a public health emergency and cannot get the normal day-to-day medical care they need.

Make Your Community Healthy and Prepared

People passing sand bags down a line to prepare for a hurricane You can help improve the health of your community by taking a look at your health and the health of your family. Take actions to ensure that you are as healthy as possible. Before an emergency, if you eat well, get regular checkups and vaccinations, and are physically active, your body will be better able to handle the stress and physical demands of recovering from a disaster. Washing your hands regularly can also help reduce your chances of getting sick during and after an emergency.

Help promote health in your community by becoming more engaged in your community. Encourage local community groups and government organizations to consider community health in their emergency preparedness plans. Take action to improve your community’s health now to ensure you are better prepared to remain healthy when an emergency occurs.

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15Sep / 2015

Medicine Dispensing Exercise Held at Virginia Costco

volunteer packing medicine container in dispensing bag during emergency response exercise

When you think “community,” what comes to mind? Maybe you immediately think of neighbors and friends who live nearby, or perhaps local businesses, churches, civic organizations and others. What about some of your regular stops around your community such as your pharmacy where you fill your prescriptions or buy over-the-counter medicine? Most people have trusted community partners they know well and with whom they interact regularly in everyday life. In fact, some of these same community partners are working with local, state, and federal public health planners to help your communities prepare for emergencies.

Pharmacists standing over table of clipboards. — Pharmacists set up a screening station in a recent exercise to determine which medicine a person should receive to counteract exposure to anthrax.

In June 2015, a Costco warehouse in Potomac Mills, VA, partnered with Prince William Health District (Virginia Department of Health) to show how a private business can step up to help its community in an emergency. In this particular exercise, Costco regional pharmacy staff exercised a local plan to dispense medication – actually empty training bottles – to nearly 200 public volunteers as part of an open, or public, point of dispensing (POD). The scenario was based on a large-scale anthrax attack that would require mass dispensing of antibiotics from the Strategic National Stockpile (SNS). In an emergency where many people were exposed to anthrax, these antibiotics would help prevent people from becoming sick.

Volunteers wait to receive their “pill bottles” in a recent exercise with Costco and Prince William, Va. Health District to test a public dispensing plan in an emergency.

“Public health and the private sector can share resources and work together as a community to reach one goal,” said Patrick Ashley, emergency preparedness and response coordinator for Prince William Health District. “We have realized that government cannot do everything on its own – and shouldn’t. The success of this exercise comes from having engagement on all sides. Costco came to the table and has been a great partner.”

This public/private dispensing pilot, facilitated by the Centers for Disease Control and Prevention (CDC), demonstrates how large private retailers can partner with state and local public health departments to dispense medications to the public in an emergency. Costco has partnered with public health to operate both closed PODs, which would serve its own employees and their families, and public PODs open to the larger community.

“Costco has a history of serving the community,” said Christopher Loving, Costco regional pharmacy supervisor in Virginia. “This was a great opportunity for us to show our region’s pharmacy managers how this kind of event would work. The POD exercise at Potomac Mills was a huge success.”

At CDC, we know that all response begins locally, and a resilient community is simply one that has made itself ready to use all of its available resources to plan for, respond to, and recover from an adverse event. The real key to creating resilient communities is to strengthen day-to-day activities that help keep the community healthy and thriving.

table with pharmacists packing bags with medicine bottels — Regional Costco pharmacists in Virginia exercise a local dispensing plan to respond to an emergency that would result in wide-spread exposure to aerosolized anthrax.

“The SNS is the nation’s repository of medications and medical devices for responding to public health emergencies, and we focus our efforts on helping build resiliency by ensuring that everyone in a community has access to the life-saving material we can provide,” said Greg Burel, director of CDC’s Division of Strategic National Stockpile. “The National Stockpile’s supplies cannot stop significant health problems after a disaster if communities are not resilient, so we work to facilitate relationships, train people and create strong partnerships between public health and the community. By including private businesses like Costco in these planning efforts, we are able to reach more people who rely on and trust their community partners.”

From the astute healthcare provider who recognizes that a disease is emerging in a community that could pose a public health threat, to the company that wants to make sure its employees and their families are safe, all of us have an important role to play in making our communities resilient. In an emergency, the whole community will be affected. If public health jurisdictions and the private sector can collaborate on planning and partnerships in advance to make that community resilient before something bad ever happens, we are all ultimately safer.

PHPR: Health Security in Action

This post is part of a series designed to profile programs from CDC’s Office of Public Health Preparedness and Response.

The Point of Dispensing program is a program run by CDC’s Office of Public Health Preparedness and Response’s (PHPR) Division of Strategic National Stockpile.

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02Sep / 2015

Frozen Without a Plan: A Mom, 3 Kids, and the Atlanta Ice Storm

It was 4 p.m. on a Tuesday in January, and Kelly had been on the road for four hours. She was only a few miles from work, but many miles from home. Her rearview mirror showed a backseat full of children – 5-year-old Savannah, and her 9-month-old twins Caden and Kylie.

She had left work at noon, the time when most Georgians got on the road at the start of a winter storm in the Atlanta metro area. Kelly, a kindergarten teacher at the same school her children attended, had quickly loaded her kids into the car and hit the road for home. photo of television screen showing news coverage of Atlanta snowstorm

Where they sat.

And sat.

Kelly’s mind raced – they were nowhere near home. The twins would be hungry soon and she only had one bottle for each child. She only had two diapers left and both were overdue for a diaper change. But she knew her children could not see her fear.

Instead, she and Savannah played “Frozen” – pretending Elsa was freezing the road around them and singing “Let it Go” on repeat. The twins woke up from their afternoon nap and played along with “oohs” and “ahhhs.”

As the hours passed, the trip began to get scarier. Cars slid out of control on the icy road, some off the road and some into each other. More than once, Kelly gripped the wheel as a car got dangerously close to her family’s car.

map of Atlanta traffic during the 2014 snowstorm — More than three hours into her drive and Kelly still faced a series of “red” roads. Image: Google Maps

“Why is that lady crying?” asked Savannah. “Are we going to get stuck?” She and Kelly talked about snow, ice, and how scary things can happen.

“When scary things happen, we try to help other people,” Kelly told her daughter as they began a new game of looking for people helping each other. They didn’t have to look far. Commuters helped push stuck cars off the road.

Around 9 p.m., Kelly turned on to a residential street to find people walking with wagons full of supplies, handing bottles of water and packages of food to the stranded motorists. Several offered her and her children a place to stay, as did friends of friends who were following her on Facebook. Kelly declined the offers. They were still making progress. Her children had dozed off and she was focused on getting them home to fresh diapers and more baby food.

At 10:30 p.m. she made it to the final bridge before home. She was the next car in line to cross the bridge when a police officer stopped her. They had closed the bridge. A truck trying to pass had slipped back and hit cars. The bridge was not safe.

She asked him for advice on how she could get home. “He looked at me with the saddest look and said ‘I’m sorry ma’am. You’re not getting home tonight,’” Kelly remembered.

A Night on the Road

Kelly’s husband, Jon, began calling hotels. Every single hotel was booked, even their lobbies were full of people. Around 2 a.m. Kelly pulled into a parking lot and let Savannah come to the front seat to sleep on her lap.

Savannah, Caden, and Kylie enjoy breakfast after their night sleeping in the car.

Kelly wished away the minutes, texting with her husband. Her full tank of gas allowed her to keep the heat running and her phone charged. “I kept worrying the babies would wake up hungry or needing a new diaper,” said Kelly. “I’m so grateful they slept and stayed calm – and didn’t poop!”

Staying positive and making the situation into a learning experience for her daughter helped them get through the night. “I almost lost it a couple of times,” remembered Kelly. “I felt the tears coming on, but I just looked at my children and kept trucking.”

An Extra Special Breakfast and a Shopping Spree

Around 5 a.m. the babies began to wake and Kelly knew she needed to get them somewhere with fresh diapers and food. She spied an open breakfast restaurant. She carried two car seats inside, where the whole family devoured pancakes.

With diapers as the next priority, she found a grocery store with its lights on. A lobby full of stranded motorists waved her inside. “The store manager, had pastries, juice, and water out for everyone,” she shared. “I asked him if I could please buy diapers for the babies. He said the registers were closed and he couldn’t sell anything, but instead took me to the baby aisle and told me to get whatever I needed.”

Home at Last

Savannah, Caden, and Kylie play in the snow after they arrived home.

Police and her husband arrived around 7:30 in the morning, sharing news that the bridge had reopened. The family got in his car and drove the last few miles home.

Getting ready for bed the next night, safely at home in their warm house, Savannah asked “Can we sleep in the car again?”

“Not tonight,” said her mommy. “We’re not sleeping in the car tonight.”

Lessons Learned

“The most important thing is to be prepared,” said Kelly. “You never know what’s going to happen.”

A full tank of gas and a car phone charger were game changing supplies. They kept the family warm and connected. Kelly and Jon now stock their cars with a big bag holding three changes of clothes, water bottles, snacks, diapers, and wipes. The first of every month, Kelly cycles out the food, replacing snacks and updating clothes for the weather. “The little bit of time is worth every second for my peace of mind,” says Kelly.

Remember, an emergency can happen anywhere. Make sure you are prepared at home and on the go. For more family stories, visit our Caring for Children in Disasters portal.

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29Sep / 2014

Businesses Ready and Willing to Help Communities During Emergencies

During the January 2014 winter storm that crippled the Atlanta metro area and left thousands stranded on the city’s highways, businesses stepped up to the plate to assist those with nowhere to turn. Home Depot opened 26 stores in Georgia and Alabama to shelter stranded travelers, and other local stores like Walgreens, Wal-Mart, and Target welcomed weary – and cold – drivers who abandoned their cars when it was obvious they were not going to make it home that night. These businesses provided the community with resources and services when people needed them most.

In planning for public health emergencies, communities are quickly learning that businesses are true partners in response and recovery efforts. The private sector has the expertise, resources, and systems that operate every day that can assist in a public health response, be it for a pandemic, terrorist event, or natural disaster. During Hurricane Sandy, for example, big businesses used their commercial supply chain to deliver water, food, and other supplies. As the U.S. Chamber of Commerce says, “when the going gets rough, businesses gets moving.”

Staff at CDC’s Strategic National Stockpile – the largest global stockpile of pharmaceuticals and medical supplies for a public health emergency – are working to help state and local agencies forge these partnerships for both distribution and dispensing efforts and as a way to increase access to medicines in an event that affects that entire community. Partnering with public health is good business, too. These private partners are members of the community and when disaster strikes, they can help keep their employees safe and healthy and their businesses up and running.

“As a global manufacturer of computers and computer services, we have committed ourselves to providing our customers with quality products and services,” said a representative from Dell, the information technology powerhouse that has partnered with public health to assist in dispensing medicine to its employees during an emergency. “We are doing the same thing with our employees. We want them to feel good about coming to work and their company taking care of them. That’s why we have gotten very much involved in the points of dispensing program that is being offered by many of our health departments around the country.”

In addition to serving as closed points of dispensing, which allows businesses to provide medicine to their own employees, companies also are coordinating with CDC and their public health departments to provide volunteers, to assist in communications, and to serve the larger community as public dispensing sites. This type of collaboration and partnership between the private and public sector will augment and support a public health response and ultimately help keep Americans prepared, safe, and protected.

For more information on how businesses can partner for preparedness, visit http://www.cdc.gov/phpr/partnerships/.

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