21Sep / 2022

Public Health Emergency Preparedness (PHEP) funding program marks 20 years

Photo of three individuals wearing yellow personal protective equipment (PPE).

By Jill Sutton, specialist, Emergency Preparedness and Response, APHL

This year marks the 20th anniversary of the CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement, a program that was developed in 2002 to strengthen preparedness capabilities in public health departments across the US.

Public health preparedness today can be attributed to developments in policy and funding since the September 11, 2001 terrorist attacks and the anthrax attacks that followed shortly after. Over the last 20 years, public health preparedness has evolved from a bioterrorism focus to an all-hazards approach, a framework that focuses on how we prepare and respond to a wide range of public health threats like infectious diseases and natural disasters as well as biological, chemical, nuclear and radiological events.

What is PHEP?

Since 2002, the PHEP program has been a critical source of funding, guidance and technical assistance for state, local and territorial public health departments. Thanks to PHEP, health departments are able to support preparedness and response activities and strengthen their preparedness capabilities so they are ready when public health emergencies strike.

At the local level, public health departments invest their PHEP funds to:

Enhance preparedness infrastructure,
Conduct trainings and exercises,
Hire dedicated preparedness staff,
Establish and maintain systems that enable the early detection of public health threats like monkeypox or COVID-19,
Quickly acquire emergency supplies and equipment, and
Rapidly share public health data to inform response needs.

As a result of these investments, communities are more prepared for public health emergencies than they were 20 years ago, but there’s still more that needs to be done. Federal preparedness funding has declined over the last 20 years, forcing PHEP recipients to cut positions, preparedness trainings and exercises, and equipment needs from their budgets. This has caused public health departments to be unable to expand or maintain their preparedness capabilities. A lack of sustainable funding directly impacts the capacity of state, local and territorial health departments to prepare for and respond to public health threats that arise in the communities they serve.

As we also celebrate National Preparedness Month, we honor the 20th anniversary of PHEP and all that it has helped our nation accomplish. Whether we are facing a pandemic or not, we need to remain prepared for the next public health emergency. It is our sincere hope that funding for PHEP will rise to ensure our nation’s public health system is prepared for the next emerging threat.

The post Public Health Emergency Preparedness (PHEP) funding program marks 20 years appeared first on APHL Blog.

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08Sep / 2022

Parents & Teachers: Helping Children Cope with Emergencies

Kids stand in line waiting to board a school bus.

Public health emergencies affect millions of children worldwide each year. These emergencies include natural and man-made disasters.

It is difficult to predict how some children will respond to emergencies or the trauma of losing their homes or being separated from school, family, and friends. These events can cause stress and anxiety in children.

Because parents, teachers, and other adults see children in different situations, they should share information about how each child is coping after a traumatic event. Children may have strong emotions right away, or they may not show signs of difficulty until much later. Knowing how to help children cope after an emergency can help them heal and feel safe and healthy again.

Tips for Parents and Caregivers

Children react to what they see from the adults around them. Getting upset or anxious during an emergency is common. When parents and caregivers manage these emotions and deal with a disaster calmly and confidently, they can provide the best support for their children. The common reactions to distress will fade over time for most children. These include

Infants to 2 years of age
- Infants may become crankier. They may cry more than usual or want to be held and cuddled more.
3 to 6 years of age
- Preschool- and kindergarten-age children may return to behaviors they have outgrown such as toileting accidents, bed-wetting, or being frightened when separated from their parents/caregivers.
- They may also have tantrums or a hard time sleeping.
7 to 10 years of age
- Older children may feel sad, mad, or afraid the event will happen again.
- Peers may share false information; however, parents or caregivers can correct the misinformation.
- Older children may focus on the details of the event and want to talk about it all the time or not want to talk about it at all. They may have trouble concentrating.
Preteens and teenagers
- Some preteens and teenagers respond to trauma by acting out. This could include reckless driving and alcohol or drug use.
- Others may become afraid to leave the home. They may cut back on time spent with friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings and parents/caregivers or other adults.
Children and adults with special needs (of any age)
- Children and adults with special needs may need extra words of reassurance, more explanations about the event, and more comfort and assistance.
- Children and adults with physical, emotional, or intellectual limitations may have stronger reactions to a threatened or actual disaster. They might have more intense distress, worry, or anger than children and adults without special needs because they have less control over their day-to-day well-being than other people.

If children continue to be very upset, or if their reactions impact their schoolwork or relationships, parents may want to talk to a professional or have their children talk to someone who specializes in children’s emotional needs.

Tips for Teachers

As a teacher, you help to keep schools safe and support children and their families. If your students experience an emergency or disaster, there are steps you can take to help them cope and recover.

Children react to what they see from the adults around them. Getting upset or anxious during an emergency is common. When teachers manage these emotions and deal with a disaster calmly and confidently, they can provide the best support for their students.

To help students cope and continue to support their recovery from a disaster,

Talk to students about what happened in a way they can understand. Keep it simple and appropriate for their age. (Learn more about common reactions by age range.)
Provide students with opportunities to talk about what they went through or what they think about it. Encourage them to share concerns and ask questions.
Children who were directly exposed to a disaster can become upset again. Behavior changes resulting from the event may last a long time and can worsen or return if these children see or hear reminders of what happened. Be aware this could happen and know what resources are available at your school for children and families, should you need to report your concerns.

After a disaster, you may also struggle with severe post-traumatic symptoms and personal losses. This might make you hesitant to engage in any kind of post-disaster discussions with children. In this case, you should take care of yourself first and seek help from a professional.

Call or text the Substance Abuse and Mental Health Services Administration’s Disaster Distress Hotline at 1-800-985-5990. People with deafness or hearing loss can use their preferred relay service to call 1-800-985-5990. Seek other trusted adults to connect with children during the emergency.

Resources

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

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25Apr / 2022

Self-Serve Food Pantries Help Feed Local Communities

Five teenagers stand beside a freestanding wooden container filled with food. A label on the box says "TLC little free pantry" — High school students (from left) Eva Gottesfeld, Rebecca Levy, Yair Gritzman, Jonathan Hus, and Noah Rubin stand in front of a “TLC Little Free Pantry” with a quick response (QR) code and instructions posted on the front. (Photo credit: Yair Gritzman)

This student-authored post is published by CPR in partnership with Medill News Service and the Northwestern University Medill School of Journalism, Media, Integrated Marketing Communications. The views and opinions expressed in this article are the author’s own and do not necessarily reflect the views, policies, or positions of CPR or CDC.

Summer Faerman was on a walk in early 2020 when she saw a small wooden box at the entrance of a neighborhood. She investigated.

The box was a free library, where people could take a book for themselves and leave them for others. The idea inspired Faerman to create something similar—a self-serve food pantry.

Faerman started with one pantry in front of a Salvation Army. It was a strategic choice. The Salvation Army is known in the community as a place to donate goods. It’s also a block away from a local elementary school and a public housing development. callout

Over the past year, one pantry has turned into 52 TLC Little Free Pantries (LFP) located around South Florida. The newest opened last Veteran’s Day in Boca Raton at a mental health center that treats veterans.

LFPs are open 24 hours. There are no questions asked, no judgments passed, and no forms to fill out, explained Faerman.

The pantries are based on the honor system. The words “If you have, give. If you need, take” are posted in multiple languages, including Creole, Portuguese, and Spanish, on the boxes.

People who take from the self-serve food pantries also give, Faerman said. She’s seen people, including members of the local synagogue and passersby, put food in the boxes.

With the pantries being always open, Faerman ran into a problem. When there was just one box, she was able to keep up with demand.

As new pantries opened, it became more difficult for Faerman to keep them stocked. That’s even with the help of volunteers.

In January 2021, Faerman heard from a group of high school students in an engineering club at Donna Klein Jewish Academy with an offer to help. She explained to them her problem of knowing when the pantries were running low. The students suggested creating quick response (QR) codes for the pantries.

QR codes, explains Yair Gritzman, a senior in high school and member of their engineering club, were a simple and inexpensive solution to keeping tabs on the pantries’ inventory.

Gritzman and his schoolmates enlisted the help of their engineering teacher and the Institute for Sensing and Embedded Network Systems Engineering at Florida Atlantic University. Together they launched “Report That Pantry”.

Report That Pantry is a website. QR codes placed on each pantry link to the site, where users of the code can report the level of food inside the pantries to LFP volunteers.

The QR codes, which link to the website, are now being used by self-serve food pantry projects in other states, including Oregon, Louisiana, Oklahoma, and Ohio, to restock their pantries faster.

Faerman said the QR codes make it so that “if there’s one [a pantry] that’s bare, it’s not bare for long.”

People appreciate that they can go at any time and take as much food as they need, said Faerman. Children share how excited, not embarrassed, they are to go to the pantry and pick out food. Thank-you notes are left inside the pantries as well.

Faerman hopes to implement more self-serve pantries soon. For now, she’s focused on keeping the ones they have stocked with food with the help of the website.

Faerman hopes people find inspiration in the TLC LFPs—as she did in the free library—and replicate it in their communities. Building a self-serve pantry is easy and opening an account on “Report That Pantry” is free. People are only limited by their willingness to get involved.

The U.S. Department of Agriculture (USDA) reported in September 2021 that of the 13.8 million food-insecure households in the U.S., 36.5% of them reported using a food pantry in 2020. USDA defines households as food insecure if they have “difficulty providing enough food for all members at some time in the past year because there wasn’t enough money for food.”(2)

Food assistance is available for low-income individuals and communities. Call USDA’s National Hunger Hotline for information on meal sites, food banks, and other services near you. The number is 1-866-3-HUNGRY (1-866-348-6479) or 1-877-8-HAMBRE (1-877-842-6273) for Spanish. The hotline is open Monday through Friday from 7 a.m. to 10 p.m. EST.

Resources

Public Health Matters: Give & Take Bins Serve as Small-Scale Food Pantries
Food and Food System Resources
Healthy People 2023: Food Insecurity
Supplemental Nutrition Assistance Program
Emergency Food Assistance Program

References

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27Jan / 2022

Local CERTs Offer a Way to Get Involved in Your Community

A man in a green vest and hat directs traffic in parking lot.

When a 10-year-old girl went missing from her home in the middle of the night on July 23, 2021, her parents called the police.

The next morning, the Canton (Mich.) Police Department mobilized the local Community Emergency Response Team (CERT) to help find the child. She was found safe later that day.

William Hayes, the emergency management coordinator for the Canton Public Safety Department, calls CERT “a force multiplier.” CERT volunteers support Canton police on different nonviolent and noncriminal missions like in 2004 when local cell towers broke down. While repair crews fixed the towers, team members developed a system of communication using handheld radios. They used the radios to stay connected with each other and informed of the crews’ progress.

In the case of the missing girl, the combined force of CERT volunteers and police officers were able to search further, wider, and faster than the police could’ve done alone. Jeff Grand, who works full-time at a local bank and joined CERT three years ago to get involved in his community, estimates he and his partner knocked on hundreds of doors that morning.

The response capabilities of CERTs frees up professional responders to focus their efforts on more complex, essential, and critical tasks.

CERT volunteers complete hours of basic training and education on how to respond to various emergencies. Their training includes learning practical skills, such as cardiopulmonary resuscitation and first aid, team organization, and disaster medical operations.

Volunteers also get hands-on practice putting out a fire, using a jack to lift a car, and searching for missing persons. More than 600,000 people, including the 100 members of the Canton CERT, have completed training since CERT started.

All volunteers receive the same training regardless of their location. This approach makes it easier for CERTs to work together in times of need, such as when tornadoes hit Southeast Michigan in June 2021.

The extreme weather event did little damage in Canton. Neighboring towns like Dearborn, Michigan, faced more challenges. Canton CERT–one of about 20 programs in and around Metro Detroit–turned out to help their neighbors, many of whom struggled with power outages and flooding.

The COVID-19 response has created the need for volunteers to staff local testing and vaccine distribution sites around Wayne County, Michigan. Volunteers who are medically trained help administer vaccines.

Grand has spent the better part of his CERT career registering people at vaccination sites. Thousands of people received vaccines at these sites.

Hayes wants more people to join Canton CERT. He believes the stronger the CERT program in a community, the more resilient the community.

The first CERT was established in Los Angeles, California, in 1985 by the city’s fire department. It became a national program in 1993. Today there are over 2,700 local CERT programs nationwide.

Visit the CERT website to find a team near you and to download basic training materials.

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07Dec / 2021

Get Involved with Your Neighbors During Hi Neighbor Month

December is Hi Neighbor Month.

Social connections are important to your personal health preparedness. The relationships we build with others are ties that bind during an emergency. One of the more important social connections you can make is with your neighbors.

The Importance of Neighbors

Neighbors can be an important source of assistance in the days after an emergency. Because they live close—maybe even next door—neighbors might be your first and best option for help after a tornado or during something like a power outage.

Research shows that people who think they’re prepared for disasters often aren’t as prepared as they think. Forty-six percent of people surveyed by FEMA expect to rely heavily on their neighbors for help within the first 72 hours after an emergency.(1)

Yes, ask your neighbors for help if you need it, but—if possible—try to be the helper. The more prepared neighbors are to meet the basic and personal needs of their families on their own, the more resilient the community.

Be a Good Neighbor

There’s no science to being a good neighbor. But there are things you can do to create a feeling of community where you live. Here are some neighborly suggestions on how you can build trust with your neighbors.

Introduce yourself. A survey conducted by Pew Research Center in 2018 found that most Americans (57%) knew only some of their neighbors.(2) Starting an initial introduction with neighbors you don’t know can help them and you feel more comfortable about asking for help.
Show kindness. Look for small ways you can be kind to your neighbors. For example, offer to watch their house, collect mail, put out trash cans, or water their yard while they are on vacation.(3)
Be a responsible pet owner. Use a leash in public and clean up after them properly. Cleaning up after your dog helps to keep the environment clean and reduces the risk of diseases spreading to people and other animals.(4)
Lead by example. Pick a regular time to take a walk around the neighborhood. Use your walk to meet new neighbors and model community-minded behaviors, such as picking up trash or litter.(3)

Other simple ways to build goodwill with neighbors include maintaining the exterior of the house and lawn, keeping the noise down, and respecting property lines and personal space.

Neighbors Helping Neighbors

People who live in communities in which members are regularly involved in each other’s lives are more empowered to help one another after an emergency.(5) Here are some ways you can get involved in your community.

Offer to help your neighbors, especially older adults and people who live alone or with a disability or chronic disease or rely on electricity-dependent equipment, prepare for emergencies. You can offer to help them collect supplies, sign up for evacuation assistance, and collect and protect important paperwork.
Join neighborhood groups on social networking sites.
Volunteer with an organization active in disaster, such as your local Medical Reserve Corps (MRC) Unit or Community Emergency Response Team (CERT).
Emergency plan with neighbors. Just 13% of respondents to FEMA’s 2021 National Household Survey said they plan with neighbors.(6) But involving trusted neighbors in your emergency action planning can help improve your resilience. At a minimum and if possible, exchange contact information so you can reach each other in an emergency.

Learn more ways to prepare your health for emergencies.

Resources

References

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

15Sep / 2021

Risk Communication: Plan with the Whole Community

During a disaster, communication becomes especially critical. Language, accessibility, or other barriers can affect many individuals’ ability to receive, understand, and act on emergency information.

The ability of a community to communicate accurate emergency information, alerts, warnings, and notifications saves lives. Timely and effective messages can inform people on actions to stay safe, take shelter, or evacuate.

What is in the messages and who communicates them to the community is an important element of risk communication.

Why It Matters

There is widespread evidence that emergencies disproportionately impact individuals with disabilities and others with access and functional needs.

The term “access and functional needs” refers to individuals with and without disabilities, who may need additional assistance because of any temporary or permanent condition. That condition may limit their ability to act in an emergency. Individuals with access and functional needs do not require any kind of diagnosis or specific evaluation. These may include but are not limited to

individuals with disabilities,
individuals with limited English proficiency,
individuals with limited access to transportation,
individuals with limited access to financial resources,
older adults, and
others deemed “at risk” by the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA) or the Secretary of the U.S. Department of Health and Human Services.

FEMA’s whole community approach promotes community participation in emergency planning, response, recovery, and mitigation activities. Integrating community partners into the emergency planning process can help planners better understand and address the needs of the community. These stakeholders should be included in the development of risk communication messages to ensure they are accessible, understandable, and actionable.

Emergency Planning Can Save Lives

During widespread evacuations, transportation systems may be overwhelmed. Understanding the transportation needs of the whole community ahead of an incident will help identify key partners and prioritize communication. Community partners can help widely disseminate messaging to the populations they serve on actions for how to stay safe.

Parents drop off their kids at schools every day assuming they will come home within roughly 8 hours. Yet, in 2014, many Atlanta parents experienced a disaster they never would have predicted.

Icy conditions created by a winter storm paralyzed traffic just as schools were closing. Thousands of children were stranded at schools and on buses. Some children were rescued by firefighters and the National Guard after many cold and hungry hours on buses.

More than 2,000 children spent the night at schools across the metro area.

Some parents spent hours behind the wheel trying to get to their children. Others walked miles through the snow to reunite with children.

Research indicates that over one-third of American households with children are not familiar with their school’s emergency plans. Even more do not know where schools would evacuate their children to during a disaster.

Emergency action plans help everyone know what to do, who to call, and where to reunite in a disaster.

A new CDC resource for emergency planning

CDC developed a toolkit to help emergency planners, such as those for school districts, develop communication plans that consider the needs of people with disabilities and others with access and functional needs.

The Access and Functional Needs Toolkit is organized in two sections. Section 1 provides examples of groups who may be at greater risk or disproportionately affected in an emergency. This section includes noteworthy practices, key considerations, tips, and resources for effective communication with these groups.

A second section outlines a process and recommended action steps to integrate a network of community partners into risk communication strategies. It provides customizable tools and instructions, templates, worksheets, and noteworthy partner engagement practices. The resources can help create documentation to institutionalize partner engagement practices and identify areas for improvement.

Government agencies and community organizations can use the toolkit’s worksheets and templates to guide their emergency plans and communication strategies.

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

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30Oct / 2020

Seeing is Believing: The Art of Moulage in Emergency Preparedness

A first responder tends to a person with a simulated (or mock) injury during an emergency response exercise. — (Photo credit: FEMA, 2015)

Moulage is the art of applying realistic, mock injuries for the purpose of training emergency response teams, medical, and military personnel.

Good special effects in movies are effective because they make illusions seem real. Making simulated injuries seem real helps first responders better prepare for the real thing.

Moulage is the French word for molding. It started as the art of applying mock injuries for educational purposes. The practice of moulage dates to the Renaissance when wax models were used in the study of human anatomy.

As technology and medicine evolved, photographs and plastic models eventually replaced wax models, and the term “moulage” came to represent the art of using advanced makeup techniques to simulate injuries. Today, it’s used as a training tool for emergency response, medical, and military personnel.

Classical Art with Practical Applications

Moulage is a 16^th-century art form with 21^st-century applications. It is often used in emergency response training and exercises to simulate the kinds of injuries first responders are most likely to see after events like natural disasters, explosions, and hazardous materials incidents.

“Moulage adds layers of complexity and realism to exercises,” said Richard Brewer, a moulage artist at FEMA’s Center for Domestic Preparedness (CDP). “Simulated injuries such as lacerations, burns, and bruises helps CDP create realistic, immersive disaster training scenarios for students.”

Brewer explained that an average full-scale exercise at CDP includes about 130 simulated “victims.” Sometimes as many as 250 victims are needed to “flesh out” an exercise scenario and achieve training objectives. He said takes a team of two to four artists to apply moulage for such large-scale exercises.

Moulage artists, Brewer said, use molded silicone and everyday foods, like oatmeal, coffee grounds, chocolate syrup, and grits, to create many of the physical reactions and injuries. Artists use materials like these to make up people and manikins to look like they have teary eyes, runny noses, burns, lacerations, gunshot wounds, and amputations. Antacids are used to imitate foaming at the mouth.

Brewer said amputations and other serious wounds are the most challenging wounds to simulate. Building materials such as glass, wood, and metal rods are used in the creation of blast wounds. Minor abrasions and burns are the easiest to create.

Moulage Like the Masters

Food is a favorite medium of moulage artists and shows up in many moulage recipes. If fact, you may have some of the items already in your pantry. Here are some examples of recipes used by moulage artists.(1)(2)

How to Make Fake Blood

Add 4 tablespoons of red food coloring and 4 drops of blue food coloring to 16 ounces of red-colored dish soap. Mix well.
To apply, use a spray bottle mixture or pour it to create a dripping effect. Apply only below the neck due to avoid irritating the eyes.

How to Simulate Vomit

Combine water, dry oatmeal, and one drop of green food color to a desired consistency and color in a small bowl.
Add corn, peas, raisins, or other solid matter if desired.
Spoon desired amounts beside the simulator’s mouth and dab traces on the side of the face. Do not allow the mixture to enter the mouth, nose, or airways.

How to Simulate a Bruise

Crush a combination of old blue, purple, aqua, and green eye shadow with half the amount of red blush into a fine powder.
Use a round rouge or make-up brush to apply.

People dressed up in costumes and makeup are a familiar sight on Halloween night. Unfortunately, events like costume parades and trick or treat can be high-risk for spreading viruses, including the virus that causes COVID-19.

How to Have a Healthy Halloween

Many traditional Halloween activities can increase the risk of getting and spreading COVID-19. Take steps to protect yourself and others, such as finding lower risk ways to participate in Halloween and trick or treating; for example:

Avoid direct contact with trick-or-treaters by giving out treats outdoors or setting up a station with individually bagged treats for kids to take, if possible.
Bring hand sanitizer with at least 60% alcohol with you, and use it after touching objects or other people. Parents should supervise young children using hand sanitizer.
Wash your hands with soap and water for at least 20 seconds when you get home and before you eat any treats.
Wear a mask if you are age 2 or older (children under the age of 2 should NOT wear masks). A costume mask is not a substitute for a cloth mask and should not be worn over a cloth mask. It can make breathing more difficult.
Stay at least 6 feet away from others who are not part of your household.

If you may have COVID-19 or you may have been exposed to someone with COVID-19, you should not participate in in-person Halloween festivities and should not give out candy to trick-or-treaters.

Learn more ways to protect yourself and others during holiday celebrations at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html

References

(1) https://www.cert-la.com/downloads/moulage/moulage-recipes.pdf

(2) https://www.vdh.virginia.gov/content/uploads/sites/23/2016/05/PRE-025-RecipesForDisaster.pdf

Resources

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

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29Jul / 2020

Lab Culture Ep. 22: Life as a public health lab scientist testing for COVID-19

Matt Sinn and Jessica Bauer pose with the Missouri state flag

Jessica Bauer and Matt Sinn are scientists at the Missouri State Public Health Laboratory. On this episode, they shared their experiences performing COVID-19 testing, working long hours seven days a week, supporting their staff while trying not to burnout themselves. As they describe in this conversation, the experience has been nothing they ever could have expected.

Jessica Bauer, molecular unit chief
Matthew Sinn, molecular laboratory manager

Listen here or wherever you get your podcasts:

Links:

Missouri State Public Health Laboratory
APHL: Responding to the COVID-19 Pandemic
COVID-19 posts on APHLblog.org

The post Lab Culture Ep. 22: Life as a public health lab scientist testing for COVID-19 appeared first on APHL Lab Blog.

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16Apr / 2020

Variability in states’ testing numbers: It’s not that simple

By Gynene Sullivan, manager, communications, APHL

Throughout the COVID-19 response, there has been a lot of discussion about the fact that laboratory testing numbers across the United States have been varied, and this is nowhere more evident than our public health laboratories. But this concept is more than numbers; it resides in a variety of factors.

Being Able to Prioritize
It is incorrect to assume that some states are doing things right, and other states are not performing tests or testing incorrectly. If a state has fewer issues with backlogs, they may have been more successful in prioritizing surge testing, or have been recognized as a hotspot, which leads them to be prioritized for receipt of supplies. This leads to other states not receiving supplies or equipment and, therefore, when surge testing is needed they are less able to respond. If a public health laboratory is able to perform verified testing on equipment that is usually reserved for other testing, they get the advantage of having a backup system in case they run out of supplies for the main testing protocol.

Not All Tests Are Created Equal
There are many different tests that are performed in order to get results during an epidemic. Public health laboratories have a standard operating procedure for each test that is unique to their laboratory, based on their equipment, staff training and certifications. They also follow a meticulous series of protocols to ensure that tests are performed safely and correctly, and that they are not reporting false positives or false negatives. In a situation like this, public health laboratories are using all the tools available in their testing arsenal, while maintaining rigorous scientific processes to get the right results.

Allocation of Needed Resources
There are currently public health system-wide issues that point to supply shortages, equipment shortages and shortages of qualified staff. These tests are deemed to be highly complex that require scientific staff who have been trained to process and analyze them, require specific equipment to perform the testing and require specific materials to ensure the integrity of samples. Even though a state may be able to perform testing 24/7, they would have to suspend any testing if they run out of supplies such as test kits and reagents. And this would result in a cascade effect of non-testing and non-reporting.

Laboratory Capacity
The reality is different states have different capacity to stand up surge testing in a public health emergency. While public health laboratories have preparedness plans to respond to just about anything, no laboratory can be entirely prepared for a global pandemic. If states have the ability to convert to 24/7 surge testing, other requests such as newborn screening, food testing, water testing or STD testing may be deprioritized.

The post Variability in states’ testing numbers: It’s not that simple appeared first on APHL Lab Blog.

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13Apr / 2020

APHL EVALI response spurred by strong communication

Whether it be a disease outbreak, a natural disaster or a devastating lung condition, regular, responsive communication drives response to public health emergencies. In the summer of 2019, with cases of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) steadily rising, partners at federal, state and local health agencies, health associations, hospitals, poison control centers and other players were in constant contact.

APHL Director of Environmental Health Julianne Nassif recalls, “At the height of the EVALI response, I spent most of my day on conference calls with [the US Centers for Disease Control and Prevention (CDC), US Food and Drug Association, Council of State and Territorial Epidemiologists] and member labs. It was many long hours fortified by a lot of caffeine, but these calls kept us up-to-date and on-task in a rapidly evolving situation.”

EVALI Community Links Members, Partners

APHL facilitated the exchange of time-sensitive information by creating an EVALI community of practice, linking member laboratories, federal agencies and others working on the issue. Building upon relationships developed through various laboratory networks, the group held conference calls to brainstorm ideas and discuss surveillance reports, testing methodology and legal considerations. Experts in testing for e-liquids in vaporized products joined the calls to explain methods unfamiliar to many public health laboratories. The community also served as a nexus for rapid distribution of sampling guidance and analytical methods to scientists working on analysis of EVALI case-related specimens and products. For example, CDC deployed standards for collection of bronchial lavage specimens through the EVALI community. The community continues to hold routine conference calls to exchange notes on recent findings.

APHL also polled member laboratories to solicit their advice on resources and services needed for EVALI response. They returned six recommendations:

Elevation of the EVALI response to an agency-wide level
Addition of experts in environmental and occupational medicine and in epidemiology
Guidance for specimen collection and storage
A template for submitting data to CDC
Extending the time allotted for collection of samples
Building non-targeted testing capability for 1000s of chemicals and providing technical support to assist states with chemical analysis

When APHL forwarded these recommendations to CDC’s Emergency Operations Center, the response was prompt: CDC would provide almost all that APHL had requested.

Existing Relationships Facilitate Response

So why did APHL laboratories and partners communicate so well during the peak of the EVALI outbreak? In short, because they knew each other. By participating in the Laboratory Response Network for Chemical Threats (LRN-C), the National Biomonitoring Network, Opioid Biosurveillance and the APHL Community of Practice for Cannabis Testing, they knew each other personally and trusted one another. Through these same networks, they had also built relationships with hospital staff, poison control specialists, epidemiologists and forensics scientists. In an emergency, these connections proved invaluable.

Learn More

A plenary session about how strong communications enhanced the laboratory response to the EVALI outbreak had been planned for the APHL 2020 Annual Conference, which unfortunately has been canceled due to the COVID-19 pandemic. There are plans underway to turn the session into a webinar, so keep an eye out on the APHL Webinars page for more information.

The post APHL EVALI response spurred by strong communication appeared first on APHL Lab Blog.

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