In Case of Emergency, Read This Blog

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A Citizen’s Eye View of Public Preparedness

Some Lessons From H1N1 Flu Outbreak & Response For Citizen Preparedness In Future Emergencies (Part 1)

June 29th, 2009 · 4 Comments

Though public and media attention on the H1N1/Swine Flu outbreak has waned, there is a clearly need to examine its lessons for future citizen preparedness and response — whether that be for a reoccurrence of a more deadly H1N1 flu in the Fall or another national emergency situation. So, I thought I would contact some experts as well as ask for reader input to see what we should be learning from the H1N1 situation when it comes to informing, engaging and preparing citizens for future emergencies. Below are some of the responses; I will be posting another collection in a week or two. If you would like to contribute a “lesson” for Part 2, please either write a Comment at the bottom of this post or email me at


* Jeff Levi, Executive Director, Trust For America’s Health (

During the outbreak, there was clear and consistent communication from President Obama on down — led by the public health professionals — which was effective in calming the American people. However, the social and economic consequences of community mitigation guidance have not been as carefully thought through as had been hoped. The value of some mitigation strategies implemented, such as face masks in Mexico, were overstated. While reopening the schools was driven in part by the fact that the virus turned out to be less virulent, the full impact of the challenges of finding alternative child care had not been planned for, even though the CDC had been warned about this.

At present, the nation does not have in place the social and economic policies that support public health recommendations. During the H1N1 outbreak there were numerous media reports of people with influenza-like illnesses not staying home from work, because they had no sick leave and feared losing their jobs or had concerns about the costs in seeking early medical attention. There must be consideration of these work and school policies in a future public health emergency.

There is also a need to consider that the “worried well” did at times stress emergency departments and private practices who were not as prepared as they need to be. Though there were examples of some health departments which did a good job of warning people to stay away from emergency rooms if they did not exhibit symptoms of H1N1.

* Jan Lane, Senior Policy Advisor, George Washington University Homeland Security Policy Institute (

Our experience with H1N1 over the past few months provided a number of important lessons, and gave us the opportunity to test a number of areas of pandemic preparedness planning.

Overall, government communications with the general public were handled well, and did much to maintain the public’s trust. However, we still have work to do when it comes to planning at the community level — for example, decisions regarding school closures, and workplace sick leave policies.

Over the coming months, as we face the potential for a more virulent strain to emerge in the Fall, we have a unique opportunity to actively engage the public in community problem solving. While the federal government health authorities can provide general guidance, community needs vary and we can’t always apply a one-size-fits-all response. Local health departments, local emergency managers, schools and businesses would be wise to include members of the general public at their planning tables, as they review lessons learned so far and plan for the future. What do citizens believe they need if we are faced with a more deadly form of the flu? What are their expectations? If they are briefed and understand the issues and limitations of medical surge capabilities of their local health care facilities, can they help reduce the number of patients that could overwhelm emergency rooms?

Real community engagement is an asset to federal, state and local governments as they prepare for what may come next. It requires a re-thinking of roles and responsibilities and the courage to let the public be part of the solution instead of being viewed as a group that needs to be ‘handled’ during a major public health emergency.”

* David Fleming, Director, Public Health – Seattle & King County (

One of the major lessons learned here, but it isn’t learned yet because we still have to work on it, is how to handle illnesses in schools and school closings in the setting of an H1N1 outbreak. Most of the schools that were affected had low income students in them with parents, both of whom work, and there weren’t really any good alternatives for parents other than to take the children to an alternate site like a community center or a library. What we really need to do looking into the future is to figure out how to give parents, particularly double income parents, alternatives that are going to work for them to keep their children isolated. That’s a major challenge that we are going to have be looking at in the fall.

Image: Worker disinfects high school in Cibolo, Texas

A worker disinfects a classroom at Byron P. Steele High School in Cibolo, Texas where all public schools and parks were closed during the H1n1 outbreak. (Associated Press photo)

* Jimmy Jazz, In Case of Emergency (

I would argue that the first thing that needs to be done is to bring everyone to the table –to all of the tables. Hospital emergency preparedness staff should bring everyone in for a hotwash. Public health departments should pull those pandemic plans off the shelf and point out where the the pinch-points were — where specifically did we run into problems and what do we need to do to make sure that everyone can do their jobs even with a proposed 30% absentee rate. Then the public health departments should pull together stakeholders from all of the industries and partners and government agencies and school districts and go through the same exercise. This should happen at both the state and local levels. The feds should conduct the same operation, but include the states on all of these meetings. And they should reach out to the international community, including neighbors, places where we frequently get travelers from as well as WHO and start reviewing everything. In the Congress, there should be hearings. There should be funding approved and sent to the White House for disbursement. The Public Health Workforce Act should be voted on immediately and implemented in full force. And public health departments should put their lessons learned and re-written plans in the public sphere for public comment.

* Eric Holderman, Eric Holderman & Associates, Disaster-Zone (

Watching the event on popular media was interesting:
-Early deaths reported in Mexico got everyone’s attention
-Alarm bells went off, appropriately
-WHO maybe took it too far to fast with elevating to Phase V
-Messaging, “don’t panic” is poor. People are watching too many disaster movies
-Message now should be about the Fall flu season in 2009 here in USA
-Some will read this as false alarm–and may not prepare/act again.
-Prior planning paid off, there was a system in place
-Capture what is learned and “Don’t Panic” :)

* Brian McDaniel, Strong Media, On Strategic Communications (

1. Think Health First

For all of the hype around H1N1 influenza, people stayed calm. The media may have hyperventilated, but there were no riots in the streets, fist-fights over masks, and the like. This novel strain of influenza hasn’t proven itself to be very virulent. In fact, most of the deaths-even in Mexico-were intertwined with other health issues in the patients. There is no reason to be anxious about the coming flu season. There also is no reason why should shouldn’t be prepared either.

From eating a balanced diet to properly disinfecting surfaces in your home and workspace, you can’t go wrong by forming health habits. The CDC has an entire section on Individual and Family Planning with respect to Pandemic Influenza. But their suggestions are great for the common cold or warding off “cooties,” if that was a real problem.

2. Have a Plan if Your School Closes

Besides the fact that schools risked losing federal funding when they closed at the onset of H1N1 influenza, there was a major problem with the CDC’s guidelines on school closings: parents found themselves in a hard place of an unscheduled seven day vacation. Taking your kids to the movies, the mall, or letting little Suzie spend time at Cathy’s house, isn’t what the CDC had in mind when schools closed. They wanted to isolate sick children from healthy ones. I expect that the idea of taking sick children out of school for 7-10 days will be the guideline this fall, allowing schools to remain open. But what many parents don’t realize is that schools that see major spikes in absenteeism because of H1N1 can be closed still. So what will you do if your school closes this fall? Plan now.

3. Emergency Supplies

Nearly every home has a stash of band-aids, hydrogen peroxide, and the like; but this summer is the time to put together (or replenish) you home healthcare drawer. The CDC has a great list here. This isn’t about preparing for a nuclear attack, just a simple reserve for the unexpected. Cash crunch? Purchase these items over several weeks. Seasonal flu shouldn’t hit until the fall.

4. Have a Reliable Source of Information

Many people keep up with news and information by using an RSS reader such as Google Reader or News Gator. Regardless of which one you use, there are several good feeds you should include in your feed list when it comes to following seasonal influenza.

CDC Flu Update
CDC H1N1 Flu Updates
WHO’s Disease Outbreak

5. Relax and Enjoy the Summer

* Bruce Hennes, Hennes Communications (

Here’’s the bottom line: We have been warned. So what does this mean for your business, government agency or nonprofit? Now is the time to pull out your crisis communications plan and make sure everything is up to date. Do you have current contact information for your staff and a mechanism in place to quickly notify them if, for example, one of your employees is diagnosed with the flu? Do you have a way for employees to quickly notify you if they are affected by the illness? Have you communicated your policies about what they should do if a member of their family becomes ill?

* Ralph Dutcher, Office of Public Health Preparedness, Monroe County, New York:

Simply put, Wash your hands, be aware of the situation around you and be more prepared. The smart money says that this will likely be a preparedness marathon and not a sprint to the finish.

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Tags: Pandemic Flu · Preparedness Lessons

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