Strengthening The Public Health System: To Protect Our Nation

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Strengthening The Public Health System To
Protect Our Nation

• National Governors Association
• J.W. Marriott Hotel
• Washington, D.C.
• February 25, 2001
• Georges C. Benjamin MD, FACP
• Secretary, Maryland Department
• of Health Mental Hygiene
• Parris N. Glendening
• Governor

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World Trade Center Attack - September 11,
2001Emergency Response - High Rise Fire
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World Trade Center Attack - September 11,
2001Emergency Response - An Earthquake
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Anthrax Sent By Mail September / October 2001
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Anthrax Attacks What Happened

• 4-5 letters containing anthrax spores sent in
  mail
• 4 regions initially affected in US
• Florida
• New York / New Jersey
• Washington Metro
• Connecticut

• Mild contamination of other US postal facilities
• Nationwide Effects
• Threats
• Concerns
• 18 human cases in US
• 11 inhalation
• (5 deaths)
• 7 cutaneous
• 33,000 people prophylaxed

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What We Thought We Knew!

• Anthrax hard to weaponize
• Hard to deliver in mass
• Stays put e.g. no reaerosolization
• Must open letter to get exposed
• 8,000 spores required to get sick
• Inhalation anthrax is 90 fatal
• 60 days of antibiotics is enough

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Marylands Experience

• Tested over 1,200 packages, letters etc.
• Tested over 30 private mailrooms, also post
  offices government buildings
• Handled over 1,000 public inquires
• Responded to over 500 press calls
• Followed 85 cases
• Prophylaxed over 3,000 individuals
• Cost over 2 million since 9/11/01

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What Did We Learn?

• Public Health Preformed well overall
• Exposed severe shortcomings in basic public
  health systems
• Another major event would have been serious
  problem!

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Everyday Public Health Practice Now Changed

• E. Coli
• Cholera
• Salmonella
• Common causes of outbreaks
• We now have to determine intent
• CDC has list of 36 agents

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Must Also Prepare For The High Risk Agents

• Plague
• Anthrax
• Botulism
• Smallpox
• Viral Hemorrhagic Fevers
• Tularemia

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Biological TerrorismSeveral Ways To Present

• Overt event
• Covert release
• Threats and hoaxes
• High-risk events (Olympics, Inaugural)
• Police actions that uncover a site

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Educate The General Public

• Improve knowledge about biological chemical
  agents
• Address language culture issues
• Consistent accurate messages
• Therapeutic education to improve compliance
• Rapid dissemination of facts
• Get your medical Talking Heads out fast
• Education includes the media

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Educate The Medical Community

• Increase education about intentional use of
  biological chemical agents
• Raise index of suspicion
• Diagnostic therapeutic options
• Rapid dissemination of new knowledge
• Need to address language culture issues
• Where to call for clinical guidance help

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Health Care Security Training

• Working in an unified command
• Handling suspicious packages mail
• Epidemiology, diagnosis and treatment of
  biological chemical weapons
• Securing the workplace
• High risk communications

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Controlling Access To Biological Agents

• Enhance biosecurity
• Know location of high-risk agents
• Both federal state government need to know
• Enhance state and federal laws/regulations
• Improve reporting from private academic labs

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Public Health Linkages

• Intelligence agencies
• Early linkages essential
• Must be improvements in sharing
• Veterinarians
• Police, Fire, EMS disaster prep
• National experts and resources
• Practicing medical community

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Links to Medical Community

• Pre-hospital care Medical control
• Hospital preparedness in general
• Outpatient inpatient surge capacity
• Staff training
• Communications
• Security
• Medical Providers/Clinics - Knowledge
  dissemination, clinical competency
• Other health facilities

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Public Health Surveillance

• Improve Reporting Systems
• Passive and active system
• Syndromic case reporting
• Improve speed and accuracy (Electronic)
• Identify sentinel events
• Enhance communication
• Know who when to call
• Update call lists

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Impact of Surveillance on Survivability (Anthrax)
ANTHRAX Impact of Active Surveillance on
Survivability
Phase II Acute Illness
Phase I Initial Symptoms
Traditional Disease Detection
Surveillance
Gain of 2 days
Effective Treatment Period
t
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Public Health Laboratory

• Specimen Collection and Transport
• Forensic issues and chain of custody
• Transport testing safety
• Capacity to Diagnose
• Surveillance
• Rapid screens - People/environmental
• Definitive testing
• Requires appropriate facilities

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Other Laboratory Issues

• Specimen disposal
• Internal laboratory biosecurity
• Surge capacity of labs
• Worker vaccination

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Disease Control Strategies

• Update Policies Concerning
• Environmental surety decontamination
• Prophylaxis and vaccination
• Isolation quarantine
• Monitoring of rescue workers
• Hospital closure reroute

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Therapeutic Measures

• Local access to therapeutics
• National stockpile
• Treatment Issues - Anthrax, smallpox vaccine
  issues, others
• Therapeutic compliance
• Role of research new therapies

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Consequence Management

• Legal issues - Public Health Powers Act,
  liability issues, medical nursing credentials
• Medical examiner issues
• Mental health substance abuse - Big issue and
  long term

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Communication

• Standing conference call capacity
• Linkages at several levels
• Add regional state health officials to senior
  war room discussions
• Risk communication skills essential
• Early Public Health Media Presence Is Essential
  !!!!!!!

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Funding Priorities (Tularemia)

• Enhance laboratory
• Communication technology
• Policy knowledge dissemination
• Connectivity to medical community
• Infectious disease investigation
• Bioterrorism planning

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Federal Public Health Infrastructure Funding

• Health Human Services1.1 billion
• Your state public health agency is lead
• HRSA - Hospitals
• CDC - State local public health
• OEP - To designated cities for MMRS
• 16 critical benchmarks identified

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Federal Public Health Infrastructure Funding

• Money will come in two parts
• First 20 for initial planning response
• Remaining 80 after plan is written
• Applications due by April 15, 2001
• Requires Governors sign off
• We need stable flexible funding
• Focus on FY03 FY04 budgets

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Cute But Dangerous

• We have to be prepared for threats like this
  Plague As well as...

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..Our Greatest Challenge

• Smallpox
• Last outbreak in New York City in 1947
• 12 cases 2 deaths
• 6 million vaccinated
• over 1 month
• Some vaccine deaths

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Rebuilding Public HealthTo Protect Our Nation
The Baltimore Sun, 09/01