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Strengthening The Public Health System: To Protect Our Nation

Strengthening The Public Health System: To Protect Our Nation. National Governor’s 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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Strengthening The Public Health System: To Protect Our Nation

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  1. Strengthening The Public Health System: To Protect Our Nation National Governor’s 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

  2. World Trade Center Attack - September 11, 2001Emergency Response - High Rise Fire

  3. World Trade Center Attack - September 11, 2001Emergency Response - An Earthquake

  4. Anthrax Sent By Mail September / October 2001

  5. 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 Anthrax Attacks What Happened

  6. 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

  7. Maryland’s 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

  8. 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!

  9. 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

  10. Must Also Prepare For The High Risk Agents • Plague • Anthrax • Botulism • Smallpox • Viral Hemorrhagic Fevers • Tularemia

  11. Biological TerrorismSeveral Ways To Present • Overt event • Covert release • Threats and hoaxes • High-risk events (Olympics, Inaugural) • Police actions that uncover a site

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Impact of Surveillance on Survivability (Anthrax) (Linear) Anthrax Attack Non Communicable Victims Directly Exposed 105 Fatalities With Early Warning and an Informed Public Health Response Fatalities With Traditional Public Health Response Number Dead = 0 Time (days) Animal or Human Indicators 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

  20. 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

  21. Other Laboratory Issues • Specimen disposal • Internal laboratory biosecurity • Surge capacity of labs • Worker vaccination

  22. Disease Control Strategies Update Policies Concerning • Environmental surety & decontamination • Prophylaxis and vaccination • Isolation & quarantine • Monitoring of rescue workers • Hospital closure & reroute

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

  24. 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

  25. 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 !!!!!!!

  26. Funding Priorities(Tularemia) • Enhance laboratory • Communication technology • Policy & knowledge dissemination • Connectivity to medical community • Infectious disease investigation • Bioterrorism planning

  27. Federal Public Health Infrastructure Funding • Health & Human Services:$1.1 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

  28. 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 Governor’s sign off We need stable & flexible funding Focus on FY03 & FY04 budgets

  29. Cute But Dangerous We have to be prepared for threats like this: Plague As well as…...

  30. …..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

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

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