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    Sunday, December 11, 2005

    Preparedness Update: The White House exercise yesterday found the public health emergency plans not yet ready for prime time:

    After role-playing an outbreak of pandemic flu, White House officials said that saving lives and containing the economic damage will require more planning in local communities and increased production of vaccines and medications. Officials declined to give details about the drill or its results.

    The Washington Post has more:

    Health and Human Services Secretary Mike Leavitt said the federal government alone cannot handle a major flu outbreak. "State and local governments, state and local communities, schools need to have a plan, businesses need to have a plan, faith organizations need to have a plan," he said. "The public health community understands a pandemic. . . . It's now time to engage a broader community so that we have a true nationwide response effort that's not only planned, but exercised and ready."

    Neither he nor Townsend offered specifics for possible plans, but each urged Americans to seek information from the Web site pandemicflu.gov . Leavitt plans to visit health officials in every state to discuss strategies.

    Well, let's hope that when they offered no "specifics for possible plans" it was just because they didn't want to offer them to a reporter. An adequate public health response to an epidemic - be it from a natural vector or a bioterrorist attack - is going to require that someone take the lead and offer all of these local entities some specifics. Responding to an epidemic is a little more complicated than responding to weather threats.

    Once upon a time, our public health system was geared to just this sort of thing. Infectious disease threats were their specialty, indeed their sole reason for being. But in the past fifty years, they and we have grown complacent. Antibiotics and immunizations have made their role in controlling infectious disease minimal and sporadic. The only time they have had to respond to an infectious disease threat in recent memory is for small outbreaks of meningitis or measels. Instead, they concentrate on promoting childhood immunizations, well child clinics, and sexually transmitted disease clinics. The people in charge of these local health departments no longer know how to organize around a true infectious disease emergency.

    To give you an idea of how narrow their focus is, I recently called our local health department with a question about rabies. One of my patients likes to feed squirrels - out of his hand. And one day, one of the little beasts bit him. Every
    reference I consulted, including those by the CDC said that squirrels weren't usually a problem, but that I should "consult my local health department" to be sure. So I did. Maybe I got connected to the wrong department, but the woman I spoke to didn't have a clue. She read me the same CDC references I had already read, but couldn't give me a definitive answer as to whether squirrels were a problem in our area or not. But, at the end of the call, she did ask if I would like someone from the health department to come out to my office to talk to my staff and myself about the importance of childhood immunizations!

    Someone needs to make sure all of these different local health departments take preparation for a real public health emergency seriously.

    Addendum: Canadian doctors are also worried about the state of preparedness. The same thing applies here. We need to make sure that doctors who see acutely ill people - the emergency room physicians, pediatricians, urgent care doctors, internists, and family physicians - know how to respond hand-in-hand with the public health system. Otherwise, all the planning will be for naught.

    posted by Sydney on 12/11/2005 01:45:00 PM 0 comments


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