EMERGENCY PREPAREDNESS: Ebb & Flow in Public Health

As usual, I am up early and watched the sky brighten while consuming coffee… The news is filled with new Covid-19 numbers and the second-guessing of individuals and governments, in both cases, some persons and governments may dodge the bullet of increasing case counts, but I think there will almost certainly be increased cases where people or decision-makers move too quickly, without appreciating the science that we are watching in real-time.

John M. Barry’s book, The Great Influenza (ISBN-13: 978-0143036494) provides a great insight into not only the science of the day, some of which is being repeated with Covid-19 today, but into national-level decision making, and some information for local-level activities as well. In preparation for the novel influenza pandemic of 2009, I pulled local articles from 1918: schools were closed and turned into temporary hospitals. Segregation was an issue as a complicating factor of care for the community, there was no local health department but there was a Public Health Service Officer in this maritime community.

Similarly, an ancient disease, Plague, is relatively new to the United States. Although now endemic in the west, it was not always so. David K. Randall describes the power politics of the Public Health Service of the time and the politics and prejudice in San Francisco surrounding the initial outbreaks in his book, Black Death at the Golden Gate (ISBN-13: 978-0393609455).

Both of these books provide a historical context for what we are seeing in our communities, in our governing bodies at many levels, and, in retrospect, the effects we see in both policy and funding. Beginning in 2000, significant amounts of funding flowed down to the local level to support preparedness training, infrastructure, and planning. As the concerns about Anthrax, Smallpox, and other threats decreased, so did funding from the national level (https://www.naccho.org/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Zika-Response.pdf).

As all local health departments scramble to respond to the current pandemic, the tools of the Public Health Emergency Preparedness Program are valuable: Incident Command System familiarity internal to the department and in concert with locality responders. Communications and information sharing between departments, laboratories, and hospital systems. The experience of Public Health staff in other events; Pandemic Influenza (2009), Ebola (2014), or Zika (2016).

Policy-makers are relearning lessons of history, as are public health practitioners.


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