By Dr. Darrell Dantzler, faculty member, Emergency and Disaster Management at American Military University
On January 30, the World Health Organization (WHO) determined the novel coronavirus, formally known as 2019-nCoV, posed an international risk and declared it a Public Health Emergency of International Concern (PHEIC) and a global health emergency, a designation only declared five times previously.
The number of diagnosed 2019-nCoV cases has surpassed SARS cases, including the first known human-to-human spread of the new virus in the United States.
The Centers for Disease Control and Prevention (CDC) expects many more cases, largely due to the virus’s ability to spread from person to person.
However, despite these designations and concerns from health experts, the 2019-nCoV is not classified as a pandemic; although that is subject to change based on the rate of human-to-human transmissions and determination of the lethality of the virus.
It is critical that state, local, tribal, and territorial (SLTT) emergency managers, public health professionals, and other public safety professionals understand global and national comprehensive emergency management strategies for handling a pandemic outbreak. They include how these strategies affect them and their SLTT emergency management initiatives.
The WHO’s Global Strategy and Response to 2019-nCoV
The WHO’s primary role is to direct and coordinate international health within the United Nations system. The WHO’s goals during the 2019-nCoV outbreak are to strengthen global diagnostic capacity and improve surveillance, early detection, and capabilities to track the spread of disease. WHO lists the following six strategic objectives for responding to the 2019-nCoV:
- Limit human-to-human transmission including reducing secondary infections among close contacts and healthcare workers, preventing transmission amplification events, and preventing further international spread from China
- Identify, isolate, and care for patients early, including providing optimized care for infected patients
- Identify and reduce transmission from the animal source
- Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines
- Communicate critical risk and event information to all communities and counter misinformation
- Minimize social and economic impact through multisector partnerships
WHO has implemented a three-pronged approach to enhance the diagnostic capacity for 2019-nCoV:
- Network: The WHO formed a network of specialized international laboratories specializing in the molecular detection of coronaviruses. These network labs support national labs to confirm 2019-nCoV cases and troubleshoot their molecular assays.
- National Capacity: The WHO strengthened national capacity to detect 2019-nCoV, allowing diagnostic testing to be performed quickly on location without having to send samples to other locations globally.
- Test Availability: Starting the first week of February 2020, the WHO made the following test available to its regional and country offices: (a) screening of 2019-nCoV PCR protocols from academic laboratories for validation data; (b) looking for sequence alignment of established commercial coronavirus assays to see if any were likely to be able to detect 2019-nCoV with high sensitivity; and (c) working with commercial and non-commercial agencies with capacity to manufacture and distribute newly developed 2019-nCoV PCR assays.
The Federal Government’s National Strategy and Response
The U.S. Department of Health and Human Service’s (HHS) mission is to enhance and protect the health and well-being of Americans by providing effective health and human services and by fostering advances in medicine, public health, and social services. The secretary of HHS is vested with the authority to act to protect public health and welfare, declare a public health emergency, and prepare for and respond to public health emergencies. The CDC, within the HHS, is the nation’s health protection agency and the leading national public health institute in the country.
HHS developed seven domains in its Pandemic Influenza Plan to thwart a severe worldwide event. Although 2019-nCoV has not reached the pandemic threshold yet, it’s important to understand the Pandemic Influenza Plan’s seven domains, which details areas where capabilities can be optimized:
- Surveillance, Epidemiology, and Laboratory Activities: Detecting and monitoring seasonal and emerging novel influenza viruses for rapid recognition and response.
- Community Mitigation Measures: Actions and response measures that community members can take to slow the spread of novel influenza virus.
- Medical Countermeasures include Diagnostic Devices, Vaccines, Therapeutics, and Respiratory Devices: Applying research findings in diagnostics, therapeutics, and vaccines to discover strategies to mitigate the next influenza pandemic.
- Health Care System Preparedness and Response Activities: Health care systems must be prepared to respond to a pandemic, recognizing that potentially large numbers of people with symptoms of influenza, as well as those concerned about the pandemic, will present for care. Systems must implement surge strategies so people will receive appropriate care.
- Communications and Public Outreach: Early and effective messaging regarding awareness of a pandemic. Messaging is accurate, consistent, timely, and actionable communication that is enhanced by the use of plain language and accessible formats.
- Scientific Infrastructure and Preparedness: Strong scientific foundations bolster development of new vaccines and therapeutics, and determine how well other control efforts are working.
- Domestic and International Response Policy, Incident Management, and Global Partnerships and Capacity Building: Coordinate domestic and international pandemic preparedness and response activities, including having clearly defined mechanisms for rapid exchange of information, data, reagents and other resources needed domestically and globally to prepare for and respond to an influenza pandemic outbreak.
Regarding the 2019-nCoV, the CDC has accomplished the following strategic response objectives:
- Monitored and worked with WHO and SLTT public health partners to respond with the goal of containing the outbreak and preventing sustained spread in the U.S.
- Established a 2019-nCoV Incident Management Structure on January 7, 2020, and on January 21, 2020, activated its Emergency Response System.
- Issued updated travel guidance for China on January 27, 2020.
- Along with Customs and Border Protection (CBP), conducted enhanced entry screening of passengers who have been in Wuhan, China, within the past 14 days at five designated U.S. airports. Additionally, monitoring travelers with symptoms compatible with 2019-nCoV infection and a travel connection with China.
- Issued an updated interim Health Alert Notice (HAN) advisory on January 17, 2020, to inform state and local health departments and health care providers about this outbreak.
- Deployed multidisciplinary teams to Washington state, Illinois, California, and Arizona to assist their health departments with clinical management, contact tracing, and communications.
- Developed a real-time test to diagnose 2019-nCoV in respiratory and serum samples from clinical specimens. Posted the assay protocol for this test on January 24, 2020. Currently, testing for this virus must take place at CDC. But in the coming days and weeks, the CDC will share these tests with domestic and international partners.
- Uploaded the entire genome of the virus from all five reported cases in the United States to GenBank.
- Currently growing the virus in cell culture, which is necessary for further studies, including for additional genetic characterization.
Action by State, Local, Tribal, and Territorial (SLTT) Emergency Managers
At this point, most SLTTs have reviewed and put into place their comprehensive emergency management plan, including the Pandemic annex and the Emergency Support Functions (ESF), including ESF #8, as well as companion ESFs.
SLTT public safety professionals should monitor the global and national climate, along with maintaining situational awareness in their jurisdiction. The director of the HHS stated, “(t)he playbook for responding to an infectious disease outbreak is relatively simple: You monitor and communicate, identify cases, isolate the people, diagnose them, and treat them. Then you track down all of the contacts of the infected person, and you do the same with those people, and the same with contacts of contacts if necessary.” This is often easier said than done, as virus outbreaks foster volatile, uncertain, complex, and ambiguous (VUCA) environments that require immense coordination. Communication and social distancing are among challenges that SLTT public safety official encounter.
The goal of communication before, during, and after VUCA events like 2019-nCoV is to provide and share accurate and relevant information with the public, partners, and stakeholders, so that well-informed decisions are made that protect the public’s health and safety.
Social media is a “double-edged sword” when communicating during disease outbreaks. Currently, hoaxes about the coronavirus have spread faster than the actual virus on platforms like Facebook, YouTube, and Twitter. Some examples include Bill Gates being responsible for the virus; the Chinese created a weaponized version of coronavirus and lost control of it; drinking bleach keeps the virus away; coronavirus will cause the zombie apocalypse; parents have abandoned their children in an airport; FEMA proposes martial law to contain the coronavirus; and the US patented a vaccine years ago for the coronavirus.
Misinformation about disease outbreaks is even harder to control because of intense public interest, fear, lack of credible information, and the unknown. The WHO has actively sought to discredit misinformation and has responded to rumors through “myth busting” on WHO’s social media channels and website.
The CDC indicated that the right message at the right time from the right person can save lives. The health agency implemented a six-step crisis communication plan that SLTT public safety agencies can employ to improve communication:
- Be First: Crises are time-sensitive. Communicating information quickly is crucial. For the public, the first source of information often becomes the preferred source.
- Be Right: Accuracy establishes credibility. Information can include what is known, what is not known, and what is being done to fill in the gaps.
- Be Credible: Honesty and truthfulness should not be compromised during crises.
- Express Empathy: Crises create harm, and the suffering should be acknowledged in words. Addressing what people are feeling, and the challenges they face, builds trust and rapport.
- Promote Action: Giving people meaningful things to do calms anxiety, helps restore order, and promotes some sense of control.
- Show Respect: Respectful communication is particularly important when people feel vulnerable. Respectful communication promotes cooperation and rapport.
If a 2019-nCoV outbreak is found in a SLTT jurisdiction, public safety managers can mitigate person-to-person transmission through social distancing. Social distancing is when public health officials restrict when and where people can congregate in order to stop or slow down the spread of a highly contagious disease. These social distancing measures have a considerable effect on the community; therefore, actions must be coordinated among all stakeholders including city leaders, federal partners, police departments, business, and schools.
Below are some examples of social distancing that can be used to control the spread of 2019-nCoV. It’s important for SLTT emergency managers to remember that civil liberties must be balanced with public health.
- Isolation: Separating and restricting movement of persons who are known to have a specific infectious illness when the disease is communicable
- Quarantine: Separating and restricting movement of persons who are not ill, but have been exposed to or are believed to have been exposed to an infectious disease during the period when it would be communicable. For example, on January 31, 2020, as a precautionary and preventive step to maximize the containment of the virus in the interest of the health of the American public; the CDC, under statutory authority of the HHS, issued federal quarantine orders to all 195 United States citizens returning from China on January 29, 2020. The quarantine order is for 14 days from when the plane left Wuhan.
- Cordon Sanitaire: A French term that means sanitary cordon. A disease outbreak-control method in which a quarantine zone is determined and those inside are not allowed to leave. The strategy has ethical concerns because it’s similar to confinement. It was used in Africa to combat the Ebola spread.
- Protective Sequestration: The shielding from outsiders of a defined and still healthy group of people from the risk of infection. For example, on January 31, 2020, President Trump signed a declaration barring entry into the U.S. of foreign nationals — other than immediate family of U.S. citizens and legal permanent residents — who traveled to China within the past 14 days.
- Closures: These closures include public gathering places, services, and the cancellation of activities like school, workplace, mass transit, and mass gathering venues like sports events, films, or musical shows.
In summary, the global and national strategies for controlling and eradicating pandemics or the 2019-nCoV directly impacts the strategies at the SLTT jurisdictional levels. Public safety officials should understand the global and national climate to better prepare for, respond to, mitigate, and recover from a potential pandemic in their jurisdiction.
Additionally, SLTT public safety officials must understand crisis communication and ensure their jurisdictions have the most updated and accurate information. Lastly, when determining social distancing strategies, civil liberties must be balance with public health.
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About the Author: Dr. Darrell Dantzler is a faculty member at American Military University, teaching courses in Emergency & Disaster Management. He is also the Director of the Fire Protection Analysis and Field Engineering Division within the Office of Fire Protection in the Bureau of Overseas Buildings Operations at the US Department of State. Darrell brings more than 35 years of experience in Disaster and Emergency Management Planning and Response. He is a 20-year United States Air Force Veteran and a 15-year public servant with the Department of State. At State, he conducted fire assessments, fire investigations, and special emergency management assessments in over 70 countries. Darrell graduated from the National Preparedness on Leadership Initiative, Executive Education Leadership Program at Harvard University’s T.H. Chan School of Public Health and Harvard’s Kennedy School of Government. He is a Certified Emergency Manager through the International Association of Emergency Managers. Darrell holds a Ph.D. in Public Safety Leadership with a specialization in Disaster and Emergency Management. To contact the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.