Clairmont Heights Civic Association

By Jean O’Connor, JD, DrPH, Deputy State Public Health Director, Oregon

About a week and a half ago, the Oregon Public Health Division learned about a child with hemolytic-uremic syndrome (HUS), this sounds complicated but it’s essentially kidney failure brought on by an infection of the digestive system. In an otherwise healthy child, E. coli O157:H7 is often the cause of HUS, and more often than not, it’s acquired by consuming infected food. Every year E. coli causes an estimated 70,000 cases of human illness and about 2,100 hospitalizations. When public health practitioners see a case of HUS alarm bells go off because there may be something in the environment that could harm others.

As soon as the child was diagnosed, Oregon disease detectives started their investigation. They learned that a group of families, likely unaware of the danger, drank raw milk from a cow infected with E. coli. Raw, or unpasteurized milk, is risky to consume and is illegal to sell it because it’s so dangerous. Without pasteurization, which is a heating process that kills most germs, people who drink the milk may be exposed to all the dangerous bacteria found in cow feces. Some of the people who drank the milk became sick with bloody diarrhea, and four of the children who drank it have been hospitalized. This week, Oregon Public Health Division’s epidemiologists and laboratorians—some of whom are paid with preparedness dollars–worked to identify those who sought medical treatment and confirmed that the milk was the likely source of the outbreak. By identifying the cause and working with the farmer producing the milk, lives have been saved. 

This recent outbreak demonstrates how the funding CDC provides to states for public health preparedness and response is being used to protect the public’s health every day. These dollars are an incredibly important way to connect the health care delivery system (e.g., hospitals and doctors offices) with public health and save on healthcare costs for everyone. In Oregon, we use these funds to literally get down in the dirt to find the cause of an illness and to fund sophisticated communications tools that will help us connect across the state even when an event such as an earthquake takes out daily telecommunication systems. 

I don’t want you to get the idea that Oregon is any more dangerous than other states—public health professionals all over the country work to prevent and control disease outbreaks all the time—but there are a few more recent examples I want to share with you about how public health preparedness dollars save lives every day.

Return on Investment: Vaccination Campaign

One of those examples comes from a small town in the central part of our state, located in Oregon’s fantastic high desert and a great place to visit. In this town, they had three cases of a rare, but vaccine preventable bacterial illness, meningococcal disease (meningitis is one of these diseases). Meningococcal disease can cause an infection in the brain and spine that causes swelling, and many people who get it either die or suffer some permanent disability, such as loss of a limb or hearing. As the cases were reported and confirmed by our state public health laboratory, state and Crook County public health staff worked together to identify the contacts of those who were infected and provide them with antibiotics to prevent them from becoming ill.  

When the third meningococcal case was identified(constituting an outbreak), state and county staff convened on a conference call and quickly realized that the number of potential contacts was so large that the best protection for the community would be to vaccinate people at risk. To tackle such a large undertaking, we brought together our leadership team, risk communications expert, vaccine program staff who could order the vaccine the county needed from CDC, and our epidemiologists who understood the outbreak. During the subsequent days, state staff worked to support Crook County Health Department, which did amazing on-the-ground work to vaccinate more than 1,000 people in the community.  Public health preparedness dollars went in to funding many of the staff who worked on this response.

Return on Investment: Preventing Injuries

During the floods in Oregon this past winter, we used our preparedness resources to stand up an Incident Management Team in our public health Agency Operations Center to ensure our response was coordinated with other state agencies and to provide surveillance of flood and storm clean-up related injuries. We also activated the public health emergency communication system, which is paid for with preparedness dollars, to coordinate emergency risk communication messages with county health departments. The emergency messages focused on the dangers of entering flood water, safety tips on using chainsaws during flood clean-up, and warnings about carbon monoxide poisoning from using generators incorrectly. The local media was a great partner in alerting the public; our messages went out to radio and newspapers across the state. Injuries are one of the leading causes of death for children and young adults and preventing them is an important priority for public health. 

I worked for many years at CDC, and was directly involved with the H1N1 and Haiti cholera responses, a good chunk of that time was spent answering questions from Congress and the Office of Management and Budget about the value of public health preparedness dollars. When the chance to work in a public health leadership role in my home state came up, despite the tenuous budget situation for public health nation-wide, I couldn’t turn it down. And now that I’m here, I often find myself wishing I could show people just how important this federal investment in preparedness and response is to protecting the public’s health every day. There is a common misperception that the dollars and systems sit around waiting for a big event or a bioterrorist attack. The reality is that we use preparedness dollars to fund tools and systems that are used every day to protect the public’s health. And as much as I like to think my home state and the people I work with are special, I just paid a visit to our neighbor to the north, Washington State, where I heard similar stories to the ones I shared with you today and they include cows, vaccines, and I think someone even mentioned zombies, too!

Public health preparedness is one of the 10 great public health achievements of the past decade. If I had a crystal ball that predicted the future, I know it would tell us that public health preparedness and community resilience will turn out to be one of the greatest achievements of this century. The critical issue is finding a way to sustain this investment.

This week, CDC’s Division of Strategic National Stockpile is practicing how it would respond to the release of anthrax in multiple locations across the nation. Four states – North Carolina, Alabama, Tennessee and Kentucky – also are participating in this exercise so they, too, can test their abilities to respond.

In a biological attack using anthrax spores – scientifically known as Bacillus anthracis – large numbers of people could develop fatal inhalation anthrax. Luckily, CDC stores large quantities of antibiotics, which if taken before symptoms appear, can prevent inhalation anthrax. In an emergency response, CDC is prepared to provide these antibiotics to counteract anthrax exposure and protect the health of the American people.

How would these antibiotics reach the public? Once they’re distributed to the local health departments, public health staff and trained volunteers would operate points of dispensing (PODs) for exposed people to receive medications. These locations would be announced through local media and will serve as central places for the public to get these life-saving medical countermeasures. Take a look at how PODs work…

This time last year, storms ripped through the central and southern United States spawning more than 300 tornadoes and claiming hundreds of lives. This year we observed National Severe Weather Preparedness Week in memory of these tragic events and to encourage everyone to learn what to do when severe weather strikes.

Even though this week is drawing to a close, that doesn’t mean your preparedness work is over. If you took the time to learn about your weather risks, develop an emergency plan or strengthen your home against severe weather then give yourself a pat on the back. But in the weeks to come, why not try convincing your friends, family, and co-workers to do the same. Review your workplace emergency plans, sign-up for alerts, or become a certified storm spotter. NOAA, FEMA, and CDC have a number of online resources, take the time to look at them and become a force of nature all year long!

With the 2012 Summer Olympics less than 100 days away, people around the world are preparing. Athletes are putting in their final weeks of training, London officials are getting the city ready for visitors, and spectators are making travel plans. In CDC’s case, we’re trying to make sure everyone’s healthy for the big event.

One area of concern is measles, in particular, unvaccinated travelers contracting measles while they’re abroad and bringing it back to the States. Last year, 222 people in the U.S. were reported to have measles—these cases were mostly due to overseas travel.

While traveling, you may be exposed to people from countries where measles is still common, including countries in Europe, Asia, the Pacific, and Africa. In 2011, over 30,000 people in Europe had measles. So, as you prepare for your trip abroad, make sure you’re protected against measles before you leave.

Why are people still getting sick?

Measles vaccination coverage in many countries around the world is not as high as in the United States and the Americas. Thanks to the vaccine, measles was declared eliminated in the U.S. in 2000. However, measles is still common worldwide—about 20 million people get measles each year. So, there’s a risk of being exposed to measles while you’re overseas.   

Measles is highly contagious and very good at finding unvaccinated people. This includes babies who are too young to be vaccinated and people who have health conditions, like cancer. Measles spreads through the air when an infected person breaths, coughs, or sneezes. So, you can catch it just by being in a room where an infected person has been, even after they’re gone. You can be exposed in airports, airplanes, buses, hotels, or any place where there are infected people. You can even get measles from an infected person who doesn’t have measles rash yet.

If you’re not vaccinated, you put yourself and others at risk for measles and its complications, like pneumonia, encephalitis, or even death.

Luckily, the measles vaccine is highly effective. So, if you’re planning to travel overseas this summer, make sure you and your family are up to date on all vaccinations, including the measles vaccine. You can get more information about measles and the vaccine here: www.cdc.gov/measles.  

When you travel, bring back memories, not measles!

By Charles Stokes, President and CEO, CDC Foundation

I’ve been thinking a lot lately about the deep budget cuts that are straining the capacity of CDC, along with state and local health agencies across the country.  In these tough times, community leaders have to figure out creative ways to help close the gaps to keep America healthy, safe and secure.

One model approach for bringing communities together is the Meta-Leadership Summit for Preparedness.  A “meta-leader” is a leader of leaders – someone who can mobilize people and organizations to collaborate in times of crisis.

The CDC Foundation partnered with CDC, the Robert Wood Johnson Foundation and the National Preparedness Leadership Initiative (NPLI)-Harvard School of Public Health to host these highly evaluated networking and training events from 2006 to 2011, connecting close to 5,000 business, government and nonprofit leaders in 36 communities representing approximately 139 million Americans.

What makes the Meta-Leadership Summit for Preparedness unique is its focus on cross-sector collaboration.  The initiative evolved after 9/11 and Hurricane Katrina underscored the need for leaders to work collaboratively to respond to crises.  The reality is that business, government and nonprofit leaders can do much more working together, than individually.

It is this reality that led the CDC Foundation, working with CDC, to reach out to Dr. Leonard Marcus and Dr. Barry Dorn at NPLI. Their research and expertise in developing the concept and practice of
meta-leadership has played a key role in shaping strategic thinking on national and international terrorism preparedness and emergency response.  We proposed expanding the meta-leadership training they had been conducting at Harvard for government leaders to community leaders across sectors nationwide.   

Dr. Marcus and Dr. Dorn joined with us, traveling across the country to teach meta-leadership concepts to local leaders. Frontline meta-leaders from CDC and other federal agencies served as their co-presenters, providing real-world perspectives on leading in emergencies.   

Thanks to the generosity of the Robert Wood Johnson Foundation and local sponsors, thousands of business, government and nonprofit leaders in communities across the country are better prepared to protect Americans from dangerous threats like large-scale disasters or disease outbreaks. 

Long after the Summits ended in June 2011, CDC’s post-Summit team was hard at work bringing participants back together – and casting an even wider net – through more than 30 post-Summit activities that helped leaders tackle their gaps in community preparedness.

Meta-leaders across the nation are working together to build stronger, more connected, more resilient communities. In Minneapolis, for example, the Meta-Leadership Summit was the perfect launch pad for a new Downtown Emergency Advisory Committee.  Formed by the nonprofit Minneapolis Downtown Improvement District, the committee has united a diverse group of business, government and nonprofit partners to host preparedness and training events that protect downtown residents. 

“There was a time when the government could fund everything. Those days are gone,” said Bill Anderson, emergency manager for the City of Minneapolis.  “Today is the day of collaboration between sectors.”

Deanna Harris, a life flight nurse in Cleveland, Ohio, puts meta-leadership into action when she works alongside firefighters, police officers and emergency room personnel.  For Deanna, every second counts – whether she’s rushing to the aid of a premature baby or tending to the elderly victims of a house fire.  Meta-leadership taught Deanna to get her own adrenalin in check and regroup in the face of a crisis. And she learned how to quickly organize people and resources in stressful situations.  Deanna, a member of the Ohio Emergency Medical Services Board, also encourages board members to think creatively about non-traditional resources and partners to strengthen the state’s emergency planning efforts.

In Boston, Mayor Menino held a cross-sector Boston Influenza Preparedness Summit, building on the meta-leadership model.  In Illinois, eight meta-leaders who participated in a fellowship program made the case for the nation’s first Meta-Leadership Institute and applied meta-leadership to specific challenges in their communities including school violence, flu vaccination and diabetes.

Following the Gulf oil spill, Southeast Louisiana meta-leaders developed a proposal template and process for BP-funded emotional support services that are essential to long-term community support. 

Kay Wilkins, CEO, American Red Cross Southeast Louisiana Chapter said, “What the Meta-Leadership Summit did was open avenues to other people and groups we might not have thought about.”

CDC protects people from major health threats 24/7, including catastrophic events. In light of the ongoing budget cuts, helping leaders understand their counterparts’ interests and establishing connectivity to protect the safety of their families, businesses and communities before disaster strikes is crucial.

Learn more: Charles Stokes, president and CEO of the CDC Foundation, wrote an expert commentary about Meta-Leadership  for the December 2011 Trust for America’s Health issue report, Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism. The report finds key programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts. To learn more about the concept of meta-leadership, visit the National Preparedness Leadership Initiative-Harvard School of Public Health. To learn more about the Meta-Leadership Summit for Preparedness, visit the Meta-Leadership Resource Center .

By Christine Griffith and Carol Jeffers, Sarasota County Health and Human Service, and Patrick Gardner, University of South Florida 

Located on the Gulf of Mexico in southwest Florida, Sarasota County is no stranger to extreme weather and natural disasters. But as Emergency Management Chief Ed McCrane says, “You don’t have to be hit by a hurricane to be impacted by one.”  In addition to direct blows from Mother Nature, Sarasota must also be prepared to receive evacuees from other areas affected by disasters. 

 Helping Neighbors

Following Hurricane Charley in 2004, evacuees from neighboring counties arrived in Sarasota when their shelters were destroyed.  Sarasota County emergency shelters were immediately opened until longer-term housing was located.  With homes destroyed, a vacant mobile home park was filled with FEMA trailers and a make-shift “trailer city” grew overnight for this displaced population.  This created a multitude of needs, including public health, transportation and security.  County leaders were obliged to develop communication plans, collaborative partnerships, and recovery decisions in real time without a formalized strategy. 

 On the heels of the 2004 hurricanes, Sarasota County became the recipient of hundreds of families fleeing the destruction of Hurricane Katrina.  These families arrived needing food, housing, healthcare, replication of lost identification, school entry for children, and other basic requirements for relocation.  

 USF Center for Leadership in Public Health Practice director Dave Rogoff points out, “Disaster survivors who have had to leave their homes and possessions are newly-arrived residents in need of services and support.”  

 To address these needs, Sarasota County Health and Human Services requested assistance from local non-profit agencies, faith-based organizations, the school board, hospitals, etc. and, within three days, developed a “one-stop shop” for services.  Families were able to meet their needs through make-shift offices set up at the Health Department.  In addition, employment counseling, food stamps, Medicaid application and cash assistance was made available.  The lesson learned was that immediate response and recovery to any disaster is a local responsibility.

 Joining Forces

So began the development of an all-county, collaborative response and recovery coalition, the “Sarasota Community Organizations Active in Disaster” (Sarasota COAD).  This unique model owes much of its success to the active participation of Sarasota County Emergency Management and Sarasota County Health and Human Services and their leaders.  Sarasota COAD is a key member of the county’s disaster management system, is among the first to receive notification of potential disaster-related events, and is included when planning for recovery.  It operates under the support of the Community Alliance of Sarasota County and the National Incident Management System. It  has multiple subcommittees and strike teams which facilitate disaster recovery efforts with an emphasis on addressing the needs of specific groups needing assistance (such as elder care, behavioral health, etc.).   The coalition was activated during the H1N1 pandemic and Haiti Orphan Airlift.  Strike team activities during “Blue Sky” periods have included work to enhance the counties’ 2-1-1 system, streamlining access to resources via the web, publishing an Emergency Resource Guide for the developmentally disabled, and creating a directory of community mental health services. 

 Teaching Others

The Sarasota COAD model has become a best-practice model  for meeting community resilience and post-disaster workforce development goals.  In addition, Sarasota County Health and Human Services and Emergency Management personnel have travelled to Louisiana, Mississippi, and Arkansas to showcase the coalition and explain how it can be duplicated to cement the local partnerships essential for an effective post-disaster community recovery. 

 Most recently, the Sarasota COAD has partnered with the University of South Florida’s Preparedness and Emergency Response Learning Center (PERLC) in its College of Public Health and USF Sarasota-Manatee to offer CDC-funded trainings to other Florida counties. .  These trainings assist with the formation of local community-based disaster coalitions or the strengthening of existing ones. The teams are composed of staff from county health departments, human services, and emergency management, as well as non-profit agencies. These groups attend kick-off training in Sarasota and receive web-based presentations and on-site support for two years.  To date, representatives from 18 counties have attended the kick-off trainings and are moving forward.  Additional 2012 kick-off training dates have been scheduled for May, June, July, and November, with a hiatus during hurricane season.

 As Pat Gardner from USF put it, “The purpose of the Coalition Project is to build and strengthen disaster coalitions and train people so they can help others in their time of need.”

 For more information about the Sarasota COAD, visit www.sarasotacoad.org.  Additional information regarding the USF PERLC trainings can be found at: http://health.usf.edu/publichealth/clphp/programs/cdpc/index.htm.