Transcript of Get Ready Report podcast, episode 49: Preparing for the next public health emergency

This is APHA’s Get Ready Report coming to you from Washington, D.C.

Hi, everyone. Welcome to our latest Get Ready Report. Our expert today is Dr. Linda Landesman, who is here to talk about disaster preparedness and the fourth edition of her book, Landesman’s Public Health Management of Disasters,” published this year by APHA. How are you today, Dr. Landesman?

I’m great, Amy. Thank you so much for having me on.

Alright, so let’s get started. My first question is: As a disaster preparedness expert, what steps have you taken to be more prepared and do you recommend that similar steps be taken by everyone?

heat waves 1That’s agreat question. Our family has done basic preparedness and these are steps that anyone can do. We prepare for an event that’s most likely to affect us, like Hurricane Sandy, when many of our neighbors lost power and heat for several weeks. We always have a case of bottled water and protein bars to eat.

We also have a can opener and cans of food in the cupboard. We have a battery-operated radio and spare batteries. We have a “go-bag” with a change of clothes and a pill box with two weeks of medication that we rotate out every two weeks. And with that we keep a list of our medications.

What is the best way for the public to stay informed about — and prepare for — disasters in their areas?

Well, there are federal resources and there are local resources. The Federal Emergency Management Agency, some people may know of it as FEMA, has a terrific website called Ready.gov which guides both individuals and communities on how to get better prepared. Individuals should also sign up for emergency alerts. I get text messages from New York City, so I know when bad weather is coming and can get prepared.

People can also volunteer in their community and receive training so that they are better prepared in their homes and can help their neighbors when disaster strikes. Two such volunteer groups are the Citizen Corps and Community Emergency Response Team, and the Ready.gov site will people more information about how to get involved there.

Great! So now let’s turn to your book. How has public health changed since the last edition of “Landesman’s Public Health Management of Disasters” and how is that reflected in the new edition?

That’s a great question. Each edition of my book reflected the lessons that were learned after a major disaster in the U.S. And it’s helpful to understand how the field of public health preparedness has evolved. The fourth edition of my book, which was just published, continues to bring that essential knowledge and the continued actions that improve public health preparedness it brings it together.
We are now applying the lessons learned following Hurricane Sandy, which occurred in 2012; the Ebola outbreak, which occurred in 2014; and the Zika virus, which we have begun fighting since last year.heat waves 1

Now by the third edition, being prepared had become the responsibility of everyone: the government at all levels, the private sector such as business, non-profit organizations such as APHA and the residents of communities across the U.S.

And here in 2017, there’s a national push for communities to developresilience. Communities and individuals who are resilient are better prepared when they plan for the potential impacts that they can anticipate, instead of just planning to respond to whatever may happen. Also, the ability to understand the effects of disasters has shifted. There is now a system to help scientists more quickly conduct research to better inform community officials about public health impacts, and this is called science preparedness.

Alright, so you went over resilience already. Can you explain a bit more about what this means in disaster response?

Oh, sure. Resilience is a very important concept and it’s an important practice that people need to develop. Resilience, which we’ve been talking about, is the ability to bounce back. We know that when individuals have larger support networks, they do better following disasters. And when individuals are better able to recover from a disaster, communities also recover faster.

In our country, people often move to new communities for employment. So to increase their resilience, individuals who may be new to a community should get to know their neighbors and join groups that can provide support. These could be neighborhood groups, or groups that play sports or religious congregations. Any group that can provide support helps people become more resilient.

This push for greater resilience has led to the creation of what are called health care coalitions, which include organization such as hospitals or emergency medical service providers, emergency management associations, long term care facilities, behavioral health organizations, public health agencies and other public and private sector partners work together to plan for disasters.
These coalitions help communities coordinate and more efficiently deliver public health and health care services following a disaster. And health care coalitions, which is a relatively new concept, help communities become more resilient.

That’s great to know that there’s so many organizations working together to prepare us for disasters. My next question is about how modern transportation plays a role. So today, we know that the next devastating pandemic is just a plane ride away. Can we expect a pandemic like the Ebola crisis to reach the U.S in the near future? And can such pandemics ever be predictable?

That is a great question and I’m sure many people are concerned about this. Diseases such as Ebola are known as emerging infections. There are hundreds of emerging infections that have been identified around the world. Most exist in animals and have not spread to humans. Very few have spread beyond the local area where they were identified. Ebola and Zika are examples of infections that were very local until they moved across borders.


Being able to predict a possible pandemic is dependent on several factors. First, knowing that an emerging infection is spreading among humans will depend on how developed the country’s public health system is. Unlike the United States, which has a robust public health system, the African countries that tried to control the spread of Ebola had very few medical resources to prevent the disease from moving from one village to the next.
And sometimes, a country may not inform the World Health Organization that the number of people infected with an emerging infection is increasing in the country. This happened when China did not report the spread of SARS until many months later. By the time they reported it, it was too late to keep the disease from moving to other countries. So we must work to help countries that are poorer and undeveloped have better public health systems and we must also work to increase communication with the World Health Organization among countries that may not want to report increasing infections in their own country.

That’s interesting. So my next question is, when we talk about the need for special accommodations during an emergency, we usually talk about people with disabilities. But also at risk are others with access and functional needs who don’t necessarily have a medical condition. How can those with access and functional needs and their family members better prepare for a disaster?

I’m not sure that everyone in the audience knows what we mean by access and functional needs so let me give you a little background. The groups of individuals who are likely to need additional assistance in a disaster is quite broad. When we think of individuals with access and functional needs, we think of conditions that may interfere with people’s ability to receive health care, their ability take care of themselves, their ability to get to shelter or take preparatory actions or their ability to understand the implication of what may be happening before, during or after a disaster.

Examples of people who might have access and functional needs include children; older adults; individuals with disabilities who live in institutional settings; or people who are from diverse cultures, have limited English proficiency or are non-English speaking, so that they don’t understand warnings or advice that’s being given to them; or that lack access or the ability to use transportation; people who are homeless; people who have chronic medical disorders; those who rely on electricity to power life-sustaining medical and assistive equipment; or people who are dependent on drugs.
Individuals with disabilities and other others with access and functional needs should know where to go if they need shelter, transportation or support services and keep needed assistive devices and equipment nearby. They should know how to evacuate and should have a plan and practice it repeatedly.

There are three main things that people with access and functional needs can do to be better prepared. The first thing is get informed to know what disasters might happen in their community. The second is to make a plan and share it with friends and family. And finally to prepare a go-bag, or a bag that contains the medications and supplies that they might need if they have to be evacuated.

Alright, my last question for you is: Your book includes a new chapter entitled “Ethical Considerations in Public Health Emergencies.” Can you give examples of possible ethical dilemmas that may arise and solutions that may apply?

It’s likely that at some point in the future, the world will experience an influenza pandemic that is as severe as the one that started in 1918. In that pandemic, 500 million people around the world were infected and 50 to 100 million people died, which was 3 to 5 percent of the world’s population. We don’t know the exact figures because it occurred at a time before we had systems in place to collect that information.

So when the next pandemic happens, there will not be enough medical resources to care for everyone. Ethical decisions will need to be made about who gets a ventilator, or medications or even a hospital bed. The elderly? The young? We don’t know. There are no solutions to avoid these difficult decisions. The best plan is for communities to participate in a thoughtful process to decide in advance how they will provide care. And with this thoughtful process, health professionals and public health professionals will be better able to make ethical decisions when this difficult time comes.

Thank you for tuning in to APHA’s Get Ready Report. For more information on APHA’s Get Ready campaign, visit www.aphagetready.org.

Posted Sept. 6, 2017. Listen to this podcast on our main podcast page.

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