Is Pooster's Fork, Wyoming, ready for the big one?

With all the bureaucratic reorganizing, redirection of public health funding, and presidential and vice presidential squealing and yapping about bioterrorism, you probably figure we've made major progress in preparing for possible epidemics. Yeah yeah, it probably won't be "bioterrorism," but just a natural event such as pandemic flu or a more novel infection, but the necessary infrastructure and plans are about the same, right?

Maybe, I dunno. But just as a reality check, this is what the national bioterrorism (and/or infectious disease emergency) plan consists of: templates and checklists, that state health departments post on their web sites, for cities and towns to follow. It all falls on your local Board of Selectment and Commissioner of Health -- the guy who inspects the hamburger stands to make sure the screen doors are intact.

These researchers pretended to be nurses or citizens, and they called the hotline number of various local public health agencies, reporting what appeared to be cases of bubonic plague, anthrax, smallpox, etc. Fewer than half of the agencies met the federal guideline of responding within thirty minutes. Some of them didn't get back to the caller for more than an hour and four did not return calls at all. Three of them didn't call back after being called five times.

Once they did manage to reach a responsible party, responses varied:

Respondents varied widely in their handling of simulated cases. Several action officers asked relevant questions about the location of the patient and about clinical details, but in several cases the responses were troubling. For example, among respondents presented with a case report from an emergency department physician of a patient presenting with “pustules on the face, arms, and legs with lesions in the same stage of development,” none suggested isolation of the patient or advised the caller to use personal protective equipment. Similarly, when presented with a case consistent with botulism, one action officer responded, “You’re right, it does sound like botulism. I wouldn’t worry too much if I were you.” In response to classic symptoms of bubonic plague, the action officer told the caller not to worry and to “go back to bed” because no similar cases had been reported that day.

I'm going to write quite a bit more about this general subject in coming days (and check out Effect Measure as well on this), but this will get us started. We need to be engaged with our local governments, big city or small town, if we want to make sure we're ready. The top down approach is not working.