Transcription
Oh, it says recording. Alrighty. Okay, hi everyone. Oh, let me do it again. You were touching your glasses. Hi everyone, welcome to Lehman College's Health Services Administration's guest speaker event. This is Evangeline Franklin, MD, MPH. She used to be my preceptor, and that was about 15 years ago. And I think you guys offered me a job toward the end of my precept. Probably. Yeah. During my interview? Probably. Yeah. Well, you know, to me, that part of my life can become a blur. Okay, but I remember. And I just want to make sure that, you know, whoever has their internship, it's really important to take it as a real job because you never know when you're going to get hired or even if they don't have a position, maybe they know someone that they can introduce you to that might be offering a, um, position that you might be interested in. So, no further ado, Dr. Ven, um, Benji, I used to call her Benji. Dr. Benjy Franklin.
Hi everybody. I hope you're doing okay. I can't see any people, so I'm going to have to pretend like I'm speaking to a blank wall. You'll have to forgive that. So, let's see. I'm going to share my screen. Okay, here it is. Okay, host, you have to allow me to share my screen. I'm allowed. Okey-doke.
As Tammy has indicated, um, she and I have the relationship of preceptor, precept t. Um, she's one of my fabulous students, and I'll have to tell you that I enjoyed working with her. And as you can see, we still have a continued relationship. Um, what I'm going to talk about is what's going on with COVID today because as an emergency manager involved in the health department's participation in Hurricane Katrina, the COVID epidemic pandemic would have created significant problems in managing Hurricane Katrina, our response, and our preparation. So I'll show you what it is that I'm talking about. But you can see that this graphic has some significant meaning because you've got the COVID virus, you have some networking or circuitry, um, designs that are embedded into the slide. And really, what we're talking about is the connection between individuals and in their health and disease, how to prepare for it, how to protect against what may or may not be coming, and how to have a response that is robust and interconnected.
Okay, you already know all this stuff about me, so I don't need to go through it again. But you really will have this information in the slideshow. Uh, you'll get a copy of it at the end of the talk. As we're going through the slides, though, I'd like for you to write questions down for me. Um, those questions, I'll either answer, you'll find that I will answer them through the talk, or I will answer them at the end of the talk. But that way, we can keep track of what it is that you're interested in.
So, the objectives, uh, include the following. What is this talk about? It really is about the interconnectedness between the public health infrastructure and the national preparedness infrastructure. There always has been, since 2005, actually, a pandemic influenza plan. Um, and we've already known that there are actual, uh, COVID viruses that are out there. Although COVID-19 was a novel coronavirus that hit our country relatively unaware. Then we're going to talk about some politics, what the Trump administration did in response to the epidemic pandemic, and the Biden administration actions. An important question will be, are we ready for the next pandemic? This is a slow-moving slideshow.
Okay, what we're not going to talk about is medicine versus public health in depth. There really is a distinction between one and the other. Medicine really being the focus on the individual patient, and public health being the focus on the community. We're not going to talk about hospital levels of care, like trauma levels or specialty units or specialty hospitals, like cancer hospitals. We're not going to talk about the life center of various facilities, laboratories, or health departments in terms of their organization and management. We're not going to talk about codes of conduct for hospitals, medical offices, or codes of conduct for practitioners, physicians, nurses, first responders, etc. We're also not going to get into the specifics of urology, microbiology, and immunology, except for taking a look at a little bit about the history of where those sciences became critical.
Our roadmap for today, however, we will talk about the following things: basic definitions, some examples of epidemics and pandemics in the past, a brief history and overview of the U.S. and global public health biosecurity infrastructure. We're going to use New York State and City as an example for that discussion. A brief history and overview of the national preparedness infrastructure. We're going to take a look at El Paso as an example, as a, with a really interesting set of issues that they have to deal with. Then we're going to look at an actual timeline of actions and reactions to the pandemic, first through the Trump administration and the Biden administration. We'll also deal with some questions. I hope folks raise questions regarding vaccine and mask mandates, um, in terms of how that can stave off the spread of disease. And once again, are we ready for the next big one?
Here's, uh, some definitions. You can see that these hexagons have colors to them with a healthy person, sick person, dead person. So, in terms of the spread of disease, we've got four continents here. And on one continent, continent, I guess we could call it C, we actually have two dead people, a couple, I'm sorry, two, two sick people, some healthy people, a dead person, and some people who are actually sort of in the prodromal phase of the infection. And then you have some other continents where the epidemic has not yet spread. Now, you see that there is spread in one continent only. You see more people who are suffering. Then you see it spreading more, so in the next continent to it, and so forth. You also see these dots sort of floating in between. Let's think of this as either air travel, ground travel, or travel on water because this is really how pandemics get spread around the earth.
So, our second point is to take a look at the epidemics that have been experienced in the Americas. And some of these epidemics are not really just confined to North America, but historically, they have been a significant contribution to our past. This is a list really of all of them, except for the Black Death. Although there are plague bacteria that are out in the Southwest of the United States. Um, all of these viruses have been identified in the United States, and some bacteria. So, we've got tuberculosis as a bacteria, and we've got malaria as a protozoa. Smallpox is the only virus that has been eradicated, and that was due to a very, uh, well-enforced, uh, mass vaccination program that happened worldwide. So, smallpox virus only resides in Russia and the United States in highly secure laboratory environments. Recently, there has been a malarial vaccine that is now available, so that should make a big difference in terms of, uh, the incidence and and, um, prevalence of malaria, mostly in Africa and South America. Tuberculosis has become a bacteria that has a very complex treatment regimen and a prophylaxis protocol, and because of the AIDS epidemic, we now have drug-resistant tuberculosis. I don't need to go through all of the rest of these, but some names that are associated with, uh, one particular virus, yellow fever. You might all recognize that there's a hospital called Walter Reed Medical Center. Walter Reed actually defined the source of how yellow fever was spread. He put himself in a box with a bunch of mosquitoes in Cuba, and he contracted the disease. Pandemic influenza in 1918 was a significant hit to the world. This book here, The Great Influenza, I think I've read it six or seven times. It is an amazing book, and it talks about not just the influenza epidemic itself, but it also talks about how medical science came about in this country. The flu is a common seasonal illness, and we don't know, uh, from year to year whether or not it can be severe. But in 1918, it was a severe, rapidly lethal illness with a very short time period from onset to death. So, you could be sick in the morning and dead by nightfall. Death was gruesome. People turned blue and black. Their skins actually changed color with the severity of the disease. So, it, it, it was also, um, supported by the movement of troops for World War I because of the cramped quarters and the cramped trains and boats that moved troops around the world. So, World War I actually helped spread the disease at that time. Clinical laboratory measurements, X-rays, and supportive modalities, nor medicine that are commonly in use today to help with with influenza were not available at the time. So, getting the flu meant you either got better or you died.
What's really special about this period was the opening of Johns Hopkins University Medical School, Hospital, Laboratory, and School of Public Health around the turn of the century. The reason why this institution is so important is because the institution based its entire curriculum on the scientific medicine. It was one of the first places where microscopes were actually used, where pathology laboratories looked at microscopic slides of tissue, and also tried to develop epidemiological responses to health and disease. What's also interesting is that vaccination, the use of plasma for treatment, uh, as well as isolation and quarantine were very critical during the period of time. In 1918, Public Health Reports, which still exist today, began in 1878. The Civil War was a very critical time in terms of improving communication and the recording of medicine since surgery was the predominant specialty at the time because there was really no response, no, no ability to respond to infections. Public Health Reports actually had most information on surgical techniques. Infections were reported, but they were not understood in terms of how to treat them. The Public Health Service now is the 6,700-plus member cadre of uniformed health professionals. The Surgeon General really is the chief officer of the Public Health Service. The U.S. Marine Hospital Service for sick and injured seamen in 1871 was started as the response to trying to quarantine, uh, for diseases that might come into the country through transportation, mostly by water travel. As I said, travel was limited to ground and sea. So, the pattern of spread was similar to that of the Black Plague, which was also a pandemic. And if you look at map descriptions of how the Black Plague spread, you will see that it went from port to port to port to port, and then it traveled inland as goods and services were transported inland. It wasn't until much later on, and it was discovered that fleas on rats were really the transmitting vector for the disease. Quarantine was understood. It wasn't really well understood in terms of why a disease might be spread from one person to another, but quarantine was highly utilized, even though it wasn't clear whether or not there was a skin-to-skin transmission of disease or respiratory droplet of disease, etc. It was not sophisticated, and many times reflected bigotry. And by that, I mean is that when Chinese immigrants came to the West Coast and the plague broke out in San Francisco, the Chinese, without any particular understanding of who got sick in San Francisco, were all quarantined basically in a fenced-in area. So, there's a long world history of quarantine, even though the mechanisms of spread weren't understood. There is also a history of legal battles over mandatory smallpox inoculations and quarantine in the United States. One thing I want to point out about smallpox inoculations is that that was distinctly different from what we call vaccination, but it was actually one of the first really important ways of understanding the spread of disease. So, if you got smallpox, you had pustules all over your body, and in order to protect other people, the pus that was in, uh, that that was taken out of the pustules on a particular set of individuals was liquefied and then was placed under the skin of those people who were actually at risk for catching disease. It sounds pretty yucky because it is pretty yucky.
Okay, so now let's take a look at the public health infrastructure, biosecurity infrastructure with New York as an example. Biosecurity here is a very, very new term, and it actually approaches the issues regarding terrorism. But biosecurity is also important in terms of the spread of unintentional spread of disease. New York is our example. New York was one of the earliest departments of health for committees for health improvement as a local phenomenon. So, New Amsterdam was first, which grew up into the state health department, which grew up into the national, uh, efforts to control health, and into also global mechanisms for developing treaties to help improve health and protect the entire world. Lots of words here, good to read after the talk. But the thing that's really key is that 1625 was the organized colonial governing body that was established in what is now New York City. The health department started in 1655, and the public health laboratory didn't come about until 1892. The late 1800s, the late 19th century, is critical in terms of the availability of the microscope to take a look at what was in tissues. And so bacteria were eventually discovered. Since then, New York City has actually become one of the best public health departments, or public health laboratories, let me make that clear, in the world. And now the public health and bioterrorism laboratory performs over 200 tests on specimens that receive, 200,000 tests on specimens it receives each year. The current New York City government is responsible for the, the things that are listed: public education, correctional institutions, public safety, recreational facilities, sanitation, water supply, welfare services, etc. All of those locations, uh, in institutions and organizations under the government have public health concerns. New York City, or our New Amsterdam colony, developed its own court system, which also focused on public health concerns, which were things like removing garbage. The old theories of disease came from what's known as the miasma theory. So, if it smelled bad, it was probably not good for you, which was a reasonable leap of faith, even though the bacteriology was not determined as a science until much later.
This list will make you crazy, but I have several of those. And if you take a look at it, you will find that there are a number of different things that are done in the New York State Health Department that are critical and are very, very, very scientific. If you go down to 1950, you can have the discovery of nystatin, the first safe and effective anti-fungal antibiotic, um, which came out of that laboratory. 1981, electron microscopy and computer processing used to analyze 3D structures of large biomolecules, so new targets for antibiotics were identified. Uh, uh, 2001, sensitive biomonitoring analytics used to detect low levels of environmental toxins in human samples. 2013, new prototype for brain mapping techniques were licensed. And if you go down to 2017, you'll actually see that there is a scientist who was awarded the Nobel Prize in Chemistry for pioneering work at the New York State Health Department.
Okay, I think I'm frozen. Okay. So, in 1789, we had won the Revolutionary War. We had determined that we wanted to be a country, and we had also determined that we wanted to have the rule of law, really, is the way to manage this collection of colonies and then states. Out of that, we have executive orders, proclamations, and declarations that can come from the president to change the U.S. Code or to influence the U.S. Code. But the U.S. Code contains all legislative public laws. If you just Google U.S. Code, you'll find you will be able to find underneath each particular line item all the laws that have been passed in this country since the beginning. We also now have departments and regulatory agencies, in particular DHS, which includes FEMA, and DHHS, which includes CDC and FDA. DHS, Department of Homeland Security, and DHHS being Health and Human Services. The rules and regulations that come out of the agencies such as FEMA, CDC, and FDA can actually have a legal, legal effect on what happens, for instance, at ports, at standing up responses to disasters, and at the approval of medications.
Now, we'll get past World War II. The U.N. Charter was ratified in 1945, and now there's close to 200 member nations in the U.N. The principal organs are listed here, but the key ones that are important in health include the Economic and Social Council, of which the World Health Organization is a part. The World Health Assembly is a decision-making body of the World Health Organization. Discussions about the spread of disease actually occurred very early on. Um, there were various, what were called, sanitary conferences to talk about really the movement of garbage and smelly things that were decaying in the streets, which evolved, as you could see the evolution of the New York State Department of Health. The World Health Organization has a scientific end, which also does research along with the CDC and conducts surveillance activities in order to determine where diseases are breaking out in the world. The World Health Assembly is the decision-making body of the World Health Organization, which means that it is a binding treaty or a treaty-binding set of activities that occur. In the World Health Assembly, there is something known as the International Health Regulations, which were published in 2008, which are the culmination of all of the scientific work that has been done over the last, oh, half, half, half century to two centuries of work internationally.
As you all know, commerce has always been a critical activity of governments of nations. This goes back as far as time immemorial when boats could be built and there were goods that were being exchanged from one country to another. The exchange of goods and the movement of people on those boats also emphasized the movement of possible disease. The evolution of quarantine, not just of the people, but of the goods that were on the ships, and the management of those relationships through agreed-upon treaties.
Another terrible slide, but a slide that has some active links in it where you can look up information. Public Health Service Act, 42 U.S.C. 247-d, specifies the foundation of DHHS's legal authority for responding to public health emergencies. The Secretary of HHS can lead all federal public health and medical responses to public health emergencies. So, a public health emergency is not just what we commonly know now as a pandemic. A public health emergency can exist in a situation where something has happened locally but has been contained in a specific region. As I went through understanding these issues, what I found is that there is really a connectedness around the world to identify specific diseases in locations and to try to make sure that the disease is confined to a specific area. And I've also read some information about the scientists who actually went to locations to help identify where the disease came from, how it evolved, what was spreading it, etc. So, remember the slide that spoke about epidemics? There were scientists who actually went to locations and risked their own lives to study new outbreaks with new symptoms at various locations, and some of these discoveries were quite harrowing. You'll see that there are significant amendments to the Public Health Service Act, uh, that help to improve protecting the nation, the location, the state, the nation, and the world from various diseases by developing preparedness. Pandemic and all-hazards preparedness is an important critical notion here because when I get to that particular part of the discussion, you will see that the structure of a response is pretty much like an org chart that can be used in multiple organized organizations.
The Stafford Act was a result of some of the things that happened with Hurricane Katrina in order to release and release resources to a particular locale that is expecting a disaster. The governor of an ex, of an affected state or the chief executive of an affected Indian tribe has to declare an emergency. That kicks off the flow of lots of money and lots of assistance. It turns FEMA into an organization that has services, loans, resources available to those lower cases. So, when you, when you hear the statement "declaration of emergency," the idea here is to kick off the Stafford Act. The Social Security Act actually provides for the president or for the head of DHS in a public health emergency to modify various, uh, various funding sources to help expand care. So, you, um, if you look, follow my area, we're talking Medicare, Medicaid, Children's Health Insurance, health insurance portability, etc. What's important about that? I'll use Katrina as an example. Hurricane Katrina and its evacuation, because of the situation in the city where it could not be inhabited, meant that hundreds of thousands of people actually dispersed across the nation. Many of those people who had very different needs in terms of financing for their healthcare, financing for healthcare, even though it may be provided in terms of funds from the federal government, is actually in many, many cases managed by the states. So, the way that the states could have access to funds meant that the secretary had to waive or modify certain programs so that those funds could be made available.
The Defense Production Act, you probably heard of with the pandemic, especially as it related to the availability of PPE. The Defense Production Act actually allows the president to expedite and expand the supply of critical resources. That means that PPE, ventilators, hospital equipment, vaccines, vaccine bottles, needles, the availability of certain antibiotics which are stored in what's known as the Strategic National, uh, Stockpile, can be produced with specific contracts with one or more companies in order to get that supply up. So, when they talk about all these millions of dollars or millions of, of doses of vaccine that have been made available to U.S. citizens and also to the world, it's because the Defense Production Act has actually made funds available and has given the president authority to make those priority contracts.
Food and Drug Administration is the entity which actually monitors the safety and effectiveness of human and veterinary drugs, biologic products, and medical services. Now, this brings up an interesting point because veterinary drugs and agricultural interventions need to go through the Food and Drug Administration. The reason for that is is that our food chain is a combination of the work of all these scientists and all of these practitioners. And when I say veterinary drugs here, I'm talking about pigs, cows, chickens, our meat supply. So, the Food and Drug and Cosmetic Act authorization was used in developing emergency use authorizations of unapproved drugs, devices, etc., in the situation where those drugs are necessary. An EUA is very, very close to actually an approval, except for the fact that instead of a small study size population that is involved in receiving a certain number of drugs, it is the approval will come after there are millions and millions of individuals who've been exposed to those drugs. And I'm speaking here of vaccinations.
Okay, so now I'm going to talk about the preparedness infrastructure. You've had some introduction in terms of some of the laws that have been available as the preparedness infrastructure is being built up, but this will give you some idea of where that came from. I've got the several administrations listed on the left side of the slide, but then I have some information that is based on specific decisions that were made during specific time periods. You can see that even Thomas Jefferson had to deal with a request from the state of New Hampshire for a fire that created a lot of damage in the state. You can see that the Civil Defense Act during the Truman administration, so this is post-World War II, development of bomb shelters, which packaged disaster hospitals to protect against enemy raids. So, the Disaster Relief Act grew out of that particular activity. The Nixon administration actually started coordinating state and federal responses. So, this is where you actually get a vertical set of responses from what happens in a very specific location or locations regarding a disaster. Carter, Reagan, Bush, and Clinton also had very specific acts. You can see that FEMA was established in 1979 by the Carter administration. The Reagan administration, there was the Stafford Act, which we spoke about before. And some of you may be old enough to remember the Exxon Valdez oil spill and several other pretty nasty events that happened during the Bush administration. Hurricane Andrew was actually the big one up until, uh, at that time, of all of the different hurricanes that occurred in the United States. Clinton actually took a look at critical infrastructure. By critical infrastructure, we're talking about power, dams, bridges, roadways, etc., as areas that needed some special attention in terms of the delivery of services to protect the population. And also, the directorates in FEMA were solidified. You can see that there are three main directorates at this time: mitigation, which meant, um, not only fixing things up but improving infrastructure in order to be resilient against various disasters; preparedness, including training and training exercises; response and recovery. What do you do during or immediately after a hurricane or an event, and how do you recover from it? And as you can see through all of these administrations, there's a set of disasters that have been occurring that sort of add to the list of things which have become hazards. The very, very last item on the page is the Columbine High School massacre, which is probably the most noted individual school shooting and attempted bombing. It's like the beginning of what has been a very serious problem with protecting students in schools. Through the, the George, the G.W. Bush administration, you have the development of the Department of Homeland Security, with the Homeland Security Act of 2002. Um, the World Trade Center also focused responses to disaster on bioterrorism types or terrorism types of events. And then there was Hurricane Katrina at that time. So, FEMA is still a young organization with, uh, what I would say, the beginning of some very specific information available for local, state, and national emergency managers to help deal with possible hazards. Um, the Obama administration, um, once again, we have a series of problems, focus on bioterrorism. And then in the Trump administration, we have hurricanes Harvey, Irma, and Maria. Um, one thing I can say about the hurricanes that hit Texas, I recently spent a couple of months in Texas because I had a family member who was being treated at MD Anderson Cancer Hospital, and I noticed that in driving from where I was staying to get to the hospital, the underpasses actually had levels of how deep the water was that were actually made into the concrete. So, someone who would be surveying a possible flood in a particular area or a flood that occurred in a particular area could get on a boat and say there was seven feet of water in this particular underpass. Also, the way that the roads are monitored, certain roadways are immediately closed. Anybody who's been to Houston knows that there's an interstate to get to anywhere, but some of those roads need to be automatically closed, and some of those underpasses need to be automatically closed to actually prevent disasters and rescues of people who might be trapped in those areas.
So, now we're in the Biden administration. We've got Hurricane Ida, which knocks out all the other previous terrible hurricanes, totally knocks them out. Has caused an immense amount of destruction in the Gulf Coast and all the way up through to New York City. Anyone who has been to Lower Manhattan, and Tammy and I know exactly the subway, we know where that subway is, we've been in that subway. You had subways that were flooded basically because of the huge amounts of rain that occurred as a result of Hurricane Ida. Wildfires in the West are growing. We have earthquakes, floods. I put on here withdrawal from Afghanistan because humanitarian disasters can also be included in taking a look at what is a particular hazard.
So, the emergency preparedness and management system. This shows you the copy of one document out of hundreds of documents which provide templates for how information should be structured and how response, preparedness, and mitigation should be handled. It is an all-discipline, all-hazards national response plan. I want you to be very cognizant that we're talking about a generic plan, as one would talk about a generic org chart, as one would talk about one business textbook versus another, where the table of contents typically is quite similar. The idea here is that we want all individuals to have access not only to the same material but to actually be able to speak to each other with the same language and to know immediately who is upstream from them, who can help solve a problem. So, this slide basically repeats what I just said in terms of a single comprehensive framework. And I've got here the management of domestic incidents, but this template can actually be used worldwide. It's really a document that, that makes it clear, um, what is the structure and the mechanisms for functioning in these types of situations.
The all-hazards plan also includes terrorist attacks because if you have an explosion because of gas in the mine and the consequences of that, if you have an earthquake with the collapse of buildings, you also have what is the result of a terrorist act. It's not so dissimilar. It's not so dissimilar from a mass casualty event that is related to gunfire or poisoning. You still have to do what you have to do, and that makes your reaction very much streamlined. You know that the techniques that you have developed and used over time can actually apply. So, this approach will also reduce the vulnerability to all natural and man-made hazards. You'll find that the reaction to one type of dam, of of disaster, will help to minimize damage in another type of disaster.
Incidents of national significance are the big ones. We are currently in an incident of national significance, a high-impact event that requires an extensive and well-coordinated multi-agency response to save lives, minimize damage, and provide the basis for long-term community and economic recovery. So, those who are involved in leading in these instances, once again, the Secretary of Homeland Security can actually declare an incident of national significance in consultation with other departments and agencies. So, DHS and DHHS were first in line in terms of initiating the response to, uh, the pandemic.
Okay, so who is this multi-agency team? Who are all the stakeholders involved? It's everybody. You can see you've got all of the departments of the executive area and all their agencies. You can see that Ag, Commerce, Department of Defense, Education, DHHS, DHHS, Housing and Urban Development, Department of the Interior, Labor, State, Transportation, Treasury, Veterans Affairs. Depending upon the affected population, any or all of these departments can be involved depending upon the type of problem that has occurred or list of problems that have occurred in a disaster. You can see that there are specific administrations that would be part of the response, the evaluation or response to a disaster. The Nuclear Regulatory Commission, for instance, would pose a very important role in terms of what would happen if we had a nuclear meltdown. The American Red Cross is a quasi-governmental organization, but it is a significant partner in terms of response to a disaster. The Postal Service, as an example, is important in terms of providing good access to snail mail. When I was living on a cruise ship in the city of New Orleans because there was no housing in the city after Katrina, the post office had to stand up the availability of post boxes on the dock for all the people who were on the cruise ships so that we could stay in contact not only with our friends and family but also our creditors because if we don't know what our creditors are interested in, we can't respond to them. We can't let them know that, guess what folks, I'm in the middle of a disaster.
So, what are the six components of national, of the national preparedness system? You've got to identify what all these risks are and assess what the risk level is in your particular area. Avalanches, for example, would not be something that would happen in Central America. Mudslides might be, but not an avalanche. You've got to estimate what is your capability to respond to a particular event. So, if you have high-rises that are in your city, you have to decide or determine if you actually have firefighters who can handle high-rise firefight or high, high-rise fires or disasters like the World Trade Center building. And sustaining those capabilities means actually writing the laws and creating the funding to support them. So, capabilities for responding to various events come from taking a look at what possible situations are going to occur in your area and and then taking care of it. Planning to deliver those capabilities, validate them after or before the disaster occurs, making sure that they work, and then afterwards, review and update them.
This is a slide from the Department of Education. The reason why it's listed is because the notions for pandemic planning as an all-hazards type of activity shows that this notion is government-wide. When they speak of, they use a phrase that's actually kind of peculiar. It's called "all of government response" or "all of community response." The planning, preparedness, response, and recovery actually has to work for everybody. The Department of Education may focus not only on pandemics but also school shootings. The disaster emergency cycle can apply to anything, including to you as an individual. Say you're going from point A to point B. Okay, so you want to go, say, Baltimore to New York City. The first thing you do is you look at your choices. What are your objectives? What is the risk assessment of your various choices, and how do they all work? So, I can get from Baltimore to New York City by train, car, or air. If I'm really robust, I could probably also walk, but that would take a long time. So, you would assess what you need for your trip. You assess the, how expensive your trip is, and you may want to look at the safety records of all of the ways that you can get from A to B. You prepare for any emergencies that can occur on the way. You could get sick, you could get hit by a car, the train can derail, you can run out of gas, etc. And then take a look at your response. If, in fact, you do have an event, the response might be learning how to put your brakes on properly if you're stuck in an ice storm and there's a sheet of ice on the ground. Then you have to take a look at your recovery after you have gone through that event. So, if I've walked from Baltimore to New York, I've got to figure out that once I get there, how long is it going to take me to rest up to do whatever it is I want to do in New York.
So, let's put some terms together. We've talked about a preparedness goal being prepared, identifying all the things that might be hazards. Then we need to establish our core capabilities for executing what: prevention, protection, mitigation, response, and recovery. I'll let you take a look at the detail in this slide, but it's much of the information that I've already discussed.
Now, let's take a look at all-hazards planning and an analysis of those hazards. So, this is a list that is probably not exhaustive, but it's a pretty good example of what it is that may or may not happen in a given event. It could be a natural reason for an issue. And in an avalanche, you can see that you, you may have lots of different things that can happen. In a tsunami, you may see that that may result from an earthquake. It usually does. From a winter storm, you can see that you've got history issues of not just heat and light and the protection of people in their homes from the cold, but also protection of their medication in the event that the power goes out. Technological events can include dam failures, mine accidents, train derailments, urban conflagration. So, your whole city burns down. I think of London, the fire of London, as an example. The fire of London basically had no firemen to take care of it, so most of London actually burned down. This is in the 18th century, or maybe the 17th century, but London got rebuilt, looks like it does today, because that area was destroyed by fire. Human-caused events can include an active shooter, an armed assault, chemical biological attacks, a cyber attack. We've had this year a cyber attack against the grid. We've had, um, hacking into, uh, various movie studios to, to really release information that they wanted to keep private. Explosives attack, nuclear terrorism attack, radiologic attack.
Okay, so there's epidemic and pandemic. That's actually highlighted under natural. Now, what I want you to think about is if more than one of these occurred in a particular area or areas at the same time. I'm going to pause and count to 20 while you think about that. 10, 11, 12, 13, 14. Now, if you're me, your reaction should be, "Holy crap!" For example, there's currently a specific document that has come out from FEMA that talks about how to do shelter planning for hurricane, for those individuals who need to seek shelter at state-regulated shelters or any other shelters, and what the consideration should be during the COVID pandemic, how do you minimize the spread of disease in a shelter?
So, the assets that are at risk include people, basic services, power and fuel, property, supply chain. We see that President Biden has been working hard to improve supply chain issues that have cropped up not just in the United States but across the world. Systems and equipment, IT, business operations, reputation of or confidence in entities. Do you trust the FDA? Do you trust a leader? Do you trust the CDC's recommendations? Regulatory and contractual obligations, and the environment. What are the impacts? Casualties, property damage, business interruption. If you've noticed, the cost of bacon has skyrocketed along with the cost of gas. Loss of customers, environmental contamination. In certain Mississippi River floods, because some of the levees have actually been busted, there's been contamination of agricultural fields, and therefore the loss of the ability of farmers in specific areas to grow any plant, any food plants in that area for a certain number of years. Once again, the loss of confidence in an organization, fines and penalties, lawsuits, and collapse of the economy. So, we have basically this entire set of impacts has been a result of the spread of COVID.
So, how do you organize in a city? You can see on the left-hand side, I've got a graphic that shows what a city might look like with lots of high-rises, but think about this as a city with low-rises too. Think about this as also a rural area. We have these things called Emergency Operations Centers. This is the org chart. This is the org chart for every Emergency Operations Center, pretty much worldwide. I'll say that again, worldwide. You may actually have titles that are slightly different, but you will find that the organization is pretty much the same. It starts out with one person who is monitoring certain, certain outcomes alone in one particular monitoring center, to those people who are working at the state or city level, to those people who are working at the national or international level. So, does the World Health Organization have an EOC? Probably several. Does the CDC have an EOC? I've been in it. It runs 24 hours a day. Do various cities and states have EOCs? They do have it, and there has been funding available to actually develop these EOCs so that you have similar technology available, software that can be accessible from any location if you need to exchange information, and the ability to request, say, for instance, you are in transportation, ESF 1, where my arrow is, or if you're in what I was in, uh, public health, which is ESF 8, which is right here, you actually have a counterpart who you can actually connect with at the state level, etc. And if you need to copy that information to someone who can help facilitate or make sure that the information gets through, then you have the planning section, logistics section, and the finance and administration section, which has information and the ability to charge out what those resources cost. When you get statistics on what a particular disaster costs, what, say, let's pick a number, $18 billion, that basically comes from a structure like this, where you can actually charge that activity up to a place that was that has a central, uh, place to reside. Those locations can then put the statistics together. Now, during Katrina, guess what? We may have had a system that was like this or like this next one, the incident management system framework, but we actually had paper records. I'm going to say that again. We did not have computerized exchange of information except where it was very rudimentary. So, there was lots of paper, and lots of papers that were being turned into specific heads of departments so that that information could be co-collated, and we would have a whiteboard in the front of the EOC where certain pieces of information were written out. So, you wouldn't have pop-ups that would give you information. So, imagine the technology that we have access to right on our phones, for example, that was at some point not there. It was simply not there. It made our lives a lot crazier because of that, and it also made those estimates a lot more difficult to manage.
The slides you're looking at right now shows the various organization charts that will take certain activities which are national and state down to the local level, either by some sort of connectivity or by actually putting a specific representative from these groups in the area. So, I can remember a JFO, which is the multi-agency coordination agency. The JFO is actually a joint field office, which was similar to an EOC, but it had people who had a different level of responsibility who were actually in the field level from the national level. So, we were able to refer back to other people who could give us some information. If you look down at the bottom where it says "command structures," you will see the incident command post, green, the very bottom. That's the person who is actually at the level of the event. The event may be something as simple as, even though it could be a pretty nasty one, a car crash. You have someone there who is incident commander, who will make sure that the fire department does what it needs to do. If they need the jaws of life to get people out of various vehicles, they can call for that equipment. You have Hazmat, which will clean up whatever is the fuel that has been spilled in the particular area, and you have the first responders who will take people to the hospitals. And the first responders, if you've ever been in an ambulance or if you've ever watched ER or some of these other programs, you'll know that ambulances actually have connection with the emergency rooms so that they can get a specific person to a specific ER and they can get the care that is required. Now, you've got to remember that those ERs may be packed with people or they may anticipate being packed with people, so they've got to have a plan in the ER as part of their emergency response to get beds empty so they can put people in beds. If you take a look at the top of that particular box at something called the JTF, the JTF is the joint task force, which really has to do with bio, bio, I'm sorry, with terrorism, um, and all of the forces that need to be involved in a terrorist response. A terrorist response includes very special pieces of infrastructure like the FBI, um, in order to get those individuals investigated who might be bad actors on the spot.
So, what does an event do? It triggers a response all over the country. And what it didn't do for COVID, it didn't trigger a response immediately because it was really the first time that we've ever had a pandemic since 1918. It's supposed to trigger a response that is global. So, the frameworks for public health are the same as those for everything else. You can see that it doesn't say anything here about special situations in these frameworks or protection plans. It just talks about the plan. Then you get underneath the plan, various activities which are very specific. If you look at underneath the National Response Framework, that's the example that I spoke about before. What would be the COVID-19 pandemic operational concerns, uh, for the hurricane season of 2020? So, this slide is to show you that everybody's getting educated about developing a plan and about what to do in an incident or an event. The CDC has information up above. You can see that Health and Human Services has their information. I use the state of Maryland to talk about a response plan in the two slides on the right. And then there's specific organizations that have training for response activities for various groups that may be responsible, like the EMS medical director for the state of Maryland, listed on the bottom in the middle. You can see Homeland Security has a pandemic, uh, influenza plan. And below that, Knoxville, Tennessee has a business pandemic flu plan. So, all of the, all of the organizations that we are exposed to and we that create good lives for us are now planning in the same way because the activities of these practitioners is quite similar.
So, here's a list of a bunch of laws that you can take a look at at your leisure. But once again, we talk about Homeland Security, Intelligence, and Reform, and Terrorism Prevention, and Implementation of the recommendations of the 9/11, uh, commission, um, and there's
can see all of the various areas where the law has indicated responsibilities. Stafford Act, once again, the Post-Katrina Emergency Management Reform Act, etc.
Immigration and border security. This is a particular, particularly important area because we have immigrants who come to our borders, especially the southern border, and we have to not only deal with that group of people in a humanitarian way, but we also have to deal with the fact that as those people come to us through the border, they come with whatever diseases or level of health that they have. These people are not very different from those people who will fly into a particular airport from a particular set of countries, like to New York, San Francisco, L.A., Miami, who will also bring whatever diseases that they might have.
Then there's also cruise ships: Boston, New York, uh, Miami, San Francisco, Los Angeles. Once again, where you get people who bring their diseases. Then you have cargo ships with those people who work on cargo ships and the stuff that they bring with them, which actually has to be dealt with.
The TSA, which is also a group that consistently gets criticized, also takes a look at the possible event of bringing firearms and other explosives on onto aircrafts. Maritime security deals with ports. The Coast Guard actually is one of the oldest military groups in this nation, and the Coast Guard has been the group of uh sailors who have been in charge of managing quarantine from the seas. So all of these decks will show that you also have to not only protect the country from the people who come in and the stuff that comes in, but you also have to protect this group of people as a workforce.
Okay, so this is El Paso, Texas. I've got a, a bunch of symbols here. So we've got the city, this is the mayor, this is the city manager, you've got a police captain, you've got the sheriff's office, you've got uh fire department, and you've got border security.
Now, from a practitioner point of view, you have emergency management, public safety, emergency management, not at the level, just the level of El Paso, but of there's emergency management level of the state and the national level. The reason why I picked El Paso is because they got a lot of stuff going on, and I'll just sort of go through this briefly. Um, El Paso is a hot place, um, but it also can get quite cold in the wintertime because the water table is almost non-existent. You can also have fires, wildfires that break out, and the wildfire response has been particularly stressed this year. You have motor vehicle accidents, and you have with the fire department, before you get to the quote "jaws of life," you have stuff that they carry around to help break doors off, etc., so they can get people out. You've had water rescue. You can see water rescue going on here. And then you have the response of first responders, helicopters that will actually fly out to locations because El Paso may be a city, but it's in Texas, so there's a lot of rural areas that are around El Paso. So they need helicopter service to deal with accidents rurally and also to bring in people from other medical centers. And then you have what goes on in the trauma room to stabilize individuals before they get up to emergency surgery, etc.
Then you have immunizations. Now, the immunization plan movement. I was actually in an exercise in New Orleans that was to address the distribution of antibiotics in the event of an anthrax attack, and basically, that exercise was to show us how we could go through a drive-through and get our packs of pills that we should take as prophylactics, prophylaxis, in the case of an airborne anthrax attack. So this model has been tested with anthrax and it's been useful. I just got a flu shot in my car also.
The International Health Regulations. I mentioned earlier, the International Health Regulations really is a treaty. Um, Congress actually funds our relationship with the World Health Organization, and the Health Regulations actually provide road maps for how we should share information regarding diseases and also how we should bind together to help countries that are less capable of developing health systems that are similar to ours. So, for example, during the Ebola outbreak, President Obama sent members of the Army to build health clinics and hospitals in West Africa because there's so few of them in West Africa, because you need a place to take care of folks, a place to quarantine them, etc. He also made sure that a lot of PPE was sent during the Ebola outbreak.
What are the diseases that are reportable under the International Health Regulations of 2005, that were renewed in 2008? Epidemics, we've talked about that list. Food-borne illnesses, accidental and deliberate outbreaks, toxic chemical incidents, radio nuclear accidents, environmental disasters, etc.
So, not only do we have emergency operations centers locally, state, and federally, we've got folks that are sitting around the table or tables that are at the World Health Organization, and we have laboratories that are all over the world. These reference laboratories actually have relationships with local practitioners to analyze blood samples that are obtained in specific areas. And if you look at the geographic space that exists, for example, in Africa, China, South America, you'll find that there's not a lot of these reference laboratories for the collection of individuals in those areas. So you need to be able to transport samples securely, safely. You need to be able to have a lab which is responsive 24 hours a day to test those. You need to have an IT system which communicates information. You need to have the available intellectual capacity to look at the data in order to determine, for instance, if this is just a local event or something that can occur internationally. And then you have to have triggers which actually will set off things like closing borders, um, etc.
So here's a World Health Organization Influenza Preparedness and Response pamphlet, um, a strategic preparedness and response pamphlet, again from the World Health Organization. And up above, you can see that the laboratory role is something that is specific in disease surveillance. Now, I don't know about you, but I always wondered, what does it mean to have disease surveillance? Having disease surveillance means very intensive individual activity by those people who will collect samples, blood samples from people who are sick, people who are recovering, people before they get sick, and autopsy information or autopsy specimens to be analyzed so that it can be determined if there is a new disease, a new virus, a new bacteria, or if this is something that we've seen in some other location.
You're going to really, well, the Trump administration slides are interesting, and I've included lots of resources here. The timeline for the coronavirus pandemic that you see on the left and the US response is a collection of events, a timeline from justsecurity.org that actually takes a look at what happened during the events of the Trump administration as it relates to the dis, the dismantling of the public health infrastructure pre-epidemic and then the responses during the epidemic, pandemic. So this is a really good list for you to take a look at, and it's listed in the other slides. The red information is really important in terms of trying to pick out those events that were problematic.
The Coming Plague is a book that was published in 1996. Lori Garrett, who was a molecular biologist, actually became a scientific news journalist who developed a list and the process for how certain diseases were identified, um, showing examples of basically not only how difficult it is to determine a specific disease situation, but also how critical it is. It's a great book to to read. Nightmare Scenario: Preventable America in the Time of the Coronavirus, Bob Woodward's book, Fear, Apollo's Arrow, and Uncontrolled Spread are all lay books regarding what was going on during this period of time. Lawrence Augustine wrote Global Health Security, which I'm reading currently and just came out in September of this year. It's a really good summary, similar to what it is that I've given you about what we can do to help improve global health security. He covers, he dots all the I's and crosses all the T's in this textbook. Lawrence Gostin has been a public health law expert for 30, 40 years, so he has actually gone through all of the issues regarding epidemics, the development of certain techniques to isolate genomic information about various bacteria and viruses, and also the protection of the public against those pieces of, of, of uh, things like smallpox that are stored. So he's a very, very good resource.
So this is information with the time period that is first listed, the various dates that are important, and in the red, those activities which showed that the Trump administration was actually a problem in terms of how it reacted, not only by actively reacting in real time, but what it did to break down the public health infrastructure by firing individuals who had expertise from the National Security Council, defunding certain activities, not funding things like the strategic national net, uh, national stockpile, etc. Also, it talks about some of his reactions that were not necessarily appropriate in terms of promoting the best protection of individuals in our country who might be exposed to the disease. There's pages of this, and this, this is an excerpt. So the red is an excerpt of an excerpt, but this is an excerpt from my timeline. This is worth reading because it gives you a really good overview of all of those activities which are key to making sure that the public health infrastructure and the preparedness response mitigation infrastructure interact.
This is an example of a picture that is really pretty tragic, and that's a look at what had to be used as PPE before PPE could be ramped up in terms of manufacturing. So this goes through the Trump administration information, but these are the laws that were passed during the Trump administration that were assistive to Americans in terms of preparedness and response. The politics are listed in the red in the previous slides, but these are the laws that actually helped us along the way. If some of you may have gotten some of the six hundred or twelve hundred dollar checks that were made available through the Paycheck Protection Program, some of you may be have been involved in the lockdown and had to transition your role from being face to face in a situation to going to a Zoom activity. Operation Warp Speed was a way of fast-tracking the research and development of vaccines and manufacturing, but was basically unnecessary if the Defense Production Act had been utilized. So this was an infrastructure that was unnecessary, given the fact that laws already existed to ramp up uh private contracts and the development of vaccines.
The Biden administration has yet to have a lot of red all over it, and the reason I say "has yet to have a lot of red all over it" is because we're still going through the uh, what's happening during this particular situation. But in the beginning of the administration, basically, Mr. Biden reversed many of the activities that Mr. Trump had put in place, either by executive order or by changing the ability of the government to actually spend money on certain events like the Strategic National Stockpile. Travel restrictions were also modified so that there would be no discrimination against particular groups of people, but rather areas which actually had high COVID incidents and prevalence. Anthony Fauci became center stage as the advisor uh to President Biden, and not only is he important in terms of the infectious disease piece, he's very important in terms of being advised to the president on a regular basis for all medical issues. Doses of vaccine, which the Trump administration actually did not take as much credit for as they should have, were being ramped up as fast as possible in order to make a move to provide us with vaccines. Who Trump wanted to to move out of the World Health Organization's funding that was actually reinstated during the Biden administration quite early on, and two billion dollars was provided for the COVAX program, which is to help the world to get access to vaccines.
So we get up to September, and there's a, on, on the White House website, there's a document called "Pass Out of the Pandemic," which actually takes a look at vaccinations as well as masks, which are in great debate at this point in time with lots of lawsuits everywhere to try to inhibit the use of well-founded activities to help decrease the spread of the disease. So Sanjay Gupta has written this book, which is yet to come out, about what do we do next. Like Lewis Gauston's book, he tries to present what have we learned and where will we go.
So I will accept anybody who has, I have only one question so far. I'll give you a few minutes if you wanna think about any questions you may have written now, but not typed in, please do so at this particular point. And if you have no questions, I don't know what to say about you guys. I've certainly given you lots to think about.
Okay, so the only question that I have so far is, how long did researchers and scientists take to invent the flu vaccine during the influenza pandemic? I assume that's the influenza pandemic of 1918.
Okay, this is where we get into some real medicine stuff. Um, vaccines, as we understand them today, are still pretty new. I would say that they're, oh, less than 70 years old. The initial treatments for influenza came from what's known as pooled plasma. Immunology was not well worked out at the time of the pandemic. Information, um, I'm sorry, at the pandemic influenza, uh, of 1918. Um, but it was discovered that if you took the blood of individuals who had the disease and you spun all the cells out of it, and you just had plasma, and then you gave that to a patient who was very ill, they would get better. There's a lot of talk about experimentation in medicine and lots of controversy, but essentially, it took a lot of experimentation in order to get to the point where we are in understanding medicine. Some of that experimentation really was untoward, but some of it was actually quite helpful, and the result of a desperate situation because there were so many people, and we're talking about troop ships full of soldiers, training camps full of soldiers, etc. Something had to be tried. So the, the pooled plasma treatment was very useful. And now pooled plasma is used in very specific diseases. And vaccines, since the technology of immunology has been applied to developing those very critical drugs, we now have vaccines which are very, very, very specific. So, for example, if you remember the slide that I showed early on with a picture of the COVID virus and the spikes, the mRNA vaccines, Moderna and Pfizer, basically have antibodies to the spikes, so those spikes cannot stick to cells and infect them. In so doing, COVID, yes, can be shed from people who have received the vaccine, but you certainly can't get sick because you don't have the loads of virus that are high enough to give you symptoms. I would like that person to indicate for me if that satisfies the answer to that question.
The next question is, based on the current infrastructure in place, do I think we are ready for the next pandemic endemic? I think you mean epidemic here. Endemic refers to a virus that or to a disease that basically has set up shop in a particular community for which responses seem to be effective and keep it at bay. That, that's a tough question. Um, the infrastructure that I showed you is an infrastructure that is a design which is effective only if the steps are followed and only if everybody agrees to function with each other in a productive fashion. The World Health Organization has been rightly accused of not informing the world that this was going on as quickly as possible, but that may in fact be a function of China not giving information to the World Health Organization that would help them come to a conclusion that this was going to be a worldwide phenomenon. What's interesting is is that we have some supercharged information, including satellite images of a difference of those individuals who had become sick and who were going to the hospital in Wuhan, China. So there's more cars, um, that showed up at that hospital shortly after the time period that supposedly there was the outbreak in Wuhan. So we can make rules to a game. Let's just think about any game we would like to play. Monopoly. Monopoly has rules. They're in the box with the stuff. So we play the game either according to the rules or we play the game not according to the rules. So if one person who is playing the game, the board game, decides not to follow the rules, it can basically screw up everybody else's activity. Think of the pandemic as a Monopoly game or as any kind of board game, Scrabble, whatever have you. If somebody decides that they're not going to play by the rules, for instance, let's take Scrabble, they're going to keep all the blank tiles to themselves, we're going to hide them in their pocket, and then use them in a time that is inappropriate for their use, then that's going to affect not only the game, but that's going to affect the relationships of the participants. So Trump's tune changed as he learned more about what went on in Wuhan. At first, he said that China was doing everything that they could, it was the right thing, etc., etc. And then he started using terms like "the China virus," a particularly unacceptable term for that virus, to try to communicate that China is not only responsible, but in fact, they may have developed that virus and released it into the community. So in terms of being ready, we've got a structure, and we can actually go back and take a look at that, how well we function against that structure in order to determine if it should be adjusted or determine if, in fact, we need to put the brakes on certain things in our relationships with bad actors. For instance, should, should sanctions be placed on China for the late release of that data? That's a political question, but it's an important political question because we need to be able to share this data across the board. I hope that answers that question. Please let me know if I did.
Okay, so I've thought of some questions that might be interesting to take a look at. See if I can get to them. Okay, here's a question: Why do CDC recommendations change so frequently? It seems as if we've been going through a pandemic where we have had to learn as we go. That, in, in actuality, is the case. COVID-19 was not only a novel virus, which means it's a new virus, it's a virus for which many, many, many, many people had no immunity because it's never been out there before. Because it's novel, we've had to go through several iterations of what that illness does, not only to individuals, but to growing numbers of individuals. I'll give you an example. First of all, we had a number of deaths among the elderly and those people who were in nursing homes in the state of Washington. Not only did those people, not only were those people old and immunocompromised, they were also in an area where they could get exposed to a large amount of virus from one individual who may have come into that nursing area and brought the virus with them. As vaccines became available and groups of individuals got those vaccines, we're now down to the level of kids. There's a bunch of stuff going on in the politics of this that are quite, it's quite unfortunate because children basically are under the control of their parents, and they, parents may or may not agree with what is going on. So the recommendations are responsive to collecting data about the disease, the disease in the short term and in the long term. So now we've got this syndrome called long COVID, which indicates that some people actually have certain levels of the disease, certain symptoms from a disease, even after the virus has cleared significantly from their bloodstream.
Next question: Why was the Strategic National Stockpile empty of PPE and other stuff? It was empty because the funding was not renewed, as simple as that. To put ventilators and PPE and other stuff in the Strategic National Stockpile, which is like the cloud we talk about for, um, computer technology and information technology, there's really not a cloud. There's really a place that is a server farm where that information that we put in what's called the cloud to be managed and protected. The Strategic National Stockpile is actually a bunch of warehouses that are located all over the United States in specific areas for stay prepared to be staged for the distribution of the contents of the Strategic National Stockpile to be distributed locally. See, so it's like a Walmart or an Amazon warehouse. You got to pay upfront to get the stuff in there, and you also have to get it from manufacturers who will provide the stuff according to standards that are required for it to function in a particular situation.
How do hospitals participate in incident management? I'm going to make the assumption that everybody on this call has been to an emergency department at least once. If you're hospital administrators, your emergency department is one of your most important locations in terms of the responsibility of the hospital for the community. Hospitals participate in incident management all the time, from everything as small as whether or not a cold virus is going around, flu season is going around, there is one car accident, a 40-car pileup, to an epidemic, pandemic like COVID. And your emergency department can be overrun, okay, with one diagonal set of diagnoses versus another, depending upon the situation. So being able to shift resources is incredibly important. Hospitals generally speaking have to be able to distribute care for their patients, and that means that they go out and actually call around to see if there is the ability to have a patient cared for in a situation because there's no availability at the hospital where the patient has arrived. There's plenty of stories in the newspaper about specific individuals who have either died because they're in the hospital with a disease that has nothing to do with COVID, but there's no beds available in a particular community, um, to situations where it took 169 calls to find a bed, which means that the patient has to be put on a plane or put in an ambulance in order to get to that hospital. Some of those systems exist currently with organ transplantation, with helicopters that go out to remote areas to pick up people, etc. But in a situation where you need lots and lots and lots of beds, you've either got to figure out how to get the resource to the patient or build a resource to match up the resources, rather. So you get the patient to the resource, or to create a local resource, which is an expanded field hospital, to provide those extra beds. Those extra beds make all the difference if, in fact, you've got the staff to work those beds. So you've even heard talk about nursing and physician staff that has been transported or have volunteered from one state to another to help support the care of patients in hot spots. So this becomes a complicated exercise, but the complicated nature of the exercise is not one that is not exercised on a regular basis with the transport of casualties from war zones. Um, if you recall the Marines that were, were injured and killed in Afghanistan, or in any, any place where we have been in combat, you will find that there is local stabilization of the patient, and maybe even surgery, then transfer to a regional hospital, typically in, in Landstuhl, Germany, and then transport to the United States for further care. This is where the idea of levels of care at various hospitals becomes critical to understand. So it's not like we have never done it. I decided not to put in a bunch of pictures of how people who were sick were transported out of New Orleans because of, of Katrina, but they included the transport of patients to military hospitals because it was, this, it was the most efficient way to take care of patients.
What can I do as a citizen, employee, family to improve preparedness? Well, the first thing you can do is get vaccinated if you haven't already. Um, I'm about to get my booster shot for my Moderna vaccines. I'm immuno, I'm old, and I'm immunocompromised, and I'm not that old, but I'm old enough that my immune system would be more at risk. But we have definitely seen this disease kill healthy young people who haven't been sick, quote, "a day in their lives," have never been sick. What you can also do is to like take a look at this presentation and build your own emergency plan. If you go to the FEMA website, you will actually find that there is so much information there, and, and also to a website called Ready.gov, ready.gov, in order to look at how you can develop a plan for your family, look out, look at how you can develop a plan for whatever department you're responsible for, and as a citizen, how you may also be able to participate in various activities which can support the community. In the course that I give on emergency preparedness, I go through all of that information pretty much in detail. Um, mask and vaccine mandates, as you might guess, I'm for mandates and for vaccines, and I've heard some pretty ridiculous arguments against both from some people who I would think would be smarter than they appear to lead on. Um, vaccines, vaccines are safe. We've been taking vaccines now for a very long time, and if you are an individual who is in their late 20s, you've had all the childhood vaccinations, probably some flu vaccinations, and as you get into my age range, you will get into shingles and pneumonia vaccinations that make all the difference in terms of people, keeping people healthy. Um, what's also not been really made available to most people is how this, as a public health measure, is at least as critical as clean water, clean air, the separation of sewage from water so that we can have sewage that is treated and released in a safe manner, regulations on chemicals, regulations on transportation, etc. And I go through what happens when you drive down an interstate highway and you pass a tanker and you see these funny diamond-shaped signs on the sides of tankers that indicate whether or not what's in them is a terribly dangerous substance or not. The, the activities that we take, take advantage of because we live in the United States are too numerous to count because we don't even know what they all are. We don't know how our foodstuffs are protected. We don't know about the interface that we have between radioactive material and the community. We don't know what the fire department does, um, or the Department of Energy does. We don't know what services and regulations actually make our lives much safer than they would be if we lived in the jungle of South, South America or Africa, or if we lived in rural China, or if we lived in North Korea, where you can actually get worms from food that's grown because fertilizer is human fertilizer in North Korea. So what I'm talking about when I talk so enthusiastically about the notion of public health and preparedness is protecting the community, because the community is not just people, although people are the chief actors in the community. It's all the stuff underground, it's all the stuff in the walls of buildings, it's all the building codes that keep roofs from falling down, it's all in, uh, road markers, it's all in a lot of things that we're so not aware of in this country that we take it for granted when we live here.
So I'm going to close with that and a list of stuff that will help you get an idea of what's been going on and the references that I have used just in the preparation of this talk, which has been a phenomenal experience, I might, I might add, and I'm so happy to, and I want to thank Tammy Christensen for inviting me. She's one of my best buds, um, and allowing me to give this presentation to you. So I'm done.
Thank you, Benji, for speaking. I learned so much from you today. There were so, so much intricate details that I didn't know of or I was not up to date with.
Two, well, you're most welcome, most welcome. Can you see me now? I can see you. Oh, um, you need to stop sharing your screen. Okay, this is an IQ test. Zoom is such an IQ test. There it is. Okay, we're all here. Um, does anyone else have any questions too? Um, thank you very much, Benji. Um, I really appreciate that you came and speak to us. Um, as you know, as usual, when I speak to you, I feel like I went a couple, um, numbers up in IQ too.
Thanks. Well, you know, we're both a couple of nerds, so that, you know, it goes both ways. It really does. Tammy, thank you. And we'll include Ramon and the students on that nerdiness too. Okay, guys, you have great careers in health administration, and if you want me to give a presentation anywhere at any time, just let me know.
All right, thank you, Benji. Thank you, Ramon, um, for helping me us set this Zoom up, and thank you for all the students who came to, um, I will have a recording of this in Blackboard, um, sometime this week. Okay, guys, have fun. Take it easy. Bye-bye. Oh, there's another question. Oh, thank you. Thank you, everyone, with the thank yous too. I hope you guys enjoy it and you also learn a lot from it. All right, um, have a good evening, and I'll see you all soon. Bye-bye.