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Waiting for the Boogie Man: Ebola, Flu and Other Reasons to Build Community Resilience

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By William Waugh
October 7, 2014

Public health officials have spent more than a half century trying to educate us about the risk of pandemic. For them, pandemic is the boogie man, the scariest scenario, the worst disaster that humanity faces. For other public officials, the boogie man is everything else. Emergency management agencies were created largely to deal with the threats posed by earthquakes, hurricanes and other natural disasters. Homeland security programs were implemented to deal with the threats posed by unnatural disasters perpetrated by domestic and international terrorists. While, the pandemic hazard has been on the list, it has not been near the top. The lessons learned in 1918 and 1919 when the so-called Spanish flu decimated communities all over the world have either been forgotten or were not really learned in the first place. Now we are being reminded that there is a boogie man out there and we should be prepared to deal with it.

The human population has experienced numerous devastating pandemics. In fact, the human inhabitants of our planet have danced on the edge of extinction more than once with the population being reduced to a few thousands. Entire civilizations have disappeared, which explains the shallow gene pool. The Black Death killed about one-third of Europe’s population in the 14th century. Cholera, typhoid fever, yellow fever, smallpox and other diseases have taken their toll. Many of us remember the Asian flu of 1957-58, the Hong Kong flu of 1968-69 and the Swine flu scare of 1976. While apparently not the boogie man, they were scary enough. Hospitalizations and fatalities in the United States increased beyond the usual annual 200,000 hospitalizations and 36,000 deaths. The Avian and Swine flu outbreaks of the 1990s and 2000s are fresher memories. The point is that disease outbreaks all too common and are a hazard that we have to address.

Influenza viruses are much better understood, but flu viruses evolve and can defy medical science long enough to kill millions. We even joke about illnesses that produce flu-like symptoms – which seem to be almost every illness that we commonly experience. We now are used to hearing about West Nile virus and Middle Eastern Respiratory Syndrome or MERS, but neither seems an immediate threat to us. Enterovirus D68, the cold-like respiratory infection currently spreading among children around the world, seems serious, but not yet serious enough to focus our attention on the threat. Even less attention is being paid to the spread of dengue fever, Chikungunya and other mosquito-borne illnesses in the United States. Consequences of global warming seem more compelling.

Waugh octHowever, the Ebola virus is different. Even though it is not as contagious as measles and other more familiar diseases, it is scary. Ebola is not transmitted through coughs and sneezes. It is transmitted via direct contact with the body fluids of an infected person. But that might change if the virus mutates.

It is scary because we have now seen that the pandemic is only an airline flight away. It arrived in Texas from West Africa with brief stops in Brussels and Dulles, Virginia. Monitoring programs are being established in West African airports. It is common to see thermal scanners to detect people with fevers in major international airports and other border crossing facilities in developed countries. Despite the attendant ethical issues, it may become more common to have passengers scanned on airplanes before they disembark so that authorities can turn flights around rather than deal with potentially sick passengers.

All of this is to say that disease outbreaks do pose serious threats to us and others. Public health officials are now concerned about the threat to herd immunity caused by those who refuse to get vaccinations and/or have their children vaccinated. The antivax movement is making everyone more vulnerable. Outbreaks of diseases that have been controlled by vaccinations in the past are now posing serious health hazards and even deaths. Measles, mumps and rubella are not the boogie man, but our vulnerability to those familiar diseases may portend vulnerability to the next major pandemic.

The reality is that the boogie man, the as yet undefined threat to life, can become a real threat to our families and communities. It is a threat that is difficult to address in the same manner in which we address other threats. It may not be localized. If we experience a pandemic on the scale of the 1918 flu outbreak that killed millions of people, our local, state, and federal resources may be overwhelmed. Help may not come for weeks or months. Vaccines, if available, may be slow in coming. Human and material resources will be stretched very thin. Families, indeed whole communities, may have to fend for themselves for weeks or even months. Local emergency management offices, law enforcement agencies, public health agencies, medical facilities, private doctors, community organizations and volunteers will have to make do.

Watch what is happening in West Africa. The Centers for Disease Control and Prevention (CDC) estimates that 1.4 million people may be infected if the Ebola outbreak is not stopped quickly. Forced quarantine is being used to isolate the infected, along with their families, to keep the outbreak from spreading. The World Health Organization, with the help of the CDC, is organizing medical support. The Clinton Global Initiative is helping strengthen community resources by supporting public health workers and clinics. The answer is building community resiliency rather than strengthening centralized control. The approach is to resource the community-level efforts.

Note that the discussions of family and community preparedness in the United States have slowly moved from recommending that we all have 72-hour kits– three days of food and water plus flashlights, radios, and other supplies– to 96-hour kits or even two months of supplies. Do you have everything that you will need to get by for three days, a week or even a month? Does your community have sufficient resources to help? Is your community doing what it can to reduce the impact of catastrophic events, including developing emergency plans, mitigation strategies to reduce known risks and strategies to help those who cannot help themselves? Even if the boogie man does not appear, more resilient communities can deal better with the lesser disasters they might face.

Pandemics are cascading events. The 1918 experience demonstrated that the social infrastructure can break down when there are too few well people to care for the sick and to maintain critical services. Food deliveries can stop, garbage pickup can stop, water systems can break down, power grids can fail, and so on. The boogie man may or may not be a pandemic. There are other natural and unnatural hazards that can cause widespread devastation and disrupt the emergency management networks.

Watch West Africa and take the lessons to heart. Prepare for boogie men.  

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