2007 SUMMIT COVERAGE: CDC chief calls pandemic preparedness a marathon

Feb 6, 2007 (CIDRAP News) – Orlando, FL – Julie Gerberding, MD, director of the Centers for Disease Control and Prevention (CDC), today challenged health and business leaders to stay focused on the "marathon" of preparing for an influenza pandemic.

Gerberding, speaking at a conference on business preparedness, said it's not possible to maintain high public interest in the pandemic threat indefinitely, but leaders must keep preparing anyway.

The question for planners, she said, is "How do we run this marathon when we're living in a society that only wants to sprint?" Gerberding spoke at "Business Preparedness for Pandemic Influenza: Second Annual Summit," sponsored by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News. The meeting drew leaders from about 200 companies to Orlando, FL.

To suggest why the pandemic threat represented by the H5N1 avian influenza virus is taken so seriously, Gerberding recalled how SARS (severe acute respiratory syndrome) put the world on edge in 2003.

The disease spread internationally after several people became infected while staying on the same floor of a Hong Kong hotel as an infected man from China. Despite the dramatic way it crossed the world, scientists learned that SARS "is really not very transmissible," Gerberding said. The incubation period and the generation time between cases are long, and the attack rate (how many exposed people become infected) is very low.

Flu, in contrast, has a very short incubation period and a high attack rate, and people can transmit the disease before they feel sick, she said. "Think about the reality of trying to quench an influenza outbreak given those numbers and the connectivity of the world. It's a very, very daunting challenge."

In discussing the difficulty of maintaining focus on a health threat, Gerberding also recalled other threats that have seized the attention of the CDC and the public in recent years.

For a year or so after the anthrax attacks in the fall of 2001, the hot topic was "anthrax, anthrax, anthrax, anthrax" and terrorism preparedness, she said. "And finally someone said, 'Let's change the subject,' and what did we talk about next? Well, smallpox, smallpox, smallpox, smallpox. We moved from one topic to another without recognizing that we needed an 'and' in that sentence."

Gerberding said the CDC has come up with a list of 1,600 tasks under the heading of pandemic preparedness. The recent publication of guidance on community mitigation (nonpharmaceutical) measures was just one of those.

To stay on task, leaders need to overcome complacency—their own, if not the public's. "What we have to do here is accept human nature and reality," she said. "We're not going to be able to keep this issue in the news indefinitely, or on everyone's plate. But . . . it's our responsibility to keep this issue moving forward so that when people back away from it, we don't."

Preparedness requires careful planning—distasteful as it may be—followed by exercises to test the plans, Gerberding went on to say. Last week the CDC conducted a major exercise that was very instructive, she said.

The 24-hour live exercise—not a tabletop simulation—involved about 1,000 people, with 150 people staffing the CDC operations center. The drill required officials to make decisions about whether to declare a public health emergency, how to explain the difference between an emergency and a pandemic, and whether to change the handling of sick airline passengers—which would have immense effects on the travel industry.

"As we struggled with the decisions we had to make, there was not a bone of complacency in anyone's body," she said. "We learned why it was so important, why it was hard. . . . It really made the situation real." The exercise was opened to the news media, in part so that reporters would understand the seriousness of the risk and not become complacent themselves, she added.

"We thought it was a tremendously successful exercise," noted Gerberding.

The agency is planning to follow up with another exercise involving both federal agencies and state and local public health, she said. Further, "In May we'll exercise an even broader group of people in Atlanta, on the premise that the pandemic has arrived in Atlanta and CDC is functioning with a 40% loss of its work force."

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