# 2815
Gathering dust on shelves, or hidden away in desk drawers, are hundreds . . . perhaps thousands of pandemic and all-hazards disaster plans for cities, agencies, and the private sector.
Many are impressive looking.
Some are produced in-house, others are commissioned works. Thick presentations, filled with charts and graphs, four-color printed on glossy paper, with an embossed cover. One hundred . . sometimes two hundred pages or more in length.
What Mayor, agency head, or CEO wouldn't be proud and comforted by having such a plan? After all, there is much comfort in the idea of being prepared for a disaster.
Unfortunately, peace of mind may be the only thing these plans are good for.
And that may last only until a crisis begins.
All-Hazard disaster plans are vital for every organization, of course, but they don't cover long-term events like pandemics particularly well. Too often they assume that outside help will be arriving in a matter of hours or days.
You can't just use your hurricane, flood, or earthquake plan as boiler plate - replace a few words - and call it a pandemic plan.
Well actually . . . you can. It just won't do you much good in a pandemic.
Over the past few years I've seen more than a few pandemic plans, both from the public and private sector. Most came from the United States, but some have come from Canada and the UK.
Some look pretty good, at least on paper.
And I'm comforted to see some organizations actually testing their plans, and making adjustments to them.
The annual Coyote Crisis drill held in Scottsdale, Arizona is a great example (see Scottsdale Arizona: Pandemic Drill) of entities creating, and improving, on disaster plans.
But far too many of these plans are static documents, sometimes cobbled together without a lot of real thought. They get read once (maybe) by the CEO, signed off on, and then relegated to the bottom drawer of their desk.
Without testing, employee training, and ongoing modifications, most disaster plans (pandemic or all-hazards) are going to come apart like a $2 watch during a crisis.
I know there is much disbelief, even among some public officials, that a pandemic could happen on their watch. And if one does happen . . . why this is the 21st century! . . . it surely couldn't be as bad as some people have predicted.
With two relatively mild pandemics in the recent past (1957 & 1968), for many, envisioning a 1918 style pandemic - or worse - simply doesn't compute.
And so testing and revising pandemic plans (assuming they even have one) comes very far down the CEO's, and some local and state agency's list of important things-to-do.
All of that, after all, costs money, and is disruptive to the day-to-day operations.
Having a written plan is a great first step, but without extensive testing and modification, it is the equivalent of a Boy Scout helping a little old lady halfway across a busy street.
It not only doesn't get the job done, someone's likely to get hurt.
A few of the common shortcomings I've seen in some of these plans include:
- Overly optimistic assumptions on the severity of a pandemic
- Over reliance on human resources that may not be available
- Dependence on resupply of critical materials during a pandemic
Point 1
Overly optimistic assumptions on the severity of a pandemic
You might be surprised to know that while the HHS & CDC released recommended assumptions about the severity of the next pandemic - that not every state accepted them.
Here are the base assumptions as found on the HHS's pandemicflu.gov website. It lists the assumptions for a `moderate pandemic', and for a `severe pandemic'.
In terms of mortality and morbidity, the severe scenario is roughly 10 times worse than the moderate one.
Last summer the Minnesota Department of Health and the University of Minnesota Center for Public Health Preparedness held an ethics seminar on pandemic planning.
Ethics in the Worst of Times: Rationing to Protect the Public's Health during a Severe Influenza Pandemic
This event took place on June 5, 2008.
One of the slides used in the presentation depicts the assumptions states are using in their pandemic planning.
Roughly 20% of our states (orange) are preparing for a severe 1918-style pandemic, while 20% are preparing for a moderate (some might even say `mild') event (white).
For the remaining 60% of our states (gold), the severity level they are preparing for is ambiguous.
This graphic also appears in the powerpoint presentation by Dorothy Vawter, PhD. entitled Age-Based Rationing in a severe Pandemic. This chart is current as of Sept.2007.
While no one can know what the next pandemic will bring, the U.S. federal government has adopted the attitude that it is prudent to prepare for a severe 1918-style pandemic.
Incredibly, some states aren't even using the `moderate scenario'.
The upshot of all of this is that if we see a severe pandemic, tens of millions of Americans will reside in states that only prepared for a mild or moderate event.
Point II
Over reliance on human resources that may not be available
Sadly, some plans depend heavily on resources that very likely won't be available, which just about ensures that they will fail. Like expecting the local or state law enforcement agencies to provide security or manpower for your agency or business.
Last year, Lt. Joseph McClellan of Alabama's Homeland security agency warned that too many other agency's plans called for support from Alabama State Troopers.
There aren't enough state troopers to fill those spots," he said. Those plans need to be changed.
Police, Fire, EMS, and Hospital workers will all be heavily impacted by a pandemic. At the same time that their workload is going up, their numbers will be going down due to illness, family responsibilities, or even death.
Those on the front line will be going in harm's way far more than the average citizen. Plans that include calling on them to do `extra duty', like providing security at a hospital, or setting up ad hoc flu hospitals may collapse very early in a pandemic.
Few agencies, or companies, have cross-trained their employees to be able to fill in for employees out due to the pandemic.
How many companies would have to shut their doors if they lost their accounting staff, IT team, or payroll clerk for the duration?
While it is possible to operate many entities with a skeleton crew, at least for a time, it won't happen unless people are cross-trained before a crisis begins.
Point III
Dependence on resupply of critical materials during a pandemic
According to Minnesota's Health Department, there are enough N95 masks stockpiled - if reserved exclusively for health care workers - to last about 3 weeks into a pandemic wave.
How Health Care workers will be protected once those are gone, is a big unanswered question.
It does conveniently give HCW's enough time to tender their two-week's notice before the masks run out, however.
Getting resupplied during a pandemic could be very difficult, and perhaps even impossible. Particularly those items that the entire world will be clamoring for in a crisis.
PPE's (Personal Protective Equipment), vaccines, antivirals, antibiotics . . . all may very well become scarce during a pandemic. All easily understandable.
But since a pandemic could last a year . . . or even two, eventually even more mundane things may become difficult to obtain. There are real questions about the timely delivery of food to grocery stores, or prescription medicines to pharmacies.
Items seen as less critical for the public good, such as spare parts, offices supplies, or other `non-essential' items may very well get the lowest priority when it comes to shipping.
Pandemic plans that depend upon a fully functioning supply chain may need to add, ". . . and then a small miracle occurs . . ." , to the top of each page.
If your agency, or business already has a pandemic plan, great! At least you've started. You have a base to work from.
If you don't have a plan yet, its well past time to get cracking on it.
But if you want it to be worth more than the paper its written on, you need to make sure that:
- The assumptions are reasonable. Don't plan on taking a knife to a gun fight. Use the HHS's severe scenario as a minimum.
- You don't presume that you can call for help from other agencies or businesses whenever you need it. If it happens, well . . .you got lucky. And you should definitely try to help others out as well. But during a pandemic, everyone will be faced with the same problems that you are.
- If your pandemic plan calls on you having supplies, like PPE's, or antivirals . . . you'd better be getting them now. Once a pandemic begins, you will be in competition with the entire world for a limited supply of items.
- You consider your pandemic plan to be a `living document', one that requires testing, revision, and practice on an ongoing basis. Every drill and every test is an opportunity to improve your plan.
There is a very old joke, about a tourist lost in Manhattan, who asks a local, "How do you get to Carnegie Hall?"
The local replied, "Practice . . Practice . . .Practice. . ."
The same advice applies to how you end up with a good pandemic plan.
Practice . . Practice . . .Practice. . .
To get started, visit the HHS's pandemic planning page. There you will find toolkits designed to help begin the process of creating a plan. You can also check out Pandemic Toolkits: You Don't Have To Start From Scratch
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