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Claire Rubin, the Diva of all things disaster recovery, is on top of the latest developments, including this new CRS policy analysis report on FEMA’s Public Assistance program. Thanks for keeping us all informed Claire!
The Congressional Research Service recently released this report of FEMA’s Public Assistance Grant Program: CRS-FEMA-PA. The download is 64 pages.
This report provides a great deal of descriptive detail about the program, including the changes needed to comply with the Sandy Recovery Improvement Act. It is longer than most CRS reports. It should be a useful resource for those responsible for disaster response and recovery after a Presidential disaster declaration.
Just updating the Ebola “crisis” in the United States:
Confirmed Ebola cases diagnosed in the United States: 4
Number of those cases contracted in the United States: 2
Number of non-healthcare workers to have contracted Ebola in the U.S.: 0
Number of U.S. citizens to die of Ebola in the United States: 0
Number of foreign-born citizens to die of Ebola in the U.S.: 1
Total confirmed Ebola cases in West Africa since March 2014: 13,015 (per the CDC)
Number of deaths: 4808
Among all of the hand-wringing, grandstanding, and debate taking place over what protocols are appropriate for implementation in the United States due to Ebola, seems no one is using some fairly easy statistics that would help make the decision easier….
I will use data that is available from Medicins Sans Frontieres (http://www.msf.ca/en/faq-msfs-ebola-response-and-protocols) as the baseline. Currently they estimate they have 3200 staff working in Ebola affected areas, and the number working since March is “significantly higher”. 24 staff have become infected with Ebola, 7 of whom were international staff. Most of the individuals to have contracted Ebola were local staff who contracted it outside of MSF facilities. So 30% of Ebola cases among staff have been international workers.
Let us conservatively estimate that 6000 staff have worked to treat Ebola since March 2014. To err on the side of caution, let us also assume all 24 staff members to have been infected with Ebola were international workers.
Percentage of workers to have contracted Ebola: 24/6000 x 100= 0.4% = less than 1 in 200
This would be the worst-case scenario and assumes that every individual does not show symptoms of Ebola until after leaving Africa; AND that they all came to the United States (Remember only 1 MSF volunteer has developed Ebola after their return to the U.S.). At the most, 1 in 200 returning healthcare workers would develop Ebola illness. So if you impose quarantine you will quarantine 199 people who won’t get Ebola to catch 1 who will. Remember this is the worst case scenario: the actual probability would be much lower than this worst-case estimate.
Number of non-healthcare workers to be infected by another person with Ebola while in the United States: 0
Estimated number of contacts Ebola patients in U.S. had before being admitted to hospital: 250
Chance of contact getting Ebola outside of healthcare setting: less than 1 in 250
So, using the existing protocols where those who had treated Ebola patients in Africa would self-monitor for symptoms without any form of self-quarantine, there have been NO secondary infections in the United Sates besides healthcare workers in the hospital setting.
Neither self-imposed nor mandatory quarantines are needed at this point to protect the public. The protocols for returning healthcare workers that was in place before the first Ebola case in the U.S. works just fine. Stop worrying America. Governors Christie, Cuomo, and others ought to go ahead and ban automobile driving : they will prevent far more deaths and injuries, thus protecting public health to a far greater degree, by doing this than they will by cynically scapegoating valiant healthcare workers returning from Africa.
All is Not Well on the Good Ship “American Red Cross”: Another Reorganization and More Staff Thrown Overboard
A couple of years ago I applied to become a paid employee at my American Red Cross chapter. While awaiting word on the hiring decision, I attended the International Association of Emergency Managers annual conference, which that year was held in Las Vegas. Several of the faculty members from my Masters program at American Military University where also attending. and I enjoyed the chance to meet and talk with my instructors in person. At dinner one evening I mentioned to one of the instructors applying at the Red Cross. He looked at me and said, “Why would you want to cross over to the dark side? You have it good as a volunteer. There is someone I want you to talk to…” The next day he introduced me to someone who had experience at the higher levels of the Red Cross, and he relayed a similar message. Although I had suspected based upon my own observations, that the world of the paid staff was much different than that of the volunteers, this was the first time anyone had stated this explicitly. I ended up not getting the job, Events of late seem to suggest I should be thankful.
In case you hadn’t heard the Red Cross is once again reorganizing and cutting down on paid staff.
For anyone keeping count, I think this will make the third or fourth significant reorganization/restructuring effort in the last six years. I only became aware of this last week when a county official mentioned hearing something, and asked if it was true. Turns out it was true. The North Texas Region is losing approximately a dozen staff at the end of the month, including some of lengthy service. Red Cross apparently gave them two weeks’ notice. Isn’t that nice?
I suppose that is a little better than in 2011-2012, when most every paid employee was effectively terminated and had to re-apply for their position. Job security does not appear to be part of Red Cross culture….unless you are one of the six and seven-figure salary employees. Successful strategic planning also appears absent, as budget issues have once again been given as the reason behind the latest changes. I seem to remember writing a blog questioning the wisdom of expanding the role of the Red Cross in disaster recovery : if you are not sure you can fund ARC’s disaster relief responsibilities, why would you think it wise to add more commitments?
I am reaching the point where I no longer can, or even want, to try to keep up with all of this internal change. By the time you figure out what is going on, it is already changing again. And the lack of transparency in how these organizational transformations go from idea to reality shows a shocking lack of respect for those below by those on high at ARC management.
I hope my guess at where ARC is heading with this latest restructuring plan is just my cynicism getting carried away. The Red Cross wants to give its volunteers more of the responsibility for what has previously been done by paid staff. I think this means that volunteers will be expected to carry out providing and over-seeing the disaster relief and recovery services that are the fundamental mission of the Red Cross. Management can rely on the fact that there will be volunteers to fill service delivery needs. I expect the “professionals” who will have paid positions will be the executives, the marketing people, the public relations people, the fundraising people….not the disaster, logistics, humanitarian relief, and emergency/disaster management professionals. Many, if not most, of these paid employees will have had no experience in the field of disasters and they will do their jobs without ever having to spend a day working on a disaster relief operation. I wonder if some of them ever will.
If this is where all of these changes are heading, it will say in clear terms what the Red Cross thinks is really important. I hope I am wrong. Because if I am right, my many years of Red Cross service will come to an end.
The possibility that Ebola will mutate into an airborne virus has displayed remarkable resiliency in the news media and online, despite attempts by the CDC to put people at ease. Of course, no one should be very surprised by this, as the CDC missteps in response to Ebola in Dallas have done much in a short time to tarnish the almost unanimous respect and trust historically given to that agency. As a consequence, people appear more willing to entertain the alternative voices and alternative interpretations of the situation to fill the sensemaking void they experience once they become unsure they can trust the federal, state, and local government and health officials. These voices and interpretations range from the uninformed, to the credible, onward to the preposterous, and maybe all the way to the delusional.
Perhaps that is why the message of Michael T. Osterholmt, PhD, Director for the Center for Infectious Disease Research and Policy at the University of Minnesota, has had staying power. His dire warnings about the possibility of Ebola mutating into an airborne virus have garnered him significant media attention recently, and parts of a recent New York Times Op-Ed piece have been appearing across the internet. So on the one hand, we have the CDC saying that Ebola is not transmitted through the airborne route but you should stay at least three feet away from an Ebola patient to avoid body fluids which might be expelled (into the air) and land on you. On the other hand, you have Dr. Osterholmt, and a couple of others, warning that a deadly pandemic is but a viral replication away.
Who is right? Turns out that the messaging of both sides is inaccurate. In trying to simplify virology for those of us in the “great unwashed,” certain details appear to have been omitted. It is often said that “the devil is in the details.” This might apply even more during times of public health emergencies. Let me try my best to provide an overview of what is going on…
WHAT IS THE REAL STORY?
The distinction the CDC has drawn between airborne transmission (in the sense of a cough or a sneeze) and large droplets of body fluid being expelled and landing on someone isn’t really consistent with how airborne transmission is defined in the research literature. That the virus travels through the air is not what is of greatest importance. Whether or not inhalation of the virus produces infection is the question of greatest importance. If transmission can occur through inhalation, then it does not matter whether the virus came in the form of an aerosol, a large droplet, or rode in on the back of a dust mite blown into the air by a vacuum cleaner–that is airborne transmission. The ability of Ebola Zaire to be transmitted in aerosol form to non-human primates was experimentally shown back in 1995. The researchers wrote back then:
“Regardless, we have shown that Ebola virus (Zaire
strain) can be transmitted by aerosol in an experimental
primate model. In light of the pathogenicity of human
filovirus infections, health care personnel at risk of
exposure should use precautions to minimize the risk
of aerosol exposure while managing acutely ill haemorrhagic
fever cases of unknown or filoviral aetiology.”
At this point, you may be starting to panic as you think that just maybe the CDC has been hiding something and you can get Ebola from breathing….don’t panic yet….stay with me. In his recent New York Times piece, Dr. Osterholmt wrote, “In 2012, a team of Canadian researchers proved that Ebola Zaire, the same virus that is causing the West Africa outbreak, could be transmitted by the respiratory route from pigs to monkeys, both of whose lungs are very similar to those of humans.” What Osterholmt has left out is the fact that aerosol transmission in non-human primates had already been shown possible experimentally about 7 years earlier. Seen in this light, the 2012 findings should not be completely shocking. He also fails to mention that the researchers of the 2012 study specifically point out that the methodology of the study prevented them from any ability to determine the specific manner by which airborne transmission occurred (the distance separating the pigs from the monkeys was 20 centimeters…rather close quarters):
“The design and size of the animal cubicle did not allow to distinguish whether the transmission
was by aerosol, small or large droplets in the air, or droplets
created during floor cleaning which landed inside the NHP cages (fomites).”
You can read the actual 2012 research article here.
But the worst omission by Osterholmt is his failure to place these animal studies within the context of human to human Ebola transmission. Beginning with the 1995 research and continuing to recent articles, including this 2013 study on aerosol Ebola transmission in non-human primates, authors have repeatedly observed that there has never been a single confirmed case of airborne Ebola transmission between humans. The authors of the 1995 study hypothesized the reason for this could be that insufficient amounts of virus exist and are shed from the human respiratory system, or become airborne, to produce infection. If this were to be the case then airborne transmission would be possible but the circumstance necessary for transmission to occur (a large quantity of infected body fluid entering the respiratory system of a non-infected individual). This possibility is given credence by the fact that Ebola, even when transmitted experimentally by airborne means, is not a respiratory illness. In aerosol experiments, though there is lung involvement, the initial target of the virus appears to be the pulmonary lymph nodes where it can access the immune system and organs such as the liver and spleen. Thus, airborne transmission, at best, is a possible secondary means of infection……theoretically possible but unlikely to improbable.
To explain all of this is no easy task, and so I now think the CDC has not been trying to hide anything or attempting to backtrack on how the virus is transmitted. I think they have been trying to explain the transmission of Ebola as simply as possible to be understood by the greatest number of people. As we saw in the early days of HIV, no matter what the science says or how hard it tries to explain the details, there are going to be people who will believe officials are hiding something.
Finally, the concerns raised by Osterholmt and others that Ebola might suddenly mutate into an airborne menace…..a sensationalistic, fear-inducing load of bollocks. This requires a virus, already possessing a mode of transmission that has evolved an effective means for quickly reaching the target cells in the host necessary for the virus to replicate itself, to mutate so that a less efficient and effective secondary mode of transmission becomes its primary mode. Essentially a virus affecting the immune system would mutate into a respiratory illness. Such a radical mutation in a human virus has never been observed or documented….ever.
I suppose it is possible. It is also possible that a random mutation could result one day in the birth of pigs with wings.
So the Ebola virus has finally landed in the United States….and in my hometown, to boot! Even better, when Ebola came to town, the ER staff at Presbyterian Hospital apparently “screwed the pooch” and sent a likely contagious Ebola patient back into the community for 48 hours.
There is a bright side to look at in all of this…
If you wanted a worst case scenario with which to evaluate the likely spread of Ebola in the United States, this is the perfect opportunity. I myself am expecting perhaps one or two individuals (probably among those who were staying with him), at most, to contract Ebola from this initial case. Hopefully this will quiet any fears that Ebola is going to wipe us all out. No, there are plenty of other viral candidates out there to become the next great pandemic: it won’t be Ebola.
This is also a good chance for Public Health and Emergency Management to take notice: people do not react to possible public health emergencies the same as they do for physical hazards and disasters (with the possible exception of radiation hazards). It appears that when the threat comes to us in invisible, silent, and deadly forms, people begin to lose some rationality. This fear can make them do odd things, like residents at the apartments the Ebola patient was staying at saying they would need to move out. PH and EM officials need to take this into consideration when deciding who to tell, when to tell them, what to tell them, how to tell them, and how often to tell them. Don’t assume that everyone in the community will share in your cool, scientific, rational view of the threats.
We should also not forget the patient, who seems in all of this to have become a thing, not a person. Our thoughts and prayers should be with Mr. Duncan and his family and friends during what is most likely one of the most terrifying experiences they have ever known.
Finally, most of us should be thankful that we are fortunate enough to be of a time and place to have little to fear from Ebola. And we should have compassion for the millions living in Guinea, Sierra Leone, and Liberia, where living with the threat of death from Ebola is a very real fact of life.
The High Cost of Fear: What Has Spending Nearly $ 1 Trillion on Homeland Security Since 9-11 Bought You?
The recent activities and brutal atrocities of ISIS/ISL in Iraq and Syria have dominated the national news media and the national attention for several weeks now. I find some coverage, particularly any suggesting an army of foreign and American-born terrorists has crossed our borders and now live among us, waiting to unleash wave after wave of evil upon our nation, to be sensationalistic fearmongering of the worst kind.
Probabilities are that Jihadist Jim did not just move in next door to you.
Or perhaps it is not the probability that matters to you. The possibility that Jihadist Jim could have moved in next door is more important than the improbability this has actually happened. If this is you, then congratulations are due you sir/madam! You might have a bright future working for the Department of Homeland Security assessing terrorism risks and overseeing how billions of dollars in the DHS budget will be spent.
This period of heightened terrorism fears is a good time for the interested reader to look at Mueller and Stewart’s 2011 paper on homeland security expenditures, as well as the lack of acceptable risk analysis and cost-benefit analysis upon which to justify the expenditures. The National Research Council has also taken issue for a number of years with the methodology of DHS assessments of risk. These issues are expressed in a 2008 report on DHS’s Analysis of Bioterrorism Risks, and a 2010 report on the use of Risk Analysis at DHS.
Perhaps you think that nearly a trillion dollars spent on homeland security is money well-spent if it in any way reduces the chance of a successful terrorist attack. I think DHS needs to show its expenditures have provided us with the highest level of risk reduction in the most cost-effective ways possible. Otherwise we are wasting our money and creating illusions of homeland security.
One final thing….if you really are worried about the possibility of Jihadist Jim living next door, remember that your own coronary arteries, or All-American Bob who runs a stop sign in his SUV, are ultimately far more likely to be the cause of your demise….
The great physicist Niels Bohr once said something to the effect that anyone who didn’t come away from reading about quantum mechanics with their head spinning probably hadn’t understood it properly. I have found that, in addition to quantum mechanics, any significant time spent thinking about the nature of disciplines and how best to describe Disaster Studies and Sciences in terms of disciplinarity, also tends to make my head spin.
There is at the moment no shortage of descriptors for disciplinarity: unidisciplinary, multidisciplinary, interdisciplinary, crossdisciplinary, metadisciplinary, hyperdisciplinary, superdisciplinary, supradisciplinary, and transdisciplinary can all be found in the literature. Despite the multitude of terms, no clear, consistent, and agreed typology currently exists. So one has an veritable ocean of ideas within which to swim about. Or drown in.
Of course, there is much that is historical, sociological, political, economic, and just flat out arbitrary in the development of academic and professional “disciplines.” The quest for knowledge using systematic methods predates any attempts to make the pursuit of that knowledge the primary domain of particular individuals. So to some extent in trying to develop a logical, coherent conception of academic, scientific, and professional disciplines, we are trying to logically explain what was originally created without logic, or “big picture” in mind.
This does not mean that the concept of disciplines is of no value. It means that a degree of fuzziness and inconsistency in our concepts should be expected.
In my thesis, I assert that based upon the existence and structure of its body of knowledge, what is often referred to as “Emergency Management” involves far more disciplines than recognized. I suggest that this field/discipline is more accurately called Disaster Studies and Sciences (DSS). I am beginning to see, however, that simply calling DSS a “discipline” is more problematic. DSS is certainly not unidisciplinary and does not fit within any traditional disciplinary map of knowledge, yet it does have an organized structure. There can be no doubt that DSS is multidisciplinary but it does not appear to transcend its individual disciplines to the level of an interdiscipline or transdiscipline….
And this is the point where my head starts to hurt and I begin to think that some part of the puzzle is just out of reach…..
Imagine my surprise when I learned recently we have been living in the promise land of Whole Community Emergency Management since 2011 and somehow I had neither known nor noticed any difference!
I do not know why, but I do not recall much being made of this document in 2011, nor do I recall hearing much made of it since then. I still hear about the National Response Framework, National Incident Management System, and even occasionally the National Recovery Framework….but what has happened to Whole Community Emergency Management? Was it really meant as a paradigm shift, or simply meant to give the appearance of a major change in approach to federal emergency management?
I don’t know the answers to these questions, but something seems just a little suspect when FEMA starts coining terms to promote their “NEW!….IMPROVED!” emergency management. We already have Comprehensive Emergency Management, Integrated Emergency Management, and even (if you pay attention to what is going on in other parts of the world…) Integrated Disaster Risk Management: do we really need another? And if I wasn’t already suspicious enough, there seems to be something rather strange about FEMA claiming the idea of community-based emergency management as if this is something new and original, when scholars and researchers have been advocating community-based approaches since before there was a FEMA.
Would I be alone in thinking there is something amusingly odd, even ironic, about FEMA teaching “bottom-up” emergency management to state and local emergency management? But there will be nothing amusing to those at the community level, who have embraced and put their energies into collaborative programs of emergency and disaster management thinking this is the change they have waited for, when they discover that this new and improved version of emergency management did not come with systems to make state-level and federal level assistance faster and more responsive in addressing their needs. Go ask some of those still rebuilding after Sandy how responsive this Whole Community Emergency Management has worked out for them. Or could it be it no longer applies after the disaster strikes?
The simple fact is that calling EM “Comprehensive” or “Whole Community” or whatever catchy term someone with marketing flair thinks will catch on does not mean very much. What you call your version of EM isn’t important. In any form of professional practice, what you call the approach is not what matters. I don’t care what name my lawyer or my surgeon gives to his particular brand of lawyering or surgery: I want him to know what he is doing, and to do it well.
I don’t care what it is called, the important question is whether it is “good” emergency management, both in idea AND in practice.
In case you needed a reminder, I am rather liberal in my temperament, Democrat in affiliation, but increasingly more libertarian in what still remains of my interest in political philosophy. Increasingly I find politics and politicians, regardless of party, maddeningly insulting in their over-simplification of complex issues and unwillingness to embrace compromise. Decisions seem to be guided more and more by appeals to the mob, and stubborn, and out-of-touch, if not completely nonsensical, ideological stances that have become more and more inflexible with time.
My girlfriend is pretty much a tea party conservative. The future longevity of our relationship will likely be inversely proportional to the number of hours we discuss politics (just kidding sweetie…I love you, Fox News Channel and all :-)….)
Last night, however, I did give in to her recent request that we watch Sarah Palin’s recent CPAC address together. And about halfway through her speech, Sarah’s speech-writer just had to do it….reduced climate change and sea-level rise to a half-a-sentence punch line for an Obama joke. I was not amused, and attempted to explain to the love of my life, as I have to my ultra-conservative family members and others, that from an Emergency Management point of view, the climate is changing and it is going to have an effect on our country…and the effects will happen whether you “believe” in climate change or not (for many years a lot of smokers chose not to “believe” the body of accumulated medical science that showed cigarette smoking could kill you- for many that choice not to believe in the science can be reasonably argued to have contributed to their eventual deaths from cancer, COPD, heart disease, and other smoking-related illnesses).
Identifying and rectifying the root causes of that climate change is on the whole mostly inconsequential to the Emergency Manager. Emergency Managers, a majority of whom likely have conservative rather than liberal leanings, could care less if it is greenhouse gases or Martians causing it–the scientific consensus is that it is coming and we need to prepare for its possible consequences. Even if some of the effects are less than predicted, there are things in this world being over-prepared for is a far sight better than being under-prepared….especially if you are responsible for a coastal community.
My girlfriend was not amused.
But the truth appears to be that larger and larger numbers of conservatives are beginning to tire of the official stance of climate change denial and downplay used by many conservatives, especially those of Tea Party sympathies, as has been noted in several articles, such as this 2010 NY Times, and this 2013 National Journal article. It should be telling us something important when a noted conservative economist (Arthur Laffer) and Al Gore agree on something about climate change: some (many perhaps?) issues and one’s stance towards it, have nothing to do with whether you identify yourself as liberal or conservative. It does have something to do with whether you are a rational, reasonable, and thoughtful type of problem-solving individual; or whether you are an anti-intellectual, anti-science, if-I-hide-my-head-up-my-ass-I-can-believe-whatever-I-want-to-believe-and-its-true type of person.
On the positive side, if you are a doubter of climate change and you are wrong, it is unlikely to be of much consequence to your life…..it will be your children and grandchildren who will be paying the check you left sitting on the nation’s table….