This presentation includes a discussion of the five factors influencing an increase in the frequency, scope, scale, and impact of pandemics (and other major disasters). Also discussed are initiatives that may enhance our collective “posture of preparedness” for the health care and public health sectors. This event was organized by WADEM’s Student and Young Professional Special Interest Group (SIG).
if for a quick comment uh because it’s uh it should be pointed out that amongst the federal partner agencies uh only the Department of Defense uh mince breeds uh trains and provides a full career path uh to uh people who uh are titled as medical planners uh and part of the reason why I became so heavily involved in the post 911 ERA with so many of the Strategic level plans that were created for the United States to respond to high-end incidents of national significance uh were brought to the table in the dod uh for us to help uh the agencies uh address at the most senior level uh so with that in mind uh I’m going to take my perspective now with some 35 plus years uh in this space of medical planning uh primarily for uh not only incidents of national significance that occur on the terrorism side uh but also large scale disasters and especially disease events that uh could qualify uh as pandemic so with that in mind let’s go all right we’re not advancing let’s try this here we go so here’s the the normal statement about uh attribution everything that you see today is available for attribution I would respectfully ask though uh That You observe the fact that the material is copyrighted because I have published uh most of it in one form or another either in book chapters or peer-reviewed uh journals uh so if you’re going to use it I request that you at least appropriately represent me as a reference uh I need to say for the record doe that these uh comments today uh represent uh my opinion and my opinion alone and are not to be construed with the three organizations that I remain uh principally involved in uh that being the George Washington University uh the New York state division of military and Naval affairs and the Marshall Center for European security studies so I thought it would be a good idea to start off with uh creting a definition uh for pandemic and I put the question mark up here against the the title of the slide uh because uh one could argue that in the the last 25 years especially that that defin definition has has had its own sliding scale a lot of it being driven uh by the politics of Public Health that we uh seem to have to wrestle with on a fairly frequent basis now U so with with that in mind uh we started hearing about pandemics in the general population I would suggest around the 2005 and 2006 time frame when we started becoming very concerned about what everybody should be aware of now uh and that being the Avan flu uh which is the h5n1 variant of human influenza A uh we’re going to talk about that in in in some uh deeper depth uh more further into the presentation today but according to the the standard Marian Webster college dictionary definition uh the word pandemic is derived from the Greek pandemos which means for all of the people uh the broadest definition definition is that a pandemic is a disease event that covers a very wide geographic area and affects an exceptionally High proportion of people uh other acceptable definitions that we’ve seen uh emerge uh the last one being the one that I think prior to 2005 and six was the most generally accepted definition uh that it’s a disease outbreak that has spread simultaneously to three or more uh continents around the world uh and could easily be qualified as an epidemic that is occurring uh worldwide uh we again are going to talk about this notion of how fast diseases spread uh why we have more concerns about pandemics uh in the modern age uh and how that definition uh is is changing sometimes on a on a very quick basis but with that in mind let’s get the uh the the big elephant in the room out of the way first and that’s small poox uh throughout the presentation today you’re going to see uh the covers of various books that I offer as exceptional uh references that you might uh consider uh doing or looking at uh one of them is uh this book that uh came out I believe in the 1986 uh time frame written by Donald Hopkins um it’s a tremendously good history uh a lot of numbers and and the numbers are one of the things that’s important to to know about small pox uh in the first place I maintain that small pox is one of the diseases in all of history that might be qualified as as being an ongoing p pic that has lasted for more uh than two Millennia uh it certainly meets the requirements of the definition uh that it is occurred while it was still an active disease amongst the human population uh on more than three cont continent simultaneously at almost all of the given time uh that small pox was still endemic to the human population the very earliest evidence of the disease that we have dates back to before 2500 uh in the Common Era uh that’s part of the early Egyptian dynastic periods we got the evidence of uh small pox outbreaks uh mainly from our colleagues in the field of egyptology who in the course of uh uncovering some of the bu buried pharaohs uh and various mum mummies that were left behind by the great Egyptian civilizations notice that uh some of the oldest ones uh of the mummies had very readily apparent small poox scars or the classic pitting that you normally see on a smallpox small poox victim’s face um it was as I mentioned emic on every continent U and reported by virtually every major civilization uh that has has come through uh the course of of time uh in fact it was such a big deal to many of these civilizations that they created Gods uh not only uh of it it in its honor but also in its fear uh many people created these Gods with the the sole purpose of of praying to them uh to reduce the horrendous suffering uh and death that normally came with this disease if you know nothing about small pox if you’re starting off on a Greenfield slate if you will about it it’s it’s one of the nastier diseases that the human if not the nastiest disease that the human race has suffered through and with uh for all of this time uh creates unbelievably horrible and painful um symptoms and side effects uh and it kills uh roughly between 20 and 30% uh of its victims that is what we refer to by the way as the CFR or case fatality ratio uh the numbers over time are nothing short of Staggering if you read this book uh and again don’t caught up don’t get caught up in in just the numbers that Dr Hopkins uh is presenting what you what you realize is that cumulatively as you go through the pages and it’s broken up by uh the sections of of the the world and some of the great Empires that have had records of small pox uh to say that small pox has affected and killed uh in in the billions is not understatement uh it’s it’s absolutely true uh and because of it wars were lost empires have ended uh some argue that the great Athenian uh Empire uh for example during the pelian war as sort of a starting point of of its impact on History uh was one of the countries or or Empires that small pox helped precipitate uh its Decline and fall uh so this has been with us for a long time and this is one of the overarching themes of my presentation today uh about how much disease and public health issues are are more than than just a medical and Public Health issue uh alone uh that they have in in impactful societal geopolitical economic uh and Global uh impacts that have uh in course small Fox literally changed the course of history uh and as we’ll see where we’ve had other events over time that have virtually done uh the same thing so with smallpox out of the way uh let’s start our discussion with influenza uh if only because uh I I said in in the uh the prequel or or overview of of this presentation today that we were going to look back over pandemics in history uh but only in about a hundred-year time frame uh this is another great book that uh everybody in the medical and public health field uh should have uh Dr RS Bray uh was a British uh medical historian uh not a physician of PhD uh Who provided one of the best if not the best uh overviews of of what disease has done to the human species and the great civilizations uh over time uh he points out that the very earliest historical records related to uh influenza uh occurred in Sicily uh uh in the uh last Millennium before the Common Era was referred to as the sweating sickness then uh we know that there were six uh major outbreaks uh major epidemics that occurred in the Roman Empire uh which started small in the Italian Peninsula and by the time they reached their Apex uh before the the fall of the Roman Empire with Marcus aurelus uh there were six additional outbreaks up into uh the 900s ad uh that uh were historically of note uh more generally accepted dates for uh pandemics start around 1170 uh with more than 300 outbreaks in Europe through 1875 uh the term itself comes from the French grip uh or gripper meaning seizure or grasp or hook if you’ve ever read you know some of the books uh by uh people like John Barry and Gina colada that I’ll talk about uh in a minute that exclusively covered flu uh that grip will make sense because there’s anecdotal reporting especially from the 197 1918 and 1919 pandemic uh where people would be standing on the corner of a street suddenly turned acutely cyanotic uh collapse uh and die so it was if someone unseen had grabbed their throat restricted their ability to air uh to oxygenate uh turned them blue and and immediately caused a rapid deceleration to uh death the first time we we see the word influenza actually or something like it comes from around 1580 uh in Florence during another major outbreak or epidemic that Dr Bray uh covers uh influenza by the way in this particular book just to give you a note on how important it is in terms of its impact in history is the only disease amongst the many he covers uh that has two separate chapters uh devoted to it so that’s a marker right there for its significance uh with that in mind we’re going to go right to the uh the 1918 and 199 influenza pandemic which was uh erroneously called the Spanish flu I’ll come back back to that in a second this was considered the single deadliest dise disease outbreak uh in recorded history uh the nearest comparison uh for those of you who like history and and follow its uh course you know in the the realm of Public Health would say well wait what about the black plague uh which occurred in 1346 and 1347 uh that killed an estimated 75 million people worldwide uh mainly in uh Central northern and southern Europe and um uh the near East um but the mortality uh for the global impact of the 19 18 and 19 uh influenza pandemic started at around 22 million people uh when they were uh doing look backs on on the Eminem or morbidity and mortality in the 1920s and 30s uh but Oakridge did a significant oakd being the n one of the National Laboratories uh did some very significant modeling in the uh early 2000s uh right around the time we were becoming very concerned with uh the rise of the number of cases of Aven flu um related to h5n1 and they believe it’s closer to a 100 million people uh relative to the number of deaths uh that were caused by this uh worldwide globally the attack rate of the entire human population uh was between 40 and 50% uh keep this number in mind at the time of the uh Spanish influenza the global population was 1.8 billion I’m going to come back to that uh and I’ve already mentioned this notion of the case fatality ratio uh for the um Spanish Flu was between 0.5 and 1 to 2% globally although some of the the populations who had never had an exposure before uh such as uh the Samoan Islands and some villages in es in the above the Arctic Circle that were home to Eskimo populations or indigenous uh Indian populations in that region uh had mortality uh that went up to between 25 and 100% of the population uh because they were a Greenfield population they’ had never been exposed uh to this type of disease before uh and when it whipped through their population it was a uh major killer uh there was a previous pandemic in 1889 uh and 91 uh that had three distinct waves I I always found the how they qualified these waves uh in history and these These are the actual terms that they use the first wave that occurred between February and March of 19 18 was considered a bad wave uh the second wave that occurred uh started in the late summer uh of 18 August through October was a really bad wave actually John Barry writes in his book the great influenza that it was a really really bad wave uh and then the February uh 2019 by February 2019 uh the third distinct wave was labeled a resolving wave when people started to demonstrate uh Global hert immunity against that particular strain uh remember at the time uh although uh we did have uh vaccine available as a process uh back from the late 1700s uh as discovered by Edward Jenner using small cowpox U to um first inoculate and later vaccinate people uh there was no vaccine available for uh any type of influenza uh at this time uh so that was not a solution to help reduce uh its overall impact as a progress to the human population I mentioned already that it was erroneously thought to have originated in Madrid Spain and hence its dubbing or title as the Spanish flu or the Spanish lady that happened uh because of what was going on uh at the time and here’s what we’re really going to start factoring in uh history if if you’re a good historian you’ll know that in 1918 uh we were pretty much at the Apex of World War I uh at once time considered to be uh the war to end all wars I’ll come back to that in a few minutes in fact uh the outbreak or the index case or initial index cluster uh occurred here in the United States uh at an army camp called Camp Funston uh in the state of Kansas uh why it ended up getting this moniker of Spanish flu or Spanish lady is hypothesized to be over the fact that uh most of the Allied Forces uh that were being sent to Europe to do battle with uh Germany uh were massing in Spain uh and some of the countries uh west of the masino line uh at the time which was largely in in central France that separated where the the the Germans were fighting uh the Allied Forces uh so because the the cluster grew most significantly with all of these people who were waiting in Spain to be deployed to the front uh originally many people thought that that’s where uh the flu had originated but we know now uh that that was not the case uh the Spanish Flu outbreak was caused by the H1N1 variant of influenza A uh and the flu in this case uh caused what’s known as the cyto kind storm uh in the healthiest people um because uh first of all a cocine storm is for lack of a better or more complic complicated way to explain it is is really your your immune system run a muck uh when challenged by some sort of pathogen uh it sent uh the immune system into overdrive and people would end up having a very rapidly develop developing fulminating uh viral pneumonitis that would progress to respiratory failure uh and death uh if you’re um knowledgeable about flu in the first place seasonal flu uh usually affects the Pediatric populations uh the worst and the geriatric populations the worst that means our very youngest and and and oldest populations many of whom uh had um had copathology that uh would um not be helpful if they were faced with some type of immunological threat in the first place but in this case the the healthiest population the 18 to 45 demographic was the group that really was hit the hardest in terms of not only morbidity but mortality and the general rule of thumb with with the influenza A um pandemic in 1918 and 1919 was the healthy you were uh the worst that this was going to be and that has carried over for the same hypothesis in terms of other 20th century uh pandemics and any uh future pandemics uh that we have uh just kind of a a tongue and cheek note I was I was giving a presentation uh along this line uh to a fairly large group one day and I saw a woman who was in one of the front row seats who was actually squirming in discomfort about hearing this and uh I I hear her say a little bit above under her breath is man I’m G to I’m going to start smoking and drinking heavily tonight and apparently she was a a runner who you know was working hard to keep herself safe and healthy but when she heard about this you realized that those efforts might be the very thing that would cause uh an individual’s demise uh the flu was diffused uh quote unquote as fast as a man could carry it uh in most of the literature uh and at the time I want you to think of what the most common lines of communication which is a a euphemism kind of for uh how the military refers to lines of Transportation it just means that this is how people got around at the time the predominant ways of people moving around the world uh both intercontinentally and intercontinentally were ra and Maritime platforms uh respectively uh so if you think of about that both of those move relatively slow compared to Modern forms or modalities of of Transportation uh and we’re going to come back to this because this is a very very important point about uh future concerns for pandemics uh and major highly pathogenic and virulent disease uh outbreaks uh I also want to point out that uh because uh we used Rail and Maritime platforms especially at the inter in Intercontinental level uh the the use of quarantine was much much more effective uh than it is now in fact there’s healthy argument going on uh to this day especially in the wake of the recent covid-19 pandemic uh about the utility of of quarantine uh when we’re looking at a highly again virulent and pathogenic disease that is spread largely by particulate respiratory uh matter uh where people have a latency period where they remain in asymptomatic uh so with that in mind you can throw out the notion of containment because people will break the containment barrier before you have uh enough significant notice of uh the spread of an outbreak from any recognizable index cluster or case uh and hence the same would apply uh to quarantine by the time uh we would impose quarantine mainly at the lorals or or ports of Entry uh into our country R uh the utility of of the the initiative might be uh self-limiting uh by the way for for future reference This this term par that I’ll use uh pretty frequently in this discussion stands for population at risk it just refers to the the population at large that might be affected by any significant disease to say that the impact of of the influenza pandemic uh in the early 20th century was profound is gross understatement uh and here’s just a couple of pieces of uh the taale of the tape as they say in the boxing world first off it killed more people than the entire first world war which again as I noted earlier was was labeled the war to end all wars uh and this included both the military populations that lost their lives and the civilian population which was in fact much larger uh than the the actual military uh Personnel who were engaged in the war directly uh the numbers totaling about 40 million uh but even those might be slide slid a bit to the right some people argue that that could be as much as as 60 million andess it was a lot of people and it had a horrific effect on on the world at the time it occurred some historians have argued that uh the outbreak was so bad that it actually led to the German capitulation uh at the end uh and the end of the first war which is one of the first times uh in in at least recent history uh that see uh the geopolitical impact of a disease event uh that’s having an effect uh in the global uh National Security uh Arena uh again I keep noting that I’ll come back to things but this will all tie together as as we progress uh but despite its historically unprecedented impact the 1918 and 1919 pandemic uh is sometimes referred to as the Forgotten pandemic uh for a couple of reasons um even without historical precedent very little referenceable material of the event in any genre whether that be non-fiction historical fiction or historical uh narratives uh that give a contemporaneous uh overview about what was happening in near real time during the 18 and 19 uh pandemic um but as we’re going to see in a second this lack of a good accounting is that that occurred is is not by Serendipity uh or pity of interested historians uh this was very purposefully done primarily by a single individual at least here in the United States I throw up the the the covers of these three books because uh from at least a fiction perspective uh if you are um a library person who goes and and and likes to look around for pertinent subject material in areas of Interest like pandemics these are largely the only three uh that you will find uh as prominent uh historical fiction uh Pale Horse and pale rider probably being the most famous by kathern Anne Porter pretty short book uh and Thomas which was written in the 1920s Thomas Wolf’s uh fiction work of fiction lomr Angel which was written later 1930s uh but involved uh the impact on a town and a particular family while the influenza pandemic was going on uh the last town on Earth is a is a late 20th century I’m sorry early 21st century uh work work of fiction uh written by Thomas Mullen that kind of follows uh Wolf’s uh approach to it in in providing historical fiction but back to my my point contempor contemporaneously there just wasn’t that much on the time or at the time until uh the authors Gina colada and John Barry uh published these two books in 1999 and 2004 uh Gina uh in 99 and and Barry um in 2004 uh that gave their uh historical accounts of the pandemic uh I would argue both first of all these are both very very good books um John Barry’s book is um tremendously uh important uh in the field of pandemic studies uh influenza studies and understanding uh the impact uh about major disease events uh and what it does to both entire societies uh like the United States but also uh the global Society at large um both of them uh should remind us that uh it was it was it was in the cover of the very first book I I was given when I I went to boot camp and the Navy I’m prior enlisted uh called history and traditions of of the naval Service uh in the front cover was this quote from Alfred de man who was the gentleman who is considered to be the founder of the US Naval War College or Graduate School uh for uh the study of war in Newport Rhode Island uh he said the study of history is the basis for all sound decisions the actual quote is all sound military decisions but you get get my point here probably the more recognizable quote is from George sanana who said that those who cannot learn from history are doomed to repeat it uh and they’re appropo quotes to put up because there is much to learn uh about what happen happened in an event of this magnitude just a 100 years ago which was not that long ago uh Barry’s uh book in particular uh is a very useful examination of what the pandemic uh did uh and as those lessons may be applied to pandemics that might have occurred uh prior to covid-19 but certainly before any other large scale mainly influenza pandemic uh happens uh and some of the issues to to look at that you’ll see flow right into the covid discussion are President Wilson and the adequacy of the government’s crisis Communication in a nutshell Wilson was the individual that respon that was responsible uh for basically ordering um a um silencing of the coverage of the pandemic uh in print journalism um and any other media that was available at the time remember we were still in the infancy of of of our radio uh Communications in terms of spreading news uh television did not exist uh yet at the time uh so people mainly got their information from newspapers uh and written print material but Wilson’s concern was uh related to the argument that the Germans actually capitulated because of the impact of uh the influenza pandemic Wilson didn’t want uh our foes uh in in Western Europe that we were fighting uh the first quote unquote world war against uh to know just how significant the impact of the outbreak was on our military forces uh so he basically imp placed a gag order uh on things and and that may have been good for national security reasons uh it was not uh good at all in terms of the government being able to provide good crisis Communications uh to advise people about strategies for lessening the impact uh on of the disease on them their families and their communities uh and the impact of course as we know was enormous especially on the medical and Public Health Resources that were available then you see this picture right here uh which you know if we could colorize that and and turn it into a modern picture would may have been one of the the uh alternate care facilities or or sites acs’s that we were forced to uh create uh as search capacity resources uh to deal with the large influ influx of the number of patients uh who were in demand of uh support and Care uh during their illness uh we learned a tremendous amount about uh volunteerism and how the Red Cross and other like non-governmental and private volunteer organizations uh could help especially in terms of taking on some of the roles uh in the surge demand that our healthc Care Professionals were unable to provide I’ll talk about that more in a bit uh John Barry suggests in his afterward which he will tell you personally is the part that you should read of the book If you don’t read any other part of the book uh because his afterward talks about what our main concerns in a monitor pandemic would look like uh and actually underscore most of this presentation in terms of the recommendations that I will make but he argues that amongst all of the uh the areas of concern and I put these in a nice bin that I I’ve I’ve called in the in my own contribution to the literature the eight pillars of catastrophic casualty care those being search capacity demand patient movement and Transportation uh medical Logistics and Supply Mass fatality management psychosocial support to affected populations managing special needs populations managing Public Health crisis Communications and managing the graceful degradation of the standard of care uh of those eight um besides the highly recognizable one uh John argued that uh our biggest uh shortfall and potential Achilles heel uh of of things going very very south uh at least from the perspective of public opinion uh and our view of government is the mass fatality management Mission people do not want to do this uh and we are not uh architected in our current critical infrastructure and key resource sectors uh to do Mass fatality uh management because there’s no organizations or people who really specialized in in this space um and I would argue because many people have said well what about the military you’re used to dealing with large numbers of deaths not at the level of of where you’re having uh corpses having to be stacked up like firewood uh on street corners uh like they were in 1918 and 1919 the majority of of our uh fatality management resources are in the ferary industry uh and those uh occur at at the city town and and local level and are not used to dealing with more uh most funeral homes do not have more than four to five uh deaths per month in their Community to deal with uh so when you get spikes in these numbers this is a really problematic uh issue and every already talked a bit about the utility of quarantine uh and containment but here is when uh the term social distancing Sheltering in place uh and enhanced hygienics really come to the for uh as the means uh to try and and limit uhu or reduce the spread and transmission of the disease so I’m gonna kind of shift here for a second I wanted to show you might think we’re going back to small pox we’re not uh but this is kind of an intro uh slide and picture uh really that I thought was effective for us to consider in terms of the covid uh the recent covid uh outbreak uh and the number of people uh who in engaged in in what I can only qualify as a phenomenon um of being an antivaxer what you see here is two young boys who are both the same age as the slide notes they’re 13 years old uh this picture was taken in 1901 uh in Great Britain uh at the time uh you’ll see in the footnotes that uh like uh many other countries throughout the world who were uh learning to enjoy the benefits of of vaccine uh to prevent uh small pox and reduce its spread markedly uh against what had occurred previously in history uh this was mandatory uh meaning it was it was illegal not to have your children uh between largely the the ages of 12 and 18 months vaccinated with the small pox vaccine in hopes of preventing it becoming a a a community uh state or national issue uh unfortunately we have no record of how this turned out out for this poor young man on the left but as I mentioned earlier uh the mortality associated with with small poox throughout history has been pretty static uh between 10 and 20% of those infected uh some will argue now that that might be higher uh in a modern uh outbreak that occurred uh under what da Henderson the gentleman who was credited with the eradication of this of small pox during the who campaign of the late 1960s has termed uh a global Greenfield population because we don’t vac vaccinate anymore we stopped active vaccine programs at least here in the United States in 1971 DA has once in my presence uh I had the fortune to to meet the great man said that uh in the era that is now dominated by asymmetrical threats including biot terrorism uh the fact that we no longer vaccinate against this particular disease and and knowing that it could occur Again Naturally or purposefully uh as a weaponized agent uh We’ve created an environment of of great risk in fact he he said it could be the greatest risk in in public health that we have ever faced even in the wake of what we thought was the greatest uh Triumph in public health history uh in eliminating uh it this the greatest killer in history from occurring uh naturally but but what you see here that that I I want to say is important is that is an example of what’s known as conditional logic uh that term uh is actually borred from algebra uh a subject I was never very good at uh but what it really means is if a then B uh so think about how this might apply uh if a you were vaccinated uh by your parents and and by the the laws and rules of your community and Country uh then B you did not get small poox uh conversely if you were not not vaccinated because your parents uh in in the case of this child’s infancy chose not to observe those rules then B you are still at Great risk and susceptible uh to getting sick uh and potentially dying uh so if we carry this over now uh to the modern era you know and argue that you know if if we offer safe and known to be uh effective vaccine uh against an emerging uh pathogenic threat uh that has a high likelihood of of increased morbidity and mortality in our community and even in the global population how is is this notion of of of being an antivaxer of any sense in the modern eror so uh I I again you know present another book that I think is is worth reading this one is uh by uh Richard conif uh it’s a recent book 20123 and uh I think what’s most important about about this book is is he talks about um another time in history but in the case of of this being another time in history uh Mr conov uh who is a reporter he’s not a healthc care or public health professional uh brings us only back to uh about a hundred years ago or less uh when we still heard routinely about illnesses and death from the diseases that I list in in these two Co in these two columns if you are of a certain age every one of these was still endemic to our community uh to the United States and To The World At Large for the most part uh including malaria which was endemic to parts of the southeast of the United States um and and would cause very significant uh morbidity at least uh until we started to develop either very good vaccine and immunization programs or learned how to treat uh the disease itself uh better uh but they were all typical uh in fact most of them occurred as childhood diseases uh along uh others such as whooping CA mums chickenpox and measles uh that we know now we we have uh safe and effect vaccines uh for uh even against you know people who who say that uh they they cause uh things you know specifically MMR uh the Mel moms rubella vaccine causes autism there is no um clinical proof uh that that’s the case could be a whole separate presentation and discussion uh but the antivaxers have have uh raised the the concern that uh some of the these diseases May in fact be coming back and some of them are we are seeing uh increased numbers of of measel cases um in in the United States and abroad uh and that should be of concern uh to everybody but if you are closer to a person like my age or some of the other people on this call uh you can count off you know some of these diseases by how close you know you escaped Contracting uh everyone uh or attracting every one of them uh all to recently you know as 1952 before the sock vaccine uh polio uh which was a Scourge uh among childhood populations right up until this very year that the vaccine became available uh caused paralysis in 21,300 people in 52 and killed 3150 of them vast majority of them being children uh still by 1963 measles was affecting more than 350,000 American children on average uh killing more than 440 of them before the arrival of the vaccine by the way as you see in the footnote this is this is important to remember just 60 years ago two years ago after I was born uh it took 10 years to de develop the effective measles vaccine that stopped that disease dead in its tracks uh and as you’ll see in a minute uh that particular Paradigm in terms of coming up with an effective vaccine for a newly emerging disease which misles wasn’t uh has has shrunk so markedly uh that it’s a good indicator of the advances of of science and technology that are available to us now as as something that works to our favor in terms of U combating emerging diseases uh by 1974 in the very brink of the eradication of the small poox uh uh virus it was still infecting 220,000 people worldwide and by then killing 30% of them which leads to the the so-called rule of 30s uh where if we saw a modern outbreak now 30% of the population would die from it 30% would become blind which is a common side effects of small pox when when some of the pure material is rubbed into the eyes 30% % would survive but be horribly scarred which led to enormous numbers of suicide uh in the in the premodern era uh and then for some reason 10% we think would would survive because they were uh benefited by um genetic her immunity that had been passed on by previous family members who had uh contracted disease and themselves um survived it uh but with that in mind when was the last time anybody you know who’s on the the call today heard about blood poisoning from a splinter or even knows about the term lock jaw that could have been contracted to uh by by stepping on a rusty nail for example when I was a child these were real threats that that existed as closely to us as our schoolyard uh and and that parents were always warning us uh to be of care of uh so that we would not ourselves fall victim and and either get very sick uh require significant medical treatment or potentially die so the rhetorical question that I have to ask with with all of this you know as a leadup um is with with all this in mind how is it that that even within a hundred years when we have thousands of years of of historical evidence about the impact of disease uh upon the human species that our Collective memory of of the scourge of these of these disease that could be so darn poor uh because the fact is we badly booted the covid-19 response and I am happy to to engage anyone in a in a discussion about this um on your left by the way is the uh US Government covid-19 response plan that was uh published on March 13 of 2020 and I will be very blunt uh in telling you that as a medical planner I found this embarrassing uh if you read the plan uh the approach to uh covid uh which I’ll talk about in in detail in a few seconds in terms of its its pathogenicity and and where it came from uh the writers of this particular plan which were from the Department of Health and Human Services simply adopted the timeline for the 1918 and 1919 influenza a pandemic that is three sequential waves over the course of 18 uh months uh as the way of describing how they thought the covid pandemic uh would play out uh which was ridiculous because if only you know in recognition of the fact that we were dealing with an entirely different uh mutation of a pathogen uh and and and most people who who are at least being honest would tell you that we knew nothing uh about that mutation and and what it would end up doing uh to the human species uh during this most recent pandemic but here’s what it did do uh covid-19 pandemic was responsible for the deaths of at at least nearly 1.2 million people uh in the United States I’m not talking about the entire world here we’re just concentrating on the US that number and this is going to be a redundant theme in the next three points I make was more than double uh of any nation in the world uh by the top five nations and 11 other nations that had populations greater than a 100 million uh that uh would be close uh to hours and you could see on the bottom the five nations on um talking about and think about some of the public health conditions in in in a couple of those uh which on a daily basis are nothing near the the the the the quality of our Public Health infrastructure and healthc Care infrastructure available to the population in the United States uh this one I find probably the most staggering koville killed more people than the cumulative number of Americans killed by every single War fought by the United States in both the 20th and 2 first century Again by nearly double so you know forget about Vietnam and forget about Korea and forget about the first Gulf War or Iran and Afghanistan and that doesn’t mean uh that I’m I’m being the least bit disrespectful to my my fellow service members who gave their lives in defense of their country and our ideals uh but think think more along the long the lines of of the numbers that lost their lives in World War I and World War II and this should be a staggering number uh to us uh that I have been personally surprised as has not gained more attention finally more citizens uh in the United States died of co9 than those killed in the 1918 and 1919 pandemic here in the United States the total number of deaths uh for the US in in that pandemic was around 675,000 so again the numbers of of people we lost are more than double than that which occurred in the worst disease event in in recorded history so my again rhetorical question next is in this Modern Age how could this be and in and in the so-called most developed country in the world how could our numbers uh be this significantly bad and I’m going to give you a little bit of my theories about this and and then a dose of reality my my first couple of theories you know so one Theory I say maybe two is is I I think that we gen we generally tend to have a something that I I recently amended a term for and and some of my friends and colleagues in the Behavioral Health Arena uh could either take this on or not but I’ll come back to that and and that’s psych psycho aversion to disasters we we just don’t like to stare risk and threat and the face and it’s easier for us as a human species to kind of put our hands over our eyes put our other arm out at at a distance from our bodies and look away and think it just can’t happen to me uh I’ve been involved in medical planning after my military career for a good number of years uh and most of my efforts have been uh around trying to help non-military organizations in the in both the public and private sector but largely in the private sector because that’s 93% of our national infrastructure uh to help them prepare uh to address uh any type of risk whether those from natural or man-made disasters and what I’ve encountered support this this notion of of a phenomenon uh and that is if they haven’t experienced risk and more importantly or directly they haven’t experience the direct impact of of of a large scale disasters their tendency is to say well I haven’t felt this I don’t know what it feels like and I don’t think it’s going to happen to me so I’m not going to risk anything or more importantly invest anything to change their posture preparedness we know now in the wake of Hurricane Katrina for example that we can Quant if y uh this this this phenomenon in cost and that is for every dollar that is not invested in pre-event uh disaster preparedness and mitigation the first two phases of the disaster management life cycle the second being response and recovery and by the way recovery is the longest is always the longest and most expensive of the four phases of that life cycle uh we will have to spend starting at $10 for every dollar not spent and that can go as high as $10,000 for every dollar not spent so when you look at at events like Katrina that had close to a A1 18-year recovery defined recovery recovery period whose cost uh is is thought to now have run into the trillions of dollars uh you can get an idea of of how that might have changed if we really put uh investments in and enhancing the level of preparedness amongst a population that we knew was at Great risk of this type of meteorological disaster in the first place the second point I make about about my my theoretical thinking on this is that we’re simply bad students of History beside all of the information that’s available to us in these great books uh some of which I’ll site here uh and just reading you know history as as you know following Mr sanana and and and Abal mahan’s recommendations that we haven’t learned or we simply don’t want to remember the past uh if if we don’t continue to feel our own vibrational Resonance of an event that happened you know 18 months ago how do we expect to feel it um with something that happened a hundred years ago where no one is alive that could say well I remember it was like this and this is what it was like to live through I think it more realistically there’s multiple realities and none of them are are that simple first of all we simply weren’t prepared uh against what should have EAS qualified uh in terms of covid-19 as a predictable surprise uh that term by the way is uh was in invented if you will by two Harvard Business School profess professors uh baserman and Watkins who published a book of the same name the subtitle of which is uh the disasters we should have seen coming their argument is that all of the signs and warnings uh what we call in the military of indications and warning that we get through intelligence surve and reconnaissance all of which we do in in public health for monitoring uh disease outbreaks that we we we still didn’t pay attention to the signs um the covid virus as as most of you know the the its root is the Corona virus um and if if you’re are a student of Public Health or or or or know this already I’m sorry for having to point it out but Corona virus is is as normal appearing in the human species as its near cousin the rhinovirus Corona virus is what causes is one of the two viruses we believe uh most predominantly caused the common cold the problem with coronavirus is that we knew that it had mutated twice before uh in uh 2003 with the uh sudden acute respiratory syndrome or SARS and then again in 2012 and 13 with the Middle East Respiratory Syndrome uh Corona virus um both of which had fairly significant case fatality ratios above the 55% uh level which is huge uh in comparison to any other disease except Ebola in the modern era at least when Ebola Zer occurred in 1976 um we knew that these things represented uh disease events that occurred by respiratory particular transmission between uh human beings uh we knew that they came from zuntic sources uh they were both labeled by The Who as pandemic capable when they first when the first outbreaks occurred and for whatever reason that we are still at a loss to describe today simply disappeared uh thankfully before they uh were in fact able to rise to the level of a pandemic that didn’t mean that anything related to the root virus of of Corona uh was was out of our our worry field uh it should have been an indication and warning to us that if it mutated twice before there’s a very good chance it was going to mutate again and we should be looking at it in terms of what would it mean uh by by way of a pandemic uh I would argue that there are fault lines at every level of the government that were or are broken uh you’ll see a slide at the very end of this that shows um a uh XY AIS and demonstrates in in an operational Continuum moving from left to right that we we basically have three levels of of government uh tactical level which equates to city and county the operational level which equates to State and Regional and then the Strategic level which equates to Federal response I would argue that none of those people and I can argue this from from a position of of experience and knowledge because I’ve I’ve worked at every one of those levels we don’t talk to each other well we don’t communicate with one another we have a different lexicon that’s used uh in the developing vernacular of Emergency Man management that is not shared uh at each one of those levels so as I’ll point out when we have to cross over into the next level for support when resources exhaust themselves at the lower level we’re simply unable to communicate effectively with each other the simplest way I can describe it is that we don’t have any commonality in in any planning or our approach to planning nor do we have a planning template that is universal in the United States that for lack of a better way to describe it commonize the the approach we would have to All Phases of that that life cycle I referred to preparedness mitigation response and Recovery the next point is that there’s no surge capacity uh in the US Health Care system this is largely a result of uh the fact that since the late 19 1970s we have progressed first from diagnosis related groups uh as a way to approach how we monetize delivery of Health Care uh as a business to manage care which is the system that that um is is largely Universal here uh in the US and in most Western countries uh in in in the Managed Care System uh beds are viewed as profit centers so if hospital beds are not filled uh the CEOs of hospitals uh are quickly fired by their boards and if that happens to continue hospitals close which is a phenomenon that we saw uh in the late 1990s when when when thousands of beds and hundreds of hospitals across the United States closed because of these very reason they were trying to streamline uh the system to economize uh the uh the way we approach the delivery of medicine for maximization of of profit uh and and if as long as Healthcare is a business in the US this is not going to change but the translation in our space of disaster medicine and public health preparedness equates to the fact that there’s no room at the end there simply is no extra resource that we could go to when we see sudden spikes in in healthcare demand during uh mainly uh large scale disasters that produce catastrophic levels of casualties the information management in the covid-19 um pandemic in a word sucked and I apologize if that word is uh found to be distasteful to anybody uh but there was no information management uh if only uh because disinformation up to the highest levels of of our government uh was not only rampant it was extremely dangerous uh and we we even found some of our best qualified people and I I will name people like Dr Anthony fouchy and Dr Burks who were trying to give us the best information uh being constantly questioned uh shot down uh and vilified uh by the population at large because our own government officials were doing the same thing to them and not allowing them to communicate effective strategies to help mitigate the impact of the event uh there were political ethical cultural legal and operational issues that abounded uh in the uh 19 uh covid-19 pandemic all of which uh we had basically learned uh as far back uh as an exercise that was conducted 80 days before 911 uh called Dark winter which back to small poox we used that as the protagonist agent in a Terri is M scenario involving biot terrorism against the United States that exercise uh failed miserably uh in fact it was supposed to last for three days and the uh scenario play broke the back of the exercise in less than eight hours uh that said we we learned quite a bit from it um not the least of which is is that one uh the healthc care sector uh whose a priority mission in any event is to save lives and reduce suffering which I argue has to be the a prior mission of any Incident Management response especially for events that fall into the category of incidents of national significance uh that they are so busy and siloed uh to individual based outcomes that they do not work in in populationbased outcomes which is the very essence of of the public health um uh Paradigm um and and until we can we can have our our physicians or our healthc care sector understand that that there is a breakout uh as as events like this uh increase in in growth in terms of scope and scale of impact that we’re going to change from that day-to-day delivery of healthcare to to needing to or demanding uh to have adequate populationbased outcomes we’re not going to fix this uh another issue is that systemically our Healthcare and Public Health Community professionals uh lack exposure to training and Emergency Management disaster medicine and public health preparedness um Sailors like to tell Sea Stories so I I’ll tell you this one really quickly uh as indicative of of this very point we were down we being my colleague Dr Len singer uh and I who I’ve done a number of of Disaster Response planning missions with were in Puerto Rico in the wake of hurricanes Katrina and Irma in I’m sorry Maria and Irma in 2017 and uh because the Commonwealth of Puerto Rico was an island and they were isolated from the mainland and the fact that the the vast majority as in 99% of their health care and public health infrastructure were products of the University of Puerto Rico’s U educational system uh when they were asked to to staff up and support the emergency support function number eight which is emergency medical and public health response uh portion of the Joint Task Force it was evident to us within hours if you know well within days if not hours rather that they they really couldn’t even spell Incident Management and and I’m not trying to be hypercritical of my colleagues in Puerto Rico because the answer was very very simple and it wasn’t their fault uh after about three weeks we were invited to a dinner with with two or three of the lead Physicians and one of the nurses uh uh who before you know a glass of wine could even be poured said to us the reason we’re experiencing this total frustration and our inability to help prosecute the The Incident Management response is because we know nothing about this space uh and the argument was we have not been given so much as a single hour in in our training Continuum whether it was medical school or dental school or nursing school or healthcare administrator School uh that taught us about uh Emergency Management uh especially in the post 911 era when we have developed an actual vernacular uh and a lexicon for the space uh and rules and and architectures some you know for example the national Incident Management System and incident command system that we uh in place during these events um and attempt to follow but if we have an entire community of professionals that we rely on for what I argue was the most important Point saving lives and reducing uh suffering uh then we are we are handicapped from the start uh final point to make is that you from a National Security perspective we don’t get a seat at the table medical and public health u in the military uh has historically been uh something of an afterthought uh that changed slightly with the Advent of the force Health protection initiative in the wake of the global war or the Gulf War Illness uh issue that came out of the first Persian Gulf War uh but I don’t think it’s an overstatement to say that we’re an afterthought um and we are we are not invited to be at the table this was particularly um evident uh given the fact that the previous administration had fired and dissolved the entire U National Security council’s pandemic planning and response team uh in 2018 uh which meant that there was nobody at the highest levels of our government uh that were available to provide good information uh to the critical decision makers uh at the executive level of government uh which led to all the subsequent negative sequella that we saw in terms of the actual response so quick go by the way if if you’d like to read you know I think a a a direct coverage of this point uh the naval institute’s proceedings uh published uh an article that I wrote in August of 2023 called public health is a national security issue uh it covers most of the points that we talk about uh in this uh presentation um and I argue really pointedly that you know you if you’re going to ask the question of why isn’t this a national security issue when you have massive domestic casualties breakdown in essential critical infrastructure and key resource sectors across the board in both the public and private sectors uh actual violations of the democratic process civil disorder loss of confidence in government reduced flexibility strategically abroad they all occurred uh and the fact that that nothing else occurred is no small stroke of luck if if any of you have read in depth the National Response Framework and particularly uh the assumptions and limitations uh portion of it it notes that in the event of a large scale disaster in the United States uh it becomes opportunistic and I’m I’m paraphrasing but this is essentially a quote for the universal adversary to uh strike at us with a largescale Act of terrorism because they know that we have not done well uh at Prosecuting Incident Management responses to incidents of national significance from 911 moving forward to every one of those major events uh in the first uh 24 years of the 21st century so I have to give you know some time to make sure I’m giving equal uh share to some of the good points so we we did do some things uh right and uh I I cover a couple of them here first of all uh our experts in infectious disease virology and Immunology not only here in the United States but abroad uh worked hand inand um with the largely hand inand with the global pharmaceutical industry uh to develop uh a safe and effective uh series of vaccines in record time uh in fact uh I would say that it it in aggregated was probably less than a year uh before we saw the first vaccines roll out from madna and fizer uh which were effective in reducing uh the impact of the disease remember in viruses this is an important side point you can’t treat a virus uh you you can prevent a virus uh by using a vaccine either with a killed protein antigen or a live attenuated virus version of a vaccine uh but otherwise you can only pal palliatively treat the symptoms of of an advant which which is why um Pharmaceuticals um that that help reduce the symptoms are also uh very helpful and have to run hand and glove with with actual vaccine in both cases we we had assets that did both uh and and I would think that if we had not been able to do this or if it took as long as for example the measles uh vaccine took to develop uh this outcome would have been much much worse and and just for the record uh it’s important to note how difficult this is uh one thing uh that we note in the second bullet here is that viruses change they they mutate the the technical term is that they undergo antigenic reassortment and their only mission in existence is to uh most um effectively leverage their host uh that being us the the human species so with this in mind um it it’s often very difficult to develop vaccines because they have to wait for a point when it it’s hitting sort of you know for lack of a better way to explain it its Max stride in terms of impact um and and then characterize that particular form of the virus at the time as the one that they hope will be the most effective in developing a vaccine so there are very very very big organic challenges uh to this process in the first place uh but I think these these two stories are in this case success stories uh I also want to point that I think the the notion of predicting the surge went and not to be you know make a pun here it went viral uh and reduced induced Lessons Learned in preparedness in important areas of triage uh the use of alternate care sites to address that point of lack of surge uh protecting medical staff and stockpiling critical Commodities uh it also you know reminded us that that the importance of of of pre pandemic initiatives like the creation of the Strategic National stockpile uh were important and will be important in the future especially on these latter points about PPE uh and Surge and for the record surge is not just available beds my colleague Dr singer again likes to say that it’s people beds and stuff the stuff being all of the medical Logistics uh capabilities by way of medicinals and equipment and supplies that have to be available to uh support an affected population and finally one of the the better things that we’ve we’ve done at least with the new Administration is that we’ve reinstalled the pandemic preparedness planning cell uh on the National Security Council and it’s currently being run by a retired two-star uh Air Force physician uh who is uh our Point person now in in in looking at uh the future and and helping to decide how we can best plan to change uh our our future successes uh so here’s what the future may attend this is a key point of uh my presentation I think there’s five major differences from a hundred years ago uh which was the starting point of our our discussion for today’s presentation that all uh are impacting why we are seeing uh what I would say is increase in both the frequency uh and scope and scale of the impacts of of disasters that now occur in the modern era and again put your history hats back on with this because all you can you can translate this to you know points in history that have been occurring you know since almost you know are stepping out of Neolithic times and the development of of towns and Villages and eventually communities and cities and and everything else first off since 1918 and 1919 we have seen a quadrupling of the human population that now stands at roughly 8.1 billion so that’s four times bigger than the part was uh when when the um influenza pandemic occurred uh at the beginning of the last century what does this mean which just means we’ve got more people who can get sick globally uh and at the same time will place uh increased levels of Demand on that medical and public health infrastructure I previously referred to that is not necessarily Well Suited or prepared to meet those demands second we’ve seen a a rise of of a phenomenon called the the mega City uh happened since uh that term was was minted in 1971 by definition a mega city is uh is a a small geographic area where we see population clustering uh kind of a public health epidemiological term uh it’s a dense population that supports more than 10 million people at a time so what’s happening there well all of those people and let’s use New York City or Tokyo or Soul or or or any easily recog recognizable City where that population is exactly that they’re all putting enormous demands on the available critical infrastructure and key resources that are available to them on a daily basis and as we know almost all of it is is working on a just in time basis so as Malcolm Gladwell uh pointed out in his his remarkably uh astute book The Tipping Point when we see uh the environmental duress of a disaster descend those populations are pushed to a point and they essentially fall off the the the face of the of the mat uh to and and and when that occurs you know think you know sort of hypothetically we we we tend to see uh increased levels of cascading events that demonstrate second third fourth and fifth order of magnitude and higher subsequent impacts uh from the initial event think of a of a rock dropping in a in a pond uh where we we see the ripples go out much like a tsunami that the pebble may be small but by the time that the ripples go all the way to their their farest extent they become quite large uh and in some cases the disasters that they Propel forward are actually worse than the initial disaster itself uh add to this is that we’ve got vast chronic and imuno compromised populations globally that are already placing enormous demands on available Healthcare infrastructure we saw this in this classically played out in Puerto Rico we had a very old population think of some of the you know the the countries around the world you know notably Japan and the United States uh where you know people are getting older uh and have lots and lots of chronic conditions that are rather easily supported in times of of non- disaster but when disasters occur and the demand for their support resources becomes you know questionable in terms of availability they become a population that that that descends to to bad places very quickly uh add to that you know the other ongoing pandemic of HIV and AIDS uh where we have vast imuno compromised populations in places like subsaharan Africa and portions of the Caribbean uh and you can see that this demand already is placing uh on on on a global Healthcare infrastructure that is hardpressed to meet their needs number four is the climate change and and this one’s probably the biggest you know overall it’s changing everything uh for example emerging infectious diseases their frequency in open scale of other natural disasters like meteorological events hydrological events and seismic events uh not seismic events I’m sorry but uh climate change is is is more than just you know aberration in in in seasonal Norms that we we see with much greater frequency now uh and and wonder you know what kind of effects this is going to have um before I come back to that I want to come back to to Dr Bray’s book uh and and say if that wasn’t enough I want to point out that he says that there’s a single inexorable truth about the spread of disease in the human species and that is it will always travel along man’s lines or man’s most expeditious lines of communication again that’s a that’s a military euphemism for man’s lines of Transportation so think about this in 1918 and 1919 we saw three separate relatively slow waves that were facilitated by the spread of the human population moving west to east on Rail and Maritime platforms but in 1920 moving forward we now have this Global InterContinental air travel system which is how we move people around the world and the expectation is now that that that this may become I I’ve labeled in again one of my contributions to the literature is I I’ve labeled the international Healthcare or um airline industry as the vector accelerant uh of the next plague uh or Great Plague uh that is that we will hypers speed people around the earth and as long as they are uh for at least a time uh remaining in in a in a spreading uh asymptomatic uh phase of their illness where nobody’s noticing that they’re sick yet they’re not going to be restricted in their movement which is going to facilitate uh any disease outbreak moving incredibly fast around the world so this notion of waves the notion of containment the notion of quarantine are are very fast if not already uh have become Antiquated uh approaches so what what’s what’s the future um what’s a future pandemic Port 10 no no no I want to talk about the future pandemic uh there’s there’s really no predictable surprise about what’s out there right now we know what’s out there and we should be very very concerned as I note here uh currently the who along with the CDC have designated five separate strains of influenza A that are circulating uh as being pandemic capable uh the most dangerous of one uh here is h5n1 which again is the Aven strain uh and I’ll just say very quickly this is the most dangerous one because we have had these are all zuntic sources by the way uh Aven is obviously coming from the wild uh foul um um animals that that travel around the world in very predictable patterns uh but what’s problematic is that we’ve seen uh the the disease this this particular form jump into the human species already uh and amongst the the approximately 686 Plus cases we’ve had since 19 I’m sorry since 2006 uh the case fatality ratio is 63% that’s Off the Mark it’s off the hook in terms of of of what that could could pretend when you match it against uh the um growth in population to 8.1 billion and the fact that if the attack rate in 1918 and 1919 was was 50% of the the human species living on the planet at the time but never went above a CFR of 1.2% a 63% uh CFR is is apocalyptic uh one of the the better articles about this appeared in National Geographic uh in 2006 uh largely written by Dr Michael ome uh from the centers for infectious disease reporting uh at the University of Minnesota uh and it was uh combined with some modeling that had been done by Oak again oakd Laboratories uh that that showed if if if this does hit us in full impact uh this will be historically uh unpre unprecedented uh and finally about the climate change this come back to is it’s likely to cause thousands not hundreds not tens but thousands of new viruses to emerge from zoonatic sources why because we’re we’re we’re seeing a vast increase in man’s contact with animals that we normally didn’t have contact with one of the best examples uh comes from the the most recent outbreaks of Ebola uh in U in Africa which uh originally started in in the Abola Zer region of Central Africa but uh moved in into the most recent outbreaks uh from 2014 to 2018 to West Africa Dr Skip burkel who’s a giant in in the public health world of disaster medicine humanitarian medicine ofine that it wasn’t Ebola that changed it was Africa that changed and and it’s because of all the things that i’ I’ve just been talking about uh increased Transportation increased uh contact with animals we previously didn’t have contact with as sources of zuntic infections uh the fact that our transportation modalities move much faster we’re we’re having these vastly increased um demographic hubs around the world especially in the lorals which also are coincidentally the same places that we have our aerial ports of embarcation and debarkation a fancy term for our our major AirHeads uh where people are trans shipping on a daily a daily basis and and if that wasn’t enough there’s a permafrost issue that’s that’s just really come to light in as recently as as 2021 um as you know global warming is is causing uh some of the areas of the world that were uh under permafrost um in um places like the Himalayan steps for potentially 40,000 years uh since the last great Ice Age and and and in the the glaciers that are rapidly receding uh recently in 21 uh number of scientists had been in the Himalayan steps and found 28 different uh I’m sorry 33 different viruses in in the in the soil after these glaciers had receded and 28 of them had never been previously detected or matched to a current uh virus family meaning none of them could be related to any known verid you know the Latin term for viral Family such as hemorrhagic fevers felo viruses uh influenza or or any of the other uh great um viruses that have caused uh you know significant impacts among the human population for time IM Memorial so this is something right out of a Michael kryon scenario uh where they’re able to extract DNA from long deceased or extinct uh dinosaurs uh we’re we’re finding that uh these viruses can live and live for a very long time uh in in suspended animated States uh but now as the weather changes and climate is changing globally we may be looking at at the arrival of viruses we simply have never seen before so what are we going to do about this well I’m going to plow through this pretty quickly I know we’re getting close to time but the UN disaster uh folks say that there’s no such thing as a natural disaster only natural hazards uh disasters occur when we simply fail to prepare uh but what we do and in terms of their severity what we do in in against their severity is entirely dependent upon choices that we get to make on our lives our property and environment if we choose to ignore them and and fall into that that that almost you know pseudoscopic pocture that I I I I talked about earlier where we close our eyes and we look away then we’re not going to change this Paradigm because every decision we make will either enhance our posture preparedness or conversely degrade it um and their their call sign if you will which I think is great and I love this this line is that disasters occur at the Confluence of where hazards intersect with vulnerabilities if you reduce the vulnerabilities you reduce the impact of a disaster and if you want a modern demonstration of that uh about 2011 there was a very significant uh Cyclone that hit the Philippines uh that caused in the neighborhood of 25,000 casualties uh including a very sign significant number of deaths on a specific island in the Philippine chain uh when that exact weather pattern was uh appearing to repeat itself two years later the provincial president uh living in that area of of uh the Philippines decided to move the population at risk he basically evacuated all of the people in the predicted modeling path of where that Cyclone was going to occur instead of 255,000 casualties they had one so this is a marker for that point if you reduce the vulnerabilities that that live in in our homes amongst our persons in our communities our neighborhoods uh our states and our country then we’re going to reduce the impact of disasters there’s just no other way to look at that so how do we we break the current Paradigm first off we we have to stop treating them as as these these things that I referred to earlier as predictable surprises they occur they’re going to occur they will occur with greater frequency as I pointed out their impact is going to be worse some of them have seasons for heaven’s sakes there’s a there’s a hurricane season there’s a wildfire season and yet I’ve heard people in the media and in government say oh I’m just not sure what we could have done it’s so terrible the impact it you know if we would have just known what was coming and I I can never understand how people can say that when when we know for example that that the hurricane season lasts from June 1st to November 30th of every year so we must Embrace a culture of proactivity uh we also have to recognize that the single common denom Ator to all disasters or human casualties I’m not I’m not trying to upset anybody who’s got a high allegiance to their pets but humans have to come first and and if that’s the case we have to recognize that no other portion of our nation’s healthc care infrastructure is going to Bear a more preponderant weight in in either adjudicating the successful or unsuccessful outcome of our Incident Management uh efforts than the medical primarily the medical and to uh a near equal degree the the public health infrastructure that that is is again looking at these things from a populationbased outcome so how do we resolve these problems first off I I already mentioned uh these These are the eight pillars of catastrophic casualty management at a minimum we uh when we do write plans uh must include uh depth in addressing all of these areas because these are the areas and and this is not meant to to say that this is of any ivity I I’ve had my students you know for many years I I asked them uh primarily at George Washington University it’s not an inclusive list what would you add and many of them have have great things to add to them but what I’m arguing for is that if you if you at least focus on these eight areas and develop executable plans to address them that are shared and collaborated uh with others uh outside of the medical and Public Health Arena your chance of of of achieving Mission success uh by by way quantitatively if alone of saving more people and and reducing the impact that they might suffer uh I believe uh can be improved uh from a tactical perspective uh this is something that we need to look at from uh right down to the you know the very hospital and Health Care Systems that now populate uh our nation one of the ways uh of approaching this uh comes out of a of a theory called Network Centric Warfare uh that existed uh or that was initiated by a guy named art zabowski Admiral art sabrowski by the Navy from the Navy in the early 2000s uh sow’s theorem and initiative was very close to what is now very popular in in American Healthcare in the pr preparedness Arena and that’s Coalition initiatives uh where we are developing networks under the premise that we know that if we stand alone as an individual Silo we run the risk of of collapsing under the weight of an event so added to that was we we have to plan for alternative standards of care that shift from these individual based outcomes to population based outcomes we have to look at alternate care sites in our counties and communities covid proved that our hospitals as static brick and mortar facilities are never going to be able to to meet the demands that we will we will see um with with large scale disasters we have to plan for phac itical and supply distribution which becomes increasingly problematic as as as very specifically disease events increase because of fear and because of of the fact that that the very people we’re relying on to do these distribution are going to be impacted themselves it’s kind of a another phenomenon that we see fairly often that the Health Care community and and people who are involved in you know a supply chain on the healthcare side and specifically the pharmaceutical industry are somehow immune from from these events they’re not they’re part of the general population and they’re going to be affected by them too uh we have to expand Staffing Supply uh and capabilities develop consistent actionable plans and collaborate uh with each other to develop uh mutually um formalized support agreements almost like an extension of the Emergency Management assistance compacts or emacs that are used in in general emergency management in the United States but I argue that success is most readily going to be achieved by engaging in deliberate planning prior to any of these disasters occurring So to that end here’s my my most important admonition every community and not just the Emergency Management Community or the healthc Care Community or the Public Health Community must engage in deliberate planning ahead of any emerging threat deliberate planning is a phrase that’s born directly out of the military uh and our war planning uh through a a very uh important systemic approach uh we call The Joint planning uh exec and execution Enterprise the JP uh but it means that you’re you’re looking at all the contingencies and addressing the challenges you’re going to face ahead of the event occurring with the premise that you’re never going to be able to catch up with them once the event starts to move forward in time so I basically come up with this quote which you know huis aside is is sometimes being referred to as um as as marilla’s law and the law is that by failing to engage in preent that is pre-disaster deliberate planning your chances of mounting a successful Incident Management Mission response decrease in equal but directly inverse proportion to the scope and scale of the event if you’ve ever heard of aam’s Razer uh born from a quote uh from a guy in Great Britain named William of aam in 1346 uh which argues that all things being equal that which can be done with less is done in vain with more this approach uh comes right down to this core axium that by failing to plan you’re failing you’re planning to fail and there’s no other way around it once the event starts nobody’s ever going to be able to catch up um and I I finally put up this Continuum that I referred to earlier as a graphic and I I want you to look first I always get these wrong but I think this is the x axis this is the Y maybe reverse in any event the vertical axis is is the inherent capacity for casualty production for any type of event pick a disaster any disaster there’s an axium in the Emergency Management Community that’s existed as long as they’ve existed uh that is all disasters at least at their start are local so we see this event occurrence signified here by my my cursor circling event starting in the corner at the Confluence of the XY axis and then moving up at at a higher level to demonstrate what the event magnitude happens to be over time it builds so what I argue is that when when you’re at these lower levels and again my point is we we lack a common preparedness and response architecture we currently lack any commonality of planning we lack a commonality in in our lexicon vernacular and and the the terms and words we use in different communities uh some communities are afraid of talking to other communities I can’t tell you how many times I’ve heard Emergency Management people say well I can’t talk to the doctors because the docs speak a different language it’s that medical stuff but what I’m demonstrating here is that in in in large scale disasters as resources exhaust at the lowest level invariably we’re going to have to go to the next level to get what we need and two things I want to point out one is because of that lack of commonality we see command and control or what the Department of Homeland Security likes to call in the modern era the new C2 cooperation and collaboration breakdown there’s fractures so it we’re almost defeated before we we can start uh the other thing to point out here is I want you to look at the response times the notion that anybody is coming from the Strategic Federal end that’s going to be able to pull uh our our chestnuts out of the fire is not a good notion to bank on uh because at a minimum first of all first off they’re not arriving until it’s largely too too late uh this can be encapsulated in in something we refer to as the twin tyrannies of time and distance and I I once made a point that if you can’t get assets to an affected population then the population is ditter I invented another acronym just like we needed one in the military ditter stands for dead dispersed and recovered and it means that the assets that come from this farther level this farthest level of the operational Continuum will have no bearing whatsoever on the outcome of those lives and those people who were affected at the microt Tactical level so this Point argues that we have to take planning and preparedness as a personal Initiative for ourselves for our families for our neighborhoods communities Health Care Systems Public Health Systems our states and our country because the white Knights that we think we should be waiting on from the federal government will not be arriving and it’s important to note uh as a final point is that it’s been only recently that that FEMA the Federal Emergency Management agency that’s responsible at the highest level for uh preparedness in this nation is the first to tell you that they are not First Responders FMA is a checkw writing organization to provide resources for critical Commodities that are needed in times of disasters they don’t have control of forces so if anybody’s waiting on that white knight on the charger to come and and and pull them out of danger they’re going to be waiting a long time so it argues that that real preparedness real changes in the preparedness Paradigm are going to happen at the most local level and with that I have my references these slides will of course be made available to anybody who’s interested and now I am very happy to take questions looks like um so for questions if you just want to come off mute and ask or um put them in the chat we’ll read them out um if you so much that was a very enlightening talk and I would love to see what the audience is thinking and wants to learn more about well why don’t I start um just beat this is an excellent excellent uh uh presentation uh I was taking notes throughout uh many of your quotes perhaps on every slide or some real zingers and I’ll I’ll with your permission and and credit to the author use them again but but thank you I think this is a real Clarion Call to um government the Public Health Community and the general population uh to uh prepare and again we used to say within our communities it’s not if if but but when the next pandemic occurs so thank you I want to congratulate you on on an excellent presentation and a very uh wide uh widely dispersed and uh and uh uh very uh credible uh audience uh from all over the world so good job Pete thank you thank you Dr appreciate that hi I have a question my name is Pat Frost I’m the vice chair for the national pediatric disaster Coalition um you know tremendous tremendous um presentation you know especially about the silos um that have uh been occurring and you know we grow up with as far as that’s concerned as being in this place space of advocating for emergency um inclusion of uh children in um both The Med Health as well as on local levels um I you know I’ve kind of come to the the conclusion that we need to change the culture and in order to change the culture we really need to focus on the children and we’re not paying attention to what we need to do with children at a very very very young age in terms of making sure that they can protect themselves that they know what to do they know their name they know where they live they know how to get in contact with their parents and to all these simple things teach them about weather you know teach them about the signs of you know impending storms teach um and we have all these kids with mobile devices and they don’t even have you know the earthquake alerts or the weather alerts on their um phones and stuff like that there’s so much low-lying fruit I wanted to know if you can comment on that absolutely boy I you couldn’t have set that one better up for me as if it was a an eight foot you know softball tossed at me in the middle of Yankee Stadium uh listen I’ll go right to an example that that that worked and worked so well it changed it literally changed the the Paradigm in in the arena of home home fire deaths back in the 1960s uh and again it it everything that I’m I’m describing you know us moving towards these these mega cities the the the move towards suburbanization uh the baby boom The increased number of of of homes being built throughout the world to accommodate a larger Workforce coming back from World War II etc etc we started to see a phenomenon uh with a marked spiked increase in home uh related fire deaths so the National Fire uh Association looked at this and and thought gosh we’ve got to do something about this so what they did was they approached uh some uh professional Educators uh who uh explain to them that there’s this process called repetitive admonition uh that could be used uh and for our our our physicians and physiologists out there we have a portion in our brain as you know called the amydala uh which is not only uh scarred by events like PTSD or horrific events that cause PTSD uh the amydala is also a place that restore uh things like repetitive admonitions that will remember for a lifetime so in this case what they came up with was the stop drop enroll campaign uh where uh they targeted K through six children uh in in public and private schools throughout the United States they had a representative from the local fire department come and they would have them sit through what was essentially six hours in aggregate of of of fire safety training and they learned about um uh how to have rally points for their families they learned about rope ladders they learned about stop drop and roll which was shown to be very effective in in in stopping you know fire on a on a human person Etc and what what happened what what phenomenon in this case positively occurred was there was a 77% reduction in hom related fire deaths within two years in the United States uh all accredited to this fact that stop drop and roll stuck in people’s mind and if you’re you know a baby boomer and a child of 60s like I am stop drop and roll is is right here so we actually wrote a paper we being one of my colleagues um who wrote U um disaster preparedness for dummies Maurice Ramirez and we we wrote an article that appeared in the Journal of homeand security uh called now children repeat after me and what we we wanted to in you know induce was a repetitive ad for um disaster preparedness and and how to increase um hygienic uh initiatives you know rather lather rinse repeat was was our admonition you know to because we we know that that transmission occurs when people do things like shake hands or get too close to each other and that enhancing hygienics will change uh the the increase of the spread of disease or or or cause the decrease so um now not we sent it to the department the US Department of Education we sent it to the Department of home and security we sent it to the assistant secretary for preparedness and response at Health and Human Services crickets nothing so I I couldn’t agree with you more that we are we are missing out on a population that and I I I apologize to anybody who takes this as as as a too religious a term but children tend to be Messianic when they take on an important thing uh to remember especially as it relates to the safety of their parents themselves and their siblings and that was proven in in Spades with with the stop drop and roll campaign uh and I believe that there’s still merit in the approach and it could work uh because they they are a population that will tug our sleeves and say Mommy Daddy are you doing this do we have a a rally plan do we have an egress plan do we know you know who to call in times of emergency do we have a go bag that will give us you know iCal resources to protect us are we stockpiling water and and and non- perishable foods in the basement and and if we could do that it’s almost like a Back to the Future on civil defense uh in a way uh which had us a lot better prepared during the height of the Cold War than we are now uh and in fact I I would add that if if we we did a Back to the Future initiative on both counts you know leveraging a repetitive admonition program and reinvigorating a civil defense program program for the United States with it focused on on medical and public health surge we could we could change our Readiness capacity pretty quickly but it requires an investment in time and money and effort and that’s at the end of the day always the issue but I’d rather I’d rather see us doing positive things like that than than throwing money out the window with you know Dick Tracy wristwatches that were the the norm you know in the wake of 911 than than doing something that we know has has proven efficacy great question or comment thank you thank you Patricia thank you so much um there’s a couple questions in the chat but before I saw Carol Stewart had raised her hand so I would inviting her to come off mute and uh share her comments and questions uh good morning everyone so um I’m joining you from Al in New Zealand and thank you for a fantastic talk I really learned a lot so in New Zealand like our Co response was generally held to be one of the better ones in the world world and um our ferality rate was something like five times less than that of the United States and this was largely due to the strategy of s of closing borders and keeping the virus out completely until the V you know until the vaccine was available which helped hugely um yeah so I I teach a course on disaster environmental health here and uh I just put a link in the chat to a report that was released here a couple of days ago and it was an it was a government inquiry into our response to the massive Cyclone that we had last year Cyclone Gabriel so we last year we were hit by a series of extreme weather events and um they affected you know the scale of them were enormous quite similar to the Queensland floods and the 2010 and it’s it’s a really good report and it emphasizes many of the things that you were you were speaking out yet about the you know real Improvement can only come at from the local level and some of the best responses were in our Maly communities who live in some of the really at risk areas and uh so M communities are really um they’ve got a community structures called marai which are meeting houses and they tend to have things like big industrial kitchens and bathrooms and they’re ideal for you know for emergency response and Community hubs and the reports recommended that um you know that they they step up in times of disaster because that’s what they do but they need to be properly um formally included in the emergency management system and resource properly to do the job that they do anyway and the reports full of recommendations about uh involving strengthening the local level and I think what you said about real change coming at the local level was absolutely spot on so um I’ve just put a link to that report if anyone’s interested and um yeah thank you all and it’s really nice to um to be here on this this chat so thank you thank you for your comment Carol I I’ll just make a couple of quick comments one of my my uh very well respected colleagues doc General Donna barbish uh a Nurse Corp officer who Rose to be the uh assistant secretary of defense for uh chemical biological uh and nuclear uh preparedness uh argues that we’re we uh one of our negative cultures is were a culture of Lessons Learned and and Donna has argued in in the in her contributions to the literature that if you look at the lessons learned from disaster to disaster what changes is the location the names of the disaster and but virtually the lessons learned all the same you can just take the the old report put a new title on it you know put the new event in there and you’ve got yourself a shiny brand new lessons learn report on the other hand uh best practices are a horse of a different color and there are nations in the world notably like New Zealand who who are uh demon success stories and we should be listening and studying uh their efforts uh and and and and actually pull what can be used in our own environments it’s always going to be different right their communities are different our nations are different but there are commonalities that have have uh been shown to be effective and and useful uh and utilitarian in in these uh types of events uh and we would be well served uh to to read uh what they did in hopes that we can learn to apply those for future events uh Carol also used to used a really important word uh and that is resourced and I just want to make a real short comment we don’t do planning well but and even when we do planning most of us missed the most important part of the planning process at at the end of a planning cycle for example in the military deliberate planning cycle which used to be two years it’s now one year post 911 planners at the combat and command levels which own the the the global war plans would say to the chairman of the Joint Chiefs and his and his staff here’s our plan please read it but more importantly here’s the list of the stuff we need to execute the plan now take that to Congress and get me a portion of the assets I need that’s the resourcing process and and a lot of us you know do plans and we take a plan after lots of effort and we put it on a shelf and we say look how nice it looks it’s thick so it must be meaningful and look how much effort was put into it but unless you extrapolate out from those plans the actual requirements and capabilities to execute the mission and then put dollars behind them to have them come into existence your planning efforts are moot they for not uh so I I think that that word that Carol raised is very very important for us to consider uh because it’s something are it’s a disconnect between us and our com controllers in in in various agencies uh and that at the end of the day you know we might we need stuff but until we we hand the you know the bill of lating to them we’re not going to get it and then when when push comes to shove and and the assets are needed to be called in they’re not there for us thank you for your comments Carol and then from the chat we have Anan Prosper saying thank you for this presentation do we have a set stand set of warning indicators for emerging diseases uh I I would say in in aggregate uh no in in fact from my personal experience including um time spent at at CDC um when I was involved with with planning efforts in the mid uh early 2000s never knew how to say the 2000s right it’s you know 2000 to 2010 one of the things we we heard a lot about was uh that the CDC um and Health and Human Service had had funded something like 5050 disperate U surveillance systems and the joke was that they were kind of waiting to see which one would work it’s not a good joke uh but they were they were kind of banking on let let let’s see which one shows you know the the the the best return on the investment and that’s the one we will universalize We we’ve never come to that so there’s two issues that are being brought up here there’s the surveillance and Report there’s three issues it’s the surveillance and Reporting is one that that drive us to action and the other is uh Global Medical intelligence uh we I I recently participated in an international program on global emerging infectious diseases with a very uh aidite group of of people from a think tank in Washington uh and and this came up that that while we have an organization called the national medical Intelligence Center here in the United States even that has flaws because it’s largely only accessible by military personnel because it’s a portion of the defense intelligence agency which is a subset of the Central Intelligence Agency uh which in many case mandates that people have access and clearance to see the stuff in the first place uh and and two there is no equivalent at the global Level under for example the egis of an organization like The Who that allows us to adequately share uh good uh emerging medical intelligence uh to drive our planning and respons efforts so I would I would argue that that right now that this is still a gaping hole uh that needs to to changeed the only thing I would say that we’ve seen improved and it and it’s kind of serendipitous is that because of the availability of the worldwide web web and and the the very rapid transfer of information largely an open source that we all experience on a daily basis now we can get some of that that information through asymmetrical you know sources uh DHS for example has a has Department of home and security United States has a whole Wing uh if you will who has people dedicated to sitting in front of computers and looking for keywords that are being pulled out of of people’s conversations and and and tweets and and Facebook posts and open source things they’re not they’re not getting into people’s lives and brains but they’re picking out these words that people post and and that is helping to expedite their response the the great example is when when the uh gentleman from West Africa showed up in Dallas uh at the Catholic Hospital there uh displaying signs of Ebola that wasn’t recognizable to the hospital emergency staff at first one of the nurses tweeted I just had a guy come in from Ghana or Sierra Leon and that actually activated the CDC uh Epi intelligence service and the folks in asper and the intelligence agencies ahead of any official reporting that went through the um uh MMR the daily or weekly morbidity mortality reporting uh system that we we currently use so this I think this is one of the the extent challenges uh that is still out there for us uh and and it will always be a little bit on the hard to overcome level because of the fact that uh you know we we we don’t get along with everybody I mean you know China and Russia you know are you know we have our issues with them currently uh we we worry about you know the quality of the information that that we might get them in terms of what it represents by early warning uh systems uh for us to leverage uh quick response so I I I think we’re going to continue to see challenges in this space u and and it’s it’s it’s it’s using this term too many times tonight but it’s another greenfill opportunity for smart people to start thinking about how do we change this current Paradigm great and then um one more question from the chat um what is being done to assure that basic preparedness in healthc care curriculum is required in part of professional lure testing at the moment I think nothing uh is is my subjective uh impression uh I in fact I you know the president of watm Dr Don Donahue has spent uh no small amount of effort and years uh trying to in inject um issues related to medical and emergency uh and public health emergency preparedness and response into uh curricula uh in in the various Allied Health Sciences programs uh and the push back that we always get and I’ve heard I’ve heard this argued even we we had a document in the in the 2005 or six time frame um called home and Security Presidential Directive 21 or hspd 21 that was driven by by concerns of uh an emerging uh a near-term emerging pandemic that basically tasked uh organizations like the uniform services University which is the Federal Medical School in the United States to develop enhanced curriculum or initial curriculum on uh disaster emergency response and to the state we still don’t have a a dedicated mph program uh at that University or many other universities I’m only aware of two in the United States with a dedicated medical and public health disaster Management program uh we have a ton of Emergency Management Programs that uh came out of the the woodwork after 911 because the department of home and security you know funded them and felt like we we should be enhancing Emergency Management but but the medical community didn’t didn’t get the the same benefits of those initiatives and and I think until uh leadership in the healthc care space recognizes their role which is still questionable because an organization like the American College of healthcare Executives AC in the United States which has basically about 98% of all the CEOs and seite Executives in in the 33,000 plus Hospital in the United States as their members refuses to put curriculum into their uh annual training material or annual Congress related to disaster preparedness so I’m not sure how we Chang that I think it’s another groundwell initiative uh that uh you know the the rise of an organization like wadm w which can serve as a lobbying organization uh to to uh institutions of Higher Learning in the healthcare and public health space uh can can uh hope to invoke change in I will just quickly add that one of the reasons that the student young professional special interest group underwat exists is to serve this purpose to supplement the healthcare curriculum so if you know young professional students um you can point them towards us if you are looking to kind of bolster their education in this sphere thank you Alana very good point great and we have a couple uh hand raises so I’m gonna invite George Tatro sorry if I butchered that to come off mute and share his questions and comments thanks you almost get the name right thanks um one question for you Doctor um how good are we getting at uh standardizing communication because one problem we have in England at the moment is same thing same word means different things for different agencies like ICC like ICU so are we getting close to standardizing Communication in disaster management I think we’re making progress George uh I I refer to this as the NATO conundrum uh you know back back when I served in in the NATO community in the mid90s mid90s during the Bosnian campaign we had 18 Nations uh and it was uh not so funny joke that that none of us you know either spoke a Common Language or or had common approaches to our planning even though we knew that under the egis of of the NATO organizations we’d have to commonize everything a real good example was we we had uh we standardized the size of the litters we wanted to use in NATO if we went to war in in Central Europe but we didn’t standardize the the litter stanions that went into the airframes for U medical air evacuation uh for for patients uh so with that said I think we’re making progress if if only for the fact that uh I come back to that since 9911 what which really I think change people’s perspective on on the notion of increased scope and scale and frequency of disasters that we had to to to to bring Emergency Management and and our colleagues in the medical and public health sector dragging along to say we we have to formalize this we have to create architectures like Nims and IC that are common and that will be used universally we have to you know in invent language that applies to what we do uh we have to invent theories and constructs for Incident Management strategies especially at at Large Scale levels you know it’s for example we need to think now in in in in the world of our current threats about National Incident Management strategies where we could have entire Geographic swads of of of our countes affected by large scale disasters and all you have to do is look at the the the Indonesian tsunami to to to underscore my point in that so I I think progress is being made and again uh WM as an emerging organization dedicated to this space is is going to be I’ll use the term again a vector accelerant uh for us in in getting us to a a a more common place where our approach is is universal uh but like everything there’s still a long way to go I think George thank you thank you Al then um Helen Engle a sorry no you’re great you’re great hello everyone I’m a public health veterinarian from Western University of Health Sciences in Los Angeles and I I wanted to speak a little bit to the the concept of the vulnerabilities that you mentioned Dr margela and it’s just a real pleasure to to hear you speak directly um we in the vetenary community have been very concerned for a very long time about the um lack of BIOS surveillance across some of the species where these uh spillover events are causing the emergence of pathogens in humans we very much think that um when we’re having this conversation it starts from the human perspective we’re missing an opportunity um many in our Comm Community talk about a um species neutral approach to bios surveillance and if I can just speak one second to that in terms to a room full of perhaps primarily Physicians and emergency preparedness folks um there’s very little Companion Animal uh surveillance in the United States there’s livestock surveillance um because of foreign animal diseases and the implications to our food security um there’s a tiny little bit of wildlife surveillance um but I’m not sure that people in the room realize that all of those companion animals um that we interact with daily that are effectively Sentinels or can be Sentinels um for something happening in our local community um there is very little mandated surveillance of that um and so what I’m interested in hearing from you Dr Mela is is how much veter engagement have you had in your emergency preparedness um discussions and one thing I’ll just say before I have you answer that is you should be heightened to know or heartened to know that in my curriculum all of the veter students get IC training course good so Helen first off I I I couldn’t agree with your comments uh more uh the veterinary Community uh is a an absolutely vital link um uh and it it to the the broader medical and public health uh preparedness uh community and and on the the notion of of of being almost a principal um Sentinel surveillance uh Network resource that’s available to us we have to do a better job uh pulling them in we simply can’t look at them under under the the concern of purely the economic impact of of disaster like foot and mouth disease and others that might affect the sale of of meat from from the cattle industry um and and you know it only seems to get to the attention of somebody like Oprah Winfrey when when it’s at that condition of economic concern uh on the other hand if you take seriously my point that with climate change which I think you do that we’re we’re seeing greater interaction between um animal species and and humans uh it’s it’s default likelihood that that is where xonotic sources are are going to see an increase in causing disease making special jumps into humans and with all of the attendant problems so we do have to do a better job um I I my admonition to to anybody uh is is it comes back to the silos uh a program called the national preparedness leadership initiative or Institute at Harvard University started by David guren Dean Meritus of the Kennedy School they introduce a theory the theory of Silo isation and and one of the important points about the theory is they they they use this great demonstration it’s five or four vertical Silo looking you know entities on a piece of paper and they he points he point or they point out that independent of one another the silos are always competing against each other for attention and money and and power and ETA they ver they exercise leadership in a vertical top down topheavy Continuum and and what they argue is ver the the verticals as silos should not go away because they all provide a discreet uh and important positional resource to the the Greater Community at large of of this preparedness and response Mission what they argue is is that there needs to be a metal leader that that comes in the form of a person an organization or a policy that brings those disperate uh entities together for a common purpose and the veterinary Community if only because of this issue of increased uh zuntic sources causing uh more risk of future and and more aggravated uh pandemics has to come into the fold uh and and that’s only going to occur when when people from the community argue you got to listen to me I have to be at the table as much as as the Public Health Community has to argue that they need to be at the national security table at the National Security Council if if we’re going to be heard uh and we’re not going to wait for really bad stuff to happen before we say God I really should have talked to them in the first place so I hope that answers your question thank you yes and then our last uh question is going to be from Mark voice I just want to say um if you have any other questions um feel free to follow up with the student sck and we will direct it um so Mark if you can just come off and comment and question that’d be great hear I can hear you so my my two disclosures are I’m an adolescent psychiatrist and I’m a multi- deade member of the Physicians for Global survival ipnw Etc so I’m thinking of psycho aversion I’m thinking as a psychiatrist um with all due respect to the magnitude of how we’re talking today I wonder if psychosis is a better word as in the um coughing into your elbow stop drop and roll so I think everybody has heard the phrase one of the definitions of insanity is doing something over and over again that’s not working so the Physicians for Global survival have actually put almost all of their effort not into building bunkers preparing having lad shielding because they’ve concluded and I’m have to say listening to your talk today I’m not impressed with my survival under and I live in Canada Toronto I I’m worried this is not good but I’m just a little less worried that I’m about nuclear war because you’re saying virtually when the stuff hits the fan you’re on your own buddies like this is don’t there’s no white night coming down for you so my my two aspects of the questions are what do you consider would be an appropriate response to the mindset of people as in are we just being a little we need a nudge you know great psychon neurological term we need a little nudge we need a little reminder we need a little history lesson we need to be kind and compassionate and and arouse people to attend to the fire that’s burning their butt off or should it be the type of mindset response that deals with psychosis to it the stress of us medical professionals who were dealing with people in their dying words saying it’s a it’s a hoax this doesn’t exist you know co co no it’s a scam it’s a conspiracy and they’re they’re dying words which not to say they didn’t pay the price of death but that was really really distressing to a lot of Health Care Providers yeah Mark I would you know there’s another side of that that you know near-death and still you know denying the reality of of of an ongoing pandemic when when one is actually suffering from it and is being propelled to their own mortality in the first place the stories that I’ve heard uh you know have to do with with people who have been deniers from from day one uh about to be intubated uh because they’re on their very last leg and their last words uh to the intensivist is can I have the vaccine please and and of course the response is yeah even if I gave it to you you you wouldn’t build a level of you know immunogenicity that would be sufficient to protect you at this point what they’re not saying is you’re going to die but that’s that’s what was happening I I I I think there’s a find you know first off I go back to Dr tur Bush’s comment if and I’m glad he made it because I I should say it in in every one of my presentations um it it’s not it’s really not if and it’s not picking a disaster any disaster like you know the next pandemic it’s not if but when I I for years have done a presentation called it’s it’s always 911 uh and I I ended by by by saying you know just like on that bright clear beautiful Tuesday morning at 8:46 and 38 seconds uh it was a bright clear beautiful Tuesday Morning uh a second later the entire world you know turned on a diamond changed on us and nothing has been the same since uh from a you know I I’m for the record you know not a behavioral scientist I I I absolutely appreciate the role uh that the behavior the absolutely important role that the behavioral health Community plays uh in in this space especially on this issue of forgive me if I’m not phrasing this right the right way buying into the fact that these events hang over us as a global human POS population much like the sort of Damocles on a daily basis just in varying degrees I I don’t argue that people become Preppers because just like everything in the bell curve you know the extremes on either end are are largely useless and in in the prepper Community God loved them you know they tend to isolate themselves and and and will shoot at anything that wants to come near them for fear that they’re going to take their resources that’s an extreme on the other hand doing nothing uh is a recipe for pun intended disaster because if you’ve done nothing to protect your own sphere of influence that is your own home your own person you know by simple things like vaccinating against emerging diseases for example uh and and will and wait to see either what the outcome will be or what others will do you know including how they might help you when you know the the proverbial stuff starts to hit the fan you’re in for trouble so my argument is don’t don’t wait for higher levels of organization to come and and and help you do enough to to give yourself some increased level of enhanced posture preparedness for yourself and the people you care for your family so that at least for some period of time until outside resources are able to come in you’ve got things that can sustain you and they always come back to the basic Commodities of Life access to water access to food access to shelter um access to uh some sort of physical protection that is going to keep you safe from harm for as much time that can be afforded to you so I I look forward uh and I love your element of History I look forward to one of your talks I’m going to give you the title cultures that extinguish themselves and we can do to prevent it thank you good point if you read if you read that that that that small pox uh book that I I introduced at the beginning uh uh Mark’s not too too far off there literally have been have been Empires that have have gone away as a result of disease um and I’m I’m a I’m a a war college graduate and you know we start off with strategy and policy we start all all the way back with acidities and the pelian war you know is is one of the most recogniz recognizable first recorded incidents in history where we have good records and and the Athenians lost to the Spartans uh because of a a massive disease outbreak that most think was either um Bubonic plague or I tend to think it was a small poox outbreak but we we seem to have failed you know recognizing the the impact of disease uh on our our our our cultures and our civilizations I I’ll end if that was the last question with a with a quote from uh will Durant the great historian uh pair with with his wife that said no great civilization has ever collapsed without first allowing itself to collapse from within and you could take that from a political perspective or you could take that from you know the dangers that are inherent in our environment today if if you’re not going to do anything about it it should be no surprise uh when when you your life as you know it your community and your country as you know it you know becomes a a loud sucking noise because we we just failed to take into account that these things occur and with all of the factors I’ve enumerated today are occurring with greater frequency by ways that we really can’t prevent this is a natural progression uh the the the British Economist Thomas malus in the the 17th century had a something called Mal the malthusian prophecy where he said at some point we’re going to exhaust the the resources as humans of of what this pop this Earth can provide for us and most treated him as an extremist but if you think about it you know with with the way we’re growing and and and moving forward so fast it if we don’t take the time to think about you know what’s out there that that does the the human species harm uh I I think we’re we’re all going to suffer the attendant consequences so with that I I think we’re just past seven quite a bit past seven so I I want to thank you very much for your time and attention I do hope you enjoyed this as much as you can enjoy a subject like this uh and at least founded somewhat informative uh and and helpful to your own professions and efforts that you’re making on a daily basis and for all of that I I I want to thank you you wouldn’t be here if this wasn’t an interest uh to you and I know many of you have devoted your lives to to to uh preparedness and health care and public health and uh God love you thank thank you thank you so much everybody have a good night um if you have any questions or further followup you can see it find us at wm.org and our email at student wm.org thank you so much have a great night thank you