AGENCY PARTNERS: DSHS ROLE IN EPIDEMICS
This question and answer article explains the role of the Texas Department of State Health Services (DSHS) in the event of an epidemic, and how DSHS coordinates with the Texas Division of Emergency Management. This article also discusses lessons learned from the H1N1 influenza epidemic.
How would the Department of State Health Services (DSHS) determine that an epidemic is going on that would require DSHS intervention?
It’s important to remember that an epidemic is a higher-than-normal rate of disease, whether that’s tens of thousands of cases of something common, like the flu, or just a handful of cases of a rare illness, like food borne botulism. Health care providers, hospitals, laboratories, schools and others are required by law to report suspected cases of certain conditions to the local or regional health department.
In addition, several reference laboratories make reports electronically through the state disease management system, National Electronic Disease Surveillance System (NEDSS). More than 60 local and regional health departments and DSHS view and share disease information through the system. The system provides health departments with the background rate of disease in a community or state, and also provides evidence of possible increases in disease rates.
What are the first steps DSHS would take in response?
The first steps in responding to an epidemic or outbreak will vary with the disease and the “size” of the epidemic or outbreak. An initial step DSHS would take for any epidemic or outbreak would be to inform public health departments of the occurrence and to provide guidance on implementing appropriate control measures.
How does the agency coordinate with TDEM in an emergency situation of this nature?
As in any other disaster or emergency, DSHS would activate the State Medical Operations Center (SMOC) and support TDEM activities. During the most recent pandemic, one of the major successes was that TDEM hosted conference calls with emergency management and partners, during which DSHS executive staff communicated information and answered questions. We anticipate continuance of conference calls hosted by TDEM.
How do you communicate information about an epidemic to the public?
Since the appropriate response to an outbreak may vary with circumstances, the best guidance for the public is to monitor the news and follow the instructions of local and state health authorities. In response to an epidemic, the public will be kept informed in a number of ways: through traditional news media at the state level – and via regional and local health departments and local governments. Information will be provided through advertisements and public service announcements, the Web and social media like Twitter and Facebook, as well as directly via messages through the Texas Public Health Information Network.
A traditional or virtual Joint Information Center (JIC) can be activated to support the State Medical Operations Center (SMOC) and bring together communications personnel from various organizations that support the health and medical response. The goal is to present consistent, credible information at all levels.
What were some of the lessons learned during the H1N1 epidemic?
Prior to H1N1 our pandemic planning was based on some worst case planning assumptions. Examples include the 1918 influenza epidemic which killed millions of people and H5N1 – popularly known as avian or bird flu. This flu has caused 510 human cases, including 303 deaths, since 2003, according to the World Health Organization. It was of grave concern since it had not been seen before and spread rapidly to many countries.
Our assumptions were that another new type of flu potentially could cause mass fatalities – and that the pandemic would begin overseas – giving us plenty of time to react before cases began to appear in the United States. We assumed that we should give priority for receiving vaccines to the people who would keep government and health care operations running.
What actually happened during H1N1 is that we did not have mass fatalities compared to the number of persons infected. The disease appeared very quickly in the United States. Our priority groups were people who were vulnerable to adverse outcomes rather than persons needing to keep government up and running. The lesson learned is to build a scalable plan which is flexible and can be implemented during influenza pandemics of all severity levels.
Please describe how mass vaccinations would take place.
Within the Strategic National Stockpile plan framework, regional and local health departments have the capacity to provide mass vaccination clinics. We anticipate that we would continue to use the retail pharmacy chains, private providers such as physicians’ offices and local health departments that were used during H1N1 for mass vaccination efforts.