Effect Measure

Useless advice for public health officials

The Toronto Sun has another one of the “such and such a city/state/country isn’t prepared for a pandemic” stories. The judgment comes from the 2007 Auditor General of Ontario’s annual report. Yawn. Like it’s so easy to know what to do, right? Maybe not. So the Report has some recommendations:

The report says the ministry “does not have assurance that all members of the health system knew what to do in planning for and during a pandemic.”

As a result, the report lists recommendations that would serve to help prepare Ontario for such a catastrophic flu bug. The recommendations include, among other things, regularly updating the Ontario Health Plan For An Influenza Pandemic, requiring local public health officers to arrange for non-hospital quarantine sites, and filling the “large number of vacancies” of medical officers of health in provincial public health offices. (Toronto Sun)

I doubt health officials don’t know that there will be a problem with absenteeism. The question is what do do about it. There are a lot of possibilities, but “filling the large number of vacancies” doesn’t seem like one of them. What are they supposed to do? Go out an hire a bunch of non-existent doctors, nurses and other health care workers?

The “recommendation” I like the best, though, is “requiring local public health officers to arrange for non-hospital quarantine sites.” What exactly does this mean? That confinement sites will be established for possibly exposed but not yet sick people? Like maybe family members of the sick? Then who will take care of the sick family member? Maybe they don’t mean quarantine at all, but the frequently confused notion of “isolation,” segregating the already sick. But in a pandemic, with people getting sick all over, that’s not going to halt spread. So maybe they are talking about surge capacity. But then don’t use the loaded word quarantine when you mean something entirely different.

No one thinks any locality is fully prepared to face a true pandemic of influenza. It’s not wrong to remind officials, even if they already know it. But you’d think the criticism would be more constructive, better informed and more likely to achieve results.

Or maybe you wouldn’t. No one audits the auditors.


  1. #1 DemFromCT
    December 26, 2007

    For some reason, the auditors didn’t like “so maybe we’re – uh – screwed if it happens today”. They’re not the first people to react that way. But it’s not, as revere points out, for lack of trying.

  2. #2 M. Randolph Kruger
    December 26, 2007

    The audit will be done by the Almighty, the Reaper or whatever. This fluff you are speaking of keeps getting busted by the people who will be trying at least to keep this deal from falling into chaos first and anarchy second. I fear what could happen if these paperwork plans that the states have prepared fail.

    I have one here that is a mere six hundred pages long and if fully implemented with supplies could indeed change some outcomes. OTOH, it makes references to facilities that are not designated by name, supplied by anything that I have seen but the paper that designates them, and they are for the better part a recipe for a disaster within a disaster.

    We will know how well these plans work out after the big one because we will be able to say it wasnt good enough if we run out of food, water, medical supplies and HCW’s. At some point in time the government will have to Pan 6 it and tell the docs to withdraw because we will lose too many of something that is already in short supply.

    All things being equal in a 5% event and HCW’s being 232,000 in the State of Tennessee we will lose 11,600 and 1/2 to 1/3rd would be sick. for weeks to months. Thats everyone from the guy who mops the floor in Labor and Delivery to the guys in the ER who would take the brunt of it. This is something the table tops have yet to address. They havent in any numbers I have seen produced attrition rates for the HCW’s and that is very disturbing.

  3. #3 Library Lady
    December 26, 2007

    Dear Revere and MRK,
    Perhaps you could also address, at some point (maybe I’ve missed it), a scenario for media coverage during a
    pandemic. Are there plans for handling the media?

    I am thinking of media coverage during and after hurricane Katrina. The coverage was extensive, but poor in quality. Rumors were reported as fact–rapes and murders reported from the Superdome never happened.

    Reportage turned political very quickly, turning the spotlight on FEMA, President Bush and the Corps of Engineers, and ignoring the disastrous results of corruption in Louisiana politics.

    Hysterical interviews ensued–“Where is the Calvary!? Where is the Calvary!?” (he should have said cavalry, but ignorance being what it is…).

    Reporters say they are “writing the first draft of history”–as if first drafts never need be accurate.

    So, any thoughts about how media will respond in a pandemic? Should reporters be allowed to become “loose cannons” during a pandemic as they were during Katrina?

    Library Lady

  4. #4 revere
    December 26, 2007

    LL: Any attempt to “handle” the media usually is disastrous since the handlers also have an axe to grind. Better to let a free press run amok, IMO, with the downsides of that than to do what the gov. and politicians and corporations do anyway, which is spin. There is a great deal of handwringing of the type you are doing about the media in public health and government circles but I don’t buy it. As for Katrina, there was plenty of criticism for corrupt LA politicians (which they deserved; NB, they usually voted in Congress with Republicans, not Democrats even though they were nominally Dems) but FEMA was incompetent, corrupt and so was the C of E, so they don’t get off the hook. Of course it turned partisan. This is a Frankenstein that the Bush admin. encouraged (but it was not limited to them) and it is always a two edged sword. So it came back to bite Rove, Bush and company. Poetic justice in my book.

  5. #5 M. Randolph Kruger
    December 26, 2007

    LL-“Handling” of the media in the US is prohibited as Revere indicates. OTOH if a state of emergency is declared then the governors or President has sweeping powers. They can in fact TELL the media what to report…or face arrest, even if its a lie. Or not to report at all. They can shut them down. The Supreme Court has ruled on this before, I have it in my files somewhere but indeed they can do just about any damned thing they want. This of course would last right up until the time that the police and military just said no, they werent going to enforce that. But detention in times of a declaration have not been explored too terribly much. Hasnt happened and we dont want to know. So better to manage things better?

    As for Katrina, it was a complete “balls up” as they say in the UK. FEMA is an agency with a lot of money, but few people. Revere asserts that it was a Federal problem and I vehemently disagree as the levee’s in question were under complete and total control of the state and local parishes. The Corp’s was only allowed to inspect them for General integrity and not the height, or their base construction. They failed in 1955 too.

    But generally speaking those levee’s failed for three reasons. Height being the major one, second poor maintenance, third constructon. They were built with politics ridden dirt and somewhere about 300 million dollars from GB1 to Clinton 1 and 2, and finally on GB2 just disappeared. Magic act. They can currently account for 2 million of it, thats it. Blanco stood before Congress and refused to answer questions about it. Why? Because then they would have to open a Waxman hearing under oversight and cant do that in an election year. Shit Henry wouldnt be Chairman if the truth came out….

    The response as I have stated many times before was couched in poor federal law, the law that the states deliberately kept weak. They didnt want the government to have sway over them and the law ensured that. Granted people were suffering. But the Federal government is not allowed to break the law and it was really only three states worth. National issue? Hard to prove that at an impeachment hearing. To put one federal troop into a position of authority is a violation and the President could be impeached for it.

    That law being the intervention in states affairs, generally referred to as Posse Comitatus. States rights. The federal government is not allowed to intervene within the confines of a state without the declaration or request for federalization of a disaster. It means they the states cant handle it. Thus it HAS to be under federal control.

    Governor Blanco insisted that federal troops, FEMA and every branch of government be put under her control in the state. Uh, scuse me but they were doing such a bang up job stealing money they wanted to steal some more. Why do you think they wanted everything under their control. It was the biggest lunch pail in US history and that included Vietnam and Iraq, WWII combined if you took the costs, the post costs and the costs its going to incur for the next 20 years. Those levee’s if they get hit again are going to be toast.

    The law is specific about intervention. This is patently not allowed and either it continues to escape Revere, or he ignores it. Most people Dems and Republicans who dont know the law felt the same way. So while people died up on the overpass and of natural causes (mostly that is from being poor and not smart enough to leave in front of the then most powerful storm ever recorded) Blanco, Nagin, and the President sat on the tarmac at MSY and haggled until Nagin told Blanco that he was going out the door to out her to the press. He backed the Republican in this election or so I hear. But it doesnt change the facts. People died for various reasons, there are major problems in New Orleans and they still havent been resolved. FEMA and the Corps are allowed to put things back the way they were by mandate. They are not allowed to roof peoples houses. They are not allowed to enter private property and demolish one, or fight with their insurance companies. But you also have a population there that has been on the government dole since birth. What else could we expect?

    History lesson. This EXACT same thing happened in Florida when GB1 was in office. Then Democrat governor Lawton Chiles did the same thing when the entire length of the Florida Gold Coast was in shambles. He federalized it at day 3 as Blanco did and then blamed the whole thing on GB1. Nice politics with peoples lives.

    Federal law could not be violated and the troops were on standby but the order didnt come for three days. About the time it took for the damage to the credibility of the Presidency of the US to be done. Dem or Republican, that pisses me off.

    I dont know that BF will arrive before GWB leaves office and Revere has a well known rub with Republicans but it doesnt matter. Each and every time someone media or otherwise pot shots the Presidency and that INCLUDES me if its in a public forum, does the country a disservice. Clinton brought it down on his own head with Monica, GB1 by not stepping up to a microphone and saying to the public that Lawton Chiles was witholding the declaration and the same thing for GB2 on Blanco. All of these Presidents should have done a Kennedy Cuban Missile Crisis and said I am going to kick ass and take names..

    They didnt. None of them were up to the task and really not because they werent able to. More because they were media hounded. None of them are stupid, so how did this happen and how will history write the pages on all of them? I dont know. But media needs to get it together. When Brittney Spears outpolls all of them because of the coverage then we have a problem. We will end up with very mediocre Presidents and they will become nothing more than “pop princes and princesses”. Then when they are put to the task the media that should have been exposing things on Hillary, Thompson, McCain, Romney, Obombme will villify them because they ARENT up to the task. We need couple of real centrist assholes with a penchant for talking to the media. It gives them something to write or transmit, it keeps them busy. They dont have to go and look for trouble.

    I believe that media should be muzzled only as a last resort. Even on the day that Rodney King was getting his ass kicked and the media is whipping it up, they shouldnt be. On the other hand when publications such as the Miami Herald were publishing outright lies during the Liberty City riots, then the governor should step in or the city/county mayors and put them on notice. They are there to sell a product too…its advertising and not the news. If there is no news they go a long way to manufacture it…such as deaths in the dome. Never happened by hand against hand. Spike Lee made a movie and it was FILLED with accurate and inaccurate statements. Both though are accepted as truth. Why? Because we saw it on the tube.

    Revere might disagree but one thing is sure… media control is Imelda and Daddy Marcos type of stuff. Indeed it is the one way we can ensure that we DO maintain a democracy if there is little or no control. I like a little control.

    Might want to pull this one out. http://links.jstor.org/sici?sici=0003-0554%28196606%2960%3A2%3C285%3AACOTET%3E2.0.CO%3B2-O&size=LARGE&origin=JSTOR-enlargePage

  6. #6 Library Lady
    December 26, 2007

    Thank you for your post. Something to think about.

    Thank you for the extensive assessment of the Katrina coverage, and the historical references. I will follow up on your suggested link.

    Library Lady

  7. #7 Risk Communicator
    December 26, 2007

    Dear Revere and Library lady:
    As a public health educator and former journalist, I agree that “handling” the media doesn’t really work but working with the media does. And during a pandemic, as with many health emergencies, effective and proactive risk communication will be vital to the response (as well as pre and post event). We all know what happens when there isn’t anyone credible to provide accurate info to the media so public information and risk communication should be part of every health department/agency’s pandemic flu planning.

    Thank you for providing such an informative and interesting blog that even non-scientists can appreciate!

  8. #8 bc
    December 27, 2007

    If I understand Revere’s post, he seems to be interpreting the lack of public health personnel referred to in the news article as what might occur in a pandemic due to absenteeism.

    However, what the auditor’s report is referring to is filling the vacancies that exist TODAY in Ontario’s public health system. (One third of local public health units without a full-time medical health officer; 40 vacancies in the public health lab system, 50 vacancies in the public health division of the Ministry of Health; no physician head of communicable diseases for past two years.)

    The report repeats the words of the Ontario Medical Association, “There is a danger that the current critical mass of medical officers of health is insufficient to be viable and sustainable. The foundation has been so eroded over time that, if not protected and fortified, it will disintegrate and seriously imperil the province’s health.”

    The public health doctors, nurses and other health workers are scarce today, without a pandemic, in Ontario and in the U.S.

    See report at http://www.auditor.on.ca/en/reports_en/en07/312en07.pdf

  9. #9 revere
    December 27, 2007

    bc: You are correct. That is how I interpreted it and your clarification makes it sound much more reasonable. I stand corrected on this point. Much appreciated.

  10. #10 marquer
    December 30, 2007

    However, what the auditor’s report is referring to is filling the vacancies that exist TODAY in Ontario’s public health system.

    I recently came across a partial explanation of why such vacancies exist, and persist.

    To wit, a young woman of Chinese extraction, from one of the families who had traded domicile in Hong Kong for Vancouver in the 1990s, and who had been granted Canadian citizenship.

    She then received a top-flight medical education in Canada thanks to generous public subsidies.

    Did she then, as might have been expected, remain in her adoptive nation to put her critically needed skills to work on its behalf, and to help repay what had been invested in her lengthy training?

    She did not, and in fact disappeared southward to the States at her first opportunity, in pursuit of the almighty buck, and I doubt whether she will be back up north any time soon, if ever.

    The Canadians could have thought that whole thing through rather more clearly than they did. Communitarian idealism only works when you are starting from people who are motivated by communitarian ideals.

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