Pandemic on a table top at CDC

There are all sorts of ways to prepare for an emergency. One is to simulate it inside a computer (a computer model). But you don't have to simulate inside a computer. You can also do it in "meatspace" (aka, the real world). Dungeons and Dragons using books is one example of this. Another is to do a pandemic version of D&D. It's called a table top exercise, although the size of the table can be pretty big. Recently our wiki partner, DemFromCT (if you can call someone a partner who does all the work), observed a CDC exercise which he has described in detail over at the FluWiki Forum (here, here). Yesterday he but up a shorter but still pretty detailed version at DailyKos. Here's the scence in CDC's Emergency Operations Center (pic at DailyKos link), a room filled with operations personnel seated in front of monitors:

Each of the 50 monitors is manned by someone coordinating one or another of the fuctions CDC needs to fulfill in a pandemic, such as collecting state data on hospital beds, or sharing their expertise and advice to local and state offcilas on infection control, quarantine and legal issues. There are liasons with key government partners like State and DoD (in the scenario, military personnel on an overseas ship are affected). It's now day 6 of the pandemic, according to the exercise, and the CDC Director, Julie Gerberding, is calling the Georgia State Emergency Manager to find out if Georgia schools are closing (the answer is: not yet) to assess the impact on CDC employees if their kids are sent home.

That's important information for many reasons. School closure (more properly termed student dismissal - the buildings remain open and might be used for alternate treatment centers or school lunch distribution) is a linch pin in the community mitigation strategy that CDC recommends in a severe pandemic (see this brief discussion on community mitigation from Dec 2006). However, the dependence on local decision making means that smooth execution of well-laid plans is not assured. For example, here's what happened in Atlanta this week [from the account at Flu Wiki Forum:

The CDC was very accomodating in allowing the observers access to senior staff and section officers on duty, including sitting in on an hour briefing/conference call with the affected states (whoever played those roles, the accents were perfect - Arkansas sounded nothing like Michigan). States had varying ability to update CDC with real time case numbers ("I'll get back to you on that" must have been the most commonly heard line of the day), and difficulty with adjusting on the fly to requests for extra personnel ("we need you to send 20 staff, varying qualitications, to support screening activities at your state's busiest airport") and rapidly changing policy requests. That was especially evident when the states were asked to consider community mitigation strategies including student dismissal. Some states pushed back on that, with an observation that it would be a) difficult b) disruptive c) expensive. In addition, in some states, there was no clarity as to whether decisions would be made at the local, county or state level (states with only a few cases were less ready to pull the trigger; Hawaii was quite worried about the effect of all this on the tourist industry). (Flu Stories at Daily Kos)

This may be role playing, but as Dem observes, it can get pretty realistic and intense. Having done some of these, it is not hard to put yourself in the role and the participants here were actual officials charged with making these decisions:

Some states might be more ready, some states less. If they wanted to make a point in the exercise that states were not ready to simply throw a switch and turn on non-pharmaceutical intervention, practice social distancing, close schools, etc, on a moment's notice on a call from CDC, that point was made. [DemFromCT's comments on the exercise]

This was a very rich experience for all concerned and it is exceptionally well described by DemFromCT. I urge anyone interested in what it might be like to confront an evolving pandemic at the federal and state levels to take a look at his account at the Flu Wiki Forum or the shorter version at DailyKos. I have barely scratched the surface here, but why repeat it when you can get it from an actual participant?

Like DemFromCT, I am encouraged by these activities but add that this is just a tiny piece of the puzzle. If and when the shit hits the fan, knowing how bad things are going to be and working out some of the kinks is a leg up, but it's no substitute for having adequate resources, training and staffing. Since this is an uncertain event of uncertain magnitude that might or might not take place at an uncertain time you don't want to have a lot of special purpose people sitting around waiting for it to happen. You want them fully employed all the time keeping the community safe and providing a robust reserve for emergencies.

In other words, you want a sound, functioning and efficient public health and social infrastructure.