Monday, April 27, 2009

School Nurse Set Response in Motion - New York Times

Seeing Warning Signs of Outbreak, School Nurse Set Response in Motion - New York Times

It was a routine call last Thursday from a diligent high school nurse that put health detectives in New York City on the trail of a swine flu outbreak. Over the next few days, things unfolded much like a criminal investigation, with alert epidemiologists cast in the role of the police officer who remembers information on a wanted poster.

The newest thing on the things-to-be-scared-of list is swine flu, which has hit a number of countries around the world. In particular, Mexico, which led to cases in the U.S. So this because a Public Health emergency. And, since the coping through ignoring it and pretending it did not happen does not seem to be the U.S. policy, the first order of business is calming the public (because if you don't your doctors and emergency room will be flooded with the worried well/sympathetic illness types. The players here are the government and mass media. Because the function of mass media is to disseminate information to the population as a whole. (*really, this is what justifies their existance, otherwise news would only be subscription based to the few, a la Dow Jones corporation*)

So, how does this happen? The lazy way is news as copying press releases (e.g. Fox News and the Republican National Committee) But if you actually have a reporter who knows something about the subject and about her beat, you can do so much better. So the New York Times actually has a series of articles. One essentially communicating what the Federal Government (DHS, DHHS, CDC) are saying, articles about the city department of public health and the mayor. A couple articles of Q&A with expert doctors whose names are handy. Everything needed to let the public know that there is a plan and procedure, and noone is hiding, even with the unknowns. And throughout, the reporters know the questions to ask (not long ago, a very experienced New York Times reporter wrote an article looking back at how New York handled the 1918 Spanish Flu, no doubt giving all the young reporters there a master class on how these things are done.)

And this article is something even different. A close look at how the system works, by showing it in action. A school nurse spots the symptom (because school nurses, as well as other public health nurses, actually see entire populations first hand, not just reports that are sent in to them), the city department of public health recognizes a pattern that needs attention. Public health staff fan out and examine the affected. Centers for Disease Control are contacted and lab samples sent and tested. And a response is developed and enacted. All procedures that have been in place for years, tested on the ebbs and flows of daily life, and the occasional emergency. And refined by people who actually have to use them. Just the way you hope.

And it may be that swine flu is a little thing, a flash in the news cycle. But it is more. It is what scientists call a found experiment. Disaster response people have another name. A spontaneous exercise. Respond to something that uses all the command, control, and communications procedures that are in place for responding to something bigger. In this case, waiting for the day that a genetic drift mutates a strain of avian flu so that it is human-to-human transmittable. Just to make sure that everyone, President, cabinet secretaries, White House staff, agency leads, local officials, teachers, doctors, nurses, news media, and others, know what their role in a public health event will be.
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