Mass care in biodisasters - risk communication

[Thornton]

Posted this area 12/16/06 0720hrs EST
Mass care in biodisasters, risk communications and lessons for journalists in the Idaho Duck die off.

In the event of a biodisaster the driving force for demand on medical services is risk communication. So from my hat as a medical volunteer and behavioral health expert, I am pleading for more consistent and aggressive journalist pursuit of good information. These apparent isolated events such as the Idaho duck die off provide a real life opportunity to improve in these areas.

I will focus just on a couple of representative reports.

http://edition.cnn.com/2006/US/12/14/ducks.reut/

Moldy grain killed ducks, scientists say
POSTED: 0106 GMT (0906 HKT), December 14, 2006

? 2,000 mallards die of apparent food poisoning in Idaho
? Grain may have come from nearby agricultural operation
? Ducks often resort to poor food sources during bad weather
? Fears of avian influenza outbreak in U.S. prove unfounded

In my opinion, much of the concern and future impact of this Idaho duck die off could be mitigated with better risk communication and better journalism. Better risk communication provides better information. Better journalism would not let such poor information pass as definitive.

First the poor journalism. See the last bullet in the quote ? Fears?.prove unfounded.? I have not seen one report provide any test results for avian influenza. We do not know what tests were conducted from what samples and what results. No proof at all has been presented. There are established protocols for investigating wildlife die-offs for H5N1. The responsible journalist would see that those protocols are followed or ask why not.

Next risk communication. The cornerstone of risk communication is credibility. I have posted before my simplistic synopsis of principles described by Lanard and Sandman. Credibility is further described as competence plus compassion. Then we look at competence as authority plus expertise. In some arenas authority comes from elected office in others administrative or scientific rank suffice. In this case I see quotes mostly from the Idaho wildgame authority Mr. Parrish and the federal USGS wildlife expert Mr. Slota. The most fundamental problem is their messages do not match. The second problem, the federal expert is downplaying avian influenza while the local expert keeps an open mind. Thirdly the federal expert (s) view of local history contrasts with the statements from the local expert. Mr. Parrish says ?I have never seen anything like this in 20 years.? Whereas the USGS wildlife center puts out statements that 500 mallards died from aspergilliosis last year (which may be a true statement, but then leads you to conclude that Mr. Parrish sees this as a different type of die off).


Two other areas ? probabilities and panic.

http://www.jacksonholestartrib.com/a...4400678cef.txt

Mark Drew, a wildlife veterinarian with the state Department of Agriculture?.
Is quoted

The highly pathogenic bird flu that we see in Southeast Asia has not been reported in North America," he said. "It would be extremely unusual that this would be the first occurrence of avian influenza.

Yes a technically true statement. The known probability of something happening that has never happened before is zero. But in the context of the investigation the probability is more than zero. Thus if we allow these types of statements to become the norm, then once the improbable happens, the authorities lose credibility.

Finally my core aggravation on quotes early on the reports

It's unusual in the number of birds and the sense that it's only mallards, but it's nothing that would cause anyone to panic."

There is never a good time to panic. I urge a plan for either providing good information from the beginning, or insisting on good information in the reporting, so that we maintain an environment of trust and effective responses.

I hope to see more journalists and publishers take an interest in pursuing better information. This will serve a tremendous public health service early on in any biodisaster. Remember- the most effective way to manage demand for medical services in a biodisaster is with effective risk communication.

Joe Thornton, M.D.

[sharon sanders]

Re: Mass care in biodisasters - risk communication

From my perspective effective risk communication includes "plain speaking" and telling the truth.

Most persons can handle the truth. A plan of action can be jointly formulated and together, as a team, the situation can be dealt with.

Plain and simple. Treat people with dignity and respect and it will be returned exponentially.

[Thornton]

Re: Mass care in biodisasters - risk communication

Re the City of Austin Bird Deaths.
http://www2.flutrackers.com/forum/sh...ad.php?t=15364

Note the differences in the certainty of findings and determination of who made the conclusions between the TV news reports and the official City of Austin Health Department media release.

A&M Lab Finds Cause Of Mysterious Bird Deaths (CBS 42) AUSTIN The mystery of why dozens of birds died suddenly in Downtown Austin has been solved. The birds were found lying in the middle of Congress Ave. last week, raising concerns about public safety. Last week grackles, pigeons and a few sparrows were laying dead all along Congress Ave. from the capitol to Cesar Chavez St. Now doctors from Texas A&M University say parasites and cold weather are to blame. Temperatures dropped from about 50 degrees to 40 degrees the night before the 63 birds were found dead. In addition, pathologists found parasites in the birds' muscles, tissues and brains. Autopsies on the birds showed none had eaten in the previous 24 to 36 hours, so that ruled out poisoning.

Source
http://keyetv.com/topstories/local_story_019080339.html

versus the Health Department media release
http://www.ci.austin.tx.us/news/2007/bird_deaths.htm

Austin/Travis County Health and Human Services Department has determined that the likely cause of the recent bird deaths along Congress Avenue was a parasitic infection that predisposed the birds to illness when temperatures dropped.
While more tests are under way, the determination of the cause of death by local officials resulted from a review of reports from two labs and consultation with animal health experts.

Generally the incident has been managed well by the Austin authorities. If not for the speculative sentence on parasites and temperature this official report could close the scrutiny. However the notion that unidentifed parasites and temperature drop can affect just a few square blocks of a city to cause bird deaths seems very novel. This taken in context of other speculative causes of bird death such as the never found Idaho moldy grain leads to some unease. We should consider if this unease (perception of risk) can be better managed by official acceptance of uncertainty or to continue with speculative conclusions. If we learn to deal with uncertainty we can always make progress, but one false finding on speculative conclusions can undermine hard won gains. Often the most truthful answer is uncertain.

From a journalism point of view, the TV news report is the only source I could find with the details cited. From that report it appears the reporter was either briefed by someone inthe city manager's office or actually had a copy of the A&M report. Either way since we now have partial citations by one news source, the city may help interested observers by posting the full report or at least the executive summary.
JT

[cartski]

Re: Mass care in biodisasters - risk communication

Re the City of Austin Bird Deaths.
http://www2.flutrackers.com/forum/sh...ad.php?t=15364

[snip]....We should consider if this unease (perception of risk) can be better managed by official acceptance of uncertainty or to continue with speculative conclusions. If we learn to deal with uncertainty we can always make progress, but one false finding on speculative conclusions can undermine hard won gains. Often the most truthful answer is uncertain.


JT

Justice Campbell's recent report on the handlind of the Ontario SARS outbreak also urges officials to accept the uncertainy of outbreak situations and to err on the side of precautionary actions:

J.

___________________

SARS Commission Final Report: Volume Three: Spring of Fear

http://www.sarscommission.ca/report/v3-pdf/Vol3Chp9.pdf

Precautionary Principle

In The Commission of Inquiry on the Blood System in Canada, Mr. Justice Krever said:

?Where there is reasonable evidence of an impending threat to public
health, it is inappropriate to require proof of causation beyond a reasonable
doubt before taking steps to avert the threat.1023?

The importance of the precautionary principle that reasonable efforts to reduce risk need not await scientific proof was demonstrated over and over during SARS. The need to apply it better is noted throughout this report.
One example was the debate during SARS over whether SARS was transmitted by large droplets or through airborne particles. The point is not who was right and who was wrong in this debate. When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty.

A precautionary approach also was in use at Vancouver General Hospital when it received B.C.?s first SARS case on March 7, 2003, the same day Ontario?s index case presented at Scarborough Grace Hospital. When dealing with an undiagnosed respiratory illness, health workers at Vancouver General automatically go to the highest level of precautions, and then scale down as the situation is clarified. While the circumstances at Vancouver General and the Grace were different, it is not surprising that SARS was so effectively contained at an institution so steeped in the precautionary principle.

In Ontario there was a systemic failure to recognize the precautionary principle in health worker safety, and in the identification and diagnosis of a respiratory illness that mimicked the symptoms of other, better-known diseases. Amid this systemic absence of the precautionary principle, it is not surprising that in Ontario, unlike in Vancouver, SARS caused such devastation, infecting 375 people, including 169 health workers, and killing 44, including two nurses and a physician.

The Commission therefore recommends:

? That the precautionary principle, which states that action to reduce
risk need not await scientific certainty, be expressly adopted as a guiding
principle throughout Ontario?s health, public health and worker
safety systems by way of policy statement, by explicit reference in all
relevant operational standards and directions, and by way of inclusion,
through preamble, statement of principle, or otherwise, in the Occupational Health and Safety Act, the Health Protection and Promotion Act, and all relevant health statutes and regulations.

? That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of procedures,
guidelines, processes and systems for the early detection and
treatment of possible cases.

? That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of worker
safety procedures, guidelines, processes and systems.

[Niko]

Re: Mass care in biodisasters - risk communication

Along the same lines: regarding erring on the side of precaution, see this post by Nancy from today.

http://www.flutrackers.com/forum/showthread.php?t=15434

[AlaskaDenise]

Re: Mass care in biodisasters - risk communication

What happens when the PPEs supplies are gone?

I often wonder whether how many HCW will continue to work.

If they die because of lack of PPE, who is to blame - the hospital for lack of foresight in stockpiling PPEs or the HCW for working without following guidelines? This might be a workmen comp nightmare.

.

[cartski]

Re: Mass care in biodisasters - risk communication

Workers compensaiton is based on a social contract in which workers give up their right to sue their employer in exchange for a designated level of wage compensation and health care coverage. The actions of the employer and worker are "no fault" in terms of tort or negligence law (Canadian); however, arguably this princicple is infringed upon with certain types of employer penalties and limitations on worker entitlement to benefits due to their non-use of safety equipment (ie. metal gloves for butchers). There are also narrow and confusing exceptions to this principle depending on the worker or employer's status under the applicable compensation legislation (read - counsel's advice is required!) But likely the health care workers, or their estates, in Ontario and Vancouver would have no action in tort against their employers. "Blame", at least in a traditional, legal negligence sense, not moral, sense, is generallly removed from the worker's comp equation.

Workers compensation is not the same as Workplace Safety and Health (or Occupational Safety and Health) legislation, which is quasi-criminal. Hence employers can be charged and fined for their actions, or inactions, separately, although the administrating government department may the same entity as worker's comp in some provinces.

U.S. worker compensation is significantly different and widely variable among the states. I've always been confused about their system. There may be a subrogated negligence action against the employer for damages over and above what is paid by the private workers comp insurer - but don't quote me on that. Retaining counsel in the US is a must!

In all three parts of Justice Campbell's report he was extremely careful in avoiding the language of blame, culpability and negligence. He was on a fact-finding mission, and he was, to my reading, careful to span the differences, hostility, and legal maze that could easily erupt from the SARS outbreak. He recognized, IMO, that the real value to the commission was to make meaningful and pointed recommendations for change while at the same time repairing relationships and preparing "the system" for the inevitable future outbreaks - or worse.

But, AD, is there a nightmare brewing? Yes, indeed.

J.

[AlaskaDenise]

Re: Mass care in biodisasters - risk communication

If health care facilities are forwarned that an infectious disease is likely to break out, and they know the expected infection rate is say, 25%, and they also are forwarned to expect supply disruptions, isn't the prudent action to stockpile PPEs, & other supplies?

How many facilities have done this?

If they're concerned about their profits, why not have goverment pay for the extra stockpile?

Yes it's a nightmare in the making.

.