CDC offers pandemic communication guidance

Snowy Owl · Jan 25, 2007

Re: CDC offers pandemic communication guidance

This is from the CDC, complementary to post 1 of this thread.

Please excuse the format, it is a .ppt and that is the best I could do.
Snowy

http://www.bt.cdc.gov/coca/ppt/cerc_ pandemic_coca_01_07.ppt

Crisis & Emergency
Risk Communication
Pandemic Influenza

In a serious crisis, all affected people . . .

Take in information differently
Process information differently
Act on information differently

In a catastrophic event: communication is different
Be first, be right, be credible

What the public seeks from your communication

5 public concerns. . .

Gain wanted facts

Empower decisionmaking

Involved as a participant, not spectator

Provide watchguard over resource allocation

Recover or preserve well-being and normalc

Crisis and Emergency Risk

Communication impacts

5 organizational concerns -- you need to. . .

Execute response and recovery efforts
Decrease illness, injury, and deaths
Avoid misallocation of limited resources
Reduce rumors surrounding recovery
Avoid wasting resources

5 communication failures that

kill operational success
<DIR>

1. Mixed messages from multiple experts
2. Information released late
3. Paternalistic attitudes
4. Not countering rumors and myths in real-time
5. Public power struggles and confusion

</DIR>
5 communication steps that boost operational success

Execute a solid communication plan
Be the first source for information
Express empathy early
Show competence and expertise
Remain honest and open

What Do People Feel Inside When

a Disaster Looms or Occurs?

Psychological barriers:

Fear, anxiety, confusion, dread
Hopelessness or helplessness
Seldom panic
Fight or flight

How Do We Communicate About Risk in an Emergency?

All risks are not accepted equally

Voluntary vs. involuntary
Controlled personally vs. controlled by others
Familiar vs. exotic
Natural vs. manmade
Reversible vs. permanent
Statistical vs. anecdotal
Fairly vs. unfairly distributed
Affecting adults vs. affecting children

5 Key Elements To Build Trust

Expressed empathy
Competence
Honesty
Commitment
Accountability

Initial Message

Must

Be short

Be relevant

Give positive action steps

Be repeated

Must Not

Use jargon

Be judgmental

Make promises that can?t be kept

Include humor

Media and Crisis Coverage

Evidence strongly suggests that coverage is

more factual when reporters have more information.

They become more interpretative when they have less information.

What should we conclude?

Role of a Spokesperson

in an Emergency

Take your organization from an "it" to a "we"
Build trust and credibility for the organization
Remove the psychological barriers within the audience
Gain support for the public health response
Ultimately, reduce the incidence of illness, injury, and death by getting it right
Emergency Risk

Communication Principles

Don?t overreassure
Acknowledge that there is a process in place
Express wishes
Give people things to do
Ask more of people

What is different? National Strategy

Stop, slow, limit spread of pandemic to the U.S.
Limit domestic spread of pandemic?mitigate

disease, suffering, and death
[*]Sustain infrastructure/economy and functioning of society

What is different? Biological

Little or no immunity worldwide
More people at higher risk
Evolves in waves
2-3 waves, last 6-8 weeks, in 12-18 months

What is different?

Psychological/Spiritual

Uncertainty
Increases anxiety?people seek information
Greatest uncertainty early in pandemic
Community hardiness/personal resilience
Number of deaths "out of time"

What is different? Sociological

Behaviors impact infection rates?less control

- - Denial (it won?t happen to me)
  - High-risk (Russian roulette coughing)
  - Can?t be burdened (let someone else do it)
  - Wants to but believes can not (I need to work)

Inadequate vaccines/antivirals

- - Primary communication steps
  - Be 100% accountable

Community hardiness: Defined
<DIR><DIR>Existing protective qualities and vulnerabilities </DIR></DIR>

that will determine the community?s ability to take deliberate, meaningful, and collective action against a public health threat

Protective qualities:

robustness, redundancy, resourcefulness, & rapidity
[*]Vulnerabilities: susceptibility related tosense of community, shelter, sustenance, security,

Community hardiness: Factors

Socioeconomic status
Community-based organizations
Health care capacity
Social stressors (racial, economic, political strife)
Political and civic perspectives
Community cohesion and group self-efficacy

Personal resilience: Factors

Mental toughness more important than physical

strength

[*]
A purpose for going on: "help my family"
[*]
Self-efficacy: "I think I can"
[*]
Prior experience
[*]
Good coping strategies (repress negative and
take action)

Stigmatization

Can affect product, industry, animal, place, people

Four characteristics to stigmatization

Problem stigmatizer believes he can control
Must be distinguishable
Stigma associated with the party
Reaction that distances

<DIR></DIR><DIR></DIR>Recent examples

1997 strawberries and hepatitis A in U.S.
1997 H5N1 outbreak in Hong Kong
1999 West Nile virus outbreak in New York
2003 SARS outbreak in China and Canada
Why people stigmatize

Shortcut when uncertainty and threat are both

present to protect against physical and emotional harm
[*]Occurs in a social context
[*]Expect it early in a severe influenza pandemic unless dominant group first to become ill

Steps before, during & after

Avoid geographic links if not necessary (e.g.,

Spanish pandemic versus 1918 pandemic)

[*]
Avoid visuals that link group to threat--watch out
for subconscious links: Avian Influenza H5N1

[*]
Teach response professionals about stigma
[*]
Share with media the concern
[*]
Scan for stigma and confront quickly

Understanding

loss and bereavement

Watch out when creating historical products

Deaths in the U.S.

vs Pandemic

About 2.5 million annually
Seasonal influenza 36,000 deaths/95% ->65 yrs
In 12-18 months add 2 million
Deaths "out of time" (healthy adults/children)

Severe pandemic and loss

Multiple deaths in families
Truncated bereavement rituals
Potential for kinship from shared misery
Responders could feel guilt

Cultural differences?

Have you been to a funeral outside your own

culture? What is the color of mourning?
[*]What matters matters a lot
[*]Acculturation attenuates differences?don?t stereotype
[*]Religious difference are cultural differences
[*]Bereavement ignored will cost in personal/community resilience

Compassion in communication

People will expect demographic details of first

deaths ("How do I compare?")
[*]Look of official reports must be respectful (web)
[*]Responders may be losing members too
[*]People mourn financial loss too

Information Technology

in Pandemic Influenza Communications

The Internet as a Communication

Channel during an Emergency

97% of all internet users and 64% of

non-users expect to be able to find important information online
[*]The internet as an information source grew 8% in the two weeks after September 11th
[*]The 2001 anthrax attacks highlight the desire for any information, the prevalence of false information, and the willingness to "buy in" to panic-baiting

The Blogosphere as Community

Number of internet users who read blogs jumped 11 to 39% from 2003 to 2005

During a pandemic, blogs:

Allow for news missing from mainstream media and discussions of sensitive information or issues
May appeal to individuals and communities coping with crisis, illness or death

Shannon Bennett · Jan 25, 2007

Re: CDC offers pandemic communication guidance

Al, I agree that is a most impressive list that Snowy linked. I would like us to model our responses using this as a template. Having been a victim of a poor response by the authorities following the Loma Prieta earthquake, I can attest to many of the above suggestions as valid concerns. Now sitting on the other side of the table for disaster response, I can also be a witness to how to achieve a better response by the public. Bravo to Snowy for finding the list and to you for importing it.
:tiphat:

colormyquilt · Jan 27, 2007

Re: CDC offers pandemic communication guidance

AlaskaDenise said:

I'd like to see a one page (8 1/2 x 11) handout that we can give to people. It should provide some type of comfort (if that exists) & suggestions on how to survive mentally. This may be all most people ever get.
.

Click to expand...

I could not find a 1-pg. handout. I did find a two-page brochure-

"Managing the Emotional Consequences of Public Helath Emergencies- Coping with Anxiety Related to SARS, Avian Flu and Other Public Helath Emergencies"

Appears informative and direct-to-the-point---- link below:

www.njcphp.org/pdf/Public_Health_Emergencies_Brochure.pdf

DRJJ · Jan 27, 2007

Re: CDC offers pandemic communication guidance

Very nice brochure for our purposes. Good find, colormyquilt!

It does provide skills that focus on the lead up part of disaster, rather than on the extended trauma/grief aspects of disaster management.

I think this would be a very responsible link to provide in our resources section.

colormyquilt · Jan 27, 2007

Re: CDC offers pandemic communication guidance

DRJJ said:

It does provide skills that focus on the lead up part of disaster, rather than on the extended trauma/grief aspects of disaster management.I.

Click to expand...

Exactly. I have more info to post-hopefully, possibly later this date. There is literature suggesting the need to differentiate between the "lead-up", as you say, and mental health, and mental health issues sustained due to the specifics of pandemic- long-term, everywhere, lack of resources, high infection rate, high death rate.

Mellie · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Good info in that brochure. Simple, straightforward. Thank you colormyquilt.

I made this page years ago to help wildland firefighters recognize potential stress responses in themselves and their crew following a critical incident and/or a long and arduous season.

http://www.wildlandfire.com/docs/2003_n_before/stress_debrief.htm

Every person's response is unique.

colormyquilt · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Mellie said:
Good info in that brochure. Simple, straightforward. Thank you colormyquilt.

I made this page years ago to help wildland firefighters recognize potential stress responses in themselves and their crew following a critical incident and/or a long and arduous season.

http://www.wildlandfire.com/docs/2003_n_before/stress_debrief.htm

Every person's response is unique.

This handout is very good. It shows how many different combinations of responses there can be. I will share it, with your permission of course.

Every person's response is unique. Equally true, a response today may be different than one tomorrow.

Mellie · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Please share it.

M

DRJJ · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Excellent notion of range of reactions possible and likely to creep up over prolonged stress period.

Similar reactions can occur when there is an initial large trauma. I live in San Diego County where there were 3 colossal fires on 10/26/2004. I was standing in the entryway of a satellite Red Cross relief center when a family of 2 parents and 3 teen children requested assistance after their house had burned down the day before. They were presented with the simplist of forms, requesting their name, address, phone number and a statement of why they had come to the center. It took them about 10 minutes to fill out the name and address part. Eventually they came up with a phone number when the receptionist suggested they look at their cell phone. They consulted each other on what was their name, and, again, on what was the address of the home they lived in. They were unable to formulate any response to why they had come to the center. Eventually, one of the social workers completed the form for them. The family members appeared profoundly-slowed (cognitively), emotionally-numbed, unable to make an independent decision and demonstrated impaired access to memory of who they were or what had happened to them or what they needed or wanted. I am certain the individual family members had gone through many of the symptoms on that list in the preceding 30 hours.

I recount this story to give you an example of how dramatic the symptoms may be.

sharon sanders · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Profound.

DRJJ said:
Excellent notion of range of reactions possible and likely to creep up over prolonged stress period.

Similar reactions can occur when there is an initial large trauma. I live in San Diego County where there were 3 colossal fires on 10/26/2004. I was standing in the entryway of a satellite Red Cross relief center when a family of 2 parents and 3 teen children requested assistance after their house had burned down the day before. They were presented with the simplist of forms, requesting their name, address, phone number and a statement of why they had come to the center. It took them about 10 minutes to fill out the name and address part. Eventually they came up with a phone number when the receptionist suggested they look at their cell phone. They consulted each other on what was their name, and, again, on what was the address of the home they lived in. They were unable to formulate any response to why they had come to the center. Eventually, one of the social workers completed the form for them. The family members appeared profoundly-slowed (cognitively), emotionally-numbed, unable to make an independent decision and demonstrated impaired access to memory of who they were or what had happened to them or what they needed or wanted. I am certain the individual family members had gone through many of the symptoms on that list in the preceding 30 hours.

I recount this story to give you an example of how dramatic the symptoms may be.

colormyquilt · Jan 29, 2007

Re: CDC offers pandemic communication guidance

DRJJ said:
Excellent notion of range of reactions possible and likely to creep up over prolonged stress period.

Similar reactions can occur when there is an initial large trauma. I live in San Diego County where there were 3 colossal fires on 10/26/2004. I was standing in the entryway of a satellite Red Cross relief center when a family of 2 parents and 3 teen children requested assistance after their house had burned down the day before. They were presented with the simplist of forms, requesting their name, address, phone number and a statement of why they had come to the center. It took them about 10 minutes to fill out the name and address part. Eventually they came up with a phone number when the receptionist suggested they look at their cell phone. They consulted each other on what was their name, and, again, on what was the address of the home they lived in. They were unable to formulate any response to why they had come to the center. Eventually, one of the social workers completed the form for them. The family members appeared profoundly-slowed (cognitively), emotionally-numbed, unable to make an independent decision and demonstrated impaired access to memory of who they were or what had happened to them or what they needed or wanted. I am certain the individual family members had gone through many of the symptoms on that list in the preceding 30 hours.

I recount this story to give you an example of how dramatic the symptoms may be.

Actually this is a good example of differentiating between initial responses, responses that will continue over time due to the trauma, and responses that may become intensified due to prior mental health issues.

The family's initial contact with the Red Cross- it will be easy to check off their "symptoms" against the brochure or Mellie's handout. These are to be expected responses. Now, should they continue to experience this same type of confusion/ lost of concentration/ etc. and difficulty providing this basic info, say a month or two down the road, then we have moved beyond the initial reactions. For their own comfort and well-being, they may want then to connect with a counselor/ support network. Should someone in this family have had prior mental health issues, depression/ anxiety/ PTSD/ etc., the behaviors may intensify/ become more difficult to abate/ and/or other behaviors may appear. This is the last "situation" above. A more concerted effort may be required to stablize- in this case dealing with the fire/ that they have lost their home/ that they have lost their comfort zone- including what is familiar and safe.

So, as we will be called upon to respond to readers with concerns/ questions re: the above, whatever support we make a decision upon in offering may look somewhat different depending on the situation/ the individual/ the individual's coping style. Our task will be in being able to listen- and for that we will need to be able to receive and provide support to each other.

Should the pandemic hit with the current CFR- it is going to be difficult. We have more time. For myself, I need to busy myself prepping- in all the different ways. And now I will share a little story. I grew up in the country as a little girl. One learns about the laws of nature when you grow up playing in the woods and all. The other day, the image popped into my head about the squirrels- and remembering watching how they buried their winter food reserves. And I thought to myself, now I understand why did that with such a sense of purpose. I am not saying we all need to go out and buy nuts-

- however they are a good source of protein.

DRJJ · Jan 29, 2007

Re: CDC offers pandemic communication guidance

So, as we will be called upon to respond to readers with concerns/ questions re: the above, whatever support we make a decision upon in offering may look somewhat different depending on the situation/ the individual/ the individual's coping style. Our task will be in being able to listen- and for that we will need to be able to receive and provide support to each other.

Our purpose is not to provide emotional support to pandemic disaster victims. We can safely direct them to other resources, blogs, etc. and, in a limited way, assist them in making the best of a horrendous situation, HOWEVER, we cannot serve two masters. If we start offering succor, we will not be able to offer information. Our web site will be overwhelmed with "joiners" who may turn it into a disaster blog. Our purpose is not to support the afflicted, but to provide current and accurate information. It will take every iota of our energies and focus to fulfill this function, especially in tracking pandemic waves and morphing H5N1 genetic recombinations.

If/when the pandemic starts, perhaps we may open our "questions" forum to the press and we can take turns responding to the questions. Otherwise we will be besieged by new members who are just beginning to prep and will suck down all our efforts in supporting them and, in so doing, we will betray our purpose.

cartski · Jan 29, 2007

Re: CDC offers pandemic communication guidance

DRJJ said:
Our purpose is not to provide emotional support to pandemic disaster victims. We can safely direct them to other resources, blogs, etc. and, in a limited way, assist them in making the best of a horrendous situation, HOWEVER, we cannot serve two masters. If we start offering succor, we will not be able to offer information. Our web site will be overwhelmed with "joiners" who may turn it into a disaster blog. Our purpose is not to support the afflicted, but to provide current and accurate information. [snip} .

I would agree with the first statement highlighted more than the second.

I cannot easily differentiate the information function from the humanitartian function of FT, or any forum, board, or list service.

On 9/11 I was shocked, of course, and the images finally turned to reality. So I posted on a tandem bicycle list service some heart felt thoughts. Only a couple of people noticed the post, but one corrseponded with me - I took the risk and put my email address in the post. She was from NY state, but not directly affected by lost family or friends. Nevertheless, she was extremely distressed.

Was I over my head psychologically? Definitely. Was it a risky correspondence in which something terribly could go wrong? Perhaps, but I didn't think so from her writing. Was it relevant to the tandem cycling? Of course not. So was I wrong to make the post and correspond with her? I don't think so; she helped me and I helped her cope with the tragic situation. That's and equally important reason for FT's existence, IMO.

No, I would argue that FT must recognize, anticipate and accomodate the psychological upheaval that is likely to come. FT must be ready for the surge - the HUGE surge as everyone stays at home on their computers trying to make sense of their shattering worlds.

Maybe that means functional differentiation of the site: FT Info; FT Help; FT MicroBio, etc. (Yeesh, it sounds like Google). Or it may mean keeping the peace with other sites. No matter; whatever it takes.

J.

p.s. I'm a skeptic; but heaven help me if I try to milk a bull!

Edit: I remembered on the way home that I was a member of the tandem list serve at the time: http://www.thetandemlink.com/ Wonderful people! Cyclists helped a lot in NY on 9/11 I read, way before the Bicycling mag article did their piece. Is this relevant? I think so, but can't find the words to explain why. J.

colormyquilt · Jan 29, 2007

Re: CDC offers pandemic communication guidance

Great dialogue. Thanks to Snowy for starting this thread.

AlaskaDenise · Jan 30, 2007

Re: CDC offers pandemic communication guidance

It will be impossible for this site to respond to individual requests. The best we can do is post general guidelines and info on other sources in different areas. This site may well get millions of hits, & I would expect it will be closed to new members.

.

Thornton · Jan 30, 2007

Re: CDC offers pandemic communication guidance

Great thread.
We can see that not only will there be a lot of work to do, there is a lot of work to do. The preparedness here is developing beyond gathering supplies and information towards developing skills and organization for response. A pandemic is uncharted territory but in an all-hazards paradigm skills are transferable. For folks who are in for the duration I recommend 2 lines of on-line certified training: 1) organizational - NIMS and 2) skill based - to include psychological first aid, risk communications, and beyond. As you train, you will get a better idea of the risks and benefits of well intentioned interventions.

NIMS - basic course is IS 700
http://training.fema.gov/EMIWEB/IS/is700.asp

Psychological First Aid, Medical Reserve Core Field Guide
http://www.medicalreservecorps.gov/File/MRC_Resources/MRC_PFA.doc

Keep track of certified training, for even on this site there may come a time where specific volunteer assignments and professional liability protection could accrue.
Joe Thornton, M.D.

Jonesie · Jan 30, 2007

Re: CDC offers pandemic communication guidance

colormyquilt said:
And now I will share a little story. I grew up in the country as a little girl. One learns about the laws of nature when you grow up playing in the woods and all. The other day, the image popped into my head about the squirrels- and remembering watching how they buried their winter food reserves. And I thought to myself, now I understand why did that with such a sense of purpose. I am not saying we all need to go out and buy nuts- - however they are a good source of protein.

We really don't need to go out and buy nuts ... why not just follow our squirrels around, mark each nut burial spot, then dig them up later ... before the squirrels get to them?

colormyquilt · Jan 30, 2007

Re: CDC offers pandemic communication guidance

Jonesie said:
We really don't need to go out and buy nuts ... why not just follow our squirrels around, mark each nut burial spot, then dig them up later ... before the squirrels get to them?

A good sense of humor...we will need alot of that...as we move ahead...just as we have needed it to get to where we are. Thanks.

Mellie · Jan 30, 2007

Re: CDC offers pandemic communication guidance

Let me see if I can get my info here for easy access in pandemic prep. Mellie
From http://www.wildlandfire.com/docs/2003_n_before/stress_debrief.htm <table border="0" width="100%" cellpadding="4"> <tbody><tr> <td width="100%" colspan="4">

STRESS REACTIONS

</td> </tr> <tr> <td width="25%" align="top">Physical
Reactions</td> <td width="25%">Cognitive
Reactions</td> <td width="25%">Emotional
Reactions</td> <td width="25%">Behavioral
Reactions</td> </tr> <tr> <td width="25%" valign="top"> Chest pain*
Difficulty breathing*
Shock symptoms*
Fatigue/ exhaustion
Insomnia
Sleep disturbances
Hyperactivity
Change in appetite
Digestive problems
Headaches
Nausea/ vomiting
Profuse sweating
Rapid heart rate
Thirst
Visual difficulties
Clenching of jaw
Nonspecific aches and pains </td> <td width="25%" valign="top"> Poor concentration
Flashbacks
Difficulty with decisions
Memory disturbance
Amnesia
Confusion
Poor problem solving
Disturbed thinking
Poor abstract thinking
Change in alertness (higher or lower)
Nightmares
Disorientation
Difficulty identifying familiar objects or people </td> <td width="25%" valign="top"> Fear
Guilt
Anger
Over-sensitivity
Emotional numbing
Loss of emotional control
Anxiety
Depression
Grief
Denial
Feeling helpless
Sense of failure
Feeling overwhelmed
Blaming others or self
Irritability
Frustration Severe panic (rare)
</td> <td width="25%" valign="top"> Change in activity
Change in communication
Withdrawal
Suspiciousness
Hyper alertness
Heightened startle reflex
Emotional outbursts
Intense anger
Scapegoating
Inability to rest, pacing
Temporary loss or increase of appetite
Excessive alcohol consumption
Change in sexual functioning

</td> </tr> <tr> <td width="100%" valign="top" colspan="4"> * Get medical help if you experience chest pain, difficulty breathing, severe pain, or symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils).
**Get mental health support if your symptoms or distress continue for several weeks or interfere with your daily activities. </td> </tr> <tr> <td width="100%" colspan="4">

Within the first 24 to 48 hours, periods of strenuous physical exercise alternated with periods of relaxation will alleviate some of your physical reactions.
Talk to people - talk is the most healing medicine. Spend time with others, both those within emergency services and those in ordinary life.
Do things that feel good to you.
Beware of numbing the pain with drugs or alcohol. You don't need to complicate this with a substance abuse problem.
Structure your time - keep busy. Keep your life as normal as possible. As much as you can, keep the commitments you have made.
You are normal and are having normal reactions. Don't label yourself crazy.
Reach out - people do care. Accept offered help.
Realize that those around you are also under stress. Remember that others were also affected by this incident. Help those around you as much as possible. You can help them by sharing your feelings or simply checking out how they're doing.
Give yourself permission to feel rotten.
Keep a journal - write your way through those sleepless hours.
Eat nutritious, well-balanced meals high in carbohydrates and low in sugar. Avoid excessive use of caffeine.
Don't make any big life changes, until things have settled.

</td> </tr> </tbody> </table>

cartski · Jan 31, 2007

Re: CDC offers pandemic communication guidance

Thornton said:
Great thread.
We can see that not only will there be a lot of work to do, there is a lot of work to do. The preparedness here is developing beyond gathering supplies and information towards developing skills and organization for response. A pandemic is uncharted territory but in an all-hazards paradigm skills are transferable. For folks who are in for the duration I recommend 2 lines of on-line certified training: 1) organizational - NIMS and 2) skill based - to include psychological first aid, risk communications, and beyond. As you train, you will get a better idea of the risks and benefits of well intentioned interventions.

NIMS - basic course is IS 700
http://training.fema.gov/EMIWEB/IS/is700.asp

Psychological First Aid, Medical Reserve Core Field Guide
http://www.medicalreservecorps.gov/File/MRC_Resources/MRC_PFA.doc

Keep track of certified training, for even on this site there may come a time where specific volunteer assignments and professional liability protection could accrue.
Joe Thornton, M.D.

These are excellent, even after only a quick read.

I'm getting confused, however, with all the training suggestions in this thread.

Looks like there should be a timeline developed that links the point in the disaster with the type of training which should be taken by the entity attempting to help. The CDC page that started this thread was advice to an organization first responder, I think. That's different from indifividual first responders on the scene, or online (perhaps), or the professional dealing with the very real, entrenched reactions from traumas 50 years ago. (sorry, it's 3 a.m. and I'm in no shape to summarize this thread).

Will FT get millions of hits? Definitely. Will moderators be expected to respond to the pyschological state of every poster? No, that's unreadonable, IMO. But it's reasonable to expect lots of "well-intentioned interventions" from other posters to naturally develop. That will create, IMO, a host of ethical and logistical problems for FT organizationally.

J.

CDC offers pandemic communication guidance

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