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Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
- Thread starter Gemineye
- Start date
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
I think the response and subsequent infection of a health care worker is disappointing. Considering the amount of resources provided to the health care industry, it is disappointing that a large well funded hospital in the US does is not even prepared to deal with a single infectious disease patient without infecting health care workers (and not even caused by an accident such as a needle poke).
Proper PPE hazmat gear should not be that expensive if purchased in quantity. CDC or a similar group could negotiate reasonable costs for a large purchase so that every hospital has at least a few sets. Decontamination gear (disinfectant sprayers, basically the same as insecticide sprayers and showers) should not be over expensive either. The same with tents to house the potentially infectious patients.
If US vendors can't be reasonable about costs then (though I am loathe to suggest it) perhaps we need to purchase some of this gear from china (with adequate QA measures). I have had some experience with hazmat gear (though not for biological protection). A lot of it is outrageously expensive. But, the actual manufacturing cost is not very high so it should be possible to negotiate reasonable prices for large quantities. For example, a PAPR full face respirator designed for chemical protection has a list price of $1000, but the manufacturing cost is probably less than $50 in quantity. (I have a couple of them equipped with hepa particulate filters that I use for working with fiberglass insulation).
I think the response and subsequent infection of a health care worker is disappointing. Considering the amount of resources provided to the health care industry, it is disappointing that a large well funded hospital in the US does is not even prepared to deal with a single infectious disease patient without infecting health care workers (and not even caused by an accident such as a needle poke).
Proper PPE hazmat gear should not be that expensive if purchased in quantity. CDC or a similar group could negotiate reasonable costs for a large purchase so that every hospital has at least a few sets. Decontamination gear (disinfectant sprayers, basically the same as insecticide sprayers and showers) should not be over expensive either. The same with tents to house the potentially infectious patients.
If US vendors can't be reasonable about costs then (though I am loathe to suggest it) perhaps we need to purchase some of this gear from china (with adequate QA measures). I have had some experience with hazmat gear (though not for biological protection). A lot of it is outrageously expensive. But, the actual manufacturing cost is not very high so it should be possible to negotiate reasonable prices for large quantities. For example, a PAPR full face respirator designed for chemical protection has a list price of $1000, but the manufacturing cost is probably less than $50 in quantity. (I have a couple of them equipped with hepa particulate filters that I use for working with fiberglass insulation).
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
IMO the problem does not rest solely on the shoulders of the CDC. Until there was an imported case, their warnings about the likelihood seeing imported cases in US was largely unheeded. It's no surprise that physician and nurse organizations are saying they are unprepared.
I've seen the updates to this site with CDC guidelines and recommendations for public health, hospitals, EMS, etc They have been coming out for past two months. Detailed information for the US healthcare system. I'm not saying the CDC shouldn't do more. A lot more. It's clear there are at least some different considerations for patients treated in US and patients treated in developing nations. I don't think the training the CDC is doing for W. Africa volunteers in ETU's would be a perfect fit. Western hospitals are not spraying down people with bleach on dirt floors in makeshift structures. Then there are the extreme measures. More risk. Is it something we should be doing? Intubating, dialyzing, given the risks vs the likelihood of success?
You can lead a healthcare infrastructure to guidelines but you cannot make it train. And training is time consuming and expensive if using PPE. The PPE MSF is using costs $78/ and Frieden said today they were using PAPR. Very expensive. Richard Besser former managing director of the CDC said yesterday patients should be treated in special facilities with specially trained workers. But first have to create those special units and train those special workers and get potential Ebola patients there. How? EMS helicopter? That's about a 15-20K+ ride alone. If they would take them (which several said yesterday they wouldn't) Special ambulance? The costs of any, let alone all, of these measure will be enormous. In our health care system, who pays? Clearer in places with socialized or partly socialized medicine. The logistics of this are confounding.
IMO the problem does not rest solely on the shoulders of the CDC. Until there was an imported case, their warnings about the likelihood seeing imported cases in US was largely unheeded. It's no surprise that physician and nurse organizations are saying they are unprepared.
I've seen the updates to this site with CDC guidelines and recommendations for public health, hospitals, EMS, etc They have been coming out for past two months. Detailed information for the US healthcare system. I'm not saying the CDC shouldn't do more. A lot more. It's clear there are at least some different considerations for patients treated in US and patients treated in developing nations. I don't think the training the CDC is doing for W. Africa volunteers in ETU's would be a perfect fit. Western hospitals are not spraying down people with bleach on dirt floors in makeshift structures. Then there are the extreme measures. More risk. Is it something we should be doing? Intubating, dialyzing, given the risks vs the likelihood of success?
You can lead a healthcare infrastructure to guidelines but you cannot make it train. And training is time consuming and expensive if using PPE. The PPE MSF is using costs $78/ and Frieden said today they were using PAPR. Very expensive. Richard Besser former managing director of the CDC said yesterday patients should be treated in special facilities with specially trained workers. But first have to create those special units and train those special workers and get potential Ebola patients there. How? EMS helicopter? That's about a 15-20K+ ride alone. If they would take them (which several said yesterday they wouldn't) Special ambulance? The costs of any, let alone all, of these measure will be enormous. In our health care system, who pays? Clearer in places with socialized or partly socialized medicine. The logistics of this are confounding.
Lizw
Well-known member
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
But training does seem to be one of the major differences between the four specially equipped centers and most other hospitals. Training has to be planned and budgeted for, just as USALady has described in the nuclear industry. Emergency medical systems train frequently and rigorously, for all kinds of scenarios. And I know from a lot of time spent in hospitals for different reasons that hospitals do conduct training as well. Clearly, it needs to be more focused and taken more seriously. If the situation in Dallas does nothing else, I pray that it will make people see how important training and practice really is. My most recent encounter with a training situation in a hospital was when I was installing computer equipment, and the department administrator told me in a very annoyed voiice that I'd have to come back later, because they were going to have "another damned drill" in a few minutes. That attitude doesn't give me a lot of confidence about the current state of training.
Regarding the expense of training with PPE, that is one place where things can be safely reused.
But training does seem to be one of the major differences between the four specially equipped centers and most other hospitals. Training has to be planned and budgeted for, just as USALady has described in the nuclear industry. Emergency medical systems train frequently and rigorously, for all kinds of scenarios. And I know from a lot of time spent in hospitals for different reasons that hospitals do conduct training as well. Clearly, it needs to be more focused and taken more seriously. If the situation in Dallas does nothing else, I pray that it will make people see how important training and practice really is. My most recent encounter with a training situation in a hospital was when I was installing computer equipment, and the department administrator told me in a very annoyed voiice that I'd have to come back later, because they were going to have "another damned drill" in a few minutes. That attitude doesn't give me a lot of confidence about the current state of training.
Regarding the expense of training with PPE, that is one place where things can be safely reused.
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AlaskaDenise
In Memoriam
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
When I looked for manufacturers, I ended up on Alibaba - showing 9 mfgr. in Ireland (but not medical), a few in UAE (also not medical) and over 9000 in China (not enough detail to know which are medical). I'm not sure which of the many types listed are suitable for BSL-4, but they can only be purchased in multiples of thousands and some costs are surprisingly low. I wondered if the Chinese manufacturers are currently running at capacity or if they can step it up to meet increased demand.
Do you know of a US/European manufacturer (or just a sales rep for Chinese mfgr.)?
.
When I looked for manufacturers, I ended up on Alibaba - showing 9 mfgr. in Ireland (but not medical), a few in UAE (also not medical) and over 9000 in China (not enough detail to know which are medical). I'm not sure which of the many types listed are suitable for BSL-4, but they can only be purchased in multiples of thousands and some costs are surprisingly low. I wondered if the Chinese manufacturers are currently running at capacity or if they can step it up to meet increased demand.
Do you know of a US/European manufacturer (or just a sales rep for Chinese mfgr.)?
.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Kind of surprised- this is the lead story on CNN's website right now: Ebola: Five Ways the CDC Got it Wrong.
Summary:
1. The CDC is telling patients to "call a doctor". This shuts either down the ER while pt. is being evaluated, or patient may wrong advice.
2. The CDC says any hospital can care for Ebola patients.
3. The CDC didn't encourage the "buddy system" for doctors and nurses. Need spotters, like they have in Nebraska.
4. The CDC didn't encourage doctors to develop Ebola treatment guidelines. Specifically, avoiding intubation and dialysis & other procedures. (Edit: I think this will turn out to be very significant)
5. The CDC put too much trust in protective gear. (Edit: Well, their protective gear, anyway)
Kind of surprised- this is the lead story on CNN's website right now: Ebola: Five Ways the CDC Got it Wrong.
Summary:
1. The CDC is telling patients to "call a doctor". This shuts either down the ER while pt. is being evaluated, or patient may wrong advice.
2. The CDC says any hospital can care for Ebola patients.
3. The CDC didn't encourage the "buddy system" for doctors and nurses. Need spotters, like they have in Nebraska.
4. The CDC didn't encourage doctors to develop Ebola treatment guidelines. Specifically, avoiding intubation and dialysis & other procedures. (Edit: I think this will turn out to be very significant)
5. The CDC put too much trust in protective gear. (Edit: Well, their protective gear, anyway)
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
I do not think they are.
It felt to me that the CDC was/is attempting to do allot of, what do you call it. People management? Like the whole walking through an infected apartment with limited PPE. Ok yeah sure, you can do that, but what the eff, why take the chance? Yeah I get that their trying to convince people that its not super serious and that they have it under control. But those actions are not the kind of thing that reassure me.
I would probably have felt better if they had jumped on the situation with both boots. Locked down the area, hazmat teams. Aggressive contact tracing and quarantine procedures.
Currently, I'm quietly adding to my stockpiles of emergency food and water. Just in case I have a reason to stay inside for a few months.
I do not think they are.
It felt to me that the CDC was/is attempting to do allot of, what do you call it. People management? Like the whole walking through an infected apartment with limited PPE. Ok yeah sure, you can do that, but what the eff, why take the chance? Yeah I get that their trying to convince people that its not super serious and that they have it under control. But those actions are not the kind of thing that reassure me.
I would probably have felt better if they had jumped on the situation with both boots. Locked down the area, hazmat teams. Aggressive contact tracing and quarantine procedures.
Currently, I'm quietly adding to my stockpiles of emergency food and water. Just in case I have a reason to stay inside for a few months.
Emily
Editor, Senior Moderator
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
?Somebody had to do it?? - Alexander Fedotov (liquidator)
At least the Chernobyl liquidators knew what they were getting into. Were these young women told the truth about what they were attempting without BSL-4 protection?
?Somebody had to do it?? - Alexander Fedotov (liquidator)
At least the Chernobyl liquidators knew what they were getting into. Were these young women told the truth about what they were attempting without BSL-4 protection?
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Being an RN and knowing what I know about Ebola, in all honesty, if they asked me to enter the room wearing CDC recommendations, I would have refused. Period.
I think MSF, with the Tyvek suits and all skin covered is the more reasonable approach.
Another issue I see is how we care for patients, which is task orientated. Too many people going in and out to do ONE task, just as phleobotomy. That can be done by nursing staff. We need to keep the number of people exposed to as few as possible. Equipment needs to be disposable or dedicated.
There is no cheap way to give first world care to Ebola patients. If the case numbers start to add up, our health care system is in for a huge shock. I'm not sure how well it will function. Patient 1 and 2 are getting much better treatment than we will be administering by the time we get to patient 100,000.
Being an RN and knowing what I know about Ebola, in all honesty, if they asked me to enter the room wearing CDC recommendations, I would have refused. Period.
I think MSF, with the Tyvek suits and all skin covered is the more reasonable approach.
Another issue I see is how we care for patients, which is task orientated. Too many people going in and out to do ONE task, just as phleobotomy. That can be done by nursing staff. We need to keep the number of people exposed to as few as possible. Equipment needs to be disposable or dedicated.
There is no cheap way to give first world care to Ebola patients. If the case numbers start to add up, our health care system is in for a huge shock. I'm not sure how well it will function. Patient 1 and 2 are getting much better treatment than we will be administering by the time we get to patient 100,000.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Didn't Emory have 40+ barrels of waste to incinerate daily?! Those are the massive issues that will simply overwhelm response....
Didn't Emory have 40+ barrels of waste to incinerate daily?! Those are the massive issues that will simply overwhelm response....
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Right now, in the United States, no recent travel to West Africa is an important criteria in determining that a symptomatic patient is not at risk for Ebola. There are relatively few people in the U.S. with recent travel there. If there is even a small outbreak in the general population here or in a country where there is significant travel (e.g. Mexico) we will have a much larger problem isolating people until definitive testing can be completed.
If that were to happen, I think we would still be able to contain it but much chaos, panic, economic impact, and strain on the healthcare system would result.
Right now, in the United States, no recent travel to West Africa is an important criteria in determining that a symptomatic patient is not at risk for Ebola. There are relatively few people in the U.S. with recent travel there. If there is even a small outbreak in the general population here or in a country where there is significant travel (e.g. Mexico) we will have a much larger problem isolating people until definitive testing can be completed.
If that were to happen, I think we would still be able to contain it but much chaos, panic, economic impact, and strain on the healthcare system would result.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
If the first US case had happened 6 months ago when the outbreak in west Africa was still rather small then I could understand that the CDC had not had time to help get the nations hospitals prepared to deal with a case but they have had months to do so.
If the weatherman says that we've got a big blizzard coming with the possibility of up to 2 feet of snow I don't wait until there is already 4" on the ground before I get to the grocery store, bring in plenty of firewood and the camp stove if the power goes out, etc. I assume a worst case scenario and if it does not come to pass there is no harm done (and my supply of dark chocolate will last a long time).
It seems as though they did not do much beyond putting some guidelines on their website, hoping/assuming that would be enough and relying on it being contained before it ever reached our shores.
I guess I assumed that after Hurricane Katrina government agencies realized they had to do a much better job of figuring out what might be needed in a disaster of any sort and had plans in place.
If the first US case had happened 6 months ago when the outbreak in west Africa was still rather small then I could understand that the CDC had not had time to help get the nations hospitals prepared to deal with a case but they have had months to do so.
If the weatherman says that we've got a big blizzard coming with the possibility of up to 2 feet of snow I don't wait until there is already 4" on the ground before I get to the grocery store, bring in plenty of firewood and the camp stove if the power goes out, etc. I assume a worst case scenario and if it does not come to pass there is no harm done (and my supply of dark chocolate will last a long time).
It seems as though they did not do much beyond putting some guidelines on their website, hoping/assuming that would be enough and relying on it being contained before it ever reached our shores.
I guess I assumed that after Hurricane Katrina government agencies realized they had to do a much better job of figuring out what might be needed in a disaster of any sort and had plans in place.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
I am surprised to hear Tom Frieden speaking about 'spraying down workers with chlorine' when they exit the room. LOL, what...spray their cloth scrubs? Maybe start by putting them in Tyvek suits ala MSF style, then add the chlorine.
Sanjay Gupta did a great piece on the PPE that the CDC recommends. He repeatedly contaminated himself, brought up the issue that his skin was uncovered and also the fact that his scrub pants were also uncovered. Watching videos from W. Africa, they seem to understand that ALL skin must be covered, not to mention all inner clothing.
I do no get the disconnect between how we handle this in a lab and how we handle this on a hospital unit.
National Nurses United is having a huge phone conference on Wednesday at 2pm...I will have to check which time zone that is. I'm very tempted to call in and listen. I received the notice in my email. Although I am not working, I maintain an active license.
I think we have to understand that NUMBERS count. With one unexpected case, we messed up. How many cases will we eventually get? How will we handle this in terms of personnel and expense. It's concerning.
I am surprised to hear Tom Frieden speaking about 'spraying down workers with chlorine' when they exit the room. LOL, what...spray their cloth scrubs? Maybe start by putting them in Tyvek suits ala MSF style, then add the chlorine.
Sanjay Gupta did a great piece on the PPE that the CDC recommends. He repeatedly contaminated himself, brought up the issue that his skin was uncovered and also the fact that his scrub pants were also uncovered. Watching videos from W. Africa, they seem to understand that ALL skin must be covered, not to mention all inner clothing.
I do no get the disconnect between how we handle this in a lab and how we handle this on a hospital unit.
National Nurses United is having a huge phone conference on Wednesday at 2pm...I will have to check which time zone that is. I'm very tempted to call in and listen. I received the notice in my email. Although I am not working, I maintain an active license.
I think we have to understand that NUMBERS count. With one unexpected case, we messed up. How many cases will we eventually get? How will we handle this in terms of personnel and expense. It's concerning.
Gemineye
Well-known member
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Why is it so difficult for government agencies to be proactive? We spend billions of dollars on agencies to protect us and they fail in their missions. I could give numerous examples but it world be too depressing.
Why is it so difficult for government agencies to be proactive? We spend billions of dollars on agencies to protect us and they fail in their missions. I could give numerous examples but it world be too depressing.
Chicagogal
Well-known member
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
I think it's important to remember that the CDC has the authority to isolate and quarantine and they can recommend/educate, but they are not responsible for individual patient care.
I'm not sure why this is a CDC issue. We've had four hospitals treat Ebola patients and one has screwed it up. It was clear to me from listening to yesterday's CDC conference (where they talked about multiple opportunities they've already taken to correct hospital procedures) that this hospital was not prepared. They did almost nothing recommended by Emory, from keeping a log of people in the room to minimizing contacts to monitoring removal of PPE.
The CDC has published endless materials since 2001. As I said elsewhere, eight billion dollars was given to hospitals since 2006 specifically to prepare for pandemic flu. Where did this money and training go?
What should the CDC be doing instead? Wresting patients away from public health systems?
I think it's important to remember that the CDC has the authority to isolate and quarantine and they can recommend/educate, but they are not responsible for individual patient care.
I'm not sure why this is a CDC issue. We've had four hospitals treat Ebola patients and one has screwed it up. It was clear to me from listening to yesterday's CDC conference (where they talked about multiple opportunities they've already taken to correct hospital procedures) that this hospital was not prepared. They did almost nothing recommended by Emory, from keeping a log of people in the room to minimizing contacts to monitoring removal of PPE.
The CDC has published endless materials since 2001. As I said elsewhere, eight billion dollars was given to hospitals since 2006 specifically to prepare for pandemic flu. Where did this money and training go?
What should the CDC be doing instead? Wresting patients away from public health systems?
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
In defense of the non-designated BSL-4 hospitals out there, of which there are about 5,000 in the US, why would they expend the effort to get up to speed on Ebola? After all, gunshots and car wrecks are far, far more common, and yet not every hospital is a level III trauma center. Furthermore, they're fairly overwhelmed right now with immediate problems owing to the rapid changes undergoing healthcare, which are in the news daily and which I'll skip enumerating again here. Hospitals were reassured by the government that the risk of an outbreak occurring was extremely low to zero. And still, 99% of them will probably never see a case, yet they're supposed to devote hundreds of hours of very expensive staff time to this? It's easy to play Monday morning quarterback and fault them for it, but their choices weren't irrational.
The fault of the CDC in all of this is that they were not discussing things with leaders at these community hospitals, assessing their readiness or lack thereof. Sending guidelines out is just a one-way street. They've experienced a great deal of mission creep in the last few decades, to the point where their focus isn't mainly on communicable diseases any longer, but lifestyle issues such as obesity, safety, etc. so honestly I don't even know if they have enough personnel trained in infectious disease to conduct these conferences at every hospital. Now they may be designating hospitals, and that's exactly what should have been done in the first place. That is by far the wisest use of everyone's resources.
I also have this vague feeling that they didn't take the threat seriously enough. Dr. Friedan did say any hospital can care for an Ebola patient, and that is true. But can they do it without infecting staff? That's an entirely different question. It seems the powers that be decided that it was only due to a lack of supplies and training that caused HCWs in West Africa to be infected, even though some of those people were with western NGOs and had both knowledge and resources. I think the approach was entirely too casual & founded on assumptions that may prove to be ill-informed. This is a deadly disease, and modern high-tech medicine does not make it any less so. It may make it even worse.
In defense of the non-designated BSL-4 hospitals out there, of which there are about 5,000 in the US, why would they expend the effort to get up to speed on Ebola? After all, gunshots and car wrecks are far, far more common, and yet not every hospital is a level III trauma center. Furthermore, they're fairly overwhelmed right now with immediate problems owing to the rapid changes undergoing healthcare, which are in the news daily and which I'll skip enumerating again here. Hospitals were reassured by the government that the risk of an outbreak occurring was extremely low to zero. And still, 99% of them will probably never see a case, yet they're supposed to devote hundreds of hours of very expensive staff time to this? It's easy to play Monday morning quarterback and fault them for it, but their choices weren't irrational.
The fault of the CDC in all of this is that they were not discussing things with leaders at these community hospitals, assessing their readiness or lack thereof. Sending guidelines out is just a one-way street. They've experienced a great deal of mission creep in the last few decades, to the point where their focus isn't mainly on communicable diseases any longer, but lifestyle issues such as obesity, safety, etc. so honestly I don't even know if they have enough personnel trained in infectious disease to conduct these conferences at every hospital. Now they may be designating hospitals, and that's exactly what should have been done in the first place. That is by far the wisest use of everyone's resources.
I also have this vague feeling that they didn't take the threat seriously enough. Dr. Friedan did say any hospital can care for an Ebola patient, and that is true. But can they do it without infecting staff? That's an entirely different question. It seems the powers that be decided that it was only due to a lack of supplies and training that caused HCWs in West Africa to be infected, even though some of those people were with western NGOs and had both knowledge and resources. I think the approach was entirely too casual & founded on assumptions that may prove to be ill-informed. This is a deadly disease, and modern high-tech medicine does not make it any less so. It may make it even worse.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
Remember, we're not hearing much from the hospital regarding what they did or didn't do, due to patient confidentiality and the litigious environment we live in.
Pandemic flu is a bit different critter than Ebola from a health system perspective. Much of that activity occurs out in the community, in nursing homes, schools, etc. and especially in education about vaccination and the vaccinations themselves. The training in isolation and avoiding nosocomial transmission would be applicable, but that doesn't seem to have been a problem in the Texas situation once they realized the patient was infectious. The PPE precautions, however, are much less rigorous than with Ebola. So I don't think that money was wasted, as there's no evidence of spread to other patients. In that way, the funding for pandemic flu preparation may very well have paid off.
Remember, we're not hearing much from the hospital regarding what they did or didn't do, due to patient confidentiality and the litigious environment we live in.
Re: Discussion: Is the CDC doing a good job controlling the Ebola outbreak?
I dug a little more into the Pandemic & All-Hazards Preparedness Act (which was reauthorized in 2013) and found that HHS is supposed to be coordinating this response. Maybe it's not even the CDC's responsibility.
A specific new office was set up to coordinate health emergencies, so I'd like to ask, where is Dr. Nicole Lurie?
Nicole Lurie: Assistant Secretary Preparedness and Response
So there's part of that eight billion dollars, Chicagogal, and I don't know what it's doing, either.
I dug a little more into the Pandemic & All-Hazards Preparedness Act (which was reauthorized in 2013) and found that HHS is supposed to be coordinating this response. Maybe it's not even the CDC's responsibility.
A specific new office was set up to coordinate health emergencies, so I'd like to ask, where is Dr. Nicole Lurie?
Nicole Lurie: Assistant Secretary Preparedness and Response
July 16, 2013 Lurie's job is to plan for the unthinkable. A global flu pandemic? She has a plan. A bioterror attack? She's on it. Massive earthquake? Yep. Her responsibilities as assistant secretary span public health, global health, and homeland security. That means a lot of coordination with her colleagues at HHS, as well as state and local officials and other federal agencies. It also means a mission that includes both science and communications strategy. In the digital age, she is working to improve the department's data capabilities—the better to know who lives in a given community when disaster strikes—and its ability to harness social media to deliver messages about how to stay safe. "Both the biggest opportunity and the biggest challenge is to build communities that are more resilient to the types of challenges that come their way," she says. Lurie, 60, is from Connecticut and lives in Maryland with her husband. She's a fitness buff, generally carving time out of her afternoons to run, skate, or practice yoga. Her undergraduate and medical-school degrees both come from the University of Pennsylvania, and she holds a master's degree in public health from UCLA. Lurie keeps her clinical skills sharp by volunteering every week in a community clinic, where she also teaches medical students and residents.
So there's part of that eight billion dollars, Chicagogal, and I don't know what it's doing, either.