Author: Leanne Auyeung

Wenqi Lu presents the facts of the 2004 Indian Ocean Tsunami in this case study.  In the morning of Dec 26th, 2004, a 9.1 magnitude earthquake shook the Indian Ocean, causing an 800 miles rupture in the ocean.  Within 20 minutes Indonesia was the first country to be impacted, and eventually, the resulting damages spanned 14 countries. The total death count reached 227,898 people, with 1,740,000 people displaced, costing countries $15 billion to rebuild and recover.

From an epidemiological aspect, 3 countries (Indonesia, Sri Lanka, and India) suffered the greatest losses in lives.  Females had a significantly higher documented mortality rate than males, with twenty-year-old males having the lowest rates.  The association between distance from the coast, gender, and mortality rates was described by Wenqi Lu.  The data used in this case study was aggregated by the Synthesis Report, and documented by the survey “Mortality, The Family and the Indian Ocean Tsunami”.

The global response to this disaster was unprecedented; in just a few hours food supplies, financial aid, and resources were rapidly deployed as well as long-term assistance to rebuild and reconstruct the affected areas.  While almost half of the health clinics were damaged, the global community was able to set up mobile field hospitals and provided the necessary relief services.

From the event, lessons learned included the gaps in the warning systems and other mitigation plans, which have been adopted during the 2012 Japan earthquake and tsunami.

Read Wenqi Lu’s case study here

Community-based disaster risk reduction and community-based disaster management are emphasized in Alnsour’s exemplar on mitigation and community resilience.  Sabaa points out that the top-down approach employed by government institutions has been ineffective, or even harmful at times. Examples of such include the industrial efforts of large countries such as the United States and China; they are major emitters of pollution and contribute to the global impacts of climate-related disasters. Sabaa emphasizes the impacts of an empowered community when describing the efforts at the individual level which can be effective in disaster response and recovery.  The example of Central Luzon’s earthquake is used by the author as an example of the success that can be achieved from an involved and empowered community.  

Read Sabaa Alnsour’s exemplar here

Cheryl Liang distinguishes between community-based disaster risk reduction and community-based disaster management and describes the shared goal of community resilience and the role of individuals in building resilience. In order to achieve that goal more successfully, residents of the community play an important role in bearing the responsibility and committing to it alongside local authorities and community leaders. Cheryl describes three components of resilience, the reflectiveness of communities to learn from their past, the social connectedness to be able to communicate, and the presence of tools such as early warning systems to mitigate the impacts. Additionally, the higher authorities are responsible for building effective risk perceptions and capacities to manage future disasters, these are fundamental in building community resilience.

Read Cheryl Liang’s exemplar here

Michelle Bandel provides an analysis of the 2012 Hurricane Sandy’s epidemiological, management, and communication factors. She described the extensive infrastructural damages that resulted from the most expensive hurricane since Katrina. Hurricane Sandy caused $62 billion in damages in the US and $315 million in the Caribbean, Michelle describes the costly impact on the destruction of infrastructures such as roads and tunnels.

The total reported death toll from multiple countries was 285, with 125 deaths in the United States alone, of those 57.3% were direct deaths caused by environmental and structural forces, and 38% were indirect deaths caused by unsafe conditions. For many of the post-disaster management efforts such as the supply and distribution of medical supplies, water, and food, healthcare coalitions and multi-lateral partnerships were harnessed. Agencies like the Red Cross, the Department of Health and Human Services (HHS), FEMA, CDC, and others shared resources and knowledge to streamline operations. Additionally, FEMA  approved $600 million in direct assistance, the Senate passed a $50.5 billion Hurricane Sandy relief bill, and President Barack Obama passed an executive order to establish a task force to rebuild and recover from the hurricane.

Deployed nurses in major NYC hospitals faced challenges practicing in unfamiliar environments, Michelle described the responder’s psychosocial challenges stemming from the ongoing evacuation plans and increasing uncertainty of the future. With the exception of some unprepared hospitals during the acute phase, the response efforts were relatively effective. Throughout the case study, Michelle highlights that hospital evacuation, rescue & recovery efforts, workplace disruption and instability, and communication are all plans that need to be optimized for future occurrences. 

Read Michelle Bandel’s case study here

This case study is on the recent floods in Henan Province, China that occurred from July 16th to 21st, 2021. The floods were due to a series of extreme rainstorms over the city of Zhengzhou and the surrounding region, achieving its average annual rainfall of 25.2 inches in just one day on July 20th.  The heavy rainfall affected 14,786,000 people in the Henan province with 398 people dead or missing.  In managing the event, the Henan Provincial Flood Control headquarters issued a warning on July 16th and the Meteorological Bureau launched a level III emergency response, which was upgraded to a level I on July 21st.  Multi-lateral coordination efforts included the Ministry of Emergency Management dispatching fire and rescue workers to provide emergency relief, troops, and fire brigades were sent to assist in flooding response and prevention efforts, the local governments purchased security insurance for their residents, and hotels were used to house the displaced communities.  However, despite early warning alerts, local governments did not take measures to protect their residents and infrastructure, believing that the storm would not cause severe flooding.  The lag in suspending school and transportation and escalating the warning to a level I emergency was detrimental to the response efforts. Additionally, the rainfall affected communication capabilities, and the exchange of information was momentarily halted before drone technology was deployed.

Read Zhiyuan Chen’s case study here

On December 26, 2004, the Indian Ocean tsunami resulted in 250,000 deaths and 2 million people displaced.  It caused widespread damage to infrastructure and interrupted the livelihood of millions of people.

In this case study, Yining Liu explains that the tsunami occurred when an underwater earthquake, registered as a magnitude 9 on the Richter scale, resulted from subduction of the Indian Ocean tectonic plates.  It pushed up the ocean floor by 40 m, killing 100,000 people within 20 minutes.  The damage to infrastructure impacted hygiene and sanitation services and precipitated the spread of diseases like cholera and bilharzia. Additionally, food security worsened when the agriculture and fishing industry was impacted, and major economic losses transpired when the tourism industry was crippled.

Yining points out that information was limited during the event and was a major contributor to the vulnerability of populations, effectively inhibiting their ability to respond and evacuate on time. Due to the abruptness and magnitude of the tsunami, Yining notes that the local management faced significant challenges, drawing on international aid to support their efforts. Government response efforts focused on rebuilding the food system, providing shelters and food to the displaced populations, rebuilding infrastructure and facilities, and facilitating the coordination between different hospitals.

The lack of information was the main cause of the high death tolls and financial damages, and this event highlighted the need for early warning systems, forecasting, and predictions when designing preparedness plans.

Download the case study here.

In this review of global trends, Nancy Daneau discusses the institutional public health challenge in earning public trust.  In recent years, especially during the pandemic, trust in doctors has decreased due to various reasons; there might have been a lack of patient respect, insufficient time with patients, failure to provide information patients need, or understanding patients’ complaints or their concerns.  As such, this leads to poorer health outcomes since patients are less inclined to follow doctors’ recommendations.  Patients prefer to seek support from other sources they trust, which may not provide high-quality and evidence-based advice.  

Nancy suggests several strategies to rebuild public trust:

1. affordable and accessible healthcare;
2. reliable information free of jargon;
3. real-time, accessible, data-driven information, and;
4. present clear, verifiable, and reproducible data to the public.

With reformed health systems inclusive of public trust, the targets of health equity, resilient workforce, coordination, knowledge transfer, and incentivization become more aligned. 

Read Nancy Daneau’s work here

In March 2010, the Icelandic volcano Eyjafjallajökull began erupting and led to an increase in respiratory illness, 100,000 flight cancellations, and $200 million in economic costs. In this case study by Katrina Paleologos, she describes the details of the eruption;  Eyjafjallajökull is one of Iceland’s ice caps, therefore the eruption caused consecutive vapor explosions from hot magma coming in contact with the snow.  This led to volcanic ash ejection, plume dispersion, and the melted glacial ice flowing into the volcano, further increasing the explosive power of the eruptions.  

Katrina reported the results of a longitudinal study conducted in 2010 and 2013 to identify the effects of the volcano on 1,000 residents, exposure level was analyzed alongside the reported physical symptoms, psychological distress, perceived stress, and symptoms of Post Traumatic Stress Disorder.  It was found that there were increased physical respiratory symptoms in the exposed participants.  

The evacuation and response plans included swift relocation of civilians and limiting mobility to high-risk areas by closing roads and airspace.  This event has led to the establishment of a policy advisory group for future environmental disasters and coordination with airlines.  

Read Katrina Paleologos’s case study here

On December 26, 2004, an earthquake with a magnitude of 9.1 originated in the Indian Ocean and caused a tsunami with waves reaching speeds of 500 mph, impacting 14 countries surrounding the Indian Ocean.  The epicenter of the earthquake was recorded in Banda Aceh, Indonesia, resulting in the greatest death tolls at 108,100 with 127,700 people missing or presumed dead, and 426,800 displaced.  It was one of the deadliest disasters in modern-day history.  The destruction of the tsunami spanned multiple countries with recorded casualties occurring several hours later in southern Thailand, Sri Lanka, Chennai (India), and the east coast of Africa.  

In the case study, Sandhya Shankar reported the epidemiological details of the disaster found in the literature,  it was found that sex, age, and socioeconomic status were significant confounding variables in terms of mortality rates according to a study by Frankenberg et al.  The study noted that men and prime-age fishermen had lower mortality rates compared to their counterparts.

In terms of short-term management, Shankar points out that humanitarian donors were effective in raising a total of $13.6 billion dollars to fund the largest coordinated relief operation. However, negotiations determining recovery plans were unsuccessful and reconstruction of the infrastructure and health systems was not achieved, further impacting vulnerable communities with high levels of poverty.  

Overall, Shankar summarized that this event will become a valuable reference event for many organizations responding to a large-scale disaster in the future.

Read Sandhya Shankar’s case study here

Candida auris is a deadly fungus that can lead to death among infected patients, and it is highly resistant to drug treatments and is acquired mainly in hospitals and nursing homes.  In August 2016, the first case of the current ongoing outbreak was found in New York City, leading to 1,025 cases identified in New York State and deaths in 30-60% of the susceptible immunocompromised population.  In this case study, Caroline Romano investigates the epidemiological facts about this outbreak and reports that there is little information about the impact of C. auris on healthcare but journalists have identified that policies are poorly enforced, and lack of screening and irresponsible use of antifungals are contributing to the multi-drug resistance characteristic of the infectious agent. 

In managing the outbreak by the New York State, Caroline Romano points out that it has been ineffective since guidelines for handling or reporting infectious are not enforced and proper precautionary measures are yet to be mandated. Three years after its emergence, New York State labeled C. auris as a public health threat but did not make the screening, management, and reporting of the infection mandatory.  The lack of translational guidance from the state created gaps in communication and implementation in hospitals and public health departments alike. 

Read Caroline Romano’s case study here