Category: Spring 2022

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

In 1984, the community of The Dalles, Oregon experienced a large-scale outbreak of Salmonella Typhimurium. This foodborne disease outbreak, which infected a total of 751 people, was eventually traced back to the salad bar of a local restaurant. However, as investigators continued to pursue this case to further understand the primary food source and gather more information on the pathogen, the investigation continued to turn up with inconsistent information due to the sporadic nature of the outbreak. Following an inconclusive environmental study, a criminal investigation was conducted to find that the Salmonella outbreak was an intentional act of terrorism conducted by the members of the Rajneeshpuram religious association to affect the voter turnout of an upcoming election.

In her case study, Khadija Akther discusses the epidemiological events that made up this case along with the management of the outbreak and communication of information between health officials and the public. The 751 patients were identified through passive surveillance and examination of stool samples for the sample pathogen, which helped investigators categorize the cases into three cohorts: case employees, case customers, and secondary cases. As Akther explains, many different agencies were involved in this case due to the inconsistencies in the identification of the outbreak source. Healthcare workers first reached out to the CDC to aid in the investigation but the case was eventually passed over to law enforcement.

While the Rajneeshpuram organization was identified as the culprit, the overall handling of the case faced many limitations and inefficiencies due to lack of proper management. Akther reports lack of communication and cooperative collaboration amongst the agencies involved leading to disorganization and delays in closing the case.

You can read more about the investigation and it’s implications on the future of foodborne outbreak surveillance in Akther’s case study found here.

After the occurrence of an emergency disaster, vulnerable and high-risk communities are often in a state of despair as they try to overcome the obstacles created by the disaster. By implementing early warning systems or structural modifications, mitigation can limit the adverse outcomes by giving the community tools to be less vulnerable. Ciara Freeman emphasizes the importance of informing communities to support their abilities to withstand and recover from adversity.

Especially for bigger disasters impacting large populations, like droughts, mitigation efforts in the form of community resilience can utilize local resources to improve outcomes. However, communities should be supported through regulations, policies, and resources to be able to be empowered and avoid perceptions that may hinder their ability to act.

Click here to read more.

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.

Hazard mitigation planning is a crucial step to reduce the risk of recovering from a disaster. Though emergency disasters pose a threat to the affected communities, it also creates an opportunity to improve upon risk management practices and policies for future events. Mitigation can reduce risk greatly or even eliminate it if plans focus on disaster-prone areas and consider all potential scenarios. One major way to enforce mitigation is through community resilience, which can strengthen response and recovery efforts. Michelle refers to the literature to discuss measures to strengthen local communities, which are frequently the first-line responders during an event,  such as the Community-Based Disaster Risk Reduction and the Community-Based Disaster Management programs. Resilient communities that are supported by such programs can improve their preparedness practices by addressing issues of health and health systems, resources, and adaptation.

Click here to read more about Michelle’s assessment. 

 

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

In March 2015, Cyclone Pam struck the islands of Vanuatu as the second most intense tropical cyclone of the South Pacific Ocean. Though food stocks, water sources, crops, health facilities, and schools were severely damaged, there were only 11 deaths due to the efficiency of disaster preparedness and responses by the Vanuatu government. Namely, the warnings sent by Vanuatu’s National Warning Centre to inform residents despite nearly 65% of the gross domestic product being destroyed. Cyclone Pam was a category 5 storm of intense winds; resulting in up to 70% of the population being affected, more than 70% of Vanuatu’s health facilities were damaged, and 95% of the crops were spoiled. The consequences of the cyclone were further perpetuated by poor sanitation and increasing rates of acute diarrheal disease in children. Additionally, the public health sector was faced with the possibility of worsening incidence rates of respiratory illnesses, waterborne and mosquito-borne diseases such as typhoid and dengue fever.

The public health response to Cyclone Pam was very targeted; preventative interventions were prioritized such as childhood immunization, reproductive and sexual health services, and domestic violence prevention. Furthermore, international aid partners helped residents protect their homes and provided shelter kits/hygiene supplies, communal kitchens, and clean drinking water. 

Despite the commendable efforts of Vanuatu’s government and the Ministry of Health, Vanuatu is still very susceptible to disasters so monitoring disasters and warning systems are critical for future threats.

Read the full case study here.