Local Health Agencies Faulted on Bioterror Response Times

Rand test found some staffers ignored calls or gave poor advice

TUESDAY, Aug. 30, 2005 (HealthDayNews) -- Some local public health agencies in the United States are not prepared to respond quickly to outbreaks of infectious diseases and acts of bioterrorism, a new report contends.

Researchers from the non-profit Rand Corp. looked at the ability of local agencies to meet federal standards for responding to urgent-case reports of infectious diseases like bubonic plague, anthrax or botulism.

Of 19 local public health agencies called in 18 states, only two met the U.S. Centers for Disease Control and Prevention's standards, which include prompt return of calls, being put in touch with someone who knew about the disease being reported and the ability of the agency to handle problems 24 hours a day, seven days a week.

The researchers made more than 100 calls to these agencies, and three agencies never responded to the first five calls they received.

In one instance, after being given a description of the classic symptoms of bubonic plague, a public health worker told the caller not to worry and to "go back to sleep," because no other cases had been reported.

In another call, a researcher reported a case of what appeared to be botulism and was told: "You're right, it does sound like botulism. I wouldn't worry too much if I were you."

""On the bright side, 91 percent of the agencies did call back within half an hour," the lead author of the report, David J. Dausey, an associate policy researcher at Rand, said.

The Rand study, funded by the U.S. Department of Health and Human Services, appears in the Aug. 30 online issue of Health Affairs.

"We developed a test to determine whether or not local health departments were able to meet the CDC recommendations," Dausey said. "At the outset, the health departments said they had systems in place to respond 24 hours a day, seven days a week."

In their survey, Dausey and his colleagues called a number of local health departments over a nine-month period to test their responses to a report of a possible outbreak of infectious disease.

The researchers pretended to be physicians from local hospitals. Calls were made at various times throughout the day, Dausey said. The survey included large and small public health agencies in both rural and metropolitan areas.

Some responses to the calls took anywhere from a minute to two days, the researchers found. Delays were most common at the end of the work day, evening and weekends, the researchers found.

In addition, some who responded to disease reports appeared to have no training in infectious diseases, and others gave poor advice to callers, Dausey said.

But he added, "In most instances, the health departments had someone who was clinically knowledgeable, who called back."

Patrick Libbey, the executive director of the National Association of County and City Health Officials, was not happy with the report or its findings.

"Frankly, I am surprised at the tone that was taken and the conclusions drawn. I would suggest that this was a biased report," he said.

Libbey also believes that the sample of those called was too small to justify the conclusions. "I have difficulty in drawing the sweeping generalization and conclusions from a sample of 19 local health departments out of more than 2,800," he said.

"Is there room for improvement?

Absolutely," Libbey said. It's a good goal to shoot for, "but it was never a CDC requirement," he noted. "To frame an overall statement of preparedness on a review of 19 health departments on one criteria out of 65 and draw the sweeping conclusions . . .I don't understand that from an organization that I thought had greater professional credibility."

Dausey thinks that the test shows a lack of preparedness of local health departments, which he called a serious situation.

"In an era of bioterrorism and in an era of globalization, where things like SARS can spread across the globe in a matter of months, there could be a situation in which a case or two could actually have a serious ramification," Dausey said. "Imagine if it were a missed case of smallpox."

"There is clearly room for improvement," Dausey added. But because local health departments vary state by state, improving responses will have to be tailored to individual departments. "There are probably no one-size-fits-all solutions which are going to work," he said.

One expert thinks that the federal government isn't doing enough to improve public health preparedness to respond to a disease outbreak.

"Members of the public health community have been highlighting our national neglect of public health infrastructure for decades," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.

"Health departments are perennially understaffed, under-funded and resource-poor; public health and disease prevention research receives a small fraction of the support enjoyed by bench science and clinical trials; and even the CDC is rather begrudgingly funded as compared to the National Institutes of Health," he added.

Public health systems will only function well when they are built, nurtured, and grown over time, Katz said. "Episodic, crisis-driven resource allocations can only do so much," he said.

Increased interest in and care of the public health infrastructure is a positive consequence of the 9/11 tragedy, Katz said. "For our public health systems to function robustly, and for each strand in our safety net to be strong, a dedicated commitment to funding, evaluating, and refining public health practice is required. We must be in the business of public health for the long haul, not only in the immediate aftermath of crises."

More information

The CDC can tell you more about responding to bioterrorism.

SOURCES: David J. Dausey, Ph.D., associate policy researcher, Rand Corp., Pittsburgh; Patrick Libbey, executive director, National Association of County and City Health Officials, Washington, D.C.; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Aug. 30, 2005, Health Affairs
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