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Howard County's Pandemic Flu Exercise

(Peter Beilenson, MD, MPH) -- Over the next eighteen months, Howard County will be the site of one of the most extensive emergency preparedness exercises in the country.  Building on the collaborative work of the Community Emergency Response Network (CERN) and its Continuity of Operations Plan (COOP) committee, this three-part exercise will test several components of the community's response to a potential pandemic flu outbreak.  It will assess various County agencies and providers' ability to respond to the initial "cases" of a pandemic, including the capacity of doctors and Howard County General Hospital.  The exercise will gauge the County's ability to communicate guidance to citizens (for example, recommendations to shelter at home and avoid public gatherings) and businesses.

The exercise will also measure the long-term response of the community in the face of a pandemic.   By testing continuity of operations—of county government, medical providers and vital businesses—we will learn what we need to do now to be prepared as well as possible for either a natural disaster like the pandemic flu or a man-made emergency like a bio-terror attack with a similarly contagious organism.

Let me describe what might happen in a pandemic avian flu outbreak and why continuity of operations planning is so important.  Initial evidence of an impending pandemic would likely come from a growing number of flu cases occurring in other parts of the world, with some cases hitting the shores of the United States.  

Here in Maryland, we would gear up for our initial response by immunizing as many citizens as possible (if we have an effective avian flu vaccine by then) and stocking up on anti-viral medications (although none have been shown to be too effective against the H5N1 avian flu bug).  Hospitals would discharge less sick patients and non-emergent surgery would likely be canceled as hospitals started to gear up to take on patients severely ill from the flu.  Locally, we would encourage residents to obtain a supply of essential items—from non-perishable food and water to flashlights and radio to sustain them for the time we would ask families to shelter at home.  Public gatherings—from schools to concerts—would be suspended in the hope of stemming the spread of the epidemic.  Businesses of all types would close, resulting in less intermingling of the public.  Scary, isn't it?

However, after a period of time, probably a week or so, residents would need to replenish their supplies and might need a variety of services.  Computers might need fixing, phone and data lines might require repairs, and so on.  To that end, we as a community need to develop a robust plan for continuity of operations, at least for vital businesses and organizations.  

That is what this set of exercises, coordinated by the Johns Hopkins Applied Physics Lab (APL), will be testing.  The first phase of the project is an intensive table-top, where some of the major players in the county will be given a pandemic flu scenario and will discuss responses.  This exercise will be evaluated by APL staff and will help determine what will be tested in later phases.

The exercise will culminate with a two day, full-blown community-based scenario played out in real time, early in the summer of 2009.  County government leaders and business owners and employees will all respond to a simulated avian flu outbreak, without knowing how the scenario has been designed.  Evaluation of how these individuals and entities respond is perhaps the single most important aspect of the exercises.  What we learn from our responses will allow us to develop the best possible plan for responding successfully—both initially and in the long-term—to a future biologic disaster, natural or man-made.