The People, Process, & Progress Podcast - This is How Public Health Started in the United States | PPP #11

Episode Date: March 16, 2020

In 'America's Public Health History,' I walk the listener through how the Centers for Disease Control and Prevention (CDC) started. 

Hey everybody, Kevin Pannell, welcome to People Process Progress Podcast Episode 11, which I am calling Slaying the Invisible Dragon, a History of Public Health in America. This is not an all-encompassing, every little fact that would take forever. That would be very hard to do. So really what I want to focus on is in the midst of this COVID-19 coronavirus outbreak as of Sunday, March 15th, is give everyone a background. I've heard a lot of quotes from experts or the media talking about we're not ready. We don't have plans for this, no one knows. And while this strain of the virus, because as viruses do, they change what they are based

on how they can survive in a given organism, those quotes are wrong. There's a long history of great and hard work in the United States from public health professionals in partnership with emergency management and public safety and hospitals and healthcare and a whole bunch of other people. And so what I wanted to do for the folks that are listening, and again, if you are listening, thanks again for coming back, is to provide some ground truth from my experience as a public health emergency coordinator, hospital preparedness coordinator for a little bit, and then someone that's been in healthcare and public safety for a while. So seeing both worlds with really strong focus on the Centers for Disease Control and Prevention,

the CDC in the United States. They are the premier. They are our go-to. And while the WHO, World Health Organization, is pretty front and center in the news, the CDC for us in America as public health practitioners when I was there is our source. They provide funding. They provide the guidance. And as we'll go through in this episode, their history is what's helped us build the health and resilience of the United States for decades. So please join me. Please share this episode. I've got some practical tips, some updates. the health and resilience of the United States for decades.

So please join me. Please share this episode. I've got some practical tips, some updates. I'm going to focus a little bit on Virginia because that's where I am. But also overall in these national level programs on the history of the CDC, hopefully show you they've done this before. This is a different kind of thing, but they've done this before, right? All the folks out there that I had the pleasure of working with and learning from and partnering with have put tons of work in,

and I hope this episode reassures some folks, gives some great background into the CDC, which is an outstanding organization, and as well as the works that are done by our local and regional and state folks. So thanks again for listening and subscribing on iTunes, Spotify, Stitcher, all the usual places. Please share this podcast. I really want to share the stories of the folks that I've had a chance to talk to the histories that I've gone over.

Because I think they're really beneficial, whether someone's deciding to be a corpsman and they want to learn a little bit of the history of it. They want to learn about jujitsu from Andrew Smith or being a strong woman in technology. When I talked to my wife or anything else, any of the other archived episodes. So we're on all the platforms, peopleprocessprogress.com. I need to do some updates there. I think I'm going to kind of reformat how we share all the episodes there. And you can follow me on Instagram at Pennell,

P-A-N-N-E-L-L-K-G. And let's get rolling. So so who are these folks these people of public health today local health departments are staffed with physicians typically the director of a health district is a doctor of some sort some specializing in public health or epidemiology some are general medicine or other specialties but they're physicians in other states you might not be a physician if you're the the director but there's physicians at that health department running clinics doing things like that there's epidemiologists so those are the folks who have that often masters in public health or mph and they are the disease experts their whole focus is

what is this thing why is it making someone someone sick? Do we know the solution? So epidemiologists right now are the boots on the ground, are the operations section folks 100% on COVID-19, right? Them and the doctors and the scientists. Other folks there, emergency coordinators like I was or emergency planners, depending on where you are and what you call it. So that job, all the folks in the health district that don't focus on incident management, incident command, that kind of stuff because they don't need to because they're nurses or epidemiologists or physicians or they're doing their thing. The emergency planner, emergency coordinator's job is make sure everyone knows how to work together doing incident command, that they've had their annual training.

They coordinate the annual flu shots. They help coordinate incident management for disease outbreaks, which FYI happen all the time, all over the country, every single day, right? So again, repetition muscle memory for public health happens all the time. Does it get scaled up when there's an outbreak? Absolutely. Is it more stressful? Sure. It's just like anything else. Small projects all the time, one big project, holy smokes, but that's what happens. So that's largely what the emergency coordinator does. Nurses, nurses do a whole gamut of things from disease screening to clinics, you know, from the standard kind of take blood pressures, do that, get them ready for the doctor, refugee screenings, tuberculosis programs, a whole bunch of stuff. Public health nurses do tons of work.

Administrative staff, right? So health departments, just like other organizations, have administrative staff that work anything from the front desk to patient registration and a whole bunch of other stuff. Environmental health, that's another huge component of the public health department. So well inspections, food inspections, outbreaks at restaurants, right? Someone didn't wash their hands, they came to work sick. That happens regularly. It's super gross, but it happens, right? So our environmental health folks help get us through that and help give the guidance.

And if you've seen the news, particularly in Virginia and some areas, and you see 10 critical violations. So that typically is from an environmental health inspection of a restaurant and someone didn't meet cleanliness standards or they were using chemicals over the bowl of eggs or whatever. And there's some stories that I heard that most folks don't want to hear because you won't go out to eat anymore. But there are some places that are great at cleanliness and some places that are gross with cleanliness. Another great program, big program, is Women, Infants and Children or WIC facilitators. They're part of the public health department.

So families that need help with nutrition education, with formula, with diapers and wipes and all that, Women's Health, getting the vitamins, prenatal vitamins, WIC does that and much more. So that's quite a diverse mix of folks that are in public health. But if you think about public health, it is health for the population of a given area or scale it up for the state or for the federal. And it's proactive stuff and it's reactive stuff. It's a mix, right?

So trying to keep people healthy through hand washing, through prenatal vitamins, through reducing infant mortality, and then reactive stuff like now, where, okay, now it's an outbreak. Now it's a pandemic. Now we're going to set up all these screening sites. So if you listened to that episode I did of anatomy of a point of dispensing, focus there was we're going to give you meds because you were exposed to anthrax or something like that, but it's the same operation. So when you listen to the news and watch it, and if they're going to set up a screening location or your testing location for COVID-19, you're going to get there. You're going to do some quick paperwork.

You're going to go to a station. You're going to get tested. You're going to get paperwork to take with you. Then you're out. And the goal here is going to be throughput. I just heard on one of the news programs this morning, one area is focused is going to be 6,000 a day. That's a lot. And that is all about efficiency and safety.

So when you talk about partnerships between public health, public safety, health care, there should be folks with many different outfits, uniforms, collar devices working together there to make sure that folks have the information they need. They get to the location the right way so they come in the right way if it's drive-through. And you can do, I've done drive-through flu vaccination things before. So you could do drive-through testing. That's going to require obviously traffic control, law enforcement, fire department folks on standby for medical or EMS, working with your dispatch centers and public health is at the center of that as incident command or part of a unified command and operation.

So a lot of incident management. So the incident command system trainings I've talked about on this podcast that I teach, incident management super comes into play. And a great example, and I'll give them a shout out, is the Central Virginia All-Hazard Incident Management Team, which I'm an alumni of, has helped establish a great thing in Virginia that brings hospitals health care public safety government all together because that's what should happen right it should be one big team working together and that's just an example of it and the background of that the backbone is the planning P process the all hazards planning and it's fantastic so again in public health that emergency coordinator, that emergency planner,

if you're listening to this, you should be well-versed in this because your job is help get your people through it, just like a project manager, right? My job is to get people through a good process these days, regardless of what kind of project it is. So right now, all over the country, local, state, federal emergency coordination folks in public health are facilitating processes and helping their people get through it as efficiently and as effectively as possible. So kind of like I touched on whether there's a pandemic or not, the men and women of public health work really with an abundance of passion. You have to really love this job because sometimes it is super thankless. It's scary, right? These are the folks that, and I'll touch on this a

little bit in the timeline if you remember the ebola you know outbreak we practiced suiting up because someone was from a country that was suspect they did have symptoms all this so now you are on the front lines now that activates a whole different thing so you have to have a passion for that and to go out in the community and help deliver tb treatments to people and medications and all that kind of stuff and public health does that all the time. And it's invisible enemies, right? Like influenza, tuberculosis, COVID-19, pertussis or whooping cough, water contamination, keeping

babies healthy. So these are kind of intangible things you can't see. And that's why I call it kind of the invisible dragon, because to me, that's more scary than I can see something burning. The biggest contrast from my time in public health or healthcare and public safety is you can't see what's trying to kill you in public health. When you're a firefighter, you can see the flames. You can feel the heat. If you're in a city like when I worked in Richmond, I could see blood on an injury or the police presence, you know, with guns drawn or standing there doing security.

So I know, hey, that's not safe because there's a lot of police making a perimeter. Hey, that's blood. I should put pressure and do this or that. In public health, you know, you work hard to prepare everybody and get ready, but you can't see it, right? You can't fix this problem with water. You can't fix it with handcuffs. You can't fix it with bandages. It's infectious diseases, right? So that I think leads to hysteria, to rumors, to a lot of the stuff that we've seen in the media, the politicizing of whatever. And that's another big component. So when you're doing good incident management for

a pandemic or an outbreak, Public information management is huge. Establishing that joint information system, making sure you have a joint information center so that you have coordinated messaging to the public from the public if you have a hotline to answer questions. And it is, you know, the hotline gets to the experts, right? And the information gets to people in all different mediums. And as part of annual planning, as some of the programs, you actually have to have, you know, material translated to the most commonly spoken languages, whether it's in print, whether it's electronic media. And so that's part of all this planning that I'll, again, we'll go through this history. Part of, part of the history of developing that is to prepare for exactly what's happening right now. So while

it's scary, yes, again, you know, a lot of this is built in. And so for, for the folks, you know, in public health out there, thanks for keeping your plans up to date for doing those annual exercises, those checklists for making sure that your people are prepared and ready to respond. And, you know, so how did we get this far? How did we get here? Because I think we're actually in a really good place. I know we're in a good place. It's just scary. There's a lot going on. So let's learn a bit about the CDC that we've heard from quite a bit on the news, right? And so right now, the CDC is the Centers for Disease Control and Prevention. But in 1946, when it was created, it was called the Communicable Disease Center, right? And it was created in Atlanta by Dr. Joseph Mouton to address malaria in the Deep South.

So you don't think about that a lot because, right, they worked hard, not malaria in the South, right? Or it's very rare. Malaria you hear of in other countries, but in the 40s, it was actually pretty bad. And so Dr. Moten, who's a pioneer and a great leader in public health, helped stand up the initial CDC, the Communicable Disease Center. And that was in 1946. And by 1948, the U.S. was declared malaria-free. So just like COVID-19, just like H1N1, just like other stuff we'll talk about,

Sutwood and Public Health said, hey, there's a problem. Hey, let's get people together. Hey, let's address it head on. Let's focus on it. And then they knocked it out, which is pretty awesome. And then in 48, from doing such a great job with malaria, the CDC actually expanded to include things like typhus, plague, rabies, and other diseases, or control measures like insecticides. So their scope started to expand more to what it is now, which it's huge. And again, this timeline is from the CDC's website, their history. So this is probably a 20th of what's on there. And I would encourage everyone to go look at it. Because again, these are the folks that helped build and help get us, you know, there's a reason that the US is not as overrun with disease as other countries. And it's because of these folks, and the local state and, you know, public health folks. So in the early

50s, in 1951, the epidemic, epidemic, sorry, intelligence service or EIS was established. So these are those boots on the ground epidemiologists early on right in the fifties disease investigators whose whole focus, whole expertise is, Hey, there's some sickness going on here. Let's get there on the ground. And to equate this to a movie reference, um, contagion, right, which is being streamed like crazy now, uh, which is a great movie to show response, how disease spread. I actually would recommend folks watch it. It's a little scary, but it does have fantastic information. It's pretty accurate to a real-life outbreak.

But these are the folks that you see in the movie that are sent out to go get samples and interview people. Unfortunately, some of them get sick. That, again, is part of the scariness of it is you, you have to go get in front of people that are sick to investigate this. And so the EIS folks are epidemic intelligence service folks doing a air quote shoe leather epidemiology. And that's their symbol is a shoe, the bottom of a shoe with the leather worn out on the ball of the foot is their symbol. So they really helped, you know, really develop a lot of the on-the-ground screening techniques. And again, this was in 1951.

So since then, they've come such a long way. Check out the EIS website on the CDC. You can Google CDC EIS and you'll see a fantastic infogram or timeline of all the diseases they've had a hand in slowing or stopping or curing even. And it's the big ones, right? If you think of big, scary ones, they've been involved with it. So again, institutional knowledge passed on now, this process of developing an agency, getting better and better, expanding, saying, hey, we need experts that just focus on this. The CDC is all about it. In 1960, tuberculosis has come under the purview of the CDC. And tuberculosis is a bacteria that attacks the lungs and it's spread through close contact.

And so, you know, which like many things are spread through close contact. TB, pretty deadly, pretty bad, not prevalent as much in the United States, but certainly happens. Other countries actually get the vaccine because there's so much of it. We get, if folks have ever had the PPD test, you get a little test injection under your skin, look for the dots to see if you have it or not. But we actually had an outbreak where I worked in Virginia and, or tried to prevent rather, but had exposure there and ended up, and this speaks to that shoe leather, that getting out there to the community ended up doing screening for hundreds of folks in the back

of a big box store because someone there had active TB and was exposed. So just like COVID-19, folks that are sick should not be near folks that are not sick, right? And in this case, they were. And in the 60s, certainly we didn't have the awareness, the ability to get the word out. The CDC, as it gained more prevalence and reputation, started taking on more disease investigation and ownership of prevention measures. And so in 1960, TB ended up one of those. In 69, the first containment lab or biological containment lab was established by the CDC. So these are those, if you see the movies, and again, because most people can, if you don't already know

what that is, for either holding samples or testing samples, those where they show people go through kind of the doorway and the air goes and they're suited up and then they get in the room but even in the room there's this glass box with gloves and you're working you know and i equate it to a biological bomb suit right so if you think about if you've seen a military movie with an explosive ordinal ordnance technician or ed tech with that big heavy green suit and the giant helmet and they're you know cutting wires and they're trying to diffuse bombs if you've seen the hurt locker that that suits in there quite a bit it's like that but for biological deadly biological things like the most deadly things on the planet um rice and plague you know just horrible things uh and if you get a nick in

the suit though and you're exposed or you get exposed you know in one of things. Uh, and if you get a nick in the suit though, and you're exposed or you get exposed, you know, in one of your mucus membranes, then that's, that's the deadly, you know, it's not really a game, but I guess game you play when you're working to try and solve, resolve, um, some of the most deadly diseases on the planet. And so in 1969, that's quite some time ago, the CDC stood up that containment, biological containment lab. And so they've been able to isolate samples and test them and try and find cures and find cures. And so that's pretty, pretty astounding, pretty groundbreaking. The next year, the National Communicable Disease Center is renamed to the Center for Disease Control. So the National Communicable Disease Center is renamed to the Center for Disease Control. So the National Communicable Disease Center was the place that the original CDC name, Communicable Disease Center, was renamed.

So that's when it becomes Center for Disease Control that most folks know about it now. And the full name is Center for Disease Control and Prevention, but most folks know it as the CDC. So a little name change there. So, again, part of the process is branding, right? So, you know, it's not just communicable disease center. It's now just disease control. So, and their scope had expanded so much from malaria that it includes much more now. In 76, in Fort Dix, New Jersey, swine flu, right?

So swine flu we've heard of, right? H1N1. And concludes that a pandemic's on the way. And this is going to sound a little familiar. So a national immunization program's launched. No epidemic occurs. Before the immunization campaign is terminated, several people contract Guillain-Barre syndrome. So the Guillain-Barre part is where it affects your muscles and it's a rare disorder where your

immune system damages your nerves and you get weakness and sometimes paralysis. So sometimes even with annual flu vaccines, folks get nervous that they're going to have that reaction to vaccines. In this case, as they were vaccinating for this flu, some folks did fall prey to that. But since then, we've really made the vaccination a lot better, a lot safer, and it's extremely rare. But if you think about it, in 1976, they said, hey, we see this coming out, there's going to be an outbreak or an epidemic, but they got ahead of it. And now with COVID-19, they're working on a vaccine. And as we'll touch on in a little bit, or even just now, vaccines can't happen overnight, right? You got to look at the disease, the virus,

whatever it is, figure it out, make the vaccine. And I'm obviously not a scientist or I'd explain more scientifically how that happens, but it takes time. Like any good solution, even the annual flu vaccines, there's no 100% vaccination, but 20, 30, 40% is better than 0%. So I'll be interested to see what the efficacy or what the percentage of protection from the COVID-19 immunization turns out to be. So we've got our epidemic investigative service stood up. We're already proactive in epidemic prevention or termination. And then in the early 80s, another huge impact to public health, the first case of AIDS or acquired immunodeficiency syndrome was reported in the CDC's publication, the Morbidity and Mortality Weekly Report, MMWR. And AIDS is caused by human immunodeficiency virus. And if you recall,

in the early days, it was a mystery of what HIV or AIDS was. And then initially, it was thought to be a gay man's disease. And fortunately, through science and again, rumor control and dispelling myths, it was found out that is not the case. Certainly, there was prevalence there. But the CDC was at the front of finding out more about it, stood up the first national AIDS hotline as more cases became reported, right? So that information management, this disease, we're seeing symptoms. We don't know what it is from all these different physicians and doctor's offices and hospitals all over the country. So they stood up a hotline and that's something that happens pretty often as well. So

I mentioned that tuberculosis exposure, you know, is when the public hears about that, particularly at a retail location or now COVID-19 anywhere, it's always good to stand up a hotline with either recorded standard information or, you know, in some initial you could even have recorded screening things. So, hey, do you have these things? If you don't, you're good. If you do, hit this number and keep going. Or if you have the staff, which again, this is resource intensive, and to get it landlines or virtual numbers or however you set it up, you got to have people on the end of those that also have either talking sheets or are knowledgeable themselves. In an outbreak, it's hard to reserve your folks that are experts to sit there versus being out there doing the investigation. But early in the 80s, the CDC set up that hotline, and then they also hosted the first global conference on AIDS.

So, you know, well at the forefront, very early, they got together with folks from all over the world and said, hey, we need to address this very early. And so I think that's a pretty awesome proactive thing. So one thing I heard on another podcast from another expert who certainly is an expert, but I think, you know, it's easy and I'm sure I've done it here. You misspeak on your podcast, you're in a thought stream and you miss a point was a statement by a public health physician that said, we don't have stockpiles. We haven't prepped for something like COVID-19. And I immediately thought that is absolutely not true. And this is why in 1999, the National Pharmaceutical Stockpile, it's now the Strategic National

Stockpile, it's now the strategic national stockpile, was created. And so this is a huge cache of medicines, vaccinations, other medical supplies. So it applies to, and there's a whole inventory of this that public health folks had access to that I had that I used in my plans that we could call in and coordinate at airports, a whole huge logistical plan that already exists. They've been around since 99. So, you know, medications like general things like, um, morphine, you know, for traumas or stuff like that, vaccinations for influenza and other diseases. And in the future, probably COVID-19, uh, for medical supplies like tourniquets and IV bags and backboards. I mean, anything, there's a whole national disaster management system for response. But the strategic national stockpile does exist.

So, yes, to everybody listening, yes, we do have stockpiles. We do have stockpiles. And with COVID-19, with influenza, the thing with a lot of diseases, if you look, there's a lot of comparison charts too, right? Where folks are saying, how does COVID-19 compare to SARS? How does it compare to H1N1 or seasonal flu or whatever else? There are super common threads that are called influenza like illness or ILI, right? That you'll see that almost all of them share at least two to three of the same symptoms, right? Some all have fever, some have chills, some have sore throat, cough, runny nose, right? Influenza-like illness. And

that's part of the problem with this is it looks very similar until you can get the test. And that's where we're short now. But imagine if someone said, hey, prepare, and then you have to try and game out every variation of every disease or every, you know, bacteria or whatever that could happen. It's impossible. So with those ILI or influenza-like illnesses, a lot of this cash or stockpile can help with treating the symptoms, right, while we figure out the test to actually create the vaccination or the treatment or get you antivirals if that will work, right? Like Tamiflu is a big one that some people have made a run on, which isn't cool because that should be reserved for the critically ill folks. And I'll throw this PSA out there.

If you have a cold, a viral cold, right? And it's not COVID-19, you're just a cold, you don't need antibiotics, right? Even if you have COVID-19, unless you get an infection, you don't need antibiotics, right? You fight the virus, you make yourself comfortable with your cough and cold medicine, with your NyQuil, with your tissues, with your hand washing, with all that kind of stuff, but antibiotics don't kill the cold. So that's one thing to think about. And that's the thing as an emergency coordinator or planner or someone doing logistics is having to stockpile antibiotics in your local pharmacy because folks a lot of times these days go to the doctor to get antibiotics and they may not have an infection and sometimes it helps and sometimes it doesn't but usually you

can ride it out unless you end up with a sinus infection or you actually have strep or something like that and you don't need the antibiotics but you as a nation in 1999, not crazy long ago, but we developed this whole strategic national stockpile, which I imagine is right now pre-prepped for deployment because as folks set up these screening centers, testing centers, some localities in areas that aren't as prepared either through lack of planning or they don't have the resources, are going to need help from the federal government to help stand up a location for folks to drive through to do all that screening I talked about. Some areas may just need some stuff or nothing because they're super squared away and their state is. Who knows? But the Strategic National Stockpile stands by ready right now.

And it has and it does every single day. And there's annual exercises on how do we get all these big containers onto pallets, onto a plane, to these different airports, to then unpack them. And this is stuff that's exercised all the time, if not verbally, actually in practice. So 99, then we're going to jump to 2001, right, 9-11. CDC was huge in coordinating that, you know, those anthrax cases, the inhalation anthrax. And anthrax is one of those pie-in-the-sky things that if there was a cloud of anthrax that hit a locality that I've mentioned on here before, how do we, in 48 hours, get a 10-day supply of antibiotics to over, you know, X number? For me, it was 300-plus thousand, and that grew every year, residents of where I was. That's the same mimicked all over the country. So anthrax, right, those cases, the CDC was a huge player in that. And that was, again, another kind of domestic terrorism focused public health issue

and public information management issue, right? The scare, white powder scare, and the white powder screening for particularly fire departments and hazardous materials teams at that time was just off the charts in public health. As you imagine, you're on call at a station and you start getting calls for white powder. And of course, you know, the anthrax came in a powder format. The likelihood that anthrax was being mailed around the country was extremely low in mass right but because it did happen but the fact if it was going to show up everywhere was is pretty low because access to that and the ability to make it the good thing about biological diseases or weapons is they're very hard to make they're very hard to keep um i guess sustainable to deploy them and

our intelligence services our public health our military know the places where that can happen so it's easier to stop than say you know a suicide vest or something like that and so with anthrax though it caused crazy scares and you can't treat it as if it's nothing right right? There's white powder. We know Anthrax was mailed to some folks. We know they got sick. We know some people died. And so as a public safety or public health and locality, you got to respond. So that super taxed the system. Again, many lessons learned from that that are being applied right now by everybody, including more proactivity between public health and public safety. And I'll say I'm super blessed to have been part of that as well where I was and have great partners.

So that continues today. Following 9-11 and some of the disjointed coordination there and with anthrax and some other things in 2002, the Public Health Emergency Preparedness Cooperative Agreement or FEPP was established, right? And that was really to help health departments prepare for chemical, biological, radiological, nuclear, and explosive or CBERNY, if you're out there and folks know that acronym, incidents or events. That is the funding stream that paid for my position and a few other, and I'm going to do a breakdown of that program here a little bit later. But that was a huge step in 2002 to establishing the framework for all the people that right now are planning their response for COVID-19,

that are responding, that are investigating, that are screening people, that are setting up clinics, that are setting up screening events. That program was established in 2002. So again, in the media, some experts that want to be edgy but not accurate are saying, we've never done anything for this. We're not ready. We haven't practiced this.

That's factually wrong, right? We've been practicing this for a long time. So that should help, I hope, the listener. I know it helps me, but I have a different vantage point because I used to do this. But I will say, and again, all this information is on the CDC's website, and I'll have the links in the show notes. There's been a focus on this stuff for quite some time. The issue is diseases change, viruses change, and then we have to adapt with it. But behind that is a lot of people and a lot of supplies that have been practicing this and have set up programs and organizations for quite some time.

So a few years after that in 2009, and this is when I get into public health. And I'd been in health care, if you recall, when I was a corpsman. So I had hands-on critical care folks, all that kind of stuff. Knew of isolation, you know, diseases or infections that we would have to use isolation cards and get all masked up to take care of patients. So I was familiar with that aspect of it, not as much the overall outbreak and response. So in 2009, the H1N1 pandemic, an outbreak and response was going on. That was everywhere. That was huge, right? Similar to COVID-19, there was no vaccine in 2009 when cases started rising in the U.S. and around the world.

But by the end of 2009, rather, there was a vaccine. So, again, there's hope. And there are experts right now, no doubt, working around the clock to get a vaccine for COVID-19. Just like they did in 2009 for H1N1, where we ended up giving thousands and thousands, I want to say it was in the 30,000s, H1N1 vaccinations, right, over the course of about a year between 2009 and 2010, including to government, because you got to have continuity of government. So think about your audience. Here's the stats from H1N1, right? And this is, you know, part of that comparing the past bad with the presence bad and

all that kind of stuff is in the United States, there were 12,000 deaths from H1N1, pretty crappy, mostly focused on children and elderly were the most impacted, right? There's a, there were the most vulnerable. Um, there were antivirals for treatment. Um, but most people recovered without complications, right? I'll say that again. Most recovered without complications. Most people now with COVID-19 get sick, feel horrible, and get better, right? And we'll get into this. The high-risk folks are folks that have health issues, that have lowered immune systems. Same thing with H1N1 back then. Unfortunately, with H1N1, though, children were very susceptible to that. With COVID-19 right now, from what we know, because again, viruses change, could it change? Sure. But right now,

it's largely older folks with health issues, underlying issues, or other folks that happen to get it that have health issues. So the key is the framework of your health dictates kind of what happens. So in 2009, H1N1 pandemic and developing a vaccine and getting out there and almost all of the things you see now in the news, other than it's, I do feel like it's an election year, you know, people are using it and social media is even more prevalent now than it was in 2009. Very, very similar. This new strain, we don't have a vaccine. Panic, panic, panic. Manage information.

Okay, let's get this out there. Let's do mass vaccination clinics constantly. There were weekly travel mass vaccination clinics all throughout the locality. I was in the state, in Virginia, all over the country, everywhere, really. And part of that education experience and the great work that my colleagues and I did locally, regionally, throughout the state afforded us the opportunity to be invited to Health and Human Services up in their headquarters up in DC, along with colleagues from the state of Minnesota to speak to the abilities of local health departments, right? So a couple of years, and I think 11 or 2011 or 2012, myself and a friend of mine, and

he was a battalion chief then who was the emergency management or represented the public safety and first responders from the locality I was in, went up there with the director of our program and really spoke to the federal, you know, leadership from, and there was CDC, health and human services, a whole bunch of other three-letter agencies to really let them know, like we, you know, and we focused on a different disease that's a little more scary, but to let them know, like we practice this and we've actually done this a lot, right? So to alleviate fear and that really speaks to, so in the same government system, and, you know, local is its own thing, state is its own thing, federal is its own thing, but there are connectors in funding or dotted lines or this and that, and all one team in America, right? But that really opened my eyes to agencies that just wanted their own stuff or wanted to do their own thing.

And then fortunately through great discussions, you know, realizing collaboration just like now, right. And we see that going really well with COVID-19, I think. So, you know, that was a great exercise and really spoke to our ability at the local level to say, you know what, we all the time do this. And here's some numbers like, you know,, we all the time do this. And here's some numbers like, you know, giving 30,000 vaccinations over the course of however many months, we coordinated that, right? Yep. We got some money. We got the supplies that came through

federal channels, but all the coordination, just like every other incident, disaster, anything else starts and ends locally. And while I was funded by the state and others were funded by these federal grants, we were essentially local folks, right? That's who we worked with. That's how we got this done. And that's how we're going to get it done now with COVID-19. A few years later, 2014, Ebola, right? Ebola virus disease, big outbreaks in Africa, people traveling. That one is scary, right? That one for sure is scary. So case reporting increased. The CDC stood up their Emergency Operations Center, and they helped coordinate national

preparedness and response. Certainly, they had huge teams going over there to the affected areas in Africa, and those were significant, scary numbers. And Ebola is, to me, one of the scariest diseases we could work on. Here at home, we increase screening at airports. That sounds familiar, right? With what's going on now. We track data regularly, weekly, there's daily updates, but weekly reports, all that kind of stuff of, you know, where is it? Any reports in the state? Have we moved patients? And fear management for sure.

So that, again, that public information management, the joint information system, that reality and managing not only fear for the public, but for our partners, right? For public health being the voice of reason and guidance with public safety and local government and state government to know, okay, let's get this template of screening in place. Are they from one of these affected areas? If no, that helps eliminate tons of people that call in and say they're sick to 911 or show up on a plane and they're sick because they actually ate something bad and wherever they came from, not because they were from a country. And so one big lesson learned there, particularly in 2014, while we were screening folks with Ebola and getting the 2 a.m. calls of, oh, this person's here and that,

we think it's Ebola. And we're like, where are they from? And they said, oh, Venezuela. And you're like, no, that's not really one of the countries in Africa that's primary. But if you're on the ground, this person's sick, you know, there could be someone from somewhere and they have the same symptoms. Then, you know, in the heat of the moment, it's super easy to not remember the exact checklist. So get your checklists, shore them up, do training between public health and public safety and local government and hospitals and healthcare, and make sure everybody's on the same page because it will help reduce stress for everybody.

It will make the system more efficient. It will make everybody safer. And that's one thing, one of the great things that we did through in 2014, through screening folks with Ebola and preparing locally. And if you're a local health department, you need to run through a, you know, COVID-19 for now. What if someone does show up and they're super sick? Do you have a cart with isolation stuff, right? Just like hospitals do. There's no reason public health couldn't now. If you don't already have one, just like in my Decentralizing Ebola and Charters podcast I did last year, my thoughts from the road, if you don't already have supplies now, they're going to cost more,

take longer, all that stuff, right? So still work to get them. And then for sure, don't stock up so others can't have it, but make sure you have that stuff on hand and you're doing that good inventory so you don't have expired gowns and masks and all those kind of things. But you're regularly refreshing your inventory, whether there is an outbreak or not. That should be happening. Going to take us up to 2016 with this timeline with Zika virus, right? So this is the one that was really mosquito focused, which is interesting. So 2016 Zika, where did we start with the CDC? Malaria, mosquitoes, mosquitoes, man, they're wicked. So CDC activated their emergency operations center, right? Focus controlling mosquito

populations. They have some experience with this for sure. Um, they shut down malaria, right? And the South, they helped very much. So shut down malaria in the South. They helped very much so shut down and greatly reduce Zika exposure in the United States, particularly in the South, where it's hot, standing water, mosquitoes. So there's a public health tip as well. In addition to the number one tip of wash your hands is don't leave standing water around your house. Mosquitoes love it. That's where they lay their eggs. That's how they'll, you know, hatch, go bite something with the disease, then come bite you and get you sick. So that's what was happening with Zika. That's the simple breakdown of it. Zika though, mosquitoes primarily, but also through sex, blood transfusions and pregnant

mothers to their fetus. So that was a big concern. That's what you saw on the news, right? Was the, the sick babies and with the microcephaly. So that was, you know, a birth defect that affects the brain. So Zika, not good, but you know, the CDC was on top of it, help preventing mosquitoes. So again, not just what makes someone sick, you know, what's the virus or what's the disease in this case of virus, but how do we stop people getting it, right? So that's a trend in healthcare in public health is let's not just wait till we get something let's ahead of time be healthier let's ahead of time use mosquito preventions so we had briefings on the travel of where mosquitoes were during that time like where do they live now we you know kept pushing out again use thatspray or whatever brand of mosquito repellent.

And so that's a huge thing. Empty the water. If you have empty pots sitting out and it rained, don't leave them out there in the summer because it's just going to gather mosquitoes. So that's a very quick history with my two cents here and there of the CDC. So hopefully as you can hear, and again, that's scratching the surface on the entire history. So check out CDC's website and their history. You can do CDC history. It'll come right up on Google or whatever browser you want to use. Now I want to talk about the progress of two programs in particular, the FEPP or Public Health Emergency Preparedness Program and the

HPP program or or hospital preparedness program. First, we'll start with FEPP. And these are the two big ones that are helping public health and its partners get ready, and hospitals and healthcare and all their partners get ready, which there's tons of crossover. So for FEPP, all 50 states have funding available to them, right? And so what do they fund? Epidemiologists, laboratorians. I don't think I've really used that term at all. This is from the CDC site. right and so What are they fun? epidemiologists

Laboratorians, I don't think I've really used that term at all. This is from the CDC site educators health professionals CDC staff so there's some CDC staff that are funded by this as well and they help Local health departments or state health departments make sure they're going through their plans make sure that they've checked the boxes practically On did you consider this this and this in your plans? they're going through their plans, make sure that they've checked the boxes practically on, did you consider this, this, and this in your plans? Have you exercised it, et cetera. And then other positions, IT admin, emergency planners, right? So federally funded, all 50 states have this money available. It's broken out a little differently. It's,

it's more is given to areas with more people with higher risks, less and less areas, just makes sense, right? So what do these focus on largely? The top five focuses of funding is public health surveillance and epidemiological investigation, right? So since 2002, a whole bunch of money has gone toward doing what we're doing now for COVID-19 and it's been happening. So again, I keep reiterating this because there's a lot of terms in the news or people saying it's not happening. So and so didn't do this or that. No one person that's trying to get elected really, unless they came up through the CDC or were in that field, really had anything to do with the great work that's been happening, regardless of if it's an election year. Right. You know what the election years affect?

How much money the organizations do or don't get. And that's a whole nother thing. And this is not a political podcast, so I'm not going to get into it. But that public health surveillance and epidemiologic investigation has been happening. So if you hear somebody say, it's not happening, we need to do this or that, it is. Public health laboratory testing. So again, we can test for what we know about COVID-19, different strain, the developing tests now are expanding it. So that's been funded. That's something that has been ongoing. Community preparedness. So I did an episode about public health personal preparedness. That's a big focus of that, right? For public health focused stuff, and we'll touch on this as well for some of the at-risk

folks for COVID-19, particularly older folks, that's letting folks know, have enough medications for a couple of weeks, not just for right now. Have shelf-stable food, clean water, those kind of things. Other measures in their personal preparedness as well. Information sharing. So systems that can alert all the employees that, hey, this is happening, show up at this or that place, monthly tests of those. And then, of course, media campaigns, public information officers, printed materials in many different languages. And then the fifth of the top five funding for the FET program, medical countermeasure, dispensing and distribution. That's happening or going to happen, right? So when I talk about those mass vaccination clinics, whether it's an annual test

of giving a regular flu shot, or it's the H1N1 outbreak where you're giving thousands of them regularly, or like COVID-19, which is going to happen, we're going to screen and test thousands of people. That's through medical countermeasure, dispensing, and distribution. You may not get a countermeasure, but the point of dispensing model of come in, fill out something

so we know you're not allergic or you may not have a reaction, go to this place, whether you drive to it in your car because you can cone off an area and have people just drive through. You don't have to get out of your car and then we'll probably see a mix of that. Or like in a school or another big place where you come in and walk through and then you do your test, get some information and head out. That's going to happen in mass all over the place what are the most common threats that we see environmental contamination right so groundwater contamination work through some of those investigations the environmental health folks

are just very good at that you know let's say there's a dry cleaner that's been leaking stuff out of the back of it for a while and it flows. There's a water table on the ground, right? It flows down, starts infecting people's well water. How do you get a solution to get them on city water if they can or whatever, or however you can help solve the problem, keep people safe. Severe weather, right? So that happens more often than a big COVID-19 style thing. A hurricane, tornado comes through, you know, there's public health issues there, right? So if the sewage system is down, that's a problem. Look at Katrina, Houston, areas where massive storms went through. They flood.

Remember when they flood, they don't just flood nice, clean water all over the place. Now there's dirty water with chemicals in it and biological stuff in it. Pretty gross. So that's a huge public health emergency right there. So even all those places when the water recedes, now they're covered in sewage laden water. Maybe there was a, if you think about the dump that you go to or the landfill, it's got a place for oil, right? That barrel. Imagine if a bunch of those now are in the water or other chemicals, gas stations are flooded. So a severe weather caused public health issue, right? Now it's hot. Now there's mosquitoes everywhere, this whole cycle. And then of course, infectious disease outbreaks. So that is a huge,

which I've, you know, touched on a huge focus on the FEP program. There actually used to be a primary focus on pandemic influenza planning, and that's an annex that public health plans have. And if you, you know, all hazards is kind of the word of the day in emergency planning, including public health. And public health, they may delve a bit more into the disease-focused piece of having a point-of-dispensing plan, an epidemiological plan, an influenza plan. But then you also have annexes in your emergency operations plan,

and that's the document that you create through the process of working with people for disease outbreaks. And there's some variation for sure in what you do specifically, so you work with your epidemiologist to get that guidance. But as far as how you pull people together, all hazards, right? So focus on Virginia for the FEPP program. So for my fellow Virginians, and if you're not in Virginia and you're listening to this, look it up. Look up on the CDC website, Public Health Emergency Preparedness Program, or FEPP, and you can see a breakdown by state. I'm just going to go through Virginia.

There's 119 local health departments for fiscal year 2019, over 14 million, almost $15 million was given to the state, which is pretty awesome. What positions were funded? Epidemiologists, 41 of those, 17 of those laboratorians, eight educators, two health professionals, two CDC preparedness staff, and 64 other positions, right? So again, every year that's looked at what's the threat after COVID-19. Will that number go up from 14, almost 15 million? Could be. Seems to be an uptick after this stuff happens. So that's the FEP program. And again, that's the program that myself, epidemiologists, and a few other folks were funded by, whose whole focus is public health preparedness, shoring up training, supplies, everything else that's gotten a lot of folks ready for this COVID-19 that they are working on right now.

The next program I want to talk about is HPP, or Hospital Preparedness Program. And this program developed through the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 from a lack of healthcare focus post-9-11, right? So there was big gaps identified from 9-11 after any big thing, and we learned a lot of that. And so in 2002, this act was passed that said, hey, we're going to fund this, we're going to get healthcare a little more resilient, a little more ready for big disasters that happen.

And so in 2003, the Health Resource and Services Administration, or HRSA, was developed as part of that, expanded the program as part of that. And so that was because the money was good for each individual healthcare system, but each healthcare system didn't then work together with other healthcare systems. And just like any other business, everyone has their own brand. They compete for patients, for everything else. But what we needed to do was say, hey, everybody in the healthcare space, let's all work together to get ready for the next round of natural disaster, disease outbreak, mass

casualty, whatever, and be in partnership instead of having our logos bump heads and stay in our silos. And that's just the reality of what was happening. So with the expansion with the HRSA, the focus on improving bed and personnel surge capacity. So thinking about if we have to go from 200 to 700 beds because of an outbreak like COVID-19, how are we going to do that? Do we have the supplies? Do we have an offsite location? Can we change how we screen folks and let them in? Tons of considerations. So that's a focus that folks that receive this money need to look at. And fortunately, every

year and for the short time when I was the hospital preparedness guy, part of what I looked at is we're giving you this money. How are you spending it, how are you meeting these goals? So there are checks and balances, which is great. And the other thing is to look at decontamination isolation capabilities. So a lot of high-level hospitals, and by high-level I mean kind of bigger level one trauma often, but research hospitals have bio screening areas or isolation areas even from the emergency room so whether they think it's ebola and that was a big spur for that right what was a like a pathogens kind of unit was to make sure if ems brought this patient that they suspected right and they're all gowned up and masked up and everything and they think they have whatever disease or virus that's spreading at the time that you can get them with minimal to no exposure from anyone else to a space to isolate them and then work on them.

So a huge focus there. Interoperable communications. So there are radio systems that were developed so folks could talk directly hospital to hospital, that they could also get on their local public safety's radio channels, that they could also call each other, satellite phones, just all these interoperable, redundant communication systems to have many ways to talk to each other so they could coordinate, again, like I mentioned for mass casualties, for surge capacity. A great example of really good surge capacity and response was after the Boston Marathon bombing.

The good thing is there's hospitals very close to where that happened. They even mentioned in some of the quotes from the docs, you know, we activated our incident command system, so they practiced it, right? So they were definitely on the path of good preparedness there and they could talk to each other right so they they were interoperable and they could communicate part of that is bed tracking management so developing systems when you do mass casualty triage there are paper tags so when you're at the transport group supervisor that's saying all right send these two to this

hospital and this one of that one they are talking on the other end to a medical control that is typically your level one trauma that's looking at all the hospital bed census in the area that says, okay, this place can take this many red or super critical patients, this many yellow or injured or walking wounded and this and that. And so there's a lot of communication and coordination going on. And to make that happen, we have to have these systems in place and they have to be checked regularly. And they are. So what else does the HPP focus on or the participating organizations? Hospital evacuation planning. What if we have to get out because there's an attack or really there's an exposure to a disease or say there's a fire or they lose power, right?

It didn't have to be the scariest thing. It could be a practical thing. Let's say there's a car accident that hits the power pole that's going to, you know, or poles that's going to the hospital. And sure, they should have a generator and that kicks on. And let's say that generator, something happens to that, right? And this is not making it up. It happens. So what if you have to move patients quickly to another hospital because you have a large number of folks that are on life support that are critically ill and your facility

now cannot handle them? So you need to be planning for that. Super morbid one is fatality management planning. And I participated in this quite a bit. And this is the literal planning of how you're going to take care of bodies, right? So how will you take custody of, store safely, be respectful, but move bodies of the deceased, right? So it's a very hard logistical solution. If you have, let's say, a bunch of folks that are infected with a disease and now you have to store their bodies and you have to. That has to be cool. Right. To keep the bodies at the temperature that they won't decompose. And again, gets way into it. Right. And then to do that in mass, let's say what would be good for that is a big refrigerator truck, right? Once you see going on the highway. So a practical planning consideration that is part of this program or to consider is who's going to want that truck back after you had bodies in it if it was like a produce truck, right? So there are people that plan that stuff out that have contingency plans for that.

But if you think about it, that is the level of planning that happens all the time from the nice, you know, hey, everybody wash your hands through let's take this all the way to worst case scenario where we have, you know, a lot of deaths and we have to move bodies. And you saw that more in Africa with the Ebola where you see bodies and stuff. And that's part of the continued spread of infection, right, is exposure. So how do we stop that exposure if that were to happen? So fatality management and planning is a huge component of that and definitely shouldn't be overlooked because it's not as much on the front end kind of actionable, but practically it's a huge consideration.

So there's plenty of solutions for that from cooling blankets, like you use on living patients, um, to small trailers that have racks for, um, stretchers for bodies and a whole bunch of other stuff. So that's a big consideration there. Uh, emergency training, education, drills, and exercises, right? So all this stuff we've talked about that we actually do, you get good at that through some smaller response, but for sure, training on diseases, training on the incident command system, training on working together in communication, drills and exercises, right? So a drill, you focus on one component thing. An exercise could be anything from we're going to

talk about it to we're going to get all the equipment out and all the people and we're going to walk through this whole thing. So hospitals that get this money are required to do that and they're required to work with their partners. So that pays off now when we're in COVID-19 style outbreaks, right? Is that we've already got these relationships. We're not establishing them now. We've already exercised this. So, okay, what do we do this time? What do we call this group and that group and just kind of work through that. So in, you know, as well as we were doing and started to do in 05, Katrina showed some more, you know, chinks in the armor and some changes are made to the program to say, hey, you know, let's, you know, in addition to working together,

let's develop some official hospital coalitions. So now what's in place as part of the HPP program are hospital coalitions, which means these are like regional groups that get together of all the various organizations of a hospital, plus public health, plus fire and EMS, to plan for, practice, and respond to all those things I talked about. So again, this should be comforting to know. This happens behind the scenes that unless you're in this world, hardly anybody knows about it until something like COVID-19 happens and everyone goes, we're not ready. We didn't do anything. But there are thousands of people that are ready, that practice this all the time, that work together. And for the hospital preparedness program, let's go by the numbers

for them. So this is nationally. There are 62 awardees, 476 healthcare coalitions, 31,000 coalition members, $256 million in annual appropriation. And since 2002, there's been $5.9 billion invested in hospital preparedness to establish coalitions that exist today, that exercise, that have caches of their own, that work together, that communicate, that prepare for things like COVID-19. Again, a lot of money, a lot of people doing great work have been at this for a long time. So yes, diseases that become pandemics or viruses or whatever it is are scary. Yes, we are concerned. Yes, there are things we can do. And as you see, as you listen to this, schools closed, businesses closed, events closed.

But when it comes to it, just remember behind us in the public are these public health folks partnered with public safety, partnered with emergency management, with private sector that have been at this for a long time. Let's let them do their thing. Let's not freak out and spread misinformation. Everything between my personal experience and then the CDC's website with data, and it's updated constantly for things like this, is all available on the CDC.gov. It's all there. That's the real information. That's where you should get your information. So let's talk COVID-19 because, you know, it's on everyone's mind. Here's the latest as of Sunday, March 15th, right? And some numbers, some data from the CDC will be

from the 13th just because there's updates all the time. And data, as you get it in, right, from so many places has a little bit of lag. But first, I'm going to cover some of the basics. So here are some guides per the CDC for COVID-19. The best way to prevent illness is to avoid being exposed to this virus. Go figure, right? It's spread respiratory person to person through droplets, just like other things. Don't go near people that are sick. If you're sick, stay home.

Cover your cough. Wash your hands, right? How do you self-protect? Wash your hands. Probably heard me say that before. Like I said, when I used to do presentations for folks on public health, I'd wash your hands on like every third slide because it's one of the greatest ways to stay healthy. If you use hand sanitizer, make sure it's 60% alcohol. If you're out and about touching

doorknobs and handles and whatever else in public, don't then put your hands in your mouth, your eyes, your nose, right? Do those kinds of things. If there's wipes in the store for the grocery carts, look for those, wipe the handles down, right? That'll also clean your hands as you're wiping them. So that's good stuff. For COVID-19, who is higher at risk? We mentioned this before. For this one, it's older adults. 60 and over seems to be the age. Deaths actually seem to be happening in folks even older than that, but 60 plus is the target age. What can you do? A lot of the general preparedness things that I've talked about in the past that you can read on ready.gov, stock up on supplies.

And I don't mean make a run on toilet paper and ground meat because, one, ground meat is going to go bad, but people are doing it. It's goofy. right get you know case of water you should have that all the time medications and this is where you got to be a little more proactive if you're on regular medications you're older you have high blood pressure thyroid diabetes whatever call your doctor plan to have a couple weeks of that right all the time you should have this and and have that available have shelf stable foods right shelf stable foods not foods that are going to expire that need to be refrigerated because let's say for some reason there's a power outage because there's a windstorm not even from covid19 because covid19 doesn't

call power outages you want something that's shelf stable canned meats canned because there's a windstorm, not even from COVID-19 because COVID-19 doesn't call it power outages. You want something that's shelf stable. Canned meats, canned foods. There's actually like noodles you can get that are shelf stable that you can just eat right out of there. Do we like nice microwaved warm noodles? Yes, but get things that last quite some time. Now, when you look at these foods, if you have health issues, particularly high blood pressure or something else, they have a lot of salt in them or they can. So continue to take your medications that you're supposed to, right, and look for shell-stable food that fits the diet that you should have. And there's tons of choices out there. If you're older, limit close contact, right, other than to your family.

And there's a thing in diseases and outbreaks and investigations. And we look at who's sick, what about their family, what about their friends? And it's these circles that go from real small to bigger and bigger. So limit your close contact with other folks outside of your house, right? Avoid crowds. Consider a food delivery service. Consider now is the time to reach out to your neighbors and ask for help. If you are someone that's able-bodied, that's younger, that is not at risk, you reach out and see if you can help your neighbors. That's what helps get us all through this. But to that, you could consider food delivery. There's tons of food delivery services, and now they are probably hopping with business.

For sure, avoid cruises if you've watched the news ever whether there's COVID-19 or something else you constantly hear about disease sickness something on a cruise I'm not disparaging the cruise industry but don't go on a cruise right now if you're older you're at risk that is close contact in a box on the ocean so don't do that stay home right if there's an outbreak in your area, if there's COVID-19 cases in your area, like in your town, then for sure stay at home and then, you know, do the other things we talked about. Keep washing your hands, pay attention to the news without it kind of freaking you out, take a break from it. And then, you know, get food delivery.

If you have chronic medical issues, you're also at risk. So heart disease, diabetes, lung disease, your immune system's already fighting. Take the same precautions I just mentioned. Stay away from crowds. Limit your exposure. If you start feeling bad, call your physician. I wouldn't rush to the emergency room. Again, rushing to the emergency room at a time like this is going to continue to overwhelm the healthcare system that's already probably starting to get hammered by everybody that thinks they have COVID-19. So really, you know, also don't wait if you're feeling, you know, you have just super horrible, you're having trouble breathing for something you would normally call or go to the ER for, go. If you are sick, like you have a cold, don't rush to the ER, right? Call your

primary care physician or the urgent care type places near you. So what's happening in the United States, and this is data as of the 13th, right? So a couple of days ago, you get data's coming in. There's always a bit of a lag. There's variation between what the WHO has, what the CDC has, what the news says. I just pulled this from the CDC's website like two hours ago. Okay, and it's March 15th, 2020. There are 1,629 cases in the United States. There have been 41 deaths reported through 47 jurisdictions, and those jurisdictions include 46 states and the District of Columbia.

On the news right before I started this taping, recording, because I'm not using tape, I heard there were 49 states. But again, that's part of the variability. That's part of the information management, right? Who knows what their source is? Again, I pulled this directly from the CDC situation update for the US. That's the source. That should be everyone's source. How did folks get this? So 138 of those were exposed through travel, right? Out of 1,000, 629. 129 were exposed through close contact, right?

So I may have been at work or the grocery store, probably not the grocery store, but somewhere where I'm close to somebody, right? Doing an activity where we're close together. That's how they got that. And 1,362 are still under investigation. So why so many still under investigation? So I talked about in the history of the CDC, the ESI, local health departments, epidemiologists, nurses, emergency folks, doctors, it takes time. Think of an investigation for disease exposure or when you actually get it like a murder investigation, right? You have to go ask questions of the person that was involved. So in this case, the person that's sick. Then you talk, you get their history. Where have you been?

What have you done? Travel. Again, travel history is a huge one in this screening, right? Then what about family and friends? Where have they gone? And on down the line, and you try and piece together the puzzle of this disease, right? So instead of solving a murder, you're solving where did this thing you can't see, this disease, this whatever you're exposed to, where did it come from? How do we stop it? Is someone still carrying out there? And so again, COVID-19, this is happening everywhere constantly. As of right now, there's 29 cases in Virginia reported, right? So from our Virginians, that's the latest from the CDC. That's the update.

By the time this comes out, that will probably be out of date. And, again, I just urge everyone, go to the CDC's website, get your information from there. In Virginia in particular, they have a pretty good website. They also point back to the CDC's website. Get your information from there. In Virginia in particular, they have a pretty good website. They also point back to the CDC, right? That's the guiding organization for what's happening right now in COVID-19. That's it. So what? All right.

So what we care about COVID-19. So the history is kind of cool. So it's neat to learn about how, I think and I hope comforting that for decades, the United States in particular has prepared for things like this. It is why, yes, those are some significant numbers, but compared to other countries, not near as high, right? I don't know if they'll get as high, but we are very, very well prepared. So what is it? Outbreaks are not new in the United States and certainly not new for the great men and women of local, state, and federal public health. Every day, diseases are investigated. Refugees are given a chance at a new life and screen for disease. Families that may otherwise not get their prenatal vitamins or formula are fed and provided nutrition. Every single year, free flu vaccination

clinics allow public health and their partners to exercise point of dispensing operations. If your health department advertises free flu shots, go one from them that is how you as a citizen as a listener and if you're not in America listening to this see if wherever you live does this too that's how you let those folks practice what we are doing right now for COVID-19 the more people that go to their health department when they have these uh mass vaccination clinics the better prepared they will be if they get more volume they have to practice and adjust the most we ever gave was 11 or 1200 in one day we were hopping all day it gave us the best

practice we could ask for and we were all exhausted and we thank the public for that plus that many more people got shots, right? So health departments do annual flu vaccination clinics. Go get one. I'm not getting into the vaccination debate. I'm saying if you want to help the public health system get better prepared, that's a great way to do it. Learn more about your public health department, right? It's not as sexy as driving down a vehicle going, woo, woo, woo. It's not tactical pants. But they are the underpinning of why we're not all walking around with disease, why malaria was stopped in the southern United States, how we got polio vaccinations,

how we greatly reduced exposure to insecticides that we used to drive through neighborhoods spraying around. What makes America healthier, and I'm not going to get into the obesity debate, but from a disease perspective, is strong public health. So trust in the people whose whole job day in and day out is to find the invisible threat, determine who may have been exposed, provide guidance on how to stop the threat, and establish screening and testing centers and stop the outbreak. That's all public health does. Let them do it. We will all get through COVID-19 through sensible measures like hand washing, staying home if you're sick, exercising and eating healthy, and by continuing to do what we would do every day to be as healthy as we can for ourselves and for those at risk. Thank you all very much for listening.

I hope this was helpful. I wish all of us the best. Trust in your public health system. Trust in yourselves. Stay healthy. And Godspeed.