2009 Flu Summit: Community Mitigation Measures


Uploaded by USGOVHHS on 21.07.2009

Transcript:
[MARTY CETRON] OKAY, WELCOME TO THE SESSION ON COMMUNITY MITIGATION.
MY NAME IS MARTY CETRON.
I AM THE DIRECTOR FOR GLOBAL MIGRATION AND QUARANTINE
AT CDC, AND WE ARE ON A TIGHT TIMELINE SO I AM GOING
TO KEEP MY REMARKS TO A MINIMUM.
I THINK YOU HEARD A LOT THIS MORNING ABOUT THE LAY OF
THE LAND, ABOUT THE CHALLENGE, ABOUT FACING THE UNCERTAINTY
ABOUT HAVING PREPARED FOR A MORE SEVER PANDEMIC AND THEN
HAVING TO ADJUST AND PIVOT TO THE PANDEMIC THAT WE
ACTUALLY SAW IN THE SPRING.
AND I THINK THIS IS AN IMPORTANT THEME.
I DID WANT TO COMMENT ABOUT THE FIRST SLIDE THAT
DR. FRIEDEN [PHONETIC SP] HAD THIS MORNING WHICH WAS
HIGHLIGHTING THE GOALS.
AND THIS SLIDE CAME FROM A POSTER THAT WAS UP
IN THE EMERGENCY RESPONSE ROOM AT CDC THAT ADMIRAL RED REMINDED
US EVERY DAY AS WE CAME IN THERE THAT OUR JOB WAS TO PREVENT
MORBIDITY AND MORTALITY, AND SECOND WAS TO MINIMIZE
SOCIAL DISRUPTION.
AND THAT THESE WERE REALLY IMPORTANT PRINCIPALS THAT
WE WERE KEEPING IN MIND.
AND, OF COURSE, THE CHALLENGE OF THE COMMUNITY MITIGATION
MEASURES IN GENERAL IS TO FIGURE OUT THE RIGHT WAY
TO BALANCE THE TENSION THAT'S REFLECTED BY THOSE TWO VERY,
VERY CRITICAL AMBITIONS.
IN PART, IT WAS THE DEVELOPMENT OF A SEVERITY ASSESSMENT TOOL
THAT ALLOWED THE BEGINNINGS OF THAT PIVOT.
AND WHEN THE INFORMATION THAT WE WERE GLEANING, AS WE GLEAN
MORE INFORMATION ABOUT THE PANDEMIC, NOT JUST BASED
ON THE EXPERIENCE IN MEXICO THAT WAS INITIALLY REPORTED,
BUT AS WE EXPERIENCED THE EPIDEMIC IN OUR OWN COUNTRY
WE WERE ABLE TO ADJUST AND MAKE THAT PIVOT CHANGE AND MOVE AWAY
FROM RECOMMENDATIONS AROUND SCHOOL DISMISSALS
TO RECOMMENDATIONS THAT FOCUSED ON EXCLUDING THE SICK.
NONETHELESS, IT STILL REPRESENTS A REMARKABLE CHALLENGE BECAUSE,
AS YOU HEARD, THE PANDEMIC ITSELF HAS VERY HIGH
ATTACK RATES IN SCHOOL AGE CHILDREN AND DISPROPORTIONATE
HOSPITALIZATIONS AND DEATH IN YOUNGER AGE GROUPS.
AND SO THE SETTING OF HOW TO MAKE SURE THAT WE PROTECT
THOSE MOST VULNERABLE WHILE MINIMALLY DISRUPTING OUR
SOCIAL INSTITUTIONS AND MINIMIZING ABSENTEEISM
IS A TENSION THAT WE EXPERIENCED VERY MUCH SO IN THE SPRING.
THAT WAS THE SOURCE OF GREAT DEBATE AND DISCUSSION AS
THE PANDEMIC PREPARING WAS GOING ON BETWEEN 2005 AND 2009.
AND WHAT I WOULD LIKE TO DO WITH THIS PANEL THIS MORNING IS
TO ACTUALLY GIVE THE LOCAL FLAVOR AND EXPERIENCE WITH
A DISTINGUISHED PANEL OF FOLKS THAT WERE ON THE FRONT LINE
AT THE LOCAL, STATE AND VARIOUS LEVELS TO SHARE WITH YOU
VIGNETTES OF WHAT COMMUNITY MITIGATION LOOKED LIKE IN
THE SPRING, WHAT CHALLENGES WE ARE LIKELY TO FACE.
I THINK THIS IS A BALANCE, A DELICATE BALANCE BETWEEN
THE PROTECTION GOALS AND THE MINIMIZING DISRUPTION GOALS
WITH THE ULTIMATE HOPE OF BUILDING RESILIENT COMMUNITIES
THAT ARE ABLE TO WORK TOGETHER ACROSS MANY SECTORS,
BOTH HORIZONTALLY ACROSS SECTORS AND VERTICALLY ALONG THE LINES
FROM THE FEDERAL, STATE AND LOCAL AND TRIBAL LEVELS.
AND WEAVING THAT FABRIC OF PROTECTION, THAT SORT OF QUILT
ACROSS ALL THESE LAYERS, IS WHAT CHALLENGE THAT WE FACE
AS WE LOOK TO THE FALL.
WE ALSO HAVE TO REALIZE THAT THERE IS UNCERTAINTY BECAUSE
THIS VIRUS HAS A GREAT CAPABILITY OF THROWING
CURVE BALLS AND BECOMING SOMETHING OTHER THAN IT WAS
IN THE FALL, IN THE SPRING.
IN THAT SETTING WE HAVE BOTH THE OPPORTUNITY TO DEVELOP
A PLANNING SCENARIO THAT REPRESENTS THE MOST PROBABLY
SCENARIO PERHAPS, THE EXPERIENCE THAT WE SAW.
BUT ALSO BE READY TO RESPOND TO NEW INFORMATION
AS CAPTAIN RED HIGHLIGHTED.
SO WITH THAT I AM GOING TO INTRODUCE THE PANEL.
EACH OF THEM WILL PROVIDE ABOUT FIVE MINUTES OF REMARKS AND
THEN WE WILL MOVE ON TO SOME GENERAL QUESTIONS.
AND OUR GOAL IS TO BE OUT OF THIS ROOM AND BACK INTO
THE GENERAL PLENARY ON RISK COMMUNICATION BY 2:45.
SO TO START OFF WE HAVE BRIAN SMITH.
I WON'T READ THE BIO IN THE INTEREST OF BREVITY.
IT'S INSIDE YOUR PACKET AND FOLDER.
BUT BRIAN IS GOING TO SHARE WITH US THE EXPERIENCE FROM
A BORDER REGION IN TEXAS WHERE SOME OF THESE FIRST CASES WERE
REPORTED, BRIAN.
[BRIAN SMITH] THE DEEP SOUTH TEXAS REGION IS COMPOSED OF ABOUT 2 MILLION
PEOPLE IN THE TRIANGLE BETWEEN CORPUS CHRISTI, BROWNSVILLE
AND LAREDO.
IT HAS BEEN ONE OF THE HARDEST HIT AREAS OF THE COUNTRY WITH
THE HIGHEST INCIDENCE RATES.
WE HAVE HAD 1,700 CONFIRMED CASES AND EIGHT DEATHS
INCLUDING THE FIRST U.S. DEATH.
AND UNTIL THIS WEEK, 60 PERCENT OF ALL THE TEXAS CASES WERE
REPORTED FROM REGION 11, WHICH IS THE SOUTH TEXAS REGION,
BUT IT HAS ONLY 10 PERCENT OF THE POPULATION.
ALSO 42 PERCENT OF ALL OF OUR SPECIMENS TESTED WERE POSITIVE
FOR H1N1 AND THAT IS HIGHER THAN THE REST OF THE STATES,
SO IT DOES NOT LOOK LIKE IT WAS FROM INCREASED TESTING.
IT LOOKS LIKE THE NUMBERS WERE HIGH DUE TO SIGNIFICANT EARLY
INTRODUCTION OF THE VIRUS DUE TO THE PROXIMITY TO MEXICO
AND ALSO A YOUNGER MEDIAN AGE, A YOUNG POPULATION, EVEN THOUGH
THE NEIGHBORING STATES OF TAMAULIPAS AND [UNINTELLIGIBLE]
LEON [PHONETIC SP] NEVER REPORTED THE NUMBERS SEEN
IN MEXICO, BUT WE STILL HAD SIGNIFICANT INTERCHANGE
OF POPULATIONS.
AS SOON AS THE SWINE FLU WAS REPORTED IN THE U.S. FROM
THE CASES IN SAN ANTONIA AND THE EPIDEMIC IN MEXICO WERE
REPORTED IT BECAME VERY APPARENT THAT LOCAL PHYSICIANS
IN BROWNSVILLE AND RIO GRANDE CITY IN PARTICULAR WERE ALREADY
SEEING NUMBERS OF CASES.
SO WE THINK IT HIT THERE VERY EARLY.
AS SOON AS TWO STUDENTS NEAR SAN ANTONIO THAT WERE REPORTED
THIS MORNING, THE DIRECTOR FOR THAT REGION AND THE TEXAS
COMMISSIONER FOR HEALTH DEVELOPED PROTOCOLS.
THEY HAD A PRESS CONFERENCE AND CLOSED THAT FIRST SCHOOL
AND THEN VERY QUICKLY LED TO THE CLOSURE OF THE FIRST
SCHOOL DISTRICT IN TEXAS.
AND THIS PRECEDENT GAVE US SOME PROTOCOLS TO FOLLOW FOR SCHOOL
CLOSURES WHICH WERE WHAT WE FOLLOWED.
THEN AS THE STATE LAB IDENTIFIED PROBABLY H1N1 CASES
IN CORPUS CHRISTI, BROWNSVILLE AND SEVERAL SMALLER TOWNS,
SCHOOLS WERE CLOSED.
IF WE HAD ONE PROBABLE CASE AT A SCHOOL, WE CLOSED
ENTIRE RURAL OR SMALLER HEALTH DISTRICTS, OR SCHOOL DISTRICTS
IF THEY HAD TWO SCHOOLS THAT WERE INVOLVED.
AND EVENTUALLY DOZENS OF SCHOOL DISTRICTS WERE CLOSED.
WE HAD INTENSE POLITICAL PRESSURE BOTH TO CLOSE
THE SCHOOLS AND TO KEEP THE SCHOOLS OPEN BECAUSE IT WAS
DURING THE TESTING WEEK, THE TAX TEST IN TEXAS.
AND THERE WAS FEAR OF LOSING SCHOOL INCOME EVEN THOUGH
THE TEXAS EDUCATION ASSOCIATING, THE TEA HAD ALREADY GIVEN THEM
A WAIVER AND SAID THERE WAS NOT A PROBLEM.
BUT IT WAS A VERY, VERY TIGHT BALANCE THAT REQUIRED PUBLIC
HEALTH TO BE OPEN AND LOGICAL AND IN VERY CLOSE COMMUNICATION
WITH THE SCHOOL DISTRICTS AS WELL AS THE ELECTED OFFICIALS.
WE ALSO FOUND THAT SEVEN DAYS WAS THE MAXIMUM THAT SCHOOLS
COULD ACCEPT.
THEY JUST COULD NOT GO WITH THE 10 TO 14 DAYS.
SCHOOLS THAT DID NOT HAVE CONFIRMED CASES REPORTED
THEIR DAILY ABSENTEE RATES TO PUBLIC HEALTH.
SO WE TRACKED THOSE DAILY ABSENTEE RATES.
AND THEN WE HELD CONFERENCE CALLS; WE HAD TO INCLUDE
THE COUNTY JUDGES, KEY MAYORS, THE SUPERINTENDENTS AND PUBLIC
HEALTH TO DISCUSS THE NUMBERS OF INFLUENZA-LIKE ILLNESS
THAT THEY WERE SEEING.
AND SO WE LOOKED AT WHAT THE NURSES WERE SEEING, WE LOOKED
AT ABSENTEEISM RATES AND SO IF WE SAW THAT THERE WAS
AN INCREASE -- NORMALLY THEY RUN ABOUT THREE TO FIVE PERCENT
ABSENTEEISM RATES -- IF THEY SUDDENLY GO UP TO 10 PERCENT,
ONE AREA USED 12 PERCENT, BUT IF YOU SAW A SUDDEN INCREASE
THEN WE'RE CONCERNED ABOUT AN INCREASE IN INFLUENZA-LIKE
ILLNESS, AND WE WANTED TO CLOSE THOSE SCHOOLS EARLY INSTEAD
OF WAITING UNTIL THE TYPICAL 25 PERCENT THAT SCHOOLS USE FOR --
MAINLY FOR OPERATIONAL REASONS DURING THE REGULAR
SCHOOL SEASON.
SCHOOLS ALSO POSTED WATCHERS AT THE DOORS TO MAKE SURE THAT NO
CHILDREN WHO HAD OBVIOUS INFLUENZA-LIKE ILLNESS CAME IN.
AND THEN THE SCHOOL NURSES WERE VERY ASSERTIVE ABOUT SENDING
HOME SICK CHILDREN.
WHAT WE FOUND OUT WAS THAT MANY OF THE SUPERINTENDANTS THOUGHT
THE STUDENTS WOULD BE BETTER PROTECTED BY THIS KIND OF A
WATCHER SYSTEM AT THE DOOR THAN THEY WOULD BE BY CONGREGATING
IN THE MALL.
BUT I THINK YOU CAN ALSO SURMISE THAT IT'S PROBABLY
GOING TO BE THE OLDER STUDENTS NOT THE YOUNGER STUDENTS WHO
ARE MORE LIKELY TO BE SPREADERS THAT ARE GOING TO BE AT THE
MALL.
AMONG THE BORDER CITIES, LAREDO CLOSED THEIR SCHOOLS
VERY EARLY, PRIOR TO SEEING ANY CONFIRMED CASES, AND THEY
CLOSED A BIT LONGER.
ANECDOTALLY THEIR RATES HAVE BEEN LOWER WITH 50 CONFIRMED
CASES OUT OF 200,000 OR CRUDE RATE OF 20.4.
HIDALGO COUNTY, WHICH HAS A POPULATION OF 800,000, HAD A
LATER ON SET OF CONFIRMED CASES SO THEY DIDN'T REALLY HAVE
CONFIRMED CASES UNTIL AFTER THE CDC HAD CHANGED THEIR
GUIDELINES FOR SCHOOL CLOSURES.
BUT THEY ALSO SUSTAINED THE HIGHEST NUMBERS AND THEY ENDED
UP WITH OVER 1,100 CASES FOR AN INCIDENT RATE OF 137 WHICH IS
HIGHER THAN ANY OTHER, OR ANY STATE.
AND THEY ALSO HAD MORE CASES THAN HOUSTON OR DALLAS OR ANY
OTHER PART OF TEXAS.
THE FIRST SCHOOL CLOSURE THAT WE DID IN SOUTH TEXAS -- AND WE
CALL SAN ANTONIO UP NORTH -- BUT SOUTH TEXAS AND IT MAY HAVE
ALSO BEEN AFFECTED BY VERY AGGRESSIVE TAMIFLU TREATMENT IN
TENT CLINICS BY SOME OF THE PRIVATE PHYSICIANS WAS IN THE
CITY OF 50,000 CALLED RIO GRANDE CITY.
AND THEY HAD SOME OF THE VERY FIRST CASES AND SOME OF THE
HIGHEST RATES OF INFLUENZA-LIKE ILLNESS THAT, JUST THOSE FIRST
FEW DAYS BUT WE CLOSED THE SCHOOLS THERE VERY QUICKLY.
AND THEY ENDED UP WITH AN INCIDENCE RATE OF ABOUT 80 PER
100,000; THEN BROWNSVILLE OR CAMERON COUNTY, ALSO HAD A VERY
EARLY ONSET OF CASES.
WE CLOSED A NUMBER OF SCHOOL DISTRICTS THERE.
BUT AT THE VERY HEIGHT OF THE APPARENT SPREAD IS WHEN WE
CLOSED THOSE SCHOOL DISTRICTS.
WE TRACKED THEM VERY CAREFULLY AND THEY ENDED UP WITH A CRUDE
RATE OF 88 PER 100,000, SO SOMEWHAT INTERMEDIATE BETWEEN
HIDALGO AND LAREDO.
THE KEY POINT THAT WE FOUND IS THAT UNILATERAL ATTEMPTS, WHICH
WE HAD BY CERTAIN ELECTED OFFICIALS, BUT THESE WERE NOT
EFFECTIVE WITHOUT CONSENSUS.
ONLY A COORDINATED APPROACH ACHIEVED CLOSURE OF A SCHOOL.
AND WE ALSO FOUND THAT THE RAPPORT AND THE RESPECT BETWEEN
PUBLIC HEALTH IN THE SCHOOLS WAS VERY DRAMATIC WHEN THEY
NEEDED EACH OTHER.
WE REALLY HELPED EACH OTHER OUT, AND WE REALLY GAINED A LOT
OF RAPPORT AND A GOOD WORKING RELATIONSHIP.
THE TEA WAS VERY SUPPORTIVE, HAD A WAIVER REGARDING ITS
ATTENDANCE, BUT THE SUPERINTENDANTS ALSO WANTED
LETTERS FROM PUBLIC HEALTH SO THAT THEY WERE COVERED.
THERE WERE WRITTEN GUIDELINES ON THE TEXAS EDUCATION
ASSOCIATION WEB SITE, BUT THEY WEREN'T QUITE FAST ENOUGH FOR
EVERY SCHOOL DISTRICT AND SOME OF THE SUPERINTENDANTS WERE NOT
BIG INTERNET USERS.
OUR GREATEST DIFFICULTY WAS CHILDCARE.
THE FAMILY PROTECTIVE SERVICES SENT GUIDELINES TO ALL THE
REGULATED DAYCARES, BUT PUBLIC HEALTH HAD TO EMPHASIZE SCHOOL
DISTRICTS JUST BECAUSE WE -- THERE WAS NO WAY TO GET TO ALL
OF THE CHILDCARE AND PUBLIC GROUPS THAT COULD BE DEALT
WITH.
AND RIGHT AFTER WE CLOSED SCHOOLS, DAYCARES PICKED UP NEW
STUDENTS, THE MALLS WERE REPORTED TO BE FULL, THE
UNIVERSITY CLASSES REPORTED CHILDREN COMING TO CLASSES WITH
THEIR PARENTS AND THE GOOD NEWS WAS THAT STUDENTS WERE REPORTED
TO BE OUTDOORS PLAYING FOOTBALL.
THAT WAS THE GOOD NEWS.
UNIVERSITIES WERE MUCH MORE DIFFICULT TO DEAL WITH.
THEY WERE WORRIED ABOUT FINAL EXAMS.
WE ALSO HAD DIFFICULTY IN THE WORK PLACE WHERE A LACK OF
INSURANCE AND A FEAR OF JOB LOSS OR LOST INCOME PRESSURED
WORKERS TO COME WHEN THEY WERE ILL.
AND EVEN IN OUR OWN OFFICES WE HAD COUP THREATS BECAUSE
SIGNIFICANT NUMBERS -- AS MUCH AS ONE-THIRD OF ONE OF OUR
OFFICES WAS OUT WITH INFLUENZA-LIKE ILLNESS SO IT
WAS A VERY REAL ISSUE EVEN WITHIN OUR OWN AGENCY.
WE JUST HAD TO CONSIDER EACH OFFICE ON A CASE BY CASE BASIS
AND WE ULTIMATELY WENT WITH JUST THE PROCEDURES FOR
EXCLUDING SICK WORKERS.
THANK YOU.
[MARTY CETRON] THANKS, BRIAN.
OUR NEXT SPEAKER IS JULIE MORITA, AND JULIE
IS GOING TO SHARE WITH US SOME PERSPECTIVE FROM THE CHICAGO
DEPARTMENT OF HEALTH.
[JULIE MORITA] GOOD AFTERNOON.
WHAT I CAN DO IS JUST SET A LITTLE CONTEXT FOR YOU ALL.
CHICAGO HAS A POPULATION OF ABOUT 2.6 MILLION.
AND IN TERMS OF THE H1N1 OUTBREAK, WE WERE AMONG
THE EARLIER PLACES TO IDENTIFY CASES OR TO CONFIRM CASES AND
THAT INFLUENCED OUR ACTIONS IN TERMS OF SCHOOL CLOSURE
OR COMMUNITY MITIGATION.
SO BECAUSE WE DETECTED CASES RELATIVELY EARLY AND WE HAD
FAIRLY EARLY EVIDENCE OF COMMUNITY TRANSMISSION,
OUR DECISIONS AND WHAT WE DID WERE -- MAY HAVE BEEN AHEAD
WHAT OTHER PLACES HAD DONE AND ACTUALLY MAY HAVE BEEN AHEAD
OF WHAT CDC GUIDANCE HAD BEEN.
SO WE WERE IN A LITTLE BIT AWKWARD POSITION.
WHEN OUR VERY FIRST -- WE CLOSED A TOTAL OF TWO SCHOOLS,
SO IN SOME WAYS I THINK WE ARE THE CONTROL COMMUNITY TO MANY
OF THE OTHER PLACES WHICH CLOSED MANY MORE SCHOOLS.
WE CLOSED OUR VERY FIRST SCHOOL THE LAST WEEK IN APRIL BECAUSE
OUR FIRST STUDENT WAS CONFIRMED AS H1N1.
THAT SCHOOL WAS CLOSED FOR A TOTAL OF NINE DAYS.
AT THAT SAME PERIOD OF TIME WAS WHEN MORE INFORMATION BECAME
AVAILABLE REGARDING THE SEVERITY OF ILLNESS AND VIRULENCE
OF THE VIRUS.
AND SO WE -- AND CDC RECOMMENDATIONS CHANGED
TO SWITCH OVER TO MORE OF A SCHOOL EXCLUSION RECOMMENDATION
VERSUS A SCHOOL CLOSURE RECOMMENDATION.
AND WE FOLLOWED THAT RECOMMENDATION BASED
ON WHAT WE KNEW, UNDERSTOOD FROM WHAT CDC WAS DESCRIBING IN TERMS
OF THE VIRULENCE BUT ALSO SEVERAL OTHER FACTORS.
I THINK BASED ON OUR EXPERIENCE WITH THE ONE SCHOOL CLOSURE WE
FELT LIKE THERE WAS A HUGE IMPACT, POTENTIAL IMPACT,
ON THE SCHOOL, THE STUDENTS AND THE SCHOOL IN TERMS
OF EDUCATION, BURDEN UPON PARENTS IN TERMS OF LOST WORK.
WE ALSO HAD A HIGH CONCERN ABOUT MEAL ACCESSIBILITY
FOR THESE STUDENTS BECAUSE IN THE CHICAGO PUBLIC SCHOOL
SYSTEM THERE WERE ABOUT 80 TO 84 PERCENT OF OUR CHILDREN RECEIVE
OR ARE ELIGIBLE FOR FREE OR REDUCED MEALS.
AND SO BY CLOSURE OF SCHOOLS WE KNEW THAT WE WOULD BE
WITHHOLDING FOOD AVAILABILITY TO SOME OF THESE STUDENTS
AND WERE CONCERNED ABOUT THAT.
WE ALSO HAD A LOT OF PUSHBACK FROM THE PRINCIPAL AND FROM
THE SCHOOL SYSTEM REGARDING CLOSURE OF SCHOOL FOR PROLONGED
PERIODS OF TIME BECAUSE OF CONCERN REGARDING FUNDING
AND ALSO PRINCIPAL PERFORMANCE.
ONE OF THE FACTORS THAT PRINCIPALS ARE EVALUATED
IN THE CHICAGO PUBLIC SCHOOL SYSTEM IS BASED ON ATTENDANCE
OR ABSENTEEISM RATES IN THEIR SCHOOL.
AND SOME PRINCIPALS THEMSELVES WERE RELUCTANT TO ACTUALLY
CLOSE A SCHOOL BECAUSE THEY FELT THAT MIGHT REFLECT
POORLY ON THEIR PERFORMANCE.
AND THEN FUNDING, WHICH MANY PEOPLE HAVE BROUGHT UP
PREVIOUSLY, WAS AN ISSUE FOR THE SCHOOL SO THAT WE DIDN'T
GET A WAIVER BECAUSE OUR KIDS WERE EXCLUDED FROM SCHOOL THAT
THEY WOULDN'T NECESSARILY, THE SCHOOLS WOULDN'T
NECESSARILY RECEIVE THE FUNDING THAT THEY WERE ALLOWED TO OR
SHOULD HAVE GOTTEN.
AND SO THOSE KINDS OF ISSUES CAME UP.
SO WE SWITCHED INTO A MODE OF ACTUALLY REALLY PUSHING AND
TRYING TO HAVE THE SCHOOLS ENFORCE A SEVEN-DAY EXCLUSION
POLICY, SO SAYING THAT IF CHILDREN CAME TO SCHOOL
WITH A FEVER AND COUGH OR OTHER RESPIRATORY SYMPTOMS THAT THEY
WERE KEPT OUT OF SCHOOL FOR A MINIMUM OF SEVEN DAYS AND YOUNG
CHILDREN FOR LONGER BECAUSE THERE WAS A CONCERN THAT
THEY MIGHT TRANSMIT THE VIRUS MORE FOR A PROLONGED PERIOD
OF TIME.
SO WE ENCOURAGED THE SCHOOL SYSTEMS TO USE THAT KIND
OF A POLICY.
THE CHICAGO PUBLIC SCHOOL SYSTEM ACTUALLY TOOK THE INITIATIVE
AND PURCHASED A BUNCH OF TEMPERATURE THERMOMETERS
SO THAT THEY COULD MONITOR CHILDREN'S TEMPERATURE
READILY AND EASILY IF THEY CAME IN WITH RESPIRATORY SYMPTOMS
AND THEN SEND THEM HOME.
AND SO THAT WAS A SYSTEM THAT THEY HAD IN PLACE.
IN ADDITION TO THAT WE WORKED VERY CLOSELY WITH THE CHICAGO
PUBLIC SCHOOL SYSTEM BECAUSE THEY HAVE AN ELECTRONIC DATA
BASE THAT MONITORS THEIR ABSENTEEISM AND SO WE
LOOKED AT THEIR ABSENTEEISM RATES PRIOR TO THE OUTBREAK
AND ESTABLISHED SOMEWHAT OF A BASELINE FOR EACH
OF THE SCHOOLS.
AND THEN LOOKED FOR VARIATION IN ABSENTEEISM AND WHEN WE
IDENTIFIED A SCHOOL THAT HAD HIGHER RATES OF ABSENTEEISM,
NOTIFIED THE SCHOOLS AND HAD THEM ACTUALLY FOLLOW UP TO
FIND OUT WHY THESE CHILDREN WERE MISSING SCHOOL.
AND THERE WERE A VARIETY OF REASONS.
WE FOUND SOME OF THE ABSENTEEISM WAS DUE TO SENIOR SKIP DAY,
OR TO THE DAY AFTER SENIOR PROM, OR PRE-KINDERGARTEN,
OR KINDERGARTEN ENROLLMENT DAYS.
AND SO WE WERE ABLE TO ELIMINATE SOME OF THE SCHOOLS FROM BEING
CONCERNED ABOUT AND YET IDENTIFY SOME SCHOOLS THAT HAD A HIGH
PROPORTION OF ABSENTEEISM THAT WAS DUE TO FEVER AND COUGH OR
RESPIRATORY ILLNESS.
AND THEN WHEN WE HAD THOSE SCHOOLS IDENTIFIED WE DIDN'T --
WE DECIDED WE WEREN'T GOING TO CLOSE SCHOOLS.
IF OUR GOAL WAS ULTIMATELY TO PREVENT MORTALITY OR SEVERE
DISEASE, OUR NEXT STEP WAS TO SEND A LETTER HOME TO ALL THE
STUDENTS INFORMING THEM ABOUT A LOT OF RESPIRATORY ILLNESS
IN THE SCHOOL AND THAT THE PARENTS SHOULD BE AWARE
OF THAT AND THAT THERE WAS CIRCULATION, FAIRLY WIDESPREAD
CIRCULATION OF H1N1 IN THE COMMUNITY SO THERE WAS
A RISK THAT THIS COULD BE DUE TO H1N1.
AND THAT PEOPLE WHO HAD CERTAIN UNDERLYING CONDITIONS, AND WE
PROVIDED A LIST OF HIGH RISK CONDITIONS, IF THEIR CHILDREN
HAD ANY OF THOSE CONDITIONS THEY SHOULD TALK TO THEIR
PHYSICIANS ABOUT WHETHER OR NOT THE CHILD HIMSELF OR HERSELF
SHOULD BE EXCLUDED FROM SCHOOL OR WHETHER THEY SHOULD BE
ON TAMIFLU PROPHYLACTICALLY.
OUR FEELING WAS THAT, THE PHYSICIAN, IF WE GIVE
THIS LAUNDRY LIST OF DISEASES THAT INCLUDED ASTHMA TO SEVERE
IMMUNO-COMPROMISE THE MILD ASTHMATIC MIGHT NOT NEED TO
STAY HOME FROM SCHOOL OR MIGHT NOT NEED TO BE ON TAMIFLU.
HOWEVER, THE CHILD WHO HAS A CD4 COUNT THAT IS VERY LOW
WHO WOULD BE SEVERELY IMMUNO-COMPROMISED MIGHT
BENEFIT FROM STAYING AT HOME.
BUT THE ONLY PERSON -- OR THE BEST PERSON TO MAKE
THAT DECISION WAS NOT PUBLIC HEALTH BUT REALLY
THE PHYSICIAN THAT TAKES CARE OF THE CHILD.
AND SO OUR INTERVENTION REALLY SHIFTED FROM THE SCHOOL CLOSURE
TO MORE OF INFORMING THE PARENTS ABOUT WHO WAS
AT RISK AND WHAT KINDS OF ACTIVITIES THAT THEY SHOULD
BE DOING TO PROTECT THEIR CHILD WHO MIGHT BE AT HIGHER RISK.
I GUESS FROM, SO FROM THE -- WHEN I THINK BACK ABOUT THIS
I THINK THAT THERE WERE SOME BARRIERS FOR IMPLEMENTING BOTH
THE SCHOOL CLOSURE POLICY AND ALSO THE SEVEN DAY EXCLUSION.
BECAUSE EVEN WITH JUST THE SEVEN-DAY EXCLUSION POLICY
WE HEARD A LOT OF PARENTS SAYING, "WELL HOW AM I GOING
TO PROVIDE FOR MY CHILD WHEN FOR SEVEN WHOLE DAYS I CAN'T AFFORD
TO TAKE OFF THAT AMOUNT OF TIME."
SO EVEN WITH JUST SEVEN DAYS FOR THE INDIVIDUAL STUDENT
VERSUS THE ENTIRE SCHOOL WE WERE GETTING PUSHBACK
FROM PARENTS.
AND, AGAIN, THE PRINCIPAL PERFORMANCE WAS ANOTHER ISSUE.
THEY WERE RELUCTANT TO EXCLUDE INDIVIDUAL STUDENTS AND THEY
WERE ALSO RELUCTANT TO HAVE POOR ABSENTEEISM RATES FOR
FUNDING PURPOSES AND FOR PERFORMANCE ISSUES.
SO THOSE WERE BARRIERS TO ACTUALLY FULLY IMPLEMENTING
THESE KINDS OF INTERVENTIONS.
AND THEN I GUESS IN TERMS OF THINGS OR SUGGESTIONS THAT I
WOULD SAY FOR THINGS THAT COULD BE DONE FOR THIS COMING FALL AS
WE ARE LOOKING FORWARD TO THIS FALL IS THAT IT WOULD BE HELPFUL
TO HAVE SOME MORE SPECIFIC CRITERIA FOR WHEN YOU
WOULD CLOSE A SCHOOL.
I MEAN, I THINK SECRETARY DUNCAN MENTIONED EARLIER
TODAY THAT IF WE -- THE DECISION TO CLOSE A SCHOOL SHOULD BE
MADE AT A SCHOOL BY SCHOOL BASIS OR AT A LOCAL BASIS,
ON A LOCAL BASIS.
AND I THINK THAT HAVING SOME SPECIFIC CRITERIA OR GUIDANCE
WOULD BE HELPFUL TO KNOW WHEN THOSE CIRCUMSTANCES ARISE.
I SHOULD STEP BACK A LITTLE BIT BECAUSE WE DID CLOSE A SECOND
SCHOOL WELL INTO THE OUTBREAK.
AND THAT SCHOOL WAS A LITTLE BIT DIFFERENT AND THE REASON
WE DECIDED TO CLOSE THAT SCHOOL WAS BECAUSE WE HAD --
IT WAS A HIGH SCHOOL THAT HAD 100 PERCENT OF THEIR STUDENTS
WERE SPECIAL EDUCATION STUDENTS.
AND 100 PERCENT OF THEM HAD CHRONIC UNDERLYING DISEASES,
AND 50 PERCENT OF THEM HAD DOWN'S SYNDROME, AND THEY
DIDN'T HAVE A CONFIRMED CASE OF H1N1 AT THE TIME THAT WE CLOSED
THE SCHOOL.
WHAT THEY HAD WAS INCREASED ABSENTEEISM AND A HIGH
PROPORTION OF THAT WAS DUE TO FEVER AND COUGH.
AND WHEN WE HEARD THAT, WITHOUT KNOWING IF IT WAS H1N1 OR NOT
BASED ON WHAT WE KNEW WAS GOING ON IN THE COMMUNITY, WE DECIDED
TO CLOSE THAT SCHOOL.
AND LATER, AFTER WE TRACKED DOWN A LOT OF THESE KIDS WITH
FEVER AND COUGH AND ENCOURAGED THEM TO GET TESTED WE CONFIRMED
FOUR CASES OF H1N1.
AND SO WE DECIDED TO CLOSE THAT SCHOOL FOR A TOTAL OF NINE DAYS
AS WELL.
AND I THINK, TO ME, THAT WAS A SITUATION WHERE IT WAS CLEAR.
BUT I THINK THERE ARE SOME SCHOOLS THAT ARE IN THE GRAY
ZONE WHERE IT IS NOT JUST ONE CONFIRMED CASE OR NOT JUST
100 PERCENT OF KIDS WITH SEVERE UNDERLYING DISEASES.
THERE IS THIS GRAY ZONE WHERE IT WOULD BE HELPFUL TO HAVE
SOME SPECIFIC CRITERIA IN WHEN SCHOOLS SHOULD REALLY BE CLOSED.
AND THEN I THINK THE NURSE FROM THE PREPARATORY SCHOOL IN
NEW YORK CITY THIS MORNING MENTIONED HOW EVERY SCHOOL
NEEDS TO HAVE A NURSE.
AND I ACTUALLY THINK THAT IS A REALLY GOOD THING.
IN CHICAGO PUBLIC SCHOOL SYSTEM WHERE THERE ARE 600 SCHOOLS,
OVER 430,000 CHILDREN IN THESE SCHOOLS AND EACH NURSE IS
RESPONSIBLE FOR THREE OR FOUR SCHOOLS.
SO I HAVE TO SAY WE DID NOT USE THE SCHOOL NURSES -- WORK WITH
THEM ON MONITORING INFLUENZA- LIKE ILLNESS, WE WERE WORKING
WITH SECRETARIES.
WE WERE LOOKING AT THEIR ELECTRONIC DATABASE
WHICH WAS WONDERFUL TO HAVE.
AND WORKING WITH THEIR ADMINISTRATORS BUT THERE
WAS NO SCHOOL NURSE IN ALL SCHOOLS TO REALLY HELP US OUT.
AND SO I THINK ENHANCING SCHOOL NURSING CAPACITY WOULD BE
A WONDERFUL THING TO DO IF WE REALLY WANT TO PROTECT OR
DECREASE MORBIDITY AND MORTALITY AMONG SCHOOL AGE CHILDREN.
AND THEN I GUESS THE OTHER THING I WOULD LIKE TO DO IS FOR THERE
TO BE MORE CONSIDERATION OF WHAT ALTERNATIVES THERE ARE
TO SCHOOL CLOSURE.
I THINK WE ARE TALKING A LOT ABOUT SCHOOL CLOSURE,
AND I THINK THAT THERE IS A ROLE FOR SCHOOL CLOSURE, PARTICULARLY
IF DISEASES MORE SEVERE AND THE VIRUS DOES PROVE TO BE
MORE VIRULENT.
BUT I GUESS I WOULD LIKE TO SEE MORE DISCUSSION ABOUT WHAT
ALTERNATIVES THERE ARE TO SCHOOL CLOSURE AND SOME
GUIDANCE RELATED TO WHAT WE CAN DO TO MITIGATE DISEASE WITHOUT
CLOSING THE SCHOOL AND IMPAIRING EDUCATION, FOOD SERVICES,
PARENTAL WORK, ET CETERA.
SO THANK YOU.
[MARTY CETRON] THANK YOU VERY MUCH, JULIE.
OUR THIRD SPEAKER IS MARK HORTON, AND MARK IS
A STATE PUBLIC HEALTH OFFICER AND DIRECTOR FOR THE
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH.
[MARK HORTON] GREAT, THANKS A LOT, MARTY.
AND I GUESS MY FIRST COMMENT SHOULD BE YOU KNOW I CAME TO
THIS SUMMIT A LITTLE RELUCTANT, AND I AM GOING AWAY FEELING
THAT THIS WAS AN EXTREMELY VALUABLE THING.
WE HAVE LEARNED SO MUCH THIS MORNING AND JUST HAVING THAT
ALIGNMENT AND DISCUSSION BETWEEN THE VARIOUS SECRETARIES
AND STUFF HAS BEEN SUCH AN IMPORTANT MESSAGE.
I AM FEELING MUCH MORE ENCOURAGED AS WE LEAVE TODAY.
WELL, I THINK THE THEME -- WHICH I THINK OF SEBELIUS'
REMARKS THIS MORNING THAT SHOULD BE THE THEME FOR
THIS SESSION AND FOR EVERY SESSION IS THAT THIS IDEA
ABOUT "BE PREPARED TO BE SURPRISED."
THAT WE CAN COUNT ON, THAT NO MATTER HOW MUCH PLANNING WE DO
THERE ARE GOING TO BE THINGS THAT WE HAD NOT ANTICIPATED.
AND WHAT I AM GOING TO TALK ABOUT AND TRY TO EMPHASIZE
TODAY IS WHAT SYSTEMS TO WE HAVE TO HAVE IN PLACE TO BE
"BE PREPARED TO BE SURPRISED."
IN OTHER WORDS, WHAT DO WE NEED TO HAVE IN PLACE THAT WILL TAKE
US BEYOND THE THINGS WE CAN PLAN FOR AHEAD OF TIME BUT WON'T BE
ABLE TO ANTICIPATE?
I THINK IN CALIFORNIA, I KNOW YOU WILL REMEMBER THAT A COUPLE
OF THE FIRST CASES WERE OUT OF CALIFORNIA, AND THAT WAS
A SURPRISE TO US.
WHEN I THINK BACK TO THE PLANNING THAT WE DID IN
PUTTING TOGETHER OUR PANDEMIC INFLUENZA WAS BASED ON THE
AVIAN INFLUENZA MODEL AND WE WERE SO SURE -- THE ASSUMPTION
WAS IT WAS GOING TO START SOMEWHERE ELSE, AND WE WOULD
HAVE PLENTY OF TIME TO THINK ABOUT, BASED ON SOME INFORMATION
THAT WOULD ALREADY BE AVAILABLE TO US.
AND LOW AND BEHOLD HERE IT IS RIGHT IN OUR FRONT YARD RIGHT
FROM THE BEGINNING.
SO "BE PREPARED TO BE SURPRISED" AND HAVE SYSTEMS IN PLACE.
THE ONE THING I REALLY WANT TO EMPHASIZE TODAY THAT I LEARNED
DEALING THROUGH SOME OF OUR COMMUNITY MITIGATION ISSUES
AND SPECIFICALLY THE ISSUE OF SCHOOL CLOSURES IS THE VERTICAL
INTEGRATION THAT ABSOLUTELY NEEDS TO BE IN PLACE AND
THAT WE CAN WORK ON AND SOLIDIFY RIGHT NOW BEFORE WE HAVE FURTHER
CHALLENGES AS WE REACH THE FALL.
SO THE VERTICAL INTEGRATION, I CAN'T SAY ENOUGH FOR WHAT
CDC AND ASTHO AND NACCHO DID TO ENSURE THAT THERE WAS SOLID,
CONSISTENT, REGULAR AND FREQUENT COMMUNICATION
UP AND DOWN THE PUBLIC HEALTH CORE CAPACITY LEVEL.
SO WE HAD -- HOW QUICKLY, WITHIN -- LITERALLY WITHIN
DAYS WE HAD A VERY ROUTINE PROCESS OF COMMUNICATION.
WE WOULD TUNE IN TO THE CDC CALLS AT THE STATE LEVEL.
WE WOULD HAVE CALLS WITH OUR LOCAL JURISDICTIONS.
AND I CAN'T EMPHASIZE HOW IMPORTANT IT IS.
THAT IS WHAT IS CALLED "PREPARED FOR SURPRISES,"
BECAUSE THAT IS THE COMMUNICATION SYSTEMS
THAT NEEDS TO BE HIGHLY GREASED, HIGHLY EFFECTIVE, THE RIGHT
PEOPLE ON THE PHONE, AND I JUST CAN'T EMPHASIZE THE IMPORTANCE
OF ENSURING THAT WE SUPPORT THAT KIND OF VERTICAL INTEGRATION,
PARTICULARLY THE PUBLIC HEALTH CORE COMPONENTS HERE THAT WILL
BE THE BRAIN TRUST THAT TELLS US WHAT ARE THE STEPS WE NEED TO
TAKE TO BEST MITIGATE.
WHAT ARE THE COMMUNITY MEASURES THAT NEED TO HAPPEN?
SO AND ONCE AGAIN I WANT TO TOUT THE ORGANIZATIONS THAT
WE BELONG TO.
SOMETIMES WE WONDER YOU KNOW, WHAT ARE THEY REALLY PROVIDING
TO US?
BUT IN A SITUATION LIKE THAT THEY ARE THE ONES THAT CAN
ENSURE CDC THAT THEY HAVE ADEQUATE REPRESENTATION
FROM STATE HEALTH OFFICERS AND NACCHO FROM LOCAL HEALTH OFFICES
ON THE PHONE, PAYING ATTENTION, PARTICIPATING TO ENSURE THERE
IS RIGHT DECISIONS THAT ARE BEING MADE.
AND I THINK THAT APPLIED PARTICULARLY WITH REGARD
TO THE SCHOOL CLOSURE ISSUES.
WE CONSIDER THAT TO BE HICCUPS, YOU KNOW, THAT THERE WERE SOME
MISSTEPS TAKEN.
BUT WHAT I WOULD LIKE TO EMPHASIZE IS THE POSITIVE,
THAT HOW QUICKLY WE CORRECT IT BASED ON, ONCE AGAIN,
THE ESTABLISHED COMMUNICATION.
WE GOT IMMEDIATE FEEDBACK FROM THE LOCALS ABOUT, WHOA,
WHAT IN THE HELL ARE YOU DOING HERE?
AND THAT GOT FED UP IMMEDIATELY AND THERE WERE APPROPRIATE
ADJUSTMENTS MADE IN THOSE RECOMMENDATIONS LITERALLY
WITHIN HOURS AND, IN FACT, I WAS ALREADY GOING OUT
AND SAYING, "HERE'S THE LATEST RECOMMENDATION FROM CDC" AND
AN HOUR LATER WE GOT A DIFFERENT ONE.
BUT THE POINT IS THAT'S WORKING.
THAT'S NOT DYSFUNCTION; THAT'S GETTING CORRECTIONS MADE.
SO THAT IS EXTREMELY IMPORTANT.
AND I ALSO WANT TO EMPHASIZE OF COURSE THE PART THAT NEEDS TO
BE PART AND PARCEL OF THAT AND THAT IS THE
HORIZONTAL INTEGRATION.
AT THE STATE LEVEL IN THE STATE OF CALIFORNIA,
THE COMMISSIONER OF EDUCATION IS A SEPARATELY ELECTED OFFICIAL.
HE DOES NOT ANSWER TO THE GOVERNOR SO THE GOVERNOR CAN'T
JUST KNOCK HEADS TOGETHER AND SAY, "YOU GUYS GET TOGETHER."
THE POINT IS WE NEED TO HAVE VERY EXPLICIT COMMUNICATION
RELATIONSHIPS BUILT UP WITH THOSE TYPES OF AGENCIES,
AND I AM TALKING SPECIFICALLY ABOUT LEADERSHIP TO LEADERSHIP.
I SHOULD BE ABLE TO PICK UP THE PHONE AND TALK TO
JACK O'CONNELL [PHONETIC SP] ANYTIME I WANT AND VICE VERSA,
AND WE NEED TO ACTUALLY DO THAT, MAYBE ARTIFICIALLY CREATE
OPPORTUNITIES TO DO THAT JUST TO GREASE
THAT COMMUNICATION CHANNEL.
THE SECOND THING IS TO ENSURE THAT THERE ARE CLEARLY
IDENTIFIED PROGRAMMATIC LIAISONS, PEOPLE THAT YOU
KNOW ARE GOING TO TALK TO EACH OTHER.
AND THEN I WOULD TAKE IT A STEP FURTHER AND SAY THERE SHOULD BE
SPECIFIC LETTERS OF AGREEMENT OR A MEMORANDUM OF UNDERSTANDING
PARTICULARLY ABOUT COMMUNICATIONS.
I DON'T WANT JACK O'CONNELL OUT THERE DOING A PRESS RELEASE
WITHOUT HIM HAVING FILTERED THAT THROUGH AND VICE VERSA.
YOU KNOW WE SHOULD HAVE THOSE KINDS OF ARRANGEMENTS AHEAD
OF TIME AND AGREEMENTS ABOUT COMMUNICATION.
SO VERTICAL AND HORIZONTAL COMMUNICATION HERE IS
EXTREMELY IMPORTANT.
I DID WANT TO MAKE AN IMPORTANT POINT ABOUT ANOTHER THING THAT
I LEARNED ABOUT COMMUNITY MITIGATION THAT WAS
A PARTICULAR STRUGGLE FOR US IN CALIFORNIA.
AND IT WAS MENTIONED TO SOME DEGREE THIS MORNING AND THAT
IS RECOGNIZING A SPECIFIC POPULATION IN PARTICULAR
INSTITUTIONAL SETTINGS.
WE FOUND OURSELVES VERY CREATIVELY MELDING A FEW
OF THE RECOMMENDATIONS THAT WERE COMING OUT TO MEET THE SPECIFIC
NEEDS OF INSTITUTIONS.
AND I AM TALKING ABOUT FACILITIES REQUIRING
RESIDENTIAL CARE WHETHER IT IS HOSPITALS, NURSING HOMES,
PRISONS, DEVELOPMENTAL DISABILITY FACILITIES,
MENTAL HEALTH FACILITIES.
EACH ONE OF THOSE HAS UNIQUE RULES ABOUT WHO CAN BE
EVACUATED, WHO CAN BE MOVED AND UNDER WHAT CIRCUMSTANCES.
AND WE FOUND OURSELVES HAVING TO MERGE GUIDELINES THAT DEALT
WITH WORKPLACE OR GUIDELINES THAT DEALT WITH HEALTHCARE
WORKERS AND TRYING TO FIT THEM TOGETHER FOR THE UNIQUE THING.
THERE IS AN OPPORTUNITY NOW TO DEFINE THE DIRECTION THAT WE
NEED TO BE GIVING TO THOSE KINDS OF INSTITUTIONS.
AND THEY HAVE RELEVANCE, OF COURSE, BOTH AT THE
STATE LEVEL AND AT THE LOCAL LEVEL.
WE NEED TO NOT ONLY BE SURE ABOUT WHAT DIRECTION WE ARE
GOING TO GIVE EACH ONE OF THOSE, BUT WE HAVE TO HAVE
VERY CLEAR IDEAS ABOUT WHO IS GOING TO ASSIST THEM --
IF THEY NEED MASKS, WHERE ARE THEY GOING TO GET THEM FROM?
IF THEY NEED ANTI-VIRALS, WHERE ARE THEY GOING TO GET THEM FROM?
IS THAT GOING TO BE THE LOCAL HEALTH
JURISDICTIONS RESPONSIBILITY?
IS THAT GOING TO BE THE STATES RESPONSIBILITY?
IS IT GOING TO BE THEIR OWN RESPONSIBILITY?
IT'S TIME NOW TO GET THAT ABSOLUTELY CLEAR BEFORE WE
MAKE APPROPRIATE RECOMMENDATIONS.
AND I GUESS AS A FINAL POINT JUST TO SORT OF BACK UP
A LITTLE BIT.
AND I AM THINKING AS A STATE HEALTH OFFICER, WHAT WAS THE
INFORMATION I NEEDED TO DECIDE WHAT WAS THE BEST COMMUNITY
MITIGATION, AND IT GOES BACK TO THE BASICS.
IT IS OUR EPIDEMIOLOGISTS AND IT'S OUR LABORATORY CAPACITY.
AND THOSE ARE MOST VULNERABLE.
IN THE STATE OF CALIFORNIA, WE ARE HAVING HORRIBLE
BUDGET PROBLEMS.
IT IS OUR LABORATORIES THAT ARE 95, 85 PERCENT GENERALLY FUNDED.
THOSE ARE THE MONIES THAT ARE BEING CUT.
WE HAVE TO STAND UP AND STRONGLY INSIST THAT THOSE RESOURCES BE
MAINTAINED BECAUSE THAT IS EXACTLY THE ENTITIES THAT
PRODUCE THE KIND OF DATA THAT WE NEED TO MAKE THE RIGHT
JUDGMENTS ABOUT WHAT COMMUNITY MITIGATION MEASURES NEEDS
TO HAPPEN.
AND I GUESS I WILL CLOSE WITH THAT, THANKS.
[MARTY CETRON] AND OUR LAST SPEAKER WILL BE MONIQUIN HUGGINS, DIRECTOR
OF OPERATIONS FOR CHILDCARE BUREAU AT ACF, MONIQUIN.
[MONIQUIN HUGGINS] GOOD AFTERNOON.
I'M WITH THE ADMINISTRATION FOR CHILDREN AND FAMILIES,
THE CHILDCARE BUREAU, AND SO I AM GOING TO GIVE A LITTLE BIT
OF A DIFFERENT PERSPECTIVE FROM THE FEDERAL IN OUR EFFORTS TO
SUPPORT STATE AND COMMUNITIES AS WELL AS OUR TRIBAL.
THE CHILDCARE BUREAU, WE ARE ABOUT A $5 BILLION PROGRAM
THAT PROVIDES FUNDING TO STATES, TERRITORIES AND ABOUT
260 TRIBAL GRANTEES AND THOSE FUNDS ARE USED TO PROVIDE
SUBSIDIES FOR CHILDREN WHILE THEIR PARENTS WORK, LOW-INCOME
FAMILIES WHILE THEIR PARENTS WORK OR ARE IN EDUCATION
AND TRAINING.
AND SO JUST TO KIND OF PAINT YOU A PICTURE OF THE NUMBER
OF CHILDREN THAT WE SERVE, IT IS ABOUT 1.7 MILLION CHILDREN AS
IN REGARDS TO OUR 207 DATA THAT WE SERVE A YEAR UNDER
THE CHILDCARE AND DEVELOPMENT FUND WHICH IS THE FEDERAL
FUNDING PROGRAM.
AND 29 PERCENT OF THOSE CHILDREN ARE INFANTS AND TODDLERS.
ABOUT 26 PERCENT OF THOSE CHILDREN ARE THREE- AND
FOUR-YEAR-OLDS.
AND THEN ABOUT 35 PERCENT ARE SIX- AND 12-YEAR-OLDS.
SO IT IS VERY IMPORTANT THAT CHILDCARE BE PART OF THE
PLANNING PROCESS, AND I THINK PARTNERSHIPS AND COMMUNICATIONS
IS WHAT WE HAVE HEARD TODAY.
AND WE ARE HOPING THAT CHILDCARE, WHEN WE TALK
ABOUT HEALTH AND EDUCATION, THAT CHILDCARE IS PART OF
THOSE PLANNING PROCESSES AT THE COMMUNITY LEVEL.
A GREAT NUMBER OF OUR KIDS ARE CARED FOR IN CENTER-BASED
PROGRAMS, AND I THINK THIS GENTLEMAN THIS MORNING,
JUST A MOMENT AGO TALKED ABOUT A NUMBER OF CHILDREN CARED FOR,
OR THE CHALLENGE THAT THE CHILDREN HAVE,
THAT THE FACILITIES HAVE IN ACCESSING CHILDREN WHO ARE
CARED FOR IN WHAT WE CALL HOME- BASED PROGRAMS.
AND SO ABOUT 34 PERCENT OF OUR KIDS ARE IN HOME-BASED SETTINGS.
ABOUT 59 PERCENT ARE IN CHILDCARE CENTERS.
AND I THINK WHEN YOU ARE LOOKING AT THE COMMUNITY AND THERE IS
NOT ONE SINGLE ENTITY, I THINK, IN THE STATES BECAUSE THE
LICENSING REQUIREMENTS IN HOW AND WHO IS REGULATED TO PROVIDE
CHILDCARE VARIES FROM STATE TO STATE AND FROM TERRITORIES AND
EVEN FROM TRIBAL GRANTEE TO TRIBAL GRANTEE, IT IS IMPORTANT
TO SEE IN YOUR PLANNING PROCESS TO BRING THOSE FOLKS AT THE
TABLE WHO ARE INVOLVED IN THE CHILDCARE COMMUNITY.
FOR THE CENTER-BASED PROGRAM PRETTY MUCH THEY ARE LICENSED
BY THE STATE SO YOU ARE EITHER TALKING ABOUT THE PUBLIC HEALTH
DEPARTMENT OR THE STATE LICENSING DEPARTMENT.
BUT WHEN YOU START TALKING ABOUT HOME-BASED PROGRAMS WHERE
A GREAT NUMBER OF OUR INFANTS AND TODDLERS ARE BEING CARED
FOR, THEN I THINK YOU ARE TALKING ABOUT DEPARTMENT
OF SOCIAL SERVICES WHO IS THE GRANTEE WHO RECEIVES
THE FEDERAL FUNDS.
YOU ARE TALKING ABOUT MAYBE THE PUBLIC HEALTH DEPARTMENT THAT
HAS SOME OVERSIGHT FOR HOME-BASED PROGRAMS.
BUT YOU ALSO COULD BE TALKING ABOUT THE USDA FOOD PROGRAM
OR THE CHILDCARE RESOURCE AND REFERRAL AGENCIES IN YOUR AREA.
SO IT IS IMPORTANT TO KNOW WHO, WHEN YOU ARE TALKING ABOUT
PLANNING, ARE THE ENTITIES THAT ARE PROVIDING OVERSIGHT FOR
HOME BASED PROGRAMS.
AND AS I INDICATED FOR THE CENTER BASED PROGRAMS,
THEY ARE PRETTY MUCH LICENSED BY THE STATE CHILDCARE
LICENSING DEPARTMENT.
I WANTED TO SHARE WITH YOU -- I THINK WE WANTED TO SHARE WITH
YOU, I GUESS, A STORY ABOUT HOW WE WORK TOGETHER
IN THE INFLUENZA EPIDEMIC.
CDC, I THINK, DID A GREAT JOB.
RALPH CORDELL [PHONETIC SP] WHO IS THE EPIDEMIOLOGIST WHO HAS
DONE A LOT OF WORK WITH CHILDREN IN GROUP SETTINGS CONVENED
CONFERENCE CALLS WITH THE FEDERAL AGENCIES:
THE CHILDCARE BUREAU, THE OFFICE OF HEAD START, MATERNAL AND
CHILD HEALTH BUREAU AND A NUMBER OF THE NATIONAL ORGANIZATIONS,
NAYC AND THE NATIONAL CHILDCARE RESOURCE AND REFERRAL AGENCIES.
AND WE HAD ONGOING REGULAR CALLS, AND I THINK THEY DID
A GREAT JOB OF CLEARING GUIDANCE, SPECIFICALLY FOR
CHILDCARE PROGRAMS BECAUSE WE KNOW IN SOME INSTANCE THEY ARE
NOT INCLUDED IN THE TOTAL LOOP.
SO THEY SPECIFICALLY CLEARED GUIDANCE WITH
CHILDCARE PROGRAMS.
WE WERE ABLE TO PUT THAT IMMEDIATELY ON OUR WEBS.
WE DID A TWO OR MULTIPLE PRONG APPROACH WHERE WE
SENT INFORMATION OUT TO OUR GRANTEES UNDER CCDF.
THE NATIONAL ORGANIZATIONS SENT INFORMATION THROUGH THEIR
ORGANIZATIONS AND THEN THE CDC ALSO CONTACTED
THE PUBLIC HEALTH DEPARTMENT.
AND AS A RESULT THE GUIDANCE GOT DOWN TO THE LOCAL LEVEL
THROUGH THE PUBLIC HEALTH DEPARTMENTS AND THE OTHER
CONSTITUENTS WHO PROVIDE OVERSIGHT TO THE NON-REGULATED
FAMILY CHILDCARE HOMES.
AND I THINK SECRETARY SEBELIUS MADE YOU KNOW, TALKED ABOUT
THE VACCINATION PROGRAM AND IDENTIFYING POSSIBLE
VACCINATION SITES.
AND I THINK CHILDCARE IN AND OF ITSELF PROVIDES AN ACCESS POINT
FOR CHILDREN IN CHILDCARE WHEN YOU THINK ABOUT THE NUMBER OF
CHILDREN IN CHILDCARE AND THE NUMBER OF INFANTS WHO I THINK
I LISTENED TO THE PANEL RIGHT BEFORE THIS SESSION TALKING
ABOUT HOW ARE THEY GOING TO TARGET SITES AND ONE OF
THE SITES WAS CHILDCARE PROGRAMS.
SO I THINK IT IS IMPORTANT FOR US ALL TO REMEMBER
THAT CHILDCARE PROVIDES AN IMPORTANT ACCESS TO PREVENTIVE
PROGRAMS, AND IN A TIME OF INFLUENZA WE KNOW THAT THEY
ALSO, YOU CAN ALSO ACCESS CHILDREN AS WELL AS
SCHOOL SETTINGS.
ONE OF THE THINGS WHEN I WAS TALKING IN OUR CONFERENCE CALL
PRIOR TO THE PANEL MEETING -- WHEN WE TALK ABOUT CLOSURE OF
CHILDCARE CENTERS AND WE TRY TO BALANCE THE CLOSURE AND
PROTECTION OF CHILDREN AND THEN THE LEAST AMOUNT OF DISRUPTION,
MANY OF THESE CHILDCARE PROGRAMS ARE OPERATED BY OWNERSHIPS,
SMALL BUSINESS OWNERS.
SO THEIR ABILITY TO ABSTAIN CLOSURE, COMMUNITIES WILL
PROBABLY NEED TO THINK ABOUT, HOW DO WE HELP A SMALL BUSINESS
CHILDCARE OWNERS SUSTAIN CLOSURE SO THAT ONCE PARENTS
RETURN TO WORK THAT THE SUPPLY IS THERE TO MEET THE DEMAND,
BECAUSE MANY OF THEM ARE NOT ABLE TO SUSTAIN THE CLOSURE
AND AS A RESULT THEY ARE GOING OUT OF BUSINESS.
THEN WHEN ME AS A PARENT IS BACK TO WORK THERE IS NO
CHILDCARE FOR THE CHILDREN.
SO I JUST WANTED TO LEAVE YOU WITH THAT AS YOU CONTINUE YOUR
COMMUNITY PLANNING TO THINK ABOUT, FIRST OF ALL,
HOW DO YOU ACCESS CHILDCARE?
WHO ARE THE PLAYERS THAT NEED TO BE AT THE TABLE?
AND THAT THE PLAYERS AT THE TABLE MAY NOT LOOK THE SAME
FROM STATE TO STATE BECAUSE EVERY STATE OPERATES AND
ADMINISTERS CHILDCARE DIFFERENTLY.
THANK YOU.
[MARTY CETRON] ALL RIGHT, I KNOW OUR TIME IS RUNNING QUITE SHORT, BUT I DID
WANT TO OPEN IT UP AT LEAST FOR A COUPLE OF QUESTIONS.
I AM NOT GETTING THE SIGNAL YET.
QUESTIONS FROM THE AUDIENCE?
JOHN?
[MALE SPEAKER] JOHN [INAUDIBLE], ALL THE FOCUS IN THE CONVERSATIONS HAVE BEEN
ON SCHOOLS.
I AM CURIOUS ABOUT WHETHER WE HAVE ANY DATA FROM EXPERIENCE
ON OTHER MITIGATIONS EVEN AS SIMPLE AS, YOU KNOW, THERE WAS
A LOT OF MESSAGING ABOUT HAND WASHING WHICH I REMEMBER SEEING
EVERY FIVE MINUTES.
CHANGED ANY BEHAVIOR?
THINGS LIKE THAT.
DO YOU HAVE ANYTHING?
[MARTY CETRON] SURE, SO I WILL REPEAT THE QUESTION.
THE QUESTION WAS ON GETTING AWAY FROM THE SCHOOLS,
THE OTHER MESSAGING THAT WENT OUT ON MITIGATION,
HAND HYGIENE, ET CETERA, AND DID IT CHANGE BEHAVIORS?
I THINK THERE IS A REALLY NICE SERIES OF TWO PUBLIC OPINION
POLLS THAT WERE DONE BY BOB BLENDON [PHONETIC SP] AND HIS
GROUP AT THE HARVARD SCHOOL OF PUBLIC HEALTH WHICH WERE DONE
AT ABOUT A WEEK APART OR SO SEEING WHETHER THOSE MESSAGES
WERE PENETRATING AND THERE WAS VERY, VERY HIGH BOTH KNOWLEDGE
AS WELL AS ATTITUDES AND PRACTICE CHANGES THAT WERE
COMING ACROSS WITH THOSE PUBLIC MESSAGES, SO PRETTY HIGH RATES
OF HAND WASHING ACROSS A LOT OF SECTORS.
I AM SORRY.
[MALE SPEAKER] IN MEXICO WHEN THERE MASKS [UNINTELLIGIBLE] THREE DAYS
AFTER THEY STARTED GIVING THEM OUT.
AND FIVE DAYS, ABOUT 65 PERCENT.
FIVE DAYS LATER, EVEN THOUGH THAT CAME DURING THE PERIOD
DURING WHICH THE MEXICAN GOVERNMENT HAD CLOSED ALL
[INAUDIBLE] MEXICO CITY.
MASKS USED IN PUBLIC TRANSPORTATION DECLINED
65 PERCENT TO 27 PERCENT.
SO WHAT ABOUT --
[MARTY CETRON] YEAH, JOHN'S ASKING ABOUT THE SUSTAINABILITY AND PUBLIC
TOLERANCE FOR THESE TYPES OF INTERVENTIONS.
AND THE DATES OF THE HARVARD POLL ESCAPE ME AT THE MOMENT,
BUT I THINK THEY WERE LATE APRIL AND THEN INTO THE
FIRST WEEK OF MAY.
YOU CAN FIND THEM ON THE HARVARD SCHOOL OF
PUBLIC HEALTH WEB SITE.
BUT THIS HAS CLEARLY ALWAYS BEEN AN ISSUE, HISTORICALLY
AS WELL AS CONTEMPORARILY, AND WE HEARD I THINK HERE
ON THE PANEL THAT THERE WAS ABOUT A SEVEN DAY THRESHOLD
OF TOLERANCE WITH SOME OF THE EARLY SCHOOL
DISMISSAL ACTIVITIES.
SO I THINK THAT IS AN ISSUE THAT NEEDS TO BE KEPT IN MIND
AS WE MOVE FORWARD.
OTHER QUESTIONS?
IF NOT I AM GOING TO WRAP UP WITH A COUPLE OF COMMENTS.
PROTECT THOSE AT GREATEST RISK, MINIMIZE SOCIAL DISRUPTION,
EMPOWER LOCAL ASSESSMENTS AND DECISION MAKING BY PROVIDING
CLEAR GUIDANCE THAT OFFERS FLEXIBILITY AND DOING THE
BEST WE CAN AT ALL LEVELS TO INTEGRATE VERTICALLY AND
HORIZONTALLY AND DO WHAT WE CAN NOW TO PREPARE.
I LOVED THE QUOTE THIS MORNING ABOUT, "DON'T TAKE THE RISK OF
BEING UNPREPARED."
LET'S GO FORWARD FROM HERE BOTH TO BE PREPARED FOR
THE UNEXPECTED BUT ALSO TO ELIMINATE THE BARRIERS AND
ALIGN OUR INCENTIVES SO THAT THERE ARE THE DESIRE,
THE WILLINGNESS AND THE ABILITY TO FACE THIS PANDEMIC IS
ALIGNED WITH ALL THE OTHER INCENTIVES WE FACE
AS A CHALLENGE.
THANKS VERY MUCH.