Communications during the West Virginia water crisis An unprecedented water crisis occurred in Charleston, West Virginia when crude 4-methylcyclohexanemethanol (MCHM) was detected in the Elk River water on 9th January, 2014. This chemical spill was from a Freedom Industries facility, occurring upstream from the main West Virginia American Water intake, treatment and distribution center, resulting in disruption of water supplies to approximately 300,000 residents across 9 counties. As the local, state and federal health agencies stepped up the public health response, researchers from the HSPH-PERLC conducted a population-based survey of over 600 respondents in two weeks of February, 2014 to understand how the people received the risk communication, and how well did they perceive and act upon it. Television, and not social media, was the principle channel of receiving news regarding the crisis for 70% population on the day itself (January 9); 8 out of every 10 were fully aware of avoiding tap water entirely, and instead using bottled water for drinking, cooking and bathing. In the affected counties, 70% people followed the recommendations provided by the local health department. The most surprising finding of the survey was an overwhelming 70% residents in the affected area, and 50% in the rest of the state expressing strong opinion on the necessity of stringent government regulations on environmental protection and risk reduction. An interview of the HSPH team lead, Dr. Elena Savoia at the WOWK-TV in Huntington, West Virginia can be accessed at www.wowktv.com/story/25540921/decision-makers-guests-include-rep-nick-rahall-michelle-easton-elena-savoia-and-robert-rupp (Segment 4).
Sharing ideas at the Preparedness Stakeholders & Partners Forum
A meeting of the Preparedness Stakeholders & Partners Forum was convened in June, 2014 at the Landmark Center to translate the findings of over five years of HSPH research in preparedness measurement into tools that can be used by the practice community. 30 delegates brainstormed and shared their unique experiences and perspectives. The academia was represented by senior faculty from Columbia University, Georgetown University and RAND, besides the HSPH. 6 state and local health departments participated, including professionals from Connecticut, West Virginia, Massachusetts, Vermont, Rhode Island and New Hampshire; FEMA representatives shared the national guidelines, while delegates from the WHO informed the house on global coalitions and strategic partnerships between the WHO, UNICEF and Red Cross.
A conceptual framework for preparedness planning and resources, meeting the US National Health Security Strategy objectives, has been developed by the Harvard Preparedness and Emergency Response Learning Center for the benefit of health agencies at county, town or state levels. The Harvard Preparedness and Emergency Response Research Center (HSPH-PERRC, LAMPS) on the other hand, has focused on developing valid and reliable outcome assessment measures, critically designing structure of the exercises, conducting drills, and defining ways to integrate these exercises into ongoing public health practices, through the LAMPS program. Senior academicians like Mike Stoto (HSPH & Georgetown University) expressed concerns on the statistical challenges in data analysis from disasters, and felt that the “root cause analysis” approach was the best way forward. Chris Nelson (RAND) stressed on the need for a “critical incident registry” for Public Health Emergency Preparedness which can help agencies to learn from previous crisis experiences. Risk communication surveys from the 2009-10 H1N1 pandemic to the 2014 West Virginia Water Crisis point towards a greater influence of education and race (individually and in interaction) on the sources of information for the population, noted Prof. Vish Viswanath (HSPH). David Abramson (Columbia Preparedness & Emergency Response Learning Center) spoke on interesting studies regarding engagement of vulnerable populations in a community, citing examples of the 2007-08 San Diego wild fires and the 2009-10 H1N1 pandemic.
Rahul Gupta, Chief Health Officer & Executive Director, Kanawha Charleston Health Department talked on effective health communication during the West Virginia water crisis in early 2014, and successful partnership with the PERLC. Tom Flynn, New Hampshire Division of Public Health Services informed the house that they were trying to build a system in which data sources would be open for access to all community partners. Mike Leyden, Vermont Department of Health felt that it is imperative to work on finding common perspectives between the state health agencies and the federal funding organizations; a view supported by FEMA. Dr. Gaya Gamhewage, Coordinator of the WHO Communication Capacity Building Team, was of the opinion that public trust on experts is no longer absolute, with about 35% of the world’s population receiving health advice through increased internet access. The key issues now include continuous learning from critical incidents, handling multi-hazards and exercises to assess systems & public perceptions; while it remains critical to engage with the political leadership from the planning and preparedness stages.
Communication inequalities during the H1N1 pandemic: a systematic review of literature Lin, Savoia, Agboola and Viswanath from the HSPH-PERRC (LAMPS) conducted a systematic review of 118 empirical studies to understand the social determinants which may have influenced differential public health risk communication at a population level during the 2009 H1N1 pandemic. The Structural Influence Model (SIM) of Public Health Emergency Preparedness (PHEP) Communications was applied to classify and analyze the literature. The selected studies were from across 25 countries, and were mostly population based (78%, 92 out of 118); 86% of these used quantitative approach, while 91% were cross-sectional in design. The most commonly used socio-demographic variables included age and gender (86%), socio-economic status (73% – education, income, occupation – singly or in combination), numbers of children per household (37%), race and ethnicity (36%). The population level attitude was considered as an important determinant for peoples’ preventive behavior, and was assessed by pre-existing beliefs on social stigma, social segregation, trust on government’s handling of the pandemic and fair treatment of all social groups.
Age, household income, educational attainment and owning a home were positively associated with greater knowledge on H1N1. Higher exposure to focused media warnings not only improved knowledge, but also influenced healthy behaviors. Being aware of the regular media coverage of large number of H1N1 cases and a fear factor about the disease for self and family members promoted compliance with public health guidelines. Knowledge on viral transmission and symptoms improved perceived risk and perceived susceptibility to infection, having similar good effects on preventive attitudes. Trust on social networks (friends, family, physicians), communities (work place/ church) and health agencies was associated with better compliance to health recommendations. Compliance with vaccination also followed a similar pattern. Moreover, perception of being provided a clear and honest official information as well as doctor’s opinion positively influenced immunization. Understandably, having a history of acceptance of the seasonal flu vaccine played an important role in vaccine uptake, while suspicion of adverse effects was detrimental. While being African American was a potential predictor of lower vaccination compliance, the Hispanic population were more likely to be comply. Understanding these socio-demographic, racial and behavioral factors can help developing tailored public health campaigns which are sensitive to the perceptions and needs of targeted communities, thereby addressing communication inequalities in future emergency situations. For more information: http://www.biomedcentral.com/1471-2458/14/484
MERS in the United States In May 2014, two unlinked cases of the Middle East Respiratory Syndrome (MERS) were reported from Indiana (May 2) and Florida (May 11), from two travelers who served as healthcare providers in Saudi Arabian hospitals treating this illness. MERS, a respiratory disease caused by Coronavirus (MERS-CoV) was first reported in Saudi Arabia in September, 2012. Patients suffer from severe onset fever, cough and breathlessness, progressing to serious complications like gastrointestinal symptoms, pneumonia and renal failure, resulting in a 30% case fatality rate. People with compromised immunity, and those suffering from chronic cardiac, respiratory or kidney ailments are at particular risk. So far, cases have originated from 9 countries in the Arabian Peninsula, with travel-related cases detected in 11 countries including Europe and the US. The virus is believed to spread among human contacts just like flu (but still not completely understood), and standard preventive measures like avoiding close contact with the sick (avoiding droplet spread) and hand washing are advised. Both the imported cases were fully treated in the concerned hospitals, and discharged only after testing negative for active MERS-CoV infection (no risk of transmission). Though no indigenous cases have been reported in the US, the CDC is maintaining a strong vigil, and considering efforts for vaccine production. Further information is available from the CDC at http://www.cdc.gov/coronavirus/mers/index.html. The WHO has also issued preventive advice and travel guidelines at http://www.who.int/csr/disease/coronavirus_infections/faq/en/.