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Connecticut Communications Tabletop Training

by: DemFromCT

Wed Aug 06, 2008 at 21:09:03 PM EDT

Imagine this scenario: at the main airport in your state, a young girl arrives from overseas. Maybe the plane is from Bangkok, or perhaps from Jakarta.

Wherever they are from, 5 passengers become ill with flu-like symptoms, and are taken to local hospitals. The hospital caring for the young girl announces that she has "the pandemic flu strain" that's being seen overseas.

You are the local health official, getting ready for a press conference in a few hours, and you've got limited amounts of time to convey your messages to an increasingly anxious public.

Get ready; you're on.

DemFromCT :: Connecticut Communications Tabletop Training
Participating in these exercises like this do not make us ready, but they certainly help the participants focus on issues. There's nothing like having to explain bad news to focus the mind. ;-P

I had the opportunity to participate in a 2 day tabletop workshop last week hosted by the CT Department of Public Health. The major topic was communications issues related to pandemic flu. The participants were public health directors and staff at the local (town) level; there were approximately 75 participants in all.

The scenario, a 20% CFR panflu that arrived via airport, was borrowed from our Australian friends in the form of a series of videos that showed worsening conditions over a few weeks span (day 7 and day 14). Participants had the chance to practice giving a press conference at days 7 and 14 (deteriorating conditions), with the goals of telling the truth, and not being overly optimistic.

The funds for this came from HHS and CDC. Training grants for exercises like this are imperative to get the message out beyond web sites and PSAs.

I was primarily wearing my hospital hat, but did have the chance to present to the entire group a short discussion of Flu Wiki, blogs and Mike Leavitt's video comments, which I told the group had the result of validating both blogs and two-way communication as well as increased transparency. It's one thing for me to say it, and quite another to have the HHS secretary say the same thing.

The impact, as always, remains to be seen. But for those who say the authorities always game a 1968-style pandemic, not so. Not in Connecticut.

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the participants were grouped in tables of 6-8
and most of the tables/groups were grappling with how to describe school closures (not whether to, but how to communicate the decision). The high CFR made that a necessity.

It was nice to see everyone on the same page about that.

It was also nice to hear further exercises along the same line planned for later in the year. The more that participate, the better.

Thanks, Dem
This kind of drill marks a significant step in the right direction. Thanks for sharing it.

[ Parent ]
Dem, I'm very glad to hear
they've moved on from the "do our radios work" issues to issues of what to say, at least to the public, now that the radios work.  That's a good move forward.

I'm also encouraged about one goal which you mention was part of the exercise, that of "telling the truth" in their communications to the public.  Did you feel that this was something they had a bit of resistance to, given that the CFR of the gamed virus was 20%?  How much internal reticence did the participants have to overcome in order to deliver the bad news?  

Also, beyond the issue of school closures (at 20% CFR the governor may just come in and handle the communications of that issue for them), what other strategies were they encouraging the public to undertake?      

there is not so much reluctance to tell the truth
as there is reluctance to accept the implications of something this bad. In other words, the natural tendency is to say " here's the upbeat parts of 22 million deaths to come" because to stare it in the face makes you cry.

It's day 7 and there are only 5 cases. Do you emphasize that there are only 5 cases (good job done by all), or do you emphasize that this is only the beginning, and while it might look good now, the 20% cfr overseas means "Hartford, we have a problem."

Interestingly, the scenario was that the Governor was taking it very seriously (attempts to close the state border imposed by NY and MA) with the onus on the small townships to take it seriously as well. So, to answer your last question, we were confronted with answering "what else can we do?" and "why didn't you do more sooner" and "see, that's why you prep now." Answers included closing down public gatherings, with public info sites and tel. numbers identified. Working out the "answer" was not as important as having participants wrestle with the question, because they go home with the issue squarely on their shoulders.

My advice for my small working group was 'work backwards' and don't say anything reassuring on day 7 you'd be sorry you said on day 14 (when fecal matter hits the fan.) Also, that CDC graph was great for visuals. We used in the press conference to explain why the draconian moves. "We do it when we are just getting to the peak, or it's too late.

[ Parent ]
border closings were theoretical
by the way, and added for drama. You can't close state borders, and that is not 'the plan'. The assumption was that we had the only 5 cases in the US and our neighbor states wanted us to move to the tip of South America asap.

Sidebars for discussion were how much/how little antivirals the state had purchased, and what if they don't work, etc. It was common knowledge that we have no vaccine and that was not even an option.

However point of distribution clinics (POD) are always going to be practiced, because some day we will have a vaccine.

Also, at our table we dicussed drive-throu alternate care sites because I told the officials where I was sitting that we assumed that hartford would scarf up anything that the feds sent, and we in Danbury would never see any of it. Now that's the advantage of my not being an 'official.' I can say stuff like that without getting into trouble. ;-)

[ Parent ]
As a member of the public :-)
Once a pandemic had started with as high a CFR as this I'd want them to be honest but positive.

The only way to beat a pandemic without a vaccine is for every man, woman and child to be on board. History proves that the impossible becomes just very difficult when people know what they should be doing and really, really want something bad enough.

To get people on your side you can't wrap them in cotton wool, you have to tell it like it is. OK people will panic but when people know what to do they calm down.

An appropriate quote about the Anthrax letters.


"people were legitimately anxious. They really didn't know what the scope of the problem was," Fischhoff says. "They responded the way they usually do -- responsibly, bravely and somewhat nervously.

Communication was handled pretty sloppily," Fischhoff notes. "It wasn't clear whether people were being told the truth. There appeared to be a double standard -- a privileged status for some groups. People wondered, 'Am I a postal worker or a senator?' " The lack of credibility surrounding the later color-coded warnings hardly helped.

[ Parent ]
"honest but positive"

 Yes it would be rather bad to reassure folks their coffin has been ordered, has arrived and is quite comfy! 100% customer statisfaction - no complaints, not one peep!

 For I too am a member of the lay public.

 Though I jest with UK-Bird the point is sound. "We did it before - we can do it again" 1918, 1957, 9/11, Katrina more people will survive H5N1 than not (ok I'm optomistic on that) and here is how. Here is how: ......

 The "how" part is critical in my opinon.



[ Parent ]
"(attempts to close the state border imposed by NY and MA)"
I'm wondering, having lived in the Great (little) State of Connecticut, if the states of NY and MA would realize just how many people commute to work in those states from CT. And vice versa. Thousands? Tens of Thousands? I know that trains run all day, every day along I95 into NYC.

Not only will closing the state borders hurt the commuters, but also the businesses that those people work at if telecommuting is not an option, the transportation system that depends on income from those commuters, the businesses that will be closing because the closed borders are keeping their employees away, and on down the line.

I don't see how states can even think about closing borders with other states on their own, especially in the NorthEast where each state depends on the others for survival...

[ Parent ]
they can't
It was a little drama thrown in to deal with a situation no one agreed with, and yet had to be able to explain.

[ Parent ]
"...the scenario was that the Governor was taking it very seriously...with the onus on the small townships to take it seriously as well. ...we were confronted with answering "what else can we do?" and "why didn't you do more sooner" and "see, that's why you prep now."

I really like the 'down to the very local' approach of this-it really is what needs to be stressed more.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
Well this:
Answers included closing down public gatherings, with public info sites and tel. numbers identified. Working out the "answer" was not as important as having participants wrestle with the question, because they go home with the issue squarely on their shoulders.
is why I feel that there has been such a terrible failure of duty on the part of so many in public health.  

We were here, right here, back in January of 2006. I attended Leavitt's panflu summit.  This is where we were then.  We understood back then the need to close down public gatherings.  That we have not moved beyond this level of idea generation in 2 1/2 years is really just not acceptable.  

Blue-skying possible "answers" is not funding dependant.  "Thinking" is part of the job description for a public health official yet little innovative thinking beyond "avoid crowds" has emerged.  It's terribly disappointing.          

If they meet the pandemic in this condition, one relatively unchanged from 2006 and unprepared, yes, they will cry.    

[ Parent ]
No further ahead

 I agree with you.

 Even if answers where not given at the table top, they should be found when they get back to office.

 Well as soon as they answer phone, the emails - oh another request and class. Opps! another emergency and then there is what is for dinner (point aimed at men and women)

 How many of these people have sat down with local business and citizens to say "this is what we need to do."

 Pixie, we where there then and we are here now.

 If we are pandemic crazies then harness our desire to blog and write and come up with answers. That way we look like fools - for a while.

 IMHO the first question will be "This ain't a fire, flood, tornado or chemical spill. Hmm what do we have to work with and who decides what?"  

 Sorry, I'm steppng back from the keyboard ;-)


[ Parent ]
Un equal suffering.

 Did they deal with the unequal burden of H5N1?

 The poor who live in tighter quarters with fewer rescources and limited communication may suffer more than those in large houses, with plenty of technology, backup power and food?


this was a very limited and directed exercise. We did not really go over urban vs rural challenges, or vulnerable populations specifically.

[ Parent ]

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