A coherent, coordinated and collaborative response to the Coronavirus pandemic is not going to come from Inside the Beltway
Note: This is the third installment in a series on the Coronavirus pandemic. Links to previous articles are at the end of this post
By Michael M. Barrick
On Monday, Donald Trump said during a TV interview, about the Coronavirus, “Nobody could have predicted something like this … .” Yes, somebody could have — and did. In fact, a pandemic was just one disaster scenario that was held during the transition between President Obama’s team and Trump’s team.
Meanwhile, also yesterday, a small flyer from the CDC arrived via the U.S. Mail with “President Trump’s Coronavirus Guidelines for America.” It’s insulting. We all know the mailing is thinly-veiled campaign literature. It is quite cynical. I wonder how many went into mailboxes of those sick and dying from COVID-19.
Clearly, a coherent, coordinated and collaborative response to the Coronavirus pandemic is not going to come from Inside the Beltway.
Fortunately, our states seem more prepared. The governors and mayors have experienced professionals to call upon for this scenario. If they’ve done their job, they’ve trained for it. We have seen tremendous leadership, for example, from New York Governor Andrew Cuomo. His state has been hit the hardest and it is the largest media market, explaining why we’ve seen a good bit of him. I have yet to see a moment when he is not in command and control. And, while the medical needs of his state’s residents are not being properly met, that is because of the slow federal response.
That means our governors and mayors have little room for error. That means they and their emergency response and public health experts must operate on some key principles to move quickly in developing and implementing an effective plan in their states.
- Your state has a Hazard Vulnerability Analysis (HVA) or Threat Assessment that identifies a pandemic as a potential threat to the state’s population. .
- Your state has an Emergency Operations Plan (EOP)
- Your state’s plan is based on the HVA, updated annually, drilled regularly and operates according to the National Incident Management System (NIMS)
- Your state’s Local Emergency Preparedness Committees (LEPCs) are and have been functioning properly.
- Your state follows the National Response Plan (NRP) and the Homeland Security Exercise and Evaluation Program (HSEEP)
- All of the state’s hospitals operate during emergent events using the Hospital Incident Command System (HICS)
- Your state has identified its population groups vulnerable to COVID-19
- Your state’s governor is familiar with NIMS and defers to subject matter experts to fill the various roles in the structure.
- Your state has has a modern Emergency Operations Center (EOC)
- Your state has a pandemic EOP
There are four phases of Emergency Management — Preparedness, Mitigation, Response and Recovery. At this point, for the most part, the nation, state and localities have missed the preparation phase. Preparations have undeniably been made, but resources were not mobilized quickly enough once Situational Awareness was established. So, we are taking mitigation steps — such as closures and social distancing and first receivers and first responders using PPE. However, as noted in my article, Coronavirus Requires Robust Local Response, mitigation steps at the local level have been absent, late or inconsistent. Obviously the response is ongoing and will continue for an indefinite period of time, almost certainly in waves. Again, the response is less than adequate, which is addressed in the RESPONSE section below. Recovery can wait. We all want it, but it’s not the time to be thinking about it. The issue is too big to waste time and energy on that.
There are four other phases of Emergency Management that I include with the traditional four — Assessment (After Action Report), Corrective Actions, Exercise, and Repeat. The philosophy is simple. Disasters don’t end. Only our planning for them does. If we learn anything from this, it is that this pattern must end now.
What should be done and has been done is not relevant for this analysis, as it is a summary based on a scenario in which your governor: 1) learns quickly of the threat; 2) has the highest possible level of situational awareness because of effective crisis communications and epidemiological surveillance; and, 3) is proactive in his/her response. So, while your governor may not be adhering to the following Sequence of Events, there is still time to do so. It is also important to note these are general guidelines; the intent of NIMS is to allow maximum flexibility depending upon local situations.
SEQUENCE OF EVENTS
Upon learning of the threat, the governor should immediately activate his/her Incident Management Team (IMT), which is a select group of experts (cabinet level or their department directors) that assess the situation and help the governor determine the next step(s), including activation of the NIMS team. In this case, the IMT, based on the information, should 1) immediately bring in experts in infectious control, forensic epidemiology, and outbreak investigations if they are not already part of the IMT; and 2) advise the governor to activate the EOC, meaning the NIMS team will be activated.
While breaking down the full NIMS structure is not practical in this summary, it is key to understand that it is a Command & Control structure that can be scaled to the scope and duration of the emergent event. It has proven extremely effective in saving lives and property. So, you need to know there is an Incident Commander (IC), a Safety Officer (SO), a Liaison, a Public Information Officer (PIO), and in this case a Medical/Technical specialist, more than likely an infectious disease physician. If needed, dozens of people can serve in support roles such as Section Chiefs.
The governor should not assume any of these roles, but she/he should understand them and know how to support them. The IC ideally is the Director of Emergency Management, Public Health or a designee. The IC need not necessarily be an expert in every potential disaster; rather he/she needs only be an expert in NIMS and as an IC, so as to ask the right questions and offer proper guidance. The Safety Officer would likely come from Public Safety. The Liaison would likely be a top adviser to the governor with the responsibility of keeping the lines of communication open between agencies, hospitals, cities, states and the feds. The PIO alone speaks to the public regarding the state’s disaster response. Usually, the PIO is the governor’s press secretary during non-emergent events. The PIO could also be from the agency having jurisdiction. The only two exceptions when the governor should speak are 1) to reassure the public; and 2) Introduce members of the IMT/NIMS team to the public and allow the subject-matter-experts to take questions. NOTE: The governor should also avoid the temptation to “visit” victims. It puts undue strain on first receivers and responders.
The likely Command & Control priorities of the EOC are going to include: 1) Crisis Communications; 2) Community Collaboration & Cooperation; 3) Identifying hospital surge capacity for emergency departments, med-surg units and ICUs; 4) Determining availability and distribution of federal resources such as the Strategic National Stockpile (SNS); 5) Identifying and reaching vulnerable populations; 6) Testing; 7) Identifying Healthcare Deserts and supporting Home Health agencies; 8) Establishing Rapid Response Teams (RRTs) for Outbreak Investigations (to support, not replace local epidemiologists and public health officials); and, 9) Identify personnel needed for Section Chiefs for Planning, Operations, Logistics, and Finance/Administration; set Operational Periods; reconvene at end of every operational period or sooner if the situation dictates it; and, set intervals and times for regular briefings by the PIO to the press/public. From there, the governor can attend to the other duties of governing and attend IMT meetings whenever he/she deems appropriate, has questions, directions or information to share.
The IMT will establish a plan for each operational period. Their job is to coordinate the Command & Control Objectives (such as pushing supplies to hospitals). Each section chief will have small teams of advisors. The Planning Chief, based on the Command & Control objectives, will develop an Incident Action Plan (IAP). It will then go to the Operations Chief, whose teams will determine what operations have been identified as critical functions and what they need to be supported. They, then, will share the plan with the Logistics Chief, whose team will develop a plan to acquire & distribute materials and supplies to support the operations of the plan. The Finance/Admin chief wil track costs for reimbursement. In the early stages especially, all section chiefs should be free to appropriate needed funds without prior approval from the Finance/Admin chief. Only after the situation stabilizes can costs then be added to the equation.
The various members of the governor’s IMT will stay in contact with their counterparts in hospitals, public health departments, offices of emergency services, EMS, fire, police and private industry. This is why NIMS has been adopted nationwide — so that all authorities having jurisdiction, first responders and first receivers are all talking the same language.
Looking forward, treatment options will improve and, eventually, a vaccine developed. Those developments will require ongoing activation of the EOC. Plans for Recovery will need to be started. The governor should appoint an independent panel to conduct an After Action Report at the proper time. That report, which should take no more than 90 days, should be released to the public. Then, the governor — with help of the experts from his IMT and others impacted around the state — should hold a news conference explaining the findings, Lessons Learned and Corrective Actions that will take place. Finally, all governors should ensure that emergency plans never again set on shelves gathering dust.
PREVIOUSLY PUBLISHED IN THIS SERIES ON THE CORONAVIRUS