"The issues that have arisen since the anthrax scare have highlighted the need for infrastructure," said Barbara Worgess, director of the Coconino County Department of Health Services.
That means a coordinated local, state and federal to detect infections, conduct testing to confirm them, offer mass treatments and vaccines and even make quarantines.
But even with such an infrastructure in place, Worgess
said that much of the process of responding to a biological threat will be "on the fly" -- adapting to the nature and the scope of the threat.
In a smallpox scenario, Worgess
said the first step is to detect the disease.Health care workers not familiar with symptoms of some of the diseases -- like the eradicated smallpox virus -- are being asked to become familiar.Among resources for doctors are Websites set up by the federal Centers for Disease Control and Prevention and John Hopkins University
.The county health department on King Street also has literature.
said the county's 12-member emergency management team would move into action, and all of the 120 county health department employees would be called to duty.Additional county employees could also be called into service for up to three days at a time.
Law enforcement agencies would be called in to keep the peace and do any investigations regarding the release of the smallpox virus.
The CDC's Health Alert Network would burst fax and e-mail the information to local health departments in this country and abroad, and it would be involved in any outbreak that happened in the world.Worgess
currently gets three to five e-mails a day from the HAN regarding the recent anthrax scare.
MASS TREATMENT FIRST
The first phase of the response would involve the mass treatment of people exposed to the smallpox virus, or anthrax spores.Worgess
said several sites in the city and county have been identified as places to treat large numbers of people, but using them as treatment sites still has not been formalized.Besides the heath department building, sites include other county buildings and schools.
said the team would make a request to the National Pharmaceutical Stockpile for release of medicines or vaccines to fight the outbreak.The NPS sends not only the equipment to package the medicines or vaccines into individual doses, but it also sends staff to offer technical assistance anywhere in the country within 12 hours.
Any hospitals and clinics in the affected area would be put under the auspices of the health department per state statute.
The next consideration would be levels of quarantine, which would depend on the volume of affected individuals, Worgess
said. Flagstaff Medical Center
has limited quarantine capability, perhaps only able to handle less than 10 cases, Worgess
said.Other alternatives would be homes where the affected people live, or established shelter locations similar to the treatment sites, but not the same ones.
It could even mean quarantining entire sections of the city, she
Once the outbreak reached local capacity in manpower, supplies and money, additional help will be sought.
"We'd begin to feel it pretty quickly," Worgess
said.The county board of supervisors would declare a state of emergency and seek help from the state.And should the state, with the spread of the disease, reach its limit, the governor would declare a state of emergency and seek federal aid.
Educating the community would be key, Worgess
said.The local print and broadcast media would be notified and kept up to date on the outbreak, and information lines at the health department would be manned 24-hours a day for the public to call.
Because Flagstaff has such a large volume of tourists from other states and countries, it would be impossible to contain the outbreak within the city, the state or even the country, Worgess
The NPS currently has 12 million doses of the smallpox vaccine, and Worgess
is unsure if enough vaccines could be sent in the event of an outbreak to inoculate everybody.That would force the team to make the tough decisions on who would get the vaccines and who wouldn't.Among those who would receive the vaccines would be the health care workers themselves as well as law enforcement officials.
To test the measures put into place, Worgess
said a simulated smallpox outbreak will be conducted in December to show their effectiveness and areas that need more work.
"We may not be totally prepared but we kind of have an idea on what we need to do and we're working on it," she