CDC marshals its forces for SARS

[Guest guest]

http://www.usatoday.com/news/health/2003-05-26-warroom-usat_x.htm

 

The latest alien threat, the " enemy " that draws the world together under the

loving global government wherein you give up all your rights in a state of

mass hysteria. It's the new way of thinking...

 

CDC marshals its forces for SARS By Steve Sternberg, USA TODAY Posted

5/26/2003 10:02 PM

 

ATLANTA -- The adversary is elusive, invisible and deadly, and until a few

months ago it was an alien life form never before seen on Earth.

 

It's the virus that causes SARS, severe acute respiratory syndrome, and

experts say the only way to defeat it is through a steady stream of

intelligence - knowing where the virus came from, how it's passed along, who

is most at risk and how to protect those people from becoming new links in

the global chain of transmission.

 

All these details and more flow to the dozens of people rotating through a

softly lit basement bunker at the Centers for Disease Control and

Prevention. Here, in the agency's new Emergency Operations Center, some of

the world's leading medical detectives exploit the information to plot their

campaign to control SARS.

 

This is the CDC's nerve center for any health emergency, from SARS to

bioterrorism, from West Nile virus to the investigation into Canada's

discovery of mad cow disease.

 

Ever since SARS pushed the command center to go " 24/7 " on March 14, two

weeks early, SARS has dominated the agency's priority list.

 

More than 250 people at the command center and elsewhere have been working

frantically to track and control the outbreak that exploded from China in

late February, causing 8,202 cases and 725 deaths worldwide. Sixty-five

cases have occurred in the USA. So far, no one here has died.

 

More than 30 CDC experts have traveled to China, Hong Kong, Vietnam,

Thailand and Taiwan. The risks they take as they investigate outbreaks hit

home during the weekend when four members of the Taiwan team were evacuated

by air ambulance to Atlanta after one of them came down with symptoms of SAR

S. The person with the suspected case was confined in hospital isolation;

the three remaining team members were placed in voluntary quarantine at

home.

 

Others are working with state health departments investigating U. S. cases,

tracing their contacts and trying to keep the virus from spreading locally.

Still others are monitoring studies into the virus, watching Defense

Department research into treatments and evaluating hospital

infection-control procedures. A staffer from Health Canada, the Canadian

public health agency, serves as a liaison between his country's SARS team

and the CDC.

 

The epidemic has ebbed and then surged, with early successes in Vietnam and

most other countries offset by stubborn outbreaks in parts of China, Hong

Kong, Taiwan and Singapore. The mood at CDC Director Julie Gerberding's

morning briefing one day in late May reflected the concern of those charged

with helping to end the outbreak.

 

" Unfortunately, we have bad news to report, " says James LeDuc of the CDC's

National Center for Infectious Diseases. " In Taiwan, we've had three

separate clusters in hospital rooms; 110 health care workers, patients and

visitors were quarantined. That's really a setback.

 

" In Singapore, we were almost there, and it looks like there's a new cluster

of cases in a mental health hospital. ... "

 

LeDuc's matter-of-fact delivery belies the chaos unfolding outside the

crisis command center's deliberate calm.

 

In Taiwan, the newest SARS hot spot appears to have begun in the emergency

room of the country's premier hospital, National Taiwan University Hospital

in Taipei, where patients flock for treatment. " They have people waiting in

the emergency room for days at a time, " says John Jernigan, who is head of

the CDC's clinical care team.

 

To control the outbreak, the emergency room is temporarily closed. Doctors

and nurses are quarantined, and anyone who violates quarantine can be fined

and confined by the military. Shortages of surgical face masks reportedly

prompted fearful people to make do with bra cups and plastic bowls.

 

In Singapore, health authorities ordered 1,600 staffers at Tan Tock Seng

Hospital, a mental health institute, into isolation - all because 24 elderly

patients and six nurses began showing symptoms of SARS.

 

" Hong Kong continues as normal, " LeDuc says. " Unfortunately, another health

worker was infected there. China reports 55 new cases, 39 of those in

Beijing. On the domestic front, we have two new suspect cases, both with

travel histories to Hong Kong. "

 

Gerberding nods, saying little. She is wearing her trademark business suit,

this one a somber blue. Her hair is black with a wedge of gray, and her

presence fills the room. Hints of humor occasionally penetrate her usual

South Dakota reserve, particularly when she is told that one of the 35

states with access to SARS tests is South Dakota.

 

When the meeting breaks up, Gerberding huddles with a few senior staffers.

Frosted glass doors slide open to reveal the command center itself. It is a

long rectangular room with super-sized video screens on one wall, above a

futuristic semicircular desk with four large swivel chairs. Some staffers

liken it to the bridge of the Starship Enterprise.

 

From right to left are four workstations: one for the emergency response

coordinator, whose job is to know everything that's happening worldwide

during his shift; another is for the emergency operations officer, who

handles logistics and communications; and the third is for the CDC expert

leading the emergency response. For SARS the team leader might be LeDuc or

Jim Hughes, director of the CDC's National Center for Infectious Diseases.

 

In a crisis demanding her constant attention, such as a bioterrorism attack,

Gerberding would take her place on the far left.

 

From their stations, the team leaders can swivel to view maps and statistics

or take part in videoconferences on the huge video screens. Or they may turn

to address the two rows of desks now staffed with experts from every CDC

division involved in the SARS outbreak. Along each row, people hunch over

computer screens, singly or sometimes in twos or threes.

 

In small workrooms off the main command center's rear wall, groups of half a

dozen people or more work the phones, talking with state health officers,

border control posts, hospitals, laboratories, the World Health Organization

and experts in the field.

 

CDC has about 250 experts working on SARS, including those abroad. A CDC

field team also was dealing with TOPOFF 2, the simulated terrorist attack

involving a " dirty bomb " attack in Seattle and a plague outbreak in Chicago,

which by then had reached 350 cases. Despite the two-way traffic in huge

volumes of information, CDC computers are working at just one-tenth of their

capacity.

 

The humans seem unruffled, too.

 

" It's pretty calm for the most part, " says Jeff Cook, the command center's

operations officer. A retired Army lieutenant colonel, Cook handled similar

logistics during his 21 years in the military.

 

CDC officials say the scene today marks a big change from the crisis

atmosphere during the twin nightmares of Sept. 11 and the anthrax attacks in

Florida, New York and Washington, D. C.

 

Because they lacked a command center, CDC staffers directed the dual

emergency effort from makeshift workstations hurriedly dragged onto the

stage in the CDC's auditorium. The attacks prompted Congress to support a

$15 billion overhaul of the CDC's physical plant. But it was a visit by Home

Depot co-founder Bernie Marcus that turned the command center into a

state-of-the-art facility.

 

Marcus, a longtime CDC booster and former president of the CDC Foundation

(a non-profit body authorized by Congress to assist the agency), says he was

appalled at the organization's lack of preparedness.

 

" They didn't have the right kind of equipment, " Marcus says. " They were

getting most of their information from CNN and Fox News. They had cell

phones that weren't working; they had no satellite phones. It was pathetic.

If there had been some kind of biological warfare attack, they were not

prepared to do anything about it. They wouldn't have gotten any information

for days. "

 

Former CDC director Jeffrey Koplan persuaded Marcus to help. He pledged $3.9

million to equip the command center and called on corporations for

additional support. Fifteen major computing, telecommunications and other

companies provided equipment for free or at steep discounts.

 

Marcus, through the CDC Foundation, also established a $300,000 fund to

enable emergency response teams to buy or lease equipment - like extra

satellite phones - without going through elaborate government purchasing

procedures.

 

When the crises ebb, if they ever do, the CDC will scale back its efforts.

" All emergencies have phases, " Gerberding says. " The response mode, the

recovery mode, the mitigation mode. Sometimes they're happening at the same

time; they're not consecutive.

 

" We had a meeting last week to discuss where we are in the cycle of response

to SARS. Is it time to scale up? Scale back? Generally, we don't suddenly

say it's over. "

 

The CDC, and much of the government, models its emergency response efforts

on the " incident response " system developed in California to fight

wildfires. One key component is constantly rotating staff members to

minimize burnout. " We're learning from SARS, we're learning from TOPOFF.

We're learning as we go along, " Cook says.

 

" We have to get ourselves ready for West Nile. That's on our minds right

now. "