The last week of April 2009, on college and university campuses across the United States, administrations were trying to decide what to do about commencement handshakes in light of A-H1N1 (a.k.a. swine flu). Some opted to reduce the possibility of disease transfer by eliminating the traditional handshake. Others planned to hand each graduate a diploma with one hand and a carnation with the other. And yes, there were serious and scholarly discussions about elbow bumping because the fist bump might still spread a virus.
How to achieve social distancing at commencement certainly was not a parameter the University of California at Davis envisioned during a spate of pandemic planning in 2006. Our planning scenario was for a much more virulent and novel virus: newly discovered and quickly spreading around the world, causing death and mayhem in its wake, suspending classes for perhaps weeks, seriously interfering with research and maybe even delaying our paychecks. When those first H1N1 cases were announced in April and the World Health Organization (WHO) started raising its pandemic phases, we were ready for that anticipated, requisite, full-blown response — that wasn’t really necessary.
The “fifth law of emergency management,” according to Art Botterell, a well known expert in public alert communication, is this: “The worst case is the easiest.” Logic dictates that if we build our plans and practice to respond to the worst-case scenarios, we can respond to anything. Right?
Wrong. The worst-case emergency is the easiest to identify. It’s the smaller emergencies — the ones in between nothing and everything — that trip us up. Smaller emergencies are much more ambiguous and harder to recognize. The necessary response level is uncertain, and there is much hesitancy about how, when and whether to implement a response.
What about the emergency that starts out small and takes time to become the worst case? Think of it as a continuum — not several individual emergencies, but one long emergency that gradually keeps worsening. This would be the event that takes months or years to go from being uncertain how much of a response to stage, progressing to engaging all possible resources. This type lulls us into complacency because we don’t comprehend what is happening. Picture an egg put in cold water over low heat so the water never actually boils. How long does it take to get a hard-boiled egg? And where is the tipping point — where the momentum becomes unstoppable and the egg is going to be hard-boiled whether we want it to be or not?
All influenza viruses are unpredictable; the flu vaccine we get every fall is an attempt to guess which of the known strains will be circulating that year. The WHO has worldwide surveillance systems watching for the emergence of novel strains of influenza because they can mutate or recombine into new varieties. The A-H1N1 influenza almost meets the definition of a pandemic: It is novel and widespread, but it hasn’t become as virulent as our planning scenarios suggested. Yet the death and mayhem of the 1918 Spanish influenza was preceded by almost a year of relatively mild disease.
That’s why the Centers for Disease Control and Prevention (CDC) and WHO are treating A-H1N1 seriously and aggressively. They don’t know what this virus will do.
Let’s assume the A-H1N1 influenza is similar to the influenza in 1918 and becomes the novel, virulent virus we built our plans around. Furthermore, let’s assume it follows several months of increasing numbers of seasonal flu-like illnesses, a few deaths and lots of people suggesting we are overreacting. The media would zone out, the public would zone out, and the rising evidence of that worst-case scenario would become background noise.
In other words, nobody would be paying attention until, suddenly, they are. When it finally hits the tipping point, how well your institution survives is going to depend on how well you were paying attention.
These are the lessons I have learned from the swine flu pandemic:
- Listen to the experts directly and more carefully than you listen to the media interpretation of what the experts said. The WHO and CDC were urging caution and saying “geography doesn’t equal severity” from the beginning.
- Rethink your planning scenario for an influenza pandemic. We don’t know what A-H1N1 will become, but we do know it isn’t going away. If it does become severe, it may do so gradually.
- Base your planning on factors that are relevant to your community. Our plans were pegged to the WHO phases, where a Phase 5 meant activating our plans for excessive absenteeism — and as of press time, there were three confirmed cases in our county.
- Adapt your individual response. There is a reason it is being called a marathon, not a sprint.
- Prussian Field Marshal Helmuth von Moltke the Elder said, “No battle plan survives contact with the enemy.” Emergency management is all about flexibility.
This article is reprinted from the June 2009 IAEM Bulletin, the monthly newsletter of the International Association of Emergency Managers at www.iaem.com.