Most of the U.S. likely has not adequately prepared for it, even under the umbrella of all-hazards or whole community planning. MERS has reportedly killed more than half of the 55 infected victims, once again raising concerns for a viral respiratory illness that could evolve into the next Severe Acute Respiratory Syndrome or even worse, and the U.S. is inadequately prepared for it.
Reports indicate that this virus has been identified in time to contain it and classify it quickly if encountered in other locations to institute the appropriate response. However, are we truly prepared if this novel coronavirus were to appear on our shores after a short flight if it adopts the level of person-to-person transmission that the Severe Acute Respiratory Syndrome reached? Or should we be concerned about other emerging viruses, such as the H7N9 influenza virus in China, that appear and then often recede without sustained human transmission?
If MERS were to arrive in the U.S., it would trigger a response in many critical sectors, especially medical services, public health and law enforcement. It would surely test our medical detection and surge capacity capabilities to a level that may demonstrate insufficient planning and preparedness in an all-hazards world. One of the first lines of defense, and possible failure points, would be the initial screening and identification of the virus in time to utilize designated quarantine and isolation procedures and practices to contain the spread of the virus. If possible, containment would be the most effective response to assess and control the exposure of the emerging threat. This raises at least two questions:
- Are we prepared to utilize federal- or state-ordered isolation procedures with short notice at a border, medical facility, screening location or city limit?
- Do we have comprehensive plans and resources to support this rather unique and very infrequently executed mission?
For those not directly involved in this field, this topic may be quite foreign and irrelevant for their day-to-day duties and priorities. Inaccurately, too many may view this threat solely as a federal responsibility to interdict and contain at an international border. There are national strategy documents to help frame and assign responsibilities for an obligation shared by all levels of government and the private sector. The National Strategy for Pandemic Influenza (2005) (PDF) and the Implementation Plan for the National Strategy for Pandemic Influenza (2006) (PDF) outline how the nation would prepare for, detect and respond to a potential pandemic threat, specifically influenza.
The 2005 strategy document identifies three pillars for the national strategy, the third being:
Mitigate the health, social and economic impacts of a pandemic; and where appropriate, use government authorities to limit nonessential movement of people, goods and services into and out of areas where an outbreak occurs.
(The other two pillars are Preparedness and Communication, and Surveillance and Detection.)
The 2006 implementation plan begins with the following statements to frame the threat and necessity for the involvement of all levels of government and citizens.
“In the last century, three influenza pandemics have swept the globe. In 1918, the first pandemic (sometimes referred to as the Spanish Flu) killed more than 500,000 Americans and more than 20 million people worldwide. One-third of the U.S. population was infected, and average life expectancy was reduced by 13 years. Pandemics in 1957 and 1968 killed tens of thousands of Americans and millions across the world.”
The active engagement and full involvement of all levels of government and all segments of society, including at the community level, are critical for an effective response. Ultimately, however, the actions of individuals will be the key to the response.
The 2006 implementation plan identifies numerous key considerations such as delaying a pandemic, screening procedures and other proactive measures, as well as law enforcement response during an outbreak, quarantines and other movement restrictions. The national strategies confirm the truism that all incidents begin and end locally. According to the implementation plan, state, local, tribal and private-sector entities have primary responsibility for the public safety and security of persons and nonfederal property within their jurisdictions, and are typically the first line of response and support in these functional areas.
The pandemic strategies acknowledge the unique challenges that state, local and tribal organizations would encounter during a pandemic illness that requires expanded mutual aid between them and/or federal assistance. As a result, government agencies are encouraged by the national documents to formulate comprehensive pandemic response plans and undergo training related to the execution of their plans. However, the development of these plans requires a comprehensive understanding of their operating environment in conjunction with their vulnerabilities during an emerging epidemic or pandemic. What are their capabilities and responsibilities under the national strategy in relation to other government levels? Are there other relevant federal strategies and guidance to be considered by the policymakers and planners?
There are other applicable federal strategies, laws, plans and programs to consider while developing a thorough plan for a pandemic threat including: the National Incident Management System; National Response Framework; Emergency Federal Law Enforcement Assistance Program (EFLEA); Robert T. Stafford Disaster Relief and Emergency Assistance Act; and Public Health Service Act. EFLEA can provide certain federal law enforcement resources, but may require supplemental funding to execute complex or prolonged missions depending on its current appropriation level. The Stafford Act can provide federal resources through an annually funded mechanism upon an approved presidential declaration. The Stafford-Act-funded mission support would likely be coordinated through the National Response Framework Emergency Support Functions process for a broader response to include all support functions. The Public Health Service Act provides the authority to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states.
Beyond the general authority and possible funding sources listed above, federal law also identifies the federal officers responsible for certain enforcement and quarantine activities during a public health emergency. The federal officials with legal authority, and at times mandate, to enforce federal and state quarantines are identified within the 2006 implementation plan and by federal statutes. It’s essential to identify and understand the different authorities for the assistance requested and the appropriate method for obtaining support, if available. The enforcement of quarantines is neither limited to any one level of government nor successfully executed without extensive cooperation, coordination and collaboration by many diverse public and private organizations.
Because of the financial challenges in federal, state, local and tribal organizations, it’s unlikely that a majority of organizations are fully prepared to handle an emerging threat such as a quickly expanding epidemic or pandemic illness. According to the Centers for Disease Control and Prevention, states have police power functions to protect the health, safety and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine.
These laws can vary by state and can be specific or broad. In some states, local health authorities implement state law. In most states, breaking a quarantine order is a criminal misdemeanor.
Tribes also have police power authority to take actions that promote the health, safety and welfare of their tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands, if such laws exist.
A pandemic-prone virus — stemming from H5N1, H1N1, H7N9 or other highly pathogenic strain — is often viewed as a public health and medical services responsibility, but law enforcement, military and numerous other public and private partners have critical responsibilities to execute in close coordination. As with many previous significant incidents and major disasters, there’s little time to plan and prepare when the new threat appears and rapidly expands.
The following questions should be considered: Who will support medical services and public health officials when they are overwhelmed? How would quarantine and isolation procedures be implemented within your jurisdiction if required to contain an illness and any subsequent public unrest? Can we afford to address this subject? Can we afford not to, at least within an all-hazards and whole-community mindset with multifaceted planning that shares resources?
Robert C. Hutchinson is a supervisory special agent with a federal law enforcement agency.
The opinions expressed herein are solely those of the author in his individual capacity, and do not necessarily represent the views of his agency, department or the United States government.
