http://www.nytimes.com/2005/02/07/nyregion/07bioterrorism.html?
City Weighs Plans to Deliver Medicine to Public After Attack By IAN URBINA Published: February 7, 2005 t the end of the first stage of a federal pilot program to determine how major cities could deliver medicine to thousands of people within 48 hours of a terrorist attack, New York is grappling with several proposals to achieve that goal. One plan being considered by federal and city officials involves using postal workers to distribute medicines. Another would ask the city's home-care health aides to volunteer to give out the needed drugs. Some city emergency planners have suggested using drive-through windows at restaurants and banks as points of distribution. Each idea has its drawbacks, emergency planners say. Beyond concerns about potential civil unrest and communication constraints, city health officials question the reliability of any delivery force, especially one that is made up of volunteers or people with no medical training. Health experts and emergency planners wonder whether some of the city's emergency medical supplies could be used quickly enough since some of them are stored outside the state because of jurisdictional disputes among city agencies. "New York City has learned a lot since 9/11, and in many ways it's way ahead of the curve in terms of readiness," said Dr. Shelley A. Hearne, the executive director of the Trust for America's Health, a nonprofit group based in Washington. "But the planning for actually delivering medicines and food to individuals is at a surprisingly rudimentary level." In addition to the Sept. 11 attacks, the West Nile virus, the anthrax-laced letters sent through the mail, the worldwide outbreak of severe acute respiratory syndrome or SARS and, most recently, the unexpected shortage of flu vaccine have provided the city valuable lessons, especially in the use of points of distribution for the rapid dispersal of supplies. Federal officials have been pressuring New York and the 20 other cities in the program to begin preparing a plan for delivering medicine door-to-door to thousands of people in less than two days, since certain types of biological, chemical or radiological emergencies might keep residents confined to their homes. That federal push stems in part from bioterrorism experts' fears about the ease of a large-scale release of anthrax, said Dr. William F. Raub, an emergency preparedness official at the federal Department of Health and Human Services. "There are chemicals of a very similar nature sprayed over entire national forests to kill gypsy moths," he said. "We now realize that an outdoor anthrax release over a city would not be difficult at all." That concern was one reason why the eight-month pilot program, known as the Cities Readiness Initiative, was announced by the Health and Human Services Department in May. The $27 million program, which is coordinated by the Centers for Disease Control and Prevention, provided New York City with $5.1 million to begin improving its distribution plans. The program also set aside $12 million for the United States Postal Service to recruit, train and equip volunteer mail carriers to deliver drugs from the strategic national stockpile, the country's emergency supply of drugs and medical equipment. New York is one of 10 cities that have expressed interest in the postal worker plan, but city officials and postal service representatives are still discussing details, including the possibility of using police officers to protect carriers delivering the medicine, said Patrick Mendonca, manager of corporate and field operations support for the postal service. If those issues can be worked out, he said, postal officials will begin contacting regional postmasters and local postal unions to start recruiting volunteers. Under the plan, carriers who volunteer would be contacted by phone in the event of an emergency and told to go to a designated depot where they would be given the appropriate medicine and provided protective gear. Whenever possible, carriers would be assigned to their normal mail routes. In delivering to high-rise buildings, carriers would not go door to door but would leave the medicine and printed directions in residents' mailboxes. There are various circumstances in which the city might need a strategy for fast door-to-door delivery, said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at the Mailman School of Public Health at Columbia University. A major outbreak of SARS in New York might require mass quarantines, and city officials would need to reach thousands of people, he said. If the 9/11 attack had involved an airborne release of smallpox or anthrax, Dr. Redlener said, or if a plane had hit a nuclear reactor near New York, like Indian Point, officials might have needed to tell people to stay home and deliver medicine to them. Roughly 100,000 city residents are homebound because of age, infirmity or physical disability, and officials would have to be ready to reach or relocate some of them in many kinds of emergencies. Emergency planners and local officials say the plan to use postal workers, while certainly innovative, raises questions. "Postal carriers signed up to carry the mail in times of rain, sleet or snow, not anthrax," said David Heyman, a bioterrorism specialist at the Center for Strategic and International Studies, a private research organization in Washington. "If there are questions of whether medical personnel would even show up to work under such conditions, it's certainly not clear that postal carriers would." Studies conducted by the National Center for Disaster Preparedness at Columbia University predict that about 35 percent of the city's hospital workforce would not report to work in the event of a biological or radiological catastrophe. There are also concerns that the medicine would be stolen from mailboxes and that illiterate residents and those who do not speak English would be unable to read the instructions. It is not even clear how many people would be home to receive the medicine. "Estimates indicate that about a third of the population would follow orders if told to shelter in place, a third would head for the hills, and a third would hang around to help mobilize relief efforts," said Stephen Prior, the director of the National Security Health Policy Center at the Potomac Institute for Policy Studies, an independent, nonprofit public policy research institute in Arlington, Va. "But these are the types of variables that we have to start figuring out." Dr. Isaac Weisfuse, a deputy commissioner of the city's Department of Health and Mental Hygiene, said city officials were undecided about the postal plan but were concerned about further burdening local law enforcement by asking police officers to escort the deliverers. Also, postal carriers would not be able to give medical advice to those who would probably ask for it, he said. City officials have begun talking with visiting-nurse services about possibly providing volunteers to deliver medicine to the homebound. Joseph F. Bruno, the commissioner of the city's Office of Emergency Management, said his staff was open to the postal plan and was also discussing using drive-through windows at fast food restaurants and banks to distribute supplies at points even closer to people who need them. In planning for major emergencies, jurisdiction is always a complication, but federal officials cite recent strides in the case of New York City. In November, the New York Police Department, the F.B.I. and the city's health department reached an unusual accord establishing a clear protocol for cooperating and sharing information in conducting investigations of suspected biological attacks. That kind of collaboration has not always been the case, and interagency strife has resulted in emergency medical supplies being stored outside the city. Federal officials who oversee the strategic medical stockpile, which is stored at undisclosed locations around the country, decided that the size of New York City's population warranted allotting it antibiotics and other medicines that could be kept in the city, but the city's Office of Emergency Management and the city's health department disagreed over the warehousing arrangements, according to a medical expert who was part of the discussions. The health department held jurisdiction over the supplies but it did not have warehouses that met security and other requirements for storing the material. The Office of Emergency Management did have warehouses that met those requirement but the health department did not want to cede control of the supplies, said the expert, who did not want to be identified because of security concerns. Instead, the health department officials decided to use private warehouses outside the state, the official said. "Things have gotten a lot better since then in terms of cooperation," the official said, "but it still makes no sense to have a portion of the city's supply not under the city's jurisdiction." Dr. Weisfuse, the deputy health commissioner, said that the department worked well with the emergency management office and that there were multiple storage arrangements for emergency supplies both inside and outside the city. "New York City has come a long ways since Sept. 11 in terms of moving supplies," Ms. Hearne from the Trust for America's Health said. In October the city received the highest approval rating from the Centers for Disease Control and Prevention for its preparedness plan to receive and transport emergency packages to local distribution centers. "I think it's time to start moving the discussion to the next level," she said, "which is strategies for direct outreach to people's home." ------------------------ Yahoo! Groups Sponsor --------------------~--> Take a look at donorschoose.org, an excellent charitable web site for anyone who cares about public education! http://us.click.yahoo.com/_OLuKD/8WnJAA/cUmLAA/TySplB/TM --------------------------------------------------------------------~-> -------------------------- Want to discuss this topic? 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