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Introduction: Health, Pandemics and Resilience Resilience is also an issue when confronting homeland security threats of biological, chemical weapons and a health focused virus such as COVID-19. These three threat vectors have been around for a long time and are the subject of on-going research and refine by non-state & state actors and the environment. Academics often also include radiological and nuclear devices in this type of discussion but for the purposes of this lesson the focus will stay tightly focused on chemical and biological weapons. The presence of COVID-19 has forced a complete revision of the way the world looks at this type of health threat.

(CDC.gov)

On March 20, 1995 the cult Aum Shinrikyo, led by Shoko Asahara, dropped five plastic bags of liquid sarin in the Tokyo subway system unleashing an attack that would eventually kill 13 people. The attackers pierced the bags with metal tipped umbrellas. Fortunately, their tactical expertise was not perfected, and the attack was contained. This chemical weapon, and there are many more like it and was initially developed in the late 1930s by the Third Reich. Poor planning by the attackers and exceptionally swift response by first responders prevented the death of thousands. In the end 200 members of the cult were convicted.

A more recent example of why the institution of a framework of resilience is so important occurred in 2014 as the world faced a collected threat of an international pandemic via the Ebola virus. The wide-spread international hysteria

started from a small western African village and spread quickly. For two years the World Health Organization considered this the worst international disease outbreak Black Plague. One of the many keys to arresting the spread was the institution of a Resilience Framework included developing quarantine procedures, addressing the need for protective clothing protocols while also institution exposure limits to those considered to be an “at risk” populations.

In 2019 the National Academy of Science (2019, Dec) conducted a workshop entitled, “Improving International Resilience and Response to Chemical, Biological, Radiological, and Nuclear Events”. The report from that workshop noted:

Chemical, biological, radiological, and nuclear (CBRN) events are rare, but can be highly destructive. In addition to potentially causing large numbers of fatalities and injuries, these events may also “destabilize governments, create conditions that exacerbate violence, or promote terrorism.” They may overwhelm the infrastructure and response capacity of the nations where they occur, especially those lacking specialized resources. They can also trigger global economic effects: a single CBRN event that damages facilities in one place can affect supply chains and operations worldwide. Strengthening national and international resilience and capacity to respond to CBRN events is seen as a global security priority.

Fortunately, the developed world has embraced resilience as part of an over-arching strategy to address pandemics. The center piece document for instilling a national health security strategy that places resilience as the number one strategic objective is the National Health Security Strategy (NHSS) and Implementation plan for the Department of Health and Human Services. The Office of the Assistant Secretary for Preparedness and Response (ASPR) leads the effort in collaboration with other agencies, community organizations, academia and the private sector.

U.S. Department of Homeland Security

Archived Content

In an e�ort to keep DHS.gov current, the archive contains outdated information that may not reflect current policy or programs.

Health Threats Resilience Division

The Countering Weapons of Mass Destruction (CWMD) O�ice was established in December 2017 by consolidating primarily the Domestic Nuclear Detection O�ice, a majority of the O�ice of Health A�airs, as well as other DHS elements.

For current information related to CWMD, please visit the following:

Preventing Terrorism: Weapons of Mass Destruction (/topic/weapons-mass-destruction)

Countering Weapons of Mass Destruction O�ice (/countering-weapons-mass-destruction-o�ice)

The Health Threats Resilience Division in the O�ice of Health A�airs (/o�ice-health-a�airs) manages programs to help DHS and the nation prepare for and respond to chemical and biological threats, as well as other health threats and hazards. Major programs and initiatives include:

The BioWatch Program (/biowatch-program) provides early detection of a bioterrorism event and helps communities prepare a coordinated response. National Biosurveillance Integration Center (/national-biosurveillance-integration-center) integrates and analyzes information about health threats to help ensure the nation's responses are well-informed, save lives, and minimize economic impact. Chemical Defense Program advises and help guide DHS leaders, government policymakers, and community responders to prepare for and respond to high consequence chemical incidents.

Last Updated: 07/14/2020

Food, Agriculture, and Veterinary Defense programs help government decision-makers protect the health and security of the nation by protecting its animals, plants, and food systems. Integrated Consortium of Laboratory Networks (https://www.dhs.gov/now-leaving?

external_url=https%3A%2F%2Fwww.icln.org%2F&back_url=https%3A%2F%2Fwww.dhs.gov%2Fhealth-threats-resilience-division) is building an interoperable system of laboratory networks to provide surge laboratory support to a CBRNE incident, pandemic, or infectious disease outbreak. State and Local Initiatives help bring health care partners into the homeland security conversation to help communities with prepare, plan, and respond to the evolving threat landscape. Radiological/Nuclear Health Experts ensure the health, safety, and resilience of the DHS workforce against radiological and nuclear threats, and contribute to federal, state, and local response planning for radiological/nuclear incidents.

Leadership

The Health Threats Resilience Division is led by Director and Deputy Assistant Secretary Jonathan Greene.

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. 2011 Dec;9(4):321-30. doi: 10.1089/bsp.2011.0049. Epub 2011 Sep 9.

Biosurveillance where it happens: state and local capabilities and needs

Eric S Toner , Jennifer B Nuzzo, Matthew Watson, Crystal Franco, Tara Kirk Sell, Anita Cicero,  Thomas V Inglesby

Affiliations PMID: 21905878 DOI: 10.1089/bsp.2011.0049

© Mary Ann Liebert, Inc.

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Abstract

In recent years, improved biosurveillance has become a bipartisan national security priority. As has been pointed out by the National Biosurveillance Advisory Subcommittee and others, building a national biosurveillance enterprise requires having strong biosurveillance systems at the state and local levels, and additional policies are needed to strengthen their biosurveillance capabilities. Because of the foundational role that state and local health departments play in biosurveillance, we sought to determine to what extent state and local health departments have the right capabilities in place to provide the information needed to detect and manage an epidemic or public health emergency-both for state and local outbreak management and for reporting to federal agencies during national public health crises. We also sought to identify those policies or actions that would improve state and local biosurveillance and make recommendations to federal policymakers who are interested in improving national biosurveillance capabilities.

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The NHSS Aims to Improve Community Health Resilience Note the NHSS Strategic Objective #1. “The NHSS aims to improve community health resilience—a community’s ability to use its assets to strengthen public health and healthcare systems and to improve the community’s physical, behavioral, and social health in order to withstand, adapt to, and recover from adversity. This objective focuses on encouraging social connectedness, enhancing coordination of health and human services through partnerships, and building a culture of resilience”. The department has a wonderful web site that provides how this objective is going to be addressed.

But a strategy is just that, a strategy. For a strategy to be effective it needs to be operationalized. Where is the practical application to instill resilience and address a biological attack? One such program is HHS’ BioWatch which operates a network of air-monitoring collectors at multiple locations around the country. As part of this structure BioWatch laboratories process and analyze filter samples to determine the presence of select biological agents. Additionally, BioWatch operations are held to rigorous quality standards to ensure confidence in laboratory results.

(https://www.nap.edu/cover/18495/450)

After reviewing the different kind of attack vectors, one must conclude that there is no perfect system to safeguard against terrorist use of a chemical or biological agent. But by instilling a framework of resilience will reduce anxiety and greatly mitigate the consequences of an actual attack. The ability to “withstand” and bounce back will be significantly increased through resilience. Studying this issue will require resilience analysis at the micro, macro, physical and psychological levels.

Healthcare Ready recently conducted a survey of adults in an effort to better understand the disasters feared the most by Americans and how prepared they are for disaster (Fetchko, 2019). Results show 32% of those surveyed stated their greatest fear is natural disaster such as tornadoes, wildfires, and hurricanes (Fetchko, 2019). This is compared to the 5% of Americans most fearful of an environmental disaster, the 6% of Americans fearing cyber-attacks the most, 6% also fearing a pandemic, and 14% of Americans fearing terrorist attacks the most (Fetchko, 2019). These results show Americans are more fearful of natural disaster more than cyber-attacks, environmental disasters, pandemics, and terrorism combined (Fetchko, 2019). Has the COVID-19 pandemic changed the way the world thinks about this issue, and will the world will be ready and resilient in the future?

(https://www.news-medical.net/news/20210803/Resilience-training-for-healthcare-workers-during-the-COVID-19-pandemic.aspx)

COVID-19 has tested the world’s resilience, in the form of a deadly virous in a manner that has not been seen since the black death. The diagram below from Harvard University captures the way the virus has been impactful.

https://developingchild.harvard.edu/resources/how-to-help-families-and-staff-build-resilience-during-the-covid-19-outbreak/

The pandemic’s impact on the economy is visible everywhere. However, the impact on the human psyche is even more significant. Stern (2021), writing for Harvard Medical School noted, “Since the pandemic began, mental health symptoms related to depression, anxiety, suicide, and substance use are up dramatically. As many as 40% of US adults have reported struggling with mental health or substance abuse during this time. This number represents a serious and deadly corner of the pandemic that has not received enough attention”.

The Covid-19 pandemic led many governments in countries around the world to impose lockdowns that have lasted several weeks to several months. Some examples of truly dramatic lockdowns included New Zealand, South Korea and within the United States the state of Hawaii. When these lock-downs occurred the cognitive, emotional, physical/somatic, and social stress that was impacted on children and adults in the world. Going to virtual learning essentially reduced comprehension and enhanced isolation. Professions that could allow for remote work also saw a significant impact.

Oksanen et al. (2021) looked at elements of the Finnish working population during COVID as they worked in an isolated manner. The result from stress to social media impact was significant. “Covariates included cyberbullying at work, social media usage, personality, occupational status, and sociodemographic factors. Results showed that formal SMC increased and predicted higher technostress.”

Before concluding this week, there was one other issue to consider as your review this week’s lessons. In the next few years, more and more COVID variables of the virus will be found. Is the world ready for another wave of lockdowns, shortages and isolation? Is there an impact of the very social science of our country and its’ government?

In�uenza (Flu) In�uenza (Flu) Home

Pandemic Severity Assessment Framework (PSAF) Once a novel in�uenza A virus is identi�ed and is spreading from person-to-person in a sustained manner, public health o�cials use the Pandemic Severity Assessment Framework (PSAF) to determine the impact of the pandemic, or how “bad” the pandemic will be. There are two main factors that can be used to determine the impact of a pandemic. The �rst is clinical severity, or how serious is the illness associated with infection. The second factor is transmissibility, or how easily the pandemic virus spreads from person-to-person. These two factors combined are used to guide decisions about which actions CDC recommends at a given time during the pandemic.

The framework is divided into two parts. The �rst part is the initial assessment, which happens early during a pandemic. At this time, activity may be detected in pockets or certain communities across the country so information and understanding about the pandemic virus will be limited. By studying the information that is available, CDC can produce a preliminary assessment of the potential impact of the pandemic (e.g., low to moderate transmissibility and moderate to high clinical severity). However, that assessment may change as the pandemic evolves and more information is known.

The second part, or re�ned assessment, happens later in the pandemic when more information is available. This additional information helps to provide a more re�ned and accurate picture of pandemic impact, including assessments of the pact by age group.

The results of these assessments can be compared to past pandemics (or even seasonal in�uenza epidemics), creating a quick comparative snapshot of the potential impact of the pandemic. For example, using the PSAF, the 1918 pandemic can be characterized as one with very high transmissibility and very high clinical severity whereas the 2009 H1N1 pandemic can be characterized as one with moderate transmissibility and clinical severity for the overall population. The results help public health o�cials and health care professionals make timely and informed decisions, and to take appropriate actions.

The PSAF is one of two assessment tools developed by CDC to guide and coordinate actions among federal, state, local, and tribal entities involved in pandemic response. Please refer to “Novel Framework for Assessing Epidemiologic E�ects of In�uenza Epidemics and Pandemics” for more information about the PSAF.

Related Links

Pandemic Intervals Framework

In�uenza Risk Assessment Tool

Pandemic Planning and Preparedness Resources

Pandemic In�uenza Risk Management: WHO Interim Guidance 

Last Reviewed: November 3, 2016 Source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

References National Academies of Sciences, Engineering, and Medicine. (2019). Improving International Resilience and Response to Chemical, Biological, Radiological, and Nuclear Events: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/25666.

Stern, A. (2021, Feb). Seeking solace, finding resilience in a pandemic. https://www.health.harvard.edu/blog/seeking- solace-finding-resilience-in-a-pandemic-2021022522029

Oksanen, A., Oksa, R., & Savela, N. (2021). COVID-19 crisis and digital stressors at work: A longitudinal study on the Finnish working population, Computers in Human Behavior, 122(106853). https://doi.org/10.1016/j.chb.2021.106853.

(https://www.sciencedirect.com/science/article/pii/S074756322100176X)