It’s spring break, that time of year when we Midwesterners are aching for warmer temperatures and, if we are lucky, booking a relaxing trip to the beach. But not Sandy Johnson. As frightening headlines and cases of the COVID-19 or Corona virus multiply, Johnson, who is an Army veteran and an experienced emergency response expert, is headed toward the Pacific in mid-March, where she will be working with Heart to Heart International on emergency preparedness for zoonotic disease including Dengue Fever and COVID-19 in the Marshall Islands.
We took a moment out of her busy work schedule and trip planning to learn how to prepare for a pandemic.
Sandy, can you tell us about the trip and the entities involved?
I am deploying with Heart to Heart International (HHI), a well-respected 501 3C that has several health and medical mission areas. I love this organization for several reasons: they are professional, they never deploy without being invited, and they are based in Kansas City (Lenexa)! In this instance, HHI is deploying at the request of the World Health Organization (WHO) and the Republic of the Marshall Islands (RMI) to assist with an on-going outbreak of Dengue Fever, an uptick of seasonal influenza, and the planning for any cases of COVID-19. As I prepared for the trip, I did a lot of research on the RMI and its infrastructure and culture. The team that I am traveling with consists of 9 people, mostly clinicians, and several of us logistics and planning types.
Most people are intimidated by anything Corona/COVID virus, but you are heading toward the issue. Why did you choose to go?
I am not afraid. I have great faith in science-based prevention and mitigation strategies. RMI does NOT have any cases of COVID-19 yet, so the risk is low. The mosquitos are the biggest threat right now. RMI has already started planning for the isolation and quarantine of any infected personnel and I am confident that their approaches will be fine-tuned because they are pro-actively planning and putting a lot of resources into it. You have to admire a small island — in this case many islands — nation reaching out and requesting assistance to prepare for a disease outbreak like this.
You don’t have a medical background; tell us how your experience is key for this project?
You are correct! I am so fortunate that I will be traveling and working with a team of doctors and nurses. I have a lot of respect for them, on the front lines, doing active patient care. In order to give them the time and resources to do what they need to do, teams use people like me – experienced emergency managers – to help with the logistics and planning. We get to ask “dumb” questions and use the clinical experts to help us find ways to do things that need to get done with the resources that are available.
I spent six years working in public health, focused on the logistical planning required to provide prophylactic medications to large numbers of people in a short period of time. Having that basic understanding of what the medical community needs, partnered with the knowledge of what the first responder community needs, is invaluable when preparing for health emergencies that are not in the traditional scope of response.
How is your work at SES, with Foreign Animal Disease training and emergency preparedness, relevant for this project?
The work we do at SES is very similar. Our non-veterinary team provides facilitation, planning, training and exercise expertise to assist the veterinary response community with planning for foreign animal disease outbreaks such as African Swine Fever and Foot and Mouth Disease that we hope will never happen.
What types of issues will you address?
We will start with getting to know the decision-makers and learning about their current plans and resources. I have already started this research and the team leaders have been in contact with RMI and WHO. We will work with them to identify any gaps in current planning and resource management. As we work with the community partners, the goal is to help them fill the gaps and assist them with using best practices from other outbreak responses to plan for any future disease issues. I also envision training and some smaller exercises done with leadership and clinicians. Part of the team is also tasked with the assignment of teaching local clinicians and workers how to use Personal Protective Equipment (PPE) appropriately.
How is emergency preparedness for a human pandemic similar to mitigating foreign animal disease outbreaks?
Biosecurity – this is the similarity. Effective biosecurity prevents the spread of diseases in animals and people. Everyone hears the messages from CDC – wash your hands, maintain distance, don’t sneeze and cough into the air — but I am not sure the general public understands just how these basic actions really do make a difference when it comes to disease control.
When it comes to personal protective equipment such as masks, proper use protects the wearer, but also prevents the spread of disease outside of the clinical environment. These practices are standard with human and animal disease events. Isolating infected people, quarantining exposed people, proper cleaning and disinfection in and out of quarantine areas – all standard with both responses. Previous disease responses (both human and animal) have demonstrated that a breach in biosecurity can have major consequences.
What’s different? I would say we can’t draw a circle and depopulate, but that would seem callous. But it is true. Isolation of infected patients is a critical component that we don’t often deal with in animal events, although it has been discussed when working with exotic, endangered, and high value animals. The other difference I can think of would be the fear factor. New diseases of humans are scary and there is still a lot that we don’t know about COVID-19. The public doesn’t seem to get as concerned about animal diseases, as evidenced by the Highly Pathogenic Asian Avian Influenza outbreak in 2015.
What do you pack for a pandemic?
In this case, my packing has been more focused on mosquitoes. I have a net to put over my bed and I am bringing long-sleeved shirts and bug repellent (DEET). The packing list also includes hand sanitizer and a requirement for a variety of immunizations, most of which I had in the army, but I did have to update my Typhoid. I must also travel with proof of my Measles vaccine since that disease is making a come-back in the region. I packed some stickers (for the children) and scrubs (hard to get there) for nurses. I am also in the process of downloading books and videos to my kindle to entertain myself in case COVID-19 shows up on the island and I have to sit in quarantine before returning to the US.
What are you looking forward to on the trip?
Normally, I would say the tropical weather, but this entire situation is so intriguing to me. The Marshall Islands are unique with their history and a not-too-great prognosis for the future. The islands are only 5-to-7 feet above sea level and rising ocean levels are threatening their very existence. I am looking forward to meeting and getting to know people that are so resilient and positive about the future. I am also looking forward to working with the team from Heart to Heart and doing whatever we can to lighten the load for the Marshallese people.
Our team at SES all wish Sandy and the Heart to Heart International team safe travels and a successful project. Thank you for your efforts.