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Colorado pandemic simulation exposed communication gaps before coronavirus’s arrival, state records show

State ran simulations involving highly contagious respiratory disease in 2017 and Ebola in 2019

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A pandemic simulation by Colorado’s public health department in 2017 revealed challenges in communication among state authorities, local officials and the public, including a lack of critical information available to people who don’t speak English — a problem some have said still exists during the current coronavirus outbreak.

Colorado Department of Public Health and ...
Colorado Department of Public Health and Environment Laboratory Services Division in Denver. Denver, Colorado on Saturday. March 14, 2020.

That exercise, which imagined a novel, highly contagious respiratory illness was spreading throughout the state, is one of two such simulations the Colorado Department of Public Health and Environment conducted in the past three years, according to summary reports obtained through the Colorado Open Records Act.

In 2019, a second exercise — named “Herbie-Fully Loaded,” after the Lindsay Lohan film — explored what would happen when a patient with Ebola was transported to a Colorado hospital. Through that exercise, officials discovered “how quickly the overall system might break in a real world response,” according to the five-page summary report.

The Department of Public Health and Environment’s response to the novel coronavirus pandemic is still underway. But the documents show how the agency was preparing for such a severe public health crisis, and potential issues that could arise, before the coronavirus outbreak swept the state.

Though the two reports don’t get into the types of supply issues state health officials are encountering currently — shortages in personal protection equipment, test kits and ventilators — they say that was an important lesson learned.

“The exercises highlighted challenges in obtaining supplies when there is significant nationwide demand,” said Gabi Johnston, spokeswoman for the health department, in an email. “The exercise made it clear that state resources would have to be optimized as best as possible when other states and entities are requesting the same items.”

“How can we repeat this now in 2020?”

During three days in June 2017, public health officials in Colorado ran through a scenario in which a highly contagious respiratory illness — not explicitly identified as a coronavirus — hospitalized more than 400 people and led to a number of deaths throughout the state.

In this make-believe case, health care workers were told to take antibiotics as a preventive measure and to use the same medication to treat the illness, requiring public health officials to order resources from the U.S. Centers for Disease Control and Prevention and distribute them to hospitals and residents.

The objective of the simulation was to look at officials’ ability to collect and share information between local and state agencies; their ability to develop a coordinated response strategy and manage a response to a public health incident; and to distribute and dispense medical material, according to the 21-page summary report.

The report found all exercises were “performed with some challenges” and noted that while information between local and regional officials flowed well, the communication from those agencies to the state health department was “inefficient and disorganized.”

“There’s always some differences in what the local agencies would prefer or even need at that time,” said Gunnison County Public Health Director Joni Reynolds, who participated in the 2017 simulation.

Public health experts said communication between federal, state and local agencies is critical during a crisis such as a pandemic because it helps officials understand what’s happening in a community.

And communication with the public, they said, is an essential part of the response to a public health crisis to ensure that people know what steps to take to protect themselves and how to seek help.

“If there’s not coordinated responses in terms of messaging that aren’t along the same lines, you have a problem with losing a lot of trust,” said Tara Kirk Sell, senior scholar at the Johns Hopkins Center for Health Security, when asked about the importance of crisis communications.

The 2017 exercise also noted problems with agencies’ efforts to get information to Coloradans not fluent in English, an issue advocates say still exists within the Latino population, which is seeing disproportionately high rates of coronavirus infections.

“How can we repeat this now in 2020 — in a real pandemic?” said Crystal Mariscal, a consultant for Mesa County Public Health and a New Castle town council member.

“How long is it going to take for everybody to understand that information we share to the public is how (the outbreak) is going to affect our community,” she said. “If we have a community that is ready and prepared, it is going to suffer less.”

Currently, the Department of Public Health and Environment is offering news releases in both English and Spanish. There are also translators helping to provide information in multiple languages, including Spanish, Vietnamese and Arabic, on the agency’s website and social media, said Johnston, the spokeswoman for the state health department.

“We are working diligently to ensure we are providing information in a manner that resonates with a wide variety of cultural backgrounds,” she said.

But Mariscal said there are still barriers to people who don’t speak English accessing information about the outbreak. For example, she said, many migrant workers in Mesa County work in agriculture fields and don’t have time to read news online or in print or watch a TV news broadcast. Instead, they are more likely to listen to the radio as they work.

“The difficulty is they didn’t solve those problems beforehand,” said Paul Argenti, professor of corporate communication at the Tuck School of Business at Dartmouth College, of such simulations.

“They were perfectly set up for success, they did everything right except for the most important step in the process,” he added.

“We have been flying blind”

During the “Herbie-Fully Loaded” exercise in September 2019, public health officials discussed how they would transfer potential Ebola patients in order to determine their preparedness, and found that “transport capacity broke very quickly; our resources were completely tapped with the addition of a second patient.”

The table-top exercise, according to the documents, was supposed to prepare state and local public health officials for a full-scale simulation that had been scheduled for this month.

Instead, they now find themselves in the middle of a real pandemic.

In the real-life scenario, a novel coronavirus has sickened thousands and killed hundreds of Coloradans. There is a national shortage of ventilators for patients and of protective gear for public health, hospital and other frontline workers.

There is no medication to treat patients with the respiratory disease and no vaccine to protect against it. Without a medical solution, state and local officials have resorted to steps outlined in their pandemic game books, but never implemented on such a scale — at least in recent memory.

“There’s many data points at the beginning of the exercises,” said Reynolds, the Gunnison County Public Health director. “But in this outbreak we have been flying blind.”

Officials have shuttered schools and non-essential businesses. They have banned large gatherings. The state’s mountain towns have ordered tourists to leave. All with the purpose of stemming the spread of the new coronavirus by keeping Coloradans home.

There are signs that it is working, but fears of a second wave of infections as state and local officials prepare to begin reopening society.

A second wave “could be more devastating than the first,” according to a pandemic plan drafted by the Colorado Department of Public Health and Environment in 2018. “There may be a need for public mourning, psychological support and a slow transition into a new normal.”

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