Extended Inteview: Dr. Michael Richardson
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NEWSHOUR: You have said that in effect, at a certain level we were lucky last year with the anthrax attack. Explain what you mean by that.
DR. MICHAEL RICHARDSON: Yes, and lucky is a strange word to use, I know. But had I think the anthrax event happened simultaneously in numerous cities across the nation, we certainly would not have been able to marshal our scarce resources as they were at that time to adequately respond as we did so effectively in Washington, and also in New York and New Jersey.
The anthrax unfolded from Florida, to New York, to New Jersey, to Washington in a chronological manner that made it somewhat easier for us to use federal resources and local resources, and as that occurred, we were therefore able to manage and to mitigate that terror attack much better.
[It would have been] much more difficult to manage had that occurred simultaneously across large cities and many places.
NEWSHOUR: Another concern that emerged from the anthrax attacks was communication — communicating with the public, and particularly with the pool of people affected directly by anthrax exposure. I’m thinking of the postal workers at Brentwood [the Washington, DC postal facility contaminated by the anthrax mailings] — there was just a lot of miscommunication, erroneous communication, and ultimately a climate of intense distrust developed. What did all of that teach us?
DR. MICHAEL RICHARDSON: Well, many lessons we learned from that. I think [with] Brentwood, for us in the District, our problem in that communication was made even more intense by the fact that there was a split between the recommendations that came out for workers in Capitol Hill, and then later on for workers in Brentwood. That was partly from ignorance. We weren’t sure how this was transmitted at the time, and so people took best guesses in public. And we certainly learned the lesson is never do that.
Honesty is always the best policy, and to tell the truth, even if you don’t know what that truth is, to say you don’t know is very important.
I think that distrust that came up in terms of Brentwood workers and postal workers believing or worrying that they were getting secondhand or second-class information and treatment was something that dogged that whole episode. It wasn’t true, but certainly that distrust was very difficult to overcome, and took a long time, and we still are feeling the effects of that, and managing that in speaking to many of the postal workers.
NEWSHOUR: And that episode, as you say, illustrated a critical problem of the communication among different levels of government, and it even was beyond federal versus state or local response. Has any of that been grappled with such that next time around, everyone is on the same page?
DR. MICHAEL RICHARDSON: The issue of communication among government agencies and from government to local government agencies have been grappled with, but certainly has not been solved yet.
We still are recognizing that agencies talking to each other in real time, and agreeing on uniform protocols is a challenge, particularly when we talk across federal and local and regional sorts of boundaries.
But I think that we have improved it, and we certainly are working diligently to make sure that we get even better at it.
What has improved is our understanding and our ability to speak from local government to the public, and reach out into public education and public communication ways.
NEWSHOUR: How so?
DR. MICHAEL RICHARDSON: Well, we have certainly improved in the District our ability to communicate with the public by our call center, which we now have as a hot line, up on 24 hours a day in an emergency, but certainly during business hours.
That will enable people to get information in real time. That will enable our professionals also to have a single number that they can call in and speak to a public health official if that’s necessary.
One of the things that we realized during anthrax was that there was no single point of contact that people could come and be rooted to the information that they needed, and this is something that we have improved in the department.
NEWSHOUR: So should another attack occur, individuals can call the call center, doctors can call the call center — how would it work?
DR. MICHAEL RICHARDSON: Next time around, a couple of things will have improved. Certainly between now and when that occurs, people will have heard over and over the number for the hot line because this will remain the same for the department, and therefore, they will be able to access that much more importantly, so they can call into that number and there will be people who can give them information about what is really happening…
Secondly, what they can then do is that they can be routed, if necessary, to a physician or to a point of information that can give them the information that they really need. And so they are not only getting a canned bit of information, but they are getting more tailored information to their particular needs.
The other thing that we have done in the department, and I think many departments around the country have done, has improved our Web site ability and information ability, so that we can communicate in a wireless form with our professionals in real time, with more accurate information, so they can get educational information as well as alert and health advisory information more accurately and more quickly.
NEWSHOUR: So next time around, that would mean you would immediately post updates on a Web site?
DR. MICHAEL RICHARDSON: Yes. For information purposes, in an event, the things that we’ve found were necessary were that all providers could get important information, important protocols, and change in protocols in time to be able to advise our patients that turned up at them, and we find that physicians, like all of us, don’t always go to their faxes as they should because they are too busy working.
And so we have set up a Web site where their time can go and read, and we can say there is a new alert, go to your Web site and listen. Or they can download information from that Web site and have for their patients, to give them information to read.
NEWSHOUR: And let’s also talk about the hierarchy of the threats in the bioterror realm that you believe this area faces. What’s within the realm of possibility?
DR. MICHAEL RICHARDSON: Well, from terrorist threats and bioterrorist threats, the list is endless, and we like to speak of a lot of the most common bioterrorist threats as BEPAST, which stands for botulism, ebola, plague, anthrax, smallpox, and tularemia, as these are the common bioterrorist agents that we think about.
However, we recognize in the department … that there are terror vulnerabilities that we don’t speak as commonly about, but a flu pandemic is certainly a terror, a possibility. An agricultural food-born e-coli or salmonella type infection is also a vulnerability that we must take a look at.
And in the Washington area, we certainly have been speaking to our security, our intelligence, our public health, our food and agriculture, and our animal vector people to begin to weave a surveillance system to take a look at some of these terrors because in bioterrorism, although the big ones, the smallpox and the anthrax, are the ones that seem possible and therefore the ones that grab the headlines, we also must be prepared for others that are [more common] but no less deadly, should they be unleashed upon us.
NEWSHOUR: And how would that surveillance system that is under construction work?
DR. MICHAEL RICHARDSON: Well, what we have recognized in a surveillance system for terror is that we have to take a look at some of the nontraditional places that may give us warnings. By traditional places I would mean you think of hospitals, and we have talked of syndrome surveillance, and looking at people who come into the hospital emergency department having flu-like symptoms, or having sore throats, or high fevers, and these have given us a clue towards things.
In some more nontraditional areas that we are beginning to look at surveillances, looking at over-the-counter pharmacies, if people suddenly started having Kaopectate for diarrhea and there was a huge run of diarrhea, we may begin to think that perhaps there was something happening in our food supply.
NEWSHOUR: What about public lab and overall laboratory capacity, another issue that was pointed to last year?
DR. MICHAEL RICHARDSON: In the District, our public health lab capacity is still improving. We don’t have a Level III lab, which is a level that is for some of the more serious terrorist handling abilities. But that we are improving. We belong to the regional laboratory, the response network, and so we will be getting improvements there.
We have improved very greatly in our ability, obviously, to handle anthrax and anthrax samples, and this has come through our experience last year, and with our resourcing that very much more. Our ability to respond also on a 24-hour, seven-day-a-week basis is certainly much greater. And our relationships with Maryland, which does have a Level III lab, obviously, is very strong, and at the moment they provide regional help for us.
NEWSHOUR: So that if a Level III type agent were to be used here, you could have –
DR. MICHAEL RICHARDSON: Exactly. If that happened, we could have the Maryland lab help us with that immediately.
NEWSHOUR: Finally, let’s talk about how the District has expended its share of the bioterrorism preparedness funds that were made available earlier this year. How much money has come through that, and what has the money been spent on?
DR. MICHAEL RICHARDSON: The District got two general pots of bioterrorism money from the CDC [Centers for Disease Control and Prevention], and from the feds with the rest of the states to be bioterrorist-prepared in a number of areas, and also from the Department of Defense for specific protective decontamination and other areas.
We have moved very rapidly to build on our preparedness and our abilities so far. I think like many health departments, we have recognized that some of our needs in preparedness are basic infrastructure needs, and we are moving to hire and bring on epidemiologists for response and for surveillance, as well as we are looking at building brand new IT systems for surveillance, as we spoke about. We have certainly, in terms of our EMS, in terms of our fire and our police and security, spent our money very well, and in many cases finished the money that was given to us because it was — it certainly is less than sufficient for all our needs.
But we in health are still buying medications for our first responders, and looking at making sure that all our first responders, including those that have support functions such as mental health responders and mental health counselors, are going to be well resourced.
The area I think where we still have a lot to do is in the area of training, and putting training for both providers and public in place, and I think that that is still one of our greatest challenges, and we still have some way to go towards that, although we have begun to start putting our bioterrorism money in that way into good use.
NEWSHOUR: What do you need to train them to do?
DR. MICHAEL RICHARDSON: Train them to do all things — many of the things that we have spoken about, which is understanding the context, understanding the risks, understanding what they should do, should an event — of any of these events occur.
We certainly have to, again, educate our providers so that they can learn what the symptoms and signs of agents may be and could be, because none of us have seen some of these agents, and some of us have seen these agents so long ago that we are rusty. We certainly have to begin to educate some of our professionals so that they will understand what their response should be and could be in this sort of event.
So there is a lot of training that has to go on in those areas, and this, of course, is compounded by new people coming into the system, by lab people versus epidemiologists, and so there are levels and complexities.
And then last of all, in our training, we have to model and exercise our plans because our plans are pieces of paper until we train on them and exercise on them, and this, of course, can be from anything from a tabletop exercise, right to a full deployment, I mean, a mock exercise in which, again, all cost money and all take time.