Priority Activities
- Conduct local preparedness planning for a re-emergence of severe acute respiratory syndrome-associated coronavirus (SARS-CoV), with participation by persons representing a range of disciplines and expertise. Draft and formally adopt a severe acute respiratory syndrome (SARS) response plan, or add SARS preparedness and response to an existing preparedness plan.
- Confirm the controlling authorities for actions such as declaring a public health emergency, activating the SARS response plan, and curtailing modes of transportation.
- Develop/reinforce relationships with health authorities of adjoining jurisdictions and with federal agencies to ensure effective communication and collaboration.
- Learn about the legal authorities and statutes for enforcing individual and community containment measures at the local, state, and federal levels.
- Develop/adapt a predetermined incident command system to coordinate and manage SARS response activities.
- Ensure the availability of information system(s) that can document, support, and coordinate the activities generated within an incident command system (e.g., integrate personnel and facilities, expedite real-time communication and flow of information, aid in logistics planning, resource allocation, and operational coordination).
Operational Authority
The preparation for and response to an outbreak of SARS requires a coordinated response by public health authorities and possibly other emergency response entities at the local, state, and federal levels of government. In the United States, state and local governments have primary responsibility for responding to an outbreak of SARS within their jurisdictions. The federal government has authority to support affected states or jurisdictions as necessary.
Objective 1: Determine and understand the federal authority for the response to a SARS outbreak.
Activities
The U.S. Government Interagency SARS Concept of Operations Plan (CONPlan) describes the proposed federal response to a future outbreak of SARS. According to this plan, the Department of Health and Human Services (HHS) is the U.S. Government's lead agency for the preparation, planning, and response to a SARS outbreak. As such, HHS will coordinate the U.S. Government's response to the public health and medical requirements of a SARS outbreak. The HHS Secretary's Command Center (SCC) will serve as the national incident command center for all health and medical preparedness, response, and recovery activities. The national response is based on overall geographic risk levels in the United States, as delineated in the CONPlan.
As the component of HHS responsible for disease prevention and control, the Centers for Disease Control and Prevention (CDC) will have primary responsibility for tracking a SARS outbreak and managing the operational aspects of the public health response. To this end, CDC will augment local and state resources for disease surveillance, epidemiologic response, diagnostic laboratory services and reagents, education and communication, and disease containment and control.
Objective 2: Determine and understand the state, local, and jurisdictional authority for the response to a SARS outbreak.
Activities
State and local officials provide the first line of response with respect to preparing and planning for a SARS outbreak at their own jurisdictional level, identifying, managing, and reporting SARS cases, exercising necessary authority to isolate ill persons and quarantine contacts, and imposing other community containment measures. The division of responsibilities between state and local levels
varies among states, and often within states, according to the size of the population served by local health agencies.
Local planning for a re-emergence of SARS encompasses a variety of activities and involves persons representing a range of disciplines and expertise. Suggested action steps for local and state SARS preparedness planning are provided below. These will need to be interpreted in the context of the responsibilities of particular health agencies and the division of responsibilities in the jurisdiction.
- Designate an executive committee to oversee a SARS planning process, in cooperation with local health agencies and other partners. Draft/formally adopt a SARS response plan, or add SARS
preparedness and response activities to existing preparedness plan(s).
- Ensure that the jurisdiction has an incident command structure in place to govern roles and
responsibilities during a multi-agency, multi-jurisdictional response (see below).
- Establish a legal preparedness plan (see below).
- Identify the authority responsible for declaration of a public health emergency and for officially
activating the SARS response plan during an outbreak.
- Identify key stakeholders responsible for development and implementation of specific components of the SARS plan, including enforcement of isolation, quarantine, and other community containment measures and closure and decontamination of premises.
- Ensure that the jurisdiction's elected officials, appointed officials, and other agency heads know
their respective responsibilities during a SARS outbreak.
- Understand the controlling authority over intrastate and interstate modes of transportation in
the event that these need to be curtailed during an outbreak.
- Develop/reinforce relationships with health authorities of adjoining jurisdictions and with federal
agencies to ensure effective communication.
- Identify an overall authority in charge of coordinating different medical personnel groups during
an outbreak.
- Identify the key individuals from the state and local authorities who will assist in maintaining
public order and enforcing control measures during an outbreak.
- Review procedures for enlisting the assistance of the National Guard and other emergency response
organizations.
Incident Command and Management System
Objective 1: Develop or adapt an incident command system for activation during a SARS outbreak.
Activities
SARS preparedness and response capacities at the national, state, and local levels must be carefully organized and controlled to ensure unified and consistent actions over a significant period. These requirements are best met by use of an incident command system. Such systems use a predetermined organizational structure to manage the planning, operational, logistical, financial, and administrative components of a mass casualty event to maximize the use of limited resources. For a SARS outbreak, these might include:
- Collecting and organizing real-time information on the status of the outbreak
- Managing staffing needs and requirements
- Monitoring/supplying persons in isolation and quarantine
- Maintaining an inventory of respirators and other personal protective equipment (PPE)
- Tracking the status of/procuring essential supplies
- Operating special/temporary facilities
- Managing administrative and financial aspects of the response
An incident management structure that can address these needs is an essential tool for command, control, and coordination of resources during a SARS outbreak.
A component of CDC's incident management structure is the agency's Emergency Operations System, which includes the Director's Emergency Operations Center (DEOC). The goals are to: 1) support the response of federal, state, local, and international health systems in public health emergencies, 2) support the deployment of health assets in response to or anticipation of a public health emergency, and 3) provide real-time situational information to and from federal, state, local, and international agencies, organizations, and field teams. Elements of the Emergency Operations System are operational, health and technical response teams, specialized laboratories and subject matter experts, and alert, notification, and escalation systems. These would all be available for activation and deployment in the event of a recurrence of SARS-CoV transmission.
Objective 2: Be prepared to activate information management system(s) that can document, support, and coordinate the activities generated within an incident command system.
Activities
The success of efforts to rapidly detect, respond to, and contain an outbreak also depends in large part on the availability of information systems that can support and coordinate the activities generated within an incident command system. During the 2003 SARS outbreaks in Toronto, Canadian health officials noted the constant and high demand for information on the dynamics and public health management of the outbreak. These requests derived not only from local, national, and international public health officials but also from clinicians, healthcare organizations, government officials, the media, and the public. Lack of a reliable, centralized, electronic database of outbreak-associated information posed a challenge to tracking the outbreak, monitoring and assessing the outbreak response, and meeting information needs in a timely and complete manner.
Management of future outbreaks will be aided by use of systems that can seamlessly integrate all facilities (public and private) and personnel involved in the response, expedite real-time communication and flow of information, aid in logistics planning and resource management/allocation, and facilitate decision-making and operational coordination, as well as manage information regarding suspected and confirmed cases, exposed contacts, and related laboratory findings.
Legal Authority
Legal preparedness is another key component of SARS preparedness and response. A response to an outbreak of SARS may require coordination of federal, state, and local legal authorities to impose a variety of emergency public health and containment measures, at both the individual and community levels. These measures might include: 1) active monitoring of potential cases and their contacts, 2) isolation of SARS patients to stop the spread of infection, and 3) restriction of activities of SARS contacts.
Objective: Ensure legal preparedness for a SARS response.
In general, the federal government has primary responsibility for preventing the introduction of communicable diseases from foreign countries into the United States, and states and local jurisdictions have primary responsibility for isolation and quarantine within their borders. The authority to compel isolation and quarantine is derived from each state's inherent "police power," the authority of all state governments to enact laws and promote regulations to safeguard the health, safety, and welfare of its citizens. By statute, the HHS Secretary may accept state and local assistance in the enforcement of federal quarantine and other health regulations and may assist state and local officials in the control of communicable diseases. Because isolation and quarantine are "police power" functions, public health officials at the federal, state, and local levels may occasionally seek the assistance of their respective law enforcement counterparts to enforce a public health order.
Activities
U.S. public health officials need to be knowledgeable about the legal authorities and statutes that exist at the local, state, and federal levels for enforcing these measures. Three issues related to legal authorities that might be required to contain SARS are essential to ensuring preparedness for a rapid response:
- Prior identification of relevant legal authorities, persons, and organizations empowered to invoke and enforce such authorities
- Public trust and compliance with government directives, which includes due process protections to treat individuals with dignity and fairness
- Protection of personnel required to implement and enforce the measures
