Disaster Epidemiology:Challenges for Public Health Action

Eric K. Eric K. NojiNoji, M.D., M.D.Centers for Disease Control & Prevention (Ret.)Centers for Disease Control & Prevention (Ret.)

Chairman & CEO, NGH&S, LLCChairman & CEO, NGH&S, LLCWashington, D.C.Washington, D.C.

M8.9 M8.9 EARTHQUAKE/TSUNAMI EARTHQUAKE/TSUNAMI

IMPACTS JAPAN WITH THE IMPACTS JAPAN WITH THE TSUNAMI WAVES REACHING TSUNAMI WAVES REACHING

PACIFIC RIM COUNTRIESPACIFIC RIM COUNTRIES

55THTH LARGEST QUAKE EVER LARGEST QUAKE EVER 7 7 –– 10 M TSUNAMI WAVES10 M TSUNAMI WAVES

THE EARTHQUAKE THE EARTHQUAKE OCCURRED AT 2:46 PM, OCCURRED AT 2:46 PM,

MARCH 11, 2011MARCH 11, 2011

LOCATION: 133 KM (80 MI) OFF LOCATION: 133 KM (80 MI) OFF EAST COAST OF HONSHUEAST COAST OF HONSHU

IMMEDIATE IMPACTSIMMEDIATE IMPACTS

Ground shaking lasted 300 seconds Ground shaking lasted 300 seconds (compared with about 10 (compared with about 10 -- 20 seconds 20 seconds for the 1994 Northridge, CA or the 1995 for the 1994 Northridge, CA or the 1995 Kobe, Japan quakes).Kobe, Japan quakes). Hundreds of aftershocks, many in the Hundreds of aftershocks, many in the

M6+ range and comparable in size with M6+ range and comparable in size with the damaging 1989 San Francisco CA the damaging 1989 San Francisco CA quake, followed the main shock.quake, followed the main shock.

Kobe Japan Earthquake, 1995

CRITICAL INFRASTRUCTURE CRITICAL INFRASTRUCTURE IMPACTSIMPACTS

Ground shaking from the main shock Ground shaking from the main shock and the hundreds of damaged homes, and the hundreds of damaged homes, buildings, essential facilities, nuclear buildings, essential facilities, nuclear facilities, and critical lifelines (e.g., facilities, and critical lifelines (e.g., transportation infrastructure) over a transportation infrastructure) over a wide area. wide area.

PASSENGERS STRANDED: PASSENGERS STRANDED: SENDAI STATIONSENDAI STATION

FIRE: NEAR SENDAI AIRPORTFIRE: NEAR SENDAI AIRPORT

PRELIMINARY SOCIETAL PRELIMINARY SOCIETAL IMPACTSIMPACTS

Some of the nuclear power plants in the Some of the nuclear power plants in the region shut down automatically, leading region shut down automatically, leading to an evacuation of several thousand.to an evacuation of several thousand. Radiation levels 1,000 times normal Radiation levels 1,000 times normal

levels at some locations.levels at some locations. Four million left without electricity.Four million left without electricity. Metro and trains shut down. Metro and trains shut down.

THE TSUNAMIGENIC SOURCE: THE TSUNAMIGENIC SOURCE: 130 KM (80 MI) OFFSHORE 130 KM (80 MI) OFFSHORE

The tsunami slammed the eastern coast The tsunami slammed the eastern coast of Japan, sweeping away boats, cars, of Japan, sweeping away boats, cars, homes and people, then raced across homes and people, then raced across the Pacific at 800 mph before hitting the Pacific at 800 mph before hitting Hawaii and the West Coast of the USA.. Hawaii and the West Coast of the USA..

TSUNAMI WAVES REACH COAST TSUNAMI WAVES REACH COAST OF NORTHERN JAPAN OF NORTHERN JAPAN

IN TEN MINUTESIN TEN MINUTES

TSUNAMI WAVES:NATON TSUNAMI WAVES:NATON MYIAGI PREFECTURE MYIAGI PREFECTURE

SENDAI, JAPAN AIRPORTSENDAI, JAPAN AIRPORT

OARAI INUNDATED BY OARAI INUNDATED BY TSUNAMITSUNAMI

BEFORE THE EARTHQUAKE BEFORE THE EARTHQUAKE AND TSUNAMIAND TSUNAMI

AFTER THE EARTHQUAKE AFTER THE EARTHQUAKE AND TSUNAMIAND TSUNAMI

TSUNAMI TRAVEL PATHTSUNAMI TRAVEL PATH

HAWAIIHAWAII

The Pacific Tsunami Warning Center The Pacific Tsunami Warning Center reported that water rushed ashore in reported that water rushed ashore in Honolulu, swamping the beach in Honolulu, swamping the beach in Waikiki and surging over the break Waikiki and surging over the break wall in the worldwall in the world--famous resort, BUT famous resort, BUT stopping short of the area's highstopping short of the area's high--rise hotels.rise hotels.

CRESCENT CITY, CA CRESCENT CITY, CA

SAN FRANCISCO, CASAN FRANCISCO, CA

A NIGHTMARE DISASTER A NIGHTMARE DISASTER RESPONSE SCENARIORESPONSE SCENARIO

The fires and explosions in the The fires and explosions in the Fukushima Daiichi nuclear facility and Fukushima Daiichi nuclear facility and radiation levels that were 1,000 times radiation levels that were 1,000 times normal levels created a normal levels created a ““nightmare nightmare disaster response scenariodisaster response scenario”” for the for the Government of Japan. Government of Japan.

Search and rescue operations, Search and rescue operations, evacuations, and humanitarian evacuations, and humanitarian assistance on local and global assistance on local and global scalesscales……All were limited by the possibility All were limited by the possibility of a of a ““nightmare nuclear disaster.nightmare nuclear disaster.””

All actions were conducted All actions were conducted within the framework of the within the framework of the

possibility of significant possibility of significant radiation release and a radiation release and a

nuclear melt downnuclear melt down..

THE RESULT: A CATASTROPHETHE RESULT: A CATASTROPHE

JapanJapan’’s s social, technical, social, technical, administrative, political, legal, administrative, political, legal, health care, and economic health care, and economic systems systems were tested to their limits were tested to their limits by the nature, degree, and extent by the nature, degree, and extent of the socioof the socio--economic impacts of economic impacts of the earthquake and tsunami.the earthquake and tsunami.. .

DIMENSIONS OF THE DIMENSIONS OF THE CATASTROPHE CATASTROPHE

WIDE SPREAD DAMAGE AND LOSS OF WIDE SPREAD DAMAGE AND LOSS OF FUNCTION FUNCTION

MORTALITY (LIKELY OVER 25,000)MORTALITY (LIKELY OVER 25,000)““A NIGHTMARE NUCLEAR DISASTER A NIGHTMARE NUCLEAR DISASTER ””

HUGE ECONOMIC LOSSESHUGE ECONOMIC LOSSES

Concerns for Next 30Concerns for Next 30--60 Days60 Days

CleanClean--up health issues (injuries, carbon monoxide, up health issues (injuries, carbon monoxide, electric burns etc)electric burns etc)

Contaminated food and water suppliesContaminated food and water supplies Shelters, sanitation controlShelters, sanitation control Food safetyFood safety Public health surveillancePublic health surveillance Effective public health communicationEffective public health communication Transportation difficultiesTransportation difficulties Impact of radiation leak on relief, recovery, Impact of radiation leak on relief, recovery,

reconstruction activitiesreconstruction activities Funding and logistics pipeline Funding and logistics pipeline Societal impactsSocietal impacts

MASS CARE MASS CARE

Shortages, closed roads, and Shortages, closed roads, and lack of fuel lack of fuel made it very made it very difficult to meet survivorsdifficult to meet survivors’’needs for food, water, needs for food, water, medicine, and electricity.medicine, and electricity.

MASS CARE: RESIDENTS WAITING MASS CARE: RESIDENTS WAITING TO RECEIVE SCARSE FOOD / WATERTO RECEIVE SCARSE FOOD / WATER

Disaster EpidemiologyDisaster Epidemiology

Assessment and SurveillanceAssessment and Surveillance Injury and disease profilesInjury and disease profiles Research methodologiesResearch methodologies Disaster managementDisaster management Vulnerability and hazard assessmentVulnerability and hazard assessment

Rapid Needs AssessmentRapid Needs Assessment

The collection of subjective The collection of subjective and objective information, and objective information, limited in time, performed in limited in time, performed in acute situations, which acute situations, which requires immediate action to requires immediate action to be taken to respond to the be taken to respond to the basic requirements of the basic requirements of the affected populationaffected population

Health Information Needs in Health Information Needs in Emergency PopulationsEmergency Populations

Establish health care prioritiesEstablish health care priorities Follow trends and reassess prioritiesFollow trends and reassess priorities Detect and respond to epidemicsDetect and respond to epidemics Evaluate program effectivenessEvaluate program effectiveness Ensure targeting of resourcesEnsure targeting of resources Evaluate quality of health careEvaluate quality of health care

Disaster EpidemiologyDisaster Epidemiology

PurposePurpose: : –– Identify requirements, local capabilities, gapsIdentify requirements, local capabilities, gaps–– Avoid unnecessary and damaging Avoid unnecessary and damaging

assistanceassistance

VictimsNeeds

AvailableServices

Data for Decision-Making

Disaster Information ToolDisaster Information Tool--Kits Kits for the 21st Centuryfor the 21st Century

More new things learned from the recent Haiti and Chile disasterMore new things learned from the recent Haiti and Chile disasters than in any s than in any event I can recall in 25 years as a disaster researcher (with thevent I can recall in 25 years as a disaster researcher (with the possible e possible exception of the 1985 Mexico City earthquake and the 1994 refugeexception of the 1985 Mexico City earthquake and the 1994 refugee e catastrophe in Rwanda and Zaire).catastrophe in Rwanda and Zaire).

Most surprises have come in what I call the intersection of searMost surprises have come in what I call the intersection of search, media, ch, media, technology and humanitarian aidtechnology and humanitarian aid

None of this is new technology. But first time cutting edge tecNone of this is new technology. But first time cutting edge technology hnology successfully met realsuccessfully met real--world applications, or in new ways:world applications, or in new ways:–– Twitter image integration Twitter image integration –– News aggregators, consolidators, integratorsNews aggregators, consolidators, integrators–– Visual meta analysisVisual meta analysis

Disasters are basically testDisasters are basically test--beds for new technology, ways of thinking, rise of beds for new technology, ways of thinking, rise of new leaders not afraid of taking risksnew leaders not afraid of taking risks

Haiti EarthquakeHaiti Earthquake

January 12, 2010January 12, 2010

Haiti's presidential palace before (top) and after Haiti's presidential palace before (top) and after the earthquake Photo: AFP/GETTY the earthquake Photo: AFP/GETTY

Haiti Earthquake: Haiti Earthquake: Novel uses of social media Novel uses of social media

Mapping NGOs in ActionMapping NGOs in Action::Hundreds of NGOs have ongoing operations in Haiti. But who's whoHundreds of NGOs have ongoing operations in Haiti. But who's whoand where are they? This project is gathering information to creand where are they? This project is gathering information to create an ate an overview database of relief assistance that is deployed to Haitioverview database of relief assistance that is deployed to Haiti. The . The project will create a directory of organizations, people on the project will create a directory of organizations, people on the ground, ground, where they are, what they are doing, and what they need. See where they are, what they are doing, and what they need. See spreadsheet at: spreadsheet at: http://http://haiti.sahanafoundation.orghaiti.sahanafoundation.org/prod/or/office/prod/or/office

““We Need, We Have,We Need, We Have,””::This project, in partnership with the State Department, creates This project, in partnership with the State Department, creates a a ""CraigslistCraigslist" type of self" type of self--identified needs and requests by nonidentified needs and requests by non--profits profits assisting in Haiti relief operations and technology volunteers aassisting in Haiti relief operations and technology volunteers around round the world.the world.

Communication Surveillance & Communication Surveillance & Social Media Monitoring Report Social Media Monitoring Report ((March 4, 2010)March 4, 2010)

Haiti Earthquake Haiti Earthquake

Haiti Haiti OpenStreetMapOpenStreetMap::A week ago maps of Haiti had little more than a few highways andA week ago maps of Haiti had little more than a few highways androads. In just a week, the largely empty and incomplete maps havroads. In just a week, the largely empty and incomplete maps have e been filled in by thousands of volunteers to generate what is cubeen filled in by thousands of volunteers to generate what is currently rrently the most complete map of the country of Haiti. The city of Portthe most complete map of the country of Haiti. The city of Port--auau--Prince is largely mapped and volunteers are now working on outlyPrince is largely mapped and volunteers are now working on outlying ing cities and villages. Beyond just marking roads and transit inforcities and villages. Beyond just marking roads and transit information, mation, there is now an analysis of damaged buildings, displacement campthere is now an analysis of damaged buildings, displacement camps, s, and triage centers.and triage centers.

Language & TranslationLanguage & Translation::Mainstream online translation tools don't support the Creole lanMainstream online translation tools don't support the Creole language. guage. This project is dedicated to using technology to assist in transThis project is dedicated to using technology to assist in translating lating priority content resources between Creole and English (and otherpriority content resources between Creole and English (and otherlanguages) in support of relief assistance and languages) in support of relief assistance and CrisisCampCrisisCamp projects.projects.

Haiti Haiti BasemapBasemap::The damage of the earthquake has left roads and villages inaccesThe damage of the earthquake has left roads and villages inaccessible, sible, and people displaced from their homes. This project will provideand people displaced from their homes. This project will provide new new geospatial perspectives and data points to create a base map forgeospatial perspectives and data points to create a base map for nonnon--profits in need of current geospatial information.profits in need of current geospatial information.

1896

1996

Mobile Applications 4 Crisis ResponseMobile Applications 4 Crisis Response::The Mobile Applications team is working to make mobile applicatiThe Mobile Applications team is working to make mobile applications ons for programs and projects. These applications will be useable onfor programs and projects. These applications will be useable onmobile phones and will assist users in locating news, resources,mobile phones and will assist users in locating news, resources,language translation, and visual communications tools.language translation, and visual communications tools.

Family Reunification SystemsFamily Reunification Systems::This project focuses on searching for missing persons catalogs, This project focuses on searching for missing persons catalogs, databases, and information pages. The team is providing construcdatabases, and information pages. The team is providing constructive tive suggestions for the International community in terms of access fsuggestions for the International community in terms of access for the or the gathered information.gathered information.

NPR Crisis NPR Crisis WikiWiki::This project assists National Public Radio to create a Crisis This project assists National Public Radio to create a Crisis WikiWiki to to share real time information in a collaborative space ...share real time information in a collaborative space ...

The Haiti TimelineThe Haiti Timeline::This project is an organic approach at looking at the series of This project is an organic approach at looking at the series of events, events, types of data available, when actions occurred, status of the evtypes of data available, when actions occurred, status of the events, ents, and who is doing what; this project is constantly changing and aand who is doing what; this project is constantly changing and adding dding new information in real time.new information in real time.

ACCURACY AND CREDIBILITY?ACCURACY AND CREDIBILITY?

Advances SummaryAdvances Summary Linkage of cloud with shared work spacesLinkage of cloud with shared work spaces Google search and new generations Google search and new generations -- web 3.0, semantic search.web 3.0, semantic search. Novel cell phoneNovel cell phone--based solutions for support of effective vaccinationsbased solutions for support of effective vaccinations

(vaccine delivery, vaccine tracking, data collection, etc);(vaccine delivery, vaccine tracking, data collection, etc); Cell phone applications to support frontCell phone applications to support front--line health care workers;line health care workers; Cell phoneCell phone--based diagnostic applications (combination hardware,based diagnostic applications (combination hardware,

wetware and software);wetware and software); Cell phone based algorithms and clinical decision support systemCell phone based algorithms and clinical decision support systems fors for

Global Health applications;Global Health applications; CellCell--phone based biometrics for unique patient identification;phone based biometrics for unique patient identification; Data collection and patient case management application Data collection and patient case management application

((voicepromptsvoiceprompts, instructions, voice, instructions, voice--recognition inputs).recognition inputs).

Major Challenges

AccountabilityAccountability

PerformancePerformance

Active LearningActive Learning

Active LearningActive Learning

Linking learning to accountability Linking learning to accountability and performanceand performance

ADVANCE WARNING AND ADVANCE WARNING AND VERTICAL EVACUATION VERTICAL EVACUATION

ARE THE KEYS TO ARE THE KEYS TO SURVIVING A TSUNAMI SURVIVING A TSUNAMI

ON MARCH 11ON MARCH 11THTH, MANY PEOPLE , MANY PEOPLE HAD TOO LITTLE WARNING AND HAD TOO LITTLE WARNING AND

NO PLACE TO GONO PLACE TO GO

TSUNAMI HAZARDS TSUNAMI HAZARDS (AKA POTENTIAL DISASTER AGENTS)(AKA POTENTIAL DISASTER AGENTS)

HIGHHIGH--VELOCITY, LONGVELOCITY, LONG--PERIOD PERIOD WATER WAVES WATER WAVES WAVE RUNUP WAVE RUNUP FLOODINGFLOODING WAVE RETREATWAVE RETREAT SHORELINE EROSIONSHORELINE EROSION

INUNDATIONINUNDATION

TSUNAMI DAMAGETSUNAMI DAMAGE

TSUNAMI DAMAGETSUNAMI DAMAGE

TSUNAMI DAMAGETSUNAMI DAMAGE

NATURAL HAZARDS FOR WHICH EVACUATION IS TYPICAL

NATURAL HAZARDS FOR WHICH NATURAL HAZARDS FOR WHICH EVACUATION IS TYPICALEVACUATION IS TYPICAL

FLOODS

HURRICANES

TYPHOONS

TSUNAMIS

VOLCANIC ERUPTIONS

WILDFIRES

HIGH BENEFIT/COST FOR SAVING LIVES, BUT LOW BENEFIT/COST FOR PROTECTING PROPERTY

HIGH BENEFIT/COST FOR SAVING LIVES, BUT LOW BENEFIT/COST FOR PROTECTING PROPERTY

GOAL: MOVE PEOPLE OUT OF HARM’S WAYGOAL: MOVE PEOPLE OUT GOAL: MOVE PEOPLE OUT OF HARMOF HARM’’S WAYS WAY

HIGH VELOCITY IMPACT OF INCOMING WAVES

TSUNAMIS TSUNAMIS

INLAND DISTANCE OF WAVE RUNUP

VERTICAL HEIGHT OF WAVE RUNUP

INADEQUATE RESISTANCE OF BUILDINGS

FLOODING

INADEQUATE HORIZONTAL AND VERTICAL EVACUATION

PROXIMITY TO SOURCE OF TSUNAMI

CAUSES OF

DAMAGE

CAUSES OF

DAMAGE

“DISASTER LABORATORIES”

“DISASTER LABORATORIES”

MONITORING TECHNOLOGIES MONITORING TECHNOLOGIES AND WARNING SYSTEMS ARE AND WARNING SYSTEMS ARE A VITAL PART OF THE STORY.A VITAL PART OF THE STORY.

KNOWING KNOWING WHERE, WHEN, AND WHERE, WHEN, AND WHY A TSUNAMI OCCURS IS WHY A TSUNAMI OCCURS IS

A VITAL PART OF THE ART A VITAL PART OF THE ART AND SCIENCE OF INTELLIGENT AND SCIENCE OF INTELLIGENT

EVACUATION.EVACUATION.

INTELLIGENT EVACUATION:LEAVE THE AREA OR EVACUATE VERTICALLY

INTELLIGENT EVACUATIONINTELLIGENT EVACUATION:LEAVE THE :LEAVE THE AREA OR EVACUATE VERTICALLYAREA OR EVACUATE VERTICALLY

LEAVE, IF ENOUGH ADVANCE WARNING EVACUATE TO A

TALL BUILDING OR A HIGHER ELEVATION TO GET BEYOND REACH OF THE TSUNAMI’S WAVE RUNUP.

LEAVELEAVE, IF ENOUGH , IF ENOUGH ADVANCE WARNING ADVANCE WARNING EVACUATE TO A EVACUATE TO A

TALL BUILDING OR TALL BUILDING OR A HIGHER A HIGHER ELEVATION ELEVATION TO GET TO GET BEYOND REACH OF BEYOND REACH OF THE TSUNAMITHE TSUNAMI’’S S WAVE RUNUP.WAVE RUNUP.

THE ART AND SCIENCE OF THE ART AND SCIENCE OF KNOWING WHEN TO EVACUATE KNOWING WHEN TO EVACUATE

BEFORE A TSUNAMI WAVE BEFORE A TSUNAMI WAVE ARRIVES AND WHERE TO GO ARRIVES AND WHERE TO GO

CAN BE THE DIFFERENCE CAN BE THE DIFFERENCE BETWEEN LIFE AND DEATHBETWEEN LIFE AND DEATH..

EVACUATION FOR A TSUNAMI IS EVACUATION FOR A TSUNAMI IS COMPLICATED BY:COMPLICATED BY:

1) THE SHORT TIME BETWEEN THE 1) THE SHORT TIME BETWEEN THE EARTHQUAKE AND THE TSUNAMI EARTHQUAKE AND THE TSUNAMI

WAVE ARRIVALWAVE ARRIVAL,,AND AND

2)2) DAMAGE AND LOSS OF FUNCTION DAMAGE AND LOSS OF FUNCTION TO BUILDINGS AND INFRASTRUCTURE TO BUILDINGS AND INFRASTRUCTURE CAUSED BY THE EARTHQUAKE AND CAUSED BY THE EARTHQUAKE AND

ITS AFTERSHOCK SEQUENCE. ITS AFTERSHOCK SEQUENCE.

WHEN YOU CHOOSE NOT TO WHEN YOU CHOOSE NOT TO EVACUATE, EVACUATE, OR YOU ARE OR YOU ARE

UNABLE TO EVACUATE, UNABLE TO EVACUATE, THE THE ODDS FOR SURVIVAL ARE ODDS FOR SURVIVAL ARE

LOWER, BECAUSE LOWER, BECAUSE ------

YOU CANYOU CAN’’T OUTRUN OR DIVERTT OUTRUN OR DIVERT1010--MM--HIGH, DEBRISHIGH, DEBRIS--LADEN, LADEN,

OCEAN WAVE THAT ARRIVES OCEAN WAVE THAT ARRIVES WITH AWITH A HIGH HIGH VELOCITY (E.G., VELOCITY (E.G.,

30+ KM/HR) AND MOVES 30+ KM/HR) AND MOVES RAPIDLY INLANDRAPIDLY INLAND

FOR 2FOR 2--3 KM, OR MORE 3 KM, OR MORE

BottomBottom--lineline

NOTHINGNOTHING REPLACES WELL TRAINED, REPLACES WELL TRAINED, COMPETENT AND MOTIVATED COMPETENT AND MOTIVATED

PEOPLE! PEOPLE! NOTHING!NOTHING!

PEOPLEPEOPLE ARE ARE THETHE MOST MOST IMPORTANT ASSETIMPORTANT ASSET

THANK YOUTHANK YOU