Disaster declaration, state of emergency, public health crisis.
It’s a big ol’ mess. Between all the legal acts, the paperwork, the bureaucracy, it’s tough to unravel how exactly US disaster response works.
Government officials and public personalities are talking about declarations and executive orders and the like as if everyone is supposed to actually know what the heck those things mean. Medical terms like mortality rate and viral load have us all freaking out a little. Mayors and congresspeople are using an entirely new vocabulary, speaking some made up, acronym-laden language that makes most people cross their eyes and throw out a very specific finger.
Living in the era of COVID-19 means that all manner of terms are popping out of bureaucratic wormholes we had never wanted to know existed. Hopefully, we can give a little context to the mess, and parse out just what exactly these declarations mean.
One term that keeps bouncing around the media like a ping pong ball is “public health emergency.” Should be pretty straight forward, right? An emergency situation that is caused by a public health issue, right? Well, it’s the government, so of course, there’s more to it than that.
In most recent pre-COVID-19 news, you may have heard about the opioid crisis or the H1N1 influenza outbreak being called public health emergencies, only confusing matters further because not only are those 2 things very different from each other, but they’re also obviously significantly different from what we find ourselves facing now.
Today, “public health emergency” has a smidge more intricate meaning, and it exists a little outside the usual disaster declaration context.
Give us that bureaucratic context.
It turns out that the idea of declaring a public health emergency has actually been around since 1944, but disaster response definitely did not look the same back then. Or after that. Or really any time before 1988.
Public health as a field has actually been around for way longer than us Millennials, or y’all Baby Boomers, or any living generation currently on this earth. This whole idea of emergency management as a field is still a pretty young field though, and the two only really began integrating in the aftermath of the attacks of September 11, 2001.1
We can see this lack of integration and subsequent lack of holistic national response historically—both the Spanish flu and the HIV/AIDS epidemic responses look pretty distinct from our current hot mess.
The Spanish flu response was localized almost to the extreme. Federal entities didn’t want to freak people out in the middle of World War I, or draw attention away from the war effort, so cities and states were left to make decisions that affected their own citizenry largely as they saw fit, which meant Philadelphia held a parade while San Francisco arrested people for not wearing a mask in public.2 We still see this hodgepodge approach playing out to an extent today, demonstrating our country’s continued lack of experience with truly national disasters—as well as faltering executive leadership.
The response to the HIV/AIDS epidemic was even more of a mess than the Spanish flu response. Taboo and bigotry meant that President Ronald Reagan did not even mention AIDS publicly until 1985, even though the crisis began in 1981. State and local governments shut down gay and gay-friendly establishments, the White House administration made jokes about the disease, and it was left mostly up to community organizations and groups of private citizens to assist those affected. Of course, given the general national attitude towards the groups most at risk of contracting AIDS, there was little government response across the board in the early days of the epidemic outside of policing already oppressed—and increasingly ill—populations.3
No emergency declarations were made in these cases because there was no vehicle (and in these two cases, not a lot of motivation given historical contexts) to do so.
All the officials, all the acts…
To give some of the drier background information, it was way back in 1944 that the Public Health Service (PHS) Act came into effect, allowing the Secretary of Health and Human Services to declare a “public health emergency” that opened up some federal funding and resources not usually available. However, pandemic-specific preparedness and response activities weren’t clearly defined until the PHS was amended to include the Pandemic and All-Hazards Preparedness Act in 2006, meaning even in the 2000s we had not exactly hammered out how disease outbreaks and natural or manmade disasters fit into the public health sphere.
Now, most people are probably far more familiar with a national disaster or emergency declaration than a public health emergency, and we have the Stafford Act of 1988 to thank for providing us that current framework. A federal disaster declaration through the Stafford Act allows the federal government to provide assistance to state and local governments that are overwhelmed. This assistance is often financial, but can also take the form of people (specialists, advisors, scientists, etc) and equipment (you may have heard of the Strategic National Stockpile or strategic oil and other reserves). Requests for assistance from states’ governors during disasters go to the President, who can choose to declare a national emergency or ask Congress to lay out special funding for the affected states’ recovery efforts.
We have seen this most notably following natural disasters like hurricanes, specifically with the well known Federal Emergency Management Agency (FEMA) showing up on the scene with added resources, funding, and knowledge (and paperwork… all the paperwork).4
But, with a declaration of a public health emergency, things look a wee bit different.
What do they mean by “public health emergency”?
Let’s get a little academic for a minute.
A public health emergency as a general term means that a public health situation, like a disease outbreak, is causing so much stress on the healthcare system and accompanying emergency systems so as to outstrip the capacity of those systems to effectively handle and treat the number of people affected.5
Okay…so what does that actually look like?
If there is anything we know for sure in the preparedness field, it is that emergencies and disasters are almost exclusively a local phenomenon. In the US, local (city, county, etc.) and tribal governments are expected to respond to their capacity (whatever resources and personnel they have available), and request regional and/or state assistance when they recognize they do not have the manpower or resources or specialized knowledge to handle the situation on the ground on their own. Should the same be true with the state—or tribal government that has federal recognition (pursuant to an amendment that was finally instituted in 2013)—the governor or tribal leadership can request federal assistance.
This is the case with a public health emergency as well, with the major difference between a public health emergency declaration and a different type of disaster or emergency declaration being who takes charge of the response, which is true across levels of government.
State, local, and tribal authorities that have a public health-specific disaster declaration option (not all do), look to the relevant regional, local, or state health department as the leading authority on response measures when declaring a public health emergency. In the case of a different kind of disaster, that responsibility generally falls to emergency management personnel and agencies.6
At the federal level is where this difference is most recognizable. In most cases of disaster, a presidential declaration is needed to access federal resources. With public health emergencies, that is not strictly necessary. Through the Public Health Service Act, the Secretary of Health & Human Services can make a public health emergency declaration in lieu of or in addition to a federal disaster declaration made by the president, allowing for access to health-specific federal resources that are held in reserve specifically for a national health crisis.7
What do declarations look like in practice today?
We can actively see this distinction in how the response to COVID-19 has developed in the US so far. Back in late January, a federal public health emergency was declared by the Secretary of Health and Human Services6, while the presidential declaration of a national emergency did not come until March 13.
Even before the emergency declaration made by the federal government, state and local governments across the country were making their own declarations. Santa Clara County in California declared a local health emergency on February 3rd8. The city of Seattle, Washington9 and the Lummi Nation tribal council10 declared their own individual states of emergency on March 3rd. A cascade of state and local declarations followed the outbreak as it reached across the US, each with their own restrictions, rules, and response measures in place.
State and federal declarations have brought access to funding and resources that would otherwise not be available to local communities responding to this crisis. This is undoubtedly a big help, but the unprecedented nature of COVID-19 means this whole structure could need to be revamped in the future to streamline response and provide better accessibility to those not explicitly included in the current system (or those who have pissed off the sitting president, apparently).
The fact that public health and emergency management personnel work fairly independently, with mild crossover for drills and exercises every now and then, is one of a few reasons this response may seem disjointed or inefficient. This disconnect means public health officials are less integrated into the emergency response system and emergency management personnel don’t have as much training on infectious disease containment and control as the public would like—especially when it comes to pandemics as opposed to bio-terror events. Health departments and hospitals train often for local disasters and mass casualty incidents, but not many have had the opportunity to train with state and federal resources on regional and nation-wide crisis scenarios.
For people living their lives day-to-day, this might mean that the police officers walking your streets don’t have access to appropriate protective equipment or know how to use it, or that your family doctor is not completely clear on reporting protocols for an outbreak situation. (It might even mean that our highest officials sometimes have no idea what they’re talking about because they aren’t listening to the slew of people from a bunch of different offices in the government that actually know the things, but I digress.) No one person can know all things at all times, and no response effort will be flawless, but we were not prepared for this crisis, and it shows.
From the Ground Up
Disaster response starts and ends locally. All resources filter down and are finally deployed, whenever possible, at the city or county level, by city and county authorities. That means disaster prep at the county and state level is just as critical. In 2018, FEMA reaffirmed this idea, recognizing it had an unsustainable deployment level even in times we don’t think of as mid-disaster.
But states have also neglected preparedness. While awaiting deployment of federal resources, states are supposed to support local responders until national aid can arrive; often national resource mobilization takes multiple days, even weeks depending on the resource. So, while the response on the part of the White House has been lackluster, confused, and often contrasts with other federal recommendations or information, states also share responsibility for many of the resource shortages and lack of employed epidemiologists and other public health experts.
But, since disaster preparedness and response occurs at all levels, we can help remedy these situations. And not just by voting or telling our representatives we want better public health and preparedness.
Disaster resilience and mitigation starts with you.
Not all of us are disaster people, so what the heck can we do?
Help mitigate your risk by educating yourself (read something other than just some headlines, my dudes). Recognize that the CDC and the World Health Organization are doing everything they can to learn more about this virus, and keep up with the evolving guidelines as they come out.
Wear a mask. Stay 6 feet apart or more (if you don’t know what that looks like, just imagine you’ve got Shaquille O’Neal laying on the ground between you and the next person – Wikipedia says he is 7’ 1”, so that should be a safe bet). If you are not an essential worker, and you have the option to stay home, do it! If you are currently working (from home or otherwise), ask your supervisor or your coworkers about your organization’s emergency and disaster preparedness plans and what your organization is doing to help.
Educate yourself and your loved ones on what disasters or emergencies are likely or possible in your area. Find your local emergency management office’s website and see what they work on regularly and prepare for most, same with your local or state health department. Talk to your local officials about what you can do to help and what you need from them.
Get involved, ask questions, and engage in productive conversations that will help you and your loved ones be better prepared in future, because we’ve got to do better y’all, and we can only do that if everyone knows what the heck to do.
And (most importantly, in our humble but mildly biased opinion) subscribe to our podcast, our Twittles, and our Insta-gratifications. ‘Cause our second pod we’ll be talking all about how you can be prepared!
- Rose, Dale A et al. “The Evolution of Public Health Emergency Management as a Field of Practice.” American journal of public health vol. 107,S2 (2017): S126-S133. doi:10.2105/AJPH.2017.303947 [↩]
- Milsten, Andrew. “1918 Influenza Pandemic: A United States Timeline.” American College of Emergency Physicians, www.acep.org/how-we-serve/sections/disaster-medicine/news/april-2018/1918-influenza-pandemic-a-united-states-timeline/. [↩]
- Fitzsimons, Tim. “LGBTQ History Month: The Early Days of America’s AIDS Crisis.” NBC News, 15 Oct. 2018, www.nbcnews.com/feature/nbc-out/lgbtq-history-month-early-days-america-s-aids-crisis-n919701. [↩]
- “Regulations and Laws That May Apply During a Pandemic.” Centers For Disease Control and Prevention, 3 Nov. 2016, www.cdc.gov/flu/pandemic-resources/planning-preparedness/regulations-laws-during-pandemic.htm. [↩]
- Nelson, Christopher et al. “Conceptualizing and defining public health emergency preparedness.” American journal of public health vol. 97 Suppl 1,Suppl 1 (2007): S9-11. doi:10.2105/AJPH.2007.114496 [↩]
- Wetsman, Nicole. “How Emergency Declarations Are Helping Governments Respond to COVID-19.” The Verge, 9 Mar. 2020, www.theverge.com/2020/3/3/21162783/emergency-declarations-public-health-disaster-state-local-hhs. [↩] [↩]
- Morgan, Rachel, and Joy Johnson Wilson. “Responsibilities in a Public Health Emergency.” NCSL, 29 Oct. 2014, www.ncsl.org/research/health/public-health-chart.aspx. [↩]
- “Timeline: California Reacts to Coronavirus.” Cal Matters, 1 Apr. 2020, calmatters.org/health/coronavirus/2020/04/gavin-newsom-coronavirus-updates-timeline/. [↩]
- McNerthney, Casey. “Coronavirus in Washington State: A Timeline of the Outbreak through March 2020.” KIRO7, 3 Apr. 2020, www.kiro7.com/news/local/coronavirus-washington-state-timeline-outbreak/IM65JK66N5BYTIAPZ3FUZSKMUE/. [↩]
- Lakhani, Nina. “Native American Tribe Takes Trailblazing Steps to Fight Covid-19 Outbreak.” The Guardian, 18 Mar. 2020, www.theguardian.com/us-news/2020/mar/18/covidcoronavirus-native-american-lummi-nation-trailblazing-steps. [↩]