All,
This marks the beginning of our third week of online education as the global pandemic continues to challenge healthcare systems around the world and closer to home. Most estimates suggest that the “peak” of the curve won’t be hit for two to three weeks in New York City. Much depends upon people sheltering in place and understanding that everyone is a potential carrier. Unfortunately, I’m not certain everyone has come to that realization yet. We haven’t seen the great number of cases New York has seen and I hope it doesn’t happen here but I do suspect we will see a significant increase in the number of cases around our region in the next week or two. That said, I’m encouraged by the fact that our state and local governments have been proactive and have enacted stay in place mandates earlier than most. As we live through this, people have been asking me if it reminds me of my experience with Operation Tomodachi, when I was assigned as the Command Surgeon to the United States Pacific Command (USPACOM) in Hawaii, which prompts me to tell you another “sea story” to help put what we’re living through now into some perspective. At least I hope so.
The story begins with me planning for months to surprise Tanis for her birthday and take her to Kauai, known as the “garden island” in Hawaii, for a long weekend. After months of planning, the night before we were supposed to leave, I received a phone call from my office that there was a 9.0 earthquake in Japan and they were waiting to see what the damage reports were. I was assured by my staff that Japan had a wonderful response system and they likely wouldn’t need any assistance from us and I should proceed with my plans to head out in the morning. I admit I was still focused on the trip, so I proceeded with my plan to surprise my wife. That morning, at the airport, tsunami sirens went off in Honolulu and flights were postponed for an hour or so. I didn’t get any phone calls so I assumed (wrongly) there wasn’t much to be concerned about. I’ll fast forward to Kauai, where Tanis and I are sitting down for lunch at a nice beachside restaurant when my phone rings. My staff is now telling me that in addition to the earthquake, Japan was hit with a 15-meter-high tsunami, with more information forthcoming. I told my staff to let me know when they found out more information and to call me if things changed. About 5 minutes later, I got another call informing me that there were reports that a nuclear reactor might have been damaged by the tsunami. At this point, I’m thinking next flight back to Honolulu. Well, it couldn’t have been another 10 minutes when my staff again called, this time to tell me they thought 4 reactors might be damaged with one more significantly than the others. At that point, I called the airline to try to get a flight back only to be told that I had to wait a day or so because all flights were booked. One day later I finally made it back to my office to find that Japanese officials estimated over 16,000 people were killed from the tsunami with tens of thousands missing. Four nuclear reactors at the Fukushima Daiichi nuclear power plant were severely damaged, resulting in three nuclear meltdowns, three hydrogen explosions, and the release of radioactive contamination into the air and surrounding waters. Thus, began Operation Tomodachi, the U.S. mission to support the Japanese in their response to this unprecedented emergency. My initial responsibility was for the health and safety of over 60,000 U.S. service members and their families, Department of Defense employees, contractors and their families stationed in Japan. Several days into the event, all U.S. citizens living in Japan were placed under our healthcare umbrella. Because this never happened before, we had to develop entirely new water safety standards for a nuclear emergency, because the Environmental Protection Agency (EPA) never anticipated this would occur. This fell to me and my team. Thankfully, the World Health Organization had standards that could be applied to the situation, which is exactly what we did, after working closely with EPA and my own embedded experts. There was a debate about whether or not we should evacuate personnel form our major bases near Tokyo, which was about 100 miles south of the disaster. We decided to have a voluntary evacuation, highly recommending that people who were pregnant or families with small children should go. All told, about 4,000 people took advantage of that. We also had to decide whether or not we should provide bottled water to those living on base but ultimately decided against it because it would have created a double standard for those not living on base. Further, the Japanese weren’t doing this either. This decision was based on the fact that our water quality was closely monitored both on and off base and shown to be perfectly safe. Through the entire crisis, those of us who were members of the USPACOM senior staff met with teams of experts from the EPA, Nuclear Regulatory Agency, Naval Reactors (the world’s leading expert in reactor safety), the State Department, Defense Advanced Research Projects Agency (DARPA), The Department of Defense and many others on a daily basis to monitor air, soil, water, weather conditions. We were lucky, as the wind kept blowing towards the sea and with it the radioactive plume that was being produced by the melted down reactors.
One of my key responsibilities was to assure that I was communicating all this information with the myriad medical commands around the Pacific that had responded to this, as they all reported directly to me. It was also important to have the same message go to the general public. To ensure we were aligned with the Department of State, I had multiple meetings with the U.S. Ambassador to Japan, Ambassador John Roos, who led the American Mission support efforts for Tomodachi, serving both as an advisor to him and his staff and also to ensure there were no inconsistencies in messaging concerning health safety.
Every morning at 2 a.m. (8 a.m., Washington DC time) the Command had a briefing with National Command Authority, which I often attended. U.S. Pacific Command Headquarters is located at Camp Smith, on top a rather steep hill just north or Pearl Harbor. I used to ride my bike to work every day since we only had one car at the time. I remember having to attend one of the 2 a.m. briefings and Tanis had taken one of our daughters, who was visiting at the time, camping on the other side of the island. That night, it was windy, rainy and cold and had to ride my bike up that darn hill at 1 a.m. When I got there everyone was surprised at how wide awake I was!
Throughout the entire emergency I made several trips to Japan to talk with our military members, their families and DoD employees, mostly teachers. My role was to provide them the most up-to-date information so they would feel comfortable knowing we were watching out for their welfare. Often, I had to tell them not to eat certain types of foods such as lettuce that was locally grown since it tended to absorb more radiation than other types of food and that it was perfectly safe to drink the water and bottled water wasn’t necessary. Everyone thought this was going to go on forever but like most things, over time, things came back to normal.
I know this has been a long story – and I didn’t even cover many of the details involved in this very complex emergency disaster relief effort. The reason I thought I’d bring it up now is because there are parallels to our current situation that are important to realize. This was an unprecedented event, much like what we’re living through now. People were scared, with many wanting to ignore advice from experts and go their own way. There were no scientific algorithms to accurately measure radiation levels of children who might have been exposed. Because of rumors and incorrect information being disseminated by multiple sources, many people thought they might have been exposed to radiation, but were not. We were able to overcome most of these significant events and obstacles by relying on good science, transparent communications and asking people to make some sacrifices, such as sheltering in place. One of my staff members was a radiation health expert and he actually developed a totally new algorithm for measuring radiation exposure to infants and children; a totally new science. Others developed quick ways to analyze water and we all got pretty good at providing information briefs to community meetings, the press and our superiors.
Much of that same innovation and creativity is occurring today as we confront the COVID-19 pandemic. As I mentioned last week, we have the best scientific minds in the world here in the U.S. Working with other scientists from around the world, this collective group of experts will eventually develop medications and a vaccine to treat and ultimately prevent the disease. The FDA just approved a 15-minute test for the virus and public health experts are effectively advising federal, state and local governments to put restrictions in place that will deny the virus a host.
Things will get worse before they get better. We know this. We’ll be asked to make sacrifices we don’t want to, but intellectually know they’re the right thing to do to fight the spread of the disease. We will come out of this stronger, smarter and more resilient – that’s a fact. How do I know that? Because I saw it happen in Japan, I’ve seen it happen in small communities that were devastated by storms or other disasters and I will see it now. It’s in your DNA – or you wouldn’t be here training to become a healthcare provider.
Try to say active and keep exercising Social and Physical Distancing, Washing Your Hands and Staying Put!
We are Salus Strong and we’ll get through this together.
Mike
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