during this May’s floods.
Photo by Nancy Lane/Boston Herald
when disaster strikes, the planning that happened ahead of time means everything. With that in mind, shortly after taking office in January, Methuen Mayor William Manzi tapped former state secretary of public safety James Jajuga to study the city’s emergency preparedness. Improving coordination between city departments became a focal point after Manzi had asked police and fire officials where emergency operations were headquartered-and both departments thought that the job was theirs. The resolution to that conflict came in April, when an emergency command center opened in City Hall.
The timing was fortunate. A few weeks later, in mid May, about a foot of rain soaked the Merrimack Valley and the North Shore, putting sections of Methuen and surrounding communities underwater. The deluge came close to overwhelming the 150-year-old, privately owned Spicket River Dam. Flooding forced the evacuation of more than 1,000 people in the city, and the local Red Cross opened a regional shelter at Methuen High School. The Massachusetts Emergency Management Agency (MEMA) estimates that 75 communities and 14,000 homes were affected by the floods. Gov. Mitt Romney obtained a federal public assistance disaster declaration to speed recovery funds to cities and towns, supplementing federal funds already approved for businesses and individuals.
Hurricane Carol in 1954.
Photo by Edmund Kelly/The Boston Globe
The cities and towns did a first-class job handling the floods, says Allan Zenowitz, a former director of the Massachusetts Civil Defense Agency and the Office of Emergency Preparedness (both agencies forerunners of MEMA) and a member of the US Department of Homeland Security’s advisory council. Manzi, in turn, gives the state an “A” for its response.
Praise aside, Methuen coped with the same chinks in the state’s disaster prevention and response infrastructure that Taunton faced in the rains of October 2005, when the 174-year-old Whittenton Pond Dam threatened to give way and send the downtown to ruin.
Other gloom-and-doom scenarios aren’t hard to conjure up. A hurricane’s rains and gusts could deliver devastation over hours, not days. Three state probes over nearly 30 years have catalogued a laundry list of dam deficiencies.
“The state is facing a possible Category 3 hurricane this season. We need to step up to the plate,” said state Sen. Therese Murray, a Plymouth Democrat who chairs the Senate’s Committee on Ways and Means, at a May news conference announcing the findings of a dam safety review by the Senate Post Audit and Oversight Committee. The bottom line? An accurate inventory of the state’s nearly 3,000 dams does not exist, and the scope of hazards remains unclear. Meanwhile, only 44,700 households out of 2 million in the state have flood insurance.
Massachusetts has coped with many smaller natural disaster emergencies, helping to shelter evacuees from Hurricane Katrina, cleaning up from the region’s last sizable storm—Hurricane Bob, a Category 2 storm in 1991—and mobilizing for blizzards on a nearly annual basis.
“We’ve done a pretty good job of responding to the situations we’ve had,” says Rep. Jeffrey Perry, a Republican from Sandwich who is ranking minority member of the Legislature’s Joint Committee for Public Safety and Homeland Security. “However, we haven’t had one of devastation,” he says. After a pause, he adds, “Luckily.”
That luck may run out. A Category 3 storm packs winds of 111 mph to 130 mph, the likes of which haven’t been seen here since hurricanes Carol and Edna struck 11 days apart in 1954. Meteorologists predict an active Atlantic hurricane season in 2006, with three to six major storms, and the Northeast is long overdue for one. Emergency managers cite responses to recent storms and preparations for post– September 11 events like the 2004 Democratic National Convention in Boston as evidence of readiness for catastrophe. But a devastating event like a severe hurricane, an earthquake, or a pandemic influenza outbreak has the potential to overwhelm state resources. With federal officials preaching a new gospel of local and individual self-reliance, what can cities and towns expect if a major natural disaster hits?
The May 2006 floods may have been a preview of coming attractions. Is Massachusetts ready for the big one?
Ginnie Milott Fitzgerald and her family had no real inkling of the tempest about to hit their summer home on Mattapoisett’s Crescent Beach. “There was no warning,” says Fitzgerald, who was 16 when Hurricane Carol struck Buzzards Bay shortly after high tide on the morning of August 31, 1954. Fitzgerald, who recorded residents’ recollections in a self-published memoir, Hurricane Carol: 50 Years Later, says the local radio announcer never used the word “hurricane,” saying simply to stay indoors since “a bad storm” was approaching.
As the storm surge flooded homes close to the shoreline, 30 neighbors sought refuge in her parents’ home. When the ocean reached the house next door, they headed out in three cars. Finding access to Route 6 cut off by creeks that had overtopped their banks, they waited out the storm in a wooded area. After the winds and rain abated, the Fitzgeralds returned to find the second story of a neighbor’s Colonial in their front yard. Their own home remained mostly unscathed.
Mattapoisett now performs a hurricane drill every year. After Hurricane Katrina, last year, says Mattapoisett town administrator Michael Botelho, “there’s a little more interest.”
Generating interest in hurricane preparedness is still a challenge. A Mason-Dixon Poll of Atlantic and Gulf coastal residents conducted in May for the 2006 National Hurricane Survival Initiative found that 60 percent of respondents had no family disaster plan; 13 percent said they would not follow an evacuation order; and 48 percent within 30 miles of the coasts said they didn’t believe a hurricane would affect them.
In Florida, 74 percent of residents have a disaster plan. Yet, despite that state’s substantial investment in a “culture of preparedness,” including a $3 million public education campaign and annual 12-day tax holidays for hurricane supplies, 34 percent of Floridians feel “not too vulnerable” or “not at all vulnerable” to a hurricane, a related tornado, or flooding hazards.
“The collective memory that people have about weather events does not last particularly long,” says meteorologist Ken Reeves, director of forecasting operations for AccuWeather.com.
With most Bay State residents’ hurricane memories fuzzy at best, the state has ramped up awareness campaigns and planning drills. Gov. Romney designated June as Massachusetts Hurricane Preparedness Month; before this year, the event was a single week. New England, New Jersey, and New York officials participated in a two-day federal regional “tabletop” exercise—a group discussion of an emergency scenario—in mid June. Statewide workshops and exercises will also take place this summer, including one to assess regional hurricane preparedness. But Carlo Boccia, director of the Mayor’s Office of Emergency Preparedness in Boston and the Metro Boston Homeland Security Region, warns that drills don’t have the immediacy of a disaster; the tension, fear, and panic can’t be created artificially.
The fresh interest in hurricanes by Massachusetts public officials didn’t fade after Katrina. Meteorologists sounded the call this spring, warning that tropical Atlantic waters began a warming trend in 1995, matching the conditions that spawned the storms of the 1940s to the ’60s, the last active hurricane cycle in New England.
“We knew this was coming—big hurricanes, a lot of them, and many of them getting to the East Coast,” says David Vallee, science and operations officer in the National Weather Service’s Taunton office. Other experts speculate that climate change is at work, producing more intense storms.
The strongest hurricane of modern times was the Great Hurricane of 1938, also known as the Long Island Express. The Category 3 storm that September killed an estimated 600 New Englanders, left 63,000 homeless, and decimated the New Bedford fishing fleet, causing nearly $20 billion in damage in today’s dollars. The Blue Hill Observatory registered winds of 121 mph, with gusts up to 183 mph. Gloucester experienced 50-foot waves.
Any named storm that makes landfall in the Bahamas is a potential threat, according to Vallee. Once the jet stream captures a storm, it accelerates rapidly. New England would have two days at most to prepare, as winds up to 73 mph would hit hours before the eye of the storm.
Damage would vary by region. Communities on the east side of the hurricane’s track would experience the strongest winds, and those on the west would get the heaviest rains, as central and western Massachusetts did in 1955 from back-to-back tropical storms Connie and Diane. Southern New England received more than two feet of water. Every major river in the state overtopped its banks. Large swaths of Worcester flooded, and storm-related deaths almost equaled the 90 fatalities caused by the city’s catastrophic tornado two years earlier.
Boston would be battered by winds, according to Vallee, but the capital city isn’t his big worry. “I lose sleep over Wareham, Mattapoisett, and Bourne,” he says.
A Category 3 storm that makes landfall somewhere on the Rhode Island–Connecticut border would push hurricane-force winds up Buzzards Bay. The resulting storm surges, swelling as high as 25 feet, would sweep away homes in low-lying areas of the South Coast and Cape Cod and leave debris fields eight to 12 city blocks inland. Given settlement patterns in these areas, that adds up to a lot of damage.
“We’ve got a lot of infrastructure and population packed in small, very vulnerable coastal locations,” Vallee says.
New Bedford, home to largest commercial fishing fleet on the East Coast and the highest grossing fishing port in the US, sought mitigation against severe storms after the 1954 storms. The main line of defense is the 9,100-foot-long, 22-foot-high New Bedford Hurricane Barrier, the largest stone structure on the East Coast, which protects the New Bedford/Fairhaven harbor, shipping interests, waterfront commercial properties, and downtown New Bedford. Constructed by the US Army Corps of Engineers, the 40-year-old, $18.6 million dike was built to withstand 20-foot seas, and is, by most accounts, well-built and well-maintained, unlike the mostly earthen and concrete levees that gave way in New Orleans.
For Mark Mahoney, New Bedford’s emergency management director, the biggest concern is what he would do if people needed long-term shelter. During Hurricane Bob, the city opened two large shelters, but they were closed a day and a half after the storm passed. If a stronger storm hit, Mahoney might have to house people for up to a month.
Emergency managers say they are well aware of the hurricane threat. But does that mean they’re prepared for it? “Up here, we have the luxury of not getting a lot of [hurricanes],” says Vallee. “That luxury is also a pitfall, because it delays our response.”
But Massachusetts officials argue that a unique confluence of failings compounded the Katrina disaster, missteps that are unlikely to be repeated elsewhere, much less here.
East Coast, says David Vallee of
the National Weather Service.
Photo by Mark Morelli
“The major issue with an event like Katrina everybody hearkens back to [is] the poor communication from local to state to federal,” says MEMA spokesman Peter Judge. “We think we have that figured out here.” (MEMA Director Cristine McCombs declined to be interviewed for this article.)
WAITING FOR THE CALVARY
Emergency managers compartmentalize disaster management into four areas: preparation, response, recovery, and mitigation. What they don’t do is distinguish between natural and man-made disasters.
Since the 1990s, the Federal Emergency Management Agency has taken an all-hazards approach to disaster management, helping communities to cope with anything from a severe storm to a terrorist bombing. But some critics blame shortcomings in the response to Hurricane Katrina on a post–September 11 preoccupation with terrorism.
“Up until Katrina, all we talked about was the threat of a terrorist attack. Those of us who have been involved in this issue for some time have always said you can’t separate the two. You have to combine homeland security and emergency management,” says Boston’s Boccia, who brought both areas under this new umbrella.
Former FEMA associate director Richard Moore, now a Democratic state senator from Uxbridge, says the all-hazards approach works, for the most part. “You need to focus your training and planning on things that are likely to happen,” he says, “but you have to be prepared these days for any number of things that could happen.”
By most accounts, MEMA and FEMA work well together. During the May floods, MEMA officials were embedded in local command centers, and FEMA had a representative in the state’s secure emergency operations command center in Framingham, known as “the bunker.” Linda Vaughan, a part-time Red Cross staff member, spent two days and two nights in the bunker, serving as the organization’s government liaison. She scrutinized information coming into the agency from MassHighway, the Department of Transportation, the state police, and other departments to determine if evacuations were warranted.
“The bunker ran like a well-tuned engine,” says Vaughan. “People knew what they were there for.” Massachusetts did not request any federal assistance beyond what was required to facilitate a federal disaster declaration, nor did it request activation of the Emergency Management Assistance Compact, or EMAC, the mutual aid pact that enables the 50 states and certain territories to coordinate disaster relief. According to Judge, Massachusetts has furnished aid to other states, most recently during Katrina, but has never requested assistance through EMAC.
Should a history of self-reliance and good relations with FEMA translate into a speedy response in a catastrophe? According to Moore, Massachusetts shouldn’t count on much.
“I’ve talked to people fairly high up in Homeland Security,” he says. “They’re still [dealing] with the aftermath of the last hurricane season…. We need to be prepared to go on our own for as long as we can.”
That’s where things could get dicey for Cape Cod, says Rep. Perry. State and federal agencies may be relationship-rich, but they are resource-poor. “Even if we have all the agencies working together seamlessly, we don’t have the personnel and equipment on the ground,” he says. Perry points to a Massachusetts National Guard depleted by personnel and equipment deployments to Iraq and the transfer of the Guard’s formerly Otis-based 102nd Fighter Wing to Westfield, a consequence of the military’s base closing and realignment process. The moves leave a gap for small towns that have come to rely on the military to supplement police and fire departments.
The Guard begs to differ. In testimony before the Senate Post Audit and Oversight Committee in a hearing on Guard readiness, Brigadier General Oliver Mason, Adjutant General of the Massachusetts National Guard, downplayed deployments as “a way of life” and said the Guard was ready to respond if a hurricane hits. Moreover, he said, regional EMAC support from New England, New York, and New Jersey could be summoned in case of a crisis that overwhelmed state units, with a “truly catastrophic situation” satisfied by national reinforcements.
Currently, no official statewide mutual aid structure allows cities and towns to expedite the delivery of services, such as heavy equipment to remove downed trees after a storm. A bill that would facilitate the sharing of public works and public health resources across jurisdictions is pending in the Senate Ways and Means Committee. But Mattapoisett’s Botelho says that smaller towns actually do a lot of things to help themselves.
“If you went from town to town, you would find all those informal arrangements and mechanisms in place, and they seem to work pretty well,” says Botelho. These arrangements aren’t limited to public agencies. In advance of a severe storm, local boatyards help Mattapoisett clear vessels from the town’s 1,000 harbor moorings at no charge, a feat Botelho says neither the town nor the state has the resources to accomplish. “I wouldn’t want to see anything happen that makes it more difficult for you to get those last-minute resources in place,” he says.
In most states, county governments allocate resources to smaller jurisdictions under its umbrella. But with country government all but dismantled in the Bay State, it’s difficult to orchestrate a regional approach to disaster management, according to MEMA’s Judge. During the May floods, for example, Methuen Mayor Manzi says most communities stood on their own. But federal homeland security dollars (nearly $19 million to the state’s central, western, northeast and southeast regions and about $22 million to Metro Boston, according to the Executive Office of Public Safety) are forcing communities to think differently, since those funds are now funneled through the state’s five homeland security planning councils, established in 2004.
Moreover, state and other officials are sending an unambiguous message: The burden of planning and preparedness lies with localities. Perry says it’s a temptation to rely on the next-higher level of government, and DHS advisory council member Zenowitz agrees. People generally say, “Well, government will take care of it, that’s their job, [whether it’s] Washington or Boston or Springfield,” he says. But the “action,” for Zenowitz, is on Main Street, USA. “Emergency management [and] planning in any community is what the local people want it to be.”
TO FLEE OR NOT TO FLEE?
As disaster unfolds, one of the most difficult decisions for officials is whether to evacuate. And when they make the call, they better do so emphatically: A 1997 Southern Massachusetts Hurricane Evacuation Study conducted by the US Army Corps of Engineers found that when local officials make a strong case that danger is at hand people respond, increasing the number who evacuate by at least 25 percent and as much as 50 percent.
The other thing about evacuation is it takes time. On the Cape, authorities would need eight to 10 hours to get people out of coastal areas at risk for storm surge flooding, according to Vallee. The problem, though, is not residents, most of whom would seek shelter nearby, but tourists, who would dash for the Sagamore and Bourne bridges, the twin scourges of Cape traffic.
In other vulnerable areas, however, evacuation plans seem to work at cross purposes. Mattapoisett town administrator Botelho says that, in the southeast part of the state, some plans have people evacuating from one community into another when that community is trying to evacuate in the opposite direction. “We’re all committed to try and resolve that,” he says.
In Boston, the logistics of evacuation and shelter multiply, even if emergency preparedness chief Boccia considers a hurricane akin to a snow emergency, which he says the city handles well. In December 2005, Boston launched phase one of its evacuation plan. In March, the city distributed nearly $175,000 in grants to groups aiming to improve preparedness in neighborhoods, right down to families.
“The best-laid plans will fail if the public is not completely aware of those plans and what part they play in the implementation of those plans,” says Boccia. Neighborhood groups are expected to help identify special populations requiring assistance. The MBTA would make buses or trains available to MEMA. For those who can’t get out of town under their own power, the city is working to retrofit buses and rail cars. For residents who refuse to leave, police are still working out a policy, according to Boccia.
It’s unlikely that a hurricane would require the wholesale evacuation of Boston, as opposed to moving people out of at-risk areas. But the city has to prepare for the possibility of thousands of people deciding to leave on their own, clogging evacuation routes, as Houston residents did during Hurricane Rita.
One aspect of Boston’s planning generated mirth among long-suffering commuters: the evacuation-route signs that sprang up all over town last December. Even MEMA looked at the signs “somewhat incredulously,” Judge admits. Boccia, however, has no patience for critics of his signs. “They say, ‘Well, good [that] you put up signs. Are you going to depend on that to get out of the city?’ Of course not,” Boccia says, explaining that the signs are guideposts to be supplemented by human staffing.
In addition to 13 primary evacuation routes, the city is now identifying secondary and tertiary routes out of the city. “The secret to any plan is redundancy,” says Boccia. The partial closure of the Massachusetts Turnpike due to an overturned liquid methane tanker in May showed how easily mass exodus could turn into a mammoth traffic snarl if not enough routes are identified.
In terms of sheltering Boston residents displaced by a storm, Boccia hasn’t abandoned a Superdome-style solution. The problem in New Orleans was that the city did not have the infrastructure, plumbing, electric generators, or security in place to handle the situation, he says. In addition to the Boston Convention and Exhibition Center (which likely wouldn’t be used in a hurricane, since it sits in a flood plain), he is considering locations such as the TD Banknorth Garden, as well as college dorms and arenas.
Then there are the animals. The experience of Katrina moved pet evacuation to the top of emergency planners’ checklists. (Methuen made sure there were pet-care facilities available when parts of the city were evacuated during this spring’s flood.) For reasons of compassion as well as practicality (no matter how much they are in danger, people are reluctant to leave their furry companions behind, often refusing to be saved), agencies ranging from the US Department of Homeland Security to the MSPCA now advise people to take pets with them when they evacuate—advice that has emergency managers scrambling for ways to accommodate the animals. The Pets Evacuation and Transportation Standards Act, now pending in Congress, would require state and local authorities to incorporate pets and service animals in emergency operation plans as a condition of federal emergency funds. MEMA has set up a SMART (State of Massachusetts Animal Response Team) network comprised of state agencies’ emergency managers, first responders, and animal welfare organizations to address animal safety during emergencies. In New Bedford, Mahoney says there is “still a lot of work to be done” on the pet question, while Boccia says pet issues come up all the time in his conversations with Boston neighborhood groups. Boston and the Red Cross have identified more than 75 evacuation centers and mass care facilities. In some locations, pets could be sheltered near owners, if sanitation and health concerns can be resolved, Boccia says. Otherwise, pets would be sheltered in other facilities, with registration procedures ensuring reunification with owners.
As far as the US Department of Homeland Security is concerned, Boston’s emergency plan is on the right track With most major cities receiving abysmal rankings in the department’s latest catastrophic event preparedness report, released in June, DHS praised Boston’s evacuation plan for its clear delegation of responsibility for initiating a mass care response, its allocation of governmental and non-governmental resources, and its public notification guidelines, as well as its evacuation and shelter provisions for special needs populations and companion animals. Massachusetts was one of 10 states, along with Florida and New York, whose plans received the department’s top designation of “sufficient.”
FEELING THE EARTH MOVE
It’s tough enough to get the public prepared for natural disasters that, like hurricanes, at least have precedent in living memory. But what about strong earthquakes, the most recent of which here occurred 20 years before the American Revolution?
The Cape Ann earthquake of 1755 had an estimated magnitude of 6.0 to 6.3 on the Richter scale, with capacity to cause damage in populated areas across 100 miles. But that represents the minimum seismic hazard for metropolitan Boston, according to John Ebel, director of the Weston Observatory, Boston College’s geophysical research laboratory. A 1997 FEMA-funded study, conducted by MIT, together with other universities and private firms, estimated that a 5.5 to 7.0 earthquake near Boston or off Cape Ann would kill thousands and cause billions of dollars of damage.
Slippage along the boundaries of the North American and Pacific continental plates is what produces California earthquakes. In the East, the North American continent is spreading away from Europe and Africa and running into the Pacific plate, getting squeezed as if in a vise, says Ebel.
Seismic shifts are a little hard to imagine, but it doesn’t take much shaking to get people’s attention. Last year, Boston College helped Plymouth Community Intermediate School install a seismograph in its science center as part of a joint research project. On November 17, 2005, a 2.3 magnitude tremor, centered 1.2 miles south of Plymouth Center, jostled the area. “All of sudden it made sense to them,” Ebel says of the teachers and students who felt the quake.
As hazards go, MEMA is more concerned about an earthquake than a hurricane, deputy director of operations David Martineau told a Southern New England Weather Conference audience in 2005. With good reason. Unlike hurricane forecasting, earthquake prediction is in its infancy. “The weather folks have set a high bar for us these days,” Ebel admits. But earthquakes provide no distinctive early warnings, such as telltale electrical or magnetic patterns or gas emissions, he says.
manager Mark Mahoney
worries about providing
Photo by Mark Morelli
FEMA funded an earthquake program manager in MEMA in the 1980s, but with the shift to all-hazards preparedness, MEMA emergency planners turned their attention from quakes to storms and floods, which occur more frequently, so Ebel has fewer interactions with the agency now. But when an earthquake occurs anywhere in New England that’s strong enough to be felt, MEMA contacts the Observatory for the particulars—location, magnitude, and damage assessments—which the agency distributes to other New England states. “If you only have a damaging earthquake once every couple of hundred years in a city like Boston, it’s not something the average MEMA manager will have to worry about,” Ebel suggests. But, he says, it’s precisely because earthquakes are so rare here that MEMA needs to be vigilant about planning for them.
And when an earthquake hits, look out. For Ebel, raising earthquake awareness is one challenge and striving for resistant buildings is a second. It’s a truism that earthquakes don’t kill people, buildings do. And metro Boston has scores of unreinforced masonry buildings that would collapse. Also worrisome are areas that are susceptible to liquefaction. That, explains Charles Brankman, a PhD candidate in Harvard’s Department of Planetary and Earth Sciences, who studied the phenomenon with Tufts University’s Laurie Baise, is what happens when an earthquake causes geologically young, loose, sandy soil that’s saturated with water to lose strength. Structures built on landfills sink, tilt, or tip over. Liquefaction caused much of the destruction in San Francisco’s Marina District in the 7.1-magnitude Loma Prieta earthquake in 1989.
Sections of the Back Bay, South End, South Boston, the Cambridge side of the Charles River near MIT, Logan Airport, and other areas that are built on filled in lands where the Charles River tidal estuary once met Boston Harbor are particularly vulnerable to liquefaction. The diverse types of fill used in these in areas makes pinpointing the susceptible pockets difficult, according to Brankman. There is no state inventory of at-risk buildings.
In 1975, when Massachusetts adopted a statewide building code, officials inserted a seismic provision, one of the few states in the East to do so. A decade ago, the state Board of Building Regulations and Standards’ Seismic Advisory Committee revised the code to require retrofitting if a building owner plans a major renovation or addition. (Single- and two-family homes are exempt from this provision.) Some building owners, concerned about insurance and liability issues, address seismic issues on their own initiative. But designing buildings to survive every conceivable scenario would cripple the industry, argues Robert Anderson, deputy administrator of the building regulations board. Instead, Massachusetts requires builders to take into account the types of events that occur at least once in a 50-year or 100-year period, the typical lifetime of a building.
“If you do get that catastrophic incident, certainly it’s going to cause some damage,” Anderson says. “But it’s not going to cause catastrophic damage to the building or to the people inside.”
COMING DOWN WITH THE FLU
Like an earthquake, the prospect of a pandemic influenza outbreak takes the state into uncharted territory. Again, authorities hope that people take the time to educate themselves about possible disaster. “If all the individuals in the Commonwealth were prepared, then the Commonwealth will be prepared,” says Department of Public Health Commissioner Paul Cote Jr.
But he concedes that the state could be in better shape in some areas, and a December 2005 report from the Trust for America’s Health bears him out. The survey gauged nationwide readiness for a public health emergency, such as a disease outbreak, natural disaster, or bioterrorism attack. Massachusetts achieved a six out of possible 10 on key indicators, tying with Rhode Island for the best performance in New England.
The Bay State failed to measure up in four areas that could possibly come into play in a pandemic outbreak. The state has not been recognized by the US Centers for Disease Control as being “adequately prepared” to administer and distribute vaccines and antidotes; it does not have a Internet-based disease tracking system; it lacks plans to care for patients at non-health facilities; and it does not have incentives, plans, or provisions to ensure continuity of care in case of a major outbreak. But the state claims to be in better shape in these areas even today.
“Each of the four vulnerabilities identified in the report have been priority areas for our state’s planning over the past six months,” says DPH spokesperson Donna Rheaume. “Were the survey to be conducted today, we are confident we would be found in, or on track for, substantial compliance.”
The influenza strain now under the microscopes of public health officials from Boston to Bangkok is H5N1—known as avian, or bird, flu. Naturally occurring in wild bird populations, the virus can be fatal to domestic fowl and humans. Bird-to-human transmission is thought to have caused major pandemics in 1918, 1957, and 1968. At this writing, there have been 228 cases of avian flu worldwide, and 130 people have died. Despite a cluster of cases in Indonesia, there are some signs that the virus has waned in Southeast Asia, where the disease first appeared. Vietnam, which had the highest incidence of flu transmission from domesticated birds to people, has not any human transmissions this year, and birds migrating from Africa to Europe have yet to show signs of the disease.
“It’s good news that [bird flu] appears to be declining somewhat, but I think we have to realize that influenza viruses constantly change,” says Dr. Anita Barry, director of communicable disease control for the Boston Public Health Commission. Massachusetts began testing wild bird populations, including local Canada geese and migrating ducks, for the virus in June.
Were the bird flu to make an appearance here, the DPH paints a dismal picture. A pandemic could kill as many as 20,000 people in Massachusetts, sickening up to 2 million more and requiring 80,000 hospitalizations above normal rates. The federal pandemic flu implementation plan compares an outbreak to a war or significant economic disruption, rather than a hurricane, earthquake, or terrorist attack.
As with natural disasters, federal officials emphasize that the “center of gravity” for pandemic response will be communities. Boston Public Health Commission executive director John Auerbach agrees that the burden of planning and prevention should fall to local communities, especially if multiple outbreaks occur nationwide. Despite the federal government emphasis on a community-based response mode, he says, little funding is destined for municipalities, a situation he considered “unrealistic.” Auerbach also believes that years of budget cuts have undermined the state and local public health infrastructure, impeding its ability to respond to an emergency.
In February, Gov. Romney filed a supplemental budget request of $36.5 million for pandemic planning, which would help DPH build a volunteer medical provider network, improve hospital surge capacity, upgrade state laboratories, and develop stockpiles of medications, food, and other supplies. The state can tackle two eight-week periods of pandemic flu based on this funding, officials say. At press time, the spending request was pending in the Legislature.
Methuen Mayor Manzi and others met recently with Dr. Michael Ryan, the World Health Organization’s director of epidemic and pandemic alert and response. Ryan cautioned the group that the public will forgive local officials for the mistakes and stresses that affect community resources in a medical emergency. What the public won’t forgive, he said, is lack of planning.
But, as DPH recently learned, the existence of a plan doesn’t necessarily forestall criticism. The state’s blueprint, the Massachusetts Pandemic Influenza Plan, most recently revised in January, has been slammed as vague. “The level of detail isn’t what it should have been,” says Mary Leary, of the Massachusetts League of Community Health Centers.
Sen. Richard Moore, who co-chairs the Legislature’s Joint Committee on Health Care Financing, is even less generous in his assessment of the state’s pandemic flu readiness. With the exception of a few large urban areas, he says, the public health system is a “strings and bubble gum operation,” relying mostly on volunteers and lacking in the enforcement powers necessary to handle a flu emergency. The plan itself lacks contingencies for larger businesses, schools, churches, and other public places, prompting the senator, at a committee hearing in May, to voice “no confidence in Department of Public Health.” Although DPH has prepared templates to assist cities and town with developing local infectious disease and emergency plans, Moore doubts the commissioner’s estimate that 75 percent of municipalities have completed plans. “I think he’s guessing,” he says.
Cote says a more comprehensive plan will be unveiled in July, followed by multiple exercises at various levels prior to the flu season to “test the system.” The plan does address continuity of operations and continuity of government for all state agencies. In the event of a particularly severe outbreak, a state of emergency might be declared, necessitating school closings and restrictions on sporting events and other large assemblies.
Does Massachusetts have the resources to cope? That depends on the level of outbreak. One of the issues is hospital surge capacity, or the ability of a hospital to handle a huge influx of patients in a disaster or public health emergency. Current state estimates show sufficient beds in every region, except for the southeast, where health care facilities are short about 1,000 beds. According to Cote, DPH is working with regional hospitals to identify additional capacity and alternative care sites.
Nevertheless, no city in the country is adequately prepared for the worst-case pandemic flu scenario, Auerbach says. Unlike hurricanes, when officials might steer people out of an area, a pandemic could force people to stay in. The challenge will be to cake care of people at home, he says, especially if the medical and state authorities have lost the ability to contain infection. But don’t expect a magical cure. “The assumption that there will not be a vaccine in place to vaccinate everybody for the pandemic is an important one,” says Cote. One problem is the outdated egg-based process for influenza vaccine production. Cell-based vaccines could be produced faster, but the process is still considered experimental. The US Department of Health and Human Services recently awarded contracts totaling $1 billion to five companies for developing cell-based vaccine technologies. Moreover, effectiveness of existing viral medications, such as Tamiflu, depends on the strain of influenza that appears.
As with hurricanes, federal and state officials have seized on public education as their best weapon against pandemic flu. Massachusetts has conducted five regional pandemic planning conferences. Some business organizations, such as the Greater Boston Chamber of Commerce, have briefed members on pandemic readiness. Others are only slowly awakening to the threat. According to Julie Burke, director of the Employer’s Resource Group for Associated Industries of Massachusetts, the state’s largest association of employers has had few inquiries about pandemics from human resource professionals. A few years ago, Burke points out, the viral respiratory illness SARS generated a good deal of hype, but never amounted to much. Still, she says, “We learned from that to take greater precautions.”
Greater precautions are the only defense against Mother Nature’s savagery. The region’s climatic extremes, from blizzards to hurricanes, require an emergency management mindset that doesn’t allow much seasonal downtime.
Events of the past year have taught Mark Robinson, chief operating officer of the American Red Cross of Massachusetts Bay, an important lesson. “You have to never be so arrogant as to say that you’re prepared, ” he concludes. “You have to be constantly unsatisfied with your readiness level.”
Still, most of the emergency managers interviewed for this article expressed confidence in, rather than dissatisfaction with, their own preparedness. Whether Massachusetts-isn’t-Louisiana is a valid assurance remains to be seen. The floods of this spring notwithstanding, natural disasters of recent vintage have been comparatively minor—and they are no predictor of what is to come.
“When we get that [Category] 3, the lights ain’t coming on tomorrow,” says the National Weather Service’s Vallee. “They may not come on next week. There may be people with no homes to come back to. It’s going to shock people.”
Officials readily admit that an earthquake could cause unprecedented death and destruction and that a severe pandemic influenza outbreak could cripple the health care system. The Bay State has never activated EMAC or had to plead for federal aid apart from clean up.
The summer reverie is well underway, and Indonesia and Louisiana are out of sight and out of mind. No one wants to contemplate a natural disaster, much less plan for one. Officials can only prepare for the worst and hope that relentless entreaties to wash one’s hands, get a kit, and make a plan dent the collective consciousness—before the big one, whatever it is.
“Of late, we’re getting sort of a ho-hum response,” says Boston disaster chief Boccia. “It scares me.”