Using systems modeling to enhance public health preparedness

Health Systems (2015) 4, 1–4 © 2015 Operational Research Society Ltd. All rights reserved 2047-6965/15 www.palgrave-journals.com/hs/

INTRODUCTION

Using systems modeling to enhance public health preparedness Julie Simmons Ivy1, Jennifer Horney2 and Jean-Marie Maillard3 1 Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, U.S.A. 2 Texas A&M School of Public Health, College Station, Texas, U.S.A. 3 North Carolina Department of Health and Human Services, Raleigh, North Carolina, U.S.A.

Abstract As global public health threats increase in number and worldwide impact, we must explore novel and more advanced approaches to address the complex challenges associated with public health preparedness. Public health outbreaks do not adhere to municipal, state, or national boundaries, which makes the role of systems modeling all the more critical for developing effective and efficient public health preparedness strategies. In response to the need for global and multifaceted preparedness and response efforts, this special issue highlights novel systems modeling approaches that can be applied to public health preparedness. Through these illustrative papers, one goal of this special issue is to serve as a medium for communicating systems methods to public health practice and to increase practitioners’ awareness of the role that systems methods can play in addressing complex planning and implementation issues associated with public health preparedness. Health Systems (2015) 4(1), 1–4. doi:10.1057/hs.2014.31 Keywords: public health preparedness; systems modeling; global public health; global outbreak response

As we sit in the midst of the 2014 Ebola outbreak, our attention is focused once again on a type of public health transition, toward emerging and re-emerging diseases whose spread is facilitated by the connectedness of our contemporary global society. In this ever more connected world, geographic boundaries and borders are no match for the spread of disease. Public health preparedness is a global concern that recognizes no borders. The 2014 Ebola epidemic is the largest in history, affecting multiple countries with 13,703 cases (based on World Health Organization (WHO) updates and information reported by the Ministries of Health), 7,637 laboratory-confirmed cases, and 4,922 deaths as of 27 October 2014. As global public health threats increase in number and worldwide impact, we must explore novel and more advanced approaches to address the complex challenges associated with public health preparedness. The Centers for Disease Control and Prevention’s (CDC) guidance related to the Ebola Outbreak released on 29 August 2014 and shown in Figure 1 highlights the need for global and multifaceted preparedness and response efforts. This special issue is the culmination of such a multidisciplinary effort driven by a CDC-funded research collaboration between systems engineers at North Carolina State University, public health researchers at the University of North Carolina at Chapel Hill, and public health practitioners from the North Carolina Division of Public Health (the editors of this special issue represent each of these disciplinary perspectives). The North Carolina Preparedness and Emergency Response Research Center (NCPERRC) was one of nine centers at schools of public health funded by the CDC to

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Figure 1 Summary of CDC’s response to the 2014 Ebola outbreak. Source: Centers for Disease Control and Prevention, http://www .cdc.gov/vhf/ebola/pdf/cdc-in-action.pdf, accessed 9 September 2014.

strengthen and improve public health preparedness capacity through systems and services research. While NCPERRC focused on North Carolina public health

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systems and capabilities to develop and maintain sustainable preparedness and response systems, the 2014 Ebola epidemic reminds us that the very nature of public health preparedness must be global. From the U.S. perspective, a number of states have by now learned of direct connection with the epicenter of this outbreak, as they monitor travelers arriving from the most affected countries. ‘All countries face many threats with the potential for large-scale health consequences, such as disease outbreaks, natural disasters, and terrorist attacks. Preparing for and responding to these and other threats requires the commitment of, and cooperation among, many international partners’ (http://www.phe.gov/Preparedness/international/Pages/default.aspx). Public health outbreaks do not adhere to municipal, state, or national boundaries, which makes the role of systems modeling all the more critical for developing effective and efficient public health preparedness strategies. For example, the 2009 novel Influenza A (H1N1) outbreak affected over 213 countries. The 2010 cholera outbreak in Haiti included more than 470,000 cases that led to 6,631 attributable deaths. Disease outbreaks are complex, and when they involve diseases that are novel or newly re-emerging, their recognition can be delayed. In addition to our global connectedness, long incubation periods and non-distinct symptoms may add to the difficulty of containing them. The CDC’s recent guidance regarding Ebola shown in Figure 2 highlights this complexity and the concern that every influenza-like illness may be confused with Ebola resulting in medical surge and tremendous strain on the health-care system. Similarly, the initial symptoms of inhalational anthrax also are influenza-like, and cases resulting from bioterrorism in the United States in 2001 occurred during the seasonal influenza period. Outbreaks can affect many systems beyond public health. The 2011 Shiga toxin-producing E. coli (STEC O104:H4) outbreaks in Europe resulted in large economic losses, particularly to the agricultural industry (Frank et al, 2011). The 2012 London Olympics presented a reminder of the public health and other challenges associated with mass gatherings. The 2014 Ebola Outbreak has devastated Liberia’s recent revitalization, having significant economic and social impacts on a fragile system. In the United States, the isolation and quarantine procedures associated with exposed and infected individual are raising legal issues with battles ensuing between the state and the individual. As these few recent examples illustrate, public health preparedness is a complex and multi-faceted global problem with significant societal consequences (financial, civil as well as health-based) and as such requires an interdisciplinary approach. In fact, the WHO’s view of preparedness highlights the relationship between preparedness and response: ‘The ability to respond to biological or chemical incidents depends on preparedness (what needs to be considered long before an incident takes place) and response (what needs to happen after a warning of a pending release is

Systems Modeling for Public Health Preparedness

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Figure 2 Current CDC guidance regarding the difference between the flu and Ebola. Source: Centers for Disease Control and Prevention, http://www.cdc.gov/vhf/ebola/pdf/is-it-flu-or-ebola.pdf, accessed 31 October 2014.

received, or after the release has actually occurred)’ (http://www.who.int/csr/delibepidemics/chapter4.pdf). For this special issue we have considered a wide range of public health preparedness research based on Nelson et al’s (2007) definition: ‘Public health emergency preparedness is the capability of the public health and health care systems, communities, and individuals, to

prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action’. We have highlighted research that

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addresses any of the above types of public health preparedness concerns through modeling. This issue has particularly highlighted research that focuses on modeling to address the six public health preparedness domains defined by the CDC (2011): Biosurveillance, Community Resilience, Countermeasures and Mitigation, Incident Management, Information Management, and Surge Management. Some examples of this type of multidisciplinary public health preparedness modeling research include: ● ● ● ● ● ● ● ● ●

modeling for responding to outbreaks, modeling to address the needs of vulnerable populations and disparities, modeling of communicable disease, modeling for biosurveillance, monitoring, and informatics, modeling associated with public health policy and preparedness, use of simulation for public health preparedness, modeling the economics of public health preparedness, decision support systems and tools for public health preparedness, systems dynamics modeling for public health preparedness.

Within this domain, multidisciplinary research and applications that have been able to translate research findings into public health practice are spotlighted. This issue includes papers related to: modeling the effect of natural disasters on public health needs from the

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perspective of preparing for medical surge (Howard and Zhang, 2015); using data mining to understand demand for public health resources, such as mental health services (Kudyba and Perry, 2015); and modeling the relationship between disease outbreaks, such as influenza on the hospital supply chain from the perspective of pharmaceutical resources (Vila-Parrish et al., 2015). These papers highlight novel systems modeling approaches that can be applied to public health preparedness challenges in the future. Through these illustrative papers, one goal of this special issue is to serve as a medium for communicating systems methods to public health practice and to increase practitioners’ awareness of the role that systems methods can play in addressing complex planning and implementation issues associated with public health preparedness. Our hope is that this issue will fill a void related to the translation of systems modeling research to public health preparedness practice.

Acknowledgements The preparation of this special issue was supported by the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) which is part of the UNC Center for Public Health Preparedness at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) Grant 1PO1 TP 000296. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Additional information can be found at http://nccphp.sph.unc.edu/ncperrc/.

References FRANK C et al (2011) Epidemic profile of Shiga-toxin-producing Escherichia Coli O104:H4 outbreak in Germany. New England Journal of Medicine 365(19), 1771–1780. HOWARD D and ZHANG K (2015) Hospital and skilled nursing facility patient flows during Hurricane Katrina and the Midwest floods of 2008. Health Systems 4(1), 29–40. CDC (2011) Public health preparedness capabilities: National standards for state and local planning, June. [WWW document] http://www.cdc .gov/phpr/capabilities/DSLR_capabilities_July.pdf.

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K UDYBA S and P ERRY T (2015) A data mining approach for estimating patient demand for mental health services. Health Systems 4(1), 5–11. NELSON C, LURIE N, WASSERMAN J and ZAKOWSKI S (2007) Conceptualizing and defining public health emergency preparedness. American Journal of Public Health 97(Supplement_1), S9–S11. VILA-PARRISH A, IVY J and HE B (2015) Impact of the influenza season on a hospital from a pharmaceutical inventory management perspective. Health Systems 4(1), 12–28.