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Stanford Report, November 19, 2003

Officials stage fake pneumonic plague epidemic to test readiness


The specter of Black Death visited Stanford Nov. 12 during a campuswide emergency exercise developed by Environmental Health and Safety (EH&S) that simulated an outbreak of pneumonic plague, one of the highly infectious diseases that decimated the population of Europe during the 14th century.

Dr. Ira Friedman, director of the Vaden Health Center, convenes with housing and dining chief Shirley Everett and Dr. Lucy Tompkins, an infectious disease expert in the Medical School, during a simulated outbreak of pneumonic plague staged on campus last week as part of an excercise to test the university’s disaster preparedness. Photo: Barbara Palmer

During a three-hour exercise, staff and senior administrators were asked to interpret a barrage of reports about sick and dying students and staff (six dead and 62 ill) and to act to contain the spread of confirmed cases of plague on campus -- in the case of pneumonic plague, antibiotics must be given to exposed individuals within 24 hours of the first symptoms to reduce the chance of death. (Untreated plague is fatal in almost 100 percent of cases.)

As staff worked to trace all of the possible contacts that sick students and staff could have had with others, they also had to attend to urgent questions about university operations and policy: Who should come in to work? Should classes be canceled? Where should sick individuals go? How should supplies be paid for? What about a group of first-graders visiting campus?

To add to the illusion of reality, a 30-person simulation team based at the press box in Stanford Stadium made more than 340 phone calls to individuals at the Emergency Operations Center, headquartered at the Faculty Club, and at 26 Satellite Operations Centers across campus. Simulation team members posed as panicked parents, students and staff, FBI agents, pushy news reporters, vendors terrified to come on campus and even National Security Adviser Condoleezza Rice, calling from the White House for a briefing.

In real life, it would have been even more chaotic, said Regina Phelps, an emergency management expert and consultant who worked with Stanford staff for four months to create a plausible, convincing scenario that would test how well the campus would respond to an outbreak of disease. If plague actually was confirmed on the Stanford campus, the drain on resources such as surgical masks and antibiotics in the area would have been immediate, she said. In such an emergency, local, state and federal health officials would have played a central role in decision making. Representatives from the county and state health departments and the Centers for Disease Control and Prevention in Atlanta also participated in the exercise.

"The idea of plague sounds outlandish at first, inside what everyone perceives as the protected area of Stanford," said Dr. Ira Friedman, director of Vaden Health Center, who participated in the exercise. But it is possible that such an outbreak could occur, he added. "We know we're preparing for the possibility of a rare event, but if you take those possibilities seriously, the only way to do it is to practice in advance."

In the scenario that Phelps designed, the spread of disease was consistent with what could be expected to result if a terrorist released an amount of aerosolized Yersinia pestis bacteria at a crowded event. But the emergency plans also could be activated in the event of the outbreak of a disease like Severe Acute Respiratory Syndrome (SARS) or a flu pandemic.

Emergency planning at Vaden Health Center that was prompted by the SARS outbreak proved its utility during the exercise, said Dr. Robyn Tepper, chief physician at Vaden. The student health center is stocked with emergency kits holding thermometers and surgical masks so that students can check for fever and protect against the spread of infection, she said.

But the exercise also revealed how quickly services could be stretched to their limits during an emergency. Her team was preparing for "hordes of kids who were going to start coming over" to Vaden -- even though many students likely would be well or would be suffering from less serious illnesses. "When you know there's plague, you have to assume [every case] is plague," she said. Meanwhile, Vaden medical staff were not equipped to treat seriously sick students and had no way to transport them to the hospital because no ambulances were available, she added. (The Department of Public Safety eventually volunteered to send over a Marguerite bus.)

What surprised Tepper was how difficult communication with the Emergency Operations Center proved to be, "considering that we were in the trenches," she said. "You'd think it would happen with an earthquake, but not with something like this."

There were failures of communication on many levels -- which is extremely common during such exercises, Phelps said. Participants can expect to make a "zillion, million mistakes," Phelps said. "The point is to learn, and I think we learned a lot."

Stanford has additional obstacles to overcome since the university is so decentralized, she added. Even during the exercise, people still continued to work in their "silos" -- delaying communication, she said. "It is very typical of academics, and it will lead to mistakes in decision making."

Overall, the exercise was very successful, said Larry Gibbs, associate vice provost and director of EH&S. "The exercise was quite challenging, and that was our goal. Communication during a crisis is one of the key challenges that we'll have to deal with across campus." The exercise also revealed conflicts over roles and responsibilities across Satellite Operations Centers and within the Emergency Operations Center, he said.

By continuing to devote resources to emergency planning, he said, "we'll be better prepared tomorrow than we are today."