In August, CSTE activated its Concept of Operations (ConOps) Plan for emergency response for the first time. The activation was in reaction to the emerging epidemic of vaping associated lung injury in the United States. That week, there were reports of outbreaks from Illinois and Wisconsin in Epi-X, CDC’s emergency communication system, and a few days later I received a call from Minnesota State Epidemiologist, Ruth Lynfield, that her state was experiencing a similar outbreak. She was concerned about the lack of a national response given the three-state experience and anecdotal reports coming in from other states, such as Utah, California, and Massachusetts.
I quickly learned that the CDC already had three Centers involved: Injury, Environmental Health, and Chronic Disease (Office of Smoking and Health) all under the Deputy Director of Non-Infectious Diseases, and that they were managing the outbreak through a multi-state Epi Aid sending CDC Epidemic Intelligence Officers (EIS) to affected states for technical assistance. These Centers had little experience with national public health emergency responses and by August 20, well into the outbreak with hundreds of cases emerging (according to media reports) there was no central epidemiological response organized to begin surveillance, and collect and analyze case data from affected states; nor methods of lab testing of human samples and vaping fluids; nor investigations through usual mechanisms of establishing standardized case definitions, medical chart abstraction forms, and patient questionnaires. Thus, on August 21, CSTE activated its ConOps (the first organization or agency to do so) to assist states and the federal government with a national epidemiological emergency response.
I’ll stop the chronologic story telling here (as most are aware of the ongoing vaping-associated lung illness outbreak) and shift focus of this article to the ConOps process and impact on the CSTE National Office. Response to public health emergencies involves, in one way or another, activation of an incident management system. The system’s intent is to better manage and align people in an organization, ensure accurate and timely communications among stakeholders, and execute a plan that leads to a response, and eventual de-escalation back to normal operations. When CSTE activated, some staff had new job titles, reporting channels, and new responsibilities (within their skillsets), and once a new work flow was established, a daily rhythm was set. All CSTE departments were involved including program, communications, finance, information technology, and human resources.
CSTE was in Incident Command mode for nearly five weeks when we held an after-action review to discuss lessons learned and de-escalation. Importantly, we learned lessons around the activation levels articulated in our original ConOps plan, differing staff and supervisory roles, and mechanisms by which the national office staff remains updated on the emergency response and in turn provides CSTE members with regular updates. As of the writing of this blog, CSTE remains in ConOps activation and the vaping associated lung injury national outbreak continues with about 200 new cases reported per week. The CSTE-led Epi Task Force leads federal and state partners in the epidemiological response through regular calls, technical assistance, and critical communications. At this time of this writing, It appears we will scale down to a Level 1 or complete deactivation in the near future, as CDC stabilizes their new surveillance system for disease notification, analysis, and response. Overall, I am pleased CSTE has been able to execute this emergency response to the EVALI outbreak and have already discussed modifications to the ConOps plan for future emergency and/or outbreak responses.
Dr. Jeffrey Engel has been CSTE’s Executive Director since 2012. Prior, Dr. Engel was the State Health Official (2009-2012) and State Epidemiologist (2002-2009) in North Carolina and served on the CSTE Executive Board as the ID Steering Committee Chair from 2008-2009.