Duke group, expert panel discuss hurricane response amid coronavirus
Duke Science & Society and a panel of experts will discuss the hurricane season forecasts, the potential for further COVID-19 spread through typical hurricane response measures like evacuations or sheltering and what additional measures must be taken to protect and respond to the needs of affected people.
all right, I think we can go ahead and get started. Um, pull everybody. Thank you for joining us today and for joining the Duke Initiative for Science and Society for the next installment of our Corona virus conversations. My name is Andrew Para Sack, and I am a research analyst here at Science and Society. I'll be moderating today's event, which is looking at the changes to hurt. It may be necessary to minimize the risk of spreading Cove in 19 especially given that forecasts for her predicted a particularly active hurricane season if response to Cover 19 was a perfect storm of challenging factors than adding on a broad scale, natural disaster will only magnify those effects storms. So in addition to holding this event of which the video recording will be on our YouTube channel in a few days, our staff here at Science and Society have collected best practices and a policy brief that was just published a few minutes ago. You can access that brief for free on our side paul dot org's website. It's S C i p o l dot org's. But to further explore this issue we have brought together today, a terrific group of scholars to share their thoughts is, and I will introduce them shortly, but just a few housekeeping notes before I do so. If you have any questions for a Panelist, you can send those to Ben Shephard using the chat function at the bottom of the screen and who he will redirect those questions to me, and I'll try to get to as many of the audience questions as possible, please throughout the event to make sure to keep your video off in your microphone muted again. If you do have questions, just use that chat function to Ben Shepherd. After the event, I invite you to visit the science and Society website, just science and society. You dot eu for Learn about a next coronavirus conversation, which will focus on the Trooper policies as we continue to see Cove in case numbers rise. That event will take place on Thursday, July 9th at 2:30 p.m. Eastern time. And while you're on the Duke Science and Society website, you can learn about our master's degree program. Where are students and faculty address? All these different issues we've been talking about in these carnivorous conversations on a daily basis. So with that a lot of the way I'll go ahead and introduce our Panelists. Dr. Mark App Quits is a professor of civil and environmental engineering professor of engineering management and the director of the Vanderbilt Center for Environmental Management Studies at Vanderbilt University School of Engineering. His research focuses on enterprise risk management, hazardous materials, transportation safety and security. Assessing the impacts of extreme weather on infrastructure adaptation and spatial analysis of freight transportation systems. Doctor App Quits is the author of Operational Risk Management. A Case study approach, Effective planning and response. Yes, served as a member of the Nuclear Waste Technical Review Board appointed to this position by President George W. Bush in June 2002 and he is the recipient of the Distinguished Service Award from the National Academy of Sciences for his leadership role with the Transportation Research Board. Next, we have Dr Elizabeth A. Albright, who is an assistant professor of the practice at Duke University's Nicholas School of the Environment. She engages in research on questions of local level resilience and community learning in response to extreme events. Elizabeth is currently working on projects studying response to disasters in various regions across United States. Funded by the National Science Foundation, her work in Colorado was awarded the Paul A Sabbatical Award for best paper and environmental politics at the American Political Science Associations and you'll meet him just published on response Extreme Events. Perceptions of Climate Change, the Advocacy Coalition Framework and Stakeholder participation in state level regulatory processes and for full disclosure. Dr. Albert was one of my favorite professors when I was a master student at Duke's Nicholas Schools Time especially glad that she could join today. And Lawrence Our is an assistant professor of emergency medicine at the Johns Hopkins University School of Medicine and the director of operations with the Johns Hopkins Office of Critical Event Preparedness and Response, was also a priest. She is also a research associate in the Department of Emergency Medicine, a doctoral candidate in health and public policy, and the Johns Hopkins Department of Health Policy and Management, where she studies quality of aid in response to disasters and the effects of disasters on healthcare infrastructure. Sour is also the program manager for the National Center for the Study of Preparedness and Catastrophic Event Response Pacer, a department of Homeland Security emeritus Center of excellence. She's worked remotely and on the ground for several disaster responses, including Hurricane Katrina, the 2009 California wildfires, the Haiti earthquake, the Pakistan floods and, more recently, the Ebola virus disease outbreak in West Africa. I'm very excited to have all three of these panels here today and look forward to hearing their expertise about both the scientific understanding of hurricanes and Kobe as well as what policy suggestions. They may have to address these coinciding perfect storms. So to start the conversation, I'm gonna give each Panelist about five minutes for any opening remarks they have on Lauren. What's go ahead and start with you if you are ready. Yeah, thanks for having me. Um, you know, as we move into words increasingly impacted by climate change and globalization, we also see significant decreases in funding at the same time to public health. Infrastructure are global and national public health workforce remains significantly overtaxed and underfunded or go. Excuse me. This is the time of year that that public health workforce, those were currently responding to Cove. It would normally be deep in the the throes of hurricane prepared activity of breast health system, and we don't have a deep bench to pull from to support this expanded need. Not only disco baby require resource is in and of itself and take away from those resurfaces from other responses. It also requires an adaptation toe, literally all of our health care and public health response planning activities for hurricane season. We know the supply chains are already disrupted. Shelter operations were require significant over and possibly conflicting message message and evacuation must be carefully delivered to thread a needle of the need to safely leave an area while keeping those critical physical distancing practices in place. So we're at a point where we need to reflect on our bill lady, to maintain the whole of response that supports the well being of the affected communities, both for Cove it and in hurricane season. We need to think about the general public more broadly, and also important is our responders workforce across the globe. We have to think of the resource is that we have prioritised for health care and public health, and this hurricane season, unfortunately, will give us the lens to do just that. So as we move into Hurricane season. Um, the idea that we structure our response such that we are still applying our resources to Corbett while also ensuring that we can make as much use of that covert response activity to prepare for the hurting response as well is absolutely critical. I'll end it there in him towards the next Panelist thing. Thank you so much. Betsy. Are you can Stern Thank you, Andrew. Thank you for the introduction and kind words. So as Under said, I'm an environmental social scientist and policy scholar. It at Duke and I study disasters and long term disaster recovery, including flooding and hurricanes. So, for example, after Hurricane Florence, which hit the coastal plain ah, a couple of years ago, three of my students and I'll give a shout out, Rachel Goes and Hauser called Cornish. Alicia Zhao. I encourage you to look at the report online. So in collaboration with a local organization, they interviewed 26 individuals and organizations on the coastal plain of North Carolina, asking about questions of recovery. So, really, that's where my research centers and at community level and focused on long term recovery. I'm awesome, most recently a part of a multi institutional team that has received a National Science Foundation grant to study policies and public perceptions and behavior change related to Kobe 19. And we're conducting surveys and analyzing covert related state and local policies. So just a couple of points I'd like to make first off one. Many communities along the Atlantic Coast, broadly and more specifically in the southeast Gulf Coast, Puerto Rico, are still recovering from past hurricanes, whether from Hurricanes Matthew Florence story in here in North Carolina, Irma Maria in Puerto Rico, Harvey in Texas and I could go on and on here. And recovery from hurricanes has been slow and policy response inadequate. As an example in North Carolina took 500 days between Hurricane Florence in the distribution of federal housing and urban development funds over 500 days. So also, our work has shown that administrative capacities of local communities is limited. And so it's not just the upcoming hurricane season that worries me. It's hurricanes of the past, worsened by layers of inadequate recovery in policy failures. So we have a system of compounding in cascading risks to think about an address which gets me to my second point when thinking about hurricanes in Cove in 19 both individually and together. We need to think about issues of disproportionate impact. We know that low wealth, communities and communities of color are disproportionately affected by cove in 19 both in health and economic impacts. This is also often the case with hurricanes, and especially in the American South. But elsewhere as well. The impacts of hurricanes air amplified disproportionately across race due to centuries of institutional and systemic racism. Further studies have documented inequitable access to resource is for hurricane recovery across race. So all this taken together, the risks of hurricanes, will magnify risks of Covad and vice versa, with more significant impacts on communities of color under resourced communities and people who are living or working and congregate facilities, nursing homes, correctional facilities, meat packing, meat processing facilities, etcetera. So, in short, we we need to figure out better policies and practices federal, state and local to empower and get needed Resource is to local communities, families, individuals, communities who are marginalized, communities who have limited access to resources, and we need to think about risks and recovery. Broadly. Recovery is more than just rebuilding homes after a hurricane or recovering from Cove it. But it's strengthening and empowering communities, addressing issues of failure and inadequate infrastructure, access to health care jobs, healthy foods, education, the Internet. And it's addressing other environmental risks. My third point and all start making these points shorter. Um, research has shown that social capital relationships ties that bind neighborhoods, communities, families together matter, and they matter a lot in disasters. Maintaining these ties when we're physically distancing becomes even more important. Governments need to support and empower community on the ground organizations to strengthen their tools, to engage with community members now and during and after a hurricane in the context of Cove in 19 organizations that have the trust of community members in long term relationships, empower organizations to disseminate information, mask PPE guidance somewhere to shelter and how etcetera. And then my final points and then off be quiets for a bit. Um, we're stuck in a process of reactive decision making. This is true for Cova. Just as it is true for hurricanes, preparedness is rarely, if ever discussed outside the disaster window. There's little if any incentives for policymakers to invest in pre disaster fairness, but we know that pre disaster planning, preparedness and risk mitigation saves lives and has a great return on investment. But we fail time and again. So just to wrap up four themes compounding risks and past disasters just proportionate impacts across race and wealth, social capital and empower the local and pre disaster planning and preparedness. Thank you. And I look forward to engaging in the panel today. Hey, thanks so much. Betsy On, then. Mark here. Okay, Thanks, Andrew. First of all, I very much appreciate the opportunity to be part of this panel and command Duke for hosting for these types of events because I think they are very important in terms of sharing ideas across a broad spectrum of folks who were involved in in different disciplines and in different communities. Uh, I've been involved in enterprise risk management for probably the last couple of decades, and I've done a fair amount of work both in the public and the private sector's. I feel I have a pretty healthy lens on on the different ways that people are witnessing and experiencing thes kinds of events. One of the ideas that I want to introduce that broadly in this discussion is something that we emphasize a lot in our work, which is very much an interdisciplinary approach. And I refer to that as the social technical nexus. And the point of the matter is, is that whether you're involved in risk management, risk assessment or risk communication, which are all part of oven enterprise approach, we have to understand not just the kinds of solutions that might be. We might be able to to apply to a situation. We have to understand the political and social environment that we're trying to solve, that problem within and in many respects that we get the tail in front of the wagging the dog and that we try to come up with these solutions when the solutions faces truly defined by the political social landscape. And in this result, many of us, but especially even in academia, sometimes get caught in our ivory towers, and we create these solutions in search of a problem which is not particularly a healthy weight to do things. Um, and I also want to point out that even the hurricanes is the topic du jour. I really any extreme weather than or natural disaster? You could even extend that to significant manmade events, eyes going to put many of the same pressures on the system on DSO. This is there's no area in the country that's immune from the conversation we're having today. We may need to substitute for for wildfire or earthquake or flood or tornado, but the context really pretty much remains the same. But with regard to hurricanes on, I think we may get into this conversation later. But the National Oceanographic and Atmospheric Administration is already predicting a A stronger than average. The season which will run well, is running out through November. So we really have a ways to go here and we're fortunate that nothing's happened yet. But what we are seeing as a general trend is that we have rising sea levels and higher storm surge coming from these more frequent and severe events. And so it's it's kind of a devastating 12 punch at the same time that demographically we're seeing more investment in coastal communities. So even if you put Corona virus aside, we're dealing with a growing problem from just managing the risks associated with hurricanes. Now, when you superimpose Corona virus on there, uh, it really presents two problems, one which my colleagues have already made reference to is Thea Neil. The risks that are imposed by having toe manage traditional emergency response practices that really become a greater threat because of Kobe. And the second thing, which was also brought up by my my colleagues, is the competition for limited resource is eso. So those are both very much prominent and in the conversation, the other thing that I would point out is the time dimension. My sense is that we're going to experience much longer periods of recovery as well. And so this is not necessarily as much of an episodic event as it is a combination of an episodic and chronic great Well, thank you all so much So a lot of really great ideas, insightful ideas there in those opening statements. What we can try to do now for the next few minutes is unpack some of those little bit, get into a little more details. Teoh, really See, You know what the situation is right now is that we look at this hurricane, cove it over that and then, you know, you think about me be what some of those reasonable policy solutions could be whether that's policy coming from the government or whether that's policy is that individual hospitals, shelters things like that might be implementing eso mark to stay with you for a little bit. You were mentioning some of those hurricane forecasts, which, as was pretty widely publicized, have seemed a little more severe the Seeker than they have in the past. Could you spend just a kind of a you know, relatively short, uh, additional explanation about you know exactly what those forecast say? Maybe. What don't they say? Like, for instance, do we know how many of those storms are going to be severe? Do you know how many are going to hit light and what can we going with this workouts? So Noah has a climate prediction center, which is where they develop these forecasts for the coming hurricane season, and it's, you know, they can't predict these things with certainty. But that they do is the established a level of confidence around their estimates. And for this coming year, their level of confidence is at 70% which, you know, some people will say, Well, what about the other 30%? You don't know what's gonna happen. And my attitude is, Well, let's think about 70%. That's, Ah, reasonably high degree of confidence more than you know, better than flipping a coin that that these are things that are more likely to happen. What they are saying is that there's a 60% chance of an above normal season and only a 10% chance of a below normal season. And they go one step further to point out that normally they on an average basis, you would probably experience about six hurricanes, and three of them will be major. Um, this year they're saying that they are expecting I I think 6 to 10 hurricanes, of which 3 to 6 will be major. So that kind of gives you a context of what we might expect relative toe the other no years past. Great and correct me if I'm wrong. But Major in this sense means at least Category three or higher, which is 111 miles an hour winds. I think that's correct. Thank you. For for that, those air, generally considered the ones that are associated with Wednesday, can be very different in terms of their damage consequences. Yes, Okay, so Yeah. So bad season. Luckily again, nothing has it yet. Um and yeah, I mean, I guess. And you the marker if anyone else wants to chime in on this, um, you know, one of the things that think someone grew up in Virginia that I'm used to seeing is, you know, all the both evacuations and the shelters that start taking place when there is a prediction of a land falling hurricane. So you know how how strong do these hurricanes have to be typically for those sort of measures to occur? I know we had a few tropical storms and, uh, hit a little bit of some coastal acres already this year, but we typically see evacuations or shelter is for smaller storms. Is it really gonna be those major storms? Well, she was bringing for someone else to say something. Anything, quickly say that the amount of damage is always It's a function first of all, of the location of the hurricane. And I'm not just how you know, it was under what form it takes landfall. But also, what side of the of the cyclone, if you will you fall on, uh, and and but But a lot of it also has to do with the vulnerability that area has to these events. You know, depending upon the structural conditions that you know, the buildings infrastructure are in what kinds of, uh, but Minster, or natural barriers or other things may be in place to keep storm surge from from being much more aggressive. But what I do also want to say is that to my way of thinking, the hurricane season concept also applies to tropical storms because some of the things so much energy that spawns thes hurricanes sometimes they may not get to the level of being considered classifies a hurricane. But a lot of people will argue, especially more inland, that tropical storms are actually more dangerous than hurricanes because they contend to stall and put 15 to 20 inches of rain on you in a very small period of time that we've seen in places like Houston that the inland flooding was a much more severe consequence in the hurricane. So yeah, I would just add to that that it's it's not just a sort of like what you're are saying. It's not just this. This product of the wind speed, which just driving the category. But, um, if conditions there won't make the area vulnerable to flooding if communities have a hard time evacuating quickly, these can all factor into decisions to make. That meant that either voluntary or mandatory evac duration order. And all of those decisions have to be made in careful context with where the evacuation order will move people to and how people out of the area. And then when can they put potentially go back in? Yeah. No, no, no, no, no, that's fine. Um, and I'm no, um, climatologists. But I The series of hurricanes we've seen in North Carolina, I would say, have not been wind driven events, but have been this sitting and excessive rainfall events that have caused the majority of problem. I just got back from okra, Coke Island, which was devastated in Hurricane Dorian, which was, in effect, a kind of seven foot storm surge from the state, Um, from the sound that washed over. So I think we need to think more broadly about, um, about hurricanes beyond beyond the category 12345 And I think that's makes a lot of sense and yeah, again. Even someone you grew up inland. Virginia. Yeah, I know. For me when the hair coming said it was like, Yeah, the flooding was more of the concern, unless so than the wind. So definitely makes us, um, Lauren to go back to you, to think now about you know, when there is going to some of the sheltering evacuation again. You know, the news media less to show images of overflowing shelters that you know, tons of cops put next to each other images that this year really frightened me. Given what we know about how Kobe might spread among individuals eso can you go into a little about, You know, maybe what some of that understanding is that we know where now, about really any dispute disease spread, but particularly cove it on what that might mean for things like shelters for hospitals, nursing homes, places like that, with a lot of vulnerable people who are in close proximity to one another. Yeah, I think a lot of the congregate setting work that's been on by a lot of the eight organizations and by the CDC and by the W. H O can be applied when you're thinking about shelter operations on. And I know the Red Cross is actively working on how they'll approach this. Is there one of the major shelter providers, Um, in natural disasters? Um, you know, when you look at some of these short term congregate examples like the comfort or like some of the large scale um, hospital of, you know, acute care facilities that have been set up these hospitals field hospitals for lack of a better term on one of the things that I think was tried to do early was to make own Kobe hospitals. But given the challenges with testing, particularly testing with very short turn around. Now we see you know practical challenges to that, and that's something to be taken into consideration. Testing on entry of of shelters and things like that, I think, will be a really big challenge and potentially sets you up for a very high risk population. We also know that people who enter into shelters rather than you know evacuating and sheltering with family members or loved ones are at other temporary housing like hotels. Um, often times are more vulnerable and more medically susceptible population, and so that's gonna present an even bigger challenge for our workforce. How you manage these people shelters aren't always set up to provide basic meant more than more than basic medical hair. And a lot of the people who staff are shelters, particularly those health care providers who support the nurses. In particular. Support shelter operations are already deployed to other activities for covert response. So purely the numbers game of staffing. Ah, potential regional response to a hurricane or any other weather event, Um, that we see coming in the next few months Here, um, is going to be a huge challenge, and we have to start thinking about it now. And we have to support the groups that think about it regularly because they're also thinking about quoted response now. And they've been pulled a covert response. We have to give them the structure to expand their workforce. Yeah, what happened? Maybe some of the more concrete things that even some of those other organizations, whether it's CDC or FEMA or state emergency management organizations, what is something more concrete things are thinking about doing That might be different this year compared to previous years. Um, well, one of them is this, like concept of open words, that sort of goal in a way. Open, you know, spacing for the cotton. You know, the mascots, the ones you're sort of talking about, that you see in these visual images over and over again, particularly out of tribune on and large storms like that. Yeah, um, putting up physical barriers, changing H vac systems, possible outdoor shelters and spaces that aren't affected by weather. All of these things are practical approaches that are very different than the way we traditionally think oftentimes were thinking of sheltering um, efficiently on that oftentimes means more bodies, less space, less privacy less, you know, of your own air. And and that becomes really hard toe to maintain in a sort of kako bid world. Um, what the hygiene looks like, what the water and sanitation looks like. How we will manage testing of the patients, I think, remains to be seen from a lot of these sites. I think there's like like I was saying earlier, the way we're approaching things like nursing homes where you go and you do community testing to do education, retraining of the staff on basic hygiene principles. Um, we've dealt with other infectious diseases in shelters settings before. And I think there's a lot of practical lessons to be learned. Um, from that. But you know, this is a very susceptible population, so keeping that in mind is really important. I'd like to just add that I think I the logistics of this whole process is challenging because way will have probably fewer resource is available. At the same time, we may have more people coming into a shelter or evacuation situation. And so consequently, you really have to think through the throughput process while maintaining a level of health standards that it doesn't put more people with risk. So lets a bunch of people show up gymnasium and you know how. How are you going to process them people that that one way is to obviously take their temperature. But you may have asymptomatic people with that point in time, and so there's no guarantee that you're going to be able to siphon off. The people that are ill are known to be ill to somewhere else. How do we feed these people? Traditionally or oftentimes they're in buffet lines to feed these folks Well, now we have to think about individual meals and and that kind of thing. So it's There are some very practical logistical questions, and I would like to advocate for emergency response agencies developing a new playbook on and maybe training exercises simulations so that this doesn't become, you know, as best he was mentioned, it doesn't become another reactive response, but actually anticipating that this will happen as opposed to being surprised when it does, we know CO, it's gonna be with us for a while. We know natural disasters are going to happen. And because Cove it is affecting everyone, it, by definition, the natural disaster, wherever it does happen, is going to happen in a covert environment. Yeah, big assure. Big loser. Six kind of, Ah, problem that we seem to be getting into here, which is, um, go out for those people that are making those plans for share. So one thing I guess, related along these lines I'm in. Maybe Lauren. Betsy, Maybe one of you can address this. Um, the started to see that, you know, as people are concerned about contracting Copan 19 that even if local, uh, emergency managers are saying we need to evacuate you need to get the filters that maybe people who just outright don't do that this year because of that fear of contracting with disease. So what sort of communication might be necessary to affected communities, especially the lower income communities, the communities of color? Who was that of communication? Do we need for those communities to make sure that they do take heed of these warnings if a hurricane is approaching? What I've, um, been thinking about one is using networks using a working with collaboratively community organizations that are already on the ground that already have trust with community members and work with Sam whether there, um, faith based organizations, community based culture, um, you know, organizations that are already established, working and serving the Latin next community, um, and working the local governments, state governments, working with a network of organizations who then convey an intermediary between the government and um, community members. And so there is a level of trust in comfort. I also think it's critical. In May I was doing a scan of, and I've been working with students to help download kind of local policies across the U. S. And some states and local governments are doing really well it putting out information in multiple languages and some aren't at all. And one. It's one thing to have information on a website. But not everyone has access to the Internet. And so information needs to be disseminated to where community members are and not expecting community members to go to the local government. And so thinking creatively about communication messaging, what type of messaging will work in a cove, it and hurricane context and working with, um, community based organizations on the ground? Yeah, I agree. I think I think we're in a trust vacuum, um, a little bit, especially with our our federal public health authorities and local public health authorities have really taken up the role of the trusted messenger in some places, and very much not another. And, um, one of the things we learned the hard way and to puts its earlier point about this lack of preparedness, you know, um and always having to be reactive is that we've learned the lesson over and over again that sometimes, in order to garner trust, the message has to be, huh? We're local and very specific to the community or trying to approach or address and the community themselves have to be involved in the building of the message on. I think that is something that that we have gotten better at globally. And I think what we're seeing in the U. S. Is that, um we're not so great at that, actually here in the US and we this is the time to get better at it because if not, none of this will work. Actually, yeah, I completely agree. We'll go ahead. Good. You know, I was just gonna say I second what Lawrence says. So I third that, But what I also wanted to point out in our experience in general, with risk communication on, you have a real window of opportunity. If you could put some of these foundational elements in place before the disaster actually strikes because people then have an opportunity to learn, absorb, act upon it on by the time that the disaster happens in these and the messaging begins, it's no longer, you know, an immediate, uh, you know, eggs anxious and stressful way of of reacting because you already sort of tuned into the idea that everything that you heard about when you have the ability to absorb, it is now coming to fruition. And it's It's not the first time you've been exposed to the whole, you know, way of thinking. Yeah, and I think, um, more work needs to be done. And it's one thing that are think I mentioned at the NSF rapid response Grantley gods of part of this risk in social policy group I'm working with is we're looking at peoples. Who we asked them a broad, open ended question about what messages do you remember? What message do we do? You recall when you think about Kobe and I think we need to really sink about. I know lots of work has been in this risk communication, but in this particular context, I think we there's a space toe from an academic lens figure out what's effective. The other thing, I would add very quickly, is that some people talk about messaging Teoh to the audience, and I think about it is messaging to the audience is there are so many different people out there that absorb information in different ways. Different languages, different perceptions, and so we really have to understand the demographics of the area and make sure that we're reaching each of those audiences in a way that they can actually absorb and understand. The onus is, should not be placed on those audiences to try to translate whatever it is. We're kind. Yes, thank you often. And since since wrongly kind of a topic of communicating to public's communities audiences one of the questions. We actually got a lot of the obvious members who RSVP'd is a little bit more a broader science communication question. And I'm kind of what people can do is individuals to prepare for hurricane season especially, you know, if they do live on the coast or even if they do live in land, which could be susceptible to flooding. Are there any particular things that individuals should be doing this year? Should state or local governments be helping out with some of that communication, and especially given that, as we were just saying that certain communities may have higher levels of distrust of government? What kind of could those broader messaging networks feet where it wants to take that I think one of the things that we can all do actually that will hope with Hurricane preparedness and our hurricane response is to take to heart. The message is around the non pharmacy well, interventions that will improve our Kobe response. And because if we can drive, it found some of the levels the high burdens of Kobe that we have across the country, particularly in our vulnerable populations. We will be better off. We're still gonna have to deal with Corbyn and hurricane season together. But the fewer cases that we have of overdid, the better we will be and the easier all of the Asian ALS measures that have to be in place will be for our public health and our health workforce. So the things like physical distancing, like limiting your time outside to either. You know, outside activities are essential trips to the store and things like that, um, wearing those face coverings, being understanding that messaging around like my mask is for you, your mask, this for me and that we're all out here trying to protect our community. Members are vulnerable, especially are vulnerable community members is critical on, I think, also the the idea that that people have plans for how they will evacuate if they need to, and with their son. What medications are you know, those those those simple activities that we reinforced with our preparedness messaging in hurricane season become all the more important during Corbett times when the recent the resource is even more limited. I think it is an interesting exercise on the personal preparation level is to think through. If you had a disaster, no, to go kick, what would you put in it if it was just a hurricane that you were responding to? And how would that be different if it's also a pandemic? And so PPE and variety of of other things, you might stockpile Under these circumstances, I'm really changed the nature of what an individual can do to be prepared. And I'd like to add on to that. I I completely agree with all that's been said and I'd add on Aziz, We've and others have found in disaster research that networks with friends with neighbours with other community members really matter so shut. You know, even though we can't be within close proximity of each other, get, you know, get your neighbor's phone numbers, check in on them, figure out what a neighborhood plan is. I know our neighborhood. We've set up a mutual aid system where, you know some folks have more resource is and can share food. Some folks are growing community gardens and sharing with others. And so sinking on a kind of an energy pendants a more resilient, more local building networks in building community ties. And I think that, um, helps out as well in a socially distant um, PPE wearing way. Yeah, and there was never works can really serve the communities and the individuals within those communities. It will be most affected, right? So if you have that network already built in, you know that someone is not good with technology and will be able to see alerts for evacuations or doesn't have a social network that's getting them groceries, air able together, three days of medication, all of those things will benefit the community as a whole, but also the individuals that are most at risk. So and I think that's again all great. And I think bringing up another interesting point which, you know we've been hearing a lot in relation to the entire Kobe crisis has been access to PPE, especially for health care workers. For the people that aren't going to be able to evacuate because they might be staying in hospitals and nursing homes are in the shelters to help care. Um, you know, even just think. Yesterday I saw the American Medical Association, uh, sent a letter to the vice president to FEMA saying that the federal government should be doing a better job with P P coordination. It still sounds like, at least for those hospitals, clinical settings. It still seems like PP is still relatively limited, even if we're getting better at wearing a zoo. A member of the public wearing cough mass eso especially, you know, thinking about again the this reference to supply chains If a hurricane hits by lines of a hurricane hits. And given that there might just be an influx of new patients of what sort of planning can there be to make sure that there is adequate PPE for healthcare professionals or for first responders are perhaps another way saying that is our local or state governments already planning for natural disasters and been the need for PP or is that still really just focused on coated right now, start I supply chains or something that are near and dear to me. I would like to expand your question, Andrew, to go beyond displaced, supplying but the hospitals and healthcare professionals with what they need, it goes to being able to provide society with with what they need, because there's a number of other important things toilet paper included that way were well recognized. You know, that's being able to provide those resource is, comes means that it comes from somewhere and it has to get to you. So the logistics, the supply train are are really a critical part of this overall process, and it's already strict, constrained by a number of factors. One is Cove. It related because we have this situation where truck drivers who might normally distribute this stuff are sick. Um, people that are manufacturing these things or sick, uh, people that would normally be on the ground at nonprofits and others are potentially sick. Eso a lot of that has to be or is being done remotely rather than boots on the ground. And then when you add to that, one of the big problems we have is that most industries, because of the global economic competition, have not been maintaining much in the way of inventory because that's costly. And so we have this situation where to be economically competitive. Rico Vid is diametrically opposed to being risk, you know, risk management oriented in a situation where we have covitz. So where we already have the supply chain is a problem. Getting resource is to places. It's also a problem because we didn't have a build up of three of inventory even draw from under those circles circumstances. The disappointing thing to me is that this could have been a great place for the federal government to to make a difference because, you know, in some ways it's their job to source thes things from places where they know it exists and to distribute it toe where it's most needed. And in that particular failure, eyes mystifying to some extent, because there is some in the military. We have the Defense Logistics Agency and and they are really capable of doing these kinds of things. If you thought of the United Cove, it is sort of the theater of operations. They would be an excellent organization to be able to manage that whole process. Absent the federal involvement in a leadership role. We're actually seeing communities trying to take on that job. There's there's coalitions of communities in various places not necessary for hurricanes but for floods and other things where they're they're basically combining their purchasing power. Teoh actually provide the backstop in the way of resource is on an inventory under the provides all that they're gonna have to fend for themselves. That's something after. And I would just add that one of the added challenges on the health care and public health side, especially when you think about the resources needed for Covad. Like the flock swabs for testing the, um, glass vials the I read eggs that are needed to treat the patients for fluids. Um, many of those are in very high risk, hurricane prone environments like Puerto Rico on we saw a significant disruption in our ability to just manage, flew immediately following the hurricanes from a few years ago. And so if you take that and amplify it with the already, um, protected supply chain crisis that we're experiencing right now, um, and put those places at risk again, Um, when Kobe it may even hit, you know, when we're managing Cove it during flu season, and that may come with the tail end of hurricane season. Um, but that has the potential to be absolutely detrimental to our ability to manage Not just any of these events, but all of them. So maybe is Ah, one more kind of broader question here on were quickly approaching the end of our time, but I guess it s sort of a broader question and maybe Betsy, you want to start here? I know you were mentioning, uh, you know, one of your concerns is just And I think when you even just living to this as well, right is that any hurricane that's gonna hit will be bad. But there are these areas, like Puerto Rico. So we're covering from Hurricane Marie, and they were cooks. It had portions of North Carolina's coast that are still, um, recovering from some of the recent hurricanes that we've had. There s Oh, I guess the question there is, you know what sort of what sort of work is necessary to make sure that if a hurricane hits one of those areas again, hopefully not, But you know, are there are the things that are happening now on the ground already in response in some of those areas, are there additional things we need to be doing on top of getting ready for new of hurricanes, on top of getting ready for potential Covad spread. You know that that might be applicable this year, and it's excellent question and one, you know that I think about a lot, both professional and you know broadly, is I think we need to get out of this disaster response, disaster response framework and really think, How do we build and empower local communities? Um, whether it's Covad risk, whether it's hurricane risk, how what do communities How did they envision their Whether these air communities recovering from a hurricane or neighboring communities that maybe we're less touched, You know, what future do they envision economically? Um, across a broad range of sectors. Education, health, right. One of the things I'm I'm worried about with, you know, his education and cove it and hurricanes and access to infrastructure and the redundancies of our systems. And who will be able to if we need to, um, you know, a 10 school from home and who won't. And these are just these risks and issues are multiplying. So what What do I think should happen is one resource is number one. But resource is isn't the end of the story? Um, you know, there's lots of different resource is they are limited. Um, but a lot of communities after disaster have limited capacity to apply for money to process, um, recovery grants to think about, um, how we should recover, right? And so I really think we need to get into a space of pre disaster planning in risk mitigation outside of this. Oh, it's it's June 1. It's hurricane season. We should be thinking about these issues all of the time. Um, and states need to support these networks of organizations who have and have been working in community for a long time, um, and have trust of community members so that those air some things that I've kind of been wrestling with, And I think toe Betsy, the one of the very first points you made, you know, this challenge of convincing people the value of preparedness is so important. And now is the time to reinforce how much how much is missing from our preparedness activities. How much we've gained but still helm far. We have to go, you know, in fairness is really challenging to sell because it's like when you do it right, it looks like you haven't done anything. And when you do wrong, it looks like you haven't done anything. But there's a big gap between those haven't done any things right. So it's hard to remind people when budgets are being slashed and money is being, you know, going out the door to all these other things that compared Mrs so absolutely essential. And the preparedness money has to be spent on preparedness and not swept because some new priorities, some new reactive responses, is up, you know, for baton needs. Resource is if there's a if there's a silver lining to this particular part of the conversation, I think it comes from Ah, lot of times folks will say, Well, that happened to you, but it didn't happen to me, and so it doesn't get the same attention. But Kobe is happening, everybody. So, in terms of a personal recent experience with serious consequences, I don't think you can hide behind why preparation is so important at this point. Great. Well, thank you all for your insights. You know, there's no there's so many more things that we could be talking about limited time. So just for the last few minutes theater Aziz we as we get ready to end if you all just want toe, spend a few minutes. Just if there's anything else you want to mention that we haven't talked about yet or any other closing thoughts, you want to leave the audience with things next steps, things that are encouraging, worrying. Whatever you want to mention is kind of just in closing, we'll go in the opposite direction is you started, so we'll start with Mark and then Betsy and I don't want to be flip about this. But in our business, we have a saying, Never let a good disaster go to waste and and I take that literally young. A lot of people look at risk is Fred and it is a dreadful thing, but it's also an opportunity. It's an inflection point. It's a time where if we can really we have a better chance to actually invest in change and get people to actually support that. So part of what I'm thinking about here is based on the conversations we've had today is these needs and challenges we've identified way have, ah, responsibility, I think, to try to figure out where is that low hanging fruit? How can we cobble together, uh, way of changing the way people are their culture of thinking about this stuff, the way re sources are prioritized on. And so I think we want to grab the bull by the horns when we do this. The other thing that I would like to to express is that I don't view this as, as they say, sort of the singular solution. I think it requires a bottom up and top down approach simultaneously. There's no question that the at the local level was is where we have Teoh be most concerned. But it's also where we have the most trustworthy people with the folks that have the best knowledge about how the community functions and how our it needs to be satisfied under these conditions. But at the same time, at the state regional federal level, they can marshal, resource is and and legislation and and edicts if you want to call it that, uh, to be able to provide the type of organizational structure and support that a local community could could never manifest for themselves. And so we have to take both approaches and get all those stakeholders at the tables that they can understand of their roles in their perceptions and how they can collaborate for the greater good. Yes, and I I very much agree with that. I think it needs to be a combination of local level state and federal action, um, empowering local giving, local voice. But resource is, you know, needs to come need to come from state Federal on and, uh, other organizations to support the needs. Um, some of the main things that you know in terms of if I were speaking to the public, I would obviously, you know, encourage people to do what they can. And, um, that was brought up over there in terms of physically distancing and including wearing face coverings, etcetera. I would also encourage state governments as North Carolina to switched over to mandating, um, and setting a norm of wearing face coverings. Um, I think that's become been shown to becoming more and more critical, um, as a means to bring down the cases on and then just thinking about pretty disaster planning. And that's pre disaster planning at the household level neighborhood community, your where you work. If you're in school, your school, um, state level federal level, we really need to think about and it's not, you know, it's not too late. Everyone should be thinking about Okay, what do we need to prepare in the world? We are now, and and where What should we be thinking about? And there's, um so I wouldn't encourage folks to do that as well. Um, and then really outside of the disaster and of framing or cycle. Or I guess the recovery part is really thinking societally about dressing some addressing some of the underlying, um, structural issues that then make cove it and hurricanes in whatever disasters come even worse. And that magnify those risks. And whether that's issues of health care, access to jobs, education, environmental hazards, all of those, um so it's It's a huge ask, obviously, but But I think we really need toe to think more broadly about disasters. Yeah, I agree completely, and I think we also in order to do any of the things that we just talked about effect. Actively. We have to work really hard to rebuild on the public's trust in the public health messengers. And, um and it can't wait. Um, you know, it has to happen now. It has. We have to We have to rebuild that conversation on. We have to rebuild the norm. That it is okay to change your mind is yet new information that the message may change, but the message may change. Doesn't mean the message that you heard before was wrong Means it was right for the time or was the best we could do then and that we're adapting with this new information to keep people informed and, um, make best practices for what with what we have. And this is all new territory, right? So it's it's a All of our activities are based on what we know to be true about good public health practice, infectious disease management, infection prevention, control, hurricane preparedness and response, general natural disasters and all hazards approach to response and its goal Teoh change at any given moment based on the current context and the cultural appropriateness of the response and the needs of the community. And so we have to be good stewards of that message that we're doing the best we can. We may get it wrong. We may try to adapt the message so it's more program and more well informed based on the information that we gathered since the last message. But that doesn't mean you can't trust us. And I think we all have an obligation to make sure communities by into that approach that that we're all in this together. We're all making the best decisions you can with information that we have, and we're going to move forward and out of this as safely as possible. Well, again, we're just about a time here, So it's amazing how quickly Narcan go, but I want to thank all our Panelists and doctor app quits, Doctor. All right, Professor Sour. I definitely learned a lot. Hope this was informative to our audience. Again, I encourage everyone to visit the Duke Science and Society website before more information about our upcoming Corona virus conversation events again, our next one will be next Thursday, a little more than a week from now at 2 30 PM, looking return to work on and again to visit cycled out of work for the policy brief that science and society issues published on this event. Um, and, you know, hopefully we will be relatively lucky this year, and we won't have Ah, major hurricane hit the U. S. But, you know, maybe if it does happen, we might consider be competing this panel again to see how we've been doing what we've been learning, if and when that does happen. So again, thank you very much. All the Panelists thank you to all the our audience members and all the questions. And, of course, apologies. Would you tell your questions on? And we hope that you'll have a good rest of your day and a happy holiday weekend. The next one. Thank you. You.