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Antibiotics for 38,000

Horizon Public Health staff run through an exercise designed to simulate the mass dispensing of medications in case of infectious disease last week at Lake Community Church in Alexandria. After filling out forms, participants went to a screening table and then were directed to the proper table for medical dispensation. (Lowell Anderson / Echo Press)

Sandy Tubbs took a phone call last week from an epidemiologist, who said an infectious disease in Douglas County had been identified. Tubbs, the administrator of Horizon Public Health, needed to set up a site by noon the next day to dispense antibiotics to the nearly 38,000 residents of Douglas County.

Tubbs was expecting the phone call. There was no real crisis — it was a full-scale exercise, dubbed Operation June Bug, to test the public health department's ability to respond to a public health crisis.

"We are trying to be prepared in terms of our ability to respond to a scenario such as a pandemic," she said. "It's not likely, but it's possible, and how would we be able to organize and respond?"

Public agencies routinely run training exercises to test preparedness for a wide variety of scenarios. It's how they can find and fix weaknesses in their response plans and policies. Horizon staff members have gone through a poverty simulation exercise to understand obstacles facing low-income people and worked with area hospitals to test their ability to respond to emergencies.

Money for training, which comes through the U.S. Centers for Disease Control, has shrunk over the years. The CDC says on its website that it helps health departments improve their abilities to respond to a range of threats, including infectious diseases, natural disasters, and biological, chemical, nuclear, and radiological events.

Preparedness training for health departments and health systems began in 2002 following the previous year's terrorist attacks, said Karen Moser, public health preparedness consultant for west-central and northwestern Minnesota. Attacks that year not only included flying airplanes into buildings, but anthrax delivered via the postal service.

"The funding level has been steadily decreasing, which makes it tough," Moser said. "Yet we have the responsibility to keep our level of preparedness somewhat high."

The CDC's budget for preparedness training has fallen from $23.3 million in 2005 to $14 million in 2016, she said. While advocates for more funding say health workers need to be ready for a range of new diseases such as ebola and zika, others say that the money already spent on training should be enough, Moser said.

Emily Ward, the state's coordinator for the Strategic National Stockpile of medicine, said staff turnover means agencies need to continuously train new employees.

"Staffing was identified as the No. 1 gap across the country to get medications out to the staff quickly because budgets are shrinking, but you have to meet the same population needs," Ward said. "Turnover is an ongoing battle. They get trained, then those people leave for something more lucrative or their position gets eliminated."

Tubbs said it's important that the public know that agencies are thinking about such possibilities and preparing for them.

"We're certainly hoping we never have to do this," she said.

During the exercise, Horizon staff members took turns acting the part of patients and emergency workers. Patients went to one table to fill out forms, another table to get screened for what kind of antibiotic they should take, and another table to receive the "antibiotic," which was either M&Ms or licorice.

After the exercise, Tubbs said, they identified weaknesses. For example, patients ended up at wrong tables, a situation that begged for more ushers or at least theater-style ropes, she said.

They discovered that nurses were miscast as antibiotic dispensers. Because their training had taught them to be thorough, they essentially re-screened patients instead of simply dispensing medicine, which slowed the process.

Other weaknesses included an inconveniently-placed First-Aid station and forms that needed tweaking.

It took staff half an hour to dispense antibiotics to 40 people, an indication of the challenge in reaching the county's 38,000 residents — a number that swells in the summer. In a real emergency, Tubbs said, there would have been more stations set up.

Ward, who observed the exercise, said she was comfortable with the time it took to reach 40 people, considering it was a training exercise. In real life, things would speed up as workers got more practice.

"They really did great," she said. "It was a well-organized exercise."

The dispensary was set up at Lake Community Church because of the space it offered. While they faced a noon deadline, it could have easily been set up much earlier, Tubbs said.

"It went much quicker than we anticipated," she said. "However, it was a non-stressful situation. If you had 30,000 people lined up outside and people were panicky, it would be unlikely they'd be as calm as the public health staff."

Horizon will repeat the exercise in 2020, as will all public health agencies in Minnesota.