Midlands Voices: Public health management of outbreaks should not be political | Columnists

The Nebraska Infectious Disease Society consists of specialists in infectious disease Nebraska, approximately 80% within the Omaha metro, both in academic centers and in the community. Many have additional education in public health.

We are writing this statement to voice our strong opposition to the amendment which limits the scope of Douglas County health director to the certification of the presence of an epidemic and creates the position of special epidemic health director to manage epidemics. It requires the mayor and/or city council to approve or reject orders recommended by the special epidemic Health Director. The Omaha Fire Department medical director would be designated as the special epidemic health director when necessary. The OFD medical director must be a licensed physician, as required by state law.

The health director of the DCHD (also acting as the city health director) is hired based on having public health education and experience that provides the understanding of detecting and managing outbreaks of disease.

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The present Douglas County Health Director, Dr. Lindsay Huse, has this knowledge and expertise; her medical expertise and ability to make clinical medical decisions is proven by her academic and clinical training for her doctor of nursing practice (DNP) degree. She earned a master in public health (MPH) degree focused on epidemiology and public health practice as well as public health leadership. She has extensive experience in communicable disease epidemiology and infection prevention. She is absolutely qualified to make PH decisions for Omaha and Douglas County. We as a group have supported her management of the pandemic.

The qualification to be the “city special epidemic health director” only includes having a license to practice medicine in Nebraska. There is no significant education in public health included in the training necessary to become a licensed physician. A physician medical director of the fire department is hired to provide medical expertise relevant to the practice of providing emergency medical services and to protect the safety and health of the firefighters and emergency medical services professionals. There is no requirement to have public health training or expertise.

The term “epidemic” is not the same as “pandemic” “epidemic” is a term similar to “outbreak” and is generally defined as the occurrence of a disease or health condition that occurs at a rate above what is usually expected (i.e., above endemic levels). A “pandemic” is an epidemic that has spread throughout the globe.

Epidemics occur relatively frequently and often require quick intervention to prevent further spread. Delays can cost lives or cause other serious health consequences. Here are some examples:

• Every flu season is an epidemic of influenza.

• The present rise in cases of syphilis.

• Highly resistant microorganisms can cause outbreaks in hospitals especially in vulnerable populations such as neonatal ICUs and burn units.

• Contaminated medical equipment and infection control breaches can cause epidemics of infectious disease such as hepatitis C.

• Poor maintenance of air conditioning and watering systems can cause epidemics of Legionnaire’s disease.

• Every winter we have outbreaks of norovirus

• Contaminated food products or infected food handlers can cause epidemics of hepatitis A, salmonella, E. coli, and other foodborne diseases.

We would argue that managing an “epidemic” involves making very complicated decisions. Education for this type of responsibility should include a degree in public health or epidemiology and very importantly years of experience in detecting and managing outbreaks. The time lost in navigating through two additional layers on each decision on the management of every epidemic would be so labor intensive and time consuming that it would impede the ability to act in a timely way to reduce spread.

In very complicated situations, however, all directors of public health work collaboratively with other specialists such as infectious disease specialists like ourselves. when necessary. Having individuals without any expertise in these areas making the final decision on public health management of disease outbreaks will make what should be an epidemiologic decision and intervention into a political one.

We strongly oppose this change in the management of epidemics in Douglas County and the city of Omaha.

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