Faces of Public Health: Jim Blumenstock, ASTHO

Oct 16, 2014, 12:30 PM

People tuning into news coverage of the Dallas Ebola cases have come to recognize David Lakey, the Texas state health officer. Every state has a similar position and those officials are charged with improving population health—from holding immunization clinics to responding to potentially fatal illnesses. The Association of State and Territorial Health Officers (ASTHO) is the professional association of the 50 state health officers. Jim Blumenstock is the chief program officer of ASTHO’s public health practice division. NewPublicHealth spoke to Blumenstock this week about state and federal coordination on Ebola detection and case treatment.

NewPublicHealth: What is ASTHO’s role in dealing with preparedness for Ebola in the United States and with the current cases?

Jim Blumenstock: In a crisis or a public health emergency like we’re experiencing with Ebola, ASTHO’s role principally is to do two things. Number one is to sort of be the glue or the hub that helps pull together the 50 states, the nine territories and the District of Columbia as an integrated, harmonious component of our public health infrastructure. The second feature is to provide a solid interface between federal efforts and state efforts. So, that’s our role with any significant public health issue.

During the H1N1 outbreak several years ago, both ASTHO and the National Association of County and City Health Officials (NACCHO) had key staff embedded in the U.S. Centers for Disease Control and Prevention’s (CDC) Emergency Operation Center because it was recognized that the value of the insight of a national organization that represents all the states and locals was so critical to the federal planning and response process. That was the first time it was done.

We’re on standby to do it and we’re sort of functioning in that capacity right now, but sort of in a virtual or remote area. For example, I’m not today embedded in CDC’s Emergency Operation Center. However, I would say I’m on the phone with them at least six to eight times a day—including last evening—and have had email exchanges already this morning, not only to get information, but also to be part of some planning and problem solving efforts they’ve requested our help on, or a request for our help on state consensus around a strategy or a tactic or an approach on a particular matter.

And our other critical roles are to help our members; to talk to federal public health officials; and to educate and inform the public. 

NPH: Was it possible to be 100 percent prepared for Ebola cases in the United States?

Blumenstock: I don’t think it would be appropriate to sort of peg it to a percentage of completion or accomplishment because preparedness is a process. Granted, Ebola is a new disease for the United States, but that doesn’t mean that we’re totally in the dark or clueless as far as what the core basic public health elements are and must be in place to protect the public’s health. When you look at disease surveillance, laboratory testing, diagnosis of illness and risk communications, public health knows what control practices and principles are needed. and that has been part of the education and training program. We were not caught off guard or surprised by Ebola. The United States’ health care system, led by CDC and HHS, has been closely monitoring the events in West Africa for months. We have begun to prepare for the possibility, and now the real-world circumstances of cases of Ebola being imported into the United States, so every day, since the first case appeared, we’ve been assessing, learning, adapting and improving our state of readiness to protect the health of the public.

NPH: How frequently are you speaking with state health officers to both be able to share what’s happening in their state and also to give them information?

Blumenstock: Speaking for ASTHO—but I think I also speak for all the other national public health organizations that are involved in this, as well as the federal government—there is a constant exchange of information. And by constant I’m saying that “24/7, seven days a week” is not an overstatement with regard to providing an opportunity for peer-to-peer exchange of information or ideas or learnings through the process. States are developing plans, policies, procedures and educational materials following federal guidance, and national organizations are providing a platform for states to share the work that they’re creating. We don’t want to reinvent the wheel if we don’t have to, so states are developing talking points, good procedures and protocols.

We are doing our very best to provide an opportunity for the states to talk about that among themselves, share the work of others and also collaborate in the development of plans and procedures. In the last three days alone, ASTHO has convened three conference calls among either our members as a whole or a subset to talk with federal partners on developing certain protocols and procedures that everyone would feel comfortable in implementing and believe that they would be effective. So there is a constant high-intensity effort to provide a strong bond between the public health organizations, agencies and jurisdictions to really ensure that they learn from each other, and they each contribute to the collective success of this public health response.

NPH: What’s the readiness level at the state health departments?

Blumenstock: As Tom Frieden has often said, our domestic shores will not be protected against Ebola until the outbreak in West Africa is under control and eliminated. How long that will be, I don’t think anybody has an answer, but I think that the one thing that we do know is that it’s not going to happen overnight. So, I think the rhythm that the nation’s public health system is now working under is that this is a long-haul response measured certainly in months—maybe even to a window of a year or more—where we’ll have to maintain this high level of vigilance and activity to ensure that if we do get additional imported cases coming in from West Africa or domestic person-to-person, that they are identified immediately and properly responded to so that additional exposures and infections do not take place.

This is not the same as other types of public health diseases or threats that could last only a couple of days or maybe a couple of weeks until interventions are effective. This is a long-haul planning effort for state public health, and at the same time it’s not the only thing that they’re focused on or concerned about. They have a whole portfolio of traditional services that they still have to maintain and provide to their community, not to mention other threats of significance. Diseases or outbreaks or disasters don’t come one at a time or in sequence. You look at where we are right now. The public health system is combatting the Enterovirus D68 outbreak. We’re beginning the flu season. We’re in the heart of hurricane season, not to mention whooping cough outbreaks, measles outbreaks and foodborne outbreaks that happen at a high degree of frequency. They’re doing effective jobs, but clearly there are continuing demands on resources that must also be recognized and addressed in the long term.

NPH: How does ASTHO monitor what’s both going on in West Africa and what’s going on in the states?

Blumenstock: As far as how we learn what’s happening in West Africa—and also, by extension, how that could influence or impact our actions going forward—clearly we have high reliance on our federal partners : the CDC, HHS Assistant Secretary for Preparedness and Response and the Department of Homeland Security Office of Health Affairs. Those agencies are sharing with us, and by extension the state health departments, a lot of the information with regard to situation awareness over in West Africa. We get regular updates, situation reports and briefings.

On the domestic side, CDC, ASTHO and other partners host a national conference call about once a week where updates are presented and discussed in an open national conference line forum. CDC, almost on a daily basis, pushes out revised guidance documents, key messages, talking points and situation reports to the practice community. ASTHO hosts calls every other Friday with our members, and as of last week Ebola will now be a standing agenda item until further notice, and that provides an opportunity for health state officials themselves to discuss key issues. The frequency of all of these calls depends on need, and in the last two or three days we’ve had three very important conference calls with state health officials and our federal partners around some of the plans and procedures on the passenger screening that’s going to be taking place at five airports.

Having the states report back to ASTHO, to each other and to the federal agency is critically important and there’s a personal feature here, as well. Leaders such as Frieden and Assistant Secretary for Preparedness and Response Nicole Lurie have relationships with state health officials across the country. It would not be out of character for either one of them to pick up the phone and call a state health officer or state health commissioner or secretary, to jump in a car or jump on a plane and go visit them and see them in action or to meet with staff and discuss it. That’s a critical added value to the relationships that they’ve cultivated with the state health officials across the country.

>>Bonus Link: ASTHO recently launched a new blog, StatePublicHealth.org. Read their recent entry on tracking and treating Ebola.

This commentary originally appeared on the RWJF New Public Health blog.