Vol. LXIII, No. 51
Wednesday, December 23, 2009
It was a relatively complicated fact pattern, said George T. DiFerdinando, Jr. recalling the local anthrax scare in 2001 when he was Acting State Health Commissioner. At least a half-dozen, if not a dozen books have been written on that specific group of facts.
Among those books is Princeton resident Laura Kahns Whos In Charge? Leadership During an Epidemic, Bioterror Attack, and Other Public Health Crises, which examines the anthrax episode, along with other recent instances of public health threats. Mr. DiFerdinando, who has read Ms. Kahns book, described it as unique in its focus on leadership and the local story. Other books tended to examine the national perspective.
But she sees it from a different angle than I do, said Mr. DiFerdinando, who is currently Adjunct Professor of Epidemiology and Co-Director, New Jersey Center for Public Health Preparedness at the University of Medicine and Dentistry of New Jersey, and a member of the Princeton Regional Health Commission. Im not so much concerned with her interpretation of events as with their implications in 2001 and what they mean for the current H1N1 pandemic.
When the Federal government chose not to declare a disaster, Mr. DiFerdinando decided to close the Hamilton post office where anthrax-tainted mail had been handled, and to treat workers who had potentially been exposed to the virus.
Dr. DiFerdinando made some difficult and heroic decisions during the anthrax crisis of 2001, observed Ms. Kahn, in comments made after a recent discussion of her book at the Princeton Public Library. He made the decision to close the large Hamilton postal facility and recommended that the postal workers receive prophylactic antibiotics. His decisions likely saved many lives.
In addition to putting the onus for decision-making on local and state authorities, the Federal governments failure to declare a disaster had other implications, said Mr. DiFerdinando.
With respect to H1N1, Mr. DiFerdinando, who grew up in Princeton and is a current resident, expressed concern about the absence of a centralized initiative for responding to the current outbreak, and the absence of a local treatment arm. Where students in Montgomery public schools were systematically walked from their classes early on and without parents present to be vaccinated, Mercer County school nurses were not pushed to do this, he said. The result was that nurses had to be paid on a per diem rate to do everything extra hours.
The sooner the general population gets vaccinated, the better, Mr. DiFerdinando observed, noting that there is a six-week interval between receiving the initial vaccination and the time when the follow-up takes effect.
There also should be consistency across municipalities, he said, with no border between Princeton and neighboring communities in responding to emergencies. Problems dont respect political boundaries, he commented. When theres an oil spill on Route 1, three or four counties could potentially be affected.
That said, Mr. DiFerdinando added that the Princeton school district has done a wonderful job of managing this H1N1 episode, and that the Princeton Health Department works extremely well with Superintendent Judy Wilson.
Public health officials are supposed to deal with it when crises arise, Mr. DiFerdinando acknowledged, but you need to make sure political back-up is there. I came up through the ranks, and I believe if theres a problem on your desk you solve it. But I didnt realize the extent to which all this had been politicized. Recalling the events of 2001, he said, I should have asked, how is this any different from other New Jersey local control issues, and why would you expect it to be any different?
Mr. DiFerdinando is more guarded than Ms. Kahn in his enthusiasm for Borough-Township consolidation and its potential benefits for local emergency preparedness. It depends on what you combine, he observed. A current proposal to combine the Health and Human Services departments might be an improvement. Its important to think about concrete issues, he said.
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