Autumn 2001 Public Health Magazine: When disaster strikes

When disaster strikes

Earthquakes in Los Angeles, San Francisco, and Kobe, Japan. The volcanic eruptions of Mt. Pinatubo in the Philippines and Cerra Negro in Nicaragua. Hurricanes Hugo, Andrew, and Iniki. Eric Noji has stood in the aftermath of them all and tried to impose order upon the chaos and devastation.

On September 12, standing amid the rubble of the World Trade Center, he quickly realized that the public health effects of this disaster would be different. Although nature can wreak considerable havoc without the help of mankind, controlling its aftermath usually assumes a predictable rhythm, says Noji, a CDC disaster response expert and adjunct professor at RSPH. Illness and death rates are high early on, ebbing as the population’s needs for food, shelter, and clean water are met. The intensity of the public health response rises and falls along with morbidity and mortality.

September 11 and the ensuing anthrax outbreaks turned that paradigm on its head. “In responding to any disaster, your adrenaline is rushing, and you are working very hard to respond the best you can, but natural and humanitarian disasters usually have an end in sight,” Noji says. “These recent events are the strangest disasters I’ve ever been involved in, because the crisis just goes on and on.

” Noji is the author of the preeminent text on the subject, The Public Health Consequences of Disaster, and has taught a course with the same name at RSPH for the past 11 years. The associate director of bioemergency preparedness and response at CDC, he was called to Washington, DC, on September 12 and was about to return home to Atlanta when the first anthrax case was diagnosed. He has been detailed from CDC to serve as senior medical adviser to the US Office of Homeland Security, working in the White House.

He returned home briefly for the holidays and then jetted back to Washington. Since September 11, he has literally been on call day and night. “We’ve been going full steam,” he says. “Things were just becoming manageable when anthrax hit Florida. Although things have calmed down somewhat, we really don’t know when we’ll go into recovery mode. We’ll be waiting for the other shoe to drop until the anthrax cases are solved, and the perpetrator is caught. For those of us in disaster response, this state of chronic, low-intensity expectancy is very nerve wrenching.”

Responding to an emergency while simultaneously formulating policy has also been challenging, he says. “As scientists, we are accustomed to a more methodical way of formulating policy, with time to think carefully and ruminate on the evidence. There’s no time for that now. We have to think on our feet. We can’t rest easy until they catch the perpetrator.”

Working with law enforcement is something else public health workers must get used to. “It’s a new way to use epidemiology—to look for clues that will solve a crime,” he says. “It’s the ‘disease detective’ made literal, and it’s unprecedented.” The anthrax response highlights the need for public health workers to be versatile.

“When you have a major emergency like the anthrax events, people have to switch gears and help out,” Noji says. “The barriers between disciplines blur. Whether in public health departments, academia, or research, everyone has to work together.”

In fact, students from every department in the school have taken his class over the years. “Disaster response requires a little bit of everything,” he says.

After the sarin gas attacks on the Tokyo subway system and the Oklahoma City bombing in the mid-1990s, Noji added lectures on the public health response to terrorism to his class curriculum. CDC colleagues are teaching his course this semester, but when his stint in the White House is over, he’ll surely have unique lessons to share with his students. “When I’m older, I’ll probably appreciate being part of history unfolding and working in the White House,” he says. “It’s a once-in-a-lifetime experience.”