1. Social Distancing Decision Making Protocol
Public Health – Seattle & King County
Summer Institute
August 2006

2. Agenda Overview and Assignment
Scope of the Protocol and Key Participants
Points of Coordination
Challenges in Development
Positive Factors
Summary

3. Overview
A severe influenza pandemic may warrant the use of “unconventional” protective actions
All such measures will have significant social, political and economic consequences
“Prescribing a treatment” with severe side effects and limited, if any, health benefits

4. Overview
Local health officers and local government leaders will make social distancing decisions
Actions taken in one local jurisdiction will impact many neighboring jurisdictions

5. The Assignment
Determine how social distancing decisions should be coordinated among jurisdictions and levels of government in order to promote consistency and concurrence
Build and maintain public confidence
Develop political strength
Possibly achieve greater health benefits

6. Puget Sound Region

7. Scope
Identify types of measures that would be considered during a pandemic
Estimate social and economic impacts of each measure
Identify primary stakeholders who require notification

8. Scope Define how decisions will be coordinated among jurisdictions
Develop protocols for timing of specific measures (phasing)

9. Key Participants Local public health representatives (decision makers)
State Department of Health
Health and Human Services Regional Administrator
Not local emergency management, elected leaders or first response agencies
Only health participants. Decisions must be made based on available data.

10. Social Distancing Coordination Points
Assess the threat (local, global surveillance data)
Assess social distancing actions already in place nationally, globally
Discuss which measures to implement and in what order (phasing)
Points that are discussed among parties via conference call.
Measures are proposed in phases for the following reasons:
Schools and day care center closures are focused on “prevention”. May need to be closed earlier than anything else. Telecommuting and library closures must be concurrent with school closures.
Larger scale social gatherings, churches, theaters, etc will have financial impacts and may be implemented as containment measures as disease continues to spread.
Suspending government functions serves as a means of limiting morbidity and mortality – last ditch effort to reduce the number of ill at the expense of normal government functions.

11. Social Distancing Coordination Points
Clarify timing of implementation – and timing of press conferences
Will state or federal authorities be invoked?
Clarify state and federal roles for implementing measures concurrent with local decisions (telecommuting, tribal lands)
States and feds must implement telecommuting of their respective agencies concurrent with local decisions.

12. Challenges with Social Distance Planning
Broad array of stakeholders
Diverse groups – different levels of understanding
All facing severe impacts
All with opinions
“Fractured” authorities – multiple leaders with responsibility, no practical experience
Establishing accountability for decisions
Health care system partners
Schools, day care centers, libraries
Government agencies
big businesses
local EM, first responders
critical infrastructure agencies
Elected officials
neighboring jurisdictions
higher levels of government
Local (city vs. county)
State
Federal
LHO
SHO
Fractured within each local jurisdiction (multiple people with same authority), between multiple local jurisdictions, and by levels of government. Defining whose authority can and would be implemented is necessary.
Example includes whether, where and when feds and state would implement social distancing (tribes, offices, state universities)
Not only defining whose authority would be implemented but identifying who is willing to make the decision and ensuring the public will actually follow the decision maker despite the inevitable impacts. Establishing the credibility of the decision maker.

13. Positive Factors High – profile issue
Education of leaders in advance energized some, scared some, interested all
Prior relationships with key partners proved essential
The real time attention on the issue coupled with intense education by PH directed at the partners needed to participate helped bring them to the table and gain quick buy in - got them motivated, interested and informed
Relationships with Local EM, DOH, Health care, first responders, electeds, businesses all were crucial to establishing credibility. They knew and respected us already – this helped focus them quickly on planning for the impacts rather than the need for the decision itself. Also helped us bring their leadership to our side quickly

14. Realizations
A decision making process that will have multiple cascading consequences should be informed by a broad range of players
No way one discipline can know all the downstream impacts, much less assess the severity on society. Connections with partners influenced our decisions greatly.
You must take action with day care centers and libraries concurrently with closing schools
Some organizations need not close, can simply restrict operations without closing (libraries, universities)
Must take some actions (emergency staffing plans) just to address the consequences of others (school closures)

15. Realizations
Credibility is the KEY leadership attribute that has most influenced this project
We need to educate, inform and convince at the same time.
Have nothing positive to offer.
Lots of bad news about what our decisions will do to our partners.
Leadership credibility focuses efforts away from analyzing / criticizing the decision and towards planning for and addressing the impacts.
Helped us shape the discussion and convince parties that we have a common challenge.

16. Questions