A Pandemic of Unintended Consequences

LEXINGTON, Ky. (Aug. 23, 2010) − When an epidemic strikes, government agencies must spring into action.

While decisions to isolate and quarantine the exposed and infected might seem like the right choices at the time, many crisis responders don't understand the long-term effects of their actions.

University of Kentucky's Center for the Study of Violence Against Children (CSVAC) was chosen to lead a National Institute of Hometown Security-funded (NIHS) project to investigate the physical, mental and social effects of quarantine and hospital isolation on children and families in pandemic events.

The team, which also includes researchers from the University of Louisville, was also charged with providing "best practice" recommendations that could be used in the event of a future pandemic.

"There can be unintended consequences of social action," said CSVAC director Ginny Sprang. "In an attempt to solve significant social issues, sometimes you create new problems."

Sprang and her band of investigators spoke with residents of five targeted U.S. states – Texas, Arizona, California, Florida and New York – who reported the largest numbers of H1N1 cases during the 2009 outbreak, as well as individuals in Toronto, Canada, Mexico City and Juarez, Mexico. "The recent H1N1 experience was a natural experiment that allowed us to study the effects of a pandemic on the U.S., Canada and Mexico," said Sprang.

The team, which included CSVAC Executive Director Sprang as principal investigator; Jim Clark as co-principal investigator; and Miriam Silman, Charmaine Mohipp, Phyllis Leigh, Candice Jackson and U of L's Andrew Scott LaJoie as researchers, developed surveys, focus groups, content analysis tools and interview questions to gather information from a wide range of participants, spending weeks traveling, conducting interviews and collecting data.

Sprang, also an associate professor in the College of Social Work and the Department of Psychiatry, heard some unbelievable stories and came away with enough data for a lifetime.

"Isolated children tended to be lonely, confused and sad , while parents were angry and frustrated ," Sprang explained. "In the worst cases, fear of isolation or quarantine can lead families to not seek medical care when they need it, or to refuse to comply with social isolation orders."

The stigma of professionals, parents and children involved in a pandemic, even peripherally, was also a surprising development. "Bus passengers didn’t want medical professionals to board for fear they were carriers of disease and children who had family members with H1N1 were disinvited to birthday parties," said Sprang. "Parents that attempted to enroll healthy children in suburban schools after their inner-city establishments were shutdown…these kids were turned away for fear these children would spread the disease to other students"

And it gets worse. In one area, a Mexican restaurant was forced to close down, due to fears of H1N1. In other regions of the country, cafeteria employees expressed concern about serving crucial free lunches at closed schools, for fear of contamination. "For many of these children, the free lunch program was the only way to get a meal," said Sprang.

Many local governments had not prepared a feasible emergency plan, either. "We saw some well-developed response plans, but no indication of what resources would be used to fund the activities," said Sprang. "Emergency plans need financial support."

For example, one small town council told Sprang and her team that they planned to increase the size of their ambulance fleet during a pandemic. But the town had no money for ambulances in the emergency budget, and furthermore, had to viable way to get the emergency vehicles.

"We want to have a set of recommendations to offer each state, especially with regard to children," said Sprang. "Each state can integrate our recommendations into their own pandemic plans."

Other issues CSVAC focuses on in its report, due out at the end of the year, include higher levels of secondary traumatic stress in healthcare professionals and family members working with quarantined and isolated patients.

"This is a new finding," explained Sprang. "There has been very little attention paid to the behavioral health needs of professionals."

The "Best Practices Guidelines for Pandemic Disaster Response: A Social Behavioral Evaluation" project is one of five that are being conducted in conjunction with U of L as part of the "Pandemic Planning and Preparedness Program." This project is the only part of the program dealing with behavioral health issues.

"We want to transform the way we respond and plan for disasters, especially with regard to children," said Sprang. "And we want to make lessons learned from previous pandemics easy to disseminate"

The NIHS, based in Somerset, Ky., is a non-profit corporation that organizes and facilitates academic research on national security issues.

CSVAC was established in fall 2007 to reduce and end violence against children and the effects of that violence across the life cycle. The center works to enhance the health and well-being of children and their families through research, service and wide dissemination of information about child abuse and trauma.